diff --git a/subfolder_0/A FMRI Study of Stages of Yoga Meditation Described in Traditional Text.txt b/subfolder_0/A FMRI Study of Stages of Yoga Meditation Described in Traditional Text.txt new file mode 100644 index 0000000000000000000000000000000000000000..3be81a078d262fd67d4c678c9f29ac6c3e17464b --- /dev/null +++ b/subfolder_0/A FMRI Study of Stages of Yoga Meditation Described in Traditional Text.txt @@ -0,0 +1,668 @@ +Volume 5 • Issue 3 • 1000185 +J Psychol Psychother +ISSN: 2161-0487 JPPT, an open access journal +Research Article +Open Access +Telles et al., J Psychol Psychother 2014, 5:3 +http://dx.doi.org/10.4172/2161-0487.1000185 +Research Article +Open Access +Psychology & Psychotherapy +J +o +u +r +n +a +l + +o +f + +P +s +y +c +h +o +l +o +g +y + +& + +P +s +y +c +h +o +t +h +e +r +a +p +y +ISSN: 2161-0487 +A FMRI Study of Stages of Yoga Meditation Described in Traditional Text +Shirley Telles1,2*, Nilkamal Singh1, K.V. Naveen2, Singh Deepeshwar2, Subramanya Pailoor2, N.K. Manjunath2, Lija George 2,3, Rose Dawn3 +and Acharya Balkrishna1 +1PatanjaliResearch Foundation, Haridwar, India +2ICMR Center for Advanced Research in Yoga and Neurophysiology, S-VYASA, Bengaluru, India +3Department of Neuro-imaging and Interventional Radiology, NIMHANS, Bengaluru, India +Abstract +Objectives: .Meditation is described in traditional yoga texts as three stages, which follow each other in +sequence: (i) Focused attention (FA), (ii) Focused attention on the object of meditation (MF), and (iii) Meditation with +one-pointed focused attention without effort (ME). When not in meditation the mind is considered to be in a state of +normal consciousness characterized by random thinking (RT). The objective of the present study was to determine +the brain areas activated during the three stages of meditation compared to the control state using fMRI. +Methods: Functional magnetic resonance images were acquired from twenty-six right handed meditators during +MF, ME and random thinking (RT) for comparison. Ten of them were experienced (average age ± SD, 37.7 ± 13.4 +years; 9 males) with 6048 hours of meditation, whereas 16 (group average age ± SD, 23.5 ± 2.3 years; all males) +were less experienced, with 288 hours of meditation. During the fMRI recordings the participants practiced RT, +non-meditative focused thinking (FA), MF and ME, each lasting for 2 minutes. Brain areas activated during the +intervention were scanned using a 3.0-Tesla Philips-MRI scanner. +Results: During the third phase of meditation (ME) the experienced meditators alone showed significant +activation in the right middle temporal cortex (rMTC), right inferior frontal cortex (rIFC) and left lateral orbital gyrus +(LOG) (p < 0.05), Bonferroni adjusted t-tests for unpaired data, comparing ME and random thinking. +Conclusions: These changes suggest that ME is associated with sustained attention, memory, semantic +cognition, creativity and an increased ability to detach mentally. +Keywords: Meditation; Yoga; Traditional texts; Random thinking; +fMRI; Focused attention; Effortless focused attention +Introduction +Meditation can be considered to be a training in awareness which +produces definite changes in perception, attention, and cognition [1]. +Meditation is also recognized as a specific consciousness state in which +deep relaxation and increased internalized attention co-exist [2]. Perhaps +related to this is the concept that directing and regulating attention are +considered an inherent part of different meditation techniques [3]. +Multiple neuroimaging studies on meditation have attempted to +describe the cognitive processes involved. The most common examples +are of focused attention and open monitoring meditation [4,5]. There +appears to be no neuroimaging study which has categorized the process +of meditation based on traditional texts whether Buddhist, Yoga, Chinese +or any others. The present study aimed to compare three stages of yoga +meditation described in Indian yoga texts with the mental state that is +described to exist when not in meditation. This non-meditative state is +characterized by both mind-wandering and switching of attention at +random. It has been described in traditional texts as the characteristic +mental state when the mind is not directed or instructed (Cancalata in +Sanskrit; Bhagavad Gita, Circa 500 B.C.; Chapter 6, Verse 34; simplified +here as random thinking or RT) [6]. This was considered as the control +state against which the stages of meditation were compared. In an +attempt to describe this mental state with contemporary descriptions it +can be considered as normal consciousness [7]. +Traditionally it is mentioned that in order to reach a meditative +state attention should be focused and maintained. In order to do this +different meditation techniques use varied objects, mantras as well as +interoception [8]. +As a practitioner attempts to meditate there are three successive +*Corresponding author: Shirley Telles, Patanjali Research Foundation, +PatanjaliYogpeeth, Haridwar, Uttarakhand 249405, India. Tel: +91 01334 244805; +Telefax: +91-1334-24008, E-mail: shirleytelles@gmail.com +Received April 07, 2014; Accepted May 26, 2015; Published June 02, 2015 +Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A +FMRI Study of Stages of Yoga Meditation Described in Traditional Text. J Psychol +Psychother 5: 185. doi: 10.4172/2161-0487.1000185 +Copyright: © 2015 Telles S, 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. +stages, these are: (i) Focused attention (FA), (ii) Meditative focusing +(MF) and (iii) Pure meditation (ME). In FA the practitioner attempts +to return to focus when the mind wanders and attention is directed +to several thoughts about the same subject (in the present study the +thoughts were on the concepts of meditation). During Meditative +focusing (MF) focusing of attention is directed to a single thought +(in the present case the Sanskrit syllable ‘Om’), with the exclusion of +all distractions, which requires effort. Pure meditation (ME) occurs +as the practitioner continues with the second stage the stage of pure +meditation is spontaneously reached, where attention is on a single +thought (in this case the syllable ‘Om) but there is no effort involved. +The descriptions of each stage of meditation in the traditional texts +give greater clarity about the processes involved. The first stage (FA) +is called ekagrata in Sanskrit (Bhagavad Gita, Chapter 6, Verse 12), +during which attention is directed to a series of associated thoughts. +As mentioned above if the thoughts are related to meditation, +the person would then be able to progress to the next two stages, +dharana (MF) and dhyana (ME). Dharana (or focusing with effort), is +described as ‘confining the mind within a limited mental area’ (‘desha- +bandhashchittasya dharana’, Patanjali’s Yoga Sutras, the sage Patanjali +Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in +Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185 +Page 2 of 6 +Volume 5 • Issue 3 • 1000185 +J Psychol Psychother +ISSN: 2161-0487 JPPT, an open access journal +Circa 900 B.C.; Chapter 3, Verse 1) [9]. The next state is dhyana or +effortless expansion called pure meditation This state is described as +‘the uninterrupted flow of the mind towards the object chosen for +meditation’(‘tatra pratyayaikatanata dhyanam’, Patanjali’s Yoga Sutras, +the sage Patanjali Circa 900 B.C.; Chapter 3, Verse 2). +The difference between dharana and dhyana in using effort to +direct attention is supported by data which show a shift towards vagal +dominance during dhyana [10]. Apart from the autonomic variables +there have been electrophysiological recordings of short [11], middle +[12] and long latency [13] auditory evoked potentials during FA, MF, +ME as well as during the control state (RT) of random thinking. The +changes were both in the time taken for information transmission (i.e., +the latency) as well as in the number of neurons recruited (indicated by +the amplitude). However auditory evoked potentials were specific for +the auditory pathway and the neural generators were correspondingly +specific to that pathway. Also evoked potential recordings do not +give spatial and temporal resolution which fMRI provides to localize +changes in brain functions. +Hence the present study was designed to compare the parts of the +brain involved in three successive stages of traditionally described yoga +meditation (i.e., FA, MF and ME) each with the mind wandering state +(RT) using fMRI. +Methods +Participants +The participants were twenty-six right handed trained meditators. +Ten of them (9 males; group average age ± SD; 37.7 ± 13.4 years) +had 7 years of experience of meditation {(7 years × 12 months × 24 +days × 180 minutes)/60} = 6048 hours), practiced as the two stages, +meditative focusing (ME) leading to pure meditation (ME). The other +sixteen meditators had 18 months experience of the same meditation. +They were all males and had an average age of 23.5 ± 2.3 years with +experience of 288 hours {(18 month × 24 days × 40 minutes)/60} = 288 +hours). The two groups significantly differed with respect to age (t = +4.11 ; df = 24 ; p = 0.0003). Baseline characteristics of the experienced +and less experienced meditators are given in Table 1. Participants were +recruited for the trial by notices on the notice boards of the institution, +the Indian Council of Medical Research Center for Advanced Research +(ICMR-CAR), located in Bangalore, south India. This center is attached +to a residential yoga training center where meditators receive training +in meditation and come for advanced retreats. There was no incentive +to take part in the study and while the study design was explained to +the participants, the research question was not. To be included in the +trial participants had to meet the following criteria (i) normal health +based on a routine physical and mental health examination, (ii) right +hand dominance based on a routine hand dominance inventory [14], +and (iii) regularity in their practice of meditation, where regularity +meant practicing for at least 40 minutes a day for six days in a week. +The experienced meditators practiced for 180 minutes in a day while +the inexperienced meditators practiced for 40 minutes each day. +Pre-determined exclusion criteria were: (i) if they were not able to +be scanned due to claustrophobia, metal implants, a pacemaker, or +pregnancy, and (ii) inability to meditate in the scanner environment. +None of the participants had to be excluded for these reasons. The +study was approved by the Institutions’ ethics committees of the (i) +Indian Council of Medical Research Center for Advanced Research +(ICMR-CAR), and (ii) the National Institute of Mental Health and +Neurosciences (NIMHANS), both located in Bangalore in south +India. Signed informed consent was obtained from all the participants +following the guidelines of the Indian Council of Medical Research. +Intervention +During the fMRI recordings, the participants were asked to practice +the control and the three meditation sessions in the following order +i.e., random thinking, non-meditative focused thinking, meditative +focusing, and effortless meditation or pure meditation, each lasting for +2 min. The oral instructions were given from the control room through +noise-canceling electrostatic headphones. +Random thinking +Participants were asked to keep their eyes closed and 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. These conversations were not connected and +hence it was thought that listening to them could induce a state of +random thinking. +Non-meditative focused thinking (FT) +Participants were asked to keep their eyes closed and listened to a +pre-recorded lecture on concepts of meditation. This was intended to +induce a state of non-meditative focusing. +Meditative focusing (MF) +During training participants were asked to open their eyes and +gaze at the Sanskrit syllable ‘Om’ as it is written in Sanskrit. However +in the scanner they were asked to keep their eyes closed. During this +time guided instructions through a pre-recorded audio tape required +them to direct their thoughts to physical attributes of the syllable, i.e., +the shape, the size and the color. The main emphasis during meditative +focusing was that thoughts are consciously brought back if they wander +to the single thought of ‘Om’. +Effortless meditation or pure meditation (ME) +During this session participants were instructed to keep their eyes +closed and dwell on thoughts of ‘Om’ +, particularly on the subtle (rather +than physical) attributes and connotations of the syllable. This would +gradually allow the participants to experience brief periods of silence, +which they reported after the session. +Variables +Experienced meditators (n = 10) +Less experienced meditators (n = 16) +Education +A minimum of 17 years +A minimum of 17 years +Age (mean ± S.D) +37.7 ± 13.4 years +23.5 ± 2.3 years +Gender (M/F) +9 /1 +16/0 +Meditation practice (minutes/day) +180 +40 +Meditation practice (total number of months) +84 +18 +Hours of meditation (total hours) +6084 +288 +Table 1: Baseline Characteristics of the Experienced and Less Experienced Meditators. Values are Group Mean. +Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in +Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185 +Page 3 of 6 +Volume 5 • Issue 3 • 1000185 +J Psychol Psychother +ISSN: 2161-0487 JPPT, an open access journal +Design +A block design was used. The paradigm consisted of two repeat +sessions of 8 minutes duration. The session was repeated on another day +at the same time of the day. Each session had 4 blocks corresponding to +Random Thinking (RT), Focusing (FC), Meditative Focusing (MF) and +‘pure’ Meditation (ME) in a fixed sequence, for 120 seconds per block, +20 dynamic scans per block (20 × 4 = 80 dynamic scans in one session); +hence in total 160 dynamic scans from the 2 sessions were used for +analysis. Participants had been informed that a simple instruction to +change their mental state would be given using the intercom to avoid +their getting startled. +The sequence (i.e., RT-FC-MF-ME) was fixed. The fact that it +was not randomized is a disadvantage of the study. However (i) this +sequence is pre-determined in the traditional descriptions [9], and +(ii) participants had been trained to follow a fixed sequence during +familiarization sessions in the scanner environment. +For one month prior to the experiment the participants were trained +to meditate in a fabricated ‘simulated scanner’ which was a cylinder +of comparable dimensions. During this time the participants were +required to listen to pre-recorded ‘scanner noise’ which was recorded +during actual acquisition. These familiarization sessions were of the +same duration as the actual recording sessions. The practice session +included two trials : that is 2 minute sessions for each of the 4 states, +practiced in 16 minute sessions, 5 days a week during the month. +Assessments +Functional image data acquisition and reduction +MRI scanning was conducted using a 3.0-Tesla Phillips-MRI head +scanner with an 8 channel head frequency coil. To minimize motion +artifact the participants’ head was padded with foam coil. Functional +images were acquired in 160 slices rotated about 30o above the anterior- +posterior commissure (AC-PC) using a T2*-weighted EPI pulse +sequence (repetition time, TR=3000; echo time, TE=35;flip angle, +FA=90°;field of view, FOV=230×230×128 mm; slice thickness = 8mm, +with 0mm slice gap). The 30oline offset was intended to reduce signal +loss due to susceptibility artifact in the orbito-frontal cortex [15]. Scan +acquisition was time-locked to the onset of each trial. Before functional +scanning, a T1-weighted MP-RAGE high resolution 3D anatomical +image was acquired. There were 160 slices, 1 mm thick; TR=8.1 ms; +TE=3.7 ms; FA=90°; FOV=240×240×160 mm. The purpose was to +evaluate structural abnormalities (there were none) and to allow for +transformation of functional data into standard reporting space for +spatial normalization [16]. With the block design paradigm used, +which is detailed above and in Figure 1,160 dynamic scans from the 2 +sessions were obtained. +Imaging data were processed using Brain Voyager (BVQX 2.1; +Brain Innovation, Maastricht, The Netherlands). Preprocessing +included (i) 3-D motion correction using trilinear interpolation, (ii) +Figure 1: Experienced meditators (n = 10): Areas showing supra threshold activation in right middle temporal cortex, right inferior frontal cortex and left orbital gyrus in +meditation (p < 0.05, t-tests for unpaired data Bonferroni adjusted following one-way ANOVA). +Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in +Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185 +Page 4 of 6 +Volume 5 • Issue 3 • 1000185 +J Psychol Psychother +ISSN: 2161-0487 JPPT, an open access journal +slice-scan time correction to temporally realign the slices, (iii) spatial +smoothing using a 3D 6mm full width at half maximum (FWHM) +Gaussian filter, (iv) voxel-wise linear detrending, and (v) temporal +filtering of frequencies below 3 cycles per time course to remove low +frequency non-linear drifts. Registration of the functional images to +anatomical volumes was completed with standard BVQX methods. +For group-wise analysis, spatial normalization of functional images +was carried out by scaling the functional images into standard +Talairach space. +Self–Report of Meditation on Visual Analog Scales (VAS) +At the end of each session participants were asked to rate the extent +that they felt they were able to follow instructions on a liner continuous +scale from 0 to 10, where 0 meant ‘not being able to at all’ and 10 meant +‘being able to do so perfectly’ +. +Data Analysis +Imaging data were analyzed using whole brain voxel-wise statistical +tests (Brain Innovation Version 2.1, The Netherlands). The Talairach +Client (Version 2.4.3) was used to assign Talairach atlas 3D co- +ordinates and overlay statistical maps onto the reference anatomical +image, transformed as standard reporting co-ordinates. +A General Linear Model was applied for group whole-brain +analysis. Following separate one-factor ANOVAs for each of the two +groups, separate t-tests were carried out to compare overlay values +of (i) Focused attention (FA), (ii) Meditative Focusing (MF), and +(iii) Pure Meditation (ME), where each of them were compared with +Random Thinking (RT) for comparison, and for any change. The level +of significance was p < 0.01 with a cluster threshold of 10. Comparisons +were made with t-tests which were Bonferroni adjusted or FDR +corrected to reduce Type I errors +Results +(i) Self-rated ability to switch between states on the VAS: All +participants rated their ability to switch between states as 7 or +more on the 10 point scale, where 0 meant ‘not able to switch at +all’ and 10 meant ‘able to switch perfectly without any difficulty +at all’ [17]. There was no further analysis performed on the self- +reports, +(ii) The imaging data of the two sets of participants, (a) experienced +meditators with 6048 hours of meditation practice, and (b) the +less experienced meditators with 288 hours of experience of +meditation practice: +Experienced meditators + The 10 experienced meditators showed a significant change in the +comparison between pure meditation (ME) and random thinking (RT) +(p = 0.049, one tailed); One Factor ANOVA followed by Bonferroni +adjusted t tests). Areas showing supra-threshold activation are +mentioned in Table 2 and shown in Figure 1. +Less experienced meditators +There were no significant areas of activation for the three +comparisons, which is (i) RT with FA, and (ii) RT with MF and (iii) +RT with ME (p > 0.05); One Factor ANOVA after Bonferroni adjusted +t tests. +Discussion +Meditators with a total of 6048 (7 years) of experience of meditation +on the Sanskrit syllable “Om’ showed significant activation in the right +medial temporal cortex (rMTG), right inferior frontal cortex (rIFG), +and left orbital gyrus (LOG) during the stage of effortless or “pure” +meditation. The comparison was with a period of random thinking. +There were no changes during meditation with focusing or during +focusing alone compared to random thinking. +In the present study the activation was observed in the right middle +temporal cortex and right inferior frontal cortex which has been +observed in earlier studies on meditation [18]. The medial temporal +cortex is known to be involved in cognition and specifically in memory +processing [19,20]. Other aspects of cognition required for memory such +as attentional control are regulated by the inferior frontal gyrus [21,22]. +Multichannel EEG of an advanced meditator during four different +meditations using Low Resolution Electromagnetic Tomography +(LORETA) was carried out. Functional images showed activation +in the right fronto-temporal region along with other areas. The right +fronto-temporal areas are considered to be involved in self-induced +meditational dissolution and reconstitution of the experience of the self. +Hence the results of the present and the earlier study [18] suggest that +meditation activates brain areas concerned with self-representation. +While the LORETA study [18] demonstrated activity in the right +fronto-temporal region, the present study showed activity specifically +in the right inferior frontal cortex. These results are comparable with +an eLORETA study. Here eLORETA was used to compare differences in +cortical source activity in intermediate (average experience 4 years) and +advanced (average experience 30 years) Australian meditators of the +Satyananda Yoga tradition [23]. Assessments were made during a body +steadiness meditation, mantra meditation and non meditation mental +calculation. Across all conditions differences were greatest in the same +regions as the present study which included the right inferior frontal +gyrus, and right anterior temporal lobe. +The above studies [18,23] demonstrated changes in the right inferior +frontal gyrus and temporal region. The activation of the rMTG reported +in the present study is in contrast to the findings of a report [24] which +measured the performance of participants during an fMRI adapted +Stroop word-color task. The comparison was between meditators and +non-meditators. The Stroop task performance was comparable for the +two groups. The MTG among other regions showed greater activity +in the non-meditators than meditators during the incongruent task +condition. The absence of activity during meditation in these areas +was considered to suggest that meditation improves efficiency possibly +through sustained attention and impulse control. The fact that the +Sl. No. +Activation Area +Brodmann Area +L/Ra +Talaraich Coordinatesb (mm) +t-test +X +Y +Z +p - valueb (uncorrected) +Bonferroni corrected +Right middle temporal cortex (rMTC) +37 +R +66 +-54 +0 +p < 0.000002 +p < 0.049 +Right inferior frontal cortex (rIFC) +44, 45 and 47 +R +-48 +14 +18 +p < 0.000002 +p < 0.049 +Left lateral orbital gyrus (LOG) +11 +L +6 +42 +-21 +p < 0.000002 +p < 0.049 +aLeft or Right Hemisphere +bFrom the atlas of Talairach and Tournoux (1988) +Table 2: Areas of Activation and Talairach Coordinates in the Comparison Between Random Thinking and Pure Meditation +Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) A FMRI Study of Stages of Yoga Meditation Described in +Traditional Text. J Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185 +Page 5 of 6 +Volume 5 • Issue 3 • 1000185 +J Psychol Psychother +ISSN: 2161-0487 JPPT, an open access journal +middle temporal gyrus was activated during pure meditation (ME) in +the present study could be related to the fact that in this state attention +was maintained on the object of focus without effort. The findings of the +present fMRI study may be correlated with a morphometry assessment +of cortical thickness in Brain Wave Vibration (BWV) meditation [25], +a practice intended to increase awareness. Among other areas the +meditators showed greater cortical thickness in the temporal cortex +[25]. The regions with greater thickness were considered to be involved +in internal mentation or attention that is detached from the external +world [26]. While the present study demonstrated significantly greater +activation in the right middle temporal cortex based on functional +neuroimaging, structural cortical thickness mapping and diffusion +tensor imaging showed greater cortical thickness in 46 experienced +meditators compared with 46 matched meditation naïve volunteers in +several brain areas including the middle temporal cortex [25]. +The increased activation in the inferior frontal cortex in the present +study has been reported in another neuroimaging study on meditation +[27]. When two meditation techniques, a ‘focused based’ practice and +a ‘breath based’ practice were studied, a strong correlation was found +between the depth of meditation and activation in several areas of the +brain including the inferior frontal cortex and temporal pole [28]. +In the present study the increased activation of the lateral orbital +gyrus during meditation may be associated with certain changes in +mental attitude. The LOG is associated with specific personality traits +including Machiavellian scores [29,30]. The Machiavelli personality +is described as unemotional and detached from social morality for +personal benefits. During meditation there is a possibility of attaining +a mental state detached from all thoughts unrelated to meditation +[31]. The activation of the LOG during ME suggests detachment +which is ideal in meditation provided it co-exists with empathy, social +consciousness and compassion. Also the orbital gyrus is considered +to have a role in processing changes in reward related information +[32]. Meditation could possibly influence factors involved in reward +gratification with a detached attitude. +In meditation the ability to voluntarily shift from normal +consciousness to meditation is enhanced. Thirty one meditators with +meditation experience between 1.5 and 25 years were assessed using +a block on-off design with 45 seconds alternating epochs. During the +onset of meditation and normal relaxation SPM and ICA analysis +showed activation in multiple regions in the frontal, temporal, parietal +and limbic areas which was presumed to constitute a combination +of fronto-parietal and cingulo-oppicular activation [33]. The block +design in the present study which required practitioners to switch +between random thinking and the three stages of meditation within a +short period suggests that experienced meditators were able to change +from non-meditation to meditation even though this was assessed +subjectively without any biological marker. + It was also found by the study of Thomas et al. [23] that the networks +greatly expanded during meditation practice to include homologous +regions of the left hemisphere. It may be speculated that this may be +true for the present study as well. Hence the apparent restriction of +activation to the right hemisphere may be a partial result with the actual +activation involving an extended network within the brain. +The absence of changes in the less experienced meditators is +possibly related to their shorter duration of meditation experience, +rather than to other differences between the groups such as the age. +This is supported partly by a single study [34] which did not find any +difference in self-focused attention between two groups whose mean +age differed by 10 years. However the contribution of the difference in +ages cannot be entirely ruled out. +The present study has certain unique features, particularly the +attempt to study changes in the brain during meditation as described +in traditional texts. This description does not specify a particular +object or mantra, but describes a process to direct attention which +can be used across different meditation techniques. The findings are +limited by factors such as (i) the fixed sequence in the block design +even though the stages of meditation are sequential, (ii) the absence of +a group of non-meditators, (iii) the experienced meditators’ ages varied +considerably, though their experience and intensity of meditation +experience was comparable and (iv) the self-reports of efficacy to shift +from state to state could have been influenced by subjectivity and the +short time intervals of each block (2 minutes) made it all the more +necessary to check this. +Conclusion +In conclusion, the present results showed that there are differences +during effortless or ‘pure’ meditation as described by traditional yoga +texts compared to random thinking, involving activation of areas +involved in semantic cognition, memory, sustained attention, creativity +and the ability to detach mentally. +Acknowledgement +The authors gratefully acknowledge the funding from the Indian Council of +Medical Research (ICMR), Government of India, as part of a grant for a Center +for Advanced Research in Yoga and Neurophysiology (CAR-Y&N), (Project No. +2001-05010). +References +1. 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Rogers RD, Owen AM, Middleton HC, Williams EJ, Pickard JD, et al (1999) +Choosing between small, likely rewards and large, unlikely rewards activates +inferior and orbital prefrontal cortex. J Neurosci 19: 9029-9038. +33. Baerentsen KB, Stødkilde-Jørgensen H, Sommerlund B, Hartmann T, +Damsgaard-Madsen J, et al. (2010) An investigation of brain processes +supporting meditation. Cogn Process 11: 57-84. +34. Gibbons FX, Smith TW, Ingram RE, Pearce K, Brehm SS, et al. (1985) Self- +awareness and self-confrontation: effects of self-focused attention on members +of a clinical population. J Pers Soc Psychol 48: 662-675. +Citation: Telles S, Singh N, Naveen KV, Deepeshwar S, Pailoor S, et al. (2015) +A FMRI Study of Stages of Yoga Meditation Described in Traditional Text. J +Psychol Psychother 5: 185. doi: 10.4172/2161-0487.1000185 +Submit your next manuscript and get advantages of OMICS +Group submissions +Unique features: +• +User friendly/feasible website-translation of your paper to 50 world’s leading languages +• +Audio Version of published paper +• +Digital articles to share and explore +Special features: +• +400 Open Access Journals +• +30,000 editorial team +• +21 days rapid review process +• +Quality and quick editorial, review and publication processing +• +Indexing at PubMed (partial), Scopus, EBSCO, Index Copernicus and Google Scholar etc +• +Sharing Option: Social Networking Enabled +• +Authors, Reviewers and Editors rewarded with online Scientific Credits +• +Better discount for your subsequent articles +Submit your manuscript at: http://www.omicsonline.org/submission diff --git a/subfolder_0/A Psycho-Oncological Model of Cancer according to Ancient Texts of Yoga.txt b/subfolder_0/A Psycho-Oncological Model of Cancer according to Ancient Texts of Yoga.txt new file mode 100644 index 0000000000000000000000000000000000000000..0c1b5b65bb8312f65e976cf636ac977bdb418b0c --- /dev/null +++ b/subfolder_0/A Psycho-Oncological Model of Cancer according to Ancient Texts of Yoga.txt @@ -0,0 +1,663 @@ +Volume 3 • Issue 1 • 1000129 +J Yoga Phys Ther +ISSN: 2157-7595 JYPT, an open access journal +Research Article +Open Access +Amritanshuram, J Yoga Phys Ther 2013, 3:1 +http://dx.doi.org/10.4172/2157-7595.1000129 +Research Article +Open Access +Yoga & Physical Therapy +A Psycho-Oncological Model of Cancer according to Ancient Texts of +Yoga +Amritanshuram R*, Nagendra HR, Shastry ASN, Raghuram NV and Nagarathna R + S-VYASA University, Bengaluru, India +*Corresponding author: Amritanshuram, Division of Life Sciences, Swami +Vivekananda Yoga Anusandhana Samsthana, Bangalore, India, E-mail: +amritram@gmail.com +Received December 17, 2012; Accepted January 28, 2013; Published January +31, 2013 +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R +(2013) A Psycho-Oncological Model of Cancer according to Ancient Texts of Yoga. J +Yoga Phys Ther 3:129. doi:10.4172/2157-7595.1000129 +Copyright: © 2013 Amritanshuram R. 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: Yoga; Psycho-neuro-immunological studies; Etiology of +cancer +Introduction +Cancer is a leading cause of death worldwide accounting for 7.4 +million deaths (13% of all deaths worldwide) in 2008 [1]. Research +to understand the etiology and eradicate the tumor burden without +harming the host has progressed greatly and has resulted in successful +cure (in a few cancers), improved longevity and quality life. But the +world statistics indicates that the prevalence of the disease has not +reduced which is intriguing. In India alone, 22.2% of women presently +suffer from cancer which is expected to increase to almost 30% in the +next five years [2]. This is one of the reasons that have led patients to +resort to complementary and alternative medicine (CAM). According to +a previous survey, approximately 21% of cancer survivors in the United +States had engaged in CAM practices [3]. In India, approximately +56% of the cancer patients took recourse to alternative therapies [3]. +Among these, yoga was the third most commonly accepted therapy +[3]. These surveys have also compiled the reasons for resorting to +CAM. They were: management of side effects, reduction of costs +involved, avoiding poor quality of life, minimizing psychological ill- +health and reducing recurrences in spite of undergoing such traumatic +treatments [3]. The reason appears to stem from a more fundamental +cause than these. As treating professionals and researchers we seem to +have missed a major factor, namely the mind, in our entire search for +a solution. Conventional treatment has concentrated on dealing with +pathophysiology at physical, physiological and molecular levels, but in +reality the human system is governed by a more powerful subtle entity +called the mind [4]. +Life style and psychosocial stresses were recognized to be +contributory to sickness, by a few researchers, as early as nineteen +seventies [4,5], but it is only recently that enough data has been +accumulated to propose a psycho-neuro-immunological model for +Abstract +Background: Several psycho-oncological models of cancer have been published. Integrated module of yoga +has been found to be effective as an add-on to conventional management of cancer through randomized control +studies. +Objectives: To develop a model of the aetiopathogenesis of cancer according to ancient yoga texts. +Methods: This process had four phases: 1) Review of modern scientific and original texts dating back to 5000 +years, 2) Focused Group Discussions (8 members) to develop the model, 3) preparation of the module based on the +proposed model and 4) field testing of yoga modules for patients with cancer. +Results: Yoga texts propose that cancer is disturbed homeostasis (an imbalance) based in the mind. Persistent, +uncontrolled, fast recycling of thoughts in the mind due to wrong knowledge about the source of happiness is the +origin. This activates wasteful release of vital energy, (prana), which in due course, expresses onto the physical body +as habituated imbalance resulting in uncontrolled molecular (gene) level activity. This ‘local violence’, progresses +by activating the chemical reactions, resulting in inflammation or uncontrolled mitosis. The goal of yoga therapy +is ‘mastery over inner chemical processes through mindfulness and alertful rest to reduce the inner violence’. +Yoga modules were developed based on this understanding of the etiology of cancer. Review of literature and +group discussions which also contributed to these modules, aided to keep the focus on scriptural relevance and +clinical feasibility. These modules were used in patients with stage 2 and 3 breast cancer in randomized control +studies between 2003 till 2008. The results of these studies pointed to the beneficial effects of yoga as compared +to conventional management. During surgery, IAYT reduced hospital stay, faster wound healing and lower drain +retention; during chemotherapy, practice of yoga demonstrated lower nausea intensity and frequency, anxiety, +depression, better immunological status and quality of life; yoga practice during radiation therapy brought about +lesser side effects, less stress levels, better cortisol rhythm, sleep. During and after the treatment period patients +indicated better quality of life. Controlled studies on breast cancer patients provided the scientific evidence that these +modules are effective in clinical settings. +Conclusion: This yoga based, workable model has incorporated the subtle aspects of mind (prana, mind and +the self) into the psycho-neuro-immunological model of cancer. Evidence suggests that yoga techniques that are +based on the models are effective in the management of breast cancer. Mechanism studies and intense dialogue are +necessary to consolidate these concepts. +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according +to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129 +Page 2 of 6 +Volume 3 • Issue 1 • 1000129 +J Yoga Phys Ther +ISSN: 2157-7595 JYPT, an open access journal +cancer [6]. This has helped to create an awareness of the role of mind +body relationship in the etiology and progression of cancer. Anderson +et al. [7] proposed a model in 1994 that pointed to a relationship +between mind and cancer. By 2006 they moved on to create a model +that portrayed a linear progressive casual relationship between +psychological stress, immune disturbance and cancer [8]. Further, in +2010 Ao P et al. [9] proposed a dynamic non linear mathematical model +of the etiology and progression of cancer based on the interaction of +the caspase-3 molecules to indicate the states of normalcy, disease and +stress. +Among the various CAM treatments available, yoga offers a holistic +model using an entirely different concept of understanding human +body in health and disease states; it also offers self corrective techniques +to restore normalcy. Ancient texts dating back to about 5000 years (Rig +Veda, Patanjali Yoga Sutra and ayurveda] provide a highly evolved +conceptual basis of aetiopathogenesis of disease and its management. +The ‘Integrated Approach of Yoga Therapy (IAYT) for Cancer’ +, used +as complimentary to conventional medicine in all studies conducted +by Swami Vivekananda Yoga Anusandana Samsthana (S-VYASA) +consisted of practices that were based on this model. The aim of the +present study is to present a holistic model of etiopathogenesis of +cancer using both the ancient and present knowledge. +Methods +This retrospective scientific narrative has been classified under four +phases (Table 1). +Content generation +Research scholars reviewed traditional yoga and ayurveda texts +for references to disease etiology and cancer specific pathology and +progression [10–13]. A comprehensive list of all the attributes and +treatment modalities were compiled for further discussion. +Scientific literature including empirical evidence and review +articles were also scrutinized and hypothesized cancer etiology models +[9] were noted apart from accumulating information regarding latest +trials that had been done in the field of mind body medicine as a disease +management strategy [14–18]. +Model development +Focused Group Discussions (FGD): The literature thus compiled +was presented to a group of experts for deliberations. The participants +of the focused group discussion (FGD) included eight members +consisting of 3 yoga experts with in-depth scriptural knowledge who +were practitioners of these techniques, one post graduate physician, two +oncologists who work with cancer patients and understand their major +concerns and needs at physical, mental and emotional levels during the +conventional therapies, and two research fellows. +For each item on the list, the experts were asked to mark ‘useful’ +, +or ‘not relevant’ for understanding cancer etiology. The group was also +asked to suggest more references regarding cancer and its etiopathology. +In addition to this, in-depth discussions ensued which formed a major +method for data generation. These discussions and suggestions thereof +were noted and were added to the pre-existing list. Inputs by the experts +were used to finalize the model for cancer etiopathogenesis. +The flexibility of the FGD structure facilitated exploratory +discussions which made the outcome more humanized rather than +a score based questionnaire method. Despite its time consuming +characteristic, it helped the researchers to interact as contributors +to the model. The probing questions and discussions facilitated the +development of the model by sharing each others’ experiences also. The +entire process involved several small group meetings, correspondences, +sitting together for meditation and visiting the experts in the field apart +from the FGDs. +All the suggestions offered by the group of experts were deemed +equally important and taken into consideration for designing the +model. This was done by the research scholars under the guidance of +the yoga experts. +Module preparation +The FGD resulted in the formation of a etiopathological model of +cancer. A check list of yoga practices which was developed based on this +model were provided to the same team of experts for their opinion. This +process followed a semi-structured format, using open-ended questions +in a face-to-face conversational style and the focus was to document the +interviews and discussions that were based on the literature review and +experiential knowledge. Inputs regarding feasibility, need, relevance of +several yoga techniques were used to develop the modules of integrated +approach of yoga that formed the material for another publication [19]. +Field testing +The modules that evolved were initially administered to patients +with different cancers as part of the pilot study. These subjects were +recruited from the residential health home of the institution, admitted +for two to three weeks to undergo integrated approach of yoga therapy. +These modules were administered to them for the period of their stay +by trained experts (two of the senior faculty who were involved in the +FGD). Feedback from these patients was recorded immediately after +each session. Based on this, further changes were made to the modules. +Further we conducted two randomized controlled studies that +used the modules of IAYT for cancer as an add-on to conventional +management of breast cancer (stages 2 and 3) results of which formed +the material for the eight publications on the complimentary role of +IAYT in breast cancer [20–27]. +Results +Contents of the model: Panchakoshva viveka (the five components +of human being). +According to yoga texts (Taittereya Upanishad), the human system +consists of five components [pancha kosha]: Physical body (Annamaya +Kosha), Subtle Energy or Prana (Pranamaya kosha), Instinctual mind +(Manomaya kosha), Intellectual or discriminative mind (Vignanamaya +kosha) and bliss-full silent state (Anandamaya kosha) (Figure 1). +Content Generation +o +Review of traditional texts +o +Review of scientific literature on cancer pathology +o +Interactions and discussions with experienced yoga +gurus +Model +Development +o +Focused Group Discussions and semi structured +interviews +o +8 experts from yoga or oncology field +o +preparation of yogic model for cancer management +Yoga Module +Preparation +o +List of practices based on etiopathology and need +o +Validation of yoga modules +Field Testing +o +Pilot studies on patients with cancer in stages 2-4 in +sites such as breast, cervix, stomach, colon cancers +included +o +Randomized controlled studies on patients with +breast cancer( stage 2-3) +Table 1: Stages in the development of yogic model for the aetiopathogenesis of +cancer. +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according +to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129 +Page 3 of 6 +Volume 3 • Issue 1 • 1000129 +J Yoga Phys Ther +ISSN: 2157-7595 JYPT, an open access journal +Shvetashvatara Upanishad [10] describes that a human being is +in perfect harmony with nature and healthy when he is established in +Anandamaya kosha which is the unchanging state of being, the self +(called Brahman) and the causal state of beings from where all other +(ever changing) Koshas emerge [28]. Analogies to explain that Ananda/ +perfect health is the unchanging core of one’s personality include ‘this +kosha is like the string in a necklace of beads’ (Bhagavad Gita 7.7), like +the gold in all jewels (Chandogya Upanishad, 6.1.6) [12] or the clay in +different shaped pots (Chandogya Upanishad, 6.1.3) [12]. This state is +experienced as a state wherein one reaches a state of inner quietitude +with awareness and the knowledge that ‘I am made of the same +universal consciousness and bliss that forms the base material of the +entire creation’ +. + (Mandukya Upanishad 2) [29]; e.g. a salt doll dives into the ocean +to understand the depth of the ocean but gets the joy of becoming the +ocean itself by losing its individual entity [30]. +Waves begin in this ocean of blissful quietitude and become grosser +and grosser to form the other four components of the body (Ch3v3-6) +[28]. The first wave (spandana) that appears is the ‘I’ (self awareness) +followed by several varieties of waves that form a template of right +knowledge, the Vignanamaya kosha. In this state man is in perfect +health as he is in tune with nature [28] and leads a healthy life style with +complete mastery over his mind (Ch1v3) [31]. As these waves gather +momentum with higher amplitude and rewinding speed (ch5v26) +[11], (ch8v88) [13] it gathers energy to become the Manomaya kosha +in which likes and dislikes begin (Tattva Bodha v49) [32]. As the +process of grossification continues it goes on to become the vital energy +(pranamaya kosha) and the physical molecules (Annamaya kosha) +(Ch3 v5) [28]. Yoga techniques offer techniques of mastering the gross +[13] to reach the subtle layers of one’s existence by introspective slowing +down of thoughts. The subtle controls the gross e.g. if one masters prana +he can manipulate the functions of physical body; mind can manipulate +prana; vignana can master the mind and prana (Ch1v40) [31]. The goal +of life is to establish in a state of complete mastery by remaining in a +state of vignana , a state of complete freedom and contentment, freedom +from all distress and disease (shvetashvatara Upanishad ch2v12) [10]. +This is a state in which one develops the ability to manipulate the laws +of nature within the body and outside the body (ch1v4) [31]. +The model proposes the ability to master the law that governs +programmed cell cycle. Mind is the most highly evolved and the +most powerful entity in the manifest universe. A living human body +is a flux of continuous changes that is programmed to live a full life +span of about a century in perfect heath if it is not disturbed by major +calamities. As man goes through the ups and downs of life (be it +exposure to external onslaughts like injury or infection, or emotionally +challenging situations), it sets off an imbalance. The scriptures are +very emphatic when they say that this imbalance occurs due to lack +of mastery over mind which is the starting point of any mind body +disease. Sage Vasistha describes the progression of this imbalance that +results in cancer (and/or other lifestyle related disorder) in the text yoga +Vasistha (ch9 v82-117) [13]. The search for happiness in outside objects +continues with unresolved conflicts due to wrong notion about the +meaning of life and nature of happiness. The nature of this conflict or +distress is described as ‘uncontrolled recycling of sentences in the mind’ +(yogic definition of stress) (ch5v23) [11], the Manomaya kosha. This +imbalance due to uncontrolled speed (udvega) of suppressed emotions +when unchecked results in an imbalance and percolates into pranamaya +kosha. This is detectable as disturbed pattern of breathing (increased +rate and irregular rhythm) and poor digestion. As this imbalance and +loss of mastery goes on for some time it becomes an involuntary habit, +a reflex. Chronic constipation or irritable bowel (alternate constipation +and diarrhea), fatigue and generalized body aches are the other +general (non-specific) manifestations at this level. When unattended +by correcting the imbalance at the root cause (the Manomaya and +Vignanamaya koshas) the process continues and localizes to a specific +zone in the physical body (Annamaya kosha). Thus, the uncontrolled +rush of prana (vital energy) results in uncontrolled electro-chemical +processes in the physical body, the annamaya kosha. This appears to +mean that the physical fight (tissue inflammation) is a reflection of +the violence or fight in the mind. We know today that inflammation +is a feature of cancer. Thus, the uncontrolled excessive prana (subtle +energy) flow seems to cause the changes in the molecular level that +goes on to alter the apoptotic programming resulting in immortal +cells and perpetuation of cancer cells (Figure 2). Further, the texts go +on to describe that the localization of the disease (cancer) depends on +external (insult by carcinogenic agents, trauma, toxins, and infections) +or internal (genetic) factors. +Thus, the yogic model proposes that the entire problem is due to +repetitive on slaught by uncontrolled thoughts (suppressed emotions) +at the mind level (Manomaya kosha) which causes excessive prana +activity and manifests as violence (inflammation) at annamaya kosha +to show up as cancer. +Figure 1: showing etiopathogenesis of cancer, combining knowledge from yoga +texts and modern literature. +Figure 2: Five Layers of the Human system. +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according +to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129 +Page 4 of 6 +Volume 3 • Issue 1 • 1000129 +J Yoga Phys Ther +ISSN: 2157-7595 JYPT, an open access journal +Integrated approach of yoga therapy for cancer +The integrated approach of yoga offers a comprehensive means +to overcome the damage by achieving mastery at all levels through +deep cellular rest (reducing the speed, violence and inflammation). At +the physical level (Annamaya kosha) there are practices that include: +cleansing the body (yogic kriyas) of the endotoxins (Aama as portrayed +in ayurveda) both at the gross (fecal matter) and subtle (molecular +toxins e.g. free radicals) levels [33]; correcting the life style through +yogic diet and injunctions for healthy behavior (sleep, activity, speech, +righteousness); and providing deep rest (reduce the speed) to the +damaged/sick tissues through physical postures (asanas). Pranayama +or breathing techniques corrects the imbalances in pranamaya kosha +through voluntary reduction in the rate of breathing (Ch2 v49) [34]. +Meditation (Dharana, Dhyana, Samadhi and Sanyama), the Manomaya +kosha practice is the most important as it aims at direct mastery over the +mind, the root cause of the problem by establishing in an introspective +state of blissful awareness (dhyana=effortless flow of a single thought) +(Ch2 v2) [31] (Ch3 v2) [34]. Devotion (bhakti yoga or emotional +culture) is another important component that helps in harnessing the +uncontrolled surge of violent suppressed emotions through using ‘pure +love’ +. At the vignanamaya kosha level (intellectual) correction of the +false notion is achieved through understanding that ‘I am made of the +universal consciousness and bliss (Ananda) which is independent of +the mind’ +. At anandamaya kosha level, karma yoga helps in achieving +blissful awareness free from all fears (including fear of death). Thus +the highlight of this model is the possibility of the practitioner to de- +identify and dissolve oneself in the universal consciousness that is +described as existence (sat), consciousness (chit) and bliss (ananda), +through right knowledge and awareness. All practices including +yogic diet, kriyas (cleansing), asanas, pranayama, dharana, dhyana, +devotion and self analysis prepare the system to stop the turbulent +fluctuations (superficial and deep seated subconscious activities) and +allow the mind to rest in a state of inner quietitude(wakeful sleep) . +A single positive thought (a resolve) dropped in the ocean of blissful +quietitude (sanyamah) has the ability to reverse the imbalances at all +levels [31]. Thus the process of reversing the structural and functional +abnormalities at the tissue level is described through this model. +Field testing +The major changes suggested by the patients, after having +undergone sessions of the yoga module, as part of the pilot study, were: +(a) the duration of each module of the practice had to be reduced from +60 to 30 minutes, (b) there was a need for recorded audio CDs/cassettes +to help them continue the practice and (c) some of the imageries used +during the practice had to be replaced. E.g.: the ‘death experience’ had +to be replaced by ‘surrender to the divine lord’ which gave much more +confidence to face the disease. +The results of randomized control trials on stage 2 and 3 breast +cancer patients have shown beneficial effects of IAYT, throughout the +entire treatment phase, as an add-on to conventional treatment. +Stage 2 and 3 breast cancer patients undergoing surgery showed +shorter hospital stay, suture removal and lower drain retention in +the group that were administered IAYT. Patients receiving IAYT +along with radiotherapy showed significantly lower levels of anxiety, +depression distress, fatigue, insomnia, and appetite loss, negative effect +and stress and improved activity levels, positive effect, emotional and +functional quality of life while the amount of change in DNA damage +was significantly lower as compared to controls. Cortisol rhythms +also showed restorative changes in yoga group. Breast cancer patients +receiving chemotherapy and IAYT reported lower nausea intensity +and frequency apart from lower state and trait anxiety, depression, +symptom severity, distress and better quality of life. Higher immune +parameters like NK cells, CD8+ and CD56+ counts were also observed +for this group. +Discussion +This narrative summary of a pre-clinical process, presents a model +of the aetiopathogenesis of cancer that has evolved over 5000 years of +research in the east by yoga masters as an introspective science. This +model of origin and progression of cancer takes into account the +existence of subtle aspects of the personality such as prana, mind, and +the self (the soul). The holistic model proposes that the root cause of +the disease is the wrong mindset or incorrect notion viz. ‘the source of +happiness is the external agents of enjoyment’ +. The life’s ambitions and +plans are all based on this notion. Frustrations occur when these are +not fulfilled. Emotional suppressions become mandatory to carry on +with life. This results in chronic imbalance that disturbs homeostasis +and culminates to cancer. This analysis provides the logical basis for +using corrective techniques that are used in yoga practices. +Our studies that used intervention modules called IAYTC +(integrated approach of yoga therapy for cancer) based on this model +as an add-on during the entire course of conventional management of +breast cancer (stages 2 and 3) have shown the beneficial effects [20–27]. +The results of these studies indicate that the IAYT modules complement +conventional treatment and are clinically relevant to cancer patients. +However, they do not provide direct evidence for the etiopathological +model that is proposed in this article and is a working hypothesis that +has been suggested. +Comparisons with other psyco-oncological models +Anderson et al. [7] proposed a bio-behavioral model of the +relationship between stresses of cancer based on several publications +up until 1994. +Her study highlighted the mechanisms by which psychological and +behavioral responses may influence biological processes and the health +outcomes and gave insights into the role of mind in compliance to +standard therapies. Further, based on a decade long (between 1995 and +2005) explosive discoveries on the relationship between psyche and the +immune modulation the same researchers Thornton and Anderson [8] +presented a psycho-neuro-immunological model of cancer. This model, +for the first time, hypothesized a causal linear relationship between the +chain of events starting from stressors, psychological stress response +that may lead to physiological stress response going on to immune +changes and the disease processes. They could also incorporate many +molecular mediators and moderators in the model. There has been +continuing debate on this psycho-neuro-immunological model of the +genesis and progression of cancer. A robust study by Surtees et al. [35] +investigated the associations between lifetime social adversity measures +that included stressful life events in childhood and adult life, stress +adaptive capacity, and perceived stress over a 10-year period. Looking +at the Incidence through the cancer registry data showed no evidence +that social stress exposure or individual differences in its experience are +associated with the development of breast cancer [35]. +Research in the last decade identified several mediators involved in +the genetics of cancer that has led to successful drug discoveries. Based +on these, Ao et al. [9] proposed a non linear mathematical physical +(stochastic dynamic) model. According to this model, the oncogenes +and other molecular and cellular agents form pathways and modules +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according +to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129 +Page 5 of 6 +Volume 3 • Issue 1 • 1000129 +J Yoga Phys Ther +ISSN: 2157-7595 JYPT, an open access journal +that cross talk to each other to form endogenous networks. The +nonlinear dynamical interactions among these generate many locally +stable states of which some states may be normal such as cell growth, +apoptosis, arresting, etc,; others may be abnormal, such as growth +with elevated immune response and high energy consumption, likely +the signature of cancer; some may be useful to deal with rare stressful +situations. +Similar to basic discoveries at molecular levels that led to safer +drugs to scavenge for cancer cells, the eastern yoga model offers a +sound conceptual basis for psycho-oncological processes that leads to +techniques of yoga with the potential of returning to normalcy. +Since the first published research article evaluating the benefits of +a support group therapy [36] in 1981, several researchers have used +techniques like mindfulness-based stress reduction (MBSR), progressive +muscle relaxation, Tibetan yoga as alternative forms of mindful and +proactive non-pharmacological methodologies in combination with +conventional treatment and seen a plethora of benefits in cancer care. +To date there are three metaanalyses [37–39] of all published papers on +yoga in cancer, that provide consistent evidence to the strong beneficial +effects on distress, anxiety and depression, moderate effects on fatigue, +general HRQoL, emotional function and social function, small effects +on functional well-being, and no significant effects on physical function +and sleep disturbances. Looking at the results of all these studies, it +raises a question as to how all these studies could show similar results +although they had used different practices ranging from only physical +practices to meditative practices. The answer lies in the understanding +that all these (asanas, pranayama, meditation etc) are only techniques to +help the patient arrive at an internal mastery over the mind and prana +that helps in correcting the imbalances. As the premise for calling any +practice ‘yoga’ is clarified in ancient Indian literature, researchers had +the freedom to modify the intervention to suit the desired objectives. +Summary +The scriptural basis of the IAYTC has been discussed. The model +incorporates all aspects of the personality with mind as the starting +point with cancer as the end point of the process. +Limitations of the study +This work refers a retrospective presentation of the steps that were +followed over the years and not a prospective planned study to assess +the validity and reliability of the model. Statistically acceptable check +lists and scoring were not used during all group discussions and the +format was semi structured. Not all members of the focused group met +during all discussions and there were several meetings that were not +documented. Statistical calculations of split half reliability were not +planned. +The clinical trials performed using yoga techniques developed +based on the proposed model cannot directly validate the model but +indicate that yoga is an effective tool for the management of cancer. +Although cancer patients and yoga teachers would greatly benefit from +the knowledge of this model, it is not a necessity that this model be the +only mechanisms of action. +Strengths +This is the first proposed model that explains the role of imbalances +at several levels of existence (physical body, prana and mind). It +forms the basis for self corrective techniques. RCTs that led to eight +publications [20–27] provide the evidence. This offers new direction to +research on cancer at subtler levels. +Conclusion +This study offers a model for holistic approach to cancer research +as it incorporates the subtle components into the psycho-neuro- +immunological model of cancer. More robust studies to understand the +mechanism are to be designed, in the future, in order to find evidence +for each process in the hypothesized model. +Acknowledgements +We acknowledge the support and the funding provided by the librarian and the +staff of S-VYASA University. +References +1. World Health Organization (2012) World health Report factsheet. +2. Ferlay J, Shin H, Bray F, Forman D, Mathers C, et al. (2008) GLOBOCAN +Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. +International Agency for Research on Cancer. 2010 +3. Gupta M, Shafiq N, Kumari S, Pandhi P (2002) Patterns and perceptions +of complementary and alternative medicine (CAM) among leukaemia +patients visiting haematology clinic of a north Indian tertiary care hospital. +Pharmacoepidemiol Drug Saf 11: 671-676. +4. CUNNINGHAM AJ (1985) THE INFLUENCE OF MIND ON CANCER. +CANADIAN PSYCHOLOGY 26: 13–29. +5. Hirayama T (1979) Nutrition and Cancer. Diet and cancer 1: 67–81. +6. 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(2011) Developement +and Validation of a need-based integrated yoga program for cancer patients. +Journal of Stem Cells 7. +20. Rao MR, Raghuram N, Nagendra HR, Gopinath KS, Srinath BS, et al. (2009) +Anxiolytic effects of a yoga program in early breast cancer patients undergoing +conventional treatment: a randomized controlled trial. Complement Ther +Med17: 1–8. +21. Raghavendra RM, Nagarathna R, Nagendra HR, Gopinath KS, Srinath BS, et +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna R (2013) A Psycho-Oncological Model of Cancer according +to Ancient Texts of Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129 +Page 6 of 6 +Volume 3 • Issue 1 • 1000129 +J Yoga Phys Ther +ISSN: 2157-7595 JYPT, an open access journal +al. (2007) Effects of an integrated yoga programme on chemotherapy- induced +nausea and emesis in breast cancer patients. Eur J Cancer Care (Engl) +16:462–474. +22. 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Integr Cancer Ther 8: 37–46. +26. Vadiraja SH, Rao MR, Nagendra RH, Nagarathna R, Rekha M, et al. (2009) +Effects of yoga on symptom management in breast cancer patients: A +randomized controlled trial. Int J Yoga 2: 73–79. +27. Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, et al. (2007) Effects of +an integrated yoga program in modulating psychological stress and radiation- +induced genotoxic stress in breast cancer patients undergoing radiotherapy. +Integr Cancer Ther 6: 242–250. +28. Gambhirananda +S +(2010) +Taittiriya +Upanishad. +(1stedn), +Kolkata: +Advaithashrama. +29. Nikhilananda S (2006) The Mandukya Upanishad with Gaudapa Karika and +Sankara’s Commentary. (6thedn), Kolkata: Advaithashrama. +30. Nikhilananda S (1984) Gospel of Sri Ramakrishna.(9thedn), Ramakrishna- +Vivekananda Center. +31. Taimni IK (1999) The Yoga Sutras of Patanjali. (1stedn), Integral Yoga +Publications. +32. Sankaracharya (1986) Tattva Bodha. (1stedn), Bangalore: Chinmaya Mission +Trust. +33. 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BMC cancer +12: 412. +Submit your next manuscript and get advantages of OMICS +Group submissions +Unique features: +• +User friendly/feasible website-translation of your paper to 50 world’s leading languages +• +Audio Version of published paper +• +Digital articles to share and explore +Special features: +• +250 Open Access Journals +• +20,000 editorial team +• +21 days rapid review process +• +Quality and quick editorial, review and publication processing +• +Indexing at PubMed (partial), Scopus, DOAJ, EBSCO, Index Copernicus and Google Scholar etc +• +Sharing Option: Social Networking Enabled +• +Authors, Reviewers and Editors rewarded with online Scientific Credits +• +Better discount for your subsequent articles +Submit your manuscript at: http://www.omicsonline.org/submission +Citation: Amritanshuram R, Nagendra HR, Shastry ASN, Raghuram NV, Nagarathna +R (2013) A Psycho-Oncological Model of Cancer according to Ancient Texts of +Yoga. J Yoga Phys Ther 3:130. doi:10.4172/2157-7595.1000129 diff --git a/subfolder_0/A Questionnaire designed to measure tridosha values in adolescents changes in score pre-post an IAYT yoga module.txt b/subfolder_0/A Questionnaire designed to measure tridosha values in adolescents changes in score pre-post an IAYT yoga module.txt new file mode 100644 index 0000000000000000000000000000000000000000..daf46c811bc34f0848dfda54c6a9f8054eabeb14 --- /dev/null +++ b/subfolder_0/A Questionnaire designed to measure tridosha values in adolescents changes in score pre-post an IAYT yoga module.txt @@ -0,0 +1,1063 @@ +Kaur et al. European Journal of Biomedical and Pharmaceutical Sciences + + +www.ejbps.com + +205 + + + +A QUESTIONNAIRE DESIGNED TO MEASURE TRIDOSHA VALUES IN +ADOLESCENTS: CHANGES IN SCORE PRE-POST AN IAYT YOGA MODULE + + +Devika Kaur1, Alex Hankey2* and HR Nagendra3 + +1S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, Kalluballu Post, Jigani, Anekal Taluk, Bengaluru District, +Karnataka 560105. +2Distinguished Professor of Yoga and Physical Science S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, +Kalluballu Post, Jigani, Anekal Taluk, Bengaluru District, Karnataka 560105. +3Chancellor, S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, Kalluballu Post, Jigani, Anekal Taluk, +Bengaluru District, Karnataka 560105. + + + + + +Article Received on 30/07/2019 Article Revised on 19/08/2019 Article Accepted on 09/09/2019 + + + + + + + + + + + + + + + + + +INTRODUCTION +India‟s ancient science of life, Ayurveda[1,2] lays great +emphasis on the concept of Prakriti[3], because that +concept provides a preliminary assessment of patients‟ +physiological tendencies when faced by stressors[4], +continuing exposure to which will inevitably lead to +pathogenesis.[5] In the historical system, many Vaidyas +were trained to use Nadi Vigyan.[6,7] Ayurveda‟s system +of pulse diagnosis, in addition to Dashavidha Pariksha, +for the all-important evaluation of Prakriti and Vikriti in +those who came to consult them.[8] + +The drift away from traditional systems of healthcare +under British influence[9,10], led to neglect of Ayurveda +and its systems of diagnosis and treatment. Medical +training colleges did not cover them, though Vaidyas +trained by traditional Guru-Shishya principles continued +to learn them. More recently, this been remedied with +present Ayurveda training institutions teaching them as +part of their curriculum.[1]* The present need is to +develop equivalent ways to obtain the same patient +information. +A +previous +paper[11] +described +the +development and testing of a questionnaire for children. +We ourselves have developed a separate questionnaire, +the Kashyapa Prakriti Inventory (KPI), aiming to +evaluate Prakriti in adolescents. This paper describes its +administration to adolescents before and after training in +a 90-minute Yoga module, designed in accordance with +the principles of the Integrated Approach to Yoga +Therapy[12] (IAYT). + +Historically, Yoga originated in India as the ancient +Vedic civilization‟s system of personal development for +the children of Rishis, Kings and other leaders of +society.[13] The discipline is informally described in the +first Upanishads[14], and slowly acquired a formal status +as the path to union (Yuj) with the Divine[15], and +consequent release from the cycle of birth and death.[16] + +Yoga focuses on gaining mastery over body and mind[17] +and consequent acceleration to gaining life‟s true goal of +self-realization and enlightenment.[18] It integrates body, +mind and spirit using a comprehensive, holistic approach +in practices emphasizing breathing and stretching, +postures and pranayama, chanting and meditation, as +detailed below. Yoga practices for the individual may +SJIF Impact Factor 6.044 + +Research Article +ejbps, 2019, Volume 6, Issue 11, 205-211. +European Journal of Biomedical +AND Pharmaceutical sciences + +http://www.ejbps.com + + +ISSN 2349-8870 +Volume: 6 +Issue: 11 +205-211 +Year: 2019 +*Corresponding Author: Alex Hankey +Distinguished Professor of Yoga and Physical Science S-VYASA, Prashanthi Kutiram Campus, Manchenahalli, Kalluballu Post, Jigani, Anekal +Taluk, Bengaluru District, Karnataka 560105. + + + + + + + +ABSTRACT +Background: Ayurveda emphases the prakriti concept as fundamental to assessing patients‟ physiologies. Recent +decades have proposed new ways to evaluate it. Previous papers describe formulation and testing of new +inventories to evaluate physiological and psychological aspects of prakriti in children and adolescents. Here, we +report changes in adolescents pre-post a Yoga intervention. Methodology: The study was conducted at a high +school and PU-college level on 82 adolescents, aged 15.29±1.65 years. The Yoga module was given thrice per +week for four weeks. It included Yoga breathing/stretching practices, postures, Mind Sound Resonance +Technique, mantra recitation and relaxation techniques. The Inventory was administered pre-and-post the +intervention. Statistical analysis used SPSS-21.0 Wilcoxon Signed-Ranks-Test. Results: Vata decreased, p<0.05; +Pitta and Kapha increased, p<0.05. Discussion: Participant‟s initial states were Vata dominant. Results indicate +that their tridosha became more balanced; psychologies calmer, personalities steadier, causing fewer problems. +Changes are attributable to alteration of underlying Tridoshas; epigenetics may provide an explanation. + +KEYWORDS: Prakriti, Psychology, Vata, Pitta, Kapha, Yoga. + +Kaur et al. European Journal of Biomedical and Pharmaceutical Sciences + + +www.ejbps.com + +206 +also include consideration of bodily compositions. The +texts hold that nature and body are directly related to +each other as described in the phrase „Avinabhaava +Sambandha‟[19], inseparable connection. + +Today, many top Yoga research institutions like +NIMHANS +and +Kaivalyadhama[20,21], +and +other +academic organizations like Harvard University[22] and +Patanjali Yoga Peeth[23], have worked with great +dedication to observe benefits of Yoga practices and +validate them. Studies have been done on all age groups: +children[24]; adolescents[25]; adults[26] and the elderly.[27] +In adolescents (the concern of this study), effects of yoga +have been seen in such fields as: increased academic +motivation and persistence[28]; social behavior[25]; coping +with stress[29], dealing with anxiety[30], and similarly yoga +as a complementary treatment for the quality of life of +adolescents suffering from IBS[31], etc. However, there +seems to be no study of possible effects of yoga on +Prakriti in adolescents; hence the present study. + +Allied to yoga is the ancient Vedic system of medicine, +Ayurveda.[1-3] According to Ayurveda, the human body is +organized by three fundamental physiological principles +called Doshas that govern all bodily functions[32], Vata +dosha, Pitta dosha & Kapha dosha.[33] Strictly speaking, +the word „Dosha‟ means impurity, because Doshas may +express imbalances in the composition of important +aspects of the physiology.[34] However, the Ashtanga +Sangraha by Vaghbata, related to the third of Ayurveda’s +main three texts[1-3], states that when functioning in +balance, Doshas are „Dhatus‟, i.e. they nourish & +support the system.[35] A fundamental idea in Ayurveda +is that each well-functioning Dosha possesses an +intrinsic strength, Bala[36], that may vary from person to +person, e.g. the strength of a person‟s digestion is +proportional to the strength of their Jataragni, an aspect +of their Pitta Dosha. If Jataragni and hence Pitta Bala is +strong, then digestion is good[37], but if it is low, then +weak digestion may give rise to toxicity, known as +Ama[38], and so to disease. + +The relative strengths of the three doshas are +summarized in Ayurveda‟s theory of Prakriti, or +„physiological types‟.[39] The dominant Dosha is used to +name the corresponding Prakriti: a Vata Prakriti type +has Vata Dosha dominant in their system; a Pitta +Prakriti type has Pitta Dosha dominant, while a Kapha +Prakriti type possesses dominant Kapha Dosha. If a +person has the strongest two Dosha Balas close to each +other, then they belong to a combination of types, Vata- +Pitta, Pitta-Kapha or Kapha-Vata.[40] + +When such matters are considered in further depth, +imbalances between a person‟s Doshas are recognized to +increase susceptibility to disease. Dosha imbalances are +thus seen as precursors to all diseases, both physical and +mental.[41] Disease in Ayurveda is seen as driven by both +general and specific considerations. Dosha imbalances +tell the general class of pathology, while more detailed +considerations +tell +the +specific +disease. +If +one +subcomponent of Vata is driven out of balance by +another subcomponent of Vata, the result is a Vata-vyadi, +a neurological disorder.[42] For example, Pranavruta- +samana vatavyadhi[43], where the Vata subdosha, prana, +drives another Vata subdosha, samana, out of balance +corresponds to Alzheimers disease. Charaka Samhita[1] +also mentions several related Vata-vyadhis which +correspond to other neurological disorders, such as MS, +Parkinson‟s disease, Hemiplegia and Paraplegia.[42] + +Common understanding of Ayurveda propagates the +view that an individual‟s Prakriti is fixed from birth – or +rather from the time of conception and zygote formation. +In reality, the process of Prakriti selection is more +complex. Sushruta Samhita states[44]: the seven prakriti +types have contributions from conception & birth, +family, place, time, age, balas and factors acquired by +the individual. However, Gangadhar Tika‟s celebrated +commentary[45] on Charaka Samhita interprets the +concept of Prakriti as a state of „equilibrium of doshas‟, +so that other types with dominance of single, or pairs of, +Doshas, are states of Arogya, i.e. pathophysiology – +Vikriti. + +In studies of human psychophysiology, it is natural to +connect strengths of various organ systems to properties +of the personality. A strong digestion, high Pitta Dosha, +may be connected to a „fiery personality‟, showing anger +more easily (Choleric)[46]; a person with dominant Vata +Dosha may be more subject to attacks of anxiety, and +neurotic disorders.[47] People with dominant Kapha +Dosha may be more relaxed, happier and easy-going +than their peers, but will be more susceptible to +overweight, and thus to the metabolic syndrome +spectrum of disorders.[48] + +In this way, ancient Indian Psychology associates +Doshas with different facades of the human personality. +The Ayurveda classics propose seven types of Prakriti: +Vataja, Pittaja, Kaphaja, Vata-Pittaja, Vata-Kaphaja, +Pitta-Kaphaja and Sama, with each of which a different +style of personality may be associated.[49] + +In addition to these seven physiological types, the +Ayurveda +texts +introduce +sixteen +mental +types, +categorized +according +to +three +different +basic +dimensions, known as Gunas or qualities. The first, +Sattvoguna, has seven types associated with it; the +second, Rajoguna, has six related types, and the third, +Tamoguna has three associated types.[50] Thus, besides +its personality types connected to the physiology, +Ayurveda texts also utilize these three, more spiritually- +oriented, personality concepts. Sattva – luminous with +wisdom and self-knowledge; Rajas – more focused on +enjoyment and pleasures in the external world, and +driven by impulsiveness, aggression etc.; and Tamas – +dragged down with inertia from failure to adhere to high +moral precepts, past disasters in life etc.[51] + +Kaur et al. European Journal of Biomedical and Pharmaceutical Sciences + + +www.ejbps.com + +207 +These last three qualities (Gunas) of personality, +Triguna, are often associated with Yoga, due to their use +to assess an individual‟s personal capacity for spiritual +growth: a soul is thought to evolve from Tamas +dominance to Rajas dominance, and on to Sattva +dominance, which is transcended in the final stages of +spiritual liberation. Such a process may take many +lifetimes.[52] + +Many studies of these concepts from Yoga and Ayurveda +have been carried out. Those on adolescents are clearly +more relevant to the study reported here. For example, in +a study in a public school, Yoga practice was seen to +improve +adolescent‟s +mood +and +affect.[53] +An +uncontrolled pilot study of a module based on Patanjali‟s +ashtanga Yoga for children and adolescents has observed +benefits for weight management and psychological well- +being.[54] A paper offering guidance to clinicians on +prescription of Yoga as a complementary therapy for +children and adolescents has proved very beneficial.[55] +In these various fields, studies of adolescents have +broadened scientific understanding gained from studies +on adults. + +Previous +papers +on +young +people +include +the +development and assessment of a self-rating scale to +measure Tridoṣhas in children aged 6 to 12 years.[56] One +study assessed changes in Triguna in children observed +in a 10-day Personality Development Camp.[57] Another +found that yoga / meditation training improved abilities +to learn self-control and self-care in adolescent sex +offenders.[58] A further study observed that exercise, +Yoga and meditation improved adolescents‟ depressive +and anxiety disorders.[59] Management through yoga of +academic anxiety was also considered, while effects of a +youth empowerment seminar on adolescents‟ impulsive +behavior has been reported.[25] A feasibility study has +validated a Yoga module for emotional and behavioral +disorders in adolescents and younger children.[60] + +Medically, a study has measured effects of yoga practice +on stress, depression, and health-related quality of life in +a non-clinical sample of adolescents, finding it very +useful.[61] Similarly yoga as a complementary treatment +for the quality of life of adolescents suffering from IBS, +hemophilia, cancer, and emotional and behavioral +disorders was found highly beneficial, as was a study of +the subjective experience of yoga as a management +strategy for stress and depression in pregnant, urban, +African-American adolescents.[62] Finally, a literature +review has evaluated the effects of yoga practice on +pulmonary function in healthy adolescents, including +perspectives on barriers to, and facilitators of, physical +activity.[63] + +AIMS AND OBJECTIVES +The aim of this study was to evaluate the use of the new +KPI for adolescents. The objective was to administer the +inventory pre and post a Yoga program and assess any +changes. To this end, the study assessed the effects on +adolescents of an IAYT Yoga module designed for that +purpose. The research hypotheses were that the module +would have significant observable changes on each +variable being assessed. The null hypotheses were either +that such changes would not occur, or that they would +not attain p < 0.05 significance. + +MATERIALS AND METHODS +Study Protocol (see Figure 1): The study was conducted +in Vivekananda Education Centre, Jayanagar and MES +Pre-University college, Maleshwaram, Bengaluru. It was +a Pre-Post design on 82 randomly selected adolescents +aged 13-18 years. For the mean ages for each gender and +both together, see Table 1. + +Table 1: Age Distribution by Gender. +AGE +13 YRS +14 YRS +15 YRS +16 YRS +17 YRS +18 YRS +TOTAL +Mean±SD +BOYS +8 +9 +8 +9 +7 +6 +47 +15.34±1.66 +GIRLS +7 +6 +7 +6 +5 +4 +35 +15.23±1.66 +TOTAL +15 +15 +15 +15 +12 +10 +82 +15.29±1.65 +Caption: Table 1 shows numbers of students in each year of age according to gender and in total. + +Inclusion Criteria: Physically and Mentally Healthy, +Either Gender, Aged 13 to 18 years. + +Exclusion Criteria: Attention Deficit Hyperactive +Disorder, Psychosis, Autism / Mentally Challenged. + +Intervention: 90-minute Integrated Yoga Module (see +Table 2) with seven different sections- Breathing +Exercises, +Dynamic +Exercises +including +Suryanamaskara, Asanas, Pranayamas, Chanting, Yogic +Games, and Relaxation Techniques; given 3 times per +week for four weeks. Also, participants were instructed +to practice at home daily for the other days of each week, +and given a printed sheet of the module to use to direct +their practices. + + + + + + + + + + + + + +Kaur et al. European Journal of Biomedical and Pharmaceutical Sciences + + +www.ejbps.com + +208 +Table 2: Integrated Yoga Module. +SECTION +PRACTICE +TIME (mins) +1. Breathing Exercises +Hands In & Out Breathing +2min + +Vertical Hand Stretch +1min + +Ankle Stretch +1min + +Tiger Breathing +1min + +Dog Breathing +1min + +Rabbit Breathing +1min + +Sectional Breathing +2min +2. Dynamic Exercise +Hand Swing +2min + +Twisting +1min + +Alternate Side Bending +1min + +Forward & Backward Bending +1min + +Jogging +3min + +Pavanamuktasana Kriya +4min +Suryanamaskara +Suryanamaskara +5 min +3. Asana +Ardhakati chakrasana +1min + +Padahastasana +2min + +Ardhachakrasana +1min + +Ushtrasana +2min + +Paschimottanasana +2min + +Suptavajrasana +1min + +Makarasana +1min +4. Pranayama +Nadishuddhi +3min + +Kapalabhati (a Yoga Kriya) +2min + +Bhramari +1min + +Sheetali +1min +5. Chanting +Vedic Chanting (Choice of 10 Sections) +6min +Different on Different Days +Bhagavad Gita +8min + +Nadanusandhana / Omkara Meditation +4min/5min +6. Yogic Games: Choice of - +Find Ram-Shyam +5min +Different on Different Days +Accepting Criticism +2min + +Find-a-Leader +1min + +Search Engine +5min +7. Relaxation Technique +IRT, QRT & DRT (from SMET Program) +1min,3min,7min + +Assessment: The KPI was administered before and after +the four-week intervention. + +Statistical Analysis: Employed SPSS version 21.0. First, +the Kolmogorov-Smirnov test was used to check whether +the data were normally distributed; since it was not, the +Wilcoxon Signed Ranks Test was applied to assess the +significance of within-group changes in the data. + +RESULTS +Results are displayed in Table 3 below, which shows that +Dosha Prakriti measured according to the KPI changed +highly significantly for each Dosha. Changes generally +indicate improved health, since, once imbalances have +set in, excess Vata Dosha tends to drive other doshas +further out of balance. The decreases in Vata Dosha seen +over the course of the four-week period indicate more +steadiness of mind suggesting reductions in a. Chitta- +Vritti activity[64], and b. generally unnerving speed of +thought, which lead to speedier actions on a physical +level. This result also suggests slowing of the breath and +/ or breathing. In contrast, the other two Doshas, Pitta +Dosha and Kapha Dosha were both strikingly much +stronger than Vata Dosha at the end of the month. + +Table 3a: Pre and Post Dosha Values of Present Study. +VATA +PITTA +KAPHA +Pre +Post +Pre +Post +Pre +Post +11.28±3.12 +8.09±2.60 +12.91±3.24 +15.86±3.32 +16.37±3.34 +19.59±3.25 +Table 3b: Pre and Post Dosha Values of Patil Study. +10.74±3.42 +7.98±2.11† +12.80±3.57 +13.96±1.85† +11.80±4.42 +13.72±2.04 +Caption: Tables 3as & 3b display Pre and Post Values of Dosha Prakritis for Adolescents (3a) & Children (3b) + + + +Kaur et al. European Journal of Biomedical and Pharmaceutical Sciences + + +www.ejbps.com + +209 +DISCUSSION +The last statement requires comment: high Kapha levels +can precipitate Kapha Rogas, of which obesity and +related disorders like metabolic syndrome are all too +common among today‟s population. However, the +participants‟ ages must be taken into consideration: ages +5 to 13 are dominated by anabolism related to physical +growth and thus naturally exhibit high levels of Kapha +Dosha; similarly, ages 13 to 18 are dominated by Pitta +Dosha, as the physicality of youth comes into play. +Observing higher levels of Pitta and Kapha Doshas, +when assessing youth in the age range addressed in this +study is quite acceptable. The final Dosha Prakriti scores +therefore reflect processes taking place all during the 4- +week module practice. They can be interpreted as +indicating restoration of Dosha Prakriti values towards +their usual ranges for this age group. + +Comparison with Patil‟s study[11] is instructive. Pre-post +percentage changes obtained in Patil‟s study and this +study are as follows: (Vata: -25.6, -28.2) (Pitta: +8.90, ++22.8) and (Kapha: +16.2, +19.7). The two studies +therefore show similar changes in Dosha scores after a +one month Yoga module intervention; the only major +difference being in percent change in Pitta score, with +adolescents, in a naturally Pitta stage of life, showing +greater increase. This observed difference was almost to +be expected. + +Generally, in recent times, because of modern Ahara- +Vihara habits common in this stage of life, we see Dosha +Balas opposite to those said to characterize the age group +in question. The data therefore indicate that inculcating +the module‟s Yoga practices at an early age will help +restore desired Dosha balances, and, as Vata Dosha +reduces and Pitta Dosha increases, the memory, +intelligence and basic learning skills characteristic of +youth. + +Practising dynamic exercises like those in the module +will tend to induce or increase sweating, sweda. +According to Ayurveda classics, swedana is a treatment +that reduces Vata Dosha, and that will benefit the three +gunas by reducing Rajas and Tamas. + +Strengths: The strengths of the study are: a. it is the first +to assess the effect of Yoga on Tridosha in adolescents; +b. being a pre-post design, the first to observe significant +changes in state in all three Doshas, Vata, Pitta and +Kapha; c. the intervention can bring changes in Tridosha +large enough to significantly alter adolescents‟ physical +and psychophysiological states – and possibly reshape +their personalities. + +Limitations: No control group was included in the +study. + +Future Research: Any future study should include a +control group along with the Yoga group. A randomized +controlled trial would then be the best study design, but +with the following caveat: here, the same Yoga module +was used for all the participants, despite their having +different Dosha Prakritis; future studies should use +several Yoga modules, each adapted to a particular +Dosha Prakriti. Then we may anticipate improved +progress towards Sama Prakriti being achieved in all +cases. + +CONCLUSIONS +The study suggests that the four-week IAYT Yoga +module employed in the intervention brings significant +balancing benefits for Tridoshas in adolescents. It may +also benefit levels of the three Gunas. Practiced regularly +over a sufficient period of time, breathing techniques like +sectional breathing, Nadi Shuddhi, and Sitali, named in +the yoga module help to reduce Vata at the physical +level, and simultaneously overcome Tamas. Adopting +dynamic practices like Suryanamaskara, Asanas & +Kapalabhati, Pitta increases so that the individual +him/herself transforms inertia (Tamas) into Rajas, thus +bringing lightness and flexibility to the body and +dynamism to brain activity (Rajas). In yogic lore, this is +considered an advance on the path to transcending the +influence of Gunas. Along with these practices, addition +of meditation, Japa, breath retention in Pranayama and +increasing time of maintaining each Asana helps to +increase stability of body and mind (Sattva).[57] + +ACKNOWLEDGEMENT +We would like to thank all the students from the school +and college for their active participation, also the +management for their kind support. I would like to thank +Dr. Suchitra for the timely discussions regarding the +study. All the experts involved in the study. + +REFERENCES +1. Panday GS. Caraka Samhita: Hindi commentary, +fifth edition: Choukamba publications, New Delhi, +1997; 1(4): 5-7. +2. Shastry KA. 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I(2): 2 +Crown Publishing, London, 2010. + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/A composite of BMI and waist circumference may be a better obesity metric in Indians with high risk for type 2 diabetes An analysis of NMB-2017, a.txt b/subfolder_0/A composite of BMI and waist circumference may be a better obesity metric in Indians with high risk for type 2 diabetes An analysis of NMB-2017, a.txt new file mode 100644 index 0000000000000000000000000000000000000000..94152987dfb6d2f970b1d14241d904fa73110507 --- /dev/null +++ b/subfolder_0/A composite of BMI and waist circumference may be a better obesity metric in Indians with high risk for type 2 diabetes An analysis of NMB-2017, a.txt @@ -0,0 +1,865 @@ +A composite of BMI and waist circumference may +be a better obesity metric in Indians with high risk +for type 2 diabetes: An analysis of NMB-2017, a +nationwide cross-sectional study +Murali Venkatrao, Raghuram Nagarathna, Suchitra S. Patil, Amit Singh, S.K. Rajesh, +Hongasandra Nagendra * +Division of Yoga and Life Sciences, SVYASA University, Prashanti Kutiram, Vivekananda Road, Kalluballu Post, Jigani, Bengaluru 560015, +India +A R T I C L E +I N F O +Article history: +Received 13 October 2019 +Received in revised form +26 December 2019 +Accepted 27 January 2020 +Available online 29 January 2020 +Keywords: +Type 2 diabetes +BMI +Central fat +Obesity +Anthropometric +A B S T R A C T +Aims: Obesity measurement is a vital component of most type 2 diabetes screening tests; +while studies had shown that waist circumference (WC) is a better predictor in South +Asians, there is evidence that BMI is also effective. Our objective was to evaluate the effi- +cacy of BMIWC, a composite measure, against BMI and WC. +Methods: Using data from a nationwide randomized cluster sample survey (NMB-2017), we +analyzed 7496 adults at high risk for type 2 diabetes. WC, BMI, and BMIWC were evaluated +using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy). +These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI +and BMIWC, and calculating Sensitivity, Specificity, and Accuracy. +Results: BMIWC had higher OR (2300) compared to WC (187) and BMI (226). WC, BMI, and +BMIWC were all highly Sensitive (075, 081, 070 resp.). But BMIWC had significantly higher +Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and +IDRSBMIWC were all highly Sensitive (087, 088, 082 resp.). But IDRSBMIWC had significantly +higher Specificity (039) compared to IDRSWC and IDRSBMI (030, 031 resp.). +Conclusions: Both WC and BMI are good predictors of risk for T2DM, but BMIWC is a better +predictor, with higher Specificity; this may indicate that Indians with high values of both +central (high WC) and general (BMI > 23) obesity carry higher risk for type 2 diabetes than +either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and +Specificity. + 2020 Elsevier B.V. All rights reserved. +1. +Introduction +Diabetes is a serious and escalating health burden in India, +with an age-adjusted comparative prevalence of 10.4%. Over +77 million people have been diagnosed with the disease. Of +equal concern is that an additional estimated 43 million peo- +ple have type 2 diabetes but are undiagnosed [1]. Obesity is a +well-known risk factor for Diabetes. In India, more than 135 +https://doi.org/10.1016/j.diabres.2020.108037 +0168-8227/ 2020 Elsevier B.V. All rights reserved. +* Corresponding author. +E-mail address: rnagaratna@gmail.com (H. Nagendra). +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +Contents available at ScienceDirect +Diabetes Research +and Clinical Practice +journal homepage: www.elsevier.com/locate/diabres +million individuals were affected by obesity [2]. There is thus +an urgent need to screen the general population for diabetes +risk and implement preventive lifestyle change interventions. +Many screening models have been developed to assess +diabetes risk [3]. All of these models include an obesity com- +ponent. The most commonly used model in India, the Indian +Diabetes Risk Score (IDRS) [4], uses Waist Circumference (WC) +for obesity; so does the German Diabetes Risk Score [5]. Other +models (Cambridge Risk Score [6] and Framingham Offspring +Diabetes Risk Score [7],) use Body Mass Index (BMI), while Fin- +nish Diabetes Risk Score [8] uses both WC and BMI. +However, it is not clear whether WC or BMI is better for +determining type 2 diabetes risk. Various studies [14–23] have +been done in this area and have drawn conflicting conclu- +sions. Some studies have found that WC is a better measure +of risk [17,18,21,22]. Other studies have drawn the opposite +conclusion [15,19]. At least one study has found both mea- +sures to be equally good [23]. Given the great breadth and +depth of these studies, these conflicting conclusions probably +point to the fact that each metric only partially captures the +etiological association between obesity and type 2 diabetes. +We postulated that a composite metric which combines +central and general obesity would be a better indicator than +either one in isolation. We defined a composite metric called +BMIWC and analyzed its performance as a risk factor. +2. +Subjects, materials and methods +2.1. +Study design +Niyantrita Madhumeha Bharata (‘‘Control of Diabetes in India”) +2017, or NMB 2017, was a two-phased study undertaken +across 29 most populous states/union territories in India. +The twin objectives of the study were: +- (Phase 1) To estimate the prevalence of diabetes and predi- +abetes in 2017 simultaneously in all zones of India +- (Phase 2) To conduct an RCT using a validated yoga life- +style protocol +Phase 1 [9] was a nationwide cross-sectional survey using +a multi-level stratified cluster sampling technique with ran- +dom selection among urban and rural populations covering +29 states and union territories of the country. In a door to door +survey, researchers used a questionnaire to collect data on +diabetes status and diabetes risk. +Phase 2 [9] involved a sub-sample of the phase-I partici- +pants, from which were selected high-risk individuals (those +with self-reported diabetes or for whom IDRS was 60) for +further assessment through blood tests and a more detailed +questionnaire; and to determine the efficacy of intervention. +The intervention was a 3-month practice of a standard Yoga +protocol [10]. +2.2. +Phase 1 sampling strategy +Sampling was done at 4 levels: Zones, States, Districts, and +Villages (rural) or Towns (urban). We chose 24 (of 29) states +and 4 (of 7) Union Territories. These states were grouped into +seven zones based on cultural homogeneity [9]. To ensure dis- +tricts samples within a state were not clustered, we grouped +the state into geographical regions and chose a district from +each region (e.g., if a state needed 3 districts, it was grouped +into north, south, and central). +Each district was also grouped into geographical regions, +and we chose: +1. (Rural) up to four villages with population between 500 and +1000. +2. (Urban) up to four Census Enumeration Blocks (CEBs), such +that total population was around 2000. +All households within the selected village or CEB were +surveyed. +2.3. +Phase 2 sampling strategy +From the Phase 1 sample, we selected adults of both genders +who had the ability to do yoga (and consented to doing it), and +satisfied one of the following criteria: +1. Self-reported and newly diagnosed diabetes with or with- +out glycemic control, using/not using oral hypoglycemic +agents or insulin +2. IDRS score was 60 +2.4. +Procedure for biochemical measures +All biochemical assays were carried out by the same method +by the same nationally accredited laboratory. HbA1c, the pri- +mary glycemic measure, was estimated by high-pressure liq- +uid +chromatography +using +VariantTM +II +Turbo +(Bio +Rad, +Hercules, CA) method [9]. +2.5. +Participants and outcomes +We included all individuals in Phase 2 for whom all the fol- +lowing data were available: WC, Weight, Height, Family his- +tory of diabetes, Age, Physical Activity, HbA1c, and Diabetes +Self Declaration (Yes or No). The sole outcome was whether +the individual had diabetes or not, as determined by the value +of HbA1c or self-declaration. +2.6. +Definitions of obesity metrics +Values of WC and BMI were bucketed into five risk categories +(Table 1). The 5 categories for BMI were picked from the stan- +dardized ranges established for Asian populations [11]. For +WC, we added two more categories at the bottom and top of +the three categories established for the Asian Indian popula- +tion [4]. +We created a composite obesity metric, BMIWC, which +combines BMI and WC according to the following algorithm: +If WC was <3, then BMI was scored as BMI – 1; if WC was +3, the value of BMI remained unchanged. Thus, BMIWC rec- +ognizes that individuals with both low WC and high BMI are +at lower risk while individuals with high WC or high BMI +2 +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +are at higher risk. This adds an additional risk category at the +lower end, with a score of zero, designated ‘‘Ultra Low” +(Table 1). +Below are some examples of obesity risk scores, calculated +using data from NMB 2017: + +Male with WC 85 cm, BMI 276 kg/m2 has: WC = 2, BMI = 4, +and BMIWC = 3 + +Male with WC 108 cm, BMI 26.3 kg/m2 has: WC = 4, BMI = 3, +and BMIWC = 3 +2.7. +Definitions of IDRS and its variants +The second part of the study sought to validate the efficacy of +BMIWC by replacing the obesity component of IDRS (WC) with +BMIWC. We also studied the efficacy of IDRS when the obesity +component is replaced by BMI. The modified risk scores were +called IDRSBMIWC and IDRSBMI resp. The definitions of IDRS [3], +IDRSBMI and IDRSBMIWC are shown in Table 2. +2.8. +Analysis +Contingency table methods (for risk assessment) and confu- +sion matrix methods (for assessing classification efficacy) +were used to evaluate each obesity metric. Validation was +done by replacing WC with BMIWC as the obesity component +of IDRS and determining classification efficiency of the mod- +ified IDRS. +WC, BMI, and BMIWC were compared for their association +to type 2 diabetes risk. A contingency table of risk categories +and outcome was created for each metric, and v2 statistic was +calculated to measure risk association. Using the lowest risk +category as a reference, Odd Ratio (OR) calculated for each +risk category. They were also compared for their ability to +classify the population into two groups: people with type 2 +diabetes and people without. An ROC curve was drawn for +each measure to determine the threshold score for classifica- +tion. Based on this threshold, a confusion matrix was created +for each measure. Efficacy of classification was determined by +calculating Sensitivity, Specificity, and Accuracy [12]. McNe- +mar’s statistic was calculated to determine the statistical sig- +nificance of the difference in Specificities, as discussed by +Hawass [13]. +IDRS, IDRSBMI and IDRSBMIWC were compared for efficacy of +classification. An ROC curve was drawn for IDRSBMI and +IDRSBMIWC to determine classification thresholds. The thresh- +old for IDRS has already been determined to be 60 [4]. Using +these threshold values, Sensitivity, Specificity and Accuracy +were calculated. McNemar’s statistic was calculated to as +before to determine statistical significance. All analyses were +done using Python v.37. Pandas v.023 was used to import +data, calculate obesity metrics and risk levels. Contingency +table creation and calculation of risk measures were done +using Statsmodels v.0101. Confusion matrix creation and +calculation +of +classification +measures +were +done +using +Scikit-learn v.0213. v2 and McNemar’s statistics were calcu- +lated using Scipy v.130. +Ethical clearance was obtained by the EC of Indian yoga +association. +The +study +was +registered +in +CTRI +CTRI/2018/03/012804. +3. +Results +3.1. +Description of data +A total of 7496 individuals at high risk (60 on IDRS) for type 2 +diabetes (3935 females, 3561 males) were analyzed. They var- +ied in age from 20 to 85 years (m = 4839, r = 1186). Waist cir- +Table 1 – Definitions of Obesity Metrics. +Metric +Risk Score +WC Value (in cm) +6999* (female), 7999* (male) +1 = Very Low (VL) +70–7999 (female), 80–8999 (male) +2 = Low (L) +80–8999 (female), 90–9999 (male) +3 = Moderate (M) +90–9999 (female), 100–10999 (male) +4 = High (H) + 100 * (female), 110* (male) +5 = Very High (VH) +BMI Value (in kg/m2) + 1849 +1 = Very Low (VL) +185–2299 +2 = Low (L) +23–2749 +3 = Moderate (M) +275–3249 +4 = High (H) +325 +5 = Very High (VH) +BMIWC (dimensionless), values of BMI and WC below refer to risk scores +BMI = 1 & WC < 3 +0 = Ultra Low (UL) +BMI = 2 & WC < 3 OR BMI = 1 & WC  3 +1 = Very Low (VL) +BMI = 3 & WC < 3 OR BMI = 2 & WC  3 +2 = Low (L) +BMI = 4 & WC < 3 OR BMI = 3 & WC  3 +3 = Moderate (M) +BMI = 5 & WC < 3 OR BMI = 4 & WC  3 +4 = High (H) +BMI = 5 & WC  3 +5 = Very High (VH) +* Two additional categories added at the top and bottom of the three categories established for Asian Indian +populations. +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +3 +cumference varied from 60 to 150 cm (m = 91.21, r = 10.91) and +BMI varied from 12.2 to 66.2 kg/m2 (m = 28.13, r = 4.60). Fig. 1 +shows the distribution of each of these characteristics across +relevant categories. +Total number with type 2 diabetes was 3079, of which 1093 +individuals were +newly +diagnosed +and +1986 +were +self- +reported. +3.2. +Risk analysis of obesity metrics +The v2 test of association showed statistically significant +association between obesity metrics and type 2 diabetes risk: +WC: v2(4, N = 7496) = 2910, p < 0001; BMI: v2(4, N = 7496) += 66.58, p < 0001; BMIWC: v2(5, N = 7496) = 59.06, p < 0001. +Odds that a person in the lowest obesity category (VL for +WC and BMI, UL for BMIWC) had diabetes was calculated for +each obesity metric, which was used as the reference odds. +Odds were also calculated at each of the higher obesity +categories, and the odds ratio was determined by taking the +ratio of this with the reference odds. +The following OR values were seen at the highest risk cat- +egory (VH) for each obesity metric: + +For WC: 187 (95% CI 1.47–2.37) + +For BMI: 226 (95% CI 1.58–3.24) + +For BMIWC: 230 (95% CI 1.51–3.51) +We can see that WC, BMI and BMIWC each higher odds in +the VH category compared to the reference (lowest) category. +But BMIWC outperformed WC and BMI by having a higher OR. +We also observed that the OR for BMIWC was higher at +every risk category than the corresponding scores for WC +and BMI, as seen in Fig. 2. +WC showed an actual decrease in OR between Moderate +(M) and High (H) risk levels but showed a dramatically +increased odds between High (H) and Very High (VH). This +non-monotonic behavior is an indication that the risk cate- +gories of WC don’t adequately capture increasing diabetes +risk. BMI encapsulates diabetes risk better by showing a +monotonically increasing OR. But BMIWC clearly outperforms +the WC and BMI: OR is monotonically increasing, and the +value of OR is higher at every risk category – as can be seen +by the blue line (representing BMIWC) lying above the orange +(WC) and green (BMI) lines. +3.3. +Classification analysis of obesity metrics +We plotted ROC curves for WC, BMI, and BMIWC to determine +the classification thresholds for each measure. These curves +are shown in Fig. 3. We can see that a risk level of three +(Moderate) is the optimum threshold. Using this value, we +calculated Sensitivity, Specificity, and Accuracy. Table 3 shows +the results. +BMI had better Sensitivity (689%) when compared to WC +but showed the same Specificity. BMIWC showed slightly +decreased Sensitivity (700%) but vastly improved Specificity +(3401%) when compared to WC. In terms of Accuracy, BMI +was slightly better than WC (441%), and BMIWC was better +still (669%). +Matched sample tables for Specificity were created using +True Negative (TN) and False Positive (FP) counts, one for +BMIWC and WC, and another for BMIWC and BMI. Table 4 +shows the counts of tied (FP-FP, TN-TN) and untied (TN- +FP, FP-TN) pairs. McNemar’s statistic calculated on the val- +ues untied pairs in these tables as described by Hawass +[12]. The results were: BMIWC and WC: v2 (1, N = 695) += 23484, p < 0001; BMIWC and BMI: v2 (1, N = 410) = 40800, +p < 0001. This shows that the increase the Specificity of +BMIWC +as +compared +to +WC +and +BMI +is +statistically +significant. +3.4. +Classification analysis of IDRS variants +We plotted ROC curves for IDRSBMI, and IDRSBMIWC to deter- +mine the classification thresholds for each score. These +curves are shown in Fig. 4. We can see that 60 is the optimum +threshold for IDRSBMI, and 70 is the threshold for IDRSBMIWC. +The threshold for IDRS has already determined to be 60 [3]. +Table 2 – Definitions IDRS, IDRSBMI, and IDRSBMIWC. +Metric +Score +IDRS +Age +<35 years +0 +35–49 years +20 +50 +30 +Physical Activity +Exercise [regular] + strenuous work +0 +Exercise [regular] or strenuous work +20 +No exercise and sedentary work +30 +Family History +No family history +0 +Either parent +10 +Both parents +20 +Obesity (WC) +WC Risk Score  2 +0 +WC Risk Score = 3 +10 +WC Risk Score  4 +20 +Range of the Score +0–100 +IDRSBMI +Age, Physical Activity, Family History +are same as IDRS +0–80 +Obesity (BMI) +BMI Risk Score  2 +0 +BMI Risk Score = 3 +10 +BMI Risk Score  4 +20 +Range of the score +0–100 +IDRSBMIWC +Age, Physical Activity, Family History are +same as IDRS +0–80 +Obesity (Composite) +If WC Risk Score  2 +0 +BMI Risk Score  2 +0 +BMI Risk Score = 3 +10 +BMI Risk Score  4 +20 +If Waist Risk Score > 2 +BMI Risk Score  2 +10 +BMI Risk Score = 3 +20 +BMI Risk Score  4 +30 +Range of the score +0–110 +4 +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +These values were used to calculate Sensitivity, Specificity, +and Accuracy. Table 3 shows the results. +IDRSBMI showed marginally better Sensitivity (127%) and +Specificity +(185%) +when +compared +to +IDRS. +IDRSBMIWC +showed slightly decreased Sensitivity (614%) but vastly +improved Specificity (2661%) when compared to IDRS. In +terms of Accuracy, IDRSBMI was slightly better than IDRS +(146%), and IDRSBMIWC was better still (479%). +Matched +sample +tables +for +Specificity +were +created +using True Negative (TN) and False Positive (FP) counts, +Fig. 1 – Respondent Characteristics, n = 7496. +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +5 +one for IDRSBMIWC and IDRS, and another for IDRSBMIWC +and IDRSBMI. Table 4 shows the counts of tied (FP-FP, +TN-TN) +and +untied +(TN-FP, +FP-TN) +pairs. +McNemar’s +statistic calculated on the values untied pairs in these +tables +as +described +by +Hawass +[12]. +The +results were: +IDRSBMIWC +and +IDRS: +v2 +(1, +N = 567) = 22604, +p < 0001; +IDRSBMIWC and IDRSBMI: v2 (1, N = 334) = 33200, p < 0001. +This shows that the increase the Specificity of IDRSBMIWC +as +compared +to +IDRS +and +IDRSBMI +is +statistically +significant. +1 +1.2 +1.4 +1.6 +1.8 +2 +2.2 +2.4 +UL +VL +L +M +H +VH +Odds Rao +Risk Categories +WC +BMI +BMIWC +Fig. 2 – Odds Ratio for WC, BMI, and BMIWC. +Fig. 3 – ROC Curves for WC, BMI, and BMIWC. +6 +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +4. +Discussion and conclusions +Although obesity is an established risk factor for type 2 dia- +betes, it is unclear what the best anthropometric measure +for this is. Current studies in this area have focused on two +metrics – WC (for central fat), and BMI (for general adiposity). +While there are many studies that have investigated the link +between WC, BMI, and Diabetes, the result of these studies +paints a confusing picture. +Some studies have found that WC is a better predictor of +Diabetes than BMI. A 2016 [17] study of Chinese, Malays, Asian +Indians found that ‘‘Abdominal adiposity measures generally +performed better than BMI in identifying undiagnosed dia- +betes.”. +A +2016 +[18] +pooled +analysis +of +four +German +population-based cohort studies found that ‘‘there were +stronger associations between anthropometric markers that +reflect abdominal obesity (WC and WHR) and incident type- +2 diabetes than for BMI and weight.” A 1991 [21] study of +South Asians settled in London found that ‘‘Insulin resistance +syndrome, prevalent in South Asian populations is associated +with a pronounced tendency to central obesity.” A 2008 [22] +collaborative analysis of cross-sectional data from 16 cohorts +from the DECODA study, which involved multiple Asian eth- +nicities, found that ‘‘WSR (Waist to Stature Ratio, a measure +of central fat) was stronger than BMI in association with +diabetes.” +Other studies have found BMI to be a better predictor of +Diabetes than WC. A 2018 [23] five-year prospective study of +elderly Chinese found that ‘‘BMI was the strongest predictor +of diabetes among both men and women.” A 2015 [16] study +of Asian Indian, Chinese, and Japanese found that ‘‘Popula- +tion Attributable Risk (PAR) for BMI was high among Indians.” +Still other studies have concluded that neither WC nor BMI +are reliable predictors of Diabetes. A 2000 [15] study of White, +Black, Hispanic Americans found that ‘‘the positive predictive +value (PPV) of WC for diabetes was low.” A 2018 [14] study of +Asian Americans found that ‘‘one in seventeen Asian Ameri- +Table 3 – Classification analysis. +Metric +Sensitivity +Specificity +Accuracy +WC +075 +027 +047 +BMI +081 +027 +049 +BMIWC +070 +036 +050 +IDRS +087 +030 +053 +IDRSBMI +088 +031 +054 +IDRSBMIWC +082 +039 +056 +Table 4 – Matched Samples tables for Specificity. +WC +BMIWC +IDRS +IDRSBMIWC +FP +TN +FP +TN +FP +2676 +145 +FP +2605 +104 +TN +550 +1046 +TN +463 +1245 +BMI +BMIWC +IDRSBMI +IDRSBMIWC +FP +TN +FP +TN +FP +2821 +0 +FP +2709 +0 +TN +410 +1186 +TN +334 +1374 +Fig. 4 – ROC Curves for IDRS, IDRSBMI, and IDRSBMIWC. +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +7 +cans with BMI less than 17 has diabetes.” The authors con- +cluded that regular screening for diabetes was required +within this group. +It is clear that neither metric adequately measures obesity +as it is related to diabetes risk. One reason could be confound- +ing factors that are inherent to each metric: a tall individual is +likely to have a higher WC and a muscular individual will +have a higher BMI, without being more obese. There could +be deeper, yet to be understood reasons as well. +Our approach was to study if a composite metric, which +combines both WC and BMI, would perform better as a risk +factor for type 2 diabetes. Following the suggestion of the +WHO expert consultation [11], our metric uses BMI as the +base metric and gives ‘‘credit” to individuals who had low +WC – i.e. reduce their risk level. +We have shown, through v2 analysis, that there is a statis- +tically significant association BMIWC and the outcome (type 2 +diabetes). We have also shown that BMIWC is superior to WC +or BMI in predicting type 2 diabetes risk, as demonstrated +by higher values of OR at every risk category. We can thus +conclude that BMIWC is a better risk factor for type 2 diabetes +either central or general fat. +We also found WC, BMI, and BMIWC are similar in their +ability to pick individuals with type 2 diabetes from a popula- +tion (this is measured by Sensitivity): 81% of people with mod- +erate or higher BMI, 75% of people with moderate or higher +WC, and 70% of the people with moderate or higher BMIWC +had type 2 diabetes. Thus, individuals with type 2 diabetes +are likely to be higher on the obesity scale, regardless of +which metric is used. +But, to be useful as a risk factor, WC, BMI, and BMIWC +should be lower in individuals without type 2 diabetes (this +is measured by Specificity). We found that WC and BMI have +low Specificity: among people who did not have type 2 dia- +betes, only 27% had lower than moderate WC or BMI. How- +ever, BMIWC was significantly more specific, as 36% of +people without type 2 diabetes had lower than moderate +BMIWC. Thus, individuals who have either high central fat or +general adiposity are at higher risk of diabetes, while individ- +uals with both low central fat and low general adiposity are at +lower risk of diabetes. It follows that BMIWC is a better risk +factor for type 2 diabetes than just WC or BMI. +It is to be noted a viable screening score considers not just +obesity, but also other risk factors such as age, family history, +and physical activity. As mentioned in Section 1, IDRS is an +effective screening technique used in India which considers +all of these risk factors. We validated our conclusion that +BMIWC is a better measure of obesity by modifying IDRS to +replace +WC +with +BMI +(IDRSBMI) +and +then +with +BMIWC +(IDRSBMIWC). All three variants were highly sensitive: among +people with type 2 diabetes, 88% had IDRSBMI of 60 or more; +87% had IDRS of 60 or more, while 82% had IDRSBMIWC of 70 +or more. However, when selecting ONLY people with type 2 +diabetes from within a high-risk population (Specificity), +IDRSBMIWC significantly outperformed IDRS by 2661% and +IDRSBMI by 2431%. +This is an important result from both public health and clin- +ical perspectives. Height, weight, and WC are typically avail- +able for a patient (or are easily measured). Thus, there is no +added cost to calculating BMIWC, and IDRSBMIWC. Given the +significantly better Specificity of IDRSBMIWC, it should be used +as a screening test in both public health and clinical situations. +4.1. +Limitations of this study +We studied high-risk individuals (4108% of the study popula- +tion had type 2 diabetes). We would expect the risk measures +and Specificity to be different in a sample reflective of the +general population. +Our study of IDRSBMIWC has established a classification +threshold of 70. This threshold may change when future anal- +ysis will be done using data on individuals in all risk +categories. +4.2. +Suggestions for future work +We postulated that a proper anthropometric measure of obe- +sity should take into account both central fat and general adi- +posity and have established that this is true among high-risk +Indians. Future work should expand this work by: (a) verifying +our conclusion within a population sample which includes +both high- and low-risk individuals, and (b) study BMIWC +among other ethnic groups. +Funding +Ministry of AYUSH, Govt. of India, routed through Central +Council for Research in Yoga and Naturopathy. +Role of the funding source +The study funder had no role in study design, collection, anal- +ysis, and interpretation of data. The authors had full access to +the data and the final responsibility to submit their results for +publication. +Declaration of Competing Interest +None. +Acknowledgements +We are thankful to (a) funding by the Ministry of AYUSH, Govt. +of India, routed through Central Council for Research in Yoga +and Naturopathy (b) the executive committee of Indian yoga +Association for conducting NMB (c) Art of Living Institute, +Vethathiri Maharishi College of Yoga, Patanjali Yogpeeth, PGI +Chandigarh, and SVYASA for providing more than 1200 vol- +unteers and (d) the members of the research advisory board +of NMB for their inputs at all stages of the study. +R E F E R E N C E S +[1] https://www.idf.org/aboutdiabetes/what-is-diabetes/facts- +figures.html. Date accessed: Dec 19, 2019. +[2] Ahirwar R, Mondal PR. Prevalence of obesity in India: a +systematic review. 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Lancet 1991;337:382–6. +[22] Decoda Study Group, Nyamdorj R, Qiao Q, et al. BMI +compared with central obesity indicators in relation to +diabetes and hypertension in Asians. Obesity (Silver Spring) +2008; 16(7):1622–35. https://doi.org/10.1038/oby.2008.73. +[23] Qiao Q, Nyamdorj R. Is the association of type II diabetes with +waist circumference or waist-to-hip ratio stronger than that +with body mass index? Eur J Clin Nutr 2010;64(1):30–4. +https://doi.org/10.1038/ejcn.2009.93. +d i a b e t e s r e s e a r c h a n d c l i n i c a l p r a c t i c e 1 6 1 ( 2 0 2 0 ) 1 0 8 0 3 7 +9 diff --git a/subfolder_0/A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain.txt b/subfolder_0/A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain.txt new file mode 100644 index 0000000000000000000000000000000000000000..c4b2702b2f69ebe61c093ae3c1cdd9234b3f377a --- /dev/null +++ b/subfolder_0/A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain.txt @@ -0,0 +1,6318 @@ +Complementary + Therapies + in + Medicine + (2012) + 20, 107—118 +Available + online + at + www.sciencedirect.com +jou + rnal + h + om + epa + ge: + www.elsevierhealth.com/journals/ctim +A + comprehensive + yoga + programs + improves + pain, +anxiety + and + depression + in + chronic + low + back + pain +patients + more + than + exercise: + An + RCT +P. + Tekur a,∗, R. + Nagarathna a, S. + Chametcha a, Alex + Hankey a, + H.R. + Nagendra b +a Division + of + Yoga + & + Life + Sciences, + Swami + Vivekananda + Yoga + Research + Foundation + (SVYASA), + Bengaluru, + India +b SVYASA, + Bengaluru, + India +Available + online + 28 + January + 2012 +KEYWORDS +Yoga; +Chronic + low + back +pain; +Anxiety; +Depression; +Mobility +Summary +Introduction: + Previously, + outpatient + Yoga + programs + for + patients + with + chronic + low + back + pain +(CLBP) + lasting + several + months + have + been + found + to + reduce + pain, + analgesic + requirement + and +disability, + and + improve + spinal + mobility. + This + study + evaluated + changes + in + pain, + anxiety, + depression +and + spinal + mobility + for + CLBP + patients + on + short-term, + residential + Yoga + and + physical + exercise +programs, + including + comprehensive + yoga + lifestyle + modifications. +Methods: + A + seven + day + randomized + control + single + blind + active + study + in + an + residential + Holistic +Health + Centre + in + Bangalore, + India, + assigned + 80 + patients + (37 + female, + 43 + male) + with + CLBP + to + yoga +and + physical + exercise + groups. + The + Yoga + program + consisted + of + specific + asanas + and + pranayamas +for + back + pain, + meditation, + yogic + counselling, + and + lectures + on + yoga + philosophy. + The + control +group + program + included + physical + therapy + exercises + for + back + pain, + and + matching + counselling + and +education + sessions. +Results: + Group + × + time + interactions + (p + < + 0.05) + and + between + group + differences + (p + < + 0.05) + were +significant + in + all + variables. + Both + groups’ + scores + on + the + numerical + rating + scale + for + pain + reduced +significantly, + 49% + in + Yoga + (p + < + 0.001, + ES + = 1.62), + 17.5% + in + controls + (p + = + 0.005, + ES + = 0.67). + State +anxiety + (STAI) + reduced + 20.4% + (p + < 0.001, + ES + = + 0.72) + and + trait + anxiety + 16% + (p + < 0.001, + ES + = + 1.09) + in +the + yoga + group. + Depression + (BDI) + decreased + in + both + groups, + 47% + in + yoga + (p + < + 0.001, + ES + = 0.96,) + and +19.9% + in + controls + (p + < + 0.001, + ES + = 0.59). + Spinal + mobility + (‘Sit + and + Reach’ + instrument) + improved +in + both + groups, + 50%, + in + yoga + (p + < 0.001, + ES + = + 2.99) + and + 34.6% + in + controls + (p + < + 0.001, + ES + = 0.81). +Conclusion: + Seven + days + intensive + residential + Yoga + program + reduces + pain, + anxiety, + and + depres- +sion, + and + improves + spinal + mobility + in + patients + with + CLBP + more + effectively + than + physiotherapy +exercises. +© + 2012 + Elsevier + Ltd. + All + rights + reserved. +∗Corresponding + author + at: + Division + of + Yoga + and + Life + Sciences, + Swami + Vivekananda + Yoga + Research + Foundation + (a + Yoga + University), +# + 19, + Eknath + Bhavan, + Gavipuram + Circle, + K.G. + Nagar, + Bengaluru. + 560019. + Tel.: + +91 + 80 + 22639963. +E-mail + addresses: + ptekur@gmail.com, p + tekur@yahoo.co.in + (P +. + Tekur), + rnagaratna@svyasa.org + (R. + Nagarathna). +0965-2299/$ + — + see + front + matter + © + 2012 + Elsevier + Ltd. + All + rights + reserved. +doi:10.1016/j.ctim.2011.12.009 +108 + +P +. + Tekur + et + al. +Introduction +Back + pain + is + a common + problem + affecting + around + 1 in + 5 adults +during + their + lifetime + with + it’s + prevalence + rising + to + 40% + when +asked + if they + have + experienced + symptoms + during + the + previ- +ous + month.1 Its + prevalence + is + well + studied: + worldwide, + 37% +of + CLBP + is + attributable + to + occupational + ergonomic + stressors, +both + physical + and + psychosocial. + In + South + East + Asia, + including +India + and + China, + the + figure + is + 39%.2 +A + comparative + study3 surveyed + back + pain + in + 3 groups + of +manual + workers + (MW) + and + 3 groups + of + office + workers + (OW) +in + India + and + the + UK + totalling + 814 + subjects. + They + found + MWs +in + India + to + have + least + prevalence + at + 15%. + In + the + UK, + they +found + 33% + for + MWs + of + Indian + origin, + and + 37% + for + white + MWs. +Similarly, + in + three + groups + of + OWs, + the + figures + were + 25% + in +India, + and + in + the + UK, + 24% + for + NRI’s, + and + 28% + for + whites. + In +India + itself, + Sharma + et + al.4 reported + a 23% + prevalence + of +CLBP + in + a north + India + outpatient + orthopaedic + unit. +Psychological + disturbances + may + cause + CLBP +, + or + result +from + it: + they + have + predictive + value5—7 and + greater + impact +than + biomechanical + factors + 8. + Most + frequently + reported +disturbances + are + depression,9 anxiety,8 fear10 and + anger.11 +Functional + disability + of + any + kind + has + a high + psychological +impact. + CLBP + is + strongly + correlated + with + state + anxiety.12 +In + patients + with + lumbar + disc + herniation, + pain + and + func- +tional + disability + correlate + with + scores + on + both + anxiety + and +depression.13 +Non + pharmacological + CAM + studies + are + being + tried + of +which + yoga + with + its + holistic + approach + has + emerged + as + an +important + modality + in + the + management + of + chronic + medi- +cal + conditions + recently. + Many + studies + of various + kinds + of +Yoga + therapy + have + shown + significant + benefits + to + CLBP + and +related + chronic + conditions + like + osteoarthritis,14 rheumatoid +arthritis,15 hypertension16 and + asthma.17 Also, + mindfulness +based + stress + reduction + (MBSR) + has + produced + increased + well- +being, + and + decreased + stress + and + pain-related + symptoms + in +patients + with + both + anxiety + and + chronic + pain.18 +There + are + several + schools + of + yoga + that + use + different + com- +ponents + of + the + 8 limbs + of + yoga + as propounded + by + Sage +Patanjali.19 Amongst + different + studies + conducted + on + yoga +therapy + specifically + designed + for + CLBP +, + two + RCTs + on + out- +patients + have + demonstrated + its + efficacy + in + reducing + pain, +analgesic + usage, + and + functional + disability: + Sherman + et + al.20 +applied + 3 months + Vini + yoga, + and + Williams + et + al.21 4 months +Iyengar + Yoga. + Vini + yoga + has + used + asanas, + pranayama, + med- +itation, + and + lectures + on + yoga + philosophy. + Iyengar + yoga + has +used + all + the + above + components + with + greater + emphasis + on +the + physical + postures. + Short + term, + 9—10 + day, + outpatient +programs + have + also + been + studied: + Bijlani + et + al.22 found +improvement + in + health + status, + while + Gupta + et + al.23 addi- +tionally + found + benefits + to + state/trait + anxiety. + The + fast + pace +of + contemporary + life + means + that + such + intensive, + short-term +programs + are + preferred: + patients + need + to + return + to + normalcy +quickly. +In + response, + SVYASA + used + its + 25 + years + experience + of + ‘Inte- +grated + Approach + of + Yoga + Therapy’ + (IAYT) + treating + similar +chronic + conditions + to + design + a special + back + pain + mod- +ule + for + CLBP +, + including: + asanas + for + back + pain; + pranayama; +relaxation + techniques; + meditation; + Yogic + counselling + for +stress + management; + chanting; + and + lectures + on + yogic + lifestyle +and + philosophy, + for + application + in + week-long, + intensive +treatments + (Table + 1). + It was + developed + from + traditional +Table + 1a + +Back + pain + special + techniques + for + yoga + group. +I. + Supine + postures +1. + Pavanamuktasana + (Wind + releasing + pose) + series +• + Supta + Pawanamuktasana + (leg + lock + pose) +• + Jhulana + Lurkhanasana + (rocking + and + rolling) +2. + Ardha + Navasana + (half + boat + pose) +3. + Uttanapadasana + (straight + leg + raise + pose) +4. + Sethubandhasana + breathing + (bridge + pose + lumbar +stretch) +5. + Supta + Udarakarshanasana + (folded + leg + lumbar + stretch) +6. + Shavaudarakarshanasana + (crossed + leg + lumbar + stretch) +II. + Prone + postures +1. + Bhujangasana + (serpent + pose) +2. + Shalabhasana + breathing + (locust + pose) +III. + Quick + relaxation + technique + in + Shavasana + (corpse + pose) +IV. + Sitting + postures +1. + Vyaghra + Svasa + (tiger + breathing) +2. + Shashankasana + breathing + (moon + pose) +V. + Standing + postures +1. + Ardha + Chakrasana + (half + wheel + pose) +2. + Prasarita + Pada + Hastasana + (forward + bend + with +legs + apart) +3. + Ardha + kati + Chakrasana + (lateral + arc + pose) +VI. + Deep + relaxation + technique, + in + Shavasana + with + folded +legs. +Table + 1b + +Control + group + practices. +(1) + Standing + hamstring + stretch +(2) + Cat + and + camel +(3) + Pelvic + tilt +(4) + Partial + curl +(5) + Piriformis + stretch +(6) + Extension + exercise +(7) + Quadriceps + leg + raising +(8) + Trunk + rotation +(9) + Double + knee + to + chest +(10) + Bridging +(11) + Hook + lying + march +(12) + Single + knee + to + chest + stretch +(13) + Lumbar + rotation +(14) + Press + up +(15) + Curl + ups +yoga + literature + (Patanjali + Yogasutras, + Upanishads, + and + Yoga +Vasishtha). + The + module + was + evaluated + in + unpublished + pilot +studies, + for + severity + of + pain, + functional + disability, + and + spinal +flexibility. + The + first + full + study + demonstrated + improvements +on + all + 3 variables.24 This + led + to + the + present + study, + which +includes + associated + changes + in + anxiety + and + depression, + as +the + most + important + causative + factors. + We + hypothesized + that +the + yoga + group + would + show + greater + reductions + on + all + mea- +sures + than + controls. +Methods +Sample + size: + a required + n = 35 + was + obtained + by + applying +Cohen’s + formula + for + an + expected + Effect + Size + (ES) + of + 0.89 +and + an + alpha + of + 0.05, + powered + at + 0.95, + using + the + G*Power +A comprehensive + yoga + programs + +109 +program.25 The + ES + was + calculated + from + the + mean + and + SD + of +the + pilot + study + on + 120 + subjects.26 A study + size + of + 80 + subjects +was + decided + on, + considerably + more + than + the + 35 + required. +Subjects: + comprised + the + first + 80 + of + 160 + CLBP + patients +admitted + between + April + 2005 + and + June + 2006, + who + satisfied +the + selection + criteria. +Inclusion + criteria: History + of + CLBP + of + more + than + 3 months; +pain + in + lumbar + spine + with + or + without + radiation + to + legs27; age, +18—60 + years. +Exclusion + criteria: Confirmed + organic + spinal + pathology +such + as + malignancy + (primary + or + secondary), + or + chronic + infec- +tion + such + as + Tuberculosis; + severe + obesity + (BMI + > 39.9) + and +critically + ill. +Medical + assessment: + was + conducted + by + a rheumatol- +ogist. + Two + experts + (radiologist + and + orthopaedic + surgeon) +gave + opinions + on + whether + anteroposterior + and + lateral +lumbar + spine + X-rays + satisfied + the + selection + criteria. + A semi- +structured + interview + was + used + to + obtain + demographic + and +vital + clinical + data, + including + personal, + family + and + stress + his- +tory. +Study + approval: + was + obtained + from + SVYASA’s + review + board +and + ethical + committee. +Signed + informed + consent: + It was + obtained + from + all + sub- +jects. + The + consent + form + clearly + stated + that + subjects + would +be + randomly + allocated + to + one + of + two + active + intervention +groups. +Study + design: was + a seven + day + randomized + single + blind +active + control + trial + comparing + two + interventions, + yoga + ther- +apy + and + physical + therapy, + both + designed + for + lower + back + pain. +Randomization: + used + two + sets + of + 40 + numbers + spanning +integers + 1—80 + created + by + a random + number + table + from +www.randomizer.org. CLBP + patients + admitted + week + by + week +were + sequentially + assigned + to + each + group. + Numbered + con- +tainers + were + used + to + conceal + the + random + allocation + before +implementation. +Blinding + and + masking: the + statistician + who + generated +the + randomization + sequence, + and + subsequently + analysed + the +data, + the + clinical + psychologist + who + administered + and + scored +psychological + questionnaires, + and + the + researcher + who + car- +ried + out + allocation + and + assessments, + were + blind + to + subjects’ +intervention + groups. + Coded + answer + sheets + were + analysed +only + after + the + study’s + completion. + In + intervention + studies +of + this + kind, + subjects + clearly + identify + their + own + treatment: +double + blinding + is + not + possible. +Setting: + SVYASA’s + Holistic + Health + Centre + (Arogyadhama) +is + situated + at + Prashanti + Kutiram + in + quiet + countryside, + 35 + km +south + of + Bangalore, + India. +Yoga + intervention + (Table + 1a) +The + IAYT + back + pain + module + described + above + is + holistic + at +physical, + mental, + emotional + and + intellectual + levels.28 Spe- +cial + asana + techniques + for + back + pain + progress + slowly + over + the +intervention’s + first + three + days + from + initial + safe + movements +to + full + asanas + aiming + to: +(a) + relax + +the + +spinal + +muscles, + +achieved + +through + +safe +stretches + of + para + spinal + muscles + during + folded + leg + and +crossed + leg + lumbar + stretch + practices, + followed + by + guided +deep + relaxation + in + supine + position29; +(b) + provide + a traction + effect + (pavanamuktasana); + and +(c) + strengthen + lumbar + (sethubandhasana) + and + abdominal +(ekapadasana) + muscles. +Subjects + avoid + acute + forward + or + backward + bends + and +jerky + spinal + movements.30 +IAYT’s + CLBP + Pranayama + practices + reduce + breath + fre- +quency + to + master + emotional + surges,31 and + increase + deep +internal + awareness + in + preparation + for + meditation, + antaranga +yoga, its + method + of + stress + management. + Lectures + help + sub- +jects + understand + corrective + yoga + healing + techniques. +Physical + exercise + therapy + intervention + (Table + 1b) +An + independent + consultant + physiatrist + specializing + in +back + +pain + +developed + +the + +module’s + +physical + +therapy +movements, + non-yogic + breathing + exercises, + and + scientific +lectures. + The + latter + included: + (a) + causes + of + back + pain, + (b) +stress + and + CLBP + and + (c) + the + benefits + of + physical + exercises. +Nature + video + programs + to + relax + and + engage + subjects + corre- +sponded + to + yoga + group + chanting. +Daily + routines: + were + matched + hour + by + hour + (Table + 2). + The +two + groups + received + identical + diets. +Final + interview: + included + qualitative + impressions + on +global + improvement, + treatment + satisfaction, + and + adverse +events. +Outcome + variables: + were + recorded + for + each + subject + on +the + first + and + final + days, + at + the + same + times. +State + — trait + anxiety + inventory + (STAI) 32: has + 2 forms, +Y1/Y2, + evaluating + state + anxiety, + how + subjects + feel + ‘at + this +moment’; + and + trait + anxiety, + how + they + feel + ‘most + of + the + time’ +respective. + It + has + been + extensively + used + in + India. +Beck’s + depression + inventory + (BDI) 33: measures + cognitive, +affective + and + vegetative + depression + symptoms. + Scores + for +each + items + are + 0—3, + total + 0—63. + Total + scores + signify: + 0—9, + no +depression; + 10—19, + mild + depression + (21 + in + CLBP + patients33; +20—25, + moderate + depression; + 26+, + severe + depression. +Numerical + rating + scale + (NRS) + for + pain: + a horizontal + 10 + cm +straight + line + on + a + white + sheet + from + ‘0’ + (No + pain) + by + cm + up +to + ‘10’ + (Worst + possible + pain). + Subjects + indicate + day’s + pain +intensity + by + a dot + on + the + line. +Sit + and + reach + (SAR)34: measures + hamstring + and + lower + back +flexibility. + Subjects + sit + on + floor + with + legs + extended, + feet +resting + against + apparatus, + bend + maximum + forward, + fingers +pushing + the + indicator + without + bending + their + elbows; + distance +measured + in + centimetres; + correlation + with + hamstring + flexi- +bility + r = 0.64. +Statistical + analysis: + used + SPSS + 10.0: + normal + distribution +of + pre + values + checked + using + Shapiro—Wilk + test. + All + between +groups + comparisons + used + post + hoc + analysis + with + Bon + Ferroni +correction. +Results +Fig. + 1 shows + the + study + profile. + There + were + no + drop + outs. + The +two + groups + were + similar + with + respect + to + socio-demographic +and + medical + characteristics + (Table + 3). + Baseline + data + for + all +variables + matched + between + groups + (p + > + 0.05). + Baseline + val- +ues + of + SAR, + BDI + and + NRS + only + had + minor + deviations + from +normality. + Because + the + two + groups + had + equal + sample + sizes35 +and + the + repeated + measures + ANOVA + test + is + robust + for + small +deviations + from + normality, + it + was + used + to + analyse + results +on + all + variables: + group + × time + interaction, + within + group + pre- +post + comparisons, + and + between + groups + comparisons. + Table + 4 +shows + results + after + the + intervention. + All + patients + reported +improvements + in + sleep, + sense + of + well + being, + and + confidence +110 + +P +. + Tekur + et + al. +Table + 2 + +Time + table + for + the + two + groups + for + the + week + long + residential + program. + Daily + schedule + of + practices + for + yoga + and + control +group. +S. + no. + +Time + +Yoga + group + +Control + Group +1 + +05.00—05.30 + am + +OM + meditation + — + 30 + min + +Walking + — + 30 + min +2 + +05.30—06.30 + am + +Yoga + based + special + technique + — + 60 + min + +Exercise + based + special + technique + — + 60 + min +3 + +06.30—07.30 + am + +Bath + & + wash + +Bath + & + wash +4 + +07.30—08.15 + am + +Chanting + of + yogic + hymns + — + 45 + min + +Video + show + (on + nature) + — + 45 + min +5 +08.15—08.45 + am + +Breakfast + +Breakfast +6 +08.45—10.00 + am + +Rest + +Rest +7 +10.00—11.00 + am +Lecture + (on + yogic + lifestyle) + — 60 + min + +Lecture + (on + healthy + lifestyle) + — + 60 + min +8 +11.00—12.00 + noon +Pranayama + (yogic + breathing) + — 60 + min + +Non + yogic + breathing + practice + — 60 + min +9 +12.00—01.00 + pm +Yoga + based + special + technique + — 60 + min + +Exercise + based + special + technique + — 60 + min +10 + +01.00—02.00 + pm + +Lunch(vegetarian + diet) + +Lunch + (vegetarian + diet) +11 + +02.00—02.30 + pm + +Deep + relaxation + technique + — + 30 + min + +Rest + at + room + — + 30 + min +12 + +02.30—04.00 + pm + +Assessments + and + counselling + +Assessments + and + counselling +13 + +04.00—05.00 + pm + +Cyclic + meditation + — + 60 + min + +Listening + to + music +14 + +06.15—06.45 + pm + +Divine + hymns + session + (Bhajan) + — + 30 + min + +Video + show + (on + nature) + — + 30 + min +15 + +06.45—07.45 + pm + +Meditation + with + yogic + chants + (mind +sound + resonance + technique) + — + 45 + min +Walking + — + 45 + min +16 + +07.45—08.30 + pm + +Dinner + (vegetarian + diet) + +Dinner + (vegetarian + diet) +17 + +08.30—10.00 + pm + +Self + study + +Self + study +Hour + to + hour + matching + for + the + type + of + practices + for + the + two + groups + was + ensured. +Figure + 1 + +Trial + Profile. +A comprehensive + yoga + programs + +111 +Table + 3 + +Demographic + data. +Variables + +YOGA + +CONTROL +Number + of + participants + +40 + +40 +Males + (M) + +19 + +25 +Females + (F) + +21 + +15 +Age + (mean + ± + SD) + +49 + ± + 3.6 + +48 + ± + 4 +Education: + +(a) + High + school + +M-3, + F-11 + +M-5, + F-3. +(b) + College +M-10, + F-8 + +M-13, + F-10 +(c) + Post + graduate +M-6, + F-2 +M-7, + F-2 +Males +Working-sedentary +14 +16 +Working-non + sedentary +5 +8 +Females +Working +6 +7 +Housewives + +15 + +8 +CLBP + +<1 + year + +10 + +11 +1—5 + years + +9 + +11 +5—10 + years + +11 + +10 +>10 + years + +10 + +8 +Cause + +Lumbar + spondylosis(LS) + +6 + +5 +Prolapsed + intervertebral + Disc(PID) + +6 + +7 +LS + with + PID + +19 + +15 +Muscle + spasm + +9 + +13 +after + the + program. + Neither + group + reported + adverse + side +effects. +STAI: + State + anxiety + scores: + Group + × + time + interactions +were + significant + (Table + 4) + [F(1,78) + = 12.96, + p < + 0.001], + as + was +difference + between + groups + (p + < 0.001). + Yoga + group + scores +decreased + 20.4% + (p + < 0.001, + ES + = 0.72). + The + control + group +showed + no + significant + change. +Trait + anxiety + scores: + Again, + group + × time + interactions +were + significant + [F(1,78) + = 14.90, + p < 0.001] + with + significant +difference + between + groups + (p + < 0.001). + Yoga + group + scores +reduced + 16% + (p + = + 0.001, + ES + = + 1.09). +BDI: + In + both + groups, + BDI + baseline + scores + were + less + than +21 + (the + cut + off + for + moderate + depression + in + CLBP + patients.33 +Group + × time + interaction + was + significant + [F(1,78) + = + 5.85, +p + = 0.018], + +with + +significant + +difference + +between + +groups +(p + < + 0.001). + Yoga + group + scores + reduced + 47% + (p + = 0.001, +ES + = 0.96). + Controls + reduced + 19.9% + (p + < 0.001, + ES + = 0.59). +NRS: + +Group + × time + +interaction + +was + +significant +[F(1,78) + = + 20.52, + +p = 0.001]. + +Between + +groups + +difference +was + significant + (p + < 0.001). + Yoga + group + NRS + score + decreased +49% + +(p + < 0.001, + +ES + = + 1.62). + +Controls + +decreased + +17.5% +(p + = + 0.005, + ES + = + 0.67). +SAR: + +Group + × + time + +interaction + +was + +significant +[F(1,78) + = + 4.16, + p = + 0.045]. + Yoga + group + SAR + scores + increased +49.5% + (p + < + 0.001, + ES + 2.99), + controls + 34.6% + (p + < 0.001, + ES +0.81), + difference + between + groups + not + significant. +Discussion +This + study + has + shown + better + improvement + in STAI, + BDI, + NRS +and + SAR + with + significant + group + × time + interactions + in + the +Yoga + group + than + the + control + group. + Within + groups + improve- +ments + were + significant + on + all + variables + in + both + groups, + except +STAI + in + controls. +Strengths + of the + study +(i) + Its + crossover + RCT + design + in + an + residential + setting +with + active + control + intervention, + consisting + of + standard +physical + therapy + and + other + practices + matched + hour + by +hour + with + the + yoga + intervention, +(ii) + Acceptability + of + short-term, + intensive + residential + pro- +grams + in + today’s + fast + pace + of + life. +(iii) + The + number + of + subjects + (80) + yielded + good + p values + and +statistical + power. +Its + weakness + is + that, + despite + special + care + being + taken + to +keep + the + two + groups + engaged + independently, + the + possibility +of + interactions + between + them + cannot + be + discounted. +Strength + and + weaknesses + in + relation + to + other + studies +Two + earlier + RCTs + of + yoga + for + back + pain,20,21 also + found +both + pain + reduction + and + increased + spinal + mobility. + No + pre- +vious + yoga + study + has + observed + significant + improvements + on +CLBP’s + psychological + components,36 A + review + by + Chou37 of +17 + nonpharmacologic + therapies + for + low + back + pain + found +that + psychological + interventions + (cognitive-behavioral + ther- +apy + and + progressive + relax + ation), + exercise, + interdisciplinary +rehabilitation, + functional + restoration, + and + spinal + manip- +ulation + were + effective + for + CLBP +. + The + exercise + therapy, +was + associated + with + small + to + moderate + effects + on + pain; +acupuncture + was + more + effective + than + sham + acupuncture; +massage + was + similar + to + other + noninvasive + interventions + and +Viniyoga + was + slightly + superior + to + traditional + exercises. + Seri- +ous + adverse + events + for + all + of + the + noninvasive + therapies + were +rare. + Some + studies + of + non-yoga + interventions + (CBT +, + phar- +macotherapy, + aerobics, + physical + therapies) + have + observed +improvements + in + CLBP + pain + and + disability + accompanied + by +reduction + in + anxiety + and + depression.38 Reductions + in + both +STAI + and + depression + scores + after + short + intensive + residential +112 + +P +. + Tekur + et + al. +Table + 4 + +Results + of + all + variables + post + intervention + (RMANOVA) + 1st + day + to + 7th + day. +Within + groups + +Between + groups +Variable + +Yoga + +Control + +ES + +p + Value +Mean + ± + SD + +95% + CI + LB + UB + +ES + +% + +p + Values + +Mean + ± + SD + +95% + CI + LB + UB + +ES + +% + +p + Values +State +anxiety +Pre +42.02 + ± + 9.80 + +38.89 +0.72 + +20.44 + +<0.001 +44.20 + ± + 8.83 + +41.38 +0.07 +1.17 +NS +1.14 +<0.001 +45.16 + +47.02 +Post 33.43 + ± + 8.08 + +30.84 + +43.68 + ± + 9.89 + +40.51 +36.01 + +46.84 +Trait +anxiety +Pre +43.18 + ± + 8.48 + +40.46 +1.09 +15.88 + +<0.001 +44.25 + ± + 8.25 + +41.61 +0.15 + +2.25 +NS + +0.94 +<0.001 +45.89 + +46.89 +Post 36.32 + ± + 7.15 + +34.05 + +43.25 + ± + 7.57 + +40.83 +38.60 + +45.67 +BDI + +Pre +12.13 + ± + 8.82 + +9.30 +0.96 + +46.99 +<0.001 +13.05 + ± + 6.53 + +10.96 +0.48 +19.92 <0.001 +0.59 +0.001 +14.95 + +15.14 +Post +6.43 + ± + 7.73 + +3.95 + +10.45 + ± + 5.55 + +8.68 +8.90 + +12.22 +VAS + +Pre +6.68 + ± + 1.82 + +6.09 +1.62 + +49.10 +<0.001 +5.88 + ± + 2.15 + +5.19 +0.67 +17.51 0.005 +0.76 +<0.001 +7.26 + +6.56 +Post +3.40 + ± + 1.88 + +2.79 + +4.85 + ± + 1.96 + +4.22 +4.01 + +5.48 +SAR + +Pre +11.62 + ± + 10.11 + +8.39 +1.189 + +49.48 +<0.001 +10.45 + ± + 8.03 + +7.88 +13.02 +11.25 +16.9 +0.81 +34.69 <0.001 + +0.34 +NS +14.86 +Post 17.37 + ± + 10.77 + +13.93 + +10.07 + ± + 8.84 +20.82 +BDI + — + beck + depression + inventory, + VAS + — + visual + analogue + scale + for + pain, + SAR + — + sit + and + reach, + CI + — + confidence + interval, + LB + — + lower + bound, + UB + — + upper + bound, + ES + — + effect + size, + % + — + percentage. +Change, + NS + — + non + significant. +A comprehensive + yoga + programs + +113 +yoga + programs + are + unique + to + this + study, + probably + a result +of + the + IAYT + module’s + stress-management + components. + In + 2 +of + our + earlier + publications + we + have + shown + significantly + bet- +ter + improvement + in + spinal + flexibility + — functional + disability +(Oswestry + disability + index) + scores + and + quality + of + life + (WHO +QOL) + in + the + yoga + group + compared + to + exercise + group.39,40 A +study + compared + graded + exercise + therapy + with + graded + behav- +ioral + exposure + program + for + CLBP + (a + 7 + h day + rehabilitation-9 +am—4 + pm, + 5 + days + a week + for + 3—5 + weeks) + comparable + to + our +study + (8 + h per + day + for + 1 week). + They + observed + 33.3% + and +43.5% + reduction + in + pain + intensity + in + exercise + and + behavioral +therapy + groups + where + as + the + changes + were + 17.5% + and + 49% +in + the + exercise + and + IAYT + intervention + groups + respectively + in +our + study. + Similarly + the + depression + scores + reduced + by + 72% +(exercise) + and + 57.6% + (behavioral + therapy)41 as + compared + to +20% + (exercise) + and + 47% + (IAYT). +A study + of + BDI42 observed + correlations + between + somatic +and + physical + function + subscales + with + dysfunctional + cogni- +tions + related + to their + CLBP +, + reflecting + how + it + was + interfering +with + their + daily + life. +Meaning + of + the + study +The + detailed + design + of + the + Yoga + module + and + its + specific + new +features + therefore + merit + consideration. + There + are + different +yoga + therapy + schools + which + incorporate + various + limbs + of + yoga +like + asanas, + pranayama, + meditation, + lectures + on + yoga + philos- +ophy + including + codes + of + conduct. + For + eg, + Iyengar + yoga + uses +more + of + the + physical + practices + combined + with + breathing. +Vini + yoga + uses + a smooth + flow + of + postures + followed + by + relax- +ation + and + meditation. + IAYT + incorporates + all + the + components +to + offer + a holistic + therapeutic + module. +A + first + observation + is that + simultaneous + muscle + strength- +ening + and + relaxation + may + be + involved. + Careful + body +movement + together + with + active + mindfulness + both + strength- +ens + spinal + and + abdominal + muscles, + and + promotes + deeper +relaxation. + This + may + explain + observed + improvements + in + both +spinal + mobility + and + pain + levels, + agreeing + with + findings + in +previous + studies + of + IAYT + in + healthy + volunteers: + improved +stamina + and + strength,43 and + decreased + metabolism.44 +Observed + stress + reduction + is + consistent + with + previous +studies, + in + which + yoga + was + observed + to + correct + disturbed +moods + in + psychiatric + patients + with + anxiety + disorders45,46 +and + major + depressive + illness,47 showing + that + it + can + bene- +fit + even + pathological + levels + of + stress. + It + suggests + that + yoga +has + the + ability + to + reverse + the + interlinked + downward + spiral, +whereby + CLBP + causes + depression, + which + gives + rise + to + fur- +ther + back + pain, + resulting + in increased + depression, + and + so + on. +This + conclusion + is + corroborated + by + several + studies, + in + which +physical + well-being, + fatigue, + stress + (PSS) + and + anxiety + (on +STAI) + after + yoga + practice29,48—50 have + been + observed. + Telles +et + al.51 found + reduced + physiological + arousal + and + improved +autonomic + stability. + Together, + these + studies + provide + strong +evidence + for + yoga’s + stress + reducing + effects, + indicating + that +it + can + neutralize + CLBP’s + psychological + impact + as + well + as + its +physical + symptoms. +Participants + often + report + that + Yoga + courses + give + them +‘space’ + to recognize + causes + of + suppressed + negative + emo- +tions. + Although, + as + yet, + we + have + no + hard + data + supporting +this, + medical + records + indicate + that + counselling + helps + IAYT +residential + learn + to + be + more + objective + about + previously + dis- +tressing + situations. + This + seems + closely + allied + to + the + CBT +perspective, + which + sees + chronic + pain + not + simply + as + a + neu- +rophysiologic + state, + but + one + including + sensory, + affective, +behavioral, + and + cognitive + factors + influencing + the + way + the +patient + cognizes + the + world + and + assigns + meaning + to + events.52 +Indeed, + yoga + texts + highlight + a major + change + in per- +spective: + ‘happiness + is + an + inner + state, + not + depending + on +external + situations’.53 Since + anxiety + and + depression + are +significant + causes + of + CLBP +, + The + three + meditations + OM +meditation,51 cyclic + meditation,54,55 mind + sound + resonance +technique56 and + yogic + counselling + helped + in + stress + manage- +ment. + Yogic + counselling, + and + lectures + similar + to + modern + CBT +. +The + ‘happiness + analysis’ + derived + from + Upanishadic + texts53 +to + encourage + participants + to + recognize + sources + of + their +emotional + surges, + restore + freedom + to + remain + unaffected, +and + change + habituated + patterns + of + response + to + chronic +pain. +This + new + perspective + makes + previously + difficult + situa- +tions + easier + to + handle. + Its + occurrence, + in + an + Indian + context, +may + explain + some + of + the + anxiety + reduction. + More + generally, +reduction + in + scores + on + anxiety + and + depression + indicate + that +subjects + were + given + a + margin + of + safety + from + subsequently +redeveloping + pathological + levels + of + these + conditions, + a point +of + significance, + since + Yoga + medicine + is + as + much + preventive +as + curative. +Next + let + us + consider + possible + mechanisms + for + the +observed + degrees + of + pain + reduction. + Part + may + have + been +produced + by + neural + impulses + from + stretch + proprioceptors +interfering + with, + and + blocking, + impulses + on + the + ascend- +ing + pain + pathway, + as + hypothesized + in + gate + control + theory.57 +A + second + level + of + explanation + for + Yoga’s + efficacy + in + pain +reduction + may + lie + in + endorphin + production + at + a cortical +level, + which + is + known + to + result + from + alternate + stretch-and- +relax + procedures + of + Yoga + asana + practice.58 Anxiety + reduction +requires + special + consideration. + Consistency + of + observed +reduction + in + state + anxiety + during + yoga + interventions45,46,48 +with + non-significant + changes + during + the + physical + exercise +intervention, + corroborates + earlier + studies + on + yoga + in + other +chronic + stress-related + conditions.59 A + previous + short + term +out-patient + yoga + study + (3—4 + h/day + for + 9 + days) + observed23 +reductions + in + trait + anxiety + in + patients + with + chronic + disease. +Thus, + the + present + study’s + improvement + in + trait + anxiety + (16%) +by + the + Yoga + group + with + significant + group + × + time + interac- +tion, + and + between + groups + differences, + may + be + considered +evidence + for + the + power + of + yoga + interventions + to + reduce +deep-rooted + stress. +The + transformation + may + be + compared + to + well + sub- +stantiated + changes + in + emotionality + as + a result + of + regular +Trancendental + Meditation + practice, + something + in + which + EPI +author + HA + Eysenck, + himself + took + great + interest + when + it + was +discovered.60 Both + emotionality + and + trait + anxiety + are + con- +sidered + long + term, + stable + properties + of + the + personality. + In +both + the + cases, + deep, + Yoga-oriented + programs + indicate + that +they + may + not + be + as + permanent + as + originally + supposed. +The + observed + improvements + apparently + continued + after +the + completion + of + the + program: + subjects + were + routinely +asked + to + continue + one + hour + daily + yoga + practice + at + home +aided + by + a video. + At + the + present + time, + over + 3 + years + after +the + study + terminated, + many + of + the + previously + most + incapac- +itated + subjects + i.e. + those + who + had + made + the + most + progress, +are + still + doing + their + home + program, + in + contact + with + SVYASA, +and + expressing + appreciation + for + having + participated + in + the +study. +114 + +P +. + Tekur + et + al. +Possible + mechanisms + and + implications + for + clinicians + or +policy + makers. + We + recommend + that + this + safe + yoga + therapy +for + backpain + program + may + be + included + in conventional + Low +backpain + management + protocols +1. + As + it + has + been + shown + that + it + is + better + than + physical + ther- +apy + in + alleviating + pain, + anxiety + and + depression +2. + It is + applicable + in + all + age + groups + since + our + study + included +adolescents + to + the + elderly + (18—65 + years) + and + both + gen- +ders. +3. Cost + effectiveness + of + this + self + corrective + techniques +which + can + be + practiced + at + home + once + learnt + is + notewor- +thy. +Unanswered + question +With + increasing + popularity + of + yoga + round + the + globe, + gener- +alisability + of + this + module + to + different + ethnic + groups + should +be + studied. +Suggestions + for + future + research +(i) + Long-term + follow-up + including + measures + of + cognitive +changes + should + be + studied. +(ii) + EMG + studies + should + be + included. +Short + term, + intensive + residential + Yoga + programs + for + back +pain, + designed + according + to + the + Integrated + Approach + of +Yoga + Therapy + (IAYT), + significantly + reduce + scores + on + state +and + trait + anxiety, + and + depression + scales + as + well + as + reducing +pain, + and + improving + lower + back + and + hamstring + flexibility +and + QoL + scores + in + CLBP + patients. + The + Yoga + intervention +significantly + outperformed + the + control + intervention + on + all +measures + except + SAR + which + did + well + in + both + groups. +Conflict + of + interest + statement +None + declared. +Source + of funding +SVYASA + (Institutional). +Acknowledgements +We + acknowledge + assistance + from + Ravi + Kulkarni + PhD + — + Bio +Statistician + and + Balram + Pradhan + PhD + in + statistical + analysis. +We + thank: + Mrs. + Ritu + Mishra + (clinical + psychologist) + and + Dr + Usha +Rani + for + administering + and + scoring + psychological + question- +naires; + SVYASA + for + co-operation + in + conducting + the + program; +and + consultant + orthopaedic + surgeon + Dr + John + Ebnezer, + for +opinions + on + X-ray + images. + We + acknowledge + the + director + of +Jubilee + Camdarc + radiological + institute + for + assistance + with +x-rays. +Appendix + A. + Line + diagrams + of + back + pain +special + techniques + for yoga + group +I. + Supine + postures +1.Pavanamuktasana + (Wind + releasing + pose) +• + Supta + Pawanamuktasana + (leg + lock + pose) +• + Jhulana + Lurkhanasana + (rocking + and +rolling) +2. + Ardha + Navasana + (half + boat + pose) +3. + Uttanapadasana + (straight + leg + raise + pose) +A comprehensive + yoga + programs + +115 +Appendix + A (Continued + ) +4. + Sethubandhasana + breathing + (bridge + pose +lumbar + stretch) +5. + Supta + Udarakarshanasana + (folded + leg +lumbar + stretch) +6. + Shavaudarakarshanasana + (Crossed + leg +lumbar + stretch) +[10pt] + II. + Prone + postures +1. + Bhujangasana + (serpent + pose) +2. + Shalabhasana + breathing + (locust + pose) +3. + Quick + relaxation + Technique + in + Shavasana +(corpse + pose) +III. + Sitting + postures +116 + +P +. + Tekur + et + al. +Appendix + A (Continued + ) +1. + Vyaghra + Svasa + (Tiger + breathing) +2. + Shashankasana + breathing + (moon + pose) +IV. + Standing + postures +1. + Ardha + Chakrasana + (half + wheel + pose) +2. + Prasarita + Pada + Hastasana + (forward + bend +with + legs + apart) +A comprehensive + yoga + programs + +117 +Appendix + A (Continued + ) +3. + Ardha + kati + Chakrasana + (lateral + arc + pose) +V. + Deep + relaxation + technique, + in + Shavasana +with + folded + legs +References +1. + Dunn + KM. + Epidemiology + and + natural + history + of + low + back + pain. +Eura + Medicophys + 2004 + Mar;40:9—13. +2. + Punnett + L, + Prüss-Utün + A, + Nelson + DI, + Fingerhut + MA, + Leigh + J, +Tak + S, + et + al. + Estimating + the + global + burden + of + low + back + pain +attributable + to + combined + occupational + exposures. + Am + J + Ind + Med +2005;48:459—69. +3. + Madan + I, + Reading + I, + Palmer + KT +, + Coggon + D. + Cultural + differences +in + muskuloskeletal + symptoms + and + differences. + Int + J + Epidemiol +2008;37:1181—9. +4. + Sharma + SC, + Singh + R, + Sharma + AK, + Mittal + R. + Incidence + of + low + back +pain + in + workage + adults + in + rural + north + India. + Indian + J + Med + Sci +2003;57:145—7. +5. + Kjellgren + A, + Bood + SA, + Axelsson + K, + Norlander + T +, + Saatcioglu + F +. +Wellness + through + a + comprehensive + yogic + breathing + program + — + a +controlled + pilot + trial. + BMC + Complement + Altern + Med + 2007;19:43. +6. + Miller + +RJ, + +Hafner + +RJ. + +Medical + +visits + +and + +psychological +disturbances + +in + +chronic + +low + +back + +pain. + +Psychosomatics +1993;32:299—316. +7. + Turk + DC. + The + role + of + psychological + factors + in + chronic + pain. + Acta +Anaesthesiol + Scand + 1999;43:885—8. +8. + Linton + SJ. + A + review + of + psychological + risk + factors + in + back + and +neck + pain. + Spine + 2000;25:1148—56. +9. + Meyer + T +, + Cooper + J, + Raspe + H. + Disabling + low + back + pain + and + depres- +sive + symptoms + in + the + community-dwelling + elderly: + a + prospective +study. + Spine + 2007;32:2380—6. +10. 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Krisanaprakornkit + +T +, + +Krisanaprakornkit + +W, + +Piyavhatkul + +N, +Laopaiboon + M. + Meditation + therapy + for + anxiety + disorders. +Cochrane + Database + Syst + Rev + 2006;25:CD004998. +46. + Nagaratna + R, + Nagendra + HR, + Crisan + HG, + Seethalakshmi + R. + Yoga +in + Anxiety + Neurosis + — + a + scientific + study. + In: + Proceedings + of + the +International + Symposium + of + the + Royal + College + of + Physicians + and +Surgeons + of + Glasgow-update + Medicine + and + Surgery. + 1988. + p. +192—6. +47. + Sharma + VK, + Das + S, + Mondal + S, + Goswampi + U, + Gandhi + A. + Effect + of +Sahaj + Yoga + on + depressive + disorders. + Indian + J + Physiol + Pharmacol +2005;49:462—8. +48. + Michalsen + A, + Grossman + P +, + Acil + A, + Langhorst + J, + Lüdtke + R, + Esch +T +, + et + al. + Rapid + stress + reduction + and + anxiolysis + among + distressed +women + as + a + consequence + of + a + three-month + intensive + yoga + pro- +gram. + Med + Sci + Monit + 2005;11:555—61. +49. + Raghuraj + P +, + Ramakrishna + AG, + Nagendra + HR, + Shirley + T +. + Effect + of +two + selected + yogic + breathing + techniques + on + heart + rate + variabil- +ity. + Indian + J + Physiol + Pharmacol + 1998;42:467—72. +50. + Telles + S, + Nagaratna + R, + Nagendra + HR, + Desiraju + T +. + Alterations + in +auditory + middle + latency + evoked + potentials + during + meditation + on +a + meaningful + syllable-OM. + Int + J + Neurosci + 1994;76:87—93. +51. + Telles + S, + Nagarathna + R, + Nagendra + HR. + Autonomic + changes + during +OM + meditation. + Indian + J + Physiol + Pharmacol + 1995;39:418—20. +52. + Turk + DC, + Meichenbaum + D, + Genest + M. + Pain + and + behavioural +medicine: + a + cognitive-behavioural + perspective. New + York: + Guil- +ford + Press; + 1983. +53. + Lokeswarananda + S. + Taittireya + upanishad. + Kolkatta: + The + Ramakr- +ishna + Mission + Institute + of + Culture; + 1996. +54. + Nagendra + HR, + Nagarathna + R. + New + perspectives + in + stress + man- +agement. + Bengaluru: + Vivekananda + Kendra + Prakashana; + 1997. +55. + Telles + S, + Reddy + Satish + Kumar, + Nagendra + HR. + Oxygen + consumption +and + respiration + following + two + yoga + relaxation + techniques. + Appl +Psychophysiol + Biofeedback + 2000;25:221—7. +56. + Nagendra + HR. + Mind + sound + resonance + technique. + Bengaluru: +Swami + Vivekananda + Yoga + Prakashana; + 1998. +57. + Melzack + R, + Wall + PD. + Pain + mechanisms: + a + new + theory. + Science +1965;150:971—9. +58. + Kjaer + TW, + Bertelsen + C, + Piccini + P +, + Brooks + D, + Alving + J, + Lou + HC. +Increased + dopamine + tone + during + meditation-induced + change + of +consciousness. + Brain + Res + Cogn + Brain + Res + 2002;13:255—9. +59. + Hayden + JA, + van + Tulder + MW, + Tomlinson + G. + Systematic + review: +strategies + for + using + exercise + therapy + to + improve + outcomes + in +chronic + low + back + pain. + Ann + Intern + Med + 2005;142(9):776—85. +60. + Abrams + AI. + A + follow-up + study + on + the + effects + of + the + transcenden- +tal + meditation + program + on + inmates + at + Folsom + State + Prison. + Paper +280. + In: + Chalmers + R, + Clements + G., + Schenkluhn + H., + Weinless +M., + editors. + Scientific + research + on + Maharishi’s + transcendental +meditation + and + TM-Sidhi + programme + collected + papers, + Vol. + 3. +Vlodrop: + MERU + Press; + 1990. + p. + 2108—12. diff --git a/subfolder_0/A randomised control trail of the effect of yoga on gunas.txt b/subfolder_0/A randomised control trail of the effect of yoga on gunas.txt new file mode 100644 index 0000000000000000000000000000000000000000..41a42d60a98246ac1ea9b272f0579cf923af8432 --- /dev/null +++ b/subfolder_0/A randomised control trail of the effect of yoga on gunas.txt @@ -0,0 +1,1324 @@ +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +2 +A randomized control trial of the effect of yoga on Gunas +(personality) and Health in normal healthy volunteers +Sudheer Deshpande, Nagendra H R, Raghuram Nagarathna +Department of Yoga Research, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India. +Objective: To study the effi + cacy of yoga on Guna (yogic personality measure) and general health in normal adults. +Methods: Of the 1228 persons who attended introductory lectures, 226 subjects aged 18–71 years, of both sexes, who satisfi + ed +the inclusion and exclusion criteria and who consented to participate in the study were randomly allocated into two groups. +The Yoga(Y) group practised an integrated yoga module that included asanas, pranayama, meditation, notional correction +and devotional sessions. The control group practised mild to moderate physical exercises (PE). Both groups had supervised +practice sessions (by trained experts) for one hour daily, six days a week for eight weeks. Guna (yogic personality) was +assessed before and after eight weeks using the self-administered Vedic Personality Inventory (VPI) which assesses Sattva +(gentle and controlled), Rajas (violent and uncontrolled) and Tamas (dull and uncontrolled). +The general health status (total health), which includes four domains namely somatic symptoms (SS), anxiety and insomnia +(AI), social dysfunction (SF) and severe depression (SP), was assessed using a General Health Questionnaire (GHQ). +Results: Baseline scores for all the domains for both the groups did not differ signifi + cantly (P > 0.05, independent samples +t test). Sattva showed a signifi + cant difference within the groups and the effect size was more in the Y than in the PE group. +Rajas showed a signifi + cant decrease within and between the groups with a higher effect size in the PE group. Tamas showed +signifi + cant reduction within the PE group only. The GHQ revealed that there was signifi + cant decrease in SS, AI, SF and SP in +both Y and PE groups (Wilcoxcon Singed Rank t test). SS showed a signifi + cant difference between the groups (Mann Whitney +U Test). +Conclusions: There was an improvement in Sattva in both the Yoga and control groups with a trend of higher effect size in +Yoga; Rajas reduced in both but signifi + cantly better in PE than in Yoga and Tamas reduced in PE. The general health status +improved in both the Yoga and control groups. +Keywords: General health; guna; Yoga. +The present age of speed and competition has increased +the stresses and strains resulting in an increasing +prevalence of life style-related health problems.[1] One +of the increasingly popular tools to overcome this new +challenge is physical activity. There is growing evidence +that has established the benefits of physical exercises in +preventing life style-related diseases[2] such as primary +prevention of diabetes,[3] prevention of cardiac diseases +through control over major risk factors such as smoking, +lipids, obesity and stress,[4] better quality of life of cancer +patients,[5] positive health in normal persons through +better physical fitness[6] and stress reduction.[7] Yoga +which is considered to be a tool for both physical and +mental development of an individual is being recognized +Original Article +around the globe only in the last century although it has +been practised in India over several centuries to promote +positive health and well being. It gives solace for the +restless mind and can give great relief to the sick.[8,9] It has +become quite fashionable even for the common man to keep +fit.[10] Some use yoga for developing memory, intelligence +and creativity.[11] With its multifold advantages, yoga is +becoming a part of school education.[12] Specialists use +it to unfold deeper layers of consciousness in their move +towards spiritual perfection.[13] With growing scientific +evidence, yoga is emerging as an important health +behavior-modifying practice to achieve states of health, +both at physical and mental levels. Several studies have +demonstrated the beneficial effects of yoga on health +Correspondence to: Dr. Nagarathna Raghuram +No19, Eknath Bhavan, Gavipuram Circle, +K. G. Nagar, Bangalore – 560 019. India. +E-mail: rn44@rediffmail.com +ABSTRACT +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +3 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +behavior in many life style-related somatic problems +such as hypertension,[14] bronchial asthma,[15] diabetes[16] +including some psychiatric conditions such as anxiety +neurosis[17] and depressive illness[18] etc. +The philosophy of yoga believes that somatic problems are +nothing but a manifestation of an imbalance between three +Gunas (Sattva, Rajas and Tamas) that go to constitute the +body-mind complex of the individual.[19] Further, in the +famous scriptural text, the Gita; a guna indicates a specific +behavior style. Sattva is symbolized by purity, wisdom, +bliss, serenity, love of knowledge, spiritual excellence and +other noble and sublime qualities. Rajas is symbolized +by egoism, activity, restlessness and hankering after +mundane things like wealth, power, valor and comforts. +Tamas is related to qualities such as bias, heedlessness +and inertia, perversion in taste, thought and action.[20] Ill +health occurs if Rajas or Tamas become dominant and +the individual gets habituated to either of these response +patterns. Furthermore, the Gita goes on to analyze the +state of mind and says that when one is dominated by +these two gunas, the individual loses mastery over the +uncontrolled, speeded-up loop of sentences of the internal +dialogue, which shows up as upsurges of emotions and +impulsive behavior. In an ideal state of perfect health, +man has the complete freedom to use any of these three +patterns (Satva, Rajas or Tamas) of responses. Hence, +the degree of positive health can be measured by a tool +that can grade these three patterns of behavior.[19] The +tool can be used for assessment of interventions used for +treatment or prevention of diseases as well as for promotion +of positive health. The Vedic Personality Inventory +(VPI)[21] is a valid and reliable inventory that can measure +the three patterns of behavior. +While Yoga is getting popular, the relative roles of yoga +and physical exercises have not been studied on gunas +and health. Hence, the present study was designed to +assess the changes in the personality and overall health +status after yoga as compared to physical exercise +in a randomized controlled study in normal healthy +volunteers. +METHOD +Subjects +Of the 1228 adults who attended motivational lectures, +226 subjects consented to participate in the study and +were randomly allocated to two groups of equal size. After +attrition, the final sample sizes were 87 in both the yoga +and control groups. +Inclusion criteria were: (a) normal healthy volunteers, (b) +age 18–71 years, (c) literacy and (d) scores less than 4/5 +in the General Health Questionnaire.[22] +Exclusion criteria were: (a) subjects with any ailment, (b) +smoking and (c) substance abuse. +Source of subjects: Normal adults were recruited from +five different locations in Bangalore after public talks at +different institutions such as colleges, health clubs, Rotary +Clubs, Lion’s clubs and big apartment complexes. +Informed consent was obtained from all the subjects +who participated in the project and also from the +institutional heads where the classes were conducted. +The institutional ethical committee of SVYASA cleared +the project proposal. +Design +This is a prospective, randomized, single-blind, controlled +study aiming to compare the efficacy of yoga (Y) and +physical exercise (PE) in normal healthy volunteers in +a South Indian population. Introductory lectures were +arranged in public centers such as colleges, health clubs, +Rotary clubs, Lion’s clubs and apartment complexes. The +classes were planned in five different centers in the city +of Bangalore. Two hundred and twenty-six persons who +consented to participate in the study and satisfied the +inclusion and exclusion criteria were randomly allotted +to two groups by using five random number tables +(different table for each center) generated from the random +number generator program.[23] The experimental group +was given Y practices and the control group was given +PE for one hour daily on empty stomach (6 to 7 a.m.). +The classes were conducted six days a week for eight +weeks and attendance was maintained by the teachers. +Trained experts (in yoga for the Y group and PT for the +PE group) conducted parallel sessions for the two groups +in different rooms in the same venue. It was ensured that +there was no interaction between the subjects. The tests +were self-administered before and eight weeks after the +intervention. Arrangements were made for the subjects to +sit in a quiet place free from distractions and influence +from other people. +Masking: The answered questionnaires were coded and +kept away for future scoring. A psychologist who was not +involved in the subject allocation or supervision of the +classes scored the questionnaires which were decoded +only after the scoring of both the before and after data +was completed. +Assessments +Assessments were done using the following +questionnaires: +1. The Vedic Personality Inventory (VPI): In 1998, Wolf +developed an inventory to assess three personality +Effect of Yoga on Gunas and Health +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +4 +constructs (gunas) based on their description in the +most ancient Indian scriptures called Vedas. Hence, +this inventory was named the VPI and it measures +the three gunas—Sattva, Rajas and Tamas. It has 30 +items for the Sattva guna, 28 for rajoguna and 32 for +tamo guna. VPI has good internal consistency and +reliability with Cronbach’s alpha ranging from 0.850 +for Sattva, 0.915 for Rajas and 0.699 for Tamas. In +terms of discriminant validity, all but one facet had +significant differences.[21] +2. General Health Questionnaire (GHQ): The GHQ +designed by Goldberg in order to identify psychiatric +morbidity in general practice, is a self-administered +questionnaire (English version). It has 28 items with +four subscales to measure somatic symptoms (SS), +anxiety and insomnia (AI), social dysfunction (SF) and +severe depression (SP). It provides information about +the recent mental status, thus identifying the presence +of possible psychiatric disturbance. This questionnaire +has acceptable psychometric properties and has good +internal consistency and reliability with Cronbach’s +alpha of 0.85 and validity of 0.76.[24] +INTERVENTION +Yoga group +The Integrated yoga module was selected from the +integrated set of yoga practices used in earlier studies on +the effects of yoga for positive health.[25] This integrated +approach is developed based on ancient Yoga texts[26] +to bring about a total development at physical, mental, +emotional, social and spiritual levels.[27] The techniques +include physical practices (kriyas, asanas, a healthy +yoga diet), breathing practices with body movements and +Pranayama, meditation, devotional sessions, lectures on +yoga, stress management and lifestyle change through +notional corrections for blissful awareness under all +circumstances (action in relaxation). Yoga was taught by +qualified yoga teachers. +Physical exercise group +The set of physical exercises were standard execises[28] +meant to provide mild to moderate activity designed by +experts in physical education. +Data extraction +The scoring of the questionnaires was carried out as per +the instructions in the manuals. The structure of these +questionnaires is described below: +1. VPI evaluates the Sattva, Rajas and Tamas gunas by +using a 7-point Likert-type scale. Scores for the gunas +are obtained by adding the responses for the items for a +guna and then dividing by the number of items for that +mode. For each subscale, a higher score indicates a greater +predominance of that mode. The minimum and maximum +possible scores for the three domains range from 1–7. +2. GHQ: This 28 item test using a binary method of scoring +(0, 0, 1, 1) yields an assessment on four robust subscales: +somatic symptoms (SS), anxiety and insomnia (AI), social +dysfunction (SF) and severe depression (SP). A sum of the +scores for these four subscales gives the score for total +health. The lower the scores in the GHQ, the better the +state of health. The cut-off scores for the GHQ used for +this study were 4 or 5 (4/5).[22] +Statistical analysis +Data was analyzed using the SPSS package version 10.0. +Based on a previous study,[29] the effect size was calculated +to be 0.8. With a power of 0.8 and alpha set to 0.05, +the minimum sample size was found to be 164. This +calculation was done using G power.[30] The size of the +sample actually used was 174. +Data at baseline was assessed for normal distribution +using Shapiro-Wilk’s test for both the groups. Independent +samples t-test was done for checking homogeneity of +baseline scores of the two groups. Paired samples t test +and independent samples t test were used for VPI which +had normally distributed data and Wilcoxon’s signed ranks +and Mann Whitney U tests were used for GHQ data which +were not normally distributed. An independent samples +t test was done to analyze between the groups and paired +samples test within groups. The effect size of the study +(mean A – mean B)/ standard deviation (SD) of difference +scores) is an absolute measure of the difference that exists +between the populations for a parameter, a concept first +introduced by the sociologist, J. Cohen.[31] +As the study population had a wide age range, statistical +analysis was also carried out by grouping them as juniors +(age ≤ 24 years) and seniors (age > 24 years) based on the +median age. The independent samples t-test for between +groups and paired samples t test for within groups were +conducted for the two age groups. The data was also +analyzed using gender as a factor. +RESULTS +Figure 1 shows the study profile wherein of 1228 subjects +who attended the motivational lectures, only 226 who +satisfied the inclusion and exclusion criteria were selected +and randomly allotted to the Y and PE groups. The reasons +Deshpande S, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +5 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +for dropout of 52 subjects are shown in Figure 1. +Table 1 shows the demographic data. There were 87 +subjects (40 females) in each group aged 18–71 years, the +mean age being 29.44 ± 11.94 years. They belonged to +different callings such as college students, professionals, +housewives and retired persons. +The baseline values were normally distributed for Tamas +(P = 0.209) and Sattva (P = 0.717) and were well-matched +for all three domains (Independent samples t-test). +Table 2 shows the comparison of the baseline scores for +the three gunas of the VPI with the norms provided in the +manual. It showed that the scores are within the predicted +normal range. The mean value is marginally higher for +Sattva and lower for Rajas and Tamas in the South Indian +population selected in the present study as compared to +the norms from studies in the USA. +Tamas: The PE group showed a significant decrease in +the Tamas score from 3.24 to 2.99 (P = 0.001) (paired +samples t test). The senior subjects (age > 24 years) in both +the Y (3.09 to 2.67) and PE (3.21 to 2.83) groups showed +a significant decrease (P = 0.001). In gender analysis, +females showed a decrease with Y (P = 0.040) and males +showed a decrease with PE (P = 0.032). +Rajas: The PE group showed a significant decrease in +scores from 3.67 to 3.43 (P = 0.002). Seniors in both the +Y (3.81 to 3.51) (P = 0.002) and PE (3.62 to 3.31) groups +(P = 0.015) have shown significant decreases. In gender +analysis, males showed a decrease with PE (3.73 to 3.37) +(P = 0.014). Significantly greater reduction was observed +in the PE than in the Y group (P = 0.005) and in juniors +(P = 0.012). +Sattva: Sattva scores have increased significantly in +both Y (4.88 to 5.26) (P = 0.001) and PE (4.91 to 5.21) +(P < 0.001) groups with a greater effect size in the Y +Table 1: Demographic data for VPI +Age Sex + +Y +PE + + +(n = 87) +(n = 87) + + +31.33±11.9 5 +32.35±11.32 +≤ 24 years (Juniors) +Male (m±SD) +26.79±12.20 +28.00±11.76 + +Female (m±SD) +20.00±1.75 +20.29±1.44 +> 24 years (Seniors) +Male (m±SD) +20.61±1.82 +20.73±1.89 + +Female (m±SD) +38.88±9.55 +30.85±8.56 +Gender +Male (m±SD) +41.36±13.89 +40.82±10.85 + +Range +18–71 +18–58 + +Female +40 +40 +Categories +Male +47 +47 + +Students +49 +44 + +Employees +18 +30 + +Housewives +10 +7 + +Business +10 +6 +Table 2: VPI scores for yoga and control groups—comparison of means (paired samples test) + +Before +After +P value +Effect Size +Before +After +P value +Effect Size + +Means±SD +Means±SD + + +Means±SD +Means±SD + + +Y +Y + + +PE +PE + +Tamas +3.12 ± 0.51 +2.97 ± 0.91 +0.095 +0.18 +3.24 ± 0.67 +2.99 ± 0.69 +0.001 +0.36 +Rajas +3.83 ± 0.62 +3.72 ± 0.51 +0.12 +0.17 +3.67 ± 0.62 +3.43 ± 0.79 +0.002* +0.33 +Sattva +4.88 ± 0.52 +5.26 ± 0.51 +<0.001 +0.61 +4.91 ± 0.53 +5.21 ± 0.65 +<0.001 +0.45 +* Rajas showed a significant difference between the groups (P = 0.005) (Independent Samples Test); (Effect size = difference in means (after–before)/SD of the +difference scores) +Table 3: VPI scores in age groups - Age ≤ 24 years and > 24 years (paired-samples t test) + + +Before +After +P value +Before +After +P value + + +Means±SD +Means±SD + +Means±SD +Means±SD + + +Y +Y + +PE +PE +Age ≤ 24 years +Tamas +3.16 ± 0.49 +3.20 ± 1.63 +0.774 +3.28 ± 0.67 +3.16 ± 2.13 +0.4 + +Rajas +3.84 ± 0.66 +3.99 ± 0.74 +0.286 +3.75 ± 0.63 +3.56 ± 0.75 +0.152 + +Sattva +4.67 ± 0.47 +5.26 ± 0.55 +<0.001 +4.79 ± 0.44 +5.14 ± 0.65 +0.002 +Age > 24 years +Tamas +3.09 ± 0.53 +2.67 ± 0.69 +0.001 +3.21 ± 0.68 +2.83 ± 0.77 +0.001 + +Rajas +3.81 ± 0.61 +3.51 ± 0.57 +0.002 +3.62 ± 0.62 +3.31 ± 0.83 +0.015 + +Sattva +4.91 ± 0.59 +5.12 ± 0.45 +0.001 +5.00 ± 0.59 +5.09 ± 0.62 +0.014 +Effect of Yoga on Gunas and Health +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +6 +(0.61) than in the PE (0.45) group. Juniors, seniors, males +and females in both the Y and PE groups have all shown +significant increase in Sattva scores. +Table 5 shows the results for all variables of the GHQ. +Somatic symptoms (SS): SS symptoms have reduced +significantly in both Y (0.57 to 0.29) (P = 0.011) and PE +(0.41 to 0.11) (P = 0.001) groups. Juniors, seniors, males +and females of the PE group have shown significant +decrease in SS. Seniors and males in the Y group have +shown significant decrease in SS. There was a significant +difference between the groups. +Anxiety and insomnia (AI): AI symptoms have decreased +significantly in both the Y (0.61 to 0.08) (P < 0.01) and PE +(0.49 to 0.18) (P = 0.011) groups. Juniors, seniors, females +and males in the in Y group have shown significant +decrease in AI whereas only seniors and males have shown +significant decrease in AI in the PE group. +Social dysfunction (SF): A significant decrease was +observed in both the Y (0.60 to 0.15) (P ≤ 0.001) and PE +(0.60 to 0.23) (P = 0.001) groups. Juniors, females and +males have shown significant decrease in SD with Yoga +whereas juniors, seniors, males and females have shown +significant decrease in SD due to PE. +Severe depression (SP): Both Y (0.44 to 0.22) (P = 0.017) +and PE (0.52 to 0.15) (P < 0.01) groups have shown +significant reduction in SP +. Juniors, seniors, females and +males have shown a significant decrease in SP due to PE. +Only seniors and males have shown a significant decrease +in SP due to yoga. +DISCUSSION +This is a randomized, controlled, prospective study in +normal adults comparing the efficacy of yoga with a +control intervention of PE of eight weeks in 174 normal +adults on changes in their personality (guna) and General +health as assessed by VPI and GHQ. The results showed +that there was an increase in Sattva scores (P < 0.001) in +both Y and PE groups and a decrease in Rajas (P = 0.002) +and tamas (P = 0.01) scores in the PE group. The scores for +Tamas decreased significantly in seniors of both the groups +(females in Y and males in PE) (paired samples t test). +The increase in Sattva scores was higher in the Y group +Orientation Seminar Conducted at different parts of Bangalore +1228 +Consented to participate in the project +226 +Centre I +66 +Centre II +30 +Centre V +32 +Centre III +50 +Centre IV +48 +Randomized +226 +Yoga +33 +PE +33 +Yoga +15 +PE +15 +Yoga +25 +PE +25 +Yoga +24 +Yoga +22 +PE +30 +No. of People dropped +52 +No, of subjects in the project +174 +Yoga +24 +PE +16 +Yoga +16 +Reasons for dropping + +Yoga PE + + + + + + + + + + + + + + + + + + + +Yoga +87 +PE +87 +1. Change of address +4 +10 +2. Unexpected duty shifts +5 +7 +3. Weather conditions +3 + 2 +4. Out of station +7 +3 +5. Ill health +3 +– +6. Wanted to shift to yoga + +8 + Total + 22 +30 +Comparison between our data and Vpi data +Deshpande S, et al. +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +7 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +(effect size 0.61) than in the PE group (effect size 0.45) +(paired samples t test). The decrease in the Rajas scores +was significantly higher in the PE than in the Y (P=0.005) +(independent samples t-test) groups and this was seen +in juniors and males. The GHQ revealed a significant +improvement on all four domains and the overall health in +both groups after the intervention (P ≤ 0.001) (Wilcoxon’s +signed rank test). It can be seen from the GHQ scores that +PE was more effective in reducing somatic symptoms +(P = 0.018) (Mann Whitney test), severe depression (effect +size for Y = 1.46, PE = 1.60) and anxiety and insomnia +(effect size for Y = 0.98, PE = 1.93). +A similar study by Dasa[32] conducted by the use of +mahamantra in a three-armed, randomized prospective, +controlled study on 62 volunteers showed that the +mahamantra group had increased Sattva and decreased +Tamas with no significant change in Rajas scores on the VPI +questionnaire after a month of chanting of mahamantra, +20 minutes daily for four weeks. In the present study, +apart from an increase in Sattva and decrease in Tamas, +there is a significant decrease in Rajas which was not +observed after Mahamantra. This difference could be +because of the inclusion of Asanas and Pranayama to +the Meditation technique in the integrated yoga program +used in the present study as compared to the mahamantra +which is mainly a form of meditation. In their study, Dasa +et al. also showed a significant reduction in stress, anxiety +and depression after mahamantra as measured by State +Trait Anxiety Inventory (STAI) comparable to the results +of GHQ in this study. +The behavior of a human being is an expression of +a combination of different gunas. Tamas (meaning +darkness) is the grossest aspect of our personality +characterized by excessive sleep, innocence, laziness, +depression, procrastination, a feeling of helplessness, +impulsivity, anger and arrogance (packed up with vital +energy). When we reduce Tamas through mastery over +the mind, we become dynamic, sensitive and sharp to +move towards Rajas (the shining one) characterized by +intense activity, ambitiousness, competitiveness, high +Table 6: GHQ scores: Age ≤ 24 years and > 24 years (Wilcoxon signed ranks test) + + +Before +After +P value +Before +After +P value + + +Means±SD +Means±SD + +Means±SD +Means±SD + + +Y +Y + +PE +PE +Age ≤ 24 years +SS +0.65 ± 0.93 +0.43 ± 0.76 +0.161 +0.43 ± 0.76 +0.14 ± 0.35 +0.01 + +AI +0.71 ± 0.96 +0.10 ± 0.47 +<0.001 +0.66 ± 0.99 +0.30 ± 1.00 +0.057 + +SF +0.80 ± 0.98 +0.18 ± 0.44 +<0.001 +0.75 ± 1012 +0.34 ± 0.64 +0.019 + +SP +0.45 ± 0.71 +0.29 ± 0.68 +0.185 +0.64 ± 0.89 +0.16 ± 0.43 +<0.001 + +TH +2.61 ± 2.54 +1.00 ± 1.44 +<0.001 +2.48 ± 3.11 +0.93 ± 1.53 +0.001 +Age > 24 years +SS +0.47 ± 0.89 +0.11 ± 0.39 +0.004 +0.40 ± 0.85 +0.09 ± 0.29 +0.044 + +AI +0.47 ± 0.86 +0.05 ± 0.23 +0.002 +0.33 ± 0.78 +0.06 ± 0.26 +0.047 + +SF +0.34 ± 0.75 +0.11 ± 0.31 +0.071 +0.44 ± 0.83 +0.12 ± 0.32 +0.017 + +SP +0.42 ± 0.76 +0.13 ± 0.41 +0.047 +0.40 ± 0.79 +0.14 ± 0.41 +0.013 + +TH +1.71 ± 2.25 +0.39 ± 1.00 +0.001 +1.56 ± 2.00 +0.42 ± 0.00 +0.003 +Table 4: Gender-based VPI scores (paired samples t test) + + +Before +After +P value +Before +After +P value + + +Means±SD +Means±SD + +Means±SD +Means±SD + + +Y +Y + +PE +PE +Females +Tamas +3.15 ± 0.52 +2.80 ± 1.04 +0.04 +3.20 ± 0.71 +2.97 ± 0.71 +0.053 + +Rajas +3.66 ± 0.62 +3.43 ± 0.48 +0.502 +3.64 ± 0.63 +3.50 ± 0.80 +0.196 + +Sattva +4.91 ± 0.42 +5.20 ± 0.50 +0.004 +4.98 ± 0.58 +5.23 ± 0.62 +0.034 +Males +Tamas +3.11 ± 0.50 +3.10 ± 0.58 +0.924 +3.28 ± 0.65 +3.01 ± 0.46 +0.032 + +Rajas +3.96 ± 0.63 +3.96 ± 0.41 +0.898 +3.73 ± 0.63 +3.50 ± 0.79 +0.014 + +Sattva +4.86 ± 0.60 +5.33 ± 0.52 +<0.001 +4.80 ± 0.49 +5.19 ± 0.68 +0.001 +Table 5: GHQ scores (Wilcoxon signed ranks test) + +Before +After +P value +Before +After +P value + +Means±SD +Means±SD + +Means±SD +Means±SD + +Y +Y + +PE +PE +SS +0.57 ± 0.91 +0.29 ± 0.65 +<0.001 +0.41 ± 0.80 +0.11 ± 0.32 +0.001 +AI +0.61 ± 0.92 +0.08 ± 0.38 +<0.001 +0.49 ± 0.90 +0.18 ± 0.74 +0.011 +SF +0.60 ± 0.91 +0.15 ± 0.39 +<0.001 +0.60 ± 0.99 +0.23 ± 0.52 +0.001 +SP +0.44 ± 0.73 +0.22 ± 0.58 +0.017 +0.52 ± 0.65 +0.15 ± 0.42 +<0.001 +TH +2.22 ± 2.48 +0.74 ± 1.21 +<0.001 +2.02 ± 2.78 +0.68 ± 1.28 +<0.001 +SS: Somatic symptoms; AI: Anxiety and insomnia; SF: Social dysfunction; SP: Severe depression; TH: Total health +SS: Somatic symptoms; AI: Anxiety and insomnia; SF: Social dysfunction; SP: Severe depression; TH: Total health +Effect of Yoga on Gunas and Health +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +8 +Deshpande S, et al. +sense of self importance, desire for sense gratification, +little interest in spiritual elevation, dissatisfaction +with one’s position, envy of others and a materialistic +cleverness.[33] With further growth and mastery, one moves +into Sattva–a dominance which includes the qualities of +truthfulness, stability, discipline, sense of control, sharp +intelligence, preference for vegetarianism, truthfulness, +gravity, dutifulness, detachment, respect for superiors +and staunch determination[21] and stability in the face of +adversity and also conscious action. Thus, we can see +that although both Rajas and Tamas have both positive +and negative qualities, they are the manifestation of a +violent state of mind in which a person lacks mastery +over upsurges of emotions and impulsive behaviour.[33] +Most of the qualities of Sattva which are manifestation +of a calm state of mind are achievable by different +yoga techniques (physical postures, pranayama and/ +or meditation) meant for mastery over the mind-body +complex.[34] Several earlier studies have independently +corroborated these notions. It has been shown that self +esteem as well as the sense of control and determination +improved after meditation.[35] Reduction in crime rate +after transcendental meditation (TM) supported the +effect of a calm state of mind on social health.[36] These +positive effects also show up as better perception and +memory as well as better motor performance (dexterity +and coordination tests).[37] Better academic performance +has also been documented.[38] +Although in this study, Yoga has shown a better effect +on the Sattva guna than PE with a better effect size, the +main difference between Y and PE practices seems to +be the effect on rajas guna. The reduction in this guna +was significantly higher after PE than after Y (this group +difference was in males and juniors). The scores for Tamas +Table 7: Gender-based GHQ scores (Wilcoxon signed ranks test) + + +Before +After + +Before +After + + +Means±SD +Means±SD + +Means±SD +Means±SD + + +Y +Y +P value +PE +PE +P value +Females +SS +0.50 ± 0.99 +0.25 ± 0.58 +0.115 +0.40 ± 0.74 +0.07± 0.27 +0.018 + +AI +0.50 ± 0.85 +0.02± 0.16 +0.001 +0.57 ± 0.98 +0.30 ± 1.04 +0.208 + +SF +0.40 ± 0.81 +0.10 ± 0.30 +0.038 +0.45 ± 0.81 +0.15 ± 0.36 +0.038 + +SP +0.35 ± 0.62 +0.28 ± 0.72 +0.584 +0.50 ± 0.85 +0.10 ± 0.45 +0.005 + +TH +1.71 ± 2.35 +0.65 ± 1.03 +0.01 +1.93 ± 2.80 +0.70 ± 1.44 +0.018 +Males +SS +0.64 ± 0.85 +0.32 ± 0.69 +0.027 +0.43 ± 0.85 +0.15± 0.36 +0.022 + +AI +0.70 ± 0.98 +0.13± 0.49 +<0.001 +0.43 ± 0.83 +0.08± 0.28 +0.007 + +SF +0.77 ± 0.96 +0.19 ± 0.45 +<0.001 +0.72 ± 1.12 +0.30 ± 0.62 +0.009 + +SP +0.51 ± 0.80 +0.17 ± 0.43 +0.008 +0.53 ± 0.86 +0.13 ± 0.40 +<0.001 + +TH +2.62 ± 2.53 +0.81 ± 1.36 +<0.001 +2.11 ± 2.78 +0.66 ± 1.15 +<0.001 +also decreased significantly in seniors of both groups +(females in Y and males in PE groups) with the effect +size being higher in the PE than in the Y groups. Thus, +significantly greater reductions in Rajas and Tamas were +worthy of note with PE than with Y. This positive effect +of PE in reducing Rajas and Tamas adds to the fund of +knowledge about several psycho-physiological benefits +of PE. Hence, it appears that physical practices are more +effective in reducing the limitations of Rajas and Tamas +such as lack of mastery over upsurges of emotions and +impulsive behavior, while yoga improves the softer +qualities of Sattva. The mechanism of how physical +exercises may reduce Rajas and tamas and how yoga may +increase Sattva needs to be investigated by further studies. +Thus, we may conclude that both physical activity (to +reduce Rajas and Tamas) and Yoga (to improve Sattva) +may be recommended for the harmonious promotion of +personality. +The GHQ showed significant differences within groups +in all domains in both groups. There was a significant +difference in SS between the Y and PE groups (Mann +Whitney Test). +Observations by Atlantis et al. on the efficacy of physical +exercise practised for eight weeks in a population of +Australian employees showed that the intervention +significantly improved the Quality of Life as compared to a +waiting list control group (measured by SF-36). They have +shown an improvement of 12.8% in physical functioning, +9.90% in general health, 44.50% in vitality and 15.90% in +mental health scores.[29] The significantly better reduction +in SS in the Yoga group in our study may be due to deeper +rest and relaxation obtained in Yoga. +TABLE 8: Comparison between our data (before and after) and standard VPI data + +n +Observed range +Observed mean±SD +n +Predicted range +Predicted mean±SD +Sattva + +3.04 - 6.17 +4.90±0.53 + +3.00 - 6.39 +4.67±0.75 +Rajas +174 +2.11 - 5.25 +3.76±0.63 +247 +2.46 - 5.96 +4.07±1.08 +Tamas + +1.47 - 5.38 +3.19±0.60 + +1.43 - 6.00 +3.49±0.90 +SS: Somatic symptoms; AI: Anxiety and insomnia; SF: Social dysfunction; SP: Severe depression; TH: Total health +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] +9 +International Journal of Yoga + +! + +Vol. 1:1 + +! + +Jan-Jun-2008 +Effect of Yoga on Gunas and Health +The results of the study seem to point out clear differences +between Y and PE on VPI whereas differences between Y +and PE are not found in most domains of GHQ (except SS). +Hence, although GHQ is a good measure of the various +aspects of health and disease, VPI seems to be a better +measure to differentiate the effects of Y and PE. +In summary, this randomized, prospective, single-blind, +comparative study has shown the efficacy of both Y and +PE in improving all components of general health. While +physical exercise has reduced Rajas and Tamas, the yogic +practice has increased Sattva. Hence, yoga which is more +traditionally practised in India and cost-effective, can be +recommended with additional benefits of promotion of +the Sattva guna. +The strength of our design is a PE intervention matched +with the integrated Y module. The study population was +taken from different parts of Bangalore from different +socioeconomic classes of the city. The improvement +observed in both groups after eight weeks of intervention +in all variables in both groups not only provides hitherto +undemonstrated evidence of the efficacy of physical +activity in a normal South Indian adult population but +also shows that yoga could be an equally effective tool. +This study also brings out the subtle differences in +the efficacy of the two interventions (Y or PE). It also +points out the utility of the VPI as a tool for measuring +the subtle dimensions of guna described in traditional +texts of yoga that can measure the steps of growth of +an individual. +ACKNOWLEDGMENTS +Our grateful acknowledgements for all who helped in this project. +We are grateful to SVYASA for supporting this study. We thank +the volunteers, teachers and supporters who participated in +this study. +REFERENCES +1. +Dhirendra B. Yoga for life and living. Central Research Institute for Yoga: +New Delhi; 1968. +2. +Margareta Eriksson K, Westborg CJ, Eliasson MC. A randomized trial +of lifestyle intervention in primary healthcare for the modification of +cardiovascular risk factors. Scand J Public Health 2006;34:453-61. +3. +Brukner PD, Brown WJ. Is exercise good for you? Med J Aust 2005; +183:538-41 +4. +Stampfer M, Hu F, Manson J, Rimm E, Willett W. Primary prevention of +coronary heart disease in women through diet and lifestyle. 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Br J Educ Psychol 1985;55:164-6. +Effect of Yoga on Gunas and Health +[Downloaded free from http://www.ijoy.org.in on Tuesday, August 18, 2009] diff --git a/subfolder_0/A randomized trial comparing effect of yoga and exercises on quality of life in among nursing population with chronic low back pain.txt b/subfolder_0/A randomized trial comparing effect of yoga and exercises on quality of life in among nursing population with chronic low back pain.txt new file mode 100644 index 0000000000000000000000000000000000000000..7e93a338a04b5fba65dfa797eca8d9f220ee28d6 --- /dev/null +++ b/subfolder_0/A randomized trial comparing effect of yoga and exercises on quality of life in among nursing population with chronic low back pain.txt @@ -0,0 +1,929 @@ +© 2018 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow +208 +Introduction +Nursing profession is the largest chunk +of health‑care professionals.[1] Physical, +psychological, +and +psychosocial +challenges contribute to musculoskeletal +disorders among nurses. Chronic low +back pain (CLBP) is the most common +musculoskeletal disorder among the nurses. +It is reported that 63%–86% of nursing +professionals suffer from LBP in their +lifetime.[1,2] CLBP in nurses is multifactorial, +and the risk factors pertain to lifestyle, +physical, +psychological, +psychosocial, +and occupational domains, namely, age, +gender, physical status, smoking, workplace +stress, awkward postures, poor ergonomics, +carrying and repositioning of patients, +prolonged standing, night shifts, working +without sufficient breaks, and psychological +stress are important causative/risk factors +for CLBP in nurses. Nurses are required +to lift and transport patients or equipment, +often in difficult environment particularly +Address for correspondence: +Assoc. Prof and Head. +Nitin J Patil, +Department of Integrative +Medicine, Sri Devaraj Urs +Academy of Higher Education +and Research, Kolar - 563 103, +Karnataka, India. +E-mail: ayushnitin@gmail.com +Abstract +Background: Chronic low back pain  (CLBP) adversely affects quality of life  (QOL) in nursing +professionals. Integrated yoga has a positive impact on CLBP. Studies assessing the effects of +yoga on CLBP in nursing population are lacking. Aim: This study was conducted to evaluate the +effects of integrated yoga and physical exercises on QOL in nurses with CLBP. Methods: A  total +of 88 women nurses from a tertiary care hospital of South India were randomized into yoga group +(n = 44; age – 31.45 ± 3.47 years) and physical exercise group (n = 44; age – 32.75 ± 3.71 years). +Yoga group was intervened with integrated yoga therapy module practices, 1 h/day and 5 days a week +for 6 weeks. Physical exercise group practiced a set of physical exercises for the same duration. All +participants were assessed at baseline and after 6 weeks with the World Health Organization Quality +of Life‑brief  (WHOQOL‑BREF) questionnaire. Results: Data were analyzed by Paired‑samples +t‑test and Independent‑samples t‑test for within‑ and between‑group comparisons, respectively, using +the Statistical Package for the Social Sciences  (SPSS). Within‑group analysis for QOL revealed a +significant improvement in physical, psychological, and social domains  (except environmental +domain) in both groups. Between‑group analysis showed a higher percentage of improvement in +yoga as compared to exercise group except environmental domain. Conclusions: Integrated yoga +was showed improvements in physical, psychological, and social health domains of QOL better than +physical exercises among nursing professionals with CLBP. There is a need to incorporate yoga as +lifestyle intervention for nursing professionals. +Keywords: Exercises, low back pain, nurses, quality of life, yoga +A Randomized Trial Comparing Effect of Yoga and Exercises on Quality of +Life in among nursing population with Chronic Low Back Pain +Original Article +Nitin J Patil, +Nagaratna R1, +Padmini Tekur2, +Manohar PV3, +Hemant Bhargav4, +Dhanashri Patil +Department of Integrative +Medicine, Sri Devaraj Urs +Academy of Higher Education +and Research, 3Department +of Orthopedics, Sri Devaraj +Urs Medical College, +Kolar, 1Medical Director, +Arogyadhama, S-VYASA +Yoga University, 2Division +of Yoga and Life Sciences, +S-VYASA Yoga University, +4Integrated Centre for Yoga +(NICY), NIMHANS, Bengaluru, +Karnataka, India +in developing nations where lifting aids are +not always available or practicable. These +multiple factors contribute toward higher +prevalence of CLBP in this population.[3] +CLBP is one of the main concerns, which +negatively impacts the quality of life (QOL) +leading to reduced work productivity, +absenteeism, +and +disabilities +among +nurses.[4] Harrington and Gill stated that +LBP is the most common cause of early +retirement on grounds of ill health, sickness +absenteeism, job changes, and a fall in the +work speed among the working population. +Especially for young nurses, the mental +demands of work have a critical influence +on their QOL and workability.[5] +QOL +measurements +are +being +used +increasingly relevant in the evaluation of +disease progression, treatment, and the +management of musculoskeletal disorders. +QOL is recognized as a concept representing +individual +responses +to +the +physical, +mental, and social effects of illness on daily +Access this article online +Website: www.ijoy.org.in +DOI: 10.4103/ijoy.IJOY_2_18 +Quick Response Code: +How to cite this article: Patil NJ, Nagaratna R, Tekur P, +Manohar PV, Bhargav H, Patil D. A randomized trial +comparing effect of yoga and exercises on quality of +life in among nursing population with chronic low back +pain. Int J Yoga 2018;11:208-14. +Received: January, 2018. Accepted: April, 2018. +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 +Patil, et al.: Yoga for nurses with low back pain +International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018 +209 +living, which influences the extent of personal satisfaction +with life circumstances that can be achieved. Measuring +QOL is recognized as an important add‑on to objectify +clinical effectiveness in recent clinical trials.[6,7] CLBP is +a major deterrent for QOL, and the QOL scores correlate +with pain and disability of CLBP. Furthermore, QOL +correlated inversely with poor quality of sleep in nursing +population. Such multifactorial problems of CLBP demand +a multifaceted approach for management.[8‑10] +Yoga has emerged as a popular mind‑body therapy for +CLBP as suggested by emerging scientific literature across +the globe.[11] Yoga adopts a multifaceted approach utilizing +practices at body (postures), breath (breathing techniques), +and mind levels  (meditation and relaxation techniques), +respectively. According to national surveys, yoga practice +and research have increased exponentially and in the last +decade with over 10 million Americans practicing yoga for +health reasons in 2002 and over  13 million in 2007.[11‑13] +Literature review reveals that viniyoga, hatha yoga, Iyengar +yoga, and integrated yoga are the most commonly used +forms to treat LBP.[14‑16] +In a systematic review, Chou and Huffman concluded +that there was a fair evidence reflecting efficacy of +yoga therapy in subacute or CLBP.[17] In another similar +review +which +included +four +randomized +controlled +trials  (RCTs), it was observed that the intervention by +Iyengar yoga and viniyoga for a period of 12–24  weeks +was beneficial in CLBP.[15] Yet, another meta‑analysis +consisting of eight RCTs by Cramer et  al. found strong +evidence for short‑term effectiveness  (pain, back‑specific +disability, and global improvement parameters) and +moderate evidences (back‑specific disability) for long‑term +effectiveness of yoga on CLBP. Yoga was not found to be +associated with serious adverse events.[18] +A study by Tekur et  al. had observed usefulness of yoga +intervention in improving QOL in patients with CLBP. +However, this study was used in general population with +intense residential yoga intervention. We did not come +across any study that has assessed the same in nursing +population with an OPD or outdoor setup intervention +(1 h/day). As discussed earlier, nursing population is more +prone for CLBP due to specific demands of the occupation. +Thus, the present randomized controlled study was planned +to compare the effect of integrated yoga and physical +exercise of similar intensity on QOL of nurses suffering +from LBP. +Methods +Subjects +This study was conducted among nursing population, +who were diagnosed by an orthopedician to be suffering +from CLBP. Participants were working in the tertiary +care teaching hospital in Kolar district of Karnataka state +in India. They were randomly divided into two groups: +yoga (n  =  44; age  –  31.45  ±  3.47  years) and physical +exercise (n = 44; age – 32.75 ± 3.71 years) using random +number generator  (www.randomizer.org). Participants in +the two groups did not differ much in relation to their age, +education, or duration of illness between the groups as +shown in Table 1. +Two groups’ randomized controlled single‑blind design was +followed with participants from both the groups (yoga and +exercise) receiving intervention for 6  weeks. Assessments +for QOL were performed at two points of time at baseline +and after 6 weeks of interventions. The statistician and the +interviewer were unaware of the allocation status of the +participants. +The inclusion requirements were as follows:  (a) female +nurses with diagnosis of either nonspecific LBP, lumbar +spondylosis, or intervertebral disc prolapse, suffering +from LBP for 3  months or more as diagnosed by an +orthopedician and  (b) knowledge of English, Hindi, +and Kannada language. The exclusion criteria were as +follows:  (a) pain due to organic causes such as infective +and inflammatory conditions, metabolic disorders, and +posttraumatic condition,  (b) patients with degenerative +disorders of muscles,  (c) patients with comorbid cardiac +or neuropsychiatric illness,  (d) history of major surgery +or injury in the past, (e) pregnant women, and (f) patients +with neurological complications of CLBP. +Written informed consent was taken from all the +participants before the study and Institutional Ethical +Clearance was obtained. +Study profile +From January 2015 to December 2016, nurses were +screened and referred by the orthopedician. Out of 176 +nurses referred for the study, 88 satisfied the study criteria. +Table 1: Sociodemographic and clinical variables +comparison between yoga and exercises +Variables +Yoga +Exercises +Number of participants (only female) +44 +44 +Age (mean±SD) +31.45±3.47 +32.75±3.71 +Education +ANM +8 +3 +GNM +28 +32 +Bachelor of nursing +8 +9 +CLBP +3 months‑1 year +34 +37 +>1 year +10 +07 +Causes +Nonspecific/muscle spasm +37 +35 +Lumbar spondylosis +6 +3 +Intervertebral disc prolapse +4 +3 +SD=Standard deviation, ANM=Auxiliary nursing midwifery, +GNM=General nursing midwifery, CLBP=Chronic low back pain +Patil, et al.: Yoga for nurses with low back pain +International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018 +210 +Informed consent was obtained. Baseline assessments +were done, and they were randomly allocated to yoga +(n  =  44) and control  (n  =  44) groups. They underwent +intervention  (either integrated yoga or physical exercise) +for 6  weeks; repeat assessments were performed on both +groups. There were no dropouts in the study. Figure  1 +provides a flow diagram of the study profile. +Materials +Assessment +The World Health Organization Quality of Life‑brief +(WHOQOL‑BREF) questionnaire English and Kannada +version was used to assess the QOL of the participants. +WHOQOL‑BREF developed by the WHO is a standardized +comprehensive +instrument +for +assessment +of +QOL +comprising 26 items. The scale provides a measure of +an individual’s perception of QOL on four domains: +(1) physical health  (seven items),  (2) psychological +health  (six items),  (3) social relationships  (three items), +and  (4) environmental health  (eight items). In addition, it +also includes two questions for “overall QOL” and “general +health” facets. The domain scores are scaled in a positive +direction (i.e., higher scores denote higher QOL). The range +of scores is 4–20 for each domain. The internal consistency +of WHOQOL‑BREF ranged from 0.66 to 0.87 (Cronbach’s +alpha coefficient). The scale has been found to have good +discriminant validity. It has good test–retest reliability and +is recommended for use in health surveys and to assess the +efficacy of any intervention at suitable intervals according +to the need of the study.[19,20] +Intervention +Integrated approach of yoga therapy  (IAYT) is based on +the basic principle that there are five layers of the existence +to human beings, namely, Annamaya Kosa  (physical +level), Pranamaya Kosa  (subtle energy level), Manomaya +Kosa (emotional level), Vijnanamaya Kosa  (level of +intellect), and Anandamaya Kosa  (level of bliss). Yogic +pathophysiology propounds that the disturbances at the +emotional level  (adhi) percolate to the physical level +(vyadhi) through the layer of prana. Furthermore, all layers +are interrelated and they affect each other indirectly. The +IAYT is an approach which consists in not only dealing +with physical layer but also includes using techniques to +operate on different layers of our existence. The practices +at body level  (Annamaya Kosa) include yogasanas, +loosening practices, at subtle energy level  (Pranamaya +Kosa) include breathing practices and pranayama, and +at the mind level  (Manomaya Kosa) are meditations and +relaxation techniques. +A 1‑h integrated yoga therapy module  (IYTM) was +designed after reviewing the literature in the field of yoga +and LBP by utilizing the components of yoga at the body, +subtle energy, and mind level, respectively. The designed +IYTM was validated by subject experts.[21] Tekur et  al. +used as a similar intervention in an earlier study.[22] This +yoga module was practiced 5 days a week for 6 weeks. The +details of yoga practice are provided in Table 2. +Self and physician refered nursing professionals with CLBP +(Recruitment Period : January 2015 to December 2016) +Assessed for Inclusion and Exclusion criteria, +Obtained informed consent form +Randomly allocatted to Yoga and Exercise group +Outcome measures were assessed at baseline for All 88 subjects +Group 1 - Yoga; n = 44 +Group 2 Exercise; n = 44 +Intervention: 1 Month (1 Hour per Day / 5 Days a week) +Group1 - IYTM for CLBP +Group 2 - Physical Exercise +Assessement of outcome measures were repeated +Statistical Analysis +Report writting +Figure 1: Trail profile +Table 2: Intervention: Integrated yoga therapy module +versus physical exercises +List of practices in IYTM for CLBP List of physical exercises +Supta udarakarshanasana (folded leg +lumbar stretch) +Standing hamstring stretch +Shava udarakarshanasana (crossed leg +lumbar stretch) +Cat and camel +Pavanamuktasana +(wind‑releasing pose) +Pelvic tilt +Setu bandhasana breathing (bridge +pose lumbar stretch) +Partial curl +Vyaghrasana (tiger breathing) +Piriformis stretch +Bhujangasana (serpent pose) +Extension exercise +Shalabhasana breathing (locust pose) +Quadriceps leg raising +Uttanapadasana (straight leg raise pose) Trunk rotation +Ardha kati chakrasana (lateral arc pose) Double knee to chest +Ardha chakrasana (half wheel pose) +Bridging +Quick relaxation techniques +Hook lying march +Nadi shuddhi (alternate nostril +breathing) +Single knee to chest stretch +Bhramari (humming bee breath) +Lumbar rotation +Nadanusandhana (A, U, M, AUM +chanting) +Press up +Deep relaxation technique +Curl ups +Laghoo shankhaprakshalana (yogic +colon cleansing) (weekly once) +IYTM=Integrated yoga therapy module, CLBP=Chronic low +back pain +Patil, et al.: Yoga for nurses with low back pain +International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018 +211 +Control group intervention +Control group practiced physical exercise of similar +intensity as IYTM for the same duration and frequency +as shown in Table  2 provides the details of control +intervention. +Data collection +Data were taken at the same time of the day on +the 1st and 43rd day. Orientation to yoga program was given +to the participants for 3  days, and then on the next day, +predata collection was done after satisfactory performance. +WHOQOL‑BREF assessments were done on day 1 and +day 43 (after 6  weeks). A  trained psychologist assisted in +data collection. +Data analysis +Statistical Package for the Social Sciences (SPSS) - (Version +21.0., Armonk, NY: IBM Corp.) was used for all analyses. +Data of all four domains were normally distributed on +Shapiro–Wilk test. Hence, the parametric tests were used. +“Paired‑samples t‑test” and “Independent‑samples t‑test” +were used to analyze within‑  and between‑group data, +respectively. +Results +Within‑group comparisons in yoga group +Within‑group pre‑  and postcomparison showed that, +after the yoga intervention, there was a significant +improvement in three domains of WHOQOL‑BREF, +namely, physical (P  <  0.01), psychological  (P  <  0.01), +and social  (P  <  0.01) with a trend of insignificant +positive impact in environmental domain  (P  =  0.07) +[Table 3]. +Within‑group comparisons in exercise group +Similar to yoga group, exercise group also showed a +significant improvement in three domains, namely, physical +(P < 0.01), psychological (P < 0.01), and social (P < 0.01) +with no significant difference in the environmental domain +(P = 0.95) [Table 4]. +Between‑group comparisons in yoga versus control +group +Preintervention data +There was a no significant difference between the +yoga and control groups at the baseline for all the four +domains of WHOQOL‑BREF:  (a) physical  (P  =  0.296), +(b) psychological  (P  =  0.987),  (c) social  (P  =  0.661), and +(d) environmental (P = 0.904) as shown in Table 5. +Postintervention data +There was a significant difference between the yoga and +control groups after the intervention in the following +domains of WHOQOL‑BREF:  (a) physical  (P  <  0.01), +(b) psychological  (P  <  0.01), and  (c) social  (P  <  0.01) +with the scores of yoga group being higher than +those of the control group for all the three domains, +respectively. +There +was +no +significant +difference +between +the +groups +for +environmental +domains +(P = 0.249). +Table 3: Within yoga group (pre and post) comparison of +World Health Organization Quality of Life‑BREF scores +Variables +Pre/ +post +Yoga group +Mean±SD +Percentage change +P +Physical +domain QOL +Pre +41.27±6.603 +44.12 +<0.001 +Post +59.48±9.041 +Psychological +domain QOL +Pre +34.91±5.356 +97.07 +<0.001 +Post +68.80±13.428 +Social domain +QOL +Pre +43.07±12.705 +55.02 +<0.001 +Post +66.77±12.004 +Environmental +domain QOL +Pre +55.70±5.325 +2.81 +0.078 +Post +57.27±6.028 +QOL=Quality of life, SD=Standard deviation +Table 4: Within exercise group (pre and post) +comparison of World Health Organization Quality of +Life‑BREF scores +Variables +Pre/ +post +Exercise group +Mean±SD +Percentage change +P +Physical +domain QOL +Pre +39.82±6.377 +25.33 +<0.005 +Post +49.91±8.575 +Psychological +domain QOL +Pre +34.93±7.315 +20.89 +<0.001 +Post +42.23±7.358 +Social domain +QOL +Pre +44.09±8.757 +14.49 +<0.001 +Post +50.48±8.609 +Environmental +domain QOL +Pre +55.84±5.278 +0.089 +0.957 +Post +55.89±5.136 +QOL=Quality of life, SD=Standard deviation +Table 5: Between group (yoga vs. exercise) comparison +of World Health Organization Quality of Life‑BREF +scores +Variables +Pre/post +Group +Mean±SD +P +Physical +domain QOL +Pre +Yoga +41.27±6.60 +0.296 +Pre +Exercise +39.82±6.34 +Post +Yoga +59.48±9.04 +<0.005 +Post +Exercise +49.91±8.57 +Psychological +domain QOL +Pre +Yoga +34.91±5.36 +0.987 +Pre +Exercise +34.93±7.31 +Post +Yoga +68.80±13.43 +<0.001 +Post +Exercise +42.23±7.36 +Social domain +QOL +Pre +Yoga +43.07±12.70 +0.661 +Pre +Exercise +44.09±8.76 +Post +Yoga +66.77±12.00 +<0.001 +Post +Exercise +50.48±8.61 +Environmental +domain QOL +Pre +Yoga +55.70±5.33 +0.904 +Pre +Exercise +55.84±5.28 +Post +Yoga +57.27±6.03 +0.249 +Post +Exercise +55.89±5.14 +Patil, et al.: Yoga for nurses with low back pain +International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018 +212 +Discussion +At the end of 6 weeks of intervention as mentioned before, +we observed that both the groups showed significant +improvements in physical, psychological, and social +domains of WHOQOL‑BREF, whereas the environmental +domain did not show significant improvements in either +of the groups. As compared to the control group, patients +who +performed +yoga +reported +significantly +higher +scores on the psychological domain  (yoga  –  97.7% and +control – 20.89%). It was further observed that percentage +improvement in physical and social domains was higher +in the yoga group as compared to the exercise group +(physical domain: yoga  –  44.12% vs. control  –  25.33%; +and social domain: yoga – 55.02% vs. control – 14.49%). +Previously, Tekur et  al.[22] demonstrated the usefulness +of a 7  day intensive residential integrated yoga in +improving QOL in 80  patients with CLBP in a highly +controlled setting where patients were away from their +occupational and other duties. They observed a significant +improvement in all the four domains of WHOQOL‑BREF +in the yoga‑based lifestyle module as compared to physical +exercise‑based lifestyle change module. One of the +limitations with such trials is that they are not practical for +working young nursing population and difficult to replicate +such studies. In our study, we used 1‑h yoga program +which included all major components of yoga therapy, +namely, asanas, pranayama, and relaxation. The exercise +group also followed similar duration and frequency of +intervention. We also observed improvement in physical, +psychological, and social domains in both the groups +but not in the environmental domain. The percentage +improvements were higher in yoga group than the exercise +group for physical, psychological, and social domains, +respectively. This may be because the intervention offered +by Tekur et al. was much more intensive than ours and the +residential setup involved exposure to such an environment +which was significantly different from the workplace. We +performed this research in much more pragmatic setup and +observed similar outcomes. +Underplaying mechanism of integrated yoga therapy +module +The probable mechanism of action of yoga may be +through improvement of autonomic functions through +triggering +neurohormonal +mechanisms +that +suppress +sympathetic activity through downregulation of the +hypothalamic–pituitary–adrenal axis.[23] Mindfulness‑based +practices may also enhance cognitive flexibility, which may +further reduce stress, anxiety, and pain, thereby improving +QOL.[24] Furthermore, the cellular effects of mechanical +and fluid pressure on structures such as cartilage suggest +that yoga postures might alter joint function. Low levels of +intermittent fluid pressure, as occur during joint distraction, +have been shown in  vitro to decrease production of +catabolic cytokines, such as interleukin‑1 and tumor +necrosis factor.[25] Yoga may be one way to provide the +motion and forces on joints needed to preserve integrity. In +addition, pranayama, meditations, and relaxation techniques +following yogasanas help to relax joints and muscles, +reduce oxidative stress, and calm the mind.[26] This study +implicates a probable role of integrated yoga therapy in the +management of patients suffering from CLBP. +In a cross‑sectional study on 501 nurses from different +hospitals of Turkey, it was observed that there was a positive +correlation between QOL as assessed by WHOQOL‑BREF +and job satisfaction  (assessed using Short‑Form Minnesota +Questionnaire).[27] Similarly, another cross‑sectional study +on 435 female nurses from five regional centers in Taiwan +revealed that associations between scores on the sleep‑quality +and QOL scales were statistically significantly inversely +correlated.[28] Another survey on 1534 nursing professionals +from eight different hospitals in Taiwan found that improved +QOL of nurses translated into better workability (which may +indirectly contribute to better health‑care service delivery to +the patients).[29] In the above study, it was also observed that +mental demands of work were a critical influence on QOL +and workability, especially in young nursing professionals. +The authors further recommended countermeasures such as +enhancing the ability to cope with the job’s mental demands +for improving and maintaining the workability of nurses. +Yoga may be considered one such intervention which +has been found useful in enhancing the ability to cope +with mental demands and thereby improve QOL and +workability of nurses. An anonymous E‑mail survey +was conducted between April and June 2010 of North +American nurses interested in mind‑body training to +reduce stress.[30] Of the 342 respondents, 96% were women +and 92% were Caucasian. Most  (73%) reported one or +more health conditions, notably anxiety  (49%), back +pain  (41%), gastrointestinal problems such as irritable +bowel syndrome (34%), or depression (33%). Their median +occupational stress level was 4 (0 = none and 5 = extreme +stress). Nearly all  (99%) reported already using one or +more mind‑body practices to reduce stress. The most +common mind‑body practices used by the nurses were +as follows: intercessory prayer  (86%), breath‑focused +meditation  (49%), healing or therapeutic touch  (39%), +yoga/tai +chi/qi +gong  +(34%), +or +mindfulness‑based +meditation  (18%). The greatest expected benefits were for +greater spiritual well‑being (56%); serenity, calm, or inner +peace (54%); better mood (51%); more compassion (50%); +or better sleep (42%).[30] +Physical domain of WHOQOL‑BREF features such as +mobility, fatigue, pain, sleep, and work capacity. The higher +percentage of improvement in the yoga group compared to +exercises therapy group can be credited to better reduction in +pain and disability with improvement in spinal flexibility.[31] +Psychological domain features such as feelings, self‑esteem, +spirituality, thinking, learning, and memory. The higher +Patil, et al.: Yoga for nurses with low back pain +International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018 +213 +percentage of improvement in the yoga group compared to +exercises therapy group may be credited to better reduction +in stress, anxiety, and depression.[31,32] +Social domain of WHOQOL‑BREF features questions +relating to problems in interpersonal relationships and +social support. Yoga also acts like cognitive behavioral +therapy; this may be the reason for the superior impact of +yoga intervention compared to physical exercises in nurses +with CLBP. +Environmental domain deals with problems relating +to financial resources, physical safety, and physical +environment such as pollution, noise, and climate. As +working environment remained same throughout, this +might have been the reason, we did not able to notice any +significant changes in the environmental domain in both +the groups. +Thus, yoga appears to be an integrated therapeutic tool +and feasible intervention for improving QOL in nursing +professionals compared to physical exercise as it offers +holistic approach. +The strengths of the study are as follows:  (a) this +multidisciplinary study encompasses the fields of yogic +science, orthopedics, and psychology;  (b) a large sample +of 88 CLBP patients were enrolled for the study with +no dropouts,  (c) no earlier study has reported effect +of integrated yoga intervention on QOL of nurses +suffering from CLBP;  (d) because the study involved +a pragmatic approach, the acceptability and adherence +to therapy were good; and  (e) as yoga and control +program was delivered through a standard protocol, +it could be reproduced in the exact way for future +interventions. +This study has a few limitations, namely: this study was +a preliminary attempt to assess the response of nursing +population suffering from CLBP, and future studies +should incorporate more objective variables such as +electromyography, radio‑imaging, biochemical measures, +and other advanced objective variables of autonomic +functions. +Conclusions +IYTM improves physical, psychological, and social +health domains of QOL among nursing professionals with +CLBP more than the physical exercises. There is a need +to incorporate yoga as lifestyle intervention for nursing +professionals with CLBP. +Acknowledgments +We are thankful for the management of Sri Devaraj Urs +Academy of Higher Education and Research, Tamaka, +Kolar, India, for their support throughout. We acknowledge +the participants who gave their consent and participated +in this study. We acknowledge Dr. Ananta Bhattacharyya, +Dr.  Balaram Pradhan, and Mr. Ravishankar S. for their +support. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +References +1. +Bls.gov. Registered Nurses Have Highest Employment in +Healthcare Occupations; Anesthesiologists Earn the Most: +The Economics Daily: U.S. Bureau of Labor Statistics; 2018. +Available from: https://www.bls.gov/opub/ted/2015/registered‑nu +rses‑have‑highest‑employment‑in‑healthcare-occupations‑anesthe +siologists‑earn‑the‑most.htm. [Last accessed on 2018 Feb 22]. +2. +Genç A, Kahraman  T, Göz E. 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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/AN EVALUATION OF THE ABILITY TO VOLUNTARILY REDUCE THE HEART RATE AFTER A MONTH OF YOGA PRACTICE.txt b/subfolder_0/AN EVALUATION OF THE ABILITY TO VOLUNTARILY REDUCE THE HEART RATE AFTER A MONTH OF YOGA PRACTICE.txt new file mode 100644 index 0000000000000000000000000000000000000000..c727031dd29c3064bf51c06c23c31c5339e22f69 --- /dev/null +++ b/subfolder_0/AN EVALUATION OF THE ABILITY TO VOLUNTARILY REDUCE THE HEART RATE AFTER A MONTH OF YOGA PRACTICE.txt @@ -0,0 +1,9 @@ + + + + + + + + + diff --git a/subfolder_0/ASSESSING DEPRESSION FOLLOWING TWO ANCIENT INDIAN INTERVENTIONS.txt b/subfolder_0/ASSESSING DEPRESSION FOLLOWING TWO ANCIENT INDIAN INTERVENTIONS.txt new file mode 100644 index 0000000000000000000000000000000000000000..c9e600c979b9dd8581b7caff2240eff86ad34d7f --- /dev/null +++ b/subfolder_0/ASSESSING DEPRESSION FOLLOWING TWO ANCIENT INDIAN INTERVENTIONS.txt @@ -0,0 +1,7 @@ + + + + + + + diff --git a/subfolder_0/Acute effects of 3G mobile phone radiations on frontal haemodynamics during a cognitive task in teenagers.txt b/subfolder_0/Acute effects of 3G mobile phone radiations on frontal haemodynamics during a cognitive task in teenagers.txt new file mode 100644 index 0000000000000000000000000000000000000000..7d2c502959e500132a32f1957bd7bf128574c36c --- /dev/null +++ b/subfolder_0/Acute effects of 3G mobile phone radiations on frontal haemodynamics during a cognitive task in teenagers.txt @@ -0,0 +1,1733 @@ +Full Terms & Conditions of access and use can be found at +http://www.tandfonline.com/action/journalInformation?journalCode=iirp20 +Download by: [14.139.155.82] +Date: 27 July 2016, At: 04:08 +International Review of Psychiatry +ISSN: 0954-0261 (Print) 1369-1627 (Online) Journal homepage: http://www.tandfonline.com/loi/iirp20 +Acute effects of 3G mobile phone radiations on +frontal haemodynamics during a cognitive task +in teenagers and possible protective value of Om +chanting +Hemant Bhargav, Manjunath N. K., Shivarama Varambally, A. +Mooventhan, Suman Bista, Deepeshwar Singh, Harleen Chhabra, Ganesan +Venkatasubramanian, Srinivasan T. M. & Nagendra H. R. +To cite this article: Hemant Bhargav, Manjunath N. K., Shivarama Varambally, A. Mooventhan, +Suman Bista, Deepeshwar Singh, Harleen Chhabra, Ganesan Venkatasubramanian, +Srinivasan T. M. & Nagendra H. R. (2016) Acute effects of 3G mobile phone radiations +on frontal haemodynamics during a cognitive task in teenagers and possible +protective value of Om chanting, International Review of Psychiatry, 28:3, 288-298, DOI: +10.1080/09540261.2016.1188784 +To link to this article: http://dx.doi.org/10.1080/09540261.2016.1188784 +Published online: 07 Jun 2016. +Submit your article to this journal +Article views: 135 +View related articles +View Crossmark data +Citing articles: 1 View citing articles +ORIGINAL ARTICLE +Acute effects of 3G mobile phone radiations on frontal haemodynamics +during a cognitive task in teenagers and possible protective value of +Om chanting +Hemant Bhargava, Manjunath N. K.a, Shivarama Varamballyb, A. Mooventhana, Suman Bistaa, +Deepeshwar Singha, Harleen Chhabrab, Ganesan Venkatasubramanianb, Srinivasan T. M.a and +Nagendra H. R.c +aAnvesana Research Laboratories, Division of Yoga and Life Sciences, S-VYASA Yoga University, Bangalore, India; bDepartment of +Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; cS-VYASA Yoga University, +Bangalore, India +ABSTRACT +Mobile phone induced electromagnetic field (MPEMF) as well as chanting of Vedic mantra ‘OM’ +has been shown to affect cognition and brain haemodynamics, but findings are still inconclusive. +Twenty right-handed healthy teenagers (eight males and 12 females) in the age range +of 18.25 ± 0.44 years were randomly divided into four groups: (1) MPONOM (mobile phone ‘ON’ +followed by ‘OM’ chanting); (2) MPOFOM (mobile phone ‘OFF’ followed by ‘OM’ chanting); (3) +MPONSS (mobile phone ‘ON’ followed by ‘SS’ chanting); and (4) MPOFSS (mobile phone ‘OFF’ +followed by ‘SS’ chanting). Brain haemodynamics during Stroop task were recorded using a +64-channel fNIRS device at three points of time: (1) baseline, (2) after 30 min of MPON/OF expos- +ure, and (3) after 5 min of OM/SS chanting. RM-ANOVA was applied to perform within- and +between-group comparisons, respectively. Between-group analysis revealed that total scores on +incongruent Stroop task were significantly better after OM as compared to SS chanting +(MPOFOM vs MPOFSS), pre-frontal activation was significantly lesser after OM as compared to SS +chanting in channel 13. There was no significant difference between MPON and MPOF conditions +for Stroop performance, as well as brain haemodynamics. These findings need confirmation +through a larger trial in future. +ARTICLE HISTORY +Received 8 January 2016 +Revised 10 April 2016 +Accepted 7 May 2016 +Published online 2 June 2016 +KEYWORDS +Electro-magnetic field; +mobile phone; om chanting; +pre-frontal activation; Stroop +Introduction +With over 5.9 billion reported mobile phone users, +mobile phone constitutes to a new rapidly growing +exposure network in the world, putting almost all the +humans into a wide spectra of electromagnetic radi- +ation. Mobile phones emit a radiofrequency electro- +magnetic field (MPEMF), a large part of energy of +which is absorbed into the user’s head (Schonborn, +Burkhardt, & Kuster, 1998). Accumulating evidence +suggests that MPEMF may alter brain physiology. +Modulating effects of MPEMF on the human electro- +encephalogram in waking and sleep have repeatedly +been demonstrated in recent years, while results on +cognitive +performance +are +inconsistent +(Regel +& +Achermann, 2011). The lack of a validated tool, which +reliably assesses changes in cognitive performance +caused by MPEMF exposure, may contribute to the +current +inconsistency +in +outcomes +(Regel +& +Achermann, 2011). Some behavioural studies have sug- +gested that EMF might have a facilitative effect on +cognitive performance (Preece et al., 2005; Smythe & +Costall, 2003), although more recent studies primarily +revealed an impairment of mental abilities or no effect +at all (Haarala, Aalto et al., 2003; Haarala, Bj€ +ornberg +et al., 2003; Regel & Achermann, 2011). Results of a +meta-analysis suggested that MPEMF might have a +small impact on human attention and working mem- +ory +(Barth, +Ponocny, +Ponocny-Seliger, +Vana, +& +Winker, 2010). All these studies have chiefly been per- +formed on adults and children. Studies on teenage +group are lacking. This age-group is among the most +prolific users of mobile phones, which puts them at +higher risk for MPEMF exposure-related effects (Aydin +et al., 2011). +Functional near-infrared spectroscopy (fNIRS) is a +new non-invasive optical method that can measure the +real +time +change +in +oxygenated +haemoglobin +(oxyHb) and deoxygenated haemoglobin (deoxyHb) +concentrations and their sum, i.e. total haemoglobin +(totalHb) or blood volume in the brain areas, suggesting +CONTACT Hemant Bhargav +hemant.bhargav1@gmail.com +Anvesana Research Laboratories, Division of Yoga and Life Sciences, S-VYASA Yoga +University, Bangalore, India + 2016 Institute of Psychiatry +INTERNATIONAL REVIEW OF PSYCHIATRY, 2016 +VOL. 28, NO. 3, 288–298 +http://dx.doi.org/10.1080/09540261.2016.1188784 +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +activation (increase in oxygenation) or deactivation +(reduction in oxygenation) of a particular brain area +(Ferrari & Quaresima, 2012). An fNIRS device has +excellent temporal resolution, and fNIRS results are +physiologically comparable to fMRI and PET results +(Obrig & Villringer, 2003). In a study using fNIRS, local +cerebral blood flow (CBF) on short-term exposure to +MPEMF was measured in 26 boys, aged 14–15 years. +Temperatures were also measured from both ear canals, +and skin temperatures at several sites of the head, +trunk, and extremities. It was found that local CBF and +ear canal temperature did not change and the auto- +nomic nervous system was not interfered with by +MPEMF (Lindholm et al., 2011). The study showed the +utility of fNIRS for EMF-related research. Compared to +previous studies using PET, fNIRS provides a much +higher time resolution, which allows investigation of +the short-term effects of EMF non-invasively, without +the use of radioactive tracers and with high sensitivity. +The Stroop task is a useful test of selective attention +and +inhibition +and +involves +frontally +mediated +cognitive processes such as response inhibition and +interference +resolution +(Stroop, +1935). +Functional +neuro-imaging studies have found several areas of the +prefrontal cortex that appear to be specifically acti- +vated during the performance Stroop task. The Stroop +task has been used in several PET, fMRI, and fNIRS +studies (Taylor, Kornblum, Lauber, Minoshima, & +Koeppe, 1997). +OM is a cosmic sound that has a harmonizing effect +on the system (Kumar, Nagendra, Manjunath, Naveen, +& Telles, 2010). An fMRI study assessed neuro-haemo- +dynamic correlates of ‘OM’ chanting and found signifi- +cant deactivation in bilateral orbito-frontal, anterior +cingulate, para-hippocampal gyri, thalami, and hippo- +campi, and right amygdala as compared to chanting of +the sound Ssss or ‘SS’. Since similar observations have +been recorded with vagus nerve stimulation treatment +which +is +used +in +depression +and +epilepsy +management, the study findings argued for a potential +role of OM chanting in clinical practice (Kalyani, +Venkatasubramanian, Arasappa, Rao, Kalmady, Behere, +et al., 2011). Another recent study used fNIRS to assess +the immediate effect of 20 min of OM meditation (men- +tal chanting with effortless defocusing on syllable ‘OM’) +on Stroop task and found better performance and effi- +ciency (deactivation of pre-frontalcortices) after OM +meditation (Deepeshwar, Vinchurkar, Visweswaraiah, +& Nagendra, 2014). +Very few studies have assessed the effect of MPEMF +exposure on cognitive functions and brain haemo- +dynamics in adolescent population using fNIRS (Kwon +& H€ +am€ +al€ +ainen, +2011). Similarly, the effect of OM +chanting on the above variables after mobile phone +exposure has not been assessed before. We hypothe- +sized that MPEMF exposure of 30 min would affect +Stroop +task +performance +and +pre-frontal +haemo- +dynamics during the task in teenagers, and OM chant- +ing of 5 min following MPEMF exposure will have a +balancing effect on changes induced by MPEMF. The +present pilot study was planned to assess feasibility of +the protocol for future larger trails. +Materials and methods +Participants +We enrolled 20 right-handed teenagers (eight males +and 12 females) in the age range of 18.25 ± 0.44 years +from educational institutes in Bangalore city of India. +All subjects were healthy, as assessed by general health +questionnaire (GHQ-12), their mean GHQ score was +0.8 ± 0.69, +and +average +body +mass +index +was +21.7 ± 3.7 kg/m2. Subjects were fresh admissions in an +undergraduate degree course after recently clearing +their higher secondary school examinations and their +last academic performance was with an aggregate of +72.48 ± 11.3%, suggesting absence of mental retardation +or other significant psychological morbidity. Subjects +who were able to read and write in English language +were selected. Subjects who had visual disturbances or +colour blindness (screened using Ishihara Charts) or +those with a peak flow rate below 150 L/min were +excluded; those who were regular meditators or who +were regularly chanting OM (or other similar mantras) +for the last 1 month or more were also excluded. +Similarly, female subjects were excluded during men- +struation. Subjects were given a week long orientation +in performing OM chanting or producing the sound +‘sssss +. . .’ +(SS) +for +same +duration +before +the +assessments. +Study design +A four groups randomized controlled design was fol- +lowed. Each subject was exposed to mobile phone on/ +off for 30 min and then was asked to chant OM or SS +for 5 min. Depending on the status of phone (on or off) +and whether it is followed by chanting OM or SS, sub- +jects +were +randomly +divided +into +four +groups. +Randomization was performed using an online ran- +domization program (www.randomizer.org). It was gen- +der-stratified randomization to include equal number of +males and females (two males and three females) in +each +group. +Four +groups +were +as +follows: +(1) +INTERNATIONAL REVIEW OF PSYCHIATRY +289 +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +MPONOM group: In this group, subjects were exposed +to MPEMF through a mobile phone in ‘ON’ mode for +30 min and after this subjects chanted OM for 5 min; +similarly, +in +(2) +MPOFOM +group: +Subjects +were +exposed to mobile phone in ‘OFF’ mode and chanted +OM; in (3) MPONSS group: Subjects were exposed to +mobile phone in ‘ON’ mode followed by ‘SS’ chanting; +and, lastly in (4) MPOFSS group: subjects were exposed +to mobile phone in ‘OFF’ mode and chanted ‘SS’ after- +wards. Assessments were done at three points of time +in each group: (1) Baseline; (2) After mobile phone on/ +off exposure; and (3) after OM/SS chanting. Table 1 +provides demographic details of the subjects in each +group. Demographic details did not differ significantly +between the groups. A schematic representation of the +study design is provided in Figure 1. Signed informed +consent was taken from the subjects who were above +18 years of age and from the guardian/parents of those +below 18 years of age. Research was approved by insti- +tutional ethical committee. +EMF exposure settings +The source of EMF was a 2100 MHz 3G mobile phone +with a Universal Mobile Telecommunications System’s +(UMTS) network. It was an FCC approved device and +had a head specific absorption ratio (SAR) of 0.4 W/ +Kg and body SAR of 0.54 W/Kg. Subjects sat on a +comfortable chair with head resting on the chair and +two identical mobile phones were kept at 0.5 cm dis- +tance from the tragus, one on each side, using an +adjustable wooden stand. On calling mode, the device +emitted average EMF energy of 1.305 ± 0.94 mW/m2 +(with peak value of 2.34 mW/m2) at 5 mm. Left side +mobile was kept in off mode permanently with battery +removed. Right side mobile status only was changed +depending on the group to which the subject belongs. +Identical phones were kept on both sides at the same +distance from the ear to rule out lateralization effects +on brain haemodynamics. When subjects were exposed +to MPEMF, i.e. in MPON groups, fully charged mobile +was placed on the right side and a call was made for +30 min from another phone. Both the phones (caller +and receiver) were kept mute throughout. During +sham exposure, the right side mobile was kept off with +battery removed. Subjects were unaware of the group +status +they +were +allocated +to. +A +counterbalanced +experiment with eight independent subjects, each with +four trials, indicated that the subjects could not detect +the EMF exposure condition any better than by guess- +ing (response accuracy 50%). FNIRS cap was fixed on +the head of the subject and recording was taken in a +dark room with a computer screen displaying Stroop +task. Figure 2 shows the settings of the study. During +the 30- min period of mobile phone on/off exposure, +subjects +heard +an +audio +describing +geography +of +Karanataka state. To ensure that subjects remained +awake during this period, subjects were asked to +Table 1. Demographic details of the subjects. +Variables/Group +MPONOM (mean ± SD) +MPOFOM (mean ± SD) +MPONSS (mean ± SD) +MPOFSS (mean ± SD) +n +5 +5 +5 +5 +Age (years) +18.40 ± 0.548 +18.40 ± 0.548 +18.20 ± 0.447 +18.20 ± 0.447 +Gender (numbers) +Male (n ¼ 2) +Female (n ¼ 3) +Male (n ¼ 2) +Female (n ¼ 3) +Male (n ¼ 2) +Female (n ¼ 3) +Male (n ¼ 2) +Female (n ¼ 3) +Height (m) +1.64 ± 0.06 +1.63 ± 0.08 +1.61 ± 0.12 +1.63 ± 0.05 +Weight (kg) +53.60 ± 4.10 +52.98 ± 6.61 +56.80 ± 8.32 +61.40 ± 20.71 +BMI (kg/m2) +20.41 ± 1.83 +20.10 ± 1.94 +21.69 ± 3.71 +22.40 ± 7.01 +Head circumference (cm) +53.80 ± 1.10 +54.40 ± 1.82 +55.00 ± 1.41 +55.20 ± 0.84 +Last academic performance (%) +74.20 ± 8.56 +77.60 ± 7.96 +71.36 ± 12.13 +72.76 ± 12.01 +GHQ-12 scores +0.9 ± 0.44 +0.8 ± 0.50 +0.8 ± 0.31 +0.7 ± 0.66 +MPONOM: mobile phone ‘ON’ followed by ‘OM’ chanting; MPOFOM: mobile phone ‘OFF’ followed by ‘OM’ chanting; MPONSS: mobile +phone ‘ON’ followed by ‘SS’ chanting; MPOFSS: mobile phone ‘OFF’ followed by ‘SS’ chanting. +Figure 1. Schematic representation of the study design. R: Rest; C: Congruent task; I: Incongruent task. +290 +H. BHARGAV ET AL. +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +answer 10 simple multiple choice questions at the end, +based on the audio. Those scoring more than 50% +were only included in the study further. +fNIRS device +We used a 64 channel continuous wave fNIRS device +(NIRx Medical Technologies, LLC, NY, USA) with a +sampling rate of 15.6 Hz. With eight light emitting +sources and eight detector probes, 18 channels were +measured quasi-simultaneously over both the pre- +frontal cortices using two wavelengths of near-infrared +light (760 nm and 850 nm). Probes were fixed on the +head based on 10–20 system using whole head stand- +ard sized caps (NIRScaps) for the age group assessed. +Figure 3 provides the montage and Table 2 provides +the channel distribution of fNIRS device followed in +the study. +Stroop task and procedure +Subjects were seated comfortably on a reclining chair +in a Faraday cage, facing a 21-inch LCD monitor +placed at a distance of 70 cm from their eyes. The cog- +nitive paradigm used in the present study was Stroop +task. The traditional 100 item paper and pencil version +of Stroop was projected on a computer screen and ver- +bal responses were recorded. The Stroop task was +designed based on the paradigm followed in previous +research (Taniguchi, Sumitani, Watanabe, Akiyama, & +Ohmori, 2012). During the Stroop task subjects were +asked to read as many words as possible on a com- +puter screen displaying 100 words. Subjects were ran- +domly presented with words ‘red’, ‘blue’, ‘yellow’, and +‘green’ which were written in red, blue, yellow, and +green ink. The task was presented in block design that +consisted of rest periods and two test conditions: con- +gruent and incongruent. In the congruent condition +the name of the word was congruent with the colour +of the ink and subjects were asked to read them out. +In incongruent conditions, the four words were written +in incongruent colours. The time for Stroop task was +fixed and it was given using an automated software for +a total duration of 2 min and 30 s in the following +blocks: 30 s rest - 30 s task (congruent) - 30 s rest - +30 s task (incongruent) - 30 s rest. In the rest periods, +clear instructions were shown to the subject for the +next task condition, for e.g. before congruent condition +the instruction was: ‘Please read the words on the +screen loudly and as quickly as possible’ and before +Figure 3. Montage of the study. +Figure 2. Settings of the study. +INTERNATIONAL REVIEW OF PSYCHIATRY +291 +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +the incongruent condition the instruction was: ‘Please +read the colour of the words on the screen loudly and +as quickly as possible’. Each subject was given orienta- +tion to the task 1 day prior to data collection. The +responses (number of total, correct, and incorrect +responses in 30 s of each condition) were recorded +manually by two trained psychologists using an answer +key for each condition. Both psychologists were blind +to the group allocations of the subject. Data was con- +sidered valid only when the scores from both the psy- +chologists were matching. The fNIRS measurement +was performed during the whole task. Markers were +applied for each task condition (congruent and incon- +gruent) +during +recording +to +segregate +respective +haemodynamic responses. +OM/SS chanting procedure +All the subjects were trained in ‘OM’ chanting by an +experienced yoga teacher and an orientation training +of 1 week was given to all the subjects before data col- +lection. The subjects were trained to chant ‘OM’ loudly +without distress and interruption—the vowel (O) part +of the ‘OM’ for 5 s continuing into the consonant +(M) part of the ‘OM’ for the next 10 s, maintaining a +ratio of 1:2. The control condition was continuous +production of ‘sssss . . .’ or ‘SS’ syllable for the same +duration. This was chosen to control for the expiratory +act of chanting ‘OM’, but without the vibratory sensa- +tion around the ears (Kalyani et al., 2011). +Data extraction and analysis +NIRS optical intensity data was processed by NIRstar +acquisition software and extracted using accompanying +topography +software +(nirsLAB; +NIRx +Medical +Technologies, LLC). Data were corrected for the effects +of vascular pulsation (Gratton & Fabiani, 2010). Pulse +corrected data were filtered using a low-pass (zero +phase +shift) +filter +with +a +cut-off +frequency +at +0.01–0.2 Hz. For every subject, the channel measure- +ments showing low signal-to-noise ratio were dis- +carded. Linear trends of continuous oxyHb changes +and fluctuations were also eliminated. For oxyhaemo- +globin (oxyHb) concentration changes a 30 s baseline +was taken for analysis. To obtain haemodynamic data, +the +modified +Beer–Lambert +Law +was +applied +to +artifact-free segments (Hoshi, Kobayashi, & Tamura, +1985). We focused on oxyHb concentration changes +for further analysis because they provide the most +robust signal-to-noise ratio and are the most sensitive +parameter of cerebral blood flow (Hoshi et al., 1985; +Sato et al., 2012). Values for changes in oxyHb were +obtained during the contrast of interest (Incongruent +minus Congruent Stroop), i.e. Stroop interference, for +all 18 channels at three points of time: (1) Baseline, +(2) Post mobile on/off, and (3) Post OM/SS for all the +four +groups +(MPONOM, +MPOFOM, +MPONSS, +MPOFSS). Similarly, Stroop task performance was +assessed at these three points of time for the four +groups. +Analysis +of +variance-repeated +measures +(RM- +ANOVA) was used for data analysis using SPSS ver- +sion 10. For analysis of Stroop performance, Stroop +task condition (correct, incorrect, and total scores for +each condition: congruent and incongruent) was the +dependent variable with ‘group’ as between-subjects +and ‘time point’ as within-subject factor. For haemo- +dynamics data, one multivariate RM-ANOVA analysis +was performed for all the 18 fNIRS channels. Channels +1–18 were the dependent variable (level), with ‘group’ +as between-subjects and ‘time point’ as within-subject +factor. +Post-hoc +comparisons +between +individual +groups/time points were made through Bonferroni’s +correction after checking for significance of main +effects or interactions. +Results +Forty-six subjects were screened, out of which 30 gave +consent to participate in the study. Out of 30, 24 satis- +fied the selection criteria and orientation training was +started. +Finally, +four +subjects +left +the +project +in +between and final data collection was successfully per- +formed on 20 subjects. +Stroop performance +As depicted in Figure 4, for Stroop incongruent total +scores (task condition), RM-ANOVA revealed signifi- +cant main effects for the time points, F(2, 15) ¼ 28.57, +p < 0.001, and a significant interaction between group +and time point, F(6, 32) ¼ 4.64, p < 0.05. Follow-up +Bonferroni’s adjustment showed that total scores in +Table 2. Channel distributions followed in the study while using fNIRS device. +Left side +S1-D1 +S2-D1 +S2-D2 +S3-D1 +S3-D3 +S4-D1 +S4-D2 +S4-D3 +S4-D4 +Ch-1 +2 +3 +4 +5 +6 +7 +8 +9 +Right side +S5-D5 +S5-D6 +S5-D7 +S5-D8 +S6-D6 +S6-D8 +S7-D7 +S7-D8 +S8-D8 +10 +11 +12 +13 +14 +15 +16 +17 +18 +S1–S8: Sources; D1–D8: Detectors; Ch1–18: Channels. +292 +H. BHARGAV ET AL. +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +incongruent Stroop task were significantly better in +MPOFOM group after OM chanting as compared to +those in MPOFSS group after SS chanting (Table 3; +Figure 4). Within-group analysis showed that there +was a significant improvement in total scores of incon- +gruent Stroop task after OM chanting in MPONOM +(p < 0.01) and MPOFOM (p < 0.001) groups as com- +pared to the baseline and in MPOFOM group as com- +pared to the post-mobile values (p < 0.05), respectively +(Table 4). Also, in MPONSS group, there was a signifi- +cant improvement in scores of same task condition +after +SS +chanting +as +compared +to +the +baseline +(p < 0.01; Table 4). For other task conditions no sig- +nificant main effects or interactions were observed. +fNIRS results +Multivariate RM-ANOVA for all the 18 channels +revealed +significant +main +effects +for +levels +[F(2, +5) ¼ 6.18; p < 0.05; Effect Size ¼0.62] and significant +interaction between level and group [F(6, 12) ¼ 5.82, +p < 0.05; Effect Size ¼0.60]. Subsequent RM-ANOVA +tests for each channel showed significant main effects +for the time points in fNIRS channels 2, 6, 7, 8, 10, +13, and 18 [Channel 2: F(2, 26) ¼ 3.51, p < 0.05; +Channel 6: F(2, 26) ¼ 3.27, p < 0.05; Channel 7: F(2, +26) ¼ 6.11, +p < 0.01; +Channel +8: +F(2, +26) ¼ 6.05, +p < 0.01; +Channel +10: +F(2, +26) ¼ 3.11, +p < 0.05; +Channel 13: F(2, 26) ¼ 3.41, p < 0.05; Channel 18: F(2, +26) ¼ 3.46, +p < 0.05] +and +a +significant +interaction +between group and time point for channels 13 and 18 +[Channel 13: F(6, 26) ¼ 2.50, p < 0.05; Channel 18: +Figure 4. Graph showing changes in total scores of incongru- +ent Stroop task in all the four groups at three points of time: +Group: 1: MPONOM; 2: MPONSS; 3: MPOFOM; 4: MPOFSS; Level: +1: Baseline; 2: After 30 min of MPON/OF exposure; 3: After OM/ +SS chanting. Y-axis: Total scores during Stroop Incongruent +Task. +Table 3. Comparison within groups for Stroop performance at the baseline, after mobile phone on/off exposure and after OM/SS +chanting. +Group +Task +condition +Scores +Baseline +(mean ± SD) (1) +After mobile +(mean ± SD) (2) +After OM/SS +(mean ± SD) (3) +F values +(df hypothesis, +error) +Effect +size +pa value +(1 vs 2) +pa value +(2 vs 3) +pa value +(1 vs 3) +MPONOM +CT +C +47.00 ± 12.79 +51.40 ± 14.69 +53.00 ± 6.86 +(2,15) 1.71 +2.53 +1 +1 +1 +IC +1.00 ± 1.00 +1.00 ± 0.71 +1.00 ± 1.22 +(2,15) 0.91 +0.01 +1 +1 +1 +T +50.40 ± 6.11 +51.60 ± 5.77 +53.20 ± 5.97 +(2,15) 0.81 +1.14 +1 +1 +1 +ICT +C +25.60 ± 3.97 +27.40 ± 7.37 +30.60 ± 4.22 +(2,15) 2.48 +2.06 +1 +0.934 +0.072 +IC +1.80 ± 2.17 +1.20 ± 1.30 +1.60 ± 1.14 +(2,15) 0.51 +0.24 +0.624 +0.533 +1 +T +27.40 ± 3.97 +28.60 ± 7.47 +32.20 ± 4.66 +(2,15) 6.03 +2.03 +1 +0.821 +0.033* +MPONSS +CT +C +45.80 ± 3.19 +43.20 ± 6.30 +46.40 ± 7.50 +(2,15) 3.76 +1.38 +1 +0.342 +1 +IC +1.20 ± 1.30 +2.20 ± 1.48 +1.60 ± 1.14 +(2,15) 0.34 +0.41 +0.267 +0.914 +1 +T +48.40 ± 4.62 +46.20 ± 4.92 +49.80 ± 4.92 +(2,15) 0.84 +1.48 +1 +0.276 +1 +ICT +C +25.20 ± 3.56 +29.20 ± 3.96 +30.00 ± 5.39 +(2,15) 2.1 +2.09 +0.057 +1 +0.072 +IC +2.00 ± 1.58 +1.80 ± 1.92 +2.00 ± 1.58 +(2,15) 0.24 +0.09 +1 +1 +1 +T +27.20 ± 3.42 +31.00 ± 2.83 +32.00 ± 4.95 +(2,15) 6.79 +2.06 +0.215 +1 +0.028* +MPOFOM +CT +C +46.40 ± 6.02 +48.80 ± 3.63 +50.00 ± 3.67 +1.93 (2,15) +1.49 +0.466 +1 +1 +IC +0.40 ± 0.89 +0.20 ± 0.45 +0.40 ± 0.55 +(2,15) 0.21 +0.24 +1 +1 +1 +T +49.80 ± 13.41 +56.00 ± 12.19 +54.80 ± 5.81 +(2,15) 21.5 +2.60 +0.662 +1 +1 +ICT +C +26.00 ± 5.10 +30.60 ± 3.91 +35.40 ± 2.07 +(2,15) 2.87 +3.83 +0.141 +0.084 +0.065 +IC +1.80 ± 1.48 +1.60 ± 0.89 +1.40 ± 1.14 +(2,15) 0.10 +0.16 +1 +1 +1 +T +27.80 ± 4.60 +32.20 ± 4.02 +36.80 ± 2.77 +(2,15) 21.5 +3.67 +0.234 +0.034* +0.052 +MPOFSS +CT +C +51.40 ± 3.78 +49.40 ± 9.15 +52.60 ± 6.39 +(2,15) 1.17 +1.31 +1 +0.226 +1 +IC +1.20 ± 1.30 +1.40 ± 1.67 +1.40 ± 1.14 +(2,15) 0.21 +0.94 +1 +1 +1 +T +45.80 ± 2.39 +43.80 ± 6.02 +48.60 ± 7.02 +(2,15) 1.1 +1.96 +1 +0.19 +1 +ICT +C +21.40 ± 8.88 +24.20 ± 5.97 +24.80 ± 4.32 +(2,15) 1.2 +1.48 +0.985 +1 +0.616 +IC +3.40 ± 3.97 +2.60 ± 2.19 +2.00 ± 2.35 +(2,15) 2.7 +0.57 +1 +0.211 +0.404 +T +24.80 ± 5.02 +26.80 ± 4.44 +26.80 ± 2.39 +(2,15) 1.32 +0.94 +0.958 +1 +0.871 +CT: Congruent task; ICT: Incongruent task; C: Correct score; IC: Incorrect score; T: Total score. +aRepeated measures ANOVA after Bonferroni’s adjustment. +*p < 0.05. +INTERNATIONAL REVIEW OF PSYCHIATRY +293 +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +F(2, 26) ¼ 2.53, p < 0.05]. Post-hoc analysis through +Bonferroni’s +correction +further +revealed +that +pre- +frontal oxygenation was significantly lesser in the +MPOFOM group after OM chanting as compared to +the MPONSS group after SS chanting in channel 13 +(p < 0.05) and channel 18 (p < 0.05; Table 5; Fig. 5 +and 6). Within-group analysis showed that there was a +significant reduction in oxygenation after OM chanting +in the MPOFOM group as compared to post-MPOF +values in channels 2, 6, 7, 8, 13, and 18 (Table 5). +Also, in the MPONSS group, there was a significant +increase in pre-frontal oxygenation in channel 10 after +SS chanting as compared to the baseline (p < 0.05; +Table 5). For other fNIRS channels no significant +main effects or interactions were observed. +Discussion +The present pilot work was planned to assess feasibility +of the protocol for future larger trails. We found the +protocol to be feasible and none of the subjects +reported any side-effects. We did not observe any sig- +nificant difference between MPON or MPOF condi- +tions +for +Stroop +Task +performance +or +brain +haemodynamics, but there was a tendency for better +Stroop incongruent performance and reduced oxygen- +ation in some channels after OM chanting as com- +pared +to +SS +chanting. +Previously, +Regel +and +Achermann (2011) reviewed 41 studies, where distinct +cognitive tasks were employed at various levels of diffi- +culty +to +evaluate +effects +of +MPEMF. +Six +studies +revealed an increase in performance speed, and seven +studies reported a decrease. Similarly, accuracy of per- +formance was reduced and elevated in several experi- +ments. Most of the previous studies have not found +any effect of MPEMF exposure for less than 20 min on +brain haemodynmaics (Regel & Achermann, 2011); +therefore, in the present trial we chose a duration of +30 min for exposure. In the present study, even after +30 min of MPEMF exposure, we did not observe any +significant improvement or decline in cognitive per- +formance or changes in brain haemodynamics. The +present study used a task (Stroop task) which requires +less duration and yet is complex enough to elicit a +cognitive response (Stroop, 1935). Previously, a cross- +sectional study used the Stroop task to find out associ- +ations between cognitive performance and mobile +phone use and found that mobile phone use was asso- +ciated with faster and less accurate responding to +higher level cognitive tasks (Abramson et al., 2009). +In +another +study, +the acute +effect +of +45 min +of +MPEMF exposure was tested on 168 subjects using +the Stroop paradigm. Subjects were in the age range +Table 4. Comparison between MPOFOM and MPOFSS groups for Stroop Performance (Incongruent Task) at the baseline, after mobile phone on/off exposure and after OM/SS +chanting. +Correct score +Incorrect score +Total score +MPOFOM +MPOFSS +F value +(df contrast, +error) +pa value +MPOFOM +MPOFSS +F value +(df contrast, +error) +pa value +MPOFOM +MPOFSS +F value +(df contrast, +error) +pa value +Baseline +26.00 ± 5.10 +21.40 ± 8.88 +(3,16) 0.67 +1 +1.80 ± 1.48 +3.40 ± 3.97 +(3,16) 0.91 +1 +27.80 ± 4.60 +24.80 ± 5.02 +(3,16) 0.63 +1 +After mobile on/off +30.60 ± 3.91 +24.20 ± 5.97 +(3, 16) 0.32 +0.5 +1.60 ± 0.89 +2.60 ± 2.19 +(3,16) 0.63 +1 +32.20 ± 4.02 +26.80 ± 4.44 +(3,16) 0.33 +0.63 +After OM/SS +35.40 ± 2.07 +24.80 ± 4.32 +(3,16) 5.38 +0.005** +1.40 ± 1.14 +2.00 ± 2.35 +(3,16) 0.17 +1 +36.80 ± 2.77 +26.80 ± 2.39 +(3,16) 5.6 +0.006** +MPOFOM: mobile phone off followed by Om chanting; MPOFSS: Mobile phone off followed by ‘SS’ chanting. +aRM-ANOVA after Bonferroni’s adjustment. +**p < 0.01. +294 +H. BHARGAV ET AL. +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +of 18–42 years. It was observed that, with neutral +Stroop condition, the mean reaction time of subjects +was significantly lesser when exposed to MPEMF +signals than in the sham condition, whereas with +incongruent Stroop condition, there was no signifi- +cant difference between the groups (Cinel, Boldini, +Fox, & Russo, 2008). In the present study, we did +not +find +any +difference +in +performance +between +MPEMF and sham exposure for either congruent or +incongruent Stroop task after 30 min of exposure. +This may be due to a very small sample size in the +present study as compared to the study by Cinel +et al. (2008). Probably, 45 min of MPEMF exposure +would have produced some changes in cognitive per- +formance, as observed by Cinel et al. (2008), but, +since the institutional ethical committee did not per- +mit exposure of mobile phone radiation for more +than 30 min to teenagers, the duration of 30 min +was chosen for our study. +A previous positron emission tomography (PET) +study found increased cerebral blood flow (CBF) in +the prefrontal cortex after 30 min exposure to a 900- +Table 5. Significant changes in oxyHb levels (lmol/l) in different groups across fNIRS channels. +Group +Channel +Side +Baseline +(mean ± SD) +(1) +After mobile +(mean ± SD) +(2) +After OM/SS +(mean ± SD) +(3) +F values +(df hypoth- +esis, error) +Effect size +pa value +(1 vs 2) +pa value +(2 vs 3) +pa value +(1 vs 3) +MPOFOM +2 +Left +1.41 ± 6.43 +4.50 ± 2.77 +4.95 ± 5.94 +(2, 26) 3.51 +0.46 +1 +0.03* +0.18 +6 +Left +2.12 ± 4.91 +3.67 ± 3.43 +7.58 ± 3.60 +(2, 26) 3.27 +0.46 +0.28 +0.03* +0.51 +7 +Left +3.76 ± 9.24 +9.21 ± 3.37 +2.27 ± 8.42 +(2, 26) 6.11 +0.52 +0.55 +0.04* +0.11 +8 +left +0.33 ± 5.22 +6.40 ± 2.27 +5.17 ± 2.88 +(2, 26) 6.05 +0.64 +0.40 +0.002** +0.26 +13 +Right +2.27 ± 5.87 +2.36 ± 2.00 +6.74 ± 5.72# +(2, 26) 3.41 +0.42 +0.86 +0.04* +0.32 +18 +Right +1.34 ± 10.46 +4.11 ± 1.50 +8.16 ± 8.39$ +(2, 26) 3.46 +0.57 +0.55 +0.03* +0.016* +MPONSS +10 +Right +1.94 ± 7.19 +0.70 ± 8.10 +3.77 ± 4.78 +(2, 26) 3.11 +0.49 +1 +1 +0.011* +13 +Right +0.81 ± 6.55 +0.40 ± 5.56 +1.68 ± 2.40# +(2, 26) 0.74 +0.04 +1 +0.71 +1 +18 +Right +0.54 ± 4.66 +2.16 ± 6.82 +1.11 ± 3.40$ +(2, 26) 0.72 +0.04 +1 +0.75 +1 +oxyHb: oxygenated haemoglobin; fNIRS: functional near infrared spectroscopy; MPOFOM: mobile phone ‘OFF’ followed by ‘OM’ chanting; MPONSS: mobile +phone ‘ON’ followed by ‘SS’ chanting. +aRepeated measures ANOVA after Bonferroni’s adjustment +*p < 0.05; +**p < 0.01. +#Significant between-group differences; F(6, 26) ¼ 2.50, p < 0.05. +$Significant between-group differences; F(2, 26) ¼ 2.53, p < 0.05. +Figure 5. Graph showing changes in oxyHb levels in channel +13 during Stroop task in all the four groups at three points of +time: Group: 1: MPONOM; 2: MPONSS; 3: MPOFOM; 4: MPOFSS; +Level: 1: Baseline; 2: After 30 min of MPON/OF exposure; 3: +After OM/SS chanting. Y-axis: Concentration of oxygenated +haemoglobin (oxyHb) expressed in lmol/l. +Figure 6. Graph showing changes in oxyHb levels in channel +18 during Stroop task in all the four groups at three points of +time: Group: 1: MPONOM; 2: MPONSS; 3: MPOFOM; 4: MPOFSS; +Level: 1: Baseline; 2: After 30 min of MPON/OF exposure; 3: +After OM/SS chanting. Y-axis: Concentration of oxygenated +haemoglobin (oxyHb) expressed in lmol/l. +INTERNATIONAL REVIEW OF PSYCHIATRY +295 +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +MHz GSM signal (Huber et al., 2005). Another +similar PET study showed decreased cerebral blood +flow +in +the +temporal +cortex +after +a +continuous +51 min exposure to a 902-MHz GSM signal (Aalto +et al., 2006). A brain energy metabolism study done +using PET on 13 young male subjects exposed to a +pulse modulated 902.4 MHz GSM for 33 min while +performing +a +simple +visual +vigilance +task +also +showed that relative cerebral metabolic rate of glu- +cose was significantly reduced in the temporo-par- +ietal junction and anterior temporal lobe of the right +hemisphere ipsilateral to the exposure (Kwon et al., +2011). Another study investigated the effects induced +by an exposure to a GSM signal on brain BOLD +(blood-oxygen-level dependent) response, as well as +its time course while performing a Go–No-Go task. +BOLD response of active brain areas and reaction +times (RTs) while performing the task were meas- +ured both before and after the exposure. It was +observed that reaction times to the somato-sensory +task did not change as a function of exposure (real +vs sham) to GSM signal. BOLD results revealed sig- +nificant activations in inferior parietal lobule, insula, +precentral, and postcentral gyri associated with Go +responses +after +both +‘real’ +and +‘sham’ +exposure, +whereas no significant effects were observed in the +between-group analysis. The authors concluded that +there were no changes in BOLD response as a con- +sequence of EMFs exposure (Curcio et al., 2012). +Most of these researches used a 900 MHz GSM sig- +nal which corresponds to the 2G spectrum and the +results were mixed. In the present study, depending +on +the +increasing +use, +we +exposed +subjects +to +2170 MHz UMTS (which corresponds to 3G spec- +trum MPEMFs) to find that results may not differ +much with the band width of EMFs. Very few stud- +ies have used a fNIRS device to assess effects of +MPEMF +before. +In +one +study +(Wolf, +Haensse, +Morren, +& +Froehlich, +2006), +effects +of +GSM +900 MHz signals (EMF) were assessed on the cere- +bral blood circulation using near-infrared spectropho- +tometry in a three armed (12 W/kg, 1.2 W/kg, +sham), double blind, randomized crossover trial in +16 healthy volunteers. During exposure there was a +borderline significant short -term responses of oxy- +haemoglobin +(oxyHb) +and +deoxyhaemoglobin +(deoxyHb) +concentration, +which +correspond +to +a +decrease of cerebral blood flow and volume. The +authors found that there was no detectable dose–res- +ponse relation or long-term response within 20 min +of exposure and the detection limit was a fraction of +the +regular +physiological +changes +elicited +by +functional activation. The above study did not use a +cognitive task along with the fNIRS device. In the pre- +sent study, we did not assess the effect of MPEMF dur- +ing the exposure on brain haemodynamics, but only +after the exposure, on the haemodynamic responses +during a cognitive challenge to understand the mechan- +ism through which MPEMF exposure may affect cogni- +tive +functions. +Our +results +also +demonstrated +no +significant change. The only effect we observed was a +slight tendency towards higher activation during Stroop +interference after MPEMF exposure in channel 10 +(right side) in the MPONSS group after SS chanting as +compared to the baseline. Since the sample size in the +present work is very small as compared to previous +researches; it is difficult to draw definitive conclusions +at present. Cognition enhancing effects of OM chanting +have been reported in a few studies before. In a com- +parative study, middle latency auditory evoked poten- +tials were recorded in 18 male volunteers with ages +between 25–45 years before, during, and after 20 min of +OM chanting as compared to chanting of syllable ‘one’. +There was a significant difference between senior and +naive subjects’ response in terms of increase and reduc- +tion in peak amplitude of Na waves, suggesting experi- +ence dependent neural changes due to OM chanting +(Telles, Nagarathna, & Nagendra, 1994). Previously, +Deepeshwar et al. (2014) assessed the immediate effect +of 20 min of OM meditation (mental chanting with +effortless defocusing on syllable ‘OM’) on Stroop task +using fNIRS technology. They found that the mean +reaction time was shorter during Stroop colour word +task with concomitant reduction in total haemoglobin +after OM meditation as compared to random thinking +for same duration, suggestive of improved performance +and efficiency after OM meditation in task-related to +attention. Our findings with OM chanting of 5 min are +similar to this study (Deepeshwar et al., 2014), i.e. there +may be lesser pre-frontal activation with better per- +formance on cognitive tasks after OM chanting. This +may suggest improved efficiency, i.e. better cognitive +output with lesser utilization of resources after OM +chanting. Previous researches also report that medita- +tion may induce a state of reduced psycho-physiological +arousal +with +enhanced +awareness +and +attention +(Subramanya & Telles, 2009). Thus, chanting OM ver- +bally may have similar effects, as produced by mental +chanting with effortless defocusing on syllable OM, +even when it is chanted for as low a duration as 5 min. +Although +there +were +between-group +differences +(MPOFOM vs MPOFSS) where incongruent Stroop +task performance after OM chanting was significantly +better as compared to SS chanting, this result was +296 +H. BHARGAV ET AL. +Downloaded by [14.139.155.82] at 04:08 27 July 2016 +found within the MPOFOM group only and not in the +MPONOM group. In our study, each subject per- +formed the Stroop task three times and the last per- +formance was after OM/SS chanting. As Stroop tasks +are +known +to +produce +a +practice +effect +(Lemay, +B +edard, Rouleau, & Tremblay, 2004), the possibility of +the results being obtained simply due to practice effect +cannot be denied. Also, the sample size in our study is +very small to draw any conclusion. Deactivation of +pre-frontal cortices following OM chanting may be +due to the vibrations produced by the sound ‘OM’, +which may have a stimulating effect on branch of +vagus nerve in the ear canal (Kalyani et al., 2011). +Although the present study followed a randomized +controlled design and used an objective functional +neuro-imaging device, along with a standard validated +cognitive task to assess effect of MPEMF exposure and +OM chanting on teenagers, small sample size is a major +limitation which restricts generalization of the results. +As a traditional version of Stroop was used, it was not +possible to record the reaction time along with Stroop +performance scores. In future, we plan to overcome +these shortcomings and repeat the same protocol with +larger sample size to confirm the findings. +Conclusion +Although it was observed that MPEMF exposure of +30 min did not produce any significant impact on cog- +nition or brain haemodynamics of teenagers, and OM +chanting had some cognition enhancing effect which +was associated with lesser oxygenation of pre-frontal +cortices during the task in some channels, no definite +conclusion can be drawn from this preliminary study. +The study protocol followed in the present study was +found feasible and a future trial with larger sample +size is implicated. +Acknowledgements +The authors are thankful to the Science and Engineering +Research +Board +(SERB), +Department +of +Science +and +Technology (DST), Ministry of Science and Technology, +Government of India for funding this research work. +Disclosure statement +The authors report no conflicts of interest. 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(2006). +Do GSM 900MHz signals affect cerebral blood circula- +tion? A near-infrared spectrophotometry study. Optics +Express, 14, 6128–6141. +298 +H. BHARGAV ET AL. +Downloaded by [14.139.155.82] at 04:08 27 July 2016 diff --git a/subfolder_0/Autonomic changes in Brahmakumaris Raja yoga meditation.txt b/subfolder_0/Autonomic changes in Brahmakumaris Raja yoga meditation.txt new file mode 100644 index 0000000000000000000000000000000000000000..16d2a709b4e40fd990ada07f76de3f821fb6a460 --- /dev/null +++ b/subfolder_0/Autonomic changes in Brahmakumaris Raja yoga meditation.txt @@ -0,0 +1,1710 @@ +International Journal of +Psychophysiology, 15 (1993) 147-152 +0 1993 Elsevier +Science +Publishers +B.V. All rights reserved +0167-8760/93/$06.00 +147 +INTPSY +00471 +Autonomic changes in Brahmakumaris +Raja yoga meditation +Shirley Telles and T. Desiraju +Department of Neurophysiology, National Institute of Mental Health and Neuroscience& Bangalore (India) +(Accepted +4 May 1993) +Key words: Autonomic +change; +Meditation; +Heart +rate; Skin resistance; +Finger plethysmogram; +Respiratory +rate +This report +presents +the changes +in various +autonomic +and respiratory +variables +during +the practice +of Brahmakumaris +Raja +yoga meditation. +This practice +requires +considerable +commitment +and involves concentrated +thinking. +18 males in the age range of +20 to 52 years (mean 34.1 5 8.1), with 5-25 years experience +in mediation +(mean +10.1 f 6.2). participated +in the study. Each subject +was assessed +in three test sessions which included +a period of meditation, +and also in three control +(non-meditation) +sessions, which +included +a period +of random +thinking. +Group +analysis +showed +that the heart +rate during +the meditation +period +was increased +compared +to the preceding +baseline +period, +as well as compared +to the value during +the non-meditation +period of control +sessions. +In contrast +to the change +in the heart rate, there was no significant +change +during +meditation, +for the group +as a whole, in palmar +GSR, finger plethysmogram +amplitude, +and respiratory +rate. On an individual +basis, changes +which met the following +criteria +were +noted: (11, changes +which were greater +during +meditation +(compared +to its preceding +baseline) +than changes +during post meditation +or non-meditation +periods +(also compared +to their preceding +baseline); +(2), Changes +which occurred +consistently +during +the three +repeat +sessions +of a subject +and (3), changes +which +exceeded +arbitrarily-chosen +cut-off +points +(described +at length +below). +This +individual +level analysis +revealed +that +changes +in autonomic +variables +suggestive +of both +activation +and +relaxation +occurred +simultaneously +in different +subdivisions +of the autonomic +nervous +system in a subject. +Apart +from this, there were differences +in +patterns +of change +among +the subjects +who practised +the same meditation. +Hence, +a single model +of sympathetic +activation +or +overall +relaxation +may be inadequate +to describe +the physiological +effects of a meditation +technique. +INTRODUCTION +Most of the reports +on physiological +effects of +meditation +have dealt with Transcendental +Medi- +tation +(TM), +Zen +and +Tantric +Yoga. +TM +was +adapted +from the Indian +Yogic tradition +by Ma- +harishi +Mahesh +Yogi. Practising +TM, subjects +sit +in a comfortable +posture +and +silently +repeat +a +given +mantram, +returning +their +attention +to it +whenever +attention +wanders. +Zen +meditation +forms an integral +part of Zen Buddhism. +Subjects +sit in the lotus position, +keep their eyes open and +their attention +focussed +(initially +on their breath- +Correspondence +to: S. Telles, +Vivekananda +Kendra +Yoga +Research +Foundation, +No. 9, Appajappa +Agrahara, +Cham- +arajpet, +Bangalore-560018. +India. +ing, and later on, on a ‘Koan’ or riddle). +Tantric +Yoga involves +intense +concentration +of attention, +with the ultimate +aim of channelling +all of ones +energies +into the spiritual +energy +of union +with +the object of devotion. +The +practice +of TM was reported +to cause +reductions +in heart +rate, +respiratory +rate, +and +oxygen consumption, +and to increase +the level or +stability +of the electrodermal +response +(Wallace, +1970; Wallace +et al., 1971). A later report +(Heide, +1986), noted +a difference +in the heart-rate +re- +sponse +but +not +in the +electrodermal +response +evoked +by 80 dB tones, +when +TM practitioners +and non-meditators +were compared. +Contradictory +results +were +observed +in Zen +and Tantric +meditations. +One +set of studies +re- +ported +changes +suggestive +of autonomic +activa- +tion +(Hirai, +1974; Corby +et al., 19781, whereas +148 +another +set of studies +reported +changes +sugges- +tive of autonomic +relaxation +(Kasamatsu +and Hi- +rai, 1966; Sugi and Akutsu, +1968; Elson +et al., +1977) +With +the background +of contradictory +reports +on the effects of meditation +techniques, +the pre- +sent study was carried +out to determine +whether +a given meditation +technique +would +bring +about +the same effects +in all the subjects +practising +it. +Practitioners +with 5 or more years of experience +in Brahmakumaris +Raja +yoga +meditation +were +chosen. +This +technique +requires +considerable +commitment +and involves +concentrated +thinking. +METHODS +Subjects +18 healthy +male volunteers +participated +in this +study They were between +20 and 52 years (mean +& S.D. was 34.1 t- 8.1 years), +and they had 5-25 +years +experience +of the +meditation +procedure +(mean + S.D. +was +10.1 f 6.2 years). +The +study +was explained +to the subjects +and +their +signed +informed +consent +was taken, +according +to the +ethics laid down by the Indian +Council +of Medical +Research; +New Delhi. +Meditation +The Brahmakumaris +Raja (= Raj) yoga medi- +tation +(BK) has spread +from +the organisation’s +headquarters +at Mount +Abu +(Rajasthan, +India) +throughout +India, +and to other +countries +as well. +During +meditation, +subjects +sit in a comfortable +posture +with their eyes open, and with gaze fixed +on a meaningful +symbol +(a light). +At the same +time they actively think positive +thoughts +about +a +Universal +force +pervading +all over, +as light +and +peace (Easy Raj Yoga, 1981). +Test sessions +Each +subject +was +assessed +in two types +of +session +involving +either +a meditation +period +(with +targetted +thinking) +or a non-meditation +period +(with random +thinking). +Each type of session +was +repeated +thrice on different +days, but at the same +time of day. +During +the recording +session +the subject +sat in +a comfortable +chair in a dimly-lit, +air-conditioned +and +sound-attenuated +cabin. +Subjects +were +ob- +served +throughout +on a closed-circuit +television. +Each session was of 36 min duration, +of which 24 +min +was spent +in meditation +(with +eyes open) +preceded +and followed +by 6-min periods +of relax- +ation, +also with eyes open. These +meditation +ses- +sions +were +repeated +thrice +by each +subject +on +different +days. In addition, +there were also three +non-meditation +(‘control’) +sessions, +which +were +similar +in design, +except +that +the period +corre- +sponding +to the 24 min of meditation +was spent +sitting +relaxed, +without +targetted +thinking. +Data acquisition +and analysis +Recordings +were +made +on Grass +model +78D +polygraph. +EKG +was recorded +using +a standard +limb lead +II configuration. +Skin resistance +(SR) +was recorded +with AgCl +disc electrodes +placed +approx. +4 cm apart +on the palmar +surface +of the +right hand. +Electrode +gel CSR (Technocarta, +Hy- +derabad, +India) +was used, and a constant +current +of 10 PA was passed. +Finger +plethysmogram +am- +plitude +was recorded +with a photo-cell +transducer +kept at the base of the right thumb +nail. Respira- +tion was recorded +via a rubber +stethograph +con- +nected +through +a pressure +transducer. +In addition, +the EEG was recorded +from elec- +trodes +placed +at F3, F4, 01 and 02, referenced +to the contralateral +earlobe. +Also, EOG +and chin +EMG +were recorded +as is usual +for sleep-stage +scoring +(Rechtschaffen +and +Kales, +1968). +This +allowed +any sleep +episodes +to be detected +and +excluded +from the analysed +data. +The SR values +were sampled +at 20-s intervals +from the continuously +acquired +record. +The heart +rate +was obtained +by counting +the +number +of +QRS complexes +occurring +in successive +epochs of +40-s periods +analysed +throughout. +The respiratory +rate was calculated +from the record +by counting +the breath +cycles in successive +40-s epochs contin- +uously. +20 s or its multiple +(i.e., 40 s) time epochs +were +used while +calculating +SR, heart +rate +and +respiratory +rate to make +it feasible +to correlate +these data with that of EEG +acquired +simultane- +ously and subjected +to computerized +power spec- +tral analysis +in 20-s epochs. +For the present +group +of meditators +the EEG data have been presented +elsewhere +(Kulkarni +et al., 1988), and have not +been +reiterated +here +as no interesting +correla- +tions +emerged +between +autonomic +and +EEG +changes. +The +finger +plethysmogram +amplitude +was calculated +from measurements +made +on 20 +plethysmogram +waves picked up randomly +in each +6-min period. +Data +analysis +was done +in two ways, viz., (I), +For the group as a whole two statistical +tests were +used. (a), A two-factor +(Factor +A, meditation +vs. +non-meditation +and +Factor +B, pre +vs. during) +ANOVA +was carried +out to assess the effects of +both factors, +as well as the interaction +of all four +variables +listed +above +(Snedecor +and +Cochran, +1967; Zar, 1984). (b), A paired +t-test (two-tailed) +149 +was performed +on the averaged +data. The values +of each variable +obtained +in the three meditation +sessions of a subject were averaged +for: (a>, the-24 +min period +of meditation; +(b), the corresponding +24 min period +of a non-meditation +session; +(cl, +the baseline +state of the 6-min period +in the eyes +open state preceding +the meditation, +or the non- +meditation +period +in the corresponding +type of +sessions +and +(d), the post-meditation +(or post- +non-meditation +period). +The +averaged +data +of +each of the 18 meditators +were subjected +to the +paired +t-test +(two-tailed) +to assess +at the group +level whether +the following +comparisons +were sig- +nificantly +different: +(a>, meditation +period +and its +preceding +(eyes open) +baseline +period; +(b), non- +meditation +period +and its preceding +(eyes open) +TABLE +I +Heart rate in different conditions of the meditation and non-meditation sessions of the 18 subjects +M, meditation +period; +pre-M, +period +preceding +Meditation; +NM, non-mediation +period; +n, number +of values averaged +per subject; +pre-NM, +period +preceding +Non-meditation; +n.s., not significant. +Subject +&e +Meditation +Heart rate per 40 s (mean i S. D.) +(years) +experience +, +f +years) +Pre-M +M +Pre-NM +NM +(n = 20) +(n = 80) +(n = 20) +(n = 80) +DRN +38 +8 +RR +48 +18 +NAR +28 +8 +MNH +28 +5 +NLN +40 +16 +AM +30 +9 +MN +52 +15 +MG +29 +5 +JGN +34 +10 +SM +41 +5 +DP +20 +8 +su +38 +6 +SVP +30 +5 +AC +31 +18 +AG +36 +15 +FE +22 +5 +MR +33 +15 +GA +35 +25 +Mean k S.D. +Paird +t-test +(two-tailed) +on data of +whole group +51.4 + 2.8 +42.1 * 0.8 +50.4 * 3.9 +51.5 f 1.6 +44.6 f 2.6 +54.4 f 0.6 +56.4 * 0.9 +50.5 f 3.5 +40.9 f 3.1 +42.8 k 3.9 +61.0 + 2.5 +63.0 + 6.1 +53.3 f 1.6 +53.4 * 0.3 +62.2 k 1.6 +39.0 * 1.4 +48.5 + 0.7 +49.2 k 4.7 +50.81 f 7.1 +51.5 k 2.7 +43.3 k 1.8 +52.6 f 4.0 +57.5 f 2.3 +45.1 f 1.8 +60.0 k 2.7 +55.6 * 0.8 +54.9 * 2.9 +48.3 f 3.0 +43.5 f 3.5 +60.3 + 3.5 +62.5 f 5.1 +51.7 k 2.1 +54.1 f 1.3 +65.2 + 2.0 +41.5 * 0.9 +48.6 f 1.1 +51.8 f 3.6 +52.7 + 6.8 +t (17) 2.66 +P < 0.02 +(M vs. pre-M) +49.6 + 1.9 +42.9 f 5.0 +53.6 i 3.9 +47.6 k 2.9 +45.8 k 3.6 +54.9 + 5.5 +55.9 f 0.8 +51.6 f 2.9 +47.4 f 0.6 +41.6 + 1.9 +54.1 f 1.6 +58.3 + 5.0 +51.2 k 1.5 +51.2 f 0.7 +59.8 + 0.7 +42.1 f 2.7 +47.8 f 3.4 +47.7 + 5.5 +50.2 * 5.3 +49.9 * 3.3 +43.2 f 4.5 +55.5 + 5.9 +47.7 k 2.4 +45.3 + 3.2 +53.9 f 5.1 +55.2 k 0.9 +51.9 * 1.9 +45.8 + 1.8 +42.0 k 2.5 +53.5 * 1.4 +58.5 k 5.1 +50.1 * 2.0 +50.2 k 1.8 +58.9 f 1.4 +42.5 + 1.6 +48.5 f 3.0 +45.7 f 4.7 +49.9 * 5.3 +t (17) 1.19 +n.s. +(NM vs. pre-NM) +Note: paired +t-test (two-tailed) +M vs. NM, t (17) 3.84 P < 0.01. +150 +baseline +period; +(cl, meditation +period +and non- +meditation +period +and +Cd), post-meditation +pe- +riod and pre-meditation +period. +(II), +On +an +individual +basis +data +were +also +examined +and changes +which +met the following +criteria +were +noted: +(a), changes +during +medita- +tion (compared +to the preceding +period) +should +exceed +those +during +post-meditation +or +non- +meditation +periods +(also compared +to the initial +baseline +period); +(b), changes +should +occur in one +direction, +consistently +during +the +three +repeat +sessions +of a subject +and Cc), in order +to quantify +the change, +arbitrary +cut-off +points +were selected +for each variable +as follows: changes +in heart rate +should +be equal +to/more +than +2 beats +per 40 s, +similarly +for respiration, +a change +equal to/more +than one breath +per 40 s, for SR a change +equal +to/more +than +10 k0; +and for finger +plethysmo- +gram amplitude +a change +equal +to or more than +0.40 cm. +RESULTS +Heart rate +Group analysis. The +two-factor +ANOVA +did +not reveal significance +of (a), meditation +vs. non- +meditation +(F = 1.35); (b), states (pre vs. during) +(F = 0.31) +or (c), interaction +between +the +two +factors +(F = 0.50). +In contrast, +with +the paired +t-test, +comparison +of the data of meditation +(Ml +against +pre-meditation +(pre-M) +for the +18 sub- +jects as a group +showed +that the heart +rate was +increased +by 2.1 beats per 40 s during +M, and the +difference +was significant +(P < 0.02) (see the last +row of the column +M of Table +I). There +was no +significant +change during +the non-mediation +(NM) +period compared +to its preceding +baseline +(paired +t-test, +two-tailed, +see the last row of the column +NM of Table +I). A third comparison +(M vs. NM) +revealed +that +the heart +rate during +M was also +significantly +higher +than +during +NM (P < 0.01, +paired +t-test, two-tailed, +last row of the column +of +the extreme +right of Table +I). Also, since one way +of removing +the regression +of each treatment +on +its baseline +is to analyse +the change +score of heart +rate of the 18 subjects +CM-pre-M +vs. NM-pre- +NM). These data were subjected +to analysis +using +the paired +t-test, which revealed +that the change +scores +of +M +(mean += + 1.4 change +of +heart +rate/40 +s) were +significantly +different +from +the +change +scores of the NM condition +(mean = 0.3 +change +of heart rate/40 +s (t (17) 2.97, P < 0.01). +Also, the heart-rate +values of the meditation +con- +dition have a significant +correlation +with the base- +line value +of the subjects +obtained +in the pre- +meditation +period +(r = 0.94, P < 0.001 (2)), or in +the pre non-meditation +sitting +period +(r = 0.93, +P < 0.001 (2)). +Individual analysis. The heart-rate +data of each +subject +were also examined +separately. +Based on +the three criteria +mentioned +above (Methods +sec- +tion, +under +data +analysis), +it was noted +that +in +eight +subjects +there +was a definite +trend +of in- +crease +in heart +rate during +M, whereas +one sub- +ject showed +a decrease +in heart +rate during +NM. +Other parameters +(SR, finger plethysmogram am- +plitude, respiratory rate) +Group +analysis (using both two factor ANOVA, +as well +as the +paired +t-test> +did +not +reveal +a +significant +effect +of meditation +compared +to its +preceding +baseline, +or to the non-meditation +pe- +riod (P > 0.10 for both tests and in all the com- +parisons +described +in detail +for heart rate). +The group mean +&S.D. values for these three +variables +were as follows (11, SR; pre-M = 256.5 ++ 62.1 kR, +M = 246.3 + 55.8 K, pre-NM += 264.3 +f 47.6 K, and NM = 271.3 + 41.3 K. (2), Respira- +tory rate; pre-M = 12.1 + 2.4 breaths/40 +s, M = +13.4 t- 3.5 +breaths/40 +s, +pre-NM += 11.9 + 1.8 +breaths/40 +s, and NM = 12.2 k 2.3 breaths/40 +s. +(31, Finger +plethysmogram +amplitude; +pre-M = +1.68 k 0.74 cm, M = 1.24 f 0.64 cm, pre-NM += +1.72 + 0.71 cm, and NM = 1.66 + 0.56 cm.. +Individual +level +analysis +(based +on the three +criteria +cited +in the Methods +section) +has been +summarized +in Table +II. +It is given +below +in +detail. +Cl), SR; During +M, 5 subjects +showed +a +decrease +and 3 showed +an increase. +In contrast, +during +NM 7 subjects +showed an increase +and 3 a +decrease. +(2), Respiratory-rate +changes +occurred +during +M (but +not during +NM), +i.e., 4 subjects +showed +a decrease, +one showed +a increase. +(3), +Finger +plethysmogram +amplitude; +during +M, 4 +151 +TABLE +II +Changes in heart rate, palmar GSR, finger plethysmogram am- +plitude and respiratory rate based on individual leuel analysis +I, increase; +D, decrease; +M, Meditation +period; +Pre-M, period +preceding +meditation; +NM, nonmeditation +period; +pre-NM, +period +preceding +non-mediation +period. +Parameter +Number of subjects showing change +M against +NM against +pre-M +pre-NM +I +D +I +D +Heart +rate +8 +0 +0 +1 +Palmar +SR +3 +5 +7 +3 +Finger +plethysmogram +amplitude +0 +4 +2 +0 +Respiratory +rate +1 +4 +0 +0 +subjects +showed +a decrease, +whereas +2 subjects +showed an increase +during +NM. +DISCUSSION +The most +important +finding +of this study +on +the effects of Brahmakumaris +Raja yoga medita- +tion was a small (but consistent) +increase +in the +heart +rate +during +meditation, +compared +to the +preceding +period, +as well +as compared +to the +non-meditation +period. +In contrast, +changes +in +respiratory +rate, finger plethysmogram +amplitude +and SR were fewer and often +in opposite +direc- +tions for the subjects +practising +the same medita- +tion. However, +they were consistent +during +repeat +sessions +of a subject. +These individual +differences +did not seem to be correlated +with differences +in +age, duration +of meditation +experience, +or com- +mitment +to meditation. +Individual +differences +in +autonomic +response +specificity +have been +known +for a long time. Detailed +descriptions +have shown +that autonomic +responses +are a function +of both +the +evoking +stimulus +(stimulus-response +speci- +ficity) and of the responding +individual +(individ- +ual response +specifity +(Engel, +1960). It is interest- +ing to speculate +that the contradictory +reports +on +Transcendental +Meditation +(TM), +Zen, +and +Tantric +yoga, +described +in the +Introduction +as +either ‘activating’ +or ‘relaxing’, +may in fact be due +to differences +in the individual +response +patterns. +Holmes +(1984) +commented +that +no +studies +showed +consistent +differences +between +resting +and meditating +subjects +in heart rate, electroder- +ma1 activity, +respiratory +rate +and +other +similar +variables. +However, +he stated +that in 4 out of 16 +experiments, +meditating +subjects +showed +greater +increases +in heart +rate than +did resting +subjects, +and none +showed +decreases. +In this study +also, +the most +consistent +change +was an increase +in +heart +rate during +the practice +of Brahmakumaris +Raja +yoga +meditation +which +was suggestive +of +cardiosympathetic +activation, +and a possible +sign +of psychophysiological +arousal. +This finding +can +be correlated +with the fact that +BK meditation +requires +intense +involvement +and concentration. +The changes +in the other variables +(though +often +consistent +for an individual) +did not reveal +any +group pattern. +These +results +suggest +that use of some auto- +nomic +and respiratory +variables +(e.g., heart +rate) +may reveal +group +effects +of meditation, +whereas +other variables +can alter in an individualistic +way. +Hence, +a single +model +of meditation +producing +either +overall +relaxation +or overall +activation +is +probably +inadequate. +REFERENCES +Corby, +J.C., +Roth, +W.T., +Zarcone, +V.P. +and +Kopell, +B.S. +(1978) +Psychophysiological +correlates +of the practice +of +Tantric +yoga meditation. +Arch. Gen. Psychiatr., 35: 571- +577. +Easy +Raj +yoga +(1981) +Prajapita Byahmakumaris +Ishwariya +Vishwa, Vidyalaya, +Bombay, +pp. 82 + 5. +Elson, +B.D., +Hauri, +P., and +Cunis, +D. (1977) +Physiological +changes +in Yoga meditation. +Psychophysiology, 14: 52-57. +Engel, B.T. (1960) Stimulus-response +and individual-response +specificity. +Arch. Gen. Psychiatr 2: 305-313. +Heide, +F. (1986) Psychophysiological +responsiveness +to audi- +tory stimulation +during +Transcendental +Meditation. +Pry- +chophysiology, 23: 71-75. +Hirai, +T. (1974) +The PsychophysioLogy of Zen, Igako +Shoin, +Tokyo. +Holmes, +D.S. (1984) Meditation +and somatic +arousal: +A re- +view of the experimental +evidence. +Am. Psychol. 39: l-10. +Kasamatsu, +A. and +Hirai, +T. (1966) +An electroencephalo- +graphic +study on the Zen meditation +(Zazen). +Folio Psy- +chiatr. Neural. Japonica, 20: 315-336. +Kulkarni, +D.D., +Ramachandra, +M., Hanumanthaiah. +B.H., +Narasimhalu, +G.. Joseph, +C. and Desiraju, +T. (1988) EEG +power +changes +in senior +practitioners +of Transcendental +Meditation, +Brahmakumaris +Raja +yoga +and +Pranayama. +Ind. J. Physiol. Pharmacol., 32: 419-420. +Rechtschaffen, +A. and Kales, +A. (1968). +A Manual of stan- +dard&d +terminology, techniques, and scoring system of hu- +man subjects, Public +Health +Service +Government +Printing +Office, +Washington, +pp. 8-15. +Snedecor, +G.W. +and Cochran, +W.G. +(1967) Statistical Meth- +ods, Oxford +& IBH, New Delhi, 593 pp. +Sugi, Y. and Akutsu, +K. (1968) Studies +on respiration +and +energy +metabolism +during +sitting +in Zazen. +Res. J. Phys. +Edu., 12: 190-206. +Wallace, +R.K. (1970) Physiological +effects +of Transcendental +Meditation. +Science, 167: 1751-1754. +Wallace, +R.K., +Benson, +H., and Wilson, +A.F. (1971) A wake- +ful hypometabollic +physiologic +state. +Am. J. Physiol., 221: +795-799. +Zar, J.H. (1984) Biostatistical analysis Prentice-Hall +Interna- +tional, +Englewood +Cliffs, pp. xiv + 718. diff --git a/subfolder_0/CHANGES IN P300 FOLLOWING TWO YOGA BASED RELAXATION TECHNIQUES.txt b/subfolder_0/CHANGES IN P300 FOLLOWING TWO YOGA BASED RELAXATION TECHNIQUES.txt new file mode 100644 index 0000000000000000000000000000000000000000..8e480373d91ea60961d075cf4106f986a5f49259 --- /dev/null +++ b/subfolder_0/CHANGES IN P300 FOLLOWING TWO YOGA BASED RELAXATION TECHNIQUES.txt @@ -0,0 +1,503 @@ +This article was downloaded by:[Telles, shirley] +On: 10 April 2008 +Access Details: [subscription number 792040367] +Publisher: Informa Healthcare +Informa Ltd Registered in England and Wales Registered Number: 1072954 +Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK +International Journal of Neuroscience +Publication details, including instructions for authors and subscription information: +http://www.informaworld.com/smpp/title~content=t713644851 +CHANGES IN P300 FOLLOWING TWO YOGA-BASED +RELAXATION TECHNIQUES +S. P. Sarang a; Shirley Telles a +a Swami Vivekananda Yoga Research Foundation, Bangalore, India +Online Publication Date: 01 December 2006 +To cite this Article: Sarang, S. P. and Telles, Shirley (2006) 'CHANGES IN P300 +FOLLOWING TWO YOGA-BASED RELAXATION TECHNIQUES', International +Journal of Neuroscience, 116:12, 1419 - 1430 +To link to this article: DOI: 10.1080/00207450500514193 +URL: http://dx.doi.org/10.1080/00207450500514193 +PLEASE SCROLL DOWN FOR ARTICLE +Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf +This article maybe used for research, teaching and private study purposes. Any substantial or systematic reproduction, +re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly +forbidden. +The publisher does not give any warranty express or implied or make any representation that the contents will be +complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be +independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, +demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or +arising out of the use of this material. +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +Intern. J. Neuroscience, 116:1419–1430, 2006 +Copyright C +⃝2006 Informa Healthcare +ISSN: 0020-7454 / 1543-5245 online +DOI: 10.1080/00207450500514193 +CHANGES IN P300 FOLLOWING TWO +YOGA-BASED RELAXATION TECHNIQUES +S. P. SARANG +SHIRLEY TELLES +Swami Vivekananda Yoga Research Foundation +Bangalore, India +Cyclic meditation (CM) is a technique that combines “stimulating” and “calming” +practices, based on a statement in ancient yoga texts suggesting that such a +combination may be especially helpful to reach a state of mental equilibrium. +The changes in the peak latency and peak amplitude of P300 auditory event–related +potentials were studied before and after the practice of cyclic meditation compared +to an equal duration of supine rest in 42 volunteers (group mean age ± SD, 27 ± +6.3 years), from Fz, Cz, and Pz electrode sites referenced to linked earlobes. The +sessions were one day apart and the order was alternated. There was reduction in +the peak latencies of P300 after cyclic meditation at Fz, Cz, and Pz compared to +the “pre” values. A similar trend of reduction in P300 peak latencies at Fz, Cz, +and Pz was also observed after supine rest, compared to the respective “pre” values, +although the magnitude of change in each case was less after supine rest compared to +after cyclic meditation. The P300 peak amplitudes after CM were higher at Fz, Cz, +and Pz sites compared to the “pre” values. In contrast, no significant changes were +observed in the P300 peak amplitudes at Fz, Cz, and Pz after supine rest compared +to the respective “pre” state. The present results support the idea that “cyclic” +meditation enhances cognitive processes underlying the generation of the P300. +Keywords cognitive processes, cyclic meditation, P300, supine rest +Received 14 October 2005. +Address correspondence to Shirley Telles, Ph.D., Swami Vivekananda Yoga Research +Foundation, #19, Eknath Bhavan, Gavipuram Circle, K. G. Nagar, Bangalore 560 019, India. +E-mail: anvesana@vsnl.com +1419 +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +1420 +S.P +. SARANG AND S. TELLES +INTRODUCTION +Meditation has been described as a training in awareness that, over long periods, +produces definite changes in perception, attention, and cognition (Brown, +1977). Most of the early reports on the effects of meditation have dealt with +Transcendental Meditation (TM). TM was adapted from ancient Indian texts +by Maharishi Mahesh Yogi. While practicing TM, subjects sit in a comfortable +posture and mentally repeat a given mantra, returning their attention to it +whenever attention wanders (Woolfolk, 1975). +The practice of TM was reported to cause reductions in heart rate, +respiratory rate, and oxygen consumption, and to increase the level or stability +of the electrodermal response as well as the alpha in the EEG (Wallace, +1970; Wallace et al., 1971). These changes were the basis for describing the +physiological state induced by TM as “wakeful and hypometabolic.” It was also +considered interesting to investigate whether TM would improve meditators’ +overall performance while producing a state of reduced physiological arousal +(Bloomfield et al., 1975). +A study was conducted to compare three different measures of attention +in 20 people who had been practicing TM for 3 months and a matched control +group who were not practicing TM. The rationale for the study was that all types +of meditations are supposed to increase the ability to concentrate on external +tasks and objects (Pelletier, 1972). Meditators performed better on a test for: +(i) auto-kinetic effect suggesting a better ability to concentrate, (ii) in a rod and +frame test that suggested that they were more in tune with internal cues, and +(iii) in an embedded figure test that suggested a better ability to concentrate +without being distracted by surrounding factors. +More recently the effects of transcendent experiences, described to +occur during the practice of TM, were studied on the contingent negative +variation (CNV) amplitude, rebound, and distraction effects in 41 healthy +volunteers (Travis et al., 2002). CNV is an event-related potential occurring +between a warning stimulus and an imperative stimulus requiring a response +(Walter et al., 1964). Late CNV amplitudes were largest in meditators who +had transcendent experiences daily. Because late CNV reflects proactive +preparatory processes including mobilization of motor, perceptual, cognitive, +and attentional resources, the data were taken to suggest that transcendent +experiences enhance cortical responses and executive functioning. +Another meditation technique, called “cyclic meditation” (CM) that also +has its origin in ancient Yoga texts was shown to reduce oxygen consumption, +breath rate, and increase breath volume more than a comparable period of +supine rest (SR) in 40 male volunteers aged between 20 and 47 years. The +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +P300 AND YOGA TECHNIQUES +1421 +magnitude of change in these three measures was greater after CM: (i) oxygen +consumption decreased by 32.1 % after CM compared with 10.1% after SR; +(ii) breath rate decreased by 18.0% after CM and 15.2 % after SR; and (iii) +breath volume increased by 28.8% after CM and 15.9% after SR (Telles et al., +2000). +The present study was planned to determine whether cyclic meditation (like +TM) would increase the ability to pay attention to a given stimulus in addition +to the already described effect of reducing metabolic and respiratory rates +(Telles et al., 2000). The P300 component of the event-related brain potentials +(ERPs) is considered as a “cognitive” neuro-electric phenomenon because it +is generated in psychological tasks when subjects attend to and discriminate +stimuli that differ from one another on some dimension. Such discrimination +produces a relatively large, positive waveform with a modal latency of about 300 +ms when elicited with auditory stimuli (Polish & Kok, 1995). The P300 event- +related brain potentials (ERP) reflect fundamental cognitive events requiring +attentional and immediate memory–processes (Polich, 1999). +Hence, in the present study the P300 was recorded before and after (i) +cyclic meditation and (ii) a comparable period of supine rest. +METHODS +Subjects +Forty-two male volunteers with ages ranging from 18 to 48 years (group mean +± S.D., 27.1 ± 6.3 years) participated in the study. They were residing at a +yoga center. Male subjects alone were studied as auditory evoked responses +have been shown to vary with the phases of the menstrual cycle (Yadav et +al., 2002) and the P300 evoked by stimuli of the visual modality also varied +with sex (Polich & Conroy, 2003). All of them were in normal health based +on a routine clinical examination and none of the volunteers were taking any +medication. The subjects had experience of the practice of cyclic meditation +for more than 3 months (mean experience ± SD, 15.3 ± 13.3 months). The +aims and methods of the study were explained to them and all the subjects gave +their informed consent. +Design of the Study +Subjects were assessed in two separate sessions, namely, cyclic meditation +(CM) and supine rest (SR). For half the subjects the CM session took place +on the one day, with SR the next day. The remaining subjects had the order of +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +1422 +S.P +. SARANG AND S. TELLES +the sessions reversed. Subjects were alternately allocated to either schedule to +prevent the order of the sessions influencing the outcome. The subjects were +unaware about the hypothesis of the study. The assessments were done before +and after each session, which lasted for 22 min 30 s. +Recording Conditions +The peak latencies and peak amplitudes of P300 were recorded using Nicolet +Bravo System (USA). The P300 component was elicited with a simple +discrimination task known as the “oddball” paradigm because two stimuli +are presented in a random series so that one of them occurred infrequently +that is, the oddball (Polich, 1999). For assessments subjects were seated in a +sound attenuated and dimly lit cabin and were monitored on a closed circuit +television with instructions being given through an intercom, so that subjects +could remain undisturbed during a session. +Electrode Positions +Ag/AgCl disk electrodes were affixed with electrode gel (Ten 20 conductive +EEG paste, D.O. Weaver, USA) at the Fz, Cz, and Pz scalp sites, referred +to linked earlobes (A1–A2) with the ground electrode on the forehead (FPz); +according to the International 10–20 system (Jasper, 1958). The electro-ocular +activity (EOG) was recorded with a bipolar derivation from electrodes placed +1 cm above and 1 cm below the outer canthus of the right eye. The electrode +impendence was kept below 5 k at all scalp sites. +Amplifier Settings +The electroencephalographic (EEG) activity was amplified with a sensitivity +of 100 µV. The low pass filter was kept at 0.01 Hz and the high pass filter was +kept at 30 Hz. The P300 ERPs were computer averaged in 300 trial sweeps, in +the 75–750 ms range. The pre-stimulus delay was kept at 75 ms and the level +of artifact rejection was set at 90%. +Stimulus Characteristics +Binaural tone stimuli of alternating polarity delivered at 0.9 ms with a frequency +of 1 KHz (50 cycles for the plateau, 10 cycles for the ramp) for the standard +stimuli and 2 KHz (10 cycles for the plateau, 20 cycles for the ramp) for the +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +P300 AND YOGA TECHNIQUES +1423 +target stimuli were used to trigger online averaging of the EEG. The percentage +of standard stimuli was set at 80 and for the target stimuli at 20. The stimulus +intensity was kept at 70 dB SPL. +Recording Procedure +Subjects were asked to avoid substances that influence cognitive performance +(e.g., coffee for the caffeine content) for the day preceding and the day of the +recording. Where this was unavoidable the session was taken on another day. +The P300 evoked potentials were recorded in the eyes-closed supine position. +The “standard” and “target” auditory stimuli were delivered through close- +fitting earphones (TDH-39, Amplivox, UK). Subjects were asked to distinguish +between the two tones by mentally counting the “target” stimuli. The P300 +responses were recorded before and immediately after the intervention. +Interventions +Cyclic Meditation. Throughout the practice subjects kept their eyes closed, +and followed pre-recorded instructions. The instructions emphasized carrying +out the practice slowly, with awareness and relaxation. The practice began +by repeating a verse (40 s) from the yoga text, the Mandukya Upanisad +(Chinmayananda, 1984); followed by isometric contraction of the muscles +of the body ending with supine rest (1 min); slowly coming up from the left +side and standing at ease (called tadasana) and ‘balancing’ the weight on +both feet (called centering) (2 min); then the first actual posture, bending +to the right (ardhakaticakrasana, 1 min 20 s); a gap of 1 min 10 s in +tadasana with instructions about relaxation and awareness; bending to the +left (ardhakaticakrasana, 1 min 20 s); a gap as before (1 min 10 s); forward +bending (padahastasana, 1 min 20 s); another gap (1 min 10s); backward +bending (ardhacakrasana, 1 min 20 s); and slowly coming down in the supine +posture with instructions to relax different parts of the body in sequence (10 +min). The postures were practiced slowly, with awareness of all the sensations +that are felt. The total duration of the practice was 22 min 30 s (Telles et al., +2000). +Supine rest. During the supine rest session, the subjects lay supine with +their legs apart and arms away from the sides of the body in corpse posture +(shavasana), with their eyes closed. This practice lasted 22 min 30 s, so that +the duration was the same as for CM. +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +1424 +S.P +. SARANG AND S. TELLES +Data Extraction +The peak amplitude and peak latency of the P300 was measured at the three +electrode sites; that is, Fz, Cz and Pz. The peak amplitude (in µV) was defined as +the voltage difference between a pre-stimulus baseline and the largest positive- +going peak of the ERP waveform within 250–500 ms latency (Polich, 1999). +The peak latency (ms) was defined as the time from stimulus onset to the point +of maximum positive amplitude within the latency window. The peak latency +and the peak amplitude were selected using the cursors. +Data Analysis +Statistical analysis was done using SPSS (Version 10.0). Data were analyzed +using the repeated measures analysis of variance (ANOVA). There were two +“Within subjects” factors, that is, Factor 1: Sessions, that is, CM and SR and +Factor 2: States, that is, Pre and Post. Paired t-test analyses were performed +to compare the data of the “post” periods with those of the respective “pre” +periods. +RESULTS +Repeated Measures Analysis of Variance +For the peak latency at Fz the repeated measures ANOVA showed a significant +difference between the two Sessions (F = 9.526, df = 1,41, p < .01, +Greenhouse-Geisser epsilon = 1.000), between the six States (F = 82.990, +df = 1,41, p < .001, Greenhouse-Geisser epsilon = 1.000), and the interaction +between Sessions and States (F = 20.532, df = 1,41, p < .001, Greenhouse- +Geisser epsilon = 1.000). +Also, for the peak amplitude at Fz there was a significant difference +between the six States (F = 9.723, df = 1,41, p < .001, Greenhouse-Geisser +epsilon = 1.000), and the interaction between Sessions and States (F = 4.944, +df = 1,41, p < .001, Greenhouse-Geisser epsilon = 1.000); however, there was +no significant difference between the two Sessions (F = 0.426, df = 1,41, p > +.05, Greenhouse-Geisser epsilon = 1.000). +For the peak latency at Cz the repeated measures ANOVA showed a +significant difference between the two Sessions (F = 22.167, df = 1,41, p +< .001, Greenhouse-Geisser epsilon = 1.000), between the six States (F = +92.290, df = 1,41, p < .001, Greenhouse-Geisser epsilon = 1.000), and the +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +P300 AND YOGA TECHNIQUES +1425 +interaction between Sessions and States (F = 16.451, df = 1,41, p < .001, +Greenhouse-Geisser epsilon = 1.000). +Also, for the peak amplitude at Cz there was a significant difference +between the six States (F = 8.932, df = 1,41, p < .01, Greenhouse-Geisser +epsilon = 1.000), and the interaction between Sessions and States (F = 6.793, +df = 1,41, p < .01, Greenhouse-Geisser epsilon = 1.000) however, there was +no significant difference between the two Sessions (F = 1.178, df = 1,41, p > +.05, Greenhouse-Geisser epsilon = 1.000). +For the peak latency at Pz the repeated measures ANOVA showed a +significant difference between the two Sessions (F = 16.622, df = 1,41, p +< .001, Greenhouse-Geisser epsilon = 1.000), between the six States (F = +130.831, df = 1,41, p < .001, Greenhouse-Geisser epsilon = 1.000), and the +interaction between Sessions and States (F = 18.163, df = 1,41, p < .001, +Greenhouse-Geisser epsilon = 1.000). +Also, the for peak amplitude at Pz there was a significant difference in +the interaction between Sessions and States (F = 4.577, df = 1,41, p < +.05, Greenhouse-Geisser epsilon = 1.000); however, there was no significant +difference between the two Sessions (F = 1.789, df = 1,41, p > .05, +Greenhouse-Geisser epsilon = 1.000) and between the six States (F = 3.310, +df = 1,41, p > .05, Greenhouse-Geisser epsilon = 1.000). +Paired t-test +There was a significant decrease in the P300 peak latencies at Fz, Cz, and Pz +sites after the practice of cyclic meditation compared to the “pre” state (p < +.001). There was a significant increase in the peak amplitude at Fz, Cz, and Pz +sites after the practice of cyclic meditation compared to the “pre” state (p < +.001). +There was a significant decrease in the P300 peak latencies at Fz, Cz, and +Pz sites after the practice of supine rest compared to the “pre” state (p < .001). +However, there was no significant change in the peak amplitude at Fz, Cz, and +Pz sites after the practice of supine rest compared to the “pre” state. +The peak latencies at Fz, Cz, and Pz sites before cyclic meditation and +before supine rest were not significantly different [p > .05, paired t-test (2)]. +However, the peak latencies at Fz, Cz, and Pz sites after cyclic meditation and +after supine rest were significantly different [p < .001, paired t-test (2)]. +The group mean ± S.D., of the peak latencies and the peak amplitudes at +Fz, Cz, and Pz sites are given in Table 1. +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +Table 1. Peak latency (ms) and peak amplitude (µV) of the P300 component in “pre” and “post” cyclic meditation and supine rest sessions. +Cyclic meditation (CM) +Supine rest (SR) +Electrode Site† +Variables +Pre +Post +Pre +Post +Fz +Latency (ms) +363.92 ± 23.63 +328.07∗∗∗± 19.95 +359.85 ± 25.52 +347.28∗∗∗± 19.41 +Amplitude (µV) +5.92 ± 3.60 +7.96∗∗∗± 3.51 +7.06 ± 4.01 +7.36 ± 3.97 +Cz +Latency (ms) +362.92 ± 24.46 +326.21∗∗∗± 21.79 +364.64 ± 27.44 +346.85∗∗∗± 19.59 +Amplitude (µV) +7.24 ± 3.62 +9.14∗∗∗± 3.43 +8.65 ± 3.72 +8.64 ± 3.66 +Pz +Latency (ms) +368.42 ± 27.34 +328.28∗∗∗± 22.06 +369.57 ± 29.81 +352.54∗∗∗± 23.32 +Amplitude (µV) +8.71 ± 3.62 +9.88∗∗± 3.84 +9.79 ± 3.67 +9.90 ± 3.86 +Values are group mean ± S.D. ∗∗∗p < .001, ∗∗p < .01, ∗p < .05. Paired t-test (2-tailed), “Post” compared with respective “Pre” values. +†Reference: linked earlobes. +1426 +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +P300 AND YOGA TECHNIQUES +1427 +DISCUSSION +The changes in the peak latency and peak amplitude of P300 auditory event- +related potentials were studied before and after the practice of cyclic meditation +compared to a comparable period of supine rest in 42 volunteers, from Fz, Cz +and Pz electrode sites referenced to linked earlobes. +Cyclic meditation consists of alternating cycles of practicing yoga postures +interspersed with periods of supine rest (Nagendra & Nagarathna, 1997). The +basis for this practice is an idea drawn from the ancient texts (Chinmayananda, +1984). 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 that combines “awakening” and “calming” practices. In cyclic meditation, +the period of practicing yoga postures constitutes the “awakening” practices, +whereas periods of supine rest comprise the “calming practices.” An essential +part of the practice of cyclic meditation is being aware of sensations arising in +the body (Nagendra & Nagarathna, 1997). +In the present study, there was reduction in the peak latencies of P300 after +cyclic meditation at Fz, Cz and Pz compared to the “pre” values. A similar trend +of reduction in P300 peak latencies at Fz, Cz and Pz was also observed after +supine rest, compared to the respective “pre” values, although the magnitude +of change in each case was less after supine rest compared to after cyclic +meditation. +The P300 peak amplitudes after CM were higher at Fz, Cz and Pz sites +compared to the “pre” values. In contrast, no significant changes were observed +in the P300 peak amplitudes at Fz, Cz, and Pz after supine rest compared to the +respective “pre” state. +Previous studies have shown definite changes in the P300 evoked responses +following Transcendental meditation (TM). The effect of TM practice on +the P300 was studied using a passive auditory listening trial paradigm with +variable interstimulus intervals (1–4 s) between identical tone stimuli (Cranson +et al., 1990). The subjects were experienced TM meditators, novices, and +nonmeditator controls with mean ages of 41, 28 and 20 years, respectively. The +P300 latency was shorter for the two meditation groups, with the long-term +meditators showing the shortest P300 latency regardless of their age. In another +study an auditory oddball task was used with eyes-closed to assess experienced +TM meditators at pretest baseline, after 10 min of rest, or after 10 min of TM +practice with conditions counterbalanced across subjects (Travis & Miskov, +1994). The P300 latency decreased at Pz after TM practice relative to no +change after the rest condition. +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +1428 +S.P +. SARANG AND S. TELLES +Sudarshan Kriya Yoga (SKY) is a meditation system that emphasizes +breathing techniques. This technique was used as an intervention for persons +with dysthymia compared with an unaffected control group. At three months, +the P300 amplitude increased to the levels of the control group in the patient +group (Naga Venkatesh Murthy et al., 1998). +The P300 amplitude is thought to indicate the amount of brain activity +related to incoming information processing and it is more sensitive to the +amount of attentive resources engaged during the task (Polich, 2004). The +P300 latency reflects the stimulus classification (cognitive) speed, is generally +unrelated to the overt response, and is independent of behavioral reaction +time. Because P300 latency is an index of stimulus processing rather than +response generation, it is used as a motor-free measure of cognitive function. +The P300 peak latency has been found to be negatively correlated with mental +function in normal subjects: shorter latencies are associated with superior +cognitive performance from neuropsychologic tests of attention and immediate +memory. +In the present study, both the peak amplitude and the peak latency of the +P300 potentials were changed following cyclic meditation. The reduction in +latency was also seen following supine rest, however the magnitude of change +was smaller than that after cyclic meditation. These results suggest increased +attentional resources, stimulus processing speed and efficiency after cyclic +meditation compared to an equal duration of supine rest. +Yoga practice has been understood to help in reducing anxiety based +on a reduction in levels of psychophysiological arousal (Telles & Srinivas, +1998). In a previous study both cyclic meditation (CM) and supine rest (SR) +practiced for the same duration as in the present study, resulted in decreased +oxygen consumption, breath rate, and increased breath volume immediately +after the practice (Telles et al., 2000). These changes suggested that both +practices reduce physiological arousal. However, for all three variables the +magnitude of change was greater following CM compared with following SR. +This supported the idea that a combination of “stimulating” and “calming” +techniques practiced with a background of relaxation and awareness (during +CM) may reduce psychophysiological arousal more than SR. Hence, CM may +be supposed to be able to reduce anxiety more than SR, which may explain the +greater magnitude of change in the performance observed in the present study +following CM. +The neuroelectric events that underlie the P300 generation stem from +the interaction between the frontal lobe and hippocampal and temporoparietal +function (Halgren et al., 1998). The primary neural generators for the P300 +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +P300 AND YOGA TECHNIQUES +1429 +components are in the anterior cingulate when new stimuli are processed into +working memory with subsequent activation of the hippocampal formation +when frontal lobe mechanisms communicate with the temporal or parietal lobe +connections (Polich, 1999). +In the present study the P300 peak amplitude increased at Fz, Cz and Pz +but the increase was maximum at Fz, which indicates greater involvement of +frontal areas, which are required for sustained attention. Various neuroimaging +studies on meditators have shown increased regional cerebral blood flow in the +frontal and prefrontal areas during meditation (Herzog et al., 1990). Hence, the +present findings may also support the idea of activation of frontal cortical areas +during meditation. +Insummary, thepresent studysupports theideathat meditation(inthis case, +“cyclic” meditation) enhances cognitive processes underlying the generation +of the P300, though further research is required to understand mechanisms +underlying the change. +REFERENCES +Bloomfield, H. H., Cain, M. P., Jaffe, D. T., & Kory, R. B. (1975). TM: Discovering +inner energy and overcoming stress. New York: Delacorte Press. +Brown, D. P. (1977). A model for the levels of concentrative meditation. The +International Journal of Clinical and Experimental Hypnosis, 25(4), 236– +273. +Chinmayananda, S. (1984). Mandukya Upanishad. Bombay, India: Sachin Publishers. +Cranson, R., Goddard, P. H., & Orme-Johnson, D. (1990). P300 under conditions +of temporal uncertainty and filter attenuation: Reduced latency in long-term +practitioners of TM. Psychophysiology, 27, S23. +Halgren, E., Marinkovic, K., & Chauvel, P. (1998). Generators of the late cognitive +potentials in auditory and visual oddball tasks. Electroencephalography and +Clinical Neurophysiology, 106, 156–164. +Herzog, H., Lele, V. R., Kuwert, T., Langen, K. J., Kops, E. R., & Feinendegen, L. E. +(1990). Changed pattern of regional glucose metabolism during Yoga meditative +relaxation. Neuropsychobiology, 23, 182–187. +Jasper, H. H. (1958). The ten-twenty electrode system of the International federation. +Electroencephalography and Clinical Neurophysiology, 10, 371–375. +Naga Venkatesha Murthy, P. J., Janakiramaiah, N., Gangadhar, B. N., & Subbukrishna, +D. K. (1998). P300 amplitude and antidepressant response to Sudarshan Kriya +Yoga (SKY). Journal of Affective Disorders, 50, 45–48. +Nagendra, H. R., & Nagarathna, R. (1997). New perspectives in stress management. +Bangalore, India: Swami Vivekananda Yoga Publications. +Downloaded By: [Telles, shirley] At: 07:09 10 April 2008 +1430 +S.P +. SARANG AND S. TELLES +Peletier, K. R. (1972). Altered attention deployment in meditators. Berkeley, USA: +Psychology Clinic, University of California. +Polich, J. (1999). P300 in clinical applications. In E. Niedermeyer & F. Lopes da +Silva (Eds.), Electroencephalography: Basic principles, Clinical applications and +related fields. (pp. 1073–1091). Baltimore-Munich: Urban and Schwarzenberg. +Polich, J., & Conroy, M. (2003). P3a and P3b from visual stimuli: Gender Effects and +normative variability. In I. Reinvang, M. W. Greenlee, & M. Herrmann (Eds.), +The sognitive neuroscience of individual differences. (pp. 293–306). Delmenhorst, +Germany: Hanse Institute for Advanced Study. +Polich, J., & Kok, K. (1995). Cognitive and biological determinants of P300: An +integrative review. Biological Psychology, 41, 103–146. +Telles, S., & Srinivas, R. B. (1998). Autonomic and respiratory measures in children +with impaired vision following yoga and physical activity programs. International +Journal of Rehabilitation and Health, 4(2), 117–122. +Telles, S., Reddy, S. K., & Nagendra, H. R. (2000). Oxygen consumption and +respiration following two yoga relaxation techniques. Applied Psychophysiology +and Biofeedback, 25(4), 221–227. +Travis, F., & Miskov, S. (1994). P300 latency and amplitude during eyes-closed rest +and Transcendental Meditation practice. Psychophysiology, 31, S67. +Travis, F., Tecce, J., Arenander, A., & Wallace, R. K. (2002). Patterns of EEG +coherence, power, and contingent negative variation characterize the integration +of transcendental and waking states. Biological Psychology, 61(3), 293–319. +Wallace, R. K. (1970). The physiological effects of transcendental meditation. Science, +167, 1751–1754. +Wallace, R. K., Benson, H., & Wilson, A. F. (1971). A wakeful hypometabolic +physiological state. American Journal of Physiology, 227, 795–799. +Walter, W. G., Cooper, R., Aldridge, V. J., Mccallum, W. C., & Winter, A. L. (1964). +Contingent negative variation: An electric sign of sensorimotor association and +expectancy in the human brain. Nature, 203, 380–384. +Woolfolk, R. L. (1975). Psychophysiological correlates of meditation. Archives of +General Psychology, 32, 1326–1333. +Yadav, A., Tandon, O. P., & Vaney, N. (2002). Auditory evoked responses during differ- +ent phases of menstrual cycle. Indian Journal of Physiology and Pharmacology, +46(4), 449–456. diff --git a/subfolder_0/Cerebrovascular Hemodynamics during the Practice of Bhramari Pranayama, Kapalbhati and Bahir-Kumbhaka An Exploratory Study.txt b/subfolder_0/Cerebrovascular Hemodynamics during the Practice of Bhramari Pranayama, Kapalbhati and Bahir-Kumbhaka An Exploratory Study.txt new file mode 100644 index 0000000000000000000000000000000000000000..40511d8d7865a33e917194f38b46f3ae279e920f --- /dev/null +++ b/subfolder_0/Cerebrovascular Hemodynamics during the Practice of Bhramari Pranayama, Kapalbhati and Bahir-Kumbhaka An Exploratory Study.txt @@ -0,0 +1,613 @@ +Vol.:(0123456789) +1 3 +Applied Psychophysiology and Biofeedback +https://doi.org/10.1007/s10484-017-9387-8 +Cerebrovascular Hemodynamics During the Practice of Bhramari +Pranayama, Kapalbhati and Bahir-Kumbhaka: An Exploratory Study +L. Nivethitha1 · A. Mooventhan1 · N. K. Manjunath1 · Lokesh Bathala2 · Vijay K. Sharma3 + +© Springer Science+Business Media, LLC, part of Springer Nature 2017 +Abstract +Various pranayama techniques are known to produce different physiological effects. We evaluated the effect of three-different +pranayama techniques on cerebrovascular hemodynamics. Eighteen healthy volunteers with the mean ± standard deviation +age of 23.78 ± 2.96 years were performed three-different pranayama techniques: (1) Bhramari, (2) Kapalbhati and (3) Bahir- +Kumbhaka in three-different orders. Continuous transcranial Doppler (TCD) monitoring was performed before, during and +after the pranayama techniques. TCD parameters such as peak systolic velocity, end diastolic velocity (EDV), mean flow +velocity (MFV) and pulsatility index (PI) of right middle cerebral artery were recorded. Practice of Kapalbhati showed +significant reductions in EDV and MFV with significant increase in PI while, Bahir-Kumbhaka showed significant increase +in EDV and MFV with significant reduction in PI. However, no such significant changes were observed in Bhramari pranay- +ama. Various types of pranayama techniques produce different cerebrovascular hemodynamic changes in healthy volunteers. +Keywords  Brain blood flow · Breath control · Fast breathing · Pranayama · Slow breathing · Yoga +Background +Cerebral hemodynamic parameters change rapidly in +response to various physiological challenges. These +responses are responsible for cerebral auto-regulation i.e. +maintaining a constant cerebral blood flow (CBF) over a +wide range of blood pressure fluctuations. Blood flow in the +large intracranial arteries can be monitored using transcra- +nial Doppler ultrasound (TCD) (Yang et al. 2015). Thus, +TCD is aptly called as a stethoscope of the brain. It is the +only diagnostic tool that can provide relatively inexpensive, +non-invasive, real-time measurement of blood flow charac- +teristics and cerebrovascular hemodynamics (Bathala et al. +2013). Since the middle cerebral artery (MCA) supplies the +largest area of the cerebral hemisphere, the flow velocity +is higher than any other intracranial arteries (Aaslid et al. +1982). +Yoga is an ancient Indian science and the way of life, +which includes practice of specific posture (asana) and +regulated breathing (pranayama). Pranayama is an art of +prolongation and control of breath (Mooventhan and Khode +2014). It consists of four important aspects: (1) Pooraka +(inhalation), (2) Rechaka (exhalation), (3) Antar-Kumbhaka +[internal breath retention (holding the breath after deep inha- +lation)], and (4) Bahir-Kumbhaka [external breath retention +(holding the breath after full exhalation)] (Saraswati 2008). +Different types of pranayamas were shown to produce dif- +ferent physiological responses. For example, practice of the +slow type of pranayama (3–6 breaths/min) (Madanmohan +et al. 2005) and Bhramari pranayama (Kuppusamy et al. +2016) were reported to produce a reduction in heart rate +(HR), rate pressure product (RPP) [a product of HR and +systolic blood pressure (i.e. HR × SP/100), used to deter- +mine the myocardial workload] and double product (Do P) +[a product of HR and mean arterial pressure (MAP) (i.e. +HR × MAP/100) an index of cardiac oxygen consumption] +(Kuppusamy et al. 2016; Madanmohan et al. 2005), while a +fast type of pranayama (≥ 60 breaths/min) was reported to +increase it (Madanmohan et al. 2005). + +* L. Nivethitha + +dr.nivethithathenature@gmail.com +1 +Division of Yoga and Life Sciences, Department of Research +and Development, S-VYASA University, Bengaluru, +Karnataka, India +2 +Department of Neurology, Aster CMI Hospital, Cauvery +Medical Centre, Bengaluru, Karnataka, India +3 +Division of Neurology, National University Hospital, +Singapore, Singapore + +Applied Psychophysiology and Biofeedback +1 3 +Many studies have reported the effect of various pra- +nayama practices on cardiovascular functions (Madanmo- +han et al. 2005; Sharma et al. 2013), pulmonary functions +(Dinesh et al. 2015), autonomic functions including HR +variability (Raghuraj et al. 1998; Raghuraj and Telles 2008), +cognitive functions (Sharma et al. 2014), fine motor skills +(finger dexterity) (Telles et al. 2012), handgrip strength, +endurance (Thangavel et al. 2014), visual discrimination +(Telles et al. 2012), reaction time (Madanmohan et al. 2005) +and perceived stress (Sharma et al. 2013). Though a study +reported the effect of Bhastrika pranayama [bellows breath- +ing (forceful inhalation followed by forceful exhalation)] and +Antar-Kumbhaka (Nivethitha et al. 2017) on cerebrovascular +hemodynamics, there is no known study reporting the effect +of various other commonly practicing pranayama techniques +including Bhramari pranayama [humming bee breath (a +slow and vibrating type of pranayama)], Kapalbhati [frontal +brain cleansing breath (a fast type of yoga breathing tech- +nique)] and Bahir-Kumbhaka (no breathing after exhalation) +on cerebrovascular hemodynamics. Hence, the present study +was conducted to evaluate the effect of Bhramari pranayama, +Kapalbhati, and Bahir-Kumbhaka on cerebrovascular hemo- +dynamics in healthy volunteers. +Materials and Methods +Participants +Eighteen healthy volunteers were recruited from a residen- +tial yoga university in South India, based on the following +inclusion and exclusion criteria. Inclusion criteria Healthy +male and female volunteers with the age of 18-years and +above, willing to participate in the study and who have had +experience in practicing yoga including pranayama for mini- +mum of 1 year. Exclusion criteria Participants with a history +of any systemic and mental illness, regular medication for +any diseases, chronic substance abuse, and the participant +who is unable to perform pranayama. The study protocol was +approved by the institutional ethics committee, S-VYASA +University, Bengaluru, India. A signed written informed +consent was obtained from each participant. +Study Design +A single group repeated measures design was used in this +study. Each participant was advised to perform three dif- +ferent pranayama techniques: (1) Bhramari pranayama, +(2) Kapalbhati, and (3) Bahir-Kumbhaka in three dif- +ferent orders. The order was randomly selected using +lottery method as follows: 18 papers [6 containing the +word ‘Bhramari’ (i.e. 1st order), 6 containing the word +‘Kapalbhati’ (i.e. 2nd order); and 6 containing the word +‘Bahir-Kumbhaka’ (i.e. 3rd order)] were put in an envelope +and each participant was asked to draw a paper from the +envelope. The paper each participant drew out determined +the order in which the respective pranayama tasks were done +(Mooventhan and Khode 2014). In the first order (n = 6), +participants performed normal breathing followed by Bhra- +mari, Kapalbhati and Bahir-Kumbhaka; in second the order +(n = 6), participants performed normal breathing followed +by Kapalbhati, Bahir-Kumbhaka and Bhramari; and in the +third order (n = 6), participants performed normal breathing +followed by Bahir-Kumbhaka, Bhramari and Kapalbhati. +Assessments were taken before (normal breath), during and +after each pranayama technique. +Assessment +Cerebrovascular Hemodynamic Changes +Cerebrovascular hemodynamic changes of the right MCA +were assessed with TCD (Multi Dop X, DWL, Germany). +A 2-MHz TCD ultrasound transducer probe (DWL Systems) +was placed in the right temporal area just above the zygo- +matic arch and in front of the tragus of the ear with the use +of a head frame (a supporting material that was placed in +the head to hold and fix the TCD transducer probe firmly in +a desired place where we get the maximum ultrasound sig- +nals). The transducer was adjusted manually to get red color +signal between 40 and 65-mm (indicator of maximum ultra- +sound signal reflected from the ipsilateral MCA) in order to +obtain the flow dynamics of the right MCA. Assessments +such as peak systolic velocity (PSV) (the first peak on a TCD +waveform from each cardiac cycle that indicates CBF veloc- +ity at systolic phase) in cm/s, end diastolic velocity (EDV) +(the second peak on a TCD waveform from each cardiac +cycle that indicates CBF velocity at diastolic phase) in cm/s, +mean flow velocities (MFV) (EDV plus one-third of the dif- +ference between PSV and EDV) in cm/s and pulsatility index +(PI) (an indicator of flow resistance) (Bathala et al. 2013) +were taken just before (baseline), during and immediately +after (post) each pranayama. Baseline assessment was taken +at 0 s i.e. just before starting of each pranayama. During +assessment was taken at 1st, 2nd, 3rd, 4th and 5th min of +Bhramari pranayama; 15, 30, 45, and 60 s of Kapalbhati +and normal breathing (as a control); and 10, 20 and 30 s of +Bahir-Kumbhaka. Post assessment was taken at 15, 30, 45, +and 60 s immediately after the practice of each pranayama +technique. +Intervention +Each participant was advised to perform three differ- +ent pranayama techniques: (1) Bhramari pranayama, (2) +Kapalbhati, and (3) Bahir-Kumbhaka for the duration of +Applied Psychophysiology and Biofeedback +1 3 +5 min, 1 min and 30 s respectively in any one of the three +different orders as mentioned in the study design. Since +the nature of each type of pranayama technique is different +from one another, the time taken to complete one round of a +particular type of pranayama is also different from another +type. Thus, the duration of each pranayama technique was +kept differently based on its nature and participants’ ability +to complete one round of each pranayama comfortably. A +rest period of 5 min was given between each intervention to +allow the cerebral hemodynamic patterns to settle at their +baseline values (Müller et al. 1995; Nivethitha et al. 2017). +Bhramari (Humming Bee Breath) +Participants were asked to perform inhalation through both +nostrils and while exhaling (through both nostrils) produces +the sound of a humming bee (with closed mouth) (Mooven- +than and Khode 2014) for the duration of 5 min. +Kapalbhati (Frontal Brain Cleansing Breath) +Participants were asked to perform forceful exhalation fol- +lowed by passive inhalation through both nostrils (Saraswati +2008) for the duration of 1 min. +Bahir‑Kumbhaka (External Breath Retention) +Participants were asked to exhale completely through both +nostrils followed by hold/retain the breath (Saraswati 2008) +for the duration of 30 s (excluding exhalation). +Normal Breathing +Participants were asked to perform normal breathing before +all the pranayama techniques and immediately after each +pranayama technique. +Data Analysis +Statistical analysis was performed using a repeated measures +of analysis of variance with post-hoc analysis and Bonfer- +roni adjustment using the Statistical Package for the Social +Sciences (SPSS) for Windows, Version 16.0. Chicago, SPSS +Inc. +Results +A total of 18 healthy volunteers were recruited in the study. +Demographic details of all the study participants have been +given in Table 1. All study participants’ demonstrated stable +cerebrovascular hemodynamic parameters and no significant +changes were observed in PSV, EDV, MFV and PI during +their normal breathing (Table 2) and Bhramari pranayama +(Table 3) tasks. +During the practice of Kapalbhati, there was a significant +reduction in EDV and MFV with significant increase in PI +from 15 to 60 s (Table 1) and those values were reverted +back to normal within 30 s (EDV and PI) and 45 s (MFV) +after cessation of the practice (Table 4). +During the practice of Bahir-Kumbhaka, there was a sig- +nificant increase in EDV and MFV with significant reduction +in PI at 30 s and those values were reverted back to normal +within 15 s after cessation of the practice (Table 5). +Discussion +CBF is regulated by the autonomic nervous system (ANS) by +altering the tone of arteriolar sphincters. Some of the impor- +tant determinants of CBF include partial pressure of arterial +­ +CO2 ­ +(PaCO2), mean arterial pressure (MAP), and cerebral +metabolism. ­ +PaCO2 is the strongest regulator of arteriolar +Table 1   Demographic variables of the study subjects (n = 18) +Variables +Study group (n = 18) +Age (years) +23.78 ± 2.96 +Gender +Males (n = 17) and +female (n = 1) +Height (m) +1.71 ± 0.08 +Weight (kg) +60.28 ± 8.82 +Body mass index (kg/m2) +20.65 ± 2.10 +Table 2   Cerebrovascular +hemodynamics during normal +breathing (n = 18) (RMANOVA +with post-hoc analysis and +Bonferroni adjustment) +All values are in mean ± Standard deviation +RMANOVA repeated measures of analysis of variance, PSV peak systolic velocity, EDV end diastolic veloc- +ity, MFV mean flow velocity, PI pulsatility index +Parameter +Baseline +15 s +30 s +45 s +60 s +PSV (cm/s) +58.56 ± 18.64 +59.06 ± 18.99 +59.67 ± 18.31 +58.11 ± 17.65 +59.28 ± 18.15 +EDV (cm/s) +22.94 ± 8.95 +21.56 ± 5.16 +22.33 ± 7.53 +22.28 ± 7.92 +21.78 ± 6.25 +MFV (cm/s) +34.94 ± 12.24 +34.22 ± 11.02 +34.72 ± 10.90 +34.39 ± 10.37 +34.78 ± 9.92 +PI +1.04 ± 0.22 +1.08 ± 0.19 +1.08 ± 0.20 +1.05 ± 0.23 +1.07 ± 0.21 + +Applied Psychophysiology and Biofeedback +1 3 +tone and an increase of 1 mm of Mercury (Hg) increases +CBF by 3–6% while a 1 mmHg reduction decreases CBF by +1–3% (Willie et al. 2014). +In this study, no significant changes in the cerebral hemo- +dynamic parameters were observed during normal breath- +ing and even during Bhramari pranayama. This effect is +probably related to the maintenance of ­ +PaCO2 and the bal- +anced state of autonomic nervous system within a very nar- +row and stable range (Battisti-Charbonney et al. 2011). In +contrast, practice of both Kapalbhati and Bahir-Kumbhaka +showed significant changes in cerebrovascular hemodynamic +parameters such as EDV, MFV and PI but no such significant +change was observed in PSV. +Interestingly, though both Kapalbhati and Bahir-Kumb- +haka produced significant changes in cerebral hemodynam- +ics, the direction of the changes was opposite to one another +(i.e. Kapalbhati produced a significant reduction in EDV and +MFV with a significant increase in PI, while Bahir-Kumb- +haka produced a significant increase in EDV and MFV with +a significant reduction in PI). +In previous studies, practice of Kapalbhati was shown +to modify the autonomic status either by increasing sym- +pathetic activity (Raghuraj et al. 1998) or by reducing par- +asympathetic modulation (Telles et al. 2011). Kapalbhati is +also known as high frequency yoga breathing (> 60 breath/ +min) which might lead to the development of hypocapnia +i.e. reduced level of the ­ +PaCO2 due to increased rate of the +respiration with forceful exhalation. Hence, the reduction +in EDV and MFV associated with the increase in PI during +Kapalbhati is probably mediated via an increased sympa- +thetic activity (Raghuraj et al. 1998) while reducing the +parasympathetic modulation (Telles et al. 2011). The cer- +ebral hemodynamic parameters gradually returned to their +baseline values within 45 s of cessation of Kapalbhati, +most probably related to the normalization of ANS and/ +or ­ +PaCO2 during the normal breathing after the practice +(Nivethitha et al. 2017). +Breath retention/holding increases the ­ +PaCO2 and +reduces the partial pressure of oxygen (Parkes 2006). +These changes resulted in an increased CBF (Willie et al. +2014). Hence, we believed in that the practice of Bahir- +Kumbhaka (breath holding after exhalation) also produces +the same phenomenon and increases CBF with a reduced +cerebrovascular resistance. +Some other limitations of the study need to be acknowl- +edged. We did not monitor the partial pressures of oxy- +gen and ­ +CO2 and autonomic variables specifically blood +pressure and HR variability during the practice of various +types of pranayama techniques to delineate the underly- +ing physiological mechanisms for the observed changes +in cerebrovascular hemodynamic parameters; study might +appear to have a small number of participants. Hence, +Table 3   Cerebrovascular hemodynamics during Bhramari pranayama (n = 18) (RMANOVA with post-hoc analysis and Bonferroni adjustment) +All values are in mean ± standard deviation +RMANOVA repeated measures of analysis of variance, PSV peak systolic velocity, EDV end diastolic velocity, MFV mean flow velocity, PI pulsatility index +Parameter +Baseline +During Bhramari +Post-test assessments +1 min +2 min +3 min +4 min +5 min +15 s +30 s +45 s +60 s +PSV (cm/s) +55.89 ± 19.98 +53.89 ± 19.39 +52.28 ± 16.24 +51.72 ± 17.87 +51.72 ± 19.03 +52.50 ± 18.63 +52.61 ± 18.72 +53.06 ± 19.68 +56.00 ± 22.38 +57.44 ± 21.70 +EDV(cm/s) +20.61 ± 6.90 +19.28 ± 6.28 +20.67 ± 6.24 +19.94 ± 5.74 +20.56 ± 7.01 +21.33 ± 7.19 +19.06 ± 8.86 +20.39 ± 8.45 +21.00 ± 10.44 +22.61 ± 8.52 +MFV(cm/s) +33.83 ± 10.59 +30.61 ± 10.29 +31.94 ± 9.36 +30.28 ± 9.46 +30.39 ± 11.25 +32.89 ± 10.06 +31.06 ± 11.50 +31.67 ± 10.86 +34.22 ± 14.36 +35.78 ± 14.12 +PI +1.03 ± 0.28 +1.11 ± 0.26 +1.00 ± 0.27 +1.03 ± 0.24 +1.02 ± 0.26 +0.93 ± 0.19 +1.10 ± 0.22 +1.02 ± 0.20 +0.97 ± 0.30 +0.98 ± 0.16 +Applied Psychophysiology and Biofeedback +1 3 +further study is required with the large sample size and +more objective measurements for the better understanding. +Conclusion +Our study shows that the practice of Kapalbhati and Bahir- +Kumbhaka produced different cerebrovascular hemody- +namic changes which are almost opposite to each other +while Bhramari pranayama produces no effect. +Compliance with Ethical Standards  +Conflict of interest  All authors declare that they have no conflict of +interest. +Ethical Approval  Study protocol was approved by the institutional eth- +ics committee, S-VYASA University, Bengaluru, India. +Informed Consent  A written informed consent was obtained from each +participant. +References +Aaslid, R., Markwalder, T. M., & Nornes, H. (1982). Noninvasive tran- +scranial doppler ultrasound recording of flow velocity in basal +cerebral arteries. Journal of Neurosurgery, 57(6), 769–774. +Bathala, L., Mehndiratta, M. M., & Sharma, V. K. (2013). Tran- +scranial doppler: Technique and common findings (Part 1). +Annals of Indian Academy of Neurology, 16(2), 174. https://doi. +org/10.4103/0972-2327.112460. +Battisti-Charbonney, A., Fisher, J., & Duffin, J. (2011). The cerebro- +vascular response to carbon dioxide in humans. The Journal +of Physiology, 589(12), 3039–3048. https://doi.org/10.1113/ +jphysiol.2011.206052. +Dinesh, T., Gaur, G., Sharma, V., Madanmohan, T., & Bhavanani, A. +(2015). Comparative effect of 12 weeks of slow and fast pranay- +ama training on pulmonary function in young, healthy volunteers: +A randomized controlled trial. International Journal of Yoga, +8(1), 22–26. https://doi.org/10.4103/0973-6131.146051. +Kuppusamy, M., Kamaldeen, D., Pitani, R., & Amaldas, J. 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International Journal of +Yoga, 7(2), 104. https://doi.org/10.4103/0973-6131.133875. +Table 4   Cerebrovascular hemodynamics during Kapalbhati (n = 18) [RMANOVA with post-hoc analysis and Bonferroni adjustment] +All values are in mean ± standard deviation +RMANOVA repeated measures of analysis of variance, PSV peak systolic velocity, EDV end diastolic velocity, MFV mean flow velocity, PI pul- +satility index +*p value < 0.05 +Parameter +Baseline +During Kapalbhati +Post-test assessments +15 s +30 s +45 s +60 s +15 s +30 s +45 s +60 s +PSV (cm/s) +58.56 ± 19.18 +54.28 ± 15.60 +57.11 ± 18.13 +54.72 ± 17.88 +54.33 ± 17.62 +53.89 ± 18.33 +53.72 ± 19.08 +54.89 ± 21.28 +55.67 ± 20.42 +EDV (cm/s) +22.56 ± 8.00 +8.72 ± 9.30* +6.39 ± 8.10* +6.61 ± 8.47* +9.78 ± 7.48* +14.00 ± 9.73* +18.11 ± 10.06 +18.28 ± 9.81 +20.22 ± 9.47 +MFV (cm/s) +36.89 ± 11.67 +26.72 ± 8.58* +24.78 ± 8.22* +24.33 ± 8.29* +24.39 ± 8.60* +27.56 ± 9.92* +30.83 ± 12.01* +33.06 ± 15.28 +34.17 ± 12.89 +PI +0.97 ± 0.20 +1.82 ± 0.64* +2.19 ± 0.74* +2.14 ± 0.81* +1.98 ± 0.81* +1.55 ± 0.61* +1.28 ± 0.61 +1.27 ± 0.74 +1.07 ± 0.37 +Table 5   Cerebrovascular hemodynamics during Bahir-Kumbhaka (n = 18) (RMANOVA with post-hoc analysis and Bonferroni adjustment) +All values are in mean ± standard deviation +RMANOVA repeated measures of analysis of variance, PSV peak systolic velocity, EDV end diastolic velocity, MFV mean flow velocity, PI pul- +satility index +*p value < 0.05 +Parameter +Baseline +During Bahir-Kumbhaka +Post-test assessments +10 s +20 s +30 s +15 s +30 s +45 s +60 s +PSV (cm/s) +55.83 ± 19.81 +55.33 ± 17.35 +59.61 ± 19.74 +63.50 ± 20.95 +58.33 ± 19.98 +54.50 ± 20.39 +56.28 ± 20.34 +55.67 ± 19.42 +EDV (cm/s) +20.50 ± 7.82 +20.33 ± 5.96 +25.22 ± 9.43 +31.44 ± 13.34* 19.78 ± 5.73 +19.78 ± 5.85 +20.28 ± 9.40 +20.33 ± 9.20 +MFV (cm/s) +33.56 ± 12.08 +32.44 ± 9.15 +37.89 ± 13.83 +44.78 ± 17.61* 33.17 ± 10.13 +32.06 ± 10.04 +32.89 ± 12.87 +33.56 ± 12.01 +PI +1.06 ± 0.22 +1.07 ± 0.25 +0.93 ± 0.20 +0.74 ± 0.14* +1.16 ± 0.28 +1.05 ± 0.19 +1.12 ± 0.24 +1.12 ± 0.25 + +Applied Psychophysiology and Biofeedback +1 3 +Müller, M., Voges, M., Piepgras, U., & Schimrigk, K. 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Asana pranayama mudra bandha (4th revised +ed.). Munger: Yoga Publications Trust. +Sharma, V. K., Rajajeyakumar, M., Velkumary, S., Subramanian, +S. K., Bhavanani, A. B., Madanmohan, S. A., & Thangavel, +D. (2014). Effect of fast and slow pranayama practice on cog- +nitive functions in healthy volunteers. Journal of Clinical and +Diagnostic Research, 8(1), 10–13. https://doi.org/10.7860/ +JCDR/2014/7256.3668. +Sharma, V. K., Trakroo, M., Subramaniam, V., Rajajeyakumar, M., +Bhavanani, A. B., & Sahai, A. (2013). Effect of fast and slow +pranayama on perceived stress and cardiovascular parameters in +young health-care students. International Journal of Yoga, 6(2), +104–110. https://doi.org/10.4103/0973-6131.113400. +Telles, S., Singh, N., & Balkrishna, A. (2011). Heart rate variabil- +ity changes during high frequency yoga breathing and breath +awareness. BioPsychoSocial Medicine, 5(1), 4. https://doi. +org/10.1186/1751-0759-5-4. +Telles, S., Singh, N., & Balkrishna, A. (2012). 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Physiological Reports, 3(4), e12378. https:// +doi.org/10.14814/phy2.12378. diff --git a/subfolder_0/Comparative impact of yoga and ayurveda practice in insomnia A randomized controlled trial.txt b/subfolder_0/Comparative impact of yoga and ayurveda practice in insomnia A randomized controlled trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..0bcdff109e33d2293237c428ba9e60586af577d7 --- /dev/null +++ b/subfolder_0/Comparative impact of yoga and ayurveda practice in insomnia A randomized controlled trial.txt @@ -0,0 +1,1731 @@ +© 2023 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow +1 +Comparative impact of yoga and +ayurveda practice in insomnia: +A randomized controlled trial +Kanika Verma, Deepeshwar Singh, Alok Srivastava1 +Abstract: +BACKGROUND: Insomnia is connected with a lifted hazard for neurocognitive dysfunction and +psychiatric disarranges. Clinical observations of psychosomatic patients indicate that their distorted +somatopsychic functioning necessitates their practice of yoga‑like therapy. Sleep and its modifications +and management have also been explained well in ayurveda. This study aimed to compare the +effectiveness of Yoga and Nasya Karma on the sleep quality, stress, cognitive function, and quality +of life of people suffering from acute insomnia. +MATERIAL AND METHODS: It was an open‑label, randomized controlled trial. A  total of +120 participants were randomly (computer‑generated randomization) equally allocated to three groups, +yoga group (G‑1), ayurveda group (G‑2), and control group (G‑3). All the groups were assessed +on the first day before the start of the yoga regime and the 48th day. Participants in the study were +included in the age group of 18 to 45 years, fulfilling DSM‑V criteria for insomnia, physically fit for +the yoga module, and Nasya procedure. Outcomes were measured by the Pittsburgh Sleep Quality +Index (PSQI) questionnaire, Perceived Stress Scale (PSS), cognitive failure questionnaire, and +WHO Quality of Life Scale‑Brief (WHOQOL‑Brief). Proportions and frequencies were described +for categorical variables and compared using the Chi‑square test. ANOVA (one‑way) and post hoc +analysis, Bonferroni test, were performed for multiple comparisons in groups at a significance level +of P < 0.05 using SPSS (23 version). +RESULTS: A total of 112 participants were analyzed as per protocol analysis. All groups have +observed significant mean differences for stress (<0.05) and sleep quality (<0.05). All five aspects +of quality of life – general health (<0.05), physical health (<0.01), psychological health (<0.05), social +health (<0.05), and environmental health (<0.05) – had a significant mean difference in all three +groups. All three aspects of cognitive failure, forgetfulness (<0.05), distractibility (<0.05), and false +triggers (<0.01) had a significant mean difference in scores for all three groups. +CONCLUSION: Yoga practice was effective, followed by ayurveda and the control group in reducing +stress and improving sleep, cognitive function, and quality of life. +Keywords: +Ayurveda, cognitive, insomnia, Nasya Karma, quality of life, sleep, stress, yoga +Introduction +I +nsomnia can be described as dissatisfaction +with rest quality, difficulty falling asleep, +frequent night arousals, and arousing prior +to the morning or the desired time.[1,2] Most +reports recommend predominance rates of +insomnia disorder at 5% to 15%.[3‑5] Insomnia +could be an ongoing issue in 31% to 75% +of patients, with more than two‑thirds +reporting side effects for at least 1 year.[1,5] +It is additionally associated with daytime +fatigue, languor, impedance in cognitive +execution, and mood changes. Insomnia +differs from sleep deprivation as it is +challenging to rest despite having adequate +opportunities.[1] Given the expanded work +weight and social challenges in an advanced +Address for +correspondence: +Kanika Verma, +Department of Yoga +and Life Sciences, +Swami Vivekananda +Yoga Anusandhana +Samsthana (S‑VYASA), +Bengaluru, India. +E‑mail: kanika.yog@ +gmail.com +Received: 12‑10‑2022 +Accepted: 24‑11‑2022 +Published: 31-05-2023 +Department of Yoga +and Life Sciences, +Swami Vivekananda +Yoga Anusandhana +Samsthana (S‑VYASA), +Bengaluru, Karnataka, +1Department of +Panchkarma, Uttarakhand +Ayurved University, +Dehradun, Uttarakhand, +India +Original Article +Access this article online +Quick Response Code: +Website: +www.jehp.net +DOI: +10.4103/jehp.jehp_1489_22 +How to cite this article: Verma K, Singh D, +Srivastava A. Comparative impact of yoga and +ayurveda practice in insomnia: A randomized +controlled trial. J Edu Health Promot 2023;12:160. +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 +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +2 +Journal of Education and Health Promotion | Volume 12 | May 2023 +society, many people cannot get adequate sleep and +endure sleep disturbance.[6‑8] A detailed study shows +that around 30% of grown‑ups show some sleep issues.[9] +Different measurements can be utilized to characterize +sleep, such as sleep quality (e.g., fulfilled with sleep), +sleep amount (e.g., add up to sleep time, sleep period +time, time in bed), and daytime languor  (e.g., the +likelihood of falling asleep but alert).[10] An agreement +that disturbed sleep significantly hinders physical +and mental well‑being has come.[11] For example, +destitute sleep has been connected with a lifted hazard +for cardiovascular illness, diabetes, hypertension, +mortality, obesity, pain, neurocognitive dysfunction, +and psychiatric disarranges.[12‑16] Outstandingly, both +sleep and stress‑responsive physiological frameworks +are transiently and functionally controlled by the +biological process, and it has been well established +that sleep incorporates a close relationship with the +stress‑responsive physiological frameworks.[17‑20] The +lack of sleep might impact bodily reactions to stress.[21,22] +Poor sleep may be an imperative hazard factor for +stress‑related diseases, including cardiovascular +illnesses and temperament disorders.[21] Besides this, +insomnia is often associated with cognitive impairment, +such as poor memory, attention, concentration, and +performance of simple tasks.[23] Also, insomnia and +its associated conditions worsen their quality of +life.[24] Clinical observations of psychosomatic patients +indicate that their distorted somatopsychic functioning +necessitates their practice of yoga‑like therapy.[25] It +is emphasized that physical yogic exercise is meant +to prepare the body for mental practices such as +samadhi.[26] Mindfulness meditation is increasingly +incorporated into mental health interventions, and its +theoretical concepts have influenced basic research on +psychopathology.[27] Yoga is restorative management +for psychophysiological effects. It incorporates a +comprehensive approach to physical, mental, and +spiritual well‑being.[25] Components of yoga have +been explored for their viability and its practice as +a comprehensive multi‑component discipline.[25,28,29] +Sleep and its modifications and management have +also been explained well in ayurveda. Nidrä is one of +the three pillars capable of supporting a healthy life. +The heart is the seat of cetanä. When it is secured by +thomas (numbness, haziness), all living creatures tend +to fall asleep. The viewpoints of emotional well‑being, +nourishment, emaciation, strength and weakness, +virility, cognition, life, and death depend upon ideal +sleep.[30] In persons whose Kapha has diminished and +vätta or pitta has expanded and those whose intellect +and body are distressed by illness or bodily injury, +sleep does not be satisfactory, resulting in nidränäç or +sleep disorder.[31] Many herbal drugs that overcome +sleep‑related disorders are mentioned. Brahmi +tail (Bacopa monnieri) is used for Abhyanga because +of its sedative and medhya properties.[32] The present +study has novelty as it aimed to compare the potential +appropriateness and adequacy of a basic yoga module +with Nasya Karma to alleviate stress and insomnia and +consequently their cognitive function and quality of +life. These practices require little preparation that can +be practiced individually on an everyday premise by +patients with insomnia. +Material and Methods +Study design and sample size +It was an open‑label, randomized controlled trial. There +were three groups in total, one for the yoga group (G‑1), +the second for the ayurveda group  (G‑2), and the +third for the control group (G‑3). Computer‑generated +randomization was performed. Participants were +randomly equally allocated to three groups, yoga +group  (G‑1), ayurveda group  (G‑2), and control +group (G‑3). All the groups were assessed on the first +day before the start of the yoga regime and the 48th day. +The sample size was calculated based on the previous +study (Bankar et al., 2013) on the beneficial effects of yoga +on insomnia.[33] The effect size and its equivalent of partial +eta square with alpha 0.05 and power 0.9 with three +groups and three measurements are used to estimate the +sample size. The optimal sample size estimated is 100. +With the assumption of attrition rate (~20%) during the +study, the total sample size planned is 120. +Study setting and participants +For the present clinical study, both male and female +participants were screened based on DSM‑5. The +participants were recruited from the out‑patient +department  (OPD) of the Panchakarma Dept. of +Ayurveda University. The study’s participants were +included based on the inclusion and exclusion criteria +below. +Participant selection criteria +Participants from 18 to 45  years were included in +the study, fulfilling DSM‑V criteria for insomnia, +willing to participate, and physically fit for the yoga +module and the Nasya procedure. Patients had an +allergy to oil application primarily through the nasal +route; any severe respiratory ailments (URTI, allergic +rhinitis, sinusitis, asthma); any severe psychiatric +disorder  (schizophrenia, mania, bipolar disorders, +OCD); chronic illness (diabetes mellitus, hypertension); +taking medications such as alpha‑blockers, beta‑blockers, +corticosteroids, ace inhibitors, and statins, drug +withdrawal syndromes (barbiturates, tranquilizers); +substance abuse such as alcohol ingestion and withdrawal; +endocrine or metabolic disorders (hypothyroidism or +hyperthyroidism); and pregnant and lactating women +were excluded. +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +Journal of Education and Health Promotion | Volume 12 | May 2023 +3 +Study intervention +Yoga Group  (G‑1): The yoga session included +physical activity, relaxation, regulated breathing, and +philosophical aspects. It was an integrated approach +to yoga, derived from principles in ancient texts +emphasizing that yoga should promote health at all +levels. The session was for 60 minutes daily, 6 days a +week. The yoga practices followed the approved protocol +based on a paper by Dr. Manjunath and Dr. Shirley +Telles, “Influence of Yoga & Ayurveda on self‑rated sleep +in a geriatric population.” +Yoga Nidrä – 1 day a week. Jal ëeti – 3 days in a week. +Ayurveda Group (G‑2): Patients were administered +in this group’s Nasya  (Pratimarça) procedure. As +Pratimarça Nasya was a daily regimen, each sitting +included two drops in each nostril for 48 days, regularly +in the morning and evening. +Control Group  (G‑3): This group followed the +conventional medical treatment. Pre‑post‑intervention +data were collected. Figure 1 CONSORT flow diagram +Data collection +Data were collected from the selected participants +through four questionnaires as Pittsburgh Sleep Quality +Index (PSQI), Perceived Stress Scale (PSS), cognitive +failure questionnaire (CFQ), and WHO Quality of Life +Scale‑Brief (WHOQOL‑Brief). Details about the nature of +the study’s intervention were explained to participants, +and informed consent was taken from them. +The PSQI questionnaire measures the quality and sleeps +patterns. It has seven domains measuring “good” to +“poor” sleep: subjective sleep quality, sleep latency, sleep +duration, sleep disturbances, habitual sleep efficiency, +daytime dysfunction, and sleep medication last month. +The client rates each of these seven domains of sleep. +Scoring is based on a 0 to 3 scale. Scoring 3 depicts the +extreme negative on the Likert Scale. A total sum of “5” +or greater indicates a “poor” sleeper.[34] +The PSS is a widely used instrument for measuring +stress. Stressful life events are closely associated with +the onset of insomnia and are mediated by certain +predisposing personality factors. Insomniacs, compared +to controls, tend to be more discontent, both as children +and as adults, have less satisfying inter‑personal +relations, and have relatively poor self‑concepts, +leading to inadequate coping mechanisms for dealing +with stress. +All the items on this scale are easy to respond to, and +alternatives are simple to grasp. All questions are general +and are relatively free of content specific to any group. +It consists of 25 items scored on a 5‑point Likert scale +ranging from 0 (never) to 4 (very often). The questions +in the PSS ask about thoughts and feelings in the last +month.[35] +Assessed for eligibility +Inclusion criteria +• Patient fulfilling DSM-5 criteria for +insomnia. +• Age – 18 to 45 years. +• Patients willing to complete our +treatment schedule. +• Patient physically fit for the Yoga +Module +Randomization (n = 120) +Allocation +Yoga Group (n = 40) +48 days Yoga practices i.e., +consisting of yoga postures, +breathing practices, relaxation +and meditation +Ayurveda group (n = 40) +48 days Nasya (Pratimarça) +procedure +Control group (n = 40) +Conventional Treatment +Follow up +Lost to follow up (n = 2) +Lost to follow up (n = 3) +Lost to follow up (n = 3) +Analyzed +Analyzed (n = 37) +Outcomes +Stress, cognitive failure, sleep +quality and quality of life +Analyzed (n = 37) +Outcomes +Stress, cognitive failure, sleep +quality and quality of life +Analyzed (n = 38) +Outcomes +Stress, cognitive failure, sleep +quality and quality of life +Analysis +Follow up +Allocation +Enrollment +Figure 1: CONSORT Flow Diagram +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +4 +Journal of Education and Health Promotion | Volume 12 | May 2023 +The CFQ is used to measure standard cognitive errors. +The questionnaire was designed to assess the frequency +of lapses in three areas, perception, memory, and +motor function and was proposed by the authors to +tap a single factor coined “cognitive failures.” It is a +5‑point Likert scale ranging from 0 (never) to 4 (very +often). Respondents were asked to assess the number of +cognitive failures within the past 4 weeks before filling +out the questionnaire.[36] +For measurements of subjective quality of life (QoL), the +WHOQOL‑Brief was used. The WHOQOL‑Brief (Field +Trial Version) includes four domains and two items +scored individually about overall perception of quality +of life and health. The four domain scores are scaled +positively. Higher scores indicate a higher quality of +life. Three items of the WHOQOL Brief must be reversed +before scoring.[37] +Data extraction and analysis +The data extraction was performed on the first day and +the 48th day for the yoga, ayurveda, and control groups. +After the pre‑ and post‑intervention data collection, +data were checked for normality, and appropriate +statistical tests were applied. The Kolmogorov–Smirnov +Z test checked the normality of data. The Statistical +Package for Social Sciences (SPSS version 23, SPSS, +Inc., Chicago, IL) is used for analysis. All quantitative +variables were measured as mean, standard deviation, +and standard error. Proportions and frequencies were +described for categorical variables and compared using +the Chi‑square test. All applied statistical tests were +two‑sided and performed at a significance level of +P < 0.05. ANOVA (One‑way) was applied to explore +the between‑ and within‑group differences among three +study groups. Post hoc analysis, Bonferroni test, was +performed for multiple comparisons in groups. +Ethical consideration +Ethical permission was taken from the Institutional +Ethical Committee (IEC). An ethical certificate number +is RES/IEC‑SVYASA/195/2021. +Results +Results were analyzed as per protocol analysis. A total +of 112 participants were analyzed, and the drop‑out +rate was 6.66%. In the yoga, ayurveda, and control +groups, 38, 37, and 37 participants were available +post intervention, respectively. Table 1 describes the +participant’s sociodemographic characteristics. It +showed that the mean age of participants was matched, +and there was no statistically significant difference. +Sociodemographic classifications were described in the +table as per modified Kuppuswamy and Udai Pareekh’s +scale.[38] +Stress and sleep quality +Results showed a significant association of selected +variables such as gender  (<0.05), habitat  (<0.001), +occupation  (<0.05), marital status  (<0.05), and +socioeconomic status  (<0.01) with sleep quality. +Table 1: Sociodemographic characteristics of participants +Variables +Categories +Yoga Group +(n=40) +Frequency % +Ayurveda +Group (n=40) +Frequency % +Control Group +(n=40) +Frequency % +Sleep +Quality (P) +Age (Mean±SD) +34.6±7.07 +32.15±6.94 +31.8±7.24 +Gender +Male +26 (65) +22 (55) +25 (62.5) +<0.05* +Female +14 (35) +18 (45) +15 (32.5) +Educational Qualification +Up to 12th standard +5 (12.5) +4 (10) +9 (22.5) +0.21 +Graduation +22 (55) +21 (52.5) +20 (50) +Post‑ Graduation +13 (32.5) +15 (37.5) +11 (27.5) +Habitat +Urban +35 (87.5) +31 (77.5) +32 (40) +<0.001** +Rural +5 (12.5) +9 (22.5) +8 (20) +Marital status +Married +32 (40) +21 (52.5) +24 (60) +<0.05* +Single +6 (15) +10 (25) +13 (32.5) +Separated +2 (5) +9 (47.5) +3 (7.5) +Occupation +Government job +10 (25) +5 (12.5) +8 (20) +<0.01** +Private job +22 (55) +26 (65) +12 (30) +Self‑employed +1 (2.5) +3 (7.5) +11 (27.5) +No occupation +7 (17.5) +6 (15) +9 (22.5) +Socioeconomic Status +Lower +‑ +‑ +<0.001** +Upper Lower +3 (7.5) +4 (10) +2 (5) +Lower Middle +33 (82.5) +31 (77.5) +29 (72.5) +Upper middle +4 (10) +5 (12.5) +9 (22.5) +Upper +‑ +‑ +‑ +‑ +Note Chi‑Square’ test, P value significant as * represents <0.05 and ** represents <0.01. SD, standard deviation +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +Journal of Education and Health Promotion | Volume 12 | May 2023 +5 +Table 2 depicts the descriptive statistics for stress and +sleep quality variables in yoga, ayurveda, and control +groups. It can be noted that the post‑intervention +mean ± SD for a perceived stress test was the lowest in +the yoga group (11.73 ± 1.96), followed by the ayurveda +group (16.51 ± 4.49) and control group (17.91 ± 4.62). +Accordingly, yoga practice reduced the stress level of +insomnia patients more than the ayurveda and control +groups. +Simultaneously, participants’ sleep quality was also +improved in the yoga group (4.63 ± 2.28), followed by the +ayurveda group (9.18 ± 3.80) and control group (11.86 ± 6.54). +The lowest mean value can be observed in the yoga group. +Table 3 describes the results of the ANOVA (one‑way) +test. All groups have observed that stress variables had +significant mean differences (F‑26.275, P value 0.011). +Participants’ sleep quality also had a significant mean +difference (F‑24.271, P value 0.021) in all groups. +Table 2: Descriptive statistics for stress, sleep, cognitive failure, and quality of life variables in yoga, ayurveda, +and control groups +Dependent +Variable +(I) Groups +n +Mean +Std. +Deviation +Std. Error +95% Confidence Interval for Mean +Lower Bound +Upper Bound +PSS +1 +38 +11.7368 +1.96846 +0.31933 +11.0898 +12.3839 +2 +37 +16.5135 +4.49457 +0.73890 +15.0149 +18.0121 +3 +37 +17.9189 +4.62108 +0.75970 +16.3782 +19.4597 +Total +112 +15.3571 +4.67860 +0.44209 +14.4811 +16.2332 +PSQI +1 +38 +4.6316 +2.28297 +0.37035 +3.8812 +5.3820 +2 +37 +9.1892 +3.80670 +0.62582 +7.9200 +10.4584 +3 +37 +11.8649 +6.54541 +1.07606 +9.6825 +14.0472 +Total +112 +8.5268 +5.42095 +0.51223 +7.5118 +9.5418 +WHOQOL‑Brief +General Health +1 +38 +7.9211 +1.14801 +0.18623 +7.5437 +8.2984 +2 +37 +7.0811 +1.32032 +0.21706 +6.6409 +7.5213 +3 +37 +6.5946 +1.38362 +0.22747 +6.1333 +7.0559 +Total +112 +7.2054 +1.38940 +0.13129 +6.9452 +7.4655 +Physical +Health +1 +38 +29.1053 +3.02056 +0.49000 +28.1124 +30.0981 +2 +37 +26.1351 +3.72799 +0.61288 +24.8922 +27.3781 +3 +37 +22.7297 +4.05277 +0.66627 +21.3785 +24.0810 +Total +112 +26.0179 +4.44381 +0.41990 +25.1858 +26.8499 +Psychological +Health +1 +38 +24.2368 +3.01738 +0.48948 +23.2451 +25.2286 +2 +37 +21.6486 +3.19910 +0.52593 +20.5820 +22.7153 +3 +37 +18.8378 +4.00356 +0.65818 +17.5030 +20.1727 +Total +112 +21.5982 +4.05916 +0.38355 +20.8382 +22.3583 +Social Health +1 +38 +12.1842 +1.81369 +0.29422 +11.5881 +12.7804 +2 +37 +10.7297 +2.06355 +0.33925 +10.0417 +11.4178 +3 +37 +9.9730 +1.89277 +0.31117 +9.3419 +10.6041 +Total +112 +10.9732 +2.12009 +0.20033 +10.5762 +11.3702 +Environment +Health +1 +38 +32.8684 +3.48875 +0.56595 +31.7217 +34.0151 +2 +37 +28.8378 +5.51520 +0.90669 +26.9990 +30.6767 +3 +37 +25.5135 +4.65845 +0.76585 +23.9603 +27.0667 +Total +112 +29.1071 +5.48931 +0.51869 +28.0793 +30.1350 +Cognitive Failure +Forgetfulness +1 +38 +10.2632 +3.20206 +0.51944 +9.2107 +11.3156 +2 +37 +15.1351 +3.35958 +0.55231 +14.0150 +16.2553 +3 +37 +18.8649 +6.57927 +1.08163 +16.6712 +21.0585 +Total +112 +14.7143 +5.80529 +0.54855 +13.6273 +15.8013 +Distractibility +1 +38 +10.8158 +3.76940 +0.61148 +9.5768 +12.0548 +2 +37 +14.5676 +3.64799 +0.59973 +13.3513 +15.7839 +3 +37 +17.0541 +6.81072 +1.11968 +14.7832 +19.3249 +Total +112 +14.1161 +5.54709 +0.52415 +13.0774 +15.1547 +False triggers +1 +38 +11.0789 +3.07897 +0.49948 +10.0669 +12.0910 +2 +37 +15.5135 +4.66441 +0.76682 +13.9583 +17.0687 +3 +37 +17.5405 +7.42965 +1.22143 +15.0634 +20.0177 +Total +112 +14.6786 +5.95965 +0.56313 +13.5627 +15.7945 +Note: PSS, Perceived Stress Scale; PSQI, Pittsburgh Sleep Quality Scale; WHOQOL‑Brief, WHO Quality of Life Scale‑Brief; Std., standard; Sig., significant. +Groups: 1, Yoga; 2, Ayurveda; 3, Control +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +6 +Journal of Education and Health Promotion | Volume 12 | May 2023 +Quality of life +Table 2 also describes the participants’ quality of life +scores under sub‑heads of general health, physical health, +psychological health, social health, and environment +health in all groups. In the yoga group, general health +scores (7.92 ± 1.14) were nearly similar to those in the +ayurveda group (7.08 ± 1.32) but higher than those in +the control group (6.54 ± 1.38). +Physical health scores were the highest in the +yoga group  (29.10  ±  3.02) compared to the +ayurveda (26.13 ± 3.72) and control groups (22.72 ± 4.05). +The psychological, social, and environmental health +scores of participants were improved in the yoga +group compared to the ayurveda and control +groups [Table 2]. +All five aspects, general health (F‑10.220, P value 0.038), +physical health (F‑29.087, P value 0.001), psychological +health (F‑23.23, P value 0.021), social health (F‑12.808, +P value 0.045), and environmental health (F‑23.849, +P value 0.013) had a significant mean difference in all +three groups. +Cognitive function +The cognitive Failure questionnaire has been +divided into three aspects  –  forgetfulness, +distractibility, and false triggers. Post‑intervention +mean scores for forgetfulness were the lowest +in the yoga group  (10.2632  ±  3.20206) compared +to the ayurveda  (15.1351  ±  3.35958) and control +groups (18.8649 ± 6.57927). Distractibility scores were +also the lowest in the yoga group (10.8158 ± 3.76940) +compared to other groups. The table also depicted the +lower and upper bounds with a standard error for all +outcomes in each group [Table 2]. +All three aspects, forgetfulness  (F‑32.477, P  value +0.011), distractibility (F‑15.095, P value 0.020), and false +triggers (F‑14.340, P value 0.001), had significant mean +Table 3: Mean differences for stress, sleep, cognitive failure, and quality of life in yoga, ayurveda, and control +groups +Sum of Squares +Mean Square +F +Sig. +PSS +Between Groups +790.346 +395.173 +26.275 +<0.01** +Within Groups +1639.368 +15.040 +Total +2429.714 +PSQI +Between Groups +1005.078 +502.539 +24.271 +<0.05* +Within Groups +2256.842 +20.705 +Total +3261.920 +WHOQOL‑Brief +General Health +Between Groups +33.838 +16.919 +10.220 +<0.05* +Within Groups +180.439 +1.655 +Total +214.277 +Physical health +Between Groups +762.764 +381.382 +29.087 +<0.01** +Within Groups +1429.201 +13.112 +Total +2191.964 +Psychological health +Between Groups +546.592 +273.296 +23.231 +<0.05* +Within Groups +1282.328 +11.764 +Total +1828.920 +Social health +Between Groups +94.939 +47.469 +12.808 +<0.05* +Within Groups +403.981 +3.706 +Total +498.920 +Environment health +Between Groups +1018.102 +509.051 +23.849 +<0.01* +Within Groups +2326.612 +21.345 +Total +3344.714 +Cognitive Failure +Forgetfulness +Between Groups +1396.840 +698.420 +32.477 +<0.05* +Within Groups +2344.017 +21.505 +Total +3740.857 +Distractibility +Between Groups +740.808 +370.404 +15.095 +<0.05* +Within Groups +2674.683 +24.538 +Total +3415.491 +False triggers +Between Groups +821.233 +410.616 +14.340 +<0.01** +Within Groups +3121.196 +28.635 +Total +3942.429 +PSS, Perceived Stress Scale; PSQI, Pittsburgh Sleep Quality Scale; WHOQOL‑Brief, WHO Quality of Life Scale‑Brief; Std., standard; significant mean difference; +* represents <0.05 and ** represents <0.01. Sig., significant. Groups: 1, Yoga; 2, Ayurveda; 3, Control +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +Journal of Education and Health Promotion | Volume 12 | May 2023 +7 +differences in scores for all three groups [Table 3]. Post +hoc analysis was also applied for multiple comparisons, +values which show a significant difference in all +groups [Tables 4‑6]. +Discussion +Acute insomnia is considered an emotional disorder. It is +associated with specific personality traits in patients.[2,3] +Table 4: Multiple comparisons for stress and sleep quality in all groups +Dependent Variable +(I) Groups +(J) Groups +MD (I‑J) +Std. Error +Sig. +95% Confidence Interval +Lower Bound +Upper Bound +PSS +1 +2 +‑4.77667* +0.89570 +<0.01** +‑6.9546 +‑2.5988 +3 +‑6.18208* +0.89570 +<0.05* +‑8.3600 +‑4.0042 +2 +1 +4.77667* +0.89570 +<0.01** +2.5988 +6.9546 +3 +‑1.40541 +0.90165 +0.366 +‑3.5978 +0.7870 +3 +1 +6.18208* +0.89570 +<0.01** +4.0042 +8.3600 +2 +1.40541 +0.90165 +0.366 +‑0.7870 +3.5978 +PSQI +1 +2 +‑4.55761* +1.05093 +<0.01** +‑7.1129 +‑2.0023 +3 +‑7.23329* +1.05093 +<0.05* +‑9.7886 +‑4.6780 +2 +1 +4.55761* +1.05093 +<0.05* +2.0023 +7.1129 +3 +‑2.67568* +1.05792 +<0.05* +‑5.2480 +‑0.1034 +3 +1 +7.23329* +1.05093 +<0.01** +4.6780 +9.7886 +2 +2.67568* +1.05792 +<0.05* +0.1034 +5.2480 +Note: Post hoc analysis, Bonferroni test for multiple comparisons. PSS, Perceived Stress Scale; PSQI, Pittsburgh Sleep Quality Scale; Std., Standard; Significant +mean difference; * represents <0.05 and ** represents <0.01. Sig., significant, MD Mean Difference. Groups: 1, Yoga; 2, Ayurveda; 3, Control +Table 5: Multiple comparisons for quality of life in all groups +Dependent Variable +(I) Groups +(J) Groups +Mean Difference (I‑J) +Std. Error +Sig. +95% Confidence Interval +Lower Bound +Upper Bound +WHOQOL‑Brief +General Health +1 +2 +0.83997* +0.29716 +<0.05* +0.1174 +1.5625 +3 +1.32646* +0.29716 +<0.01** +0.6039 +2.0490 +2 +1 +‑0.83997* +0.29716 +<0.05* +‑1.5625 +‑0.1174 +3 +0.48649 +0.29913 +0.320 +‑0.2409 +1.2138 +3 +1 +‑1.32646* +0.29716 +<0.01** +‑2.0490 +‑0.6039 +2 +‑0 0.48649 +0.29913 +0.320 +‑1.2138 +0.2409 +Physical health +1 +2 +2.97013* +0.83632 +<0.01** +0.9366 +5.0036 +3 +6.37553* +0.83632 +<0.01** +4.3420 +8.4090 +2 +1 +‑2.97013* +0.83632 +<0.01** +‑5.0036 +‑0.9366 +3 +3.40541* +0.84187 +<0.05* +1.3584 +5.4524 +3 +1 +‑6.37553* +0.83632 +<0.05* +‑8.4090 +‑4.3420 +2 +‑3.40541* +0.84187 +<0.05* +‑5.4524 +‑1.3584 +Psychological health +1 +2 +2.58819* +0.79218 +<0.01** +0.6620 +4.5144 +3 +5.39900* +0.79218 +<0.01** +3.4728 +7.3252 +2 +1 +‑2.58819* +0.79218 +<0.01** +‑4.5144 +‑0.6620 +3 +2.81081* +0.79744 +<0.01** +0.8718 +4.7498 +3 +1 +‑5.39900* +0.79218 +<0.001** +‑7.3252 +‑3.4728 +2 +‑2.81081* +0.79744 +<0.001** +‑4.7498 +‑0.8718 +Social health +1 +2 +1.45448* +0.44464 +<0.05* +0.3734 +2.5356 +3 +2.21124* +0.44464 +<0.001** +1.1301 +3.2924 +2 +1 +‑1.45448* +0.44464 +<0.05** +‑2.5356 +‑0.3734 +3 +0.75676 +0.44759 +0.281 +‑0.3316 +1.8451 +3 +1 +‑2.21124* +0.44464 +<0.001** +‑3.2924 +‑1.1301 +2 +‑0.75676 +0.44759 +0.281 +‑1.8451 +0.3316 +Environment +1 +2 +4.03058* +1.06705 +<0.001** +1.4361 +6.6251 +3 +7.35491* +1.06705 +<0.001** +4.7604 +9.9494 +2 +1 +‑4.03058* +1.06705 +<0.01** +‑6.6251 +‑1.4361 +3 +3.32432* +1.07414 +<0.01** +0.7126 +5.9361 +3 +1 +‑7.35491* +1.06705 +<0.01** +‑9.9494 +‑4.7604 +2 +‑3.32432* +1.07414 +<0.05* +‑5.9361 +‑0.7126 +Note: post hoc analysis, Bonferroni test, for multiple comparisons. WHOQOL‑Brief, WHO Quality of Life Scale‑Brief; Std., Standard; significant mean difference; +*represents <0.05 and ** represents <0.01. Sig., significant; MD, mean difference; LB, lower bound; UB, upper bound. Groups: 1, Yoga; 2, Ayurveda; 3, Control +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +8 +Journal of Education and Health Promotion | Volume 12 | May 2023 +As yoga aims to bring consensus between mind and +body,[26,27] this study assessed the effectiveness of a +basic set of yoga exercises, requiring little preparation +that patients can practice individually on an everyday +premise with insomnia. The study compared the results +with ayurveda and standard care. This randomized +control trial describes yoga as a helpful therapy +for acute insomnia patients. After an intervention, +participants in the yoga group improved global sleep +quality, subjective sleep quality, wake‑after‑sleep onset, +daytime dysfunction, and sleep efficiency compared +with ayurveda and standard care. In the same group, +we also found stress reduction and improved cognitive +function and quality of life. Because of physiopathology, +insomnia is associated with increased psychological +symptoms, cognitive dysfunction, perceived stress, and +poor quality of life as precipitating and perpetuating +factors.[39,40] Increasing melatonin levels and anxiety +reduction affect sleep quality and confirm yoga’s +effectiveness in stress reduction.[41] Morning yoga +exercise enhances night parasympathetic drive and more +curative sleep. In addition, the probable mechanisms +were linked to the cognitive structuring effects of the +yoga practice.[42] Consistently, studies have reported +improvement in objective sleep quality, even measuring +by polysomnography and sleep diary.[43,44] Yoga reduces +stress and improves general health in the young +population by reducing sympathetic activity.[45] Another +trial with a mindfulness program for stress reduction +suggested significant effects on stress, anxiety, and +cognitive emotion regulation (P < 001).[46] Even yoga +was safe and effective in improving sleep quality and +life in older adults.[47] One week of residential yoga +training program reduced the occupational stress in the +participants aged 40–59.[48] A quasi‑experimental study +states the effectiveness of yoga in coping with stress +and anxiety and enhancing happiness in professional +students.[49] +According to ayurveda, an individual’s nature (Prakriti +in Sanskrit) could consist of different doshas, with one +dosha being predominant in some cases. Ayurveda looks +at several aspects of an individual›s lifestyle.[50] The +present study found improvement in sleep quality +and reduction in stress with improvement in cognitive +function and, ultimately, the quality of life in the ayurveda +group compared to standard therapy. However, the +scores were not like those of yoga practice but improved +compared to standard therapy. Therefore, the role of +ayurveda cannot be neglected in patients with insomnia. +Previous studies have come up with biochemical, +hematological, and physiological variations in different +Prakriti, and sleep is also considered to be influenced +by psychological factors.[51] Studies also claimed its +effectiveness in enhancing memory and cognitive +functions.[52,53] Few studies suggested the failure of +short‑term effects of Bacopa monnieri supplementation +to improve sleep patterns and quality of life in +comparison to the placebo in adults with insomnia.[54] +In contrast, another trial on healthy adults identified +mood‑enhancing effects and reduced cortisol levels, +evincing a physiological mechanism for cognitive stress +reduction with supplementation of Bacopa monnieri. It +was evidenced that Bacopa monnieri supplementation +Table 6: Multiple comparisons for cognitive function in all groups +Dependent Variable +(I) Groups +(J) Groups +Mean Difference (I‑J) +Std. Error +Sig. +95% Confidence Interval +Lower Bound +Upper Bound +Forgetfulness +1 +2 +‑4.87198* +1.07104 +<0.05* +‑7.4762 +‑2.2678 +3 +‑8.60171* +1.07104 +<0.05* +‑11.2059 +‑5.9975 +2 +1 +4.87198* +1.07104 +0.060 +2.2678 +7.4762 +3 +‑3.72973* +1.07816 +<0.05* +‑6.3513 +‑1.1082 +3 +1 +8.60171* +1.07104 +<0.001** +5.9975 +11.2059 +2 +3.72973* +1.07816 +<0.05* +1.1082 +6.3513 +Distractibility +1 +2 +‑3.75178* +1.14409 +<0.001** +‑6.5336 +‑0.9699 +3 +‑6.23826* +1.14409 +<0.05* +‑9.0201 +‑3.4564 +2 +1 +3.75178* +1.14409 +<0.05* +0.9699 +6.5336 +3 +‑2.48649 +1.15169 +0.099 +‑5.2868 +0.3138 +3 +1 +6.23826* +1.14409 +<0.001** +3.4564 +9.0201 +2 +2.48649 +1.15169 +0.099 +‑0.3138 +5.2868 +False triggers +1 +2 +‑4.43457* +1.23591 +<0.01** +‑7.4397 +‑1.4295 +3 +‑6.46159* +1.23591 +<0.01** +‑9.4667 +‑3.4565 +2 +1 +4.43457* +1.23591 +<0.001** +1.4295 +7.4397 +3 +‑2.02703 +1.24412 +0.318 +‑5.0521 +0.9980 +3 +1 +6.46159* +1.23591 +<0.001** +3.4565 +9.4667 +2 +2.02703 +1.24412 +0.318 +‑0.9980 +5.0521 +Note: Post hoc analysis, Bonferroni test, for multiple comparisons. PSS, Perceived Stress Scale; PSQI, Pittsburgh Sleep Quality Scale; WHOQOL‑Brief, WHO +Quality of Life Scale‑Brief; Std., Standard; significant mean difference; * represents <0.05 and ** represents <0.01. Sig., significant; MD, mean difference; LB, +lower bound; UB, upper bound. Groups: 1, Yoga; 2, Ayurveda; 3, Control +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] +Verma, et al.: A comparative efficacy of yoga module & nasya karma in insomnia +Journal of Education and Health Promotion | Volume 12 | May 2023 +9 +produced some adaptogenic and nootropic effects.[55] A +systematic review of six randomized controlled trials +observed that Bacopa improves memory‑free recall +and cognitive abilities in studies across the cognitive +domains.[56] Evidence from animal trials has consistently +suggested its anxiolytic or antidepressant effects.[57,58] One +trial has explored its safety and efficacy in enhancing +cognitive performance in participants with age 65 or +more.[59] +After discussing studies with yoga and ayurveda practice +in reducing stress and improving sleep quality, cognitive +function, and quality of life, it needs to emphasize +that the present study’s results with yoga practice +are consistent with previous studies. However, the +availability of limited literature with similar efficacy of +ayurveda emphasized further research for its acceptance +in reducing stress and improving sleep quality, cognitive +function, and quality of life. +Strength and limitations +The present study compared the two interventions (Yoga +and Nasya karma) individually with the control group in +the same population. The sample size was also adequate, +and the drop‑out rate was meager compared to other +studies in the same intervention. However, it was an +open‑label trial. Subjective questionnaires were used to +measure and compare the results. +Conclusion +The study concluded that yoga as a holistic treatment +could bring significant changes in insomnia patients +and help with various psychosocial and cognitive +parameters, which can ultimately help alleviate stress +and improve the quality of life compared to ayurveda +and standard therapy. A vital advantage of the yoga +intervention is its recognition and acceptance as a health +practice, which should also add to the attractiveness of +such a treatment for insomnia patients. +Declaration of patient consent +The authors certify that they have obtained all appropriate +patient consent forms. In the form the patient(s) has/ +have given his/her/their consent for his/her/their +images and other clinical information to be reported in +the journal. The patients understand that their names +and initials will not be published and due efforts will +be made to conceal their identity, but anonymity cannot +be guaranteed. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +References +1. +Vahia VN. Diagnostic and statistical manual of mental disorders +5: A quick glance. Indian J Psychiatry 2013;55:220‑3. +2. +Sateia MJ. International classification of sleep disorders‑third +edition: Highlights and modifications. 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J Altern +Complement Med 2008;14:707‑13. +[Downloaded free from http://www.jehp.net on Friday, October 20, 2023, IP: 103.5.133.82] diff --git a/subfolder_0/Complexity Biology based Information Structures can explain.txt b/subfolder_0/Complexity Biology based Information Structures can explain.txt new file mode 100644 index 0000000000000000000000000000000000000000..97a403ea49c85dd55c333c18074fa6f878d6ca56 --- /dev/null +++ b/subfolder_0/Complexity Biology based Information Structures can explain.txt @@ -0,0 +1,562 @@ +Cosmos and History: The Journal of Natural and Social Philosophy, vol. 10, no. 1, 2014 + + +COMPLEXITY BIOLOGY-BASED INFORMATION +STRUCTURES CAN EXPLAIN SUBJECTIVITY, +OBJECTIVE REDUCTION OF WAVE PACKETS, +AND NON-COMPUTABILITY +Alex Hankey + + + +Abstract: +Background: how mind functions is subject to continuing scientific discussion. A simplistic +approach says that, since no convincing way has been found to model subjective experience, +mind cannot exist. A second holds that, since mind cannot be described by classical physics, it +must be described by quantum physics. Another perspective concerns mind’s hypothesized +ability to interact with the world of quanta: it should be responsible for reduction of quantum +wave packets; physics producing ‘Objective Reduction’ is postulated to form the basis for mind- +matter interactions. This presentation describes results derived from a new approach to these +problems. It is based on well-established biology involving physics not previously applied to the +fields of mind, or consciousness studies, that of critical feedback instability. +Methods: ‘self-organized criticality’ in complexity biology places system loci of control at +critical instabilities, physical properties of which, including information properties, are +presented. Their elucidation shows that they can model hitherto unexplained properties of +experience. +Results: All results depend on physical properties of critical instabilities. First, at least one +feed-back or feed-forward loop must have feedback gain, g = 1: information flows round the +loop impress perfect images of system states back on themselves: they represent processes of +perfect self-observation. This annihilates system quanta: system excitations are instability fluctuations, +which cannot be quantized. Major results follow: +1. Information vectors representing criticality states must include at least one attached information +loop denoting self-observation. +2. Such loop structures are attributed a function, 'registering the state’s own existence', +explaining + +a. Subjective ‘awareness of one’s own presence’ + +b. How content-free states of awareness can be remembered (Jon Shear) + +c. Subjective experience of time duration (Immanuel Kant) + +d. The ‘witness’ property of experience – often mentioned by athletes ‘in the zone’ +www.cosmosandhistory.org +237 + +COSMOS AND HISTORY +238 + +e. The natural association between consciousness and intelligence +This novel, physically and biologically sound approach seems to satisfactorily model +subjectivity. +Further significant results follow: +1. Registration of external information in excited states of systems at criticality reduces external +wave-packets: the new model exhibits ‘Objective Reduction’ of wave packets. +2. High internal coherence (postulated by Domash & Penrose) leading to a. Non-separable +information vector bundles. b. Non-reductive states (Chalmers' criterion for experience) +3. Information that is: a. encoded in coherence negentropy; b. non-digitizable, and therefore c. +computationally without digital equivalent (posited by Penrose). +Discussion and Conclusions: instability physics implies anharmonic motion, preventing +excitation quantization, and totally different from quantum physics of simple harmonic motion +at stability. Instability excitations are different from anything hitherto conceived in information +science. They model aspects of mind never previously treated, including genuine subjectivity, +objective reduction of wave-packets, and inter alia all properties given above. +KEYWORDS: Complexity; Information structures; Subjectivity; Objective Reduction of Wave +Packets; Roger Penrose; Alan Chalmers +INTRODUCTION +In the early 1990’s, after consulting myself, publisher Keith Sutherland recruited +Professor Jonathan Shear to help him found the Journal of Consciousness Studies, thus +bringing a new channel of publication to the field of consciousness research. +Sutherland had been stimulated by Penrose’s monumental book, The Emperor’s New +Mind, strongly arguing that analysis of the halting problem, and other aspects of +computational theory, implied that human information processing was not +computable (1). This point developed the suggestion by Penrose’s Oxford colleague, J. +Lucas, that metamathematical theorems imply the existence of consciousness, a point +supported by Penrose, based on his experience of mathematical intuition, and its role +in guiding discovery in mathematics. +The rest is history: in 1994, David Chalmers published his magnificent JCS paper +(2), amplified in his book, The Conscious Mind (3), which became the reference point for +all subsequent work in the field, from Jon Shear’s book of papers, ‘Consciousness the +Hard Problem’ (4), in which Chalmers refuted all objections to his proposals, to the +Penrose and Hameroff collaboration (5) now dominating the field. Key points made by +Chalmers were, inter alia, (A) to deny conscious experience as an ingredient of creation +is inadmissible i.e. the subjective aspect of mind, with its sense of ‘self’, whatever that +may mean, is undeniable. (B) Consciousness needs to be admitted as an a priori +ingredient of creation, as fundamental as the electron or matter-energy. (C) Since +reductive explanations of consciousness had failed, any explanation should be non- + +ALEX HANKEY +239 +reductive in nature, and (D) the brain must support special information states with a +‘Dual Aspect’: in addition to ordinary information content, they must possess an +additional aspect permitting them to support subjective experience. Chalmers’s points, +including several others in addition to these four, have served as the anvil, on which all +work in the field has since been forged. +Chalmers’s main point (1) was that the existence and nature of experience IS the +hard problem. It can be restated as follows: all of us, when we experience anything, +carry a ‘sense of our own presence’, of which we may be more or less strongly aware at +different times. When we recall a story from our life, our memory includes a ‘sense of +our own presence’ at the events we describe e.g. when our name was called out in a +roll call in class at school and we replied, ‘Present!’, our response affirmed our ‘sense of +our own presence’ in class. This factor both affirms the non-triviality of subjective +experience, and identifies what is needed to explain it: something that carries a sense +of being in ‘Time present’ (as TS Eliot puts it) (6). That is what is really required. +A largely unrecognized problem is that Chalmers’s points have not been +sufficiently rigorously implemented. The general attitude on how to represent states of +experience in physical terms is exemplified by the tacit point in the many books by +Amit Goswami (7): since classical physics cannot represent conscious experience, +quantum physics must be used to do so (sotto voce: quantum theory is all that is +available). Goswami waxes eloquent on all that can supposedly be achieved using +quantum theory, but that approach fails to take into account that standard quantum +theory is used to represent matter, so to use it to try to represent states of experience fails to +distinguish between object and subject in any fundamental way. It trivializes Chalmers’s points. +Similarly, quantum theory is basically reductive in nature (states of many particles +are represented as products) - one reason why physics likes it. Though Chalmers states +that a non-reductive theory is required to represent experience (1), in practice, no one has +proposed an intrinsically non-reductive theory to do so. All uses of quantum theory, +including the latest Hameroff-Penrose proposals (5), fail to provide the inherently non- +reductive information states required to properly fulfil Chalmers’s requirement: no +reason is given for the chosen states to be anything other than states of objective +matter! +This paper proposes to remedy these defects in current theory by adopting a +radically different approach based on theories of regulation emerging from complexity +biology, The supposed seat of conscious experience, the brain, is the ultimate regulator +of the body, so its complexity states constitute an obvious place to start a search for +possible physical states serving as the basis for experience. Indeed, conscious +experience may be considered the highest level of overall control in the brain, which + +COSMOS AND HISTORY +240 +provides many inputs to induce it to take appropriate action, but leaves final decisions +in the experiencer’s hands. Biologically speaking, this is precisely the place to start, +Complexity biology is remarkable for the obscurity of its new concepts: fractality, +edge of chaos, and self-organized criticality. Their biological rationale is not given. +‘Criticality’, the central concept, may be very simply stated, however: organisms prefer +their regulatory systems loci of control to be at critical feedback instabilities. Since +conscious experience is at the locus of control of the whole organism, feedback instability +becomes the physical condition of choice to consider as a possible basis for experience. +When Norbert Wiener first proposed his revolutionary new theory of control in +Cybernetics (8), he pointed out that all control requires feedback, which entails the +possibility of feedback instability, a mathematical ‘singularity’, with mathematical +physics as different from the physics of ordinary matter as is conceivable. Next, we list +various properties of feedback instabilities, in preparation for their use to explain +fundamental properties of experience in the following section. +METHODS +Instability only happens when the potential well for system restorative forces is not +described by the usual Hook’s Law form y = ax2, but rather y = axp, where p > 2 or +even p > 4,, making the well flat at its minimum. Energy levels are not evenly spaced: +system oscillations are neither simple harmonic, nor quantizable. Quantum theory breaks down. +(I) +Instead of being oscillations with well-defined frequencies independent of +amplitude, as in all quantum systems, frequencies are highly amplitude dependent, +and unpredictable. Excitations cannot be separated into a set of fixed frequency +oscillators – the idea of harmonic analysis in terms of normal modes does not hold. +Instead, the system becomes subject to long range correlations, representing a new +kind of ordering principle. (II) +Many authors have recognized that living organisms seem to possess abnormally +low entropy (9). Analysis of correlations at critical instabilities offers a rigorous reason for +this to hold: correlations endow a system with a form of order i.e. negative entropy. (III) +More importantly, if a system possess long range coherence, its excited states +cannot be separated into, or reduced to, mutually independent states, as in normal +mode analysis. Such a system is therefore non-reductive. Chalmers’s important point, (C) +above, is satisfied, now by the physics itself, not merely supposedly, in the philosophy. +(IV) +Next, consider the nature of the feedback leading to the instability. Critical +feedback occurs when a particular loop, possibly part of a complex system of loops, + +ALEX HANKEY +241 +attains of feedback gain, g, of precisely g = 1. But when information travels round a +(possibly multi-channel) loop with g = 1, the information returning to a given point is +unchanged, it constitutes a faithful reproduction of the information that started. In a +profound sense, the loop represents a self-observing system. (V) + +Comments: a. A more labored, but better proof may be obtained by considering +how changes in the physics as g approaches the value 1 from below. b. The above +example is not at all the same as that of a video-camera looking in a mirror, or a lady +doing her make-up, or like looking at oneself between two mirrors, with an infinite set +of images receding into the distance, or slowly bending out of sight, due to the tiny +angle between the planes of the mirrors. It constitutes a completely new and original +definition, not previously proposed. +Since a flow of information brings a system with intelligent understanding, +‘knowledge’, a system that is ‘self-observing’ due to a loop of circulating information, +becomes a potential candidate for a ‘system with self-knowledge’. (VI) +This idea that a system at a critical instability forms a ‘self-observing system’ may +seem naïve, but, for the following reason, it is highly non-trivial: it provides an +explanation, complementary to (I) and (III) above, for why such systems are non- +quantizable. In quantum theory, the quantum theory of observation states that a +process of observation annihilates quanta. A ‘self-observing system’ would annihilate all system +quanta by means of the process of self-observation. That is the dynamic reason why no quanta +are found in such systems, and they are not quantizable (VII) +Now consider the nature of excitations at critical instabilities: they are not simple +harmonic oscillations but complex, correlated mixtures known as critical fluctuations. +Their physics is responsible for all the properties of critical points. They cannot be +represented in a Hilbert Space, as is normally the case in quantum theory, for states in +Hilbert Spaces are, in principle, separable into individual states that can may +subsequently become superimposed. This luxury is not the case for critical +fluctuations, which are irreducible mixtures, inherently non-reductive members of a +different kind of mathematical ‘space’, called a ‘Banach Space’. (VIII) +Now consider information properties of such states: (a) they are mixtures, meaning +that they automatically have non-zero information; they are not like quantum +information vectors, each with zero intrinsic meaning, like letters of the alphabet. More +importantly (b) they carry the critical, g = 1, ‘self-observing’ information loop as an +irreducible aspect of their information properties. We therefore propose to represent +them as a vector bundle <===== with an added information loop: O. In other +words: <===== + O <=====O. (IX) + +COSMOS AND HISTORY +242 +Criticality states are located at ‘The Edge of Chaos’ meaning that they are +adjacent to a region containing many bifurcations. (X) +RESULTS +Now let us apply the above properties of systems at critical feedback instabilities to +derive different aspects of conscious experience. Instability physics is completely +different from stability, so many new possibilities may emerge. First, consider how +information structure (IX) applies to experience. +The information structure of the critical fluctuations (IX) carries information +content in the vector mixture bundle <=====, and also the information loop O, +representing a process of self-observation potentially yielding self-knowledge (VI). In +the 1980’s, dictionary definitions of consciousness was ‘possessing self-knowledge’, so +this seems promising. + +We therefore hypothesize that: The loop may be attributed a function, 'registering the state’s +own existence', analogous to humans ‘being aware of their own presence’ during experience. + +The hypothetical nature of this statement is important to understand. The idea that +these states may represent experience is not deductive, but inductive. It represents an +entirely new departure in scientific thought. The reasoning offered in this section +serves to justify this hypothesis +The role of the loop can also be understood by considering the approach to pure +consciousness in meditation, described in detail by Shear and others. In self- +transcending meditation systems, the content of the mind is allowed to die away, until +one is left in a state of pure self-awareness. This can be represented by the sequence: + +<=====O <====O <===O <==O <=O 2 or +even 4. +In the approach proposed here, phenomena in complexity biology are explicitly used to +model the mind-body connection. The machinery of conscious experience is linked to +structures considered the most complex in biology, probably in the entire natural +world. This seems natural: biology’s most sophisticated patterns of organization are +used to model its most complex (epi)phenomena. The proposed model thus effectively +confines ‘mind’ to the world of biology, as it should. +That the structure to which mind is proposed to couple is integral to all systems of +biological regulation is also appropriate: regulation requires feedback, and all feedback +contains the possibility of critical feedback instability. Indeed, Norbert Wiener (8) +identified feedback instability as the most significant innovation in physical theory +added by his account of regulation and control. But apparently no one has previously +considered their information properties, let alone how they may related to experience, +as proposed here. + +COSMOS AND HISTORY +248 +Subjectivity is deeply connected to intelligence and control. That feedback +instabilities and their (non)quantum properties should offer the key to understanding +experience is satisfying. Stability is characteristic of ‘matter’, to which instability seems, +in contrast, an irrelevant complication. +Convinced materialists may, possibly rightfully, claim that they have no need of +‘Mind’ to understand a purely material universe, as they understand the world of +perception. However, instability states seem to play a special role in supporting +‘experience’ in precisely the ways defined by Chalmers (1). The simple and +straightforward emergence of many properties of mind and subjective experience +previously only hypothesized brings confidence in the proposal. +CONCLUSIONS +A hitherto unsuspected, new form of information, ‘experience information’ has been +defined by considering information properties of excitations of a system at criticality – +critical fluctuations. Many reasons have been given for equating it with information +used cognition by experiencing subjects. Chiefly, the information loop(s), integral to its +information vector mixtures, can model the ‘sense of one’s own presence’ intrinsic to +subjective experience. Whether or not this is really the case for actual states of +experience should be subject to further theoretical and experimental investigation. +That self-organized criticality should apply to EEG wave packets associated with +mental cognition thus seems natural and appropriate. Freeman’s approach may play a +guiding role in helping form useful hypotheses for further research. +The theoretical work presented here provides prima facie reasoning for how all +this happens: information states built out of criticality excitations carry at least one g = +1 information loop associated with feedback instability. Interpretation of such loops as +perfect self-observing systems, suggests a physiological basis for the subjective sense of +being present in every situation, and thus for the sense of ‘self’ integral to human +experience. The proposed models may therefore account for the sense of subjectivity +accompanying human experience. +The occurrence of the g = 1 loops at loci of control adopted by complex +biosystems under self-organized criticality seems intuitively correct. It leads to another +serendipitous property of the proposed model: systems of the required complexity are +found exclusively in biosystems, and not in the world of ordinary matter, explaining +experience’s restriction to the world of biology. +The use of critical feedback instabilities from biological complexity to model +‘experience’ seems to show definite promise, and merits further work. It does not fully +explain the presence of the experiencing subject, however. That must still be taken as a + +ALEX HANKEY +249 +fundamental aspect in the universe, beyond explanation, as Chalmers (1) took pains to +emphasize. +In summary, the proposed theory seems to fit well in the following ways. +1. Complexity seems the right place in biology to find a solution to the problems of +experience and subjective intelligence, as the most complex phenomena in biology. +2. ‘Experience’ and ‘mind’ are based at the apex of the regularity hierarchy where +self-organized criticality must operate, so criticality is the condition of choice to +analyse. +3. In control theory, Wiener’s feedback singularity is the place where any radically +new and different property of a physical system should be located. +4. Singularity presents an appropriate physical condition, instability, with +correspondingly different physics from stability, the condition for matter. This +confirms criticality as the condition of choice to locate mind and experience. +5. The model presents a physics of experience distinct from the physics of matter +preserving the intuitive distinction between ‘mind’ and ‘matter’. +6. The feedback loop integral to the new kind of information is appropriate to model +the sense of ‘self’ accompanying all experience. +7. Criticality’s occurrence at the edge of chaos allows choices to be made, thus linking +the ‘sense of self’ to active intelligence, as is commonly experienced. +8. The non-linear mathematics of the singularity corresponds to the essential non- +linearity implied by the experiencing subject’s awareness of ‘self’. The essence of +subjectivity would seem to be ‘non-linearity’, a condition that should probably be +added to Chalmers’s list of the properties of experience. +9. A system that is essentially non-linear cannot be represented by linear models. The +mathematically singular feedback loop at critical instability is appropriate to do so. +10. Mathematical singularities at critical feedback instabilities at the apex of +complexity-based biological regulatory systems are therefore appropriate +mathematical, physical and biological conditions to model subjective experience. +ACKNOWLEDGEMENTS +I would like to acknowledge many conversations over the years with Jon Shear, Brian +Josephson, Madan Thangavelu, Judu Ilavarasu and John Hagelin, exceptionally +helpful inputs from Neil Hammeroff and Walter Freeman, and consultations with +ECG Sudarshan and Steven Weinberg to all of whom I am grateful for providing a +sounding board for my ideas. + + + +COSMOS AND HISTORY +250 +REFERENCES +1. Penrose R. The Emperor’s New Mind: concerning computers, minds and the laws of physics. +Oxford University Press, Oxford, 1999. +2. Chalmers D. Facing up to the Problem of Consciousness. J. Consc. Studies, 1995; +2(3):200-209. +3. Chalmers D. The Conscious Mind. Oxford University Press, Oxford, 1997. +4. Shear J. (Ed.) Explaining Consciousness the Hard Problem. Academic Press, London, +1997. +5. Penrose R. Hameroff N. Reply to criticism of the ‘Orch OR qubit’ – +‘Orchestrated objective reduction’ is scientifically justified. Physics of Life Reviews, +Volume 11, Issue 1, March 2014; 11(1): 104-112. +6. Eliot T.S. Burnt Norton in Four Quartets. Harcourt Books, New York, NY, 1971. +7. Goswami A. Reed R.E. and Goswami M. The Self Aware Universe. Penguin Putnam, +New York,1995. +8. Wiener N. Cybernetics of control and communication in the animal and the machine. M.I.T. +Press, 1948. +9. Ho M-W. The Rainbow and the Worm: The Physics of Organisms. World Sientific, +Singapore, 2008. +10. Yogi MM The Science of Being and Art of Living. Penguin, New York, 2001. +11. Penrose R. Shadows of the Mind, Oxford University Press, Oxford, 1994. +12. Domash L. Physics of Coherent States. MIU Press, Rheinweiler, 1975. +13. Kant I. The Critique of Pure Reason. (Pluhar W.S. (trans), Hackett, 1996. +14. Hankey A. Stanley H.E. Chang T.S. Geometric Predictions of Scaling at +Tricritical Points. Phys Rev. Lets. 29(5); 278-281. (1972). +15. Chang T.S. Hankey A. Stanley H.E. Generalized Scaling Hypothesis in +Multicomponent Systems. I. Classification of Critical Points by Order and Scaling +at Tricritical Points. Phys. Rev. B 8, 346–364 (1973). DOI: 10.1103/PhysRevB.8.346. +16. Hankey A. Chang T.S. Stanley H.E. Generalized Scaling Hypothesis in +Multicomponent Systems. II. Scaling Hyßpothesis at Critical Points of Arbitrary +Order. Phys. Rev. B 8, 1178–1184 (1973). +17. Kauffman S. At Home in the Universe. The search for the laws self organization and +complexity. Oxford University Press, Oxford, 1995. +18. Hankey A. Establishing the Scientific Validity of Tridosha part 1: Doshas, +Subdoshas and Dosha Prakritis. Anc Sci Life. 2010 Jan-Mar; 29(3): 6–18. +19. Freeman W. +20. Sheldrake R. Dogs that Know when their Masters are Coming Home. Three Rivers Press, +1999. +21. Sheldrake R. The Sense of Being Stared At. Arrow Books, London, 2004. diff --git a/subfolder_0/Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique (Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness.txt b/subfolder_0/Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique (Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness.txt new file mode 100644 index 0000000000000000000000000000000000000000..d4f1fc8a6118680ad31dcc9bc4953a270e9f546c --- /dev/null +++ b/subfolder_0/Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique (Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness.txt @@ -0,0 +1,357 @@ +Research Article +Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique +(Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness +1 +Abstract +Objectives: The purpose of this pilot randomized control trial study was to understand the effects of a 10- +day online intervention of a yoga and chanting-based relaxation technique called Mind Sound Resonance +Technique (MSRT) on measures of anxiety, stress, sleep, and mindfulness. This study was conducted in +parallel within the United States and India. Two-hundred and ten participants were recruited for this +pilot study, fifty participants from India and one-hundred and sixty participants from the United States. +Participants were initially administered a series of questionnaires to assess measures of state anxiety, stress, +quality of sleep, and mindfulness. Each day, participants received a link at 9 AM local time containing +the practice video of MSRT. Upon completion of the 10-day intervention, participants were administered +the same series of questionnaires to assess any changes in the previously mentioned measures. Sixty-five +participants completed all portions of the study and were compensated. Data analysis was conducted, +showing no statistically significant differences after the intervention, including cross-cultural differences. +However, several sleep related questions showed statistically significant improvements in certain aspects +of sleep such as restfulness and an improvement in insomnia. Several confounding factors could have +contributed to the lack of statistically significant results. The findings of this pilot study suggest that further +refined research within the effectiveness of an online Mind Sound Resonance Technique intervention - +specifically on various aspects of sleep such as insomnia and quality of sleep - should be designed and +implemented. ASEAN Journal of Psychiatry, Vol. 22 (1): January – February 2021: 01 04 +Keywords: Mind Sound Resonance Technique (Msrt), Anxiety, Sleep, Mindfulnes +Introduction +Stress has become an increasingly prevalent issue in +the modern world. Starting from early ages, chron- +ic stress levels among populations across the world +have been increasing. This includes populations as +young as undergraduates [1]. As a result of chronic +stress, several health problems tend to arise, such as +a weaker memory, worsened cognition and learning +abilities, weaker immune function, cardiovascular +disease, gastrointestinal complications, and endo- +crine problems [2]. Along with stress, anxiety, sleep +deprivation, and insomnia are becoming more and +more prevalent [3]. +Previous studies have shown that yoga interventions +can have significant positive effects on psychologi- +cal measures such as stress, mindfulness, quality of +life, quality of sleep, and compassion, among vari- +ous other variables [4]. A 9-day yoga intervention +can improve vigilance, self-rated sleep, state anxiety, +and self-rated sleep within military personnel [5]. +Long-term yoga interventions showed improvements +in symptoms of anxiety, stress, and depression in +patients with clinical depression [6]. Mindfulness- +based yoga practices are shown to improve quality +of sleep [7]. +Mind Sound Resonance Technique (MSRT) is a spe- +cific mindfulness-based yoga practice focused on +calming the mind-body complex. Previous literature +has shown that MSRT has immediate effects on state +anxiety and cognitive functions within people suffer- +ing from generalized anxiety disorder [8]. In addi- +tion, long-term interventions of MSRT have shown +a reduction in the levels of stress, anxiety, fatigue, +and psychological distress [9]. Single-session inter- + +Chinmay Surpur, Elliott Ihm, Jonathan Schooler, H. R. Nagarathna, Judu Ilavarasu + +Yoga Bharati, University of California, Santa Barbara, SVYASA University, United States +Cross-Cultural Study on the Effects of 10 Days of Online +Mind Sound Resonance Technique (Msrt) on State +Anxiety, Stress, Quality of Sleep, and Mindfulness +4 +4 + October-November +ASEAN Journal of Psychiatry, Vol. 22 (S1), +2021: 01-0 +Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique +(Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness +ASEAN Journal of Psychiatry, Vol. 22 (1), January - February 2021: 01-0 +2 +ventions of MSRT administered to medical students, +a population group known to have higher stress lev- +els than the average person, showed improvements +in cognitive performance immediately after the in- +tervention [10]. MSRT also has a direct impact on +stress by reducing sympathetic nervous activity and +increasing vagal dominance [11]. Finally, a study +done by Sharma et al. showed that a week-long inter- +vention of MSRT added on to regular yoga practice +enhances sleep quality and reduces stress, pain and +anxiety levels in patients suffering from chronic mus- +culoskeletal pain [12]. +The purpose of this study was to understand the ef- +fects of a 10-day online intervention of MSRT and its +effects on perceived stress, state anxiety, quality of +sleep, and mindfulness scores. In addition, the relative +effects of MSRT on the previously stated measures +in spiritually and/or religiously inclined individuals +versus those who are not inclined to spirituality and +religion were studied. An online intervention was +chosen because the efficacy of an online yoga inter- +vention has been shown by previous literature, where +the effects of Sukshma Vyayama, a yoga practice, +was administered to women with breast cancer and +results showed that AI-induced pain was significantly +reduced [13]. +The study was administered to participants between +the ages of 18-50 in the United States as well as in +India to understand the cross-cultural differences on +the proposed measures. This intervention was admin- +istered via a pre-recorded video link on YouTube, us- +ing the Qualtrics platform, between 6-10 PM local +time. Perceived stress, state anxiety, quality of sleep, +and mindfulness assessments were administered 24 +hours prior to the 10-day intervention as well as 24 +hours after the last practice session of the interven- +tion. Data was also collected about each participant’s +level of spirituality, prior history with religion and +meditation or yoga practice, and quality of life. Our +hypothesis was that MSRT, consistently practiced for +10 days, would reduce state anxiety, levels of stress, +increase quality of sleep, and scores regarding mind- +fulness. We also hypothesized that the magnitude of +the effects of MSRT on the measures +studied will be greater in spiritually and/or religious- +ly inclined individuals [14]. +Methods +UC Santa Barbara’s research pool as well as Yoga +Bharati’s outreach efforts via digital marketing were +used to recruit participants. One-hundred and eighty +participants within the age range of 18-70 years old +applied for the online research study. 130 partici- +pants were recruited within the United States and +50 participants were recruited within India. The se- +lection criteria for participants included individuals +who perceive an experience of high levels of stress. +Both genders were equally considered for the study. +Informed consent was obtained. Exclusion criteria +contained anyone on any medications for chronic +illnesses, anyone on tranquilizers, anyone who gets +good sleep, and anyone who have been doing MSRT, +any yoga, or any relaxation or mindfulness practice +in the last three months. +MSRT Steps +Participants listen to the peace chant (Maha mrutyun- +jaya mantra) once. Participants then make a positive +affirmation (sankalpa) such as “I’m full of love”, +“I’m full of forgiveness”, “I’m free of anger”, etc. +• +Participants chant the syllables “A” “U” “M” and +“AUM” 4 times out loud (ahata). +• +Participants chant the syllables within their mind, +not out loud (anahata). +• +Participants listen to the peace chant (Maha mru- +tyunjaya mantra) 3 times. +• +Participants then spend time in silence and are +encouraged to recollect the sound +• +of “om” nine times within their mind (anahata). +• +After nine times of “om” within their minds, par- +ticipants are encouraged to stay in +• +silence. +• +Within this silence, participants recollect their +positive affirmation (sankalpa) nine times. +Prior to administering the intervention, participants +were given a pre-assessment which contained ques- +tions about their spiritual/religious background and +rate of practice, questions about their personal life, +and general background information, using qualtrics +as the data-collection platform. A pre-test containing +the Perceived Stress Scale (Cohen, 1983), Spielberg- +er’s State-Anxiety Inventory (STAI), Sleep Rating +4 +Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique +(Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness +ASEAN Journal of Psychiatry, Vol. 22 (1), January - February 2021: 01-0 +3 +Questionnaire (SRQ), and The Five Facet Mind- +fulness Questionnaire (FFMQ) was administered +24-hours prior to the start of the intervention. +The practice was sent to participants each morning +at 9 AM local time and were encouraged to practice +MSRT following the pre-recorded video link upload- +ed on YouTube and hosted on Qualtrics between 6 +PM - 10 PM each day. After the last session, partici- +pants completed a post-test to assess any changes in +measures of perceived stress, state anxiety, quality of +sleep, and mindfulness. +Results +Out of 130 participants, 65 participants completed +the study. Upon applying the exclusion criteria, 47 +participants’ (10 men and 37 women) data was used +for statistical analysis. The mean age of participants +was 43.07 years old. +For the statistical analysis of the pre- and post-data +SPSS and Excel was used. Both UC Santa Barbara’s +team and Yoga Bharati’s team completed the statisti- +cal analysis for the data collected both in the United +States and in India. This paper was written jointly +by UC Santa Barbara’s team and Yoga Bharati’s re- +search team. +Initial results showed no statistically significant dif- +ference in any of the questionnaires as a whole. How- +ever, within the Karolinska Sleep Questionnaire, four +specific questions showed a significant improvement: +• +Difficulties falling asleep (M = 2.089, SD = 1.42; +t(44) = 3.0, p = 0.004). +• +Insufficient amount of sleep (M = 2.178, SD = +0.1.29; t(44) = 2.0, p = 0.05) +• +Feeling exhausted when waking up (M = 1.689, +SD = 1.39; t(44) = 2.8, p = 0.008) +• +Sleepiness during work (M = 1.33, SD = 1.10; +t(44) = 2.8, p = 0.008) +Although the results did not show statistical signifi- +cance, the testimonials go to show that MSRT was +clearly a relaxing experience for the participants. +Among people who said MSRT was relaxing experi- +ence, they also commented saying “their awareness +improved”, “I was able to understand myself better”, +“I was afraid of quietude and now I began liking qui- +etness”, “I experienced high vibrations in the body”. +Among people who said MSRT was a relaxing expe- +rience, they commented- “I am more aware”, “I was +able to understand myself better”, “I was afraid of +quietude and now I began liking quietness”, “I expe- +rienced high vibrations in the body” and “my sleep +quota reduced and relaxed”, “This intervention def- +initely helped me learn how to calm my mind and +body at least to some extent every day. I noticed that +the relaxation we so strive for can become a habit. +This experience will definitely inform my yoga/med- +itation pursuits in the future”. +Discussion +The KSQ showed that there are some questions which +showed related statistically significant improvements +in aspect of sleep. In addition, the testimonials pro- +vided by the participants were overwhelmingly posi- +tive. Further studies must be done to remove some of +the discovered confounds. There is promising future +research studying specifically on various aspects of +sleep alone, rather than including anxiety, stress, and +mindfulness as well to create a more pointed study on +the effects of Mind Sound Resonance technique on +sleep. There were some issues with the study which +can be addressed in a subsequent research project. +The researchers could not ensure that the participants +practiced daily. The researchers were unable to ensure +that participants actually followed along with all as- +pects of the intervention. Feedback from participants +indicated that several questions used in the ques- +tionnaires were misunderstood due to the confusing +nature of the questions. Besides from the pitfalls of +the study, some suggestions for a future study could +help in strengthening the study itself. Implementing +a 6-week intervention rather than 10-day intervention +could have a more significant impact on participants. +It is also important to have a large subject pool when +conducting research online. +Conclusion +While none of the results showed statistically sig- +nificant improvements in mindfulness, anxiety, and +mindfulness, there was an improvement in some +sleep-related questions. There is promising future +research studying specifically on various aspects of +4 +Cross-Cultural Study on the Effects of 10 Days of Online Mind Sound Resonance Technique +(Msrt) on State Anxiety, Stress, Quality of Sleep, and Mindfulness +ASEAN Journal of Psychiatry, Vol. 22 (1), January - February 2021: 01-0 +4 +sleep alone, rather than including anxiety, stress, and +mindfulness as well to create a more pointed study +on the effects of Mind Sound Resonance technique +on sleep. +Acknowledgements +Yoga Bharati would like to acknowledge SVYASA +University, and specifically Dr. H.R. Nagarathna, for +their support in constructing this pilot study. +References +1. Ribeiro ÍJS, Pereira R, Freire IV, Oliveira BG +de, Casotti CA, et al. Stress and Quality of Life +Among University Students: A Systematic Lit- +erature Review. Health Professions Education. +2017;4: 70-77. +2. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, +Sahebkar A. The impact of stress on body func- +tion: A review. Experimental and Clinical Sci- +ences Journal. 2017;16: 1057-1072. +3. Staner L. Sleep and anxiety disorders. Dialogues +in Clinical Neuroscience. 2003;5: 249-258. +4. Trent NL, Borden S, Miraglia M, Pasalis E, +Dusek JA, et al. Improvements in Psychological +and Occupational Well-being Following a Brief +Yoga-Based Program for Education Profession- +als. Global Advances in Health and Medicine +2019. +5. Telles S, Gupta RK, Verma S, Kala N, Balkrishna +A. Changes in vigilance, self rated sleep and state +anxiety in military personnel in India following +yoga. BMC Research Notes 2018;11: 518. +6. Shohani M, Badfar G, Nasirkandy MP, Kaikha- +vani S, Rahmati S, et al. The Effect of Yoga on +Stress, Anxiety, and Depression in Women. Inter- +national Journal of Preventive Medicine 2018;9: +2. +7. Winbush NY, Gross CR, Kreitzer MJ. The Effects +of Mindfulness-Based Stress Reduction on Sleep +Disturbance: A Systematic Review. EXPLORE +2007;3: 585-591. +8. Dhansoia V, Bhargav H, Metri K. Immediate ef- +fect of mind sound resonance technique on state +anxiety and cognitive functions in patients suf- +fering from generalized anxiety disorder: A self- +controlled pilot study. International Journal of +Yoga 2015;8: 70-73. +9. Rao M, Metri KG, Raghuram N, Hongasandra +NR. Effects of Mind Sound Resonance Technique +(Yogic Relaxation) on Psychological States, +Sleep Quality, and Cognitive Functions in Fe- +male Teachers: A Randomized, Controlled Trial. +Advances in Mind-Body Medicine 2017;31: 4-9. +10. Saoji A, Mohanty S, Vinchurkar SA. Effect of a +Single Session of a Yogic Meditation Technique +on Cognitive Performance in Medical Students: +A Randomized Crossover Trial. Journal of Reli- +gion and Health. 2017;56: 141-148. +11. Nikkam VA, Shetty S, Shetty P. Effect of mind +sound resonance technique on autonomic vari- +ables in occupational stress individuals- a ran- +domized controlled trial. Journal of Emerging +Technologies and Innovative Research. 2018;5. +12. Sharma D, Bhargav H. Effect of Mind Sound +Resonance Technique as an add on to Yoga ther- +apy on Quality of sleep, Pain, Stress and State +Anxiety levels in patients suffering from Chronic +Musculoskeletal Pain: Matched Controlled Trial. +International Journal of Review in Life Sciences. +2014;6. +13. Leibel LL, Metri KG, Prasad R, Mears JG. The +effect of sukshma vyayama joint loosening yoga +on aromatase inhibitor-induced arthralgia (AI) in +breast cancer patients: A feasibility study con- +ducted on Facebook. Journal of Clinical Oncol- +ogy. 2019;37. +14. Cohen S. Perceived Stress Scale.1983. +Correspondence author: Chinmay Surpur, Yoga Bharati, University of California, Santa Barbara, SVYASA University, United +States +Email: chinmay@chinmaysurpur.com +Received: 22 2021 +4 +October +Accepted: + 2021 + November +25 diff --git a/subfolder_0/Development and Validation of Integrated Yoga Module for Obesity in Adolescents.txt b/subfolder_0/Development and Validation of Integrated Yoga Module for Obesity in Adolescents.txt new file mode 100644 index 0000000000000000000000000000000000000000..ac1bc6dd6c540a2fc2850f192c93620ac10e1521 --- /dev/null +++ b/subfolder_0/Development and Validation of Integrated Yoga Module for Obesity in Adolescents.txt @@ -0,0 +1,434 @@ +Int J Yoga. 2018 Sep-Dec; 11(3): 231–238. +doi: 10.4103/ijoy.IJOY_38_17 +PMCID: PMC6134747 +PMID: 30233117 +Development and Validation of Integrated Yoga Module for Obesity in +Adolescents +Sunanada Surendra Rathi, Nagarathna Raghuaram, Padmini Tekur, Ruchira Rupesh Joshi, and +Nagendra Hongasandra Ramarao +Yoga and Life Sciences Department, SVYASA, Bengaluru, Karnataka, India +Address for correspondence: Dr. Sunanada Surendra Rathi, Yoga Initiative Centre, Chiranjiv Foundation, +404, Pinnacle Pride, Sadashiv Peth, Tilak Road, Pune - 411 030, Maharashtra, India. E-mail: +yogainitiatives@gmail.com +Received 2017 Jul; Accepted 2017 Sep. +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: +Obesity is a growing global epidemic and cause of noncommunicable diseases. Yoga is one of the +effective ways to reduce stress which is one of the causes of obesity. Nowadays, children in adolescent +age are more prone to get obese due to lack of physical activity making them more sedentary. +Aim: +To identify the design and validation of Integrated Approach of Yoga Therapy Module (IAYTM) for +obesity in adolescents. Materials and Methods: First phase – IAYTM for obesity was designed based on +the literature review of classical texts and recently published research articles. Second phase – +Designed IAYTM was validated by 16 subject matter (yoga) experts. Content-validity ratio (CVR) was +analyzed using Lawshe's formula. +Results: +Yoga practices were designed for Integrated Yoga Module for Obesity in Adolescents. Yoga practices +with CVR ≥0.5 and which were validated by 16 yoga experts and approved in faculty group discussion +were included in final Integrated Yoga Therapy Module. +Conclusion: +The yoga practices were designed and validated for IAYTM for obesity in adolescents. +Keywords: Adolescence, integrated approach of yoga therapy, obesity, validation +Introduction +Obesity +2 +Obesity (body mass index [BMI] >30 kg/m ) is more common in women than men. The risk of obesity +starts at a BMI of 25 kg/m + and it is much lower (23 kg/m ) in southeastern countries that contain +genetic predisposition to metabolic disorders. East Asian countries use lower values of BMI.[ ] Obesity +increases the likelihood of diseases such as heart disease, type 2 diabetes, obstructive sleep apnea, +cancer, and osteoarthritis.[ ] Researchers consider obesity as one of the most serious public health +problems of the 21 century.[ ] International organizations such as the WHO, UNICEF, and CARE +consider obesity as one of the most neglected public health problems in the society.[ ] It is commonly +caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility. +[ ] Therefore, it can be prevented through a combination of social changes and personal choices. +Adolescent obesity +The prevalence of overweight and obesity in children has dramatically increased over the past two +decades.[ ] In 2010, 43 million children were obese and this number is expected to reach 60 million by +2020. Of the approximately 45 million, 35 million live in the developing countries. Obese children are +likely to remain so in adulthood and are at greater risk of developing noncommunicable diseases such +as diabetes, hypertension, cardiovascular diseases, and cancers.[ ] Two systematic review articles[ ] +and one clinical review article[ +] suggest that yoga has beneficial effects on mental and physical +health in children and adolescents. +Yoga modules to control obesity +Yoga has emerged as one of the evidence-based practices widely used across the globe. Over 10 million +Americans practice yoga for health reasons in 2002 and the number has increased to 13 million in +2007.[ +] Several schools of yoga have come up different modules of yoga practices that have +shown a range of positive benefits on BMI in adults and children. A randomized controlled trial on 72 +obese adult males resulted in improvement in BMI, hip circumference, waist circumference, and skin- +fold thickness. Fourteen weeks of integrated yoga-based lifestyle change included yogic diet, asana, +pranayama, relaxation techniques, meditation, and yogic counseling.[ +] Yoga/meditation users with +normal BMI appeared to be more satisfied with their body weight and shape than nonyoga/meditation +users.[ +] Studies provide strong evidence that the modified Qigong breathing exercise can +significantly reduce or even suppress the sense of hunger on an empty stomach. Qigong practice +typically involves moving meditation, coordinating slow flowing movement, deep rhythmic breathing, +and calm meditative state of mind. Qigong is now practiced throughout China and worldwide for +recreation, exercise and relaxation, preventive medicine and self-healing, alternative medicine, and +cultivation. Stomach pH was increased by 3 and intestinal pressure was reduced by 12 mmHg in the +experimental group and did not change significantly in the control group. The breathing exercise +provides comfort in different circumstances, such as lack of regular meals, limited volume or caloric +diet, and even during temporary complete absence of food in therapeutic fasting which is useful in +obesity.[ +] +In a randomized controlled trial on yoga practice for reducing the male obesity and weight-related +psychological difficulties, it has been proved that the yoga practice is effective for obesity control for +adult male in an urban setting. Improvement in anthropometric and psychological parameters was +observed in that study.[ +] The 12-week yoga intervention had positive effects on anthropometric and +self-reported variables in women with abdominal obesity. Sixty women with abdominal obesity (waist +circumference ≥88 cm; BMI ≥25) were randomly allocated in a 2:1 ratio to either yoga intervention (n += 40) or a waiting list (n = 20). Intergroup significant differences in the waist/hip ratio, body weight, +BMI, body fat percentage, body muscle mass percentage, mental and physical well-being, self-esteem, +subjective stress, body awareness, and trust in bodily sensations were observed.[ +] +Mindfulness-based interventions may be both physically and psychologically beneficial for adults who +are either overweight or obese. Fifteen studies measuring posttreatment outcomes of mindfulness-based +interventions in 560 individuals were identified in an review article.[ +] Average weight loss was 4.2 +kg. Overall effects were large for improving eating behaviors, medium for depression, anxiety, and +eating attitudes, and small for BMI and metacognition outcomes. Therapeutic effects for BMI, anxiety, +2 +21 +2 +2 +3 +st +4 +5 +6 +7 +8 +9 +11 +12,13 +14 +15 +16 +17 +18 +19 +eating attitudes, and eating behaviors remained significant. Another RCT study of a 12-month +computerized mindfulness-based intervention for obese patients with binge eating disorder support that +mindfulness work as de-automation element and a moderator of motivation to exercise which can lead +to the reduction of impulsive eating and also to an increase in levels of physical activity.[ +] +Few studies has been conducted on quality of life for the obese people. A short-term yoga-based +lifestyle intervention study, including asana, pranayama, relaxation techniques, lectures, group support, +nutrition awareness program, and individualized advice, had positive effect on the overall health the +obese people.[ +] +These studies have designed and used different yoga modules for obesity. However, there is no +validated yoga module for obesity in adolescents. Therefore, this study has been designed to propose a +validated yoga module for obesity in adolescent with practices of breathing and loosening, asana, +pranayama, and relaxation techniques. +Yoga is a voluntary and mindful technique that has positive impact on obesity at physical and +psychological levels. Yoga has effect on serum leptin and serum ghrelin; there two hormones have been +recognized to harbor major influence on the energy balance mechanism. Leptin is a mediator of long- +term regulation of energy balance, suppressing food intake and thereby inducing weight loss.[ +] A +study states that voluntary exercise leads to the maintenance of a lower body weight and leaner +composition, as well as to improved leptin action, independent of fat mass.[ +] Moderated meditation +analyses showed that higher levels of mindfulness were associated with better-perceived quality of life +through lower body shame.[ +] Similar effect on serum leptin by yoga is expected as yoga is a +voluntary and mindful technique to get control over mind and body. +Yoga in adolescence +Studies suggest that school-based yoga may provide unique benefits beyond participation in physical +practice of yoga under expert supervision was helpful in achieving optimum level of self-adjustment in +adolescent students.[ +] However, to the best of our knowledge, there are no studies on the effect of +yoga on obesity in adolescence. Hence, this study was designed to provide Integrated Approach of +Yoga Therapy module (IAYTM) for obesity in adolescents. +Validation +Validation using content–validity ratio (CVR) developed by Lawson is a tool to check product, service, +or system meets requirements and specifications fulfilling its intended purposes.[ +] As there are many +different modules of yoga for obesity used by different investigators from different parts of the globe, it +was felt that there is a need to have a validated common protocol for obesity which we plan to use in a +study on yoga for obesity in adolescents. Hence, the present study for validation was planned and +implemented. +Materials and Methods +The designing, validation, and feasibility of Integrated Yoga Therapy Module (IYTM) for obesity [ +Figure 1] were carried out in the following steps: +20 +21 +22 +23 +24 +25,26 +27 +Figure 1 +Flowchart of steps in the development for obesity in adolescents +Step 1: The need of the adolescents with obesity were enlisted [Table 1]. +Table 1 +Need of adolescents with obesity +Step 2: The basis of integrated approach to yoga therapy to achieve these goals was understood by +studying several yoga texts by the researcher under the guidance of senior yoga masters. This was +complemented by the present day scientific understanding that obesity is not only a physical problem +but has also deep roots in the mind and emotions. Abdominal obesity has been suggested to be +associated with perturbations of the regulation of the hypothalamic-pituitary-adrenal axis. In a study on +51-year-old men (n = 284), salivary cortisol concentrations were determined on repeated occasions +over a random working day and perceived stress was reported in parallel which results that perceived +stress-dependent cortisol values were strongly related to perturbations of other endocrine axes as well +as abdominal obesity.[ +] Excessive stress affects biosynthesis of physiological processes and causes an +imbalance in cognition and emotions also which results in metabolic disorders such as obesity.[ +] +During stress corticotrophin-releasing hormone and norepinephrine are released which has impact on +hypothalamo–pitutary axis leading to behavioral and peripheral changes. This leads to release of large +quantity of glucocorticoids inhibiting action of insulin on skeletal muscles and adipose tissues which is +the cause of metabolic disorder such as obesity.[ +] This supports that mind and body has strong +interaction in pathophysiology of obesity. It proves that along with physical causes, disturbances or +problems in mind and emotions are also major contributing factors of obesity pathophysiology. +Attention bias for food could be a cognitive pathway to overeating in obesity. The study results +demonstrate that state differences in health versus palatability mind-sets can cause attenuated attention +bias for high-calorie food cues in participants with higher eating restraint which can cause bias +attention for food.[ +] +The concept of how obesity as a mind–body problem occurs was formulated based on the descriptions +of five aspects of human existence (Pancha Kosha Viveka)[ +] and the downward causation of stress- +induced diseases (Adhija Vyadhi). It states that human being exists at five different layers of existence +(Annamaya – body, Pranamaya – vital energy, Manomaya – mind, and Vijnaanamaya – intellect, and +Anandamaya Kosha – soul) which are interconnected and has counterimpact on each other also. Stress +at mind disturbs Prana and results in abnormalities at body level called disease. Obesity also has root +28 +29 +30 +31 +32 +cause as mental stress along with other physical causes. Hence, treatment of obesity includes working +on all Koshas (body, mind, Prana, and intellect). IAYTM for obesity in adolescents also is designed on +the basis of Pancha Kosha model. +We then went on to compile the corrective techniques described in many texts (Patanjali yoga sutra, +Hath Yoga Pradipika, Hatharatnavali, Bhagavad Gita) which offer a reversibility model. Thus, a need- +based table of practices for long-term holistic change at all the five aspects of personality[ +] was +prepared. Publications (books and published articles) on yoga for obesity were also reviewed to prepare +the list of all practices used in all these studies This yielded forty practice items that are tabulated in +Table 2. +Table 2 +Basis for development of module +Step 3: Validation of the module for obesity: Validation of the 40-item module was carried out by +arranging a focused group discussion faculty group discussion (FGD) by inviting sixteen subject matter +expert (SMEs), that included five Doctor of Medicine in Yoga, eight Doctorates (PhD) in Yoga with +minimum experience of 4–5 years in the field of yoga, and three yoga therapists (MSc in yoga) +involved continuously for >7 years in teaching the IAYT techniques to obese participants of all ages. +These 16 SMEs marked the content validity on a three (0–2)-point scale, viz., not necessary – 0, useful +but not essential – 1, and essential – 2. After validation, data were analyzed using Lawshe's CVR.[ +] +Statistical analysis +33,34 +35 +Sixteen SMEs validated all the 40 practices. Lawshe's CVR was calculated for all the 40 items using +the formula CVR = (n − N/2)/(N/2),[ +] wherein n = number of SME panelists indicating “essential” +and N = total number of SME panelists. As per Lawshe's significance table, the value of CVR for 16 +SMEs = 0.5 which means all items with CVR >0.5 are valid and essential for the module. +Results +Step 1: We presented the list of the needs of adolescents with obesity to FGD; the final +comprehensive list of 11 items evolved is tabulated in Table 1 +Step 2: Table 2 shows basis of development of the module with five yogic personality domains +and 15 categories of practices; the benefits each component would offer is also tabulated +Step 3: Table 3 shows the list of 54 items that evolved all groups of practices. +e +36 +e +Table 3 +List of 54 items that evolved all groups of practices +CVR was calculated for physical and breathing practices only. Among them, 33 yoga practices [Table 4 +] with CVR ≥0.5 were included in designed IYTM. Others practices such as diet, meditation, +counseling and lectures on yoga were discussed in faculty group discussion (FGD) meeting and were +approved by all participants. Hence, those were also included in IYTM. +Table 4 +IYTM practices with content validity ratio ≥0.5 and focused group discussion approved +practices +Discussion +This study developed a validated module of integrated yoga as a prelude to an RCT for obese +adolescents. The content validity was assessed in four steps. After enlisting the needs of obese +adolescents at their physical, mental, emotional, spiritual, and behavioral levels, 15 categories of yoga +practices under five domains with yogic scriptural basis (Annamaya – physical, Pranamaya – vital +energy, Manomaya – mental and emotional, Vijnanamaya – intellectual, and Anandamaya – spiritual +and behavioral) was tabulated. As a next step, 54 items of actual yoga practices were selected and +subjected to assessment by 16 subject experts in a focussed group discussion meeting. Then, the CVR +was calculated to develop the final list by retaining all those items with CVR >0.5. +Advances in technology has resulted in children spending their leisure time in television, mobiles, and +ipads resulting in sedentary lifestyle and childhood obesity since last two decades.[ +] Low levels of +physical activity are definitely promoted by an automated and automobile-oriented environment that is +37,38 +39 +conducive to sedentary lifestyle.[ +] Hence, weight management by changing sedentary lifestyle of +adolescents through yoga practices was the goal of designing IAYT module for obesity in adolescents. +Urbanization leads to consumption of huge amount of food items at home and at restaurants, plus +consumption of high-calorie food such as high-fat, low-fiber foods, and intake of sweetened beverages +that have been shown to promote obesity.[ +] Urbanization is only the external cause of overeating. +The root cause of overeating is a form of stress resulting from demanding situations in the academic +and personal lifestyle among adolescents. Regular practice of yoga, especially relaxation techniques, +reduces the risk of overeating. Meditation trains the mind to search for happiness form inside instead of +searching outwardly. It also make the mind to enjoy eating healthy food. The control over mind +decreases the cravings toward junk and fast food resulting in proper intake of high-fiber and less-fat +diet. +Yoga practices with CVR <0.5 was removed from IAYTM [Table 5]. The reason for their CVR <0.5 +could be these practices are not focused and not having direct impact on adolescent obesity. The +principle of selection of yoga practices is physical exercise along with relaxation of mind. However, +few texts on Hatha yoga lay more emphasis on improving health through different yogic practices.[ +] +This module for obesity in adolescents reduces weight as it provides exercise effect to different parts of +body, especially arms, abdomen, hip, and thigh region. Muscle work out in body region reduces +adipose tissues leading to weight loss. It offers enough work out to burn excessive calories that results +in proper balance of calorie intake and energy expenditure. Yoga practices provide deep relaxation to +internal body systems which is essential to regain normal functioning of the system. Yoga also +strengthens the mind determination to adhere to healthy lifestyle. +Table 5 +IYTM practices with content validity ratio <0.5 +Practices of Manomaya Kosha such as Bhajans (devotional music) and lecture on Bhaktiyoga releases +stress in mind with relaxation. Practices of Vijnanamaya Kosha such as lecture on Jnana yoga and +counseling help to motivate children in right direction towards success and their goal of life by clearing +the intellectual complexes and conflicts. Activity like Karmayoga trains their mind to do work with the +sense of duty and not as the burden of life which leads to relaxed mind. +These yoga practices makes IAYTM unique from other yoga modules. +39 +40,41 +42 +Conclusion +The yoga practices for IAYTM were designed as per yoga texts and the experience of yoga +experts +The designed IAYTM was validated by 16 yoga experts by using Lawshe's content validity +formula. +Strength and limitations +This study provides a validated yoga module for obesity in adolescents. We did not conduct other +validity and reliability tests for obesity in adolescents. Furthermore, all the panelists of SMEs were +from the same school of Yoga (S-VYASA, Bangalore, Karnataka, India). 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[Google Scholar] +Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/Development and initial standardization of Ayurveda child personality inventory.txt b/subfolder_0/Development and initial standardization of Ayurveda child personality inventory.txt new file mode 100644 index 0000000000000000000000000000000000000000..bb8fe04f25a20a70c8d4f61060afcb3b8d11bef4 --- /dev/null +++ b/subfolder_0/Development and initial standardization of Ayurveda child personality inventory.txt @@ -0,0 +1,238 @@ +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +1/7 +J Ayurveda Integr Med. 2014 Oct­Dec; 5(4): 205–208. +doi:  10.4103/0975­9476.146562 +PMCID: PMC4296431 +Development and initial standardization of Ayurveda child personality inventory +S. P. Suchitra, Arati Jagan, and H. R. Nagendra +Department of Life Sciences, SVAYSA, Yoga University, Bangalore, Karnataka, India +Address for correspondence: HR Nagendra, Swami Vivekananda Yoga Anusandhana Samsthana (S­VYASA), Eknath Bhavan, No.19, +Gavipuram Circle, Kempegowda Nagar, Bangalore ­ 560 019, Karnataka, India E­mail: svyasablr@yahoo.com +Received 2013 Oct 11; Revised 2013 Dec 18; Accepted 2013 Dec 24. +Copyright : © Journal of Ayurveda and Integrative Medicine +This is an open­access article distributed under the terms of the Creative Commons Attribution­Noncommercial­Share Alike 3.0 Unported, which +permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. +Abstract +Background: +Ayurveda inventories for prakriti (constitution) have been developed and validated for adults. Children, +however, require different categories of quarter and questions, for example, to assess the intelligence, the +questions can be related to their scholastic performances. +Objective: +To develop and standardize an inventory to assess the prakriti of the children, and to compare with Child +Personality Questionnaire (CPQ). +Materials and Methods: +A 135­item Ayurveda child personality inventory (ACPI) scale was developed on the basis of translation of +Sanskrit verses describing vataja (A), pittaja (B), and kaphaja prakriti (C) characteristics and by taking the +opinions of experts (ten Ayurveda experts and three psychologists). Study was carried out in Maxwell public +school, Bangalore. The scale was administered on parents of children of the age group 6­12 years. CPQ was +administered on children of the age group 8­12 years. +Results: +The ACPI was associated with excellent internal consistency. The Cronbach's alpha for A, B, and C scales +were 0.77, 0.55, and 0.84, respectively, and the Split­half reliability scores were 0.66.0.39 and 0.84, +respectively. Factor validity coefficient scores on each items was above 0.5. Scores on vataja, pittaja and +kaphaja scales were inversely correlated. Items of V, P, and K scales showed significant correlation (values +ranging from 0.39 to 0.84) with subscales of CPQ, which indicates that Eastern and Western psychology +concept have good correspondence. +Conclusions: +The prakrti of the children can be measured consistently by this instrument. Scores on V and P scale showed +good correlation with the anxiety primary scale of CPQ. +Keywords: Prakriti, vata, pitta, kapha, tridosha +INTRODUCTION +Ayurveda, the ancient life science, is an aspect of Vedic lore most closely connected to Rigveda and +Atharvaveda. It is centered on the principles of Panchamahabhuta (space, air, fire, water, and earth) and +tridosha­vata, pitta, and kapha. Tridosha are the metabolic principles (maintains all the functions in the body +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +2/7 +as breathing, memory, digestion, intelligence, and nourishment).[1,2,3,4,5,6,7,8,9] +Western psychologists, Carl Jung and HJ Eysenik classify the personality of an individual based on +temperament, behavior and characteristics such as ‘introvert’, ‘extrovert’ as a dimension of personality, +which HJ Eysenik extended this to include dimensions of neuroticism and psychoticism.[10] +In contrast, Ayurveda classics[1,2,3,4,5,6,7,8,9] propose a comprehensive outlook of personality, +encompassing physical­physiological aspects like color of the eyeball, texture of hair, appetite, sleep, +behavior, attitudes and interests, memory, intelligence, mental stamina of an individual based around +tridosha, recognizing that tridoshas physiological characteristics also influence mental and behavioral +qualities. Further, the texts suggests seven types of personality (vata, pitta, kapha, vata­pitta, vata­kapha, +pitta­kapha, and sama) determined by predominance of a single, pair, or all of the dosha. +Ayurveda considers the balanced state (sama) of tridosha as health. Person with predominance of single and +double doshas will always be afflicted by one or more diseases.[1] Accordingly, Ayurveda recommends +specific diet and daily regime for different types of personalities for the prevention of health. +Statistical model of dosha prakriti based on analysis of a questionnaire has been developed.[11]. An analysis +of tridosha physiology, linking it to process of cellular physiology has been carried out.[12,13] Similarly a +genetic basis of tridosha constitution has been postulated.[14,15,16] Importance of dosha in health and +treatment methods have been discussed.[17]. A study comparing the Ayurveda personality concepts and +Western psychology concepts is available.[18] However, a simple and standardized instrument to assess the +prakriti of children according to Ayurvedic comprehensive concepts is not available. Hence, the present +investigation was carried out to develop Ayurveda child Personality inventory (ACPI). +MATERIALS AND METHODS +Ethical clearance was approved by research board of SVYASA (Yoga university). The ACPI was developed +based on 522 Sanskrit characteristics from 9 authoritative ancient texts describing characteristics typical of +vataja, pittaja, and kaphaja prakriti. Item reduction was carried out by deleting the repeated items, +ambiguous items, and by selecting those items specifically suitable for children. A total of 155 items in +Sanskrit, and translation in English, were presented to 10 Ayurveda experts. They were asked to judge the +correctness of each statement and to check: (1) whether any of the items were repeated or if any item should +be added? (2) whether the features of vataja, pittaja and kaphaja prakriti selected for the scale are correct, +and (3) if the constructed items were in acceptable translation of the Sanskrit in the original texts. As per their +suggestions, 147 items were retained and some of the items were changed and refined. +Based on the final Sanskrit statements, 165 questions of ACPI were framed by the researcher. The scale was +again presented to ten Ayurveda experts and three psychologists, who reviewed the format of this scale and +recommended a dichotomous scoring (0 and 1), which was adopted in the final ACPI. Suggestions in the +phrasing of questions were incorporated. A total of 158 questions that were agreed by all Ayurveda experts +and psychologists were retained. Initially, scale was answered by parents of 60 children. Item difficulty level +was analyzed. +The final ACPI has 135 items ­ out of this, 45 items for vataja prakriti (A­scale) 44 items for pittaja prakriti +(B­scale) and 46 items for kaphaja prakriti (C­scale) subscales. The scale was to be answered by the parents +of the children [Supplementary 1]. +Supplementary 1 +Ayurveda Child Personality Inventory for Parents +Data collection and analysis +For testing the reliability and validity, the scale was administered on parents of the children who were the +students of Maxwell public school in Bangalore, of both sex with an age range of 6­12 years. +The final 135 items of ACPI was administered on parents of 230 children (122 boys and 108 girls). Child +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +3/7 +Personality Questionnaire[19] (CPQ) was administered on 30 children of either sex with an age range of 8­ +12 years. +The statistical package for social sciences (SPSS, version 10) was used for data analysis. The data were +analyzed for reliability. The split­half and Cronbach's alpha tests were applied for reliability analysis. +Pearson's correlation analysis was done to check the degree of association between vata, pitta, and kapha +scores. Principal component analysis (factor analysis) was done to check the validity. +RESULTS +Content validity +All the 10 Ayurveda experts, who served as judges, agreed for 158 questions. +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] The results obtained from the administration of ACPI on parents of 60 children showed 136 +items that had less coefficient than 0.9 (answered, yes, by the most) and below 0.3 (answered, yes, by the +less volunteers) were retained. +Internal consistency +An analysis of the data collected from 230 parents of the children showed the Cronbach's alpha for V, P, and +K scales, which were 0.77, 0.55, and 0.84, respectively. The Split­half reliability for V, P, and K scales were +0.65, 0.34, and 0.84, respectively. This shows that the three scales have good internal consistency. +Correlations +The subscales (vata, pitta, and kapha) correlated significantly (negatively) with each other [Table 1]. +Factor analysis +Factor analytic coefficient (by principle component analysis) obtained for each items in the scale for all V, P, +and K scales for total score was more than 0.5 [Supplementary 2]. +Supplementary 2 +Principle component analytic coefficients of each item +Correlation with Child Personality Questionnaire +Vata and pitta scale scores positively correlated with A (warm hearted vs reserved), D (excitable vs +phlegmatic), E (dominant vs obedient), H (venturesome vs shy), N (shrewd vs forthright), 0 (guilt prone vs +self­assured), Q4 (tense vs relaxed) subscales of CPQ. Negatively correlated with B (bright vs dull), C +(emotionally stable vs affected by feelings), G (conscientious vs expedient), I (tender minded vs tough +minded), J (internally restrained vs vigorous), Q3 (controlled vs undisciplined self­conflict) subscales of +CPQ. +Similarly, kapha scale scores positively correlated with B, C, G, I, J, Q3 subscales of CPQ. Negatively +correlated with A, D, E, H, N, O, Q4 subscales of CPQ [Table 2]. +DISCUSSION +The present study has described the development and initial standardization of 136 items, parents rating, the +ACPI as an instrument to assess the personality (prakriti) of the children. +Corelation between vataja, pittaja, and kaphaja scale scores was negative, suggesting discriminative validity. +The reliability of subscales was supported by Cronbach's alpha coefficient and Split­half analysis. This +provided the evidence of homogeneity of items.[21,22,23] The validity of items of subscales was supported +by Principle component analysis. Corelation with modern CPQ revealed significant relationship between +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +4/7 +Eastern and Western personality concepts (p). Statistical significance suggests that vata and pitta prakriti +people are extravert and vulnerable to anxiety[22] [Table 2]. +Applying the inventory to children, further validated the concept of prakriti. Among selected sample, 40% +were vata­pitta, 30%were pitta­kapha, 10% were kapha, 7% were vata, 8%were sama, and 5% were pitta [ +Table 3]. +Increased score in kapha in early age, and pitta, vata in later stages supported convergent validity [Table 4]. +Measuring the prakriti of an individual is important aspect of maintaining one's health as the equilibrium state +of three dosha is considered as health.[1,2,3,4,5,6,7,8,9] One can prevent vulnerability for the somatic and +psychological diseases by following different regime and personality development methods for different +dosha. For example, person with predominance of vata should avoid bitter, spice, astringent taste foods, and +should consume sweet, sour taste foods. The treatment modalities are also different for different prakrti. +[1,2,3,4,5,6,7,8,9] Though published scales are available to assess the prakriti of an individual, they have +been standardized for adult age group. However, children require different mode of questions. Hence, ACPI +can be potentially used to identify the predominant dosha in children and thus help to plan suitable regime at +an early age to maintain the health.   Studies should be conducted on larger sample and norms should be +established. The present scale has the limitation mainly because of parent influence, at the same time the +comprehensive approach of analyzing prakriti and paper­pencil mode are the strength of this work. +CONCLUSIONS +An ACPI is a consistent and valid instrument. Tridosha measure may point out to lifestyle management to +prevent the disease and main the health of the children. Researchers can employ this instrument to assess the +effect of Yoga, personality development program on the prakriti of the children. +ACKNOWLEDGMENT +The authors thank Dr. Kishore Kumar, NDI (CCRAS unit), Bangalore, Dr. Uma Hirisave NIMHANS, +Bangalore, Dr. Arati Jagnnath, SVYASA, Bangalore and Ayurveda experts in Hubli Ayurveda College, for +their support and participation in the study. +Footnotes +Source of Support: Nil +Conflict of Interest: None declared. +REFERENCES +1. Panday GS, editor. Caraka Samhita: Hindi Commentary, Vimanasthana Chapter 8 Verses 96­98. 5th ed. +New Delhi: Choukamba Publications; 1997. pp. 759–61. +2. Hastry KA, editor. Sushruta Samhita: Hindi Vyakhya, Sharirasthana Chapter 4 Verses 63­75. 15th ed. +New Delhi: Choukamba Publications; 2002. pp. 38–9. +3. Sharma S, editor. Ashtanga Sangraha: Sanskrit Commentary, Sharirasthana Chapter 8 Verses 9­16. 1st ed. +Varanasi: Choukamba Publications; 2006. pp. 328–29. +4. Shastri P Ashtanga Hradaya: Sanskrit Commentary. 2nd ed. Varanasi: Choukamba Publications; 2002. pp. +402–04. Sharira sthana 3 (85­94) +5. Shastri P, editor. Ashtanga Hradaya: Sanskrit Commentary, Sharirasthana Chapter 3 Verses 85­94. 2nd ed. +Varanasi: Choukamba Publications; 2002. pp. 402–04. +6. Krishnamurthy KH, editor. Bhela Samhita: English Commentary, Vimanasthana Chapter 4 verses 54­56. +1st ed. Varanasi: Choukamba Publications; 2000. pp. 183–5. +7. Brahmashankaramishra, editor. Bhavaprakash: Hindi Vyakhya, Poorvakhanda Chapter 4 verses 54­56. +10th ed. Varanasi: Chaukamba Smaskrita Bhavan; 2002. p. 103. +8. Pandit PS. Sharangadhara Samhita: Samskrita Vyakhya. 6th ed. Varanasi: Chaukamba Orientalia; 2005. +pp. 73–4. prathama khanda 6 (21­23) +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +5/7 +9. Pandit HT, editor. Harita Samhita: Hindi Vyakhya. 1st ed. Varanasi: Chaukamba Krishnadas Academy; +2005. pp. 32–34. +10. Misched W. Introduction to Personality. New York: Holt. Rinehart and Winston. Inc; 1976. +11. Joshi RR. A biostatistical approach to ayurveda: Quantifying the tridosa. J Altern Complement Med. +2004;10:879–89. [PubMed: 15650478] +12. Hankey A. The Scientific Value of Ayurveda. J Altern Complement Med. 2005;2:221–5. +[PubMed: 15865485] +13. Hankey A. A test of the systems analysis underlying the scientific theory of Ayurveda Tridosa. J Altern +Complement Med. 2005;11:385–90. [PubMed: 15992219] +14. Bhushan P, Kalpana J, Arvind C. Classification of human population based on HLA gene polymorphism +and the concept of Prakriti in Ayurveda. J Altern Complement Med. 2005;11:349–53. [PubMed: 15865503] +15. Patwardhan B, Bodeker G. Ayurvedic genomics: Establishing a genetic basis for mind­body typologies. +J Altern Complement Med. 2008;14:571–6. [PubMed: 18564959] +16. Prasher B, Negi S, Aggarwal S, Mandal AK, Sethi TP, Deshmukh SR, et al. Indian Genome Variation +Consortium, Mukerji M. Whole genome expression and biochemical correlates of extreme constitutional +types defined in Ayurveda. J Transl Med. 2008;6:48. [PMCID: PMC2562368] [PubMed: 18782426] +17. Mishra L, Singh BB, Dagenais S. Healthcare and disease management in Ayurveda. Altern Ther Health +Med. 2001;7:44–50. [PubMed: 11253416] +18. Dube KC, Kumar A, Dube S. Personality types in Ayurveda. Am J Chin Med. 1983;11:25–34. +[PubMed: 6660210] +19. Rutherford B, Cattell R. Hand book for the children's personality questionnaire. Illinois: Indian economy +edition; Institute of Personality and Ability testing. 1999 +20. Nunnaly JC. Psychometric Theory. 2nd ed. New York: Mc­Grow­Hill; 1978. +21. AK Singh. Tests, Measurements and Research Methods in Behavioral Sciences. 5th ed. Patna: Bharati +Bhavan Publishers and Distributers; 2006. +22. Anastasi A, Urbina S. Psychological Testing. 7th ed. Upper Saddle River: Pearson Education; 2005. +23. Freeman FS. Theory and Practice of Psychological Testing. 3rd ed. New Delhi: Surjeet Publications; +2006. +Figures and Tables +Table 1 +Pearson correlation among subscales +Table 2 +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +6/7 +Pearson's correlation coefficient with CPQ +Table 3 +Mean dosha scores for three different diagnostic groups +Table 4 +Mean scores in different age groups +7/29/2016 +Development and initial standardization of Ayurveda child personality inventory +http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296431/?report=printable +7/7 +Articles from Journal of Ayurveda and Integrative Medicine are provided here courtesy of Elsevier diff --git "a/subfolder_0/Development of a simplified yogic measure (bhramari time) of lung function in normal children\342\200\223 a correlational study.txt" "b/subfolder_0/Development of a simplified yogic measure (bhramari time) of lung function in normal children\342\200\223 a correlational study.txt" new file mode 100644 index 0000000000000000000000000000000000000000..250af64682df6aae47a4dad8a59e2f92626872e6 --- /dev/null +++ "b/subfolder_0/Development of a simplified yogic measure (bhramari time) of lung function in normal children\342\200\223 a correlational study.txt" @@ -0,0 +1,369 @@ +SENSE, 2014, Vol. 4 (4), 7-13 + + + + + + UDC: 233.852.5Y: 616.2 +© 2014 by the International Society for + + + + + Original Scientific Paper +Scientific Interdisciplinary Yoga Research + + + +Development of a simplified yogic measure (bhramari time) of lung function in +normal children - a correlational study + +Vikas Rawat1, Rajesh S.K., Raghuram Nagarathna +University Vivekananda +Bangalore, India + +Abstract: Yoga being accepted for use in schools there is a need for developing a scientifically acceptable +standardized tool to assess the progress of their practices that can be used in yoga classes for children. +The present study was designed to validate the acceptability of bhramari time (BHT) by checking its +correlation with Peak expiratory flow rate (PEFR) in healthy South Indian Children. Three hundred and +eighty six healthy school children who attended yoga based Personality Development Camp were +recruited for the study. Sample consist of 229 males and 157 females with a mean age of 12.78 years +(SD=1.69). Anthropometric measurements, BHT and PEFR were recorded. As hypothesized, BHT was +significantly and positively correlated with PEFR (r=.35, p<0.01), Height (r=.29, p<0.01), +Weight(r=.17, p<0.01) and Age (r=.22, p<0.01). Our study suggests that BHT can be recommended for +use in mass camps as an acceptable scientifically validated yogic tool in young population to assess the +progress of their practices in each class. + +Key words: yoga, bhramari time, lungs function + + +Introduction + +Yoga in its original form consists of a system of physical, psychological and ethical practices; although of +ancient origin, it transcends cultures and languages (Nagarathna, Nagendra, 2001). The popularity of yoga +is evident with emerging interest and research in the therapeutic applications of yoga in prevention and +management of psycho-physical conditions. Further, estimated prevalence of practicing Yoga has doubled +from 1997 to 2002, corresponding to 10.4 million adults in the U.S (Barnes, Powell-Griner, McFann, +Nahin, 2004). Recent studies suggest that implementation of yoga is acceptable and feasible in a +secondary school setting and has the potential of playing a protective or preventive role in maintaining +mental health (Khalsa et al, 2012). Further, findings suggest that a school-based yoga intervention is +acceptable to youth, teachers, and school administrators in serving chronically stressed and disadvantaged +youth (Mendelson et al, 2010). Research literature suggests that yoga improves children’s physical and +mental well-being as it helps them improve their resilience, mood, and self-regulation skills pertaining to +emotions and stress (Hagen, Nayar, 2014). + +Furthermore, yoga training improves lung function, strength of inspiratory and expiratory muscles as well +as skeletal muscle strength and endurance of students (Mandanmohan, Jatiya, Udupa, Bhavanani, 2003). +Several studies have shown that regular yoga practice increases the vital capacity, timed vital capacity, +maximum voluntary ventilation, breath holding time and maximal inspiratory and expiratory pressures +(Vedala, Mane & Paul, 2014). Yoga training has shown positive effect on improving lung function and +exercise capacity in patients with chronic obstructive pulmonary disease (Raub, 2002). Pulmonary + +1 Corresponding author: vikasrawat.svyasa@gmail.com +functions and diffusion capacity in patients of bronchial asthma before and after yogic intervention has +shown increased respiratory stamina (Soni, Singh, Munish, Singh, 2012). + +Measurements of ventilator function is useful for assessment of physical fitness in children and adults and +also for diagnosis and follow up during management of conditions with increased airway resistance, such +as asthma, chronic bronchitis, and emphysema (Petty, 2006). Peak expiratory flow rate (PEFR) which is a +measure of the maximum flow achieved during an expiration delivered with maximal force starting from +the level of maximal lung inflation (Pedersen, 1997) recording is an essential measure in the evaluation of +ventilator function. Various types of instruments including hand held mini PFR meters are available to +measure PEFR (Holcroft, Eisen, Sama, Wegman, 2003). A simple, but reliable, method of measuring the +ventilator function of the lungs has long been sought. + +Yoga lays emphasis on manipulation of breath movement (Pranayama), which contributes to positive +neurophysiologic responses (Vialatte, Bakardjian, Prasad, Cichocki, 2009). Yoga breathing exercises, as +an adjunct treatment improves pulmonary functions in both normal volunteers (Mandanmohan, Jatiya, +Udupa, Bhavanani, 2003) and in patients with bronchial asthma (Vedala, Mane & Paul, 2014). Yogic +breathing technique called Bhramari Pranayama (Bhpr), engages in producing a pulsating constant low +pitch sound imitating the buzzing of female bumble bee (Rajesh, Ilavarasu, Srinivasan, 2014). + +With yoga being accepted for use in schools there is a need for developing a scientifically acceptable +standardized tool to assess the progress of their practices that can be used in yoga classes for children that +keeps their interest going. Bhramari time that involves measuring the slow exhalation time while making +a low pitched humming sound like that of a female honey bee has been used in our yoga based personality +camps for children and adults over many years as a tool to assess the progress of the practices. The +present study was designed to validate the acceptability of bhramari time by checking its correlation with +PEFR in healthy South Indian Children. + +Methods + +Participants +Three hundred and eighty six healthy school children who attended yoga based Personality Development +Camp in summer holidays in the serene campus of SVYASA University, Bengaluru were randomly +selected from a pool of 625 children. Children with a history of asthma, a recent history of respiratory +infection with or without persistent cough within the past two weeks and those with any major disability +or illness were excluded from the study. Participants in this study had no formal training in yogic +techniques. + +Consent and ethical clearance +Signed informed consent was obtained from the parent or guardian of the child at the time of registration +after they had read the proposal of this simple non interventional study that involves non invasive data +collection. All procedures were reviewed and accepted by the institutional ethical committee of SVYASA +University. The children were explained in detail about the nature of the study and the voluntary nature of +participation and were not provided with any incentives for their participation. + +Measurements + +Demographic data +The weight (KG) was recorded using a standard electronic weighing scale. The participants were asked to +remove as much outerwear as possible. Further they were asked to remove the shoes and step up onto the +weighing scale and stand still over the center of the scale with body weight evenly distributed between +both feet. Standing height (cm) was measured without shoes and without traction using standard scale. +Procedure for bhramari time measurement +The procedure was performed in a spacious room during the morning hours between 9 AM to 11 AM in +the month of April Between third to fifth days after the inauguration of the camp. Bhramari breathing +technique: The term Bhramari is Sanskrit word signifies a female bee. This is a pranayama technique +wherein after a deep inhalation the participant exhales through the nasal airways with the mouth closed, +emulating the buzzing of bumblebees in a constant low pitch (Rajesh, Ilavarasu & Srinivasan, 2014). +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 and practiced three rounds of bhramari pranayama which was +taught to them in the classes on pranayama for three days before the child was taken up for the study. The +purpose and technique of the Bhramari breathing time was explained to the child followed by +demonstration of the correct manner of performing. They were closely observed to ensure that they +maintained the procedure correctly. Three trials were performed and the time duration of the exhalation +was measured using a stop watch. The best of the three readings was taken as the final Bhramari Time +(BHT). +Procedure for PEFR Measurement +A mini PEFR meter (Clement Clarke) was used to check the PEFR of these children. The purpose and +technique of performing PEFR was explained along with a demonstration of the correct manner of +performing the test. When subjects had understood the method and were able to perform correctly, they +were made to give the test in the standing position. They were closely observed to ensure that they +maintained an airtight seal between their lips and the mouthpiece of the instrument (Holcroft, Eisen, +Sama, Wegman, 2003). The highest value of the three readings was recorded as the final PEFR value. + +Data analysis + +All statistical analyses were performed using the Statistical Package for Social Sciences (version 16.0). +Pearson correlations were used to examine the association between height, weight, PFR and BHT. +Independent-samples t-tests were performed to compare groups. + +Results + +Three hundred ninety one subjects who satisfied the inclusion and exclusion criteria included in the study. +Five students were excluded due to missing data. Final sample consist of 229 males and 157 females. +Table I shows detail demographic profile. Participants age ranged from 9 to 16 years with a mean age of +12.78 years (SD=1.69). Table II gives Distribution of Weight, Height, Peak Expiratory Flow Rate (PEFR) +and Bhramari Time (BHT) in different Age groups. BHT, PEFR, height and weight increased +progressively with age. Table III shows the zero-order correlations on all variables. As hypothesized, +BHT was significantly and positively correlated with PEFR (r=.35, p<0.01), Height (r=.29, p<0.01), +Weight(r=.17, p<0.01) and Age (r=.22, p<0.01). Further, PEFR had significant positive correlation with +Height (r=.64, p<0.01), Weight (r=.53, p<0.01) and Age (r=.53, p<0.01). +Independent-samples t-tests were performed to determine whether statistically significant differences +existed in height, weight, PFR and BHT between boys and girls. Table IV shows the gender differences. +The average values of BHT for all age groups ranged from 3 to 34 sec for boys and 5 –26 seconds for +girls. The PEFR values for boys ranged between 160 – 510 L/min and girls between 160 –410 L/min. +Gender wise analysis has shown no difference in any variables except on PFR. Boys scored significantly +higher PEFR than girls. + + + + +Table 1. Demographic details + +N +Age +Weight +(Kg) +Height +(Cm) +PFR +(L/min) +BHT +(Sec) +386 +12,78±1,69 +43,39±11,70 +149,80±12,20 +291,30±62,75 +13,13±4,98 + +Table 2. Distribution of Weight, Height, Peak Flow Rate and Bhramari Time in different Age groups. + +Age +N +Weight +(Kg) +Height +(Cm) +PFR +(L/min) +BHT +(Sec) +9 +10 +26,75±4,53 +135,30±11,75 +216,00±33,73 +9,60±2,84 +10 +32 +31,82±7,85 +134,45±8,52 +236,25±44,49 +11,00±2,95 +11 +46 +35,74±8,31 +140,33±8,41 +262,39±44,93 +12,59±4,42 +12 +71 +39,40±9,40 +145,43±9,92 +271,30±50,99 +12,78±4,79 +13 +93 +46,96±11,37 +152,27±8,92 +295,65±51,92 +12,91±5,27 +14 +71 +47,10±9,46 +156,04±8,36 +317,83±56,28 +14,17±5,14 +15 +45 +52,95±8,27 +161,27±9,56 +334,09±63,33 +14,14±5,41 +16 +18 +51,30±9,92 +161,56±5,65 +357,78±79,52 +15,28±5,95 + +Table 3. Zero-order between Bhramari Time, Peak Flow Rate, Height, Weight and Age (N=386) + + +PFR +Height +Weight +Age +BHT +.35** +.29** +.17** +.22** +PFR + +.64** +.52** +.53** +Height + + +.74** +.68** +Weight + + + +.57** +**. Correlation is significant at the 0.01 level (2-tailed). + +Table 4. Comparison of boys and girls on all variables + +Gender +N +Weight +Height +PEFR +BHT +Age +Boys +229 +43,39±12,43 +149,91±13,15 +297,60±66,69 +13,18±5,31 +12,66±1,69 +Girls +157 +43,37±10,56 +149.64±10,67 +282,10±55,45 +** +13,06±4,48 +12,97±1,68 +**p=0,02 + + +Discussion + +This study sets out to examine the relationship between PEFR and Bhramri Time among school children +in order to establish the utility of this yogic tool for use in mass programs and by individuals as a test of +their progress in the practice of yoga. The significant relationship between Bhramri Time and PEFR +confirmed our primary hypothesis. Further, the relationship between Bhramri Time and Anthropometric +data also has shown significance. Height had the strongest relationships with other variables. Overall, the +study showed that in healthy children PEFR (Ebomoyi, Iyawe, 2005) and BHT significantly increases +with height, weight and age, which is in agreement with the report of other studies. +PEFR is a measure of a dynamic factor during exhalation as it takes into account the rate of movement of +air in and out of the lungs and is considered the best single index of ventilatory function (Pedersen, 1997). +Unfortunately, it is time consuming, fatiguing, difficult to obtain acceptable data by novices and needs a +good instrument (although simple and portable). BHT is a useful test that is cost effective as it needs no +instruments and acceptable while teaching yoga to children in a school or a camp environment because of +the playful nature of the test that promotes self encouragement to continue the practices. +Potential limitations of this research must also be considered. We have used only PEFR using a mini +PEFR instrument which is a measure of forced expiratory volume in first second (FEV1) while BHT is a +measure of slow vital capacity (SVC). It would have been ideal to compare all measures of lung function +using a spirometer to establish the utility of the BHT. Secondly, the sample included was healthy young +children in a yoga camp environment which may be difficult to generalize for all children and adults. + +Conclusion + +Despite these limitations, the present study confirmed our primary hypothesis i.e. BHT correlated +positively with PEFR. To our knowledge, this is the first study to understand the relationship between +BHT and PEFR. BHT can be enhanced by training. Practice of yoga based breathing practice can increase +pulmonary function which in turn leads to enhancement of BHT (Vedala, Mane, Paul, 2014). Our study +suggests that BHT can be recommended for use in mass camps as an acceptable scientifically validated +yogic tool in young population to assess the progress of their practices in each class. Studies comparing +BHT with other variables of lung function may be carried out in future to confirm the validity and +reliability of this observation. + + +References: + +1. Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R. L. (2004). Complementary and alternative medicine use among +adults: United States, 2002. Advance data, (343), 1-19. +2. Ebomoyi M.I., & Iyawe V.I. (2005) Variations of peak expiratory flow rate with anthropometric determinants in a population +of healthy adult Nigerians, Nigerian Journal of Physiological Sciences, 20(1-2), 85-89. +3. Hagen I., & Nayar U.S. (2014). Yoga for Children and Young People's Mental Health and Well-Being: Research Review and +Reflections on the Mental Health Potentials of Yoga. Frontiers in Psychiatry, 5:35. +4. Holcroft, C. A., Eisen, E. A., Sama, S. R., & Wegman, D. H. (2003). Measurement characteristics of peak expiratory flow. +Chest, 124, 501-510. +5. Jatiya, L., Udupa, K., & Bhavanani, A. B., with Mandanmohan. (2003). Effect of yoga training on handgrip, respiratory +pressures and pulmonary function. Indian journal of physiology and pharmacology, 47(4), 387-392. +6. Khalsa, S. B. S., Hickey-Schultz, L., Cohen, D., Steiner, N., & Cope, S. (2012). Evaluation of the mental health benefits of +yoga in a secondary school: A preliminary randomized controlled trial. Journal of Behavioral Health Services and +Research, 39(1), 80-90. +7. Mendelson, T., Greenberg, M. T., Dariotis, J. K., Gould, L. F., Rhoades, B. L., & Leaf, P. J. (2010). Feasibility and +preliminary outcomes of a school-based mindfulness intervention for urban youth. Journal of Abnormal Child Psychology, 38(7), +985-994. +8. Nagarathna, R., & Nagendra, H.R. (2001). Integrated Approach of Yoga Therapy for positive health. Bangalore: Swami +Vivekananda Yoga Prakashana; +9. Petty, T. L. (2006). The history of COPD Early historical landmarks. International Journal of COPD, 1(1), 3-14. +10. Pedersen, O. F. (1997). The Peak Flow Working Group: physiological determinants of peak expiratory flow. The European +respiratory journal. Supplement, 24, 11S-16S. +11. Rajesh, S.K., Ilavarasu, J.V., & Srinivasan, T.M. Effect of Bhramari Pranayama on response inhibition: Evidence from the +stop signal task. International Journal of Yoga, 7:138-41 +12. Raub, J. A. (2002). Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature +review. Journal of alternative and complementary medicine (New York, N.Y.), 8(6), 797-812. +13. Soni, R., Singh, K., Munish, K., & Singh, S. (2012). Study of the effect of yoga training on diffusion capacity in chronic +obstructive pulmonary disease patients: A controlled trial. International Journal of Yoga, 5(2), p.123. +14. Vedala, S.R., Mane, A.B., & Paul, C.N. (2014). Pulmonary functions in yogic and sedentary population. International +Journal of Yoga; 7:155-9 +15. Vialatte, F. B., Bakardjian, H., Prasad, R., & Cichocki, A. (2009). EEG paroxysmal gamma waves during Bhramari +Pranayama: a yoga breathing technique. Consciousness and cognition, 18(4), 977-988. + + +Received: August 3, 2014 +Accepted: September 1, 2014 + diff --git a/subfolder_0/Development, validation, and feasibility of a school-based short duration integrated classroom yoga module A pilot study design.txt b/subfolder_0/Development, validation, and feasibility of a school-based short duration integrated classroom yoga module A pilot study design.txt new file mode 100644 index 0000000000000000000000000000000000000000..87f5d6669559e9588255691d40ed87355ebd07b8 --- /dev/null +++ b/subfolder_0/Development, validation, and feasibility of a school-based short duration integrated classroom yoga module A pilot study design.txt @@ -0,0 +1,1509 @@ +© 2021 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow +1 +Development, validation, and +feasibility of a school‑based short +duration integrated classroom yoga +module: A pilot study design +Atul Sinha, Sony Kumari, Mollika Ganguly +Abstract: +BACKGROUND: The practice of yoga is proven to have physical, cognitive and emotional benefits +for school children. Despite this many schools do not include yoga in their daily schedule. The +reasons cited are lack of time and resources. To overcome these problems the present study aimed +to develop and validate a short duration Integrated classroom yoga module. The design guidelines +were that it should be possible to practice in the classroom environment and that it could be led by +the class teacher. In this way the module would overcome the problem of both time and resource. +MATERIALS AND METHODS: The study had two main  + phases. In the first phase, selected ICYM +practices based on the literature review were validated by 21 subject matter experts using Lawhse’s +content validity ratio (CVR) formula. In the second phase, a pilot study using a paired sample prepost +measurement design was carried out on 49  + high  school children. The study was conducted in June +2019. The intervention period was 1 month, and the test variables were physical fitness, cognitive +performance, self‑esteem, emotional well‑being, and personality characteristic.   + Paired sample t‑test was +the analysis tool and the software used was the Statistical Package for the Social Science version 26. +RESULTS: In the Lawshe’s CVR analysis, 17 out of the 24 practices tested were rated by experts +as essential as was the overall module (CVR score ≥0.429). In the pilot study, there were significant +differences in the postmean scores compared to premean scores, for all the 4 EUROFIT physical +fitness testing battery tests  (P  <  0.02), all the three scores of the Stroop  +  color‑word naming +task (P < 0.001) and the Rosenberg self‑esteem scale (P < 0.008). +CONCLUSION: ICYM was validated and found feasible by the present  + study. It was found to have a +statistically significant impact on physical fitness, cognitive performance, and self‑esteem variables. +However, a randomized control trial with a longer intervention period is needed to strengthen the +present study. +Keywords: +Children’s cognitive function, children’s physical fitness, children’s psychosocial well‑being, classroom +yoga, school‑based yoga +Introduction +D +espite awareness of the benefits of +school‑based yoga, most schools +either have not incorporated the practice +of yoga in the school curriculum or have +done so sub‑optimally, usually one +class a week. The reasons range from +lack of time, a packed curricular and + +co‑curricular schedule and the need for +resources such as yoga rooms, yoga mats, and +trained yoga instructors. If a solution can be +found to overcome the problems associated +with including yoga in the daily school +schedule, it will benefit children immensely. +The yogic vision of education is to lay the +foundations of character and personality +Address for +correspondence: +Dr. Sony Kumari, +Department of Yoga +and Humanities, Swami +Vivekananda Yoga +Anusandhana Samsthana, +19 Eknath Bhavan, +Gavipuram Circle, +Kempe Gowda Nagar, +Bengaluru ‑ 560 019, +Karnataka, India. +E‑mail: sonykarmanidhi@ +gmail.com +Received: 17‑06‑2020 +Accepted: 02-10-2020 +Published: 20-05-2021 +Department of Yoga +and Humanities, Swami +Vivekananda Yoga +Anusandhana Samsthana, +Bengaluru, Karnataka, +India +Original Article +Access this article online +Quick Response Code: +Website: +www.jehp.net +DOI: +10.4103/jehp.jehp_674_20 +How to cite this article: Sinha A, Kumari S, +Ganguly M. Development, validation, and feasibility +of a school-based short duration integrated classroom +yoga module: A pilot study design. J Edu Health +Promot 2021;10:148. +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 +Sinha, et al.: Validation of integrated classroom yoga module +2 +Journal of Education and Health Promotion | Volume 10 | April 2021 +based on self‑transformation.[1] Yoga is a system of +disciplines for furthering an integrated development +of multiple aspects of the individual’s personality. +Through asanas  (physical postures) the body is +maintained in a steady and supple state. By the practice +of pranayama (breathing exercises) emotional stability, +self‑confidence and self‑control are developed. Through +dhyana (meditation) the turbulent mind is stilled. The +practice of yoga creates a balance in the personality.[2] +Over the last three decades, modern research has +demonstrated positive results of yoga on children. +Serwacki and Cook‑Cottone[3] reviewed 12 preliminary +studies of yoga in schools and found that yoga had a +positive effect on cognitive performance, emotional +well‑being, anxiety and negative behavior. Physical +fitness was shown to be positively associated with yoga.[4] +Another factor for considering school‑based yoga is its +possible role in promoting  + health  literacy. Studies have +found a correlation between health literacy and health +promotion. A study by Karimi et al., 2019[5] defined +health literacy as the degree to which people are able +to choose, understand, process, communicate, and get +information for their health. They hypothesized that +health literacy aids correct decision making regarding +disease prevention, health promotion and for improving +quality of life. The authors conducted a randomized +controlled study with adolescents where the intervention +comprised the dissemination of the PBL health literacy +program. They found that the average level of health +literacy in the intervention group increased significantly, +specifically in the self‑efficacy dimension. Another study +with adolescents by Bayati et al., 2018[6] found a direct +significant correlation of health literacy with all the +dimensions of health‑promotion. A study with students +found a significant relationship between adopting health +promoting lifestyle and aspects of spiritual growth, stress +management and general quality of life.[7] An aspect +of school‑based yoga is the dissemination of self‑care +knowledge. Hyde, 2012[8] says that school‑based yoga +as critical‑emancipatory pedagogy, effectively uses +national standards for physical education, health and +safety and social‑emotional learning to provide self‑care +knowledge and skills to students and teachers. Hence, +yoga may be considered beneficial from the perspective +of health literacy too. +The problems of the packed school schedule, time and +resources come  + in the way of incorporating yoga in +the daily school schedule. We hypothesize that a short +duration integrated classroom yoga module (ICYM) +can potentially overcome the problem of time and +resources. The  + short  duration would make it possible +to be practiced in the first period of the day without +impinging materially on the time for academic lessons. +Further, the class‑teacher can lead the practice in the +limited spaces of the classroom environment. This +ensures that no additional resources will be required. +Traditional texts of yoga too support its practice in the +classroom. Yogabhakti Saraswati says that children +enter the class with different states of mind. Yoga in the +classroom helps to harmonize their minds and create the +right balance between excitement and alertness.[2] The +objective of this study was to develop a validated short +duration ICYM and confirm its feasibility and efficacy +with a pilot study design. +Materials and Methods +The present study adopted a phased methodology +to develop, validate and confirm  + the feasibility and +efficacy of the school‑based short duration ICYM. In +the first phase, yoga practices were selected based on a +review of ancient and contemporary literature on yoga. +In the second phase, the content validity of the selected +practices was assessed by a panel of 21 subject matter +experts. The content validity was calculated using +Lawshe’s content validity ratio (CVR) formula.[9] In the +third phase, the validated ICYM was developed. In the +fourth phase a pilot study was conducted to confirm +the feasibility and ascertain the efficacy of the module. +Figure 1 shows the four phases adopted in the study. +The study was approved by the Institutional ethics +committee of  + S‑VYASA  University (reference number: +RES/IEC‑SVYASA/145/2019). +Designing integrated classroom yoga module +based on literature review +Ancient and contemporary texts of yoga were reviewed +to develop the content of the module. The ancient texts +reviewed were Patanjali yoga sutra,[10] Hatha yoga +pradipika,[11] Gheranda Samhita,[12] Siva Samhita,[13] +Svetasvatara Upanishad,[14] and Brhdaranyaka +Figure 1: Phases in developing a validated school‑based integrated classroom +yoga module +Sinha, et al.: Validation of integrated classroom yoga module +Journal of Education and Health Promotion | Volume 10 | April 2021 +3 +Upansidhad.[15] The contemporary texts reviewed were +Light on Yoga,[16] Asana Pranayama Mudra Bandha[17] +and Integrated yoga therapy for positive health.[18] At an +overall level, these texts make out a compelling case for +making yoga integral to children’s education. +According to Niranjanananda[1] the purpose of education +is to develop a fully integrated personality by laying +the foundations of character and personality. He +elaborates on this theme by stating that there are two +main ingredients to achieve this objective. The first is the +development of discrimination between what is worthy +and what is not and the second is the development of a +spiritual attitude in order to face life with courage and +fortitude. Being self‑transformative, yoga aids in the +development of discrimination and a spiritual attitude. +Satyananda[2] says that yoga has immense benefits for +children. It gently massages the endocrine glands whose +proper functioning is critical for growing bodies. Regular +practice of yoga brings about emotional stability and +enhances self‑confidence, self‑awareness and self‑control. +Patanjali yoga sutra says that only a still mind is capable +of concentration and higher perception. It advises +constant practice and an attitude of nonattachment +to bring the mind under control. Asanas  (physical +postures) make the body firm and still. It lessens +the natural restlessness of the body making it easier +for the mind to concentrate. Pranayama  (breathing +exercises) removes rajas (uncontrolled restless activity) +and tamas (uncontrolled dullness) to make the mind +sattvic (controlled gentle steadiness). This in turn makes +the mind fit for concentration. Dharana (concentration) +and Dhyana (meditation) trains the mind to focus on +one subject effortlessly.[10] Hatha yoga pradipika states +that asanas  (physical postures) steadies the body, +makes it supple, induces relaxation and facilitates +free low of prana  (vital energy). The practice of +pranayama (breathing exercises) increases pranic force +and balances the mind. The left and right hemispheres +of the brain are balanced to allow both the logical and +intuitive faculties to function.[11] Gheranda Samhita says +yoga calms the mind and brings the whole personality +under control, moderation and balance.[12] According +to Siva samhita yoga helps to develop an attitude of +cheerfulness, enthusiasm and courage.[13] +Modern research has corroborated many of the +claims made by ancient texts of yoga. Studies have +shown that yoga had a beneficial effect on physical +fitness.[19] It improved musculoskeletal health.[20] It +impacted cardiopulmonary health positively,[21‑23] and +improved neuromuscular health.[23‑25] Studies have +associated yoga with significant improvements in +memory, attention and executive function.[26‑28] Yoga +enhanced self‑esteem,[29,30] and improved self‑efficacy, +self‑regulation and self‑adjustment.[31‑33] Yoga helped +improve mood state, depression, anger and anxiety.[34‑36] +Ferreira‑Vorkapic et al.[37] reviewed nine randomized +control trial studies and found positive effects of yoga +on mood indicators, tension, anxiety, self‑esteem and +memory. Yoga had a positive impact on three types +of response patterns called gunas. A study showed an +increase in  + sattva (controlled gentle steadiness) and +reduction in rajas (uncontrolled restless activity) and +tamas  (uncontrolled dullness).[38] Om chanting has +been shown to activate the neural region, increase +oxygenation, give psychological relaxation, relieve stress +and provide vigor.[39,40] Pradhan and Derle[41] reported +that chanting Gayatri mantra improved attention. +The ancient and contemporary literature on yoga were +scanned to identify and evaluate practices beneficial for +physical fitness, cognitive performance and emotional +well‑being of children. Only practices that could be +performed in the confined spaces of the classroom +environment were evaluated. Table 1 lists the selected +practices of asanas (physical postures), Table 2 lists the +selected practices of pranayama (breathing exercises), +and Table 3 lists the selected dhyana (meditation) and +mantra (chanting) practices and summarizes their benefits +as referred in yoga texts. The literature review found that all +14 asanas selected impacted physical fitness, 11 asanas were +associated with cognitive performance and 6 with emotional +wellbeing. Of the 7 pranayama practices (breathing exercises) +selected, 5 had a positive effect on physical fitness and all 7 +were beneficial for cognitive and emotional well‑being. The +3 dhyana (meditation) and mantra (chanting) practices were +found to promote cognitive performance and emotional +well‑being. +Validation of Integrated classroom yoga module +by subject matter experts +The 24 practices selected from literature review were +incorporated in 4 alternate sets of yoga module. These +sets were meant to be rotated from 1 day to the next. +A questionnaire was prepared for yoga experts. They +were required to validate the practices on a three‑point +scale: +1. Not essential: Has no role in improving physical +fitness, cognitive performance, emotional wellbeing +or personality characteristics of school children +2. Useful but not essential: Useful but not important in +improving physical fitness, cognitive performance, +emotional well‑being or personality characteristics +of school children +3. Essential: Very important for improving physical +fitness, cognitive performance, emotional wellbeing +or personality characteristics of school children. +The questionnaire further required them to rate the yoga +module as a whole on its ability to achieve the objectives +Sinha, et al.: Validation of integrated classroom yoga module +4 +Journal of Education and Health Promotion | Volume 10 | April 2021 +of impacting physical fitness, cognitive performance, +emotional wellbeing and personality characteristics of +school children. The rating was on a three‑point scale. +1. Not at all +2. Moderately +3. Very much. +Open ended suggestions for improvement of the module +were also solicited in the questions. +The experts were selected based on convenience +sampling. 21 yoga experts responded to the questionnaire. +Lawshe’s CVR formula was the statistical tool employed +to analyze the data.[9] +Designing a validated integrated classroom yoga +module +Definition of Integrated classroom yoga module +The premise worked on was that a short duration +yoga module, amenable to be led by the class teacher +and possible to practice in the limited spaces of the +classroom environment would encourage schools to +incorporate yoga in their daily schedule. ICYM was +thus conceived as a 12‑min integrated yoga module +to be practiced in the limited spaces of the classroom +environment. It could be led by the class teacher after +a 1‑week training in the practice and a working theory +of yoga. +The integrated module included different limbs of yoga +namely asanas (physical postures), pranayama (breathing +exercises), dhyana (meditation) and mantra (chanting). +The design was based on three predefined criteria: +1. It should be an integrated yoga module +2. It should be possible to practice the module in the +limited spaces of the classroom environment +3. The choice of practices should have the ability to +impact physical fitness, cognitive performance, +emotional well‑being and personality characteristics +of school children. +Table 1: Asanas (physical postures) selected from literature review +Asanas (physical postures) +Benefits +Textual references +Sideways bending/twisting +Katichakrasana +Tones upper body; corrects posture; relieves stress +Asana Pranayama Mudra Bandha. Satyananda (2009) +TirikayaTadasana +Exercises and balances side muscles +Asana Pranayama Mudra Bandha. Satyananda (2009) +ArdhakatiChakrasana +Stimulates sides and spine; improves liver function +Positive Health. Nagarathna and Nagendra (2011) +Parsvakonnasana +Tones lower body; increases peristaltic activity +Light on Yoga. Iyengar (2012) +Forward and backward bending +Prasarita Padohastasana + +Ardhachakrasana +Develops lower body muscles; improves flexibility, +increase blood flow to head region +Light on Yoga. Iyengar (2012) +Padahastasana + +Ardhachakrasana +Tones abdomen; improves digestive health; +improves metabolism, improves concentration +Light on Yoga. Iyengar (2012) +Positive Health. Nagarathna and Nagendra (2011) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Padahastasana + +Hastauthanasana +Tones abdomen; improves digestive health; +improves metabolism, improves concentration +Light on Yoga. Iyengar (2012) +Positive Health. Nagarathna and Nagendra (2011) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Stretching +Tadasana +Lightness; mental agility; physical and mental +balance; tones nerves +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +ParivrittaTrikonasana +Tones lower body; invigorates abdominal organs; +stimulates nervous system +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Gaumukhasana +Tones upper body; regulates endocrine system; +regulates prana flow; steadies body and calms +mind, increases energy and awareness +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Ardhachandrasana +Strengthens lower body and abdomen; improves +digestion; improves balance +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Balancing +Vrkshasana +Improves balance; strengthens lower body; +promotes kidney health +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Garudasana +Strengthens and loosens body; tones nerves, +develops concentration +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Veerbhadrasana Pose III +Creates harmony and balance; tones abdomen; +gives vigour; improves concentration +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Sinha, et al.: Validation of integrated classroom yoga module +Journal of Education and Health Promotion | Volume 10 | April 2021 +5 +Designing a validated Integrated classroom yoga module +The validated practices were incorporated in the ICYM. +From the open‑ended suggestions given by experts we +thought it useful to include a positive affirmation practice. +Another suggestion incorporated was to slow down the +pace of the practice to ensure that children were not tired. +The parameters followed to design the module were: +1. The module duration was 12 min +2. Two sets were to be made meant to be practiced on +alternate days to provide variety and derive more +benefits +3. The practice was to start with dhyana (meditative +silence) to harmonize the mental state of the cohort +4. The asanas (physical postures) that followed would +comprise side bending or twisting, forward and +backward bending, stretching and balancing to +ensure that the whole body was exercised +5. The +asanas +were +to +be +followed +by +pranayama  +(breathing +exercises) +6. At the tail end, there was dhyana (meditative silence) +and OM chanting to relax the body and mind. The +module  + ended  with a positive  + affirmation. +The ICYM module is presented in Table 4. +Pilot study to confirm the feasibility of integrated +classroom yoga module +Design +The aim of the pilot study was to test the feasibility +and efficacy of the validated ICYM in a school setting. +The design was a paired sample prepost measurement +of means of physical fitness, cognitive performance, +self‑esteem, emotional well‑being, and personality +characteristic variables. +Table 2: Pranayama (Breathing exercises) selected from literature review +Pranayama (breathing exercises) +Benefits +Textual reference +Bhastrika +Stimulates cerebral region; strengthens nervous +system; oxygenates blood; stimulates heart; +detoxification; unblocks prana movement; +stimulates metabolism; lowers stress; induces +clarity of thought and improves concentration +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Ujjai +Relaxes; develops psychic sensitivity; +internalises the senses; calms the mind; +promotes cardio and digestive health +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Yogic breathing (abdominal) +Relaxed and comfortable breathing; gives +vitality and calmness; clarity of thought +Asana Pranayama Mudra Bandha. Satyananda (2009) +Positive Health. Nagarathna and Nagendra (2011) +Nadi Shudhi +Purifies nadis; increases prana capacity; +eliminates bodily disorders; makes breathing +rhythmic; soothes nerves; stills the mind; +balances brain hemispheres; improves +concentration +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Positive Health. Nagarathna and Nagendra (2011) +Sheetali and Sadanta +Cools the body and mind; keeps teeth and +gums healthy; harmonises the endocrine +system; reduces BP; encourages flow of prana; +gives vigour; gives inner tranquillity +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Light on Yoga. Iyengar (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Positive Health. Nagarathna and Nagendra (2011) +Bhramari +Awakens psychic sensitivity; relieves anxiety; +alleviates anger; reduces BP; helps in throat +ailments; creates healing capacity +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Asana Pranayama Mudra Bandha. Satyananda (2009) +Positive Health. Nagarathna and Nagendra (2011) +Table 3: Dhyana (meditation) and mantra (chanting) practices shortlisted from literature review +Meditation/Chanting +Benefits +Textual reference +Dhyana (meditation) +Mauna +Control over mind; stillness, one +pointedness, continuous awareness; deep +relaxation; reduced metabolic rate; light +and expansive feeling +Patanjali Yoga Sutra. Vivekananda (1986) +Hatha Yoga Pradipika. Muktibodhananda (1985) +Gheranda Samhita. Niranjananda (2012) +Positive Health. Nagarathna and Nagendra (2011) +Mantra (chanting) +OM and Gayatri +Mantras +Steadies the senses and quietens the mind; +balances the emotions; purifies the mind +Svetasvatara Upanishad. Tejomayananda (2011) +Brhadaranyaka Upanishad. Madhavananda (1934) +Positive Health. Nagarathna and Nagendra (2011) +Sinha, et al.: Validation of integrated classroom yoga module +6 +Journal of Education and Health Promotion | Volume 10 | April 2021 +Participants +The participants for the present study were selected +from an urban campus of the multi‑campus Samsidh +Mount Litera Zee School group in Bengaluru, India. +The participants were selected randomly from Grades +7–10. A grade‑wise quota was predecided, and equal +gender ratio was fixed. The selection of participants +was made blindly and randomly by drawing from +paper slips. The inclusion criteria were: (i) participants +must be from Grades 7–10 and (ii) of both genders. The +exclusion criteria were: (i) any history of major physical +illness or surgery in the past 2 months, (ii) any mental +illness and (iii) any condition where physical activity +was contraindicated. +Intervention +The intervention period was 1 month, with 5 days a +week of practice in the beginning of the first period of the +school day. The class teachers were trained by qualified +yoga instructors over daily 1 h sessions for 7 days. The +training included an overview of the discipline of yoga +and its various limbs. The benefits of each practice were +conveyed to them. Each yoga exercise was demonstrated +and practiced. Teachers had to lead mock sessions. +A video of the module was also given to the teachers. +Every 2 weeks, there was a top‑up training session +conducted for the teachers. +Ethics +The study was approved by the Institutional ethics +committee of S‑VYASA University (reference number: +RES/IEC‑SVYASA/145/2019). The school administration +was briefed in writing and verbally on the details of +the study and the intervention. Informed consent was +obtained from the school administration. +Assessment +The participants were assessed for physical fitness, cognitive +performance, self‑esteem, emotional well‑being and +personality characteristic. Four tests from EUROFIT physical +fitness testing battery were conducted.[42] The Stroop +color-word naming task was used to measure cognitive +performance.[43] Rosenberg self‑esteem scale[44] and WHO‑5 +well‑being index[45] were utilized to measure emotional +well‑being. Sushruta child personality inventory (SCPI)[46] +was employed to measure child personality characteristic. +EUROFIT physical fitness testing battery +Flamingo balance test +Participants balanced on a narrow wooden bar on their +preferred leg. The free leg was flexed at the knee. Number +of falls in 60 s was recorded. +Sit and reach flexibility test +Participants were made to sit on the floor with both legs +stretched, touching the base of a measuring table with +Table 4: Integrated classroom yoga module: Set 1 and Set 2 practiced on alternate days +Set 1 +Set 2 +Yoga practice +Time +Description +Yoga practice +Time +Description +Dhyana (Meditative silence) +1 min +Sit straight with eyes closed. +Attention on breathing. Watch +your thoughts flowing +Dhyana (Meditative silence) +1 min +Sit straight with eyes closed. +Attention on breathing. Watch +your thoughts flowing +Asanas +Asanas +Katichakrasana +1 min +20 rounds +Ardhakatichakrasana +1 min +Hold for7 counts on each side +Hastauthanasana/ +Padahastasana +1 min +3 rounds backward‑forward +bending. On 4th round hold for +7 counts on backward bend +and then on forward bend +Ardhachakrasana/ +Padahastasana +1 min +3 rounds of backward‑forward +bending. On 4th round hold +for 7 counts on back bend +and then +Tadasana +1 min +3 rounds of up and down +followed by 1 round of holding +for 10 counts +Gaumukhasana (standing) +1 min +Hold on each side to the +count of 10 +Vrkhsasana +1 min +Hold on each side for 10 +counts +Garudasana +1 min +Hold on each side for 10 +counts +Pranayama +Pranayama +Yogic breathing (abdominal) +1 min +10 rounds +Yogic breathing (abdominal) +1 min +10 rounds +Nadi Shudhi +2 min +6 rounds +Nadi Shudhi +2 min +6 rounds +Bhramari +1 min +6 rounds +Bhramari +1 min +6 rounds +OM chanting +1 min +6 rounds +OM chanting +1 min +6 rounds +Dhyana +1 min +Mentally recap the practices. +Attention on breathing +Dhyana +1 min +Mentally recap the practices. +Attention on breathing +Affirmation +Affirmation +I am a powerful soul +0.5 min 3 rounds +I am a loveful soul +0.5 min +3 rounds +Closing +0.5 min Rub palms, massage eyes, +face, neck. With a few blinks +open eyes +Closing +0.5 min +Rub palms, massage eyes, +face, neck. With a few blinks +open eyes +Total timing +12 min +Total timing +12 min +Sinha, et al.: Validation of integrated classroom yoga module +Journal of Education and Health Promotion | Volume 10 | April 2021 +7 +their  + spine erect. The table had a measuring scale. The +initial reading on the measuring scale was taken at the +point where the tip of the longest finger touched. They +were then asked to stretch fully without bending their +legs. The final reading where the tip of the longest finger +reached was taken and the distance of stretch calculated +by subtracting the initial (non stretch reading) from the +final (full stretch) reading. +Sit ups trunk strength +Participants were required to lie on their back with knees +bent; thighs kept  + at right angle to the torso and feet flat +on the ground. Their hands were kept behind their head. +Participants performed sit‑ups from this position and +returned to the initial position. The number of sit‑ups in +30 s was recorded. Incomplete sit‑ups were not counted. +10 × 5‑m shuttle run agility test +Cones were kept at a distance of 10 m. At the word ‘Go’ +the participants ran to the cone 10 m away and back five +times without stopping. At the end of the fifth round, +the timing was recorded using a stopwatch. +Stroop color‑word naming task +The Stroop color‑word task measures the executive +function involving word, color and an interference naming +response. The test consists of three pages. The first page +tests how fast the participant can read out words (correct +number of words read in 45 s). The second page tests how +fast the participant can call out the colors (correct number +of colors called in 45 s). The third page tests the speed +with which the participant can name the color of the ink +and disregard the word printed in that color ink (correct +number of ink colors called in 45 s). The test in effect +measures the participant’s control over neuropsychological +functions involved in color and word naming responses.[39] +The test extracts three scores, namely Stroop word score, +Stroop color score and Stroop color‑word score. +Rosenberg self‑esteem scale +The Rosenberg self‑esteem scale is a self‑report scale. +It is a 10‑item scale measuring both positive and +negative feelings associated with global self‑esteem. The +instrument uses a 4‑point Likert scale. +WHO‑5 well‑being index +The WHO‑5 well‑being index is a self‑report scale. It +has 5 items measuring positive feelings associated with +emotional well‑being. The instrument uses a 6‑point +Likert scale. +Sushruta child personality inventory +The SCPI is a self‑report scale measuring personality +characteristic. It has 54 items and uses a binomial Yes/ +No scale. The scale is based on the concept that the mind +is always in a dynamic equilibrium between three types +of response patterns called gunas. The three patterns are +Sattva (controlled gentle steadiness), Rajas (uncontrolled +restless activity) and Tamas (uncontrolled dullness).[47] +Well‑being is disturbed when Rajas and Tamas become +dominant. +The raw data were analyzed using the Statistical Package +for the Social Science (SPSS) version 26, IBM, USA. +Results +Results of validation of Integrated classroom yoga +module by subject matter experts +The ICYM was evaluated by subject matter experts (n = 21). +The qualification of the experts was Ph.D., (Yoga) 13, +MD (Yoga Therapy) 1, M.Sc., (Yoga) 2, Yoga instructors +certification course 5. The mean number of years’ +experience in teaching yoga was M = 19.9 (8.57) and the +range was 4–40. The characteristics of the expert panel are +given in Table 5. To test content validity of subject matter +expert ratings, Lawshe’s CVR analysis was undertaken. +Tables 6‑9 gives the results of content validity for the +24 yoga practices proposed. For a panel size of 21 the +CVRcrit was calculated at  + 0.429. A CVR score ≥CVRcrit +would constitute sufficient evidence to validate that +practice. Conversely a CVR score 0.05). +Table 2 - This explains the comparison between pre and post +assessment on positive attitude of Experimental Group. +Note: In within group comparison (Yoga group) Wilcoxon test +did not show any significant improvement in positive attitude +Table 3 - This explains the comparison between pre and post +assessment on negative attitude of group. +Variable + +Mean=+SD +% change +of mean +P value +Afraid +Pre +Post +2.231=+1.1066 +2.654=+1.3840 +15.93 +085 +Scared +Pre +Post +2.269=+1.1509 +2.731=+1.4576 +16.91 +171 +Nervous +Pre +Post +2.385=+1.2673 +2.538=+1.2722 +6.02 +596 +jittery +Pre +Post +2.231=+1.2746 +2.423=+1.2385 +0 +689 +irritable +Pre +Post +2.192=+1.2335 +2.846=+1.6172 +22.97 +130 +hostel +Pre +Post +2.731=+1.4016 +2.615=+1.2985 +4.43 +697 +guilty +Pre +Post +2.154=+1.3173 +2.269=+1.4016 +5.06 +718 +ashamed +Pre +Post +2.038=+.8237 +2.538=+1.5028 +19.70 +260 +upset +Pre +Post +2.577=+1.2704 +2.885=+1.657 +10.67 +307 +distressed +Pre +Post +2.577=+1.2704 +3.385=+1.3879 +23.87 +001* +Variable + +Mean=+SD +% change +of mean +P +value +active +Pre +Post +3.038=+.9992 +3.308=+1.1232 +8.88 +400 +alert +Pre +Post +3.115=+.9089 +2.923=+1.0554 +6.16 +380 +attentive +Pre +Post +2.923=+.7442 +3.000=+1.2000 +2.63 +783 +determined +Pre +Post +3.192=+.7494 +2.885=+1.1073 +9.61 +314 +enthusiastic +Pre +Post +3.000=+.9798 +3.192=+1.0961 +6.4 +445 +excited +Pre +Post +3.000=+1.0583 +2.885=+1.2434 +3.83 +.824 +inspired +Pre +Post +3.000=+.9381 +3.231=+1.1767 +7.7 +385 +interested +Pre +Post +2.923=+1.0168 +3.346=+1.2944 +14.47 +119 +proud +Pre +Post +3.346=+1.0175 +2.923=+1.0168 +12.64 +491 +strong +Pre +Post +3.423=+.9454 +3.154=+1.2229 +7.85 +309 +Variable + +Mean=+SD +% change +of mean +P +value +Afraid +Pre +Post +3.542=+1.3181 +2.792=+1.2151 +21.17 +023* +Scared +Pre +Post +3.125=+1.4540 +2.958=+1.5737 +5.34 +655 +YOGA AND ATTITUDE +Voice of Research, Vol. 3 Issue 4, March 2015, ISSN 2277-7733 | 13 +Note: Within group comparison was done by using Wilcoxon +Test where the result showed significant improvement in the +attitude afraid in Control Group. +Table 4 - This explains the comparison between pre and post +assessment on positive attitude of group. +Note: Within group comparison was done by using Wilcoxon +Test where the result showed significant improvement in the +attitude active in Control Group. +Table 5 - This explains the comparison between the group +(Yoga and Control).MannWhitney (Between group) +Note: In between group comparison Yoga group showed +significant improvement in the negative attitude such as afraid, +nervous, irritable, ashamed and upset. +In a previous, open-armed observational study on 312 +participants of a weeklong free yoga camp for promotion of +positive health through integrated yoga practices showed +significant reduction in negative affect and increase in positive +affect scores on modified version of PANAS questionnaire.; +The current study reveals that in a within group comparison +Yoga Group showed a significant reduction in negative attitude, +distressed (p> .001) whereas no changes was observed in positive +attitude.; In control group negative attitude afraid was reduced +significantly (p>.023) and positive attitude active, increased +significantly with p > .05.; In between group comparison yoga +group showed significant reduction in negative attitude such +afraid (p>.05), nervous (p>.05), irritable (p>.05), ashamed (p> +.05), and upset (p>.05).; In positive attitude result betweens +group did not show any significantly improved in yoga group +after one month of intervention.; Yoga intervention has shown +significant change in reducing negative attitd ude an improvement +in positive attitude in healthy volunteers. +Reference +Allport, G. W., Vernon, P. E., &Lindzey, G. (1960). +Eagly, A. H., &Chaiken, S. (2007). The advantages of an inclusive +definition of attitude. Social Cognition, 25(5), 582-602. +Kirill Zdorov. (2000). Mastering the Perverse: State Building +and Language” Purification” in Early Soviet Russia. Slavic +Review, 133-153. +Marano, H. E. (2004). A nation of wimps. Psychology +Today, 37(6), 58-70. +Forsyth, D. M., Poppe, K., Nash, V., Alarcon, R. D., & Kung, +S. (2010). Measuring changes in negative and positive +thinking in patients with depression. Perspectives in +psychiatric care, 46(4), 257-265. +Dillard, J. P., & Peck, E. (2000). Affect and Persuasion +Emotional +Responses +to +Public +Service +Announcements. Communication Research, 27(4), 461-495. +Ajzen, I., &Fishbein, M. (1977). Attitude-behavior relations: +A theoretical analysis and review of empirical +research. Psychological bulletin, 84(5), 888. +Mathew Anad , DrJagatheesanAlagesan , Dr S Prathap Effect +of Yoga Therapy in rehabilitation of drug Addicts +Volume ;2 issue;7 July 2013 ISSN No 2277-8160 +Gupta, N., Khera, S., Vempati, R. P., Sharma, R., &Bijlani, R. +L. (2006). Effect of yoga based lifestyle intervention on +state and trait anxiety. Indian journal of physiology and +pharmacology, 50(1), 41. +Malathi, A., Damodaran, A. S. H. A., Shah, N. I. L. E. S. H., Patil, +N. E. E. L. A., & Maratha, S. R. I. K. R. I. S. H. N. A. (2000). +Effect of yogic practices on subjective well being. Indian journal +of physiology and pharmacology, 44(2), 202-206. +Bagozzi, R. P. (1993). An examination of the psychometric +properties of measures of negative affect in the PANAS-X scales. +Narasimhan, L., Nagarathna, R., &Nagendra, H. R. (2011). Effect +of integrated yogic practices on positive and negative emotions +in healthy adults.International journal of yoga, 4(1), 13. +Vadiraja, H. S., Rao, M. R., Nagarathna, R., Nagendra, H. R., Rekha, +M., Vanitha, N.&Rao, N. (2009). Effects of yoga program on +quality of life and affect in early breast cancer patients +undergoing adjuvant radiotherapy: a randomized controlled +trial. Complementary therapies in medicine, 17(5), 274-280. +Nagarathna R, Nagendra HR. 3rd ed. Bangalore: Swami +Vivekananda Yoga Prakashana; 2006. Integrated approach +of yoga therapy for positive health. +Nervous +Pre +Post +3.500=+1.4446 +3.375=+1.6101 +3.57 +758 +jittery +Pre +Post +2.708=+1.5737 +2.708=+1.3667 +0 +951 +irritable +Pre +Post +3.333=+1.3726 +3.292=+1.4590 +1.23 +828 +hostel +Pre +Post +3.000=+1.3831 +2.875=+1.5126 +4.16 +704 +guilty +Pre +Post +3.167=+1.4646 +3.458=+1.4136 +9.18 +542 +ashamed +Pre +Post +3.167=+1.4646 +2.917=+1.6659 +7.89 +639 +upset +Pre +Post +3.708=+1.2676 +3.167=+1.2039 +14.59 +172 +distressed +Pre +Post +2.583=+1.529 +2.667=+1.6594 +3.25 +947 +Variable + +Mean=+SD +% change +of mean +P value +active +Pre +Post +2.917=+1.2129 +2.958=+1.3345 +1.38 +.048* + +alert +Pre +Post +2.958=+1.5458 +3.708=+1.2676 +20.22 +088 +attentive +Pre +Post +3.375=+1.2091 +2.958=+1.3667 +14.09 +207 +determined +Pre +Post +2.625=+1.2790 +3.333=+1.4039 +21.24 +073 +enthusiastic +Pre +Post +3.083=+1.2129 +3.375=+1.3126 +8.65 +307 +excited +Pre +Post +2.917=+1.1757 +2.792=+1.2151 +4.47 +750 +inspired +Pre +Post +2.958=+1.5737 +3.458=+1.3181 +14.45 +263 +interested +Pre +Post +3.250=+1.1516 +3.208=+1.4136 +1.30 + +935 +proud +Pre +Post +3.042=+1.3667 +2.917=+1.4116 +4.28 +809 +strong +Pre +Post +3.250=+1.3593 +3.375=+1.2091 +3.70 +649 +Variable +P value +Variable +P value +Afraid pre +614 +active pre +268 +Afraid post +.006* +Active post +.580 +Scared pre +713 +alert pre +037 +Scared post +.073 +Alert post +.837 +Nervous pre +103 +attentive pr +796 +Nervous post +.017* +Attentive post +.066 +Jittery pre +527 +Determined pre +270 +jittery post +.638 +Determined post +.064 +irritable pre +263 +Enthusiastic pre +618 +Irritable post +.016* +Enthusiastic post +.684 +Hostel pre +487 +excited pre +723 +Hostel post +.959 +Excited post +.533 +guilty pre +019 +inspired pre +535 +Guilty post +.053 +Inspired post +.886 +ashamed pre +480 +interested pr +695 +Ashamed post +.027* +Interested post +.318 +upset pre +329 +Proud pre +332 +Upset post +.020* +Proud post +.561 +Distressed pre +220 +strong pre +693 +Distressed post +.420 +Strong post +.737 +YOGA AND ATTITUDE diff --git a/subfolder_0/Effect of Adjunct Tele-Yoga on Clinical Status at 14 Days in Hospitalized mild and Moderate COVID-19 Patients a Randomized Controlled Trial..txt b/subfolder_0/Effect of Adjunct Tele-Yoga on Clinical Status at 14 Days in Hospitalized mild and Moderate COVID-19 Patients a Randomized Controlled Trial..txt new file mode 100644 index 0000000000000000000000000000000000000000..a1db6ca16d31ae6dc5e00fb6d6b3e7597be11b20 --- /dev/null +++ b/subfolder_0/Effect of Adjunct Tele-Yoga on Clinical Status at 14 Days in Hospitalized mild and Moderate COVID-19 Patients a Randomized Controlled Trial..txt @@ -0,0 +1,873 @@ +Page 1/19 +Effect of Adjunct Tele-Yoga on Clinical Status at 14 +Days in Hospitalized mild and Moderate COVID-19 +Patients: a Randomized Controlled Trial +Vijaya Majumdar  +( + +Majumdar.vijaya@gmail.com +) +Swami Vivekananda Yoga Anusandhana Samsthana +Manjunath N K  +Swami Vivekananda Yoga Anusandhana Samsthana +Nagarathna R  +Swami Vivekananda Yoga Anusandhana Samsthana +Suryanarayan Panigrahi  +Swami Vivekananda Yoga Anusandhana Samsthana +Muralidhar Kanchi  +Narayana Health City +Sarthak Sahoo  +Narayana Health City +Hongasandra R Nagendra  +Swami Vivekananda Yoga Anusandhana Samsthana +Adithi Giridharan  +Swami Vivekananda Yoga Anusandhana Samsthana +Mounika Reddy  +Swami Vivekananda Yoga Anusandhana Samsthana +Rakshitha Nayak  +Swami Vivekananda Yoga Anusandhana Samsthana +Research Article +Keywords: +Posted Date: March 22nd, 2022 +DOI: https://doi.org/10.21203/rs.3.rs-1361039/v1 +License: + + +This work is licensed under a Creative Commons Attribution 4.0 International +License. +  +Read Full License +Page 2/19 +Abstract +Background: We tested if tele-yoga intervention could aid in better clinical management for hospitalized +patients with mild to moderate COVID-19 when complemented with the standard of care. +Methods: This was a randomized controlled trial conducted at the Narayana Hrudalaya, Bengaluru, India +on hospitalized patients with mild to moderate COVID-19 infection, enrolled between May 31st and July +22, 2021. Patients (n=225) were randomized in 1:1 ratio [adjunct tele-yoga (n = 113), or standard of care +(n = 112)]. Adjunct yoga group received intervention in tele-mode within 4 hours post-randomization until +14 days along with the standard of care. The primary outcome was clinical status at 14th-day post- +randomization assessed with a 7-category ordinal scale. The trial included 11 secondary outcomes, +including 28-day mortality. +Results: As compared with standard of care alone, the proportional odds of having a higher score on the +seven-point ordinal scale at day 14 was ~1.9 for the adjunct tele-yoga group (95% CI, 1.18-3.18). CRP and +LDH levels were comparatively reduced in the adjunct tele-yoga group 5th day post-randomization. CRP +reduction was also observed as a potential mediator for the improvement of clinical outcomes in the +adjunct tele-yoga group. There were no significant differences between the treatment groups concerning +the duration of hospitalization, all-cause mortality at day 28; log-rank P = 0.144, and other outcomes. +Conclusion: The observed clinically relevant outcomes in COVID-19 patients at day 14 contest the use of +tele-yoga as a complementary treatment in hospital settings. +Introduction +The rapid global spread of the Corona virus-related pneumonia outbreak, which was described first in +December 2019, has led to the evolution of one of the most extensive pandemics in human history so +far.1–3 Though, the mainstay of treatment for patients with COVID-19 pneumonia remains symptomatic +and supportive care,4–6 the devaststating impact of the pandemic led to a parallel unprecedented quest +of identifying new and/or repurposed pharmacological treatments.5–10 Unfortunately, the initial +indications from these studies were disappointing which further aggravated the search of strategies +based on complementary and alternative medicine.5–11 Amidst this uncertainty, several key clinicians and +scientitists identified and proposed the adjunct potential of yoga for enhancing the effectiveness of +standard of care with respect to Covid management in acute settings.12 Authors emphasized the +relevance of certain practices of yoga and meditation in helping reduce the severity of COVID-19 disease, +including its collateral effects and sequelae,12 further underlined with the immunomodulatory, anti- +inflammatory and stress modulatory potential of yoga.13–15 Hence, we conducted this clinical trial to +address the necessity of testing the effectiveness of adjuvant tele-yoga to the standard of care in +improving the clinical outcomes for adults hospitalized with COVID-19. This trial was supported under a +special call announced by the Department of Science and Technology, Government of India under the +scheme, Science and Technology of Yoga and Meditation (SATYAM).16 +Page 3/19 +Design And Amendments +The protocol was approved by the institutional ethics committee from each site and conducted in +compliance with the Declaration of Helsinki. The study protocol was approved for funding by Deparment +of Science and Technology, Government of India (Appendices no. I and IV). Additionally the study was +also approved in a high level committee meeting conducted by Governemnt of Karnatake, India to ensure +control and mangament of COVID-19 outbreak. All patients or legally authorized representatives provided +the written informed consent. Given the uncertainty an in the recruitment and random allocation of the +study subjects in chaotic hospital settings amidst the pandemic, the trial was initially planned as a non- +randomized one. and their presumed lack of was initially planned as a non-randomized clinical trial +wherein an integrative yoga based supportive care was planned to be administrated as an adjunct +intervention for hospitalized COVID-19 patients. However, the protocol was amended on 14th May 2020, +on the basis of emerging feasibility of conducting a randomized trial as emphasized by the clinicans and +its supeioir design.The study was registered at clinical trial registry of India (CTRI/2020/09/027915). +Participants: +Given a significant proportion of requirement of timely hospitalization and mangament of Covid 19 +patients, we recruited hospitalized COVID-19 patients in this trial. Those with moderate disease along with +the presence of comorbidities, or those with initially mild disease but experiencing worsening of +symptoms or depletion of oxygen saturation were referred and managed at the Mazumdar Shaw Medical +Center, Narayana Hrudalaya, Bengaluru, India. Laboratory confirmed SARS-CoV-2 cases defined as mild or +moderate according to FDA guidance were included with following eight symptoms:17 fever, cough, sore +throat, malaise, headache, muscle pain, gastrointestinal symptoms, and shortness of breath with exertion. +Additionally we also included the moderate disease definition od respiratory rate ≥ 15 < 30 and/or partial +90–94%.18 In line with prior reports, this trial enrolled patients with mild and moderate COVID-19 who +were receiving no more than 4 liters per minute of supplemental oxygen.19 Notable exclusion criteria +included a peripheral oxygen saturation of 93% or less while breathing ambient air, a ratio of the partial +pressure of arterial oxygen to the fraction of inspired oxygen of less than 300, a respiratory rate of at least +30 breaths per minute, and a heart rate of 125 or more beats per minute. Full eligibility criteria are listed in +eTable 2 in Supplement 3. +Outcomes: +We used the 7-category ordinal scale used that has been used in different COVID-19 therapeutic trials.7,20 +The primary outcome was clinical status at day 14th post- randomization, assessed with a 7-category +ordinal scale (the COVID Outcomes Scale) recommended by the World Health Organization.20 The scale +consisted of 7 mutually exclusive categories: 1, death; 2, hospitalized, receiving extracorporeal membrane +oxygenation (ECMO) or invasive mechanical ventilation; 3, hospitalized, receiving noninvasive +mechanical ventilation or nasal high-flow oxygen therapy; 4, hospitalized, receiving supplemental oxygen +without positive pressure or high flow; 5, hospitalized, not receiving supplemental oxygen; 6, not +Page 4/19 +hospitalized and unable to perform normal activities; and 7, not hospitalized and able to perform normal +activities. To distinguish between categories 6 and 7, study personnel assessed the patient’s performance +of usual activities with questions consistent with validated health status measures.21 +Patients who were discharged from the hospital were contacted by tele-phone for assessment of the +COVID Outcome Scale at 7, 14, and 28 days after randomization. Complete information on the inclusion +and exclusion criteria is provided in the Supplementary Appendix. All the patients provided written or +electronic informed consent before randomization.The secondary outcome set included: scores on the +COVID Outcomes Scale at days 7, and 28 post-randomization; all-cause all-location mortality at 28 days +post-randomization, duration of days at hospital, 5th day changes postrandomization for viral load +expressed as cyclic threshold (Ct), and inflammatory markers and perceived stress scores at day 14 +postrandomization. Other auxillary markers were HbA1c, blood hemogram, kidney function markers, etc. +All protocol amendments were authorized and approved by the institutional review board or independent +ethics committee. +Clinical and Laboratory Monitoring: +Assessments: +Data were collected daily, from randomization until day 14, in the patient proformas. For patients who +were discharged before day 14, a structured tele-phone call to the patient or the patient’s family was +conducted on or after day 14 by an interviewer who was unaware of the assigned trial group in order to +assess vital status and return to routine activities.. All samples were processed by PCR for genes N and E +of SARS-CoV-2. Demographic, clinical, laboratory, and radiology data from patients’ medical records were +collected by the research team. The data were evaluated by a trained team of physicians. The date of +disease onset was defined as the day when the symptom was noticed. Data on symptoms, vital signs, +laboratory values on biomarkers of disease progression, biomarkers [C-reactive protein (CRP), D-Dimer, +Interleukin 6 (IL-6), ferritin, and Lactate dehydrogenase (LDH)], and treatment measures during the +hospital stay were collected. Patient assessments included physical examination, respiratory status +(respiratory rate, type of oxygen supplementation, blood oxygen saturation, and radiographic findings), +adverse events, and concomitant medications. On study days 1, and 5, blood samples were obtained for +measurement of blood cell counts, serum creatinine, glucose, total bilirubin, and liver transaminases, and +inflammatory biomarkers. Perceived stress was assessed using Perceived Stress Scale 10 (PSS-10).22 +Site investigators assessed clinical status daily from day 1 through day 14 or hospital discharge on a 7- +point ordinal scale. In case of over a day change in the scores observed for the clinical status worse +scores of the hospitalized patients were documented. A final assessments on clinical status were done on +the day 28 personally for hospitalized patients or through tele-phonic interview for already discharged +patients. +Intervention: +Page 5/19 +We built a yoga protocol adjusted to isolated patients and staff, including deliervry through tele- (videos) +as well as in person intervention. Clinical guidelines were followed up for treating patients via tele-yoga +and hands on techniques in cooperation with the medical heads of departments. Instructional short +videos were prepared in different languages constituting the intervention. At day 1 hands on intervention +was carried out in the COVID wards through teams of certified yoga therapists in personal protective +suites, within 4 hours of randomization. Those who were discharged before 14 days post-randomization, +tele-yoga sessions were continued from their home settings. The practices of yoga were included based +on the reported effects on strengthening of the respiratory muscles, and respiratory function +[development of awareness of expansion and contraction of the airways, continuous and rhythmic +breathing, reported to aid in thorough oxygenation of the lungs etc] and also known to reduce +inflammation. (For details on the intervention see the appendices I and V). These exercises were followed +by quick relaxation and subsequent 10 minutes of pranayama (breathing exercises), consisting of right +nostril breathing/and alternate nostril breathing and Brahmari. The practice sessions ended with guided +relaxation with a resolve. Patients received daily tele–yoga intervention with relaxation/meditative +practices for twice for day. +Standard of Care: +Standard of care was based on the recommendations of the Indian Council of Medical Research, which +was updated as per the evolving evidence generated in drug trials and international consensus +guidelines.23,24 Overall, it included antibiotic agents, antiviral agents, corticosteroids, vasopressor support, +and anticoagulants at the discretion of the clinicians. +Randomization +Randomization was done in permuted blocks of 4 in sequences created by the unblinded research staff in +Microsoft Excel version 19.0 who provided masked allotment to the yoga traners. Owing to the nature of +the intervention, blinding was not possible, but outcome measures were blinded for the randomisation +groups. Eligible patients were randomly assigned in a 1:1 ratio to receive either standard of care or +adjunct yoga. Allocation assignment was concealed from investigators and patients. +Statistical analysis: +Analysis was performed with SPSS version 23 [IBM Corp., (N.Y., USA]. The total intent-to-treat (ITT) +sample size of 230 patients with a 1:1 randomization of adjunct tele–yoga to standard of care provides +approximately 80% power to detect a 15% difference between treatment groups in time cumulative +hospital discharge (i.e.,with or without limiting abilities) rates of 80% in the adjunct tele–yoga group and +75% in standard of care group, at 14th day postrandomization, using a two-sided 5% alpha. The trial was +analyzed by comparing patients randomized to adjunct tele- yoga vs those randomized to standard of +care, with the placebo group serving as the referent. The primary outcome was analyzed with a +multivariable proportional odds model with age, and sex. Further adjustments with baseline +(prerandomization) COVID Outcomes Scale category, and duration of acute respiratory symptoms are +reported as posthoc analysis. Results are presented with corresponding 95% confidence intervals For +Page 6/19 +patients who were discharged prior to 14 days after randomization, primary outcome ascertainment was +completed by tele-phone calls. Patients who could not be reached by tele-phone for the primary outcome +assessment at day 14 had the COVID Outcomes Scale score carried forward from a day 7 follow-up call if +such a call was successfully completed or had a category 6 score (not hospitalized and unable to +perform normal activities) imputed if no prior follow-up calls were successfully completed. For patients +who remained hospitalized 14 days after randomization, primary outcome ascertainment was completed +by medical record review. +Given the deviation from normality for the study variables, analysis of covariance was done using the +rank transformation to study the influence of adjunct tele-yoga intervention on biomarker levels at day +from postrandomization. +Heterogeneity of treatment effect by prespecified baseline characteristics was evaluated by adding an +interaction term between randomized group assignment and the baseline characteristic of interest in the +primary model. Baseline characteristics evaluated in heterogeneity of treatment effect analyses included +baseline COVID Outcomes Scale category, and duration of symptoms prior to randomization, age, sex, +and race/ethnicity. +All-cause mortality was estimated using the Kaplan-Meier product limit method. Adjunct tele–yoga group +was compared with the standard of care group using the log-rank test, and the mean estimates and 95% +CIs were provided. +We also used the paramed- command in SPSS to perform mediation analysis by fitting a linear regression +model to the outcomes with yoga yreatment and the mediators included were the covariates and then +fitting a regression model to the mediator (linear or logistic depending on the mediator) including +treatment as a covariate. +Post Hoc Analyses +We also conducted sensitivity analyses of the primary end point (1) adjusting for day 1 clinical score; and +(2) adjusting for duration of symptoms. Additionaly we also performed a post-hoc analysis that was +stratified by CRP and LDH levels. We also calculated and comapared the proportions of patients with a 1- +point or greater improvement, no change or worsening of clinical status at days 7, 14, and 28. +Page 7/19 +Table 1 +Baseline Patient Characteristics +Variable +Overall +(n =  +225) +Tele– +yoga +(n = 113) +Control +(n = 112) +P value +Age, median IQR +43 (35– +53) +42 (35- +53.5) +43 (36–52) +0.657 +Gender +  +  +  +; +Female +102 +(45.33) +51 +(45.13) +51 (45.54) +1.00 +Male +123 +(54.67) +62 +(54.87) +61 (54.46) +  +Coexisting conditions +  +  +  +  +Hypertension, n (%) +47 +(20.89) +21 +(18.58) +26 (23.21) +0.416 +Diabetes, n (%) +85 +(37.78) +42 +(37.17) +43 (38.39) +0.891 +Coronary artery disease, n (%) +15 +(6.67) +5 (4.43) +10 (8.93) +0193 +Hypothyroidism, n (%) +25 +(11.11) +14 +(12.39) +11 (9.82) +0.672 +COPD, n (%) +3 (1.33) +3 (2.65) +0 (0) +0.222 +Asthma, n (%) +2 (0.89) +0 (1.73) +2 (1.80) +0.244 +Symptoms +  +  +  +  +Fever/chills, n (%) +158 +(70.22) +73 +(64.61) +85 (75.89) +0.080 +Cough, n (%) +163 +(72.44) +82 +(72.57) +81 (72.32) +1.000 +Sore throat, n (%) +28 +(12.44) +16 +(10.71) +12 (14.16) +0.545 +Nausea/Vomiting, n (%)s +13 +(5.78) +7 (6.19) +6 (5.36) +1.000 +General weakness, n (%) +92 +(40.89) +48 +(42.48) +44 (39.28) +0.685 +Breathlessness, n (%) +105 +(50.72) +44 +(41.90) +61 (59.80) +0.006** +Page 8/19 +Variable +Overall +(n =  +225) +Tele– +yoga +(n = 113) +Control +(n = 112) +P value +Headache, n (%) +57 +(25.33) +34 +(30.09) +23 (20.54) +0.125 +Diarrhea, n (%) +11 +(5.31) +4 (3.81) +7 (6.86) +NS +Previous medication use — no. (%) +  +  +  +  +Glucocorticoid +7 (3.03) +5 (4.35) +2 (1.67) +NS +ACE inhibitor +12 +(5.19) +7 (6.19) +5 (4.46) +NS +Angiotensin II–receptor antagonist +8 (3.46) +3 (2.61) +5 (4.35) +NS +Baseline ordinal Covid outcome score — no. (%) +  +  +  +  +3.Hospitalized, receiving non-invasive mechanical +92 +(40.89) +54 +(47.79) +38 (33.93) +0.60 +4.Hospitalized, receiving supplemental oxygen +without positive pressure or high flow; requiring +low-flow supplemental oxygen; +125 +(55.56) +57 +(50.44) +68 (60.71) +  +5. Hospitalized, not receiving +supplemental oxygen +8 (3.56) +2 (1.77) +6 (5.36) +  +Ct value +28.00 +(22.5– +32.00) +27.00 +(22.50– +30.00) +28.0 +(22.50– +33.00) +0.125 +Inflammatory markers +  +  +  +  +C-reactive protein, mg/l +24.82 +(8.09– +63.67) +28.16 +(8.43– +65.46) +26.71 +(8.47– +67.40) +0.854 +Ferritin, mg/dl +196 +(81.85– +421) +179 +(82.30- +404.50) +203(77.40– +441) +0.616 +D-dimer, ng/ml +167 +(94.00- +242.00) +170 (94– +245) +179 (95– +250) +0.953 +LDH, U/L +302 +(241– +392) +296 +(226.50– +355) +319 (248- +436.94 +0.057 +IL-6, mg/dL +37.65 +(11.27– +80.02) +31.89 +(11.93– +79.99) +39.76 +(10.21– +76.15) +0.808 +Page 9/19 +Variable +Overall +(n =  +225) +Tele– +yoga +(n = 113) +Control +(n = 112) +P value +Haemogram +  +  +  +  +Hb (g/dL) +13.50 +(12.20– +14.60) +13.6 +(12.10– +14.70) +13.2 +(12.20- +14.45) +0.406 +ALC (×109/L) +/L)a +1.27 +(0.87– +1.92) +1.21 +(0.84– +1.86) +1.34 +(0.88– +1.95) +0.472 +AMC (×109 /L) +0.46 +(0.29– +0.74) +0.45 +(0.28– +0.72) +0.50 +(0.32– +0.77) +0.343 +ANC (×109 /L) +4.23 +(2.85– +6.71) +4.17 +(2.91– +6.64) +4.39 +(2.73– +6.83) +0.606 +PSS +19 (15– +24) +20 (16– +25) +19 (13.25- +23) +0.023* +For continuous variables, median and IQR (Interquartile range) have been presented due to the non- +normality of the data. Correspondingly, Mann-Whitney tests were used to assess if differences between +the study groups were statistically significant. For categorical variables, Chi-square/Fisherʼs exact tests +were used to check if there were any association between the groups. Ct, cyclic threshold value; ALC, +absolute lymphocyte count; AMC, absolute monocyte count; ANC, absolute neutrophil count; PSS, +Perceived stress scale. +Results +During the 60-days of enrollment period, 326 patients were screened; 66 (20.24%) patients were excluded +for being hospitalized for more than 48 hours at the time of screening, 24 (7.36%) had tested negative for +RT-PCR at day 0 (baseline) for coronavirus disease 2019. Further, 11 eligible patients refused to +participate (2.76%) (see Fig. 1, Trial Profile.). Hence, out of 236 eligible patients, 225 could be randomized, +113 were randomized to the adjunct tele–yoga and 112 were randomized to the standard of care group. +The last outcome assessment was on July 31st 2021. Overall the median age of the participants was 43 +years (IQR, 35–53 years), 54.67% were male, 32.43% had diabetes, 20.89% had hypertension, and 6.67% +had coronary artery disease. Demographics and baseline disease characteristics of participants in both +groups are presented in Table 2; there was an equal distribution of age, gender, days before onset of +symptomsa, comorbidities, and inflammatory markers between the study arms (Tables 2 and S2). Overall, +70.22% of the patients presented with perceived or objective fever, 72.44% presented with cough, 12.44% +presented with sore throat, 25.33% presented with headache and 50.72% presented with breathlessness +with no remarkable differences between groups. The median duration of symptoms prior to +Page 10/19 +randomization was 3 days (IQR, 2–4 days) in both the groups. There were no differences in vital signs, or +full blood count also between the groups (Table S2). Of 113 patients in the adjunct yoga group, 29 (76%) +were discharged before 7 days post-randomization, hence, were continued with tele–yoga sessions till +14th. +Primary Outcome: +The primary outcome (status on the seven-point ordinal scale at day 14) was assessed in all patients who +were still hospitalized on day 14th or were tele-phonically interviewed if had been discharged earlier (see +the Supplementary Appendix and Fig. S2). The distribution of patients’ scores on the seven-level ordinal +scale at 14 days is shown in Fig. 2. Patients randomized to the adjunct tele–yoga group had significantly +higher odds of a better clinical status distribution on the 7-point ordinal scale compared with those +randomized to standard care (odds ratio, 1.94, 95% CI = 1.18–3.18) (Fig. 2). Sensitivity analyses of the +primary end point adjusting for day 1 clinical status score, and symptom duration using the intention-to- +treat population produced no significant difference (Table S3). The results for the primary outcome were +not different across the prespecified subgroups (Table S4). +Secondary Outcomes: +There were significant differences between the adjunct tele–yoga and standard care groups in terms of +improvement in clinical status at 7th day (partially adjusted for age odds ratio, 3.61; 95% CI, 2.11–6.05; P  +< 0.001) but the outcome on 28th day was not significant (adjusted odds ratio,, 95% CI = 1.03–3.44) +(Table S5). At day 5, there was significant reductions in CRP (p = 0.001) and LDH levels (P = 0.029) in the +adjunct yoga group compared to the standard of care alone (Fig. 3 and Table S6). There were no +significant differences between the treatment groups in duration of hospitalization (Fig. 3). The Kaplan- +Meier estimates of all-cause mortality at day 28 were 1.80% vs 5.40% for standard of care; log rank P =  +0.144; adjusted hazard ratio [HR], 0.26; 95% CI, 0.05–1.30). (Figure S3) +Exploratory outcomes: +Since we could establish significant reductions in CRP and LDH at day 5 from post-randomization in the +adjunct yoga group compared to the standard of care group alone, we further tested for their mediating +effects on the intervention (Table 2). The analyses indicated CRP as potential mechanistic mediator of +adjunct yoga on the improved clinical status at 14th day post intervention. There was also differences +between proportions of subjects with atleast 1 unit change in outcomes at day 7 from basleine between +adjunct tele-yoga as compared to the standard of care groups. However, the distributions were not +different for days 14 and 28 (Figure S4). +Adverse Effects +None of the 8 deaths through day 28 (5 [1%] in the standard of care, and 3 [2%] in the adjunct tele-yoga +group occurred in the Covid 19 patients could be attributed to the tele-yoga intervention (Table S7). In the +Page 11/19 +tele-yoga group, extension of hospitalization was 10.62%, whereasin the standard of care alone it was 21 +18.75%. Single cases each of sinus tachycardia, and pulmonary embolism was observed in the yoga +group as compared to no cases in the standard of care. +#Only hospitalized patients who were not receiving supplemental oxygen or who were receiving up to 4 +liters per minute of supplemental oxygen were eligible for the trial. Patients who had scores on other +levels of the seven-level ordinal scale were not eligible. Adjusted for baseline age, sex, comorbidities +(diabetes, hypertension, hypothyroid, ), he primary outcome (status on the seven-point ordinal scale at day +14) was assessed in all patients who were still in the hospital on day 15 exactly and in outpatients (by +means of tele-phone interview) as close to day 14 as possible. +Primary outcome: Distribution n (%) +Total +Subjects +(n = 225) +Tele– +yoga +(n = 113) +Standard of care (n =  +112) +7: Not hospitalized with no limitations on +activities +96 (42.67) +52 +(46.02) +44 (39.29) +6: Not hospitalized but with limitations on +activities +87 (38.67) +51 +(45.13) +36 (32.14) +5: Hospitalized, not receiving supplemental +oxygen +27 (12.00) +7(6.19) +20 (17.86) +4: Hospitalized, receiving supplemental +oxygen +6 (2.67) +1 (0.88) +5 (4.46) +3: Hospitalized, receiving noninvasive +ventilation +or high-flow nasal cannula +2 (0.89) +1 (0.88) +1 (0.89) +2: Hospitalized, receiving mechanical +ventilation +3 (1.33) +1 (0.88) +2 (1.79) +1: Death +4 (1.78) +0 (0.00) +4 (3.57) +Proportional Odds Ratio (OR, 95%CI) +1.94 (1.18–3.18) P = 0.01 +Model is adjusted for age and gender +  +Table 2 +Indirect, direct and total effects of the mediation models on COVID-19 outcomes at 14 days post- +randomization +Page 12/19 +  +Effect size +Proportion mediated +Direct effect of the adjunct tele-yoga +vs. standard of care +Adjunct yoga +0.41(0.03–0.78) +- +Total effect of the model +0.54 (0.17–0.91) +- +Indirect (mediating) effects +  +  +LDH +-0.01 (-0.10-0.04) +Not significant +CRP +0.06 (0.05–0.16)* +11.11% +Discussion +This study is a pioneer clinical trial that investigated the short-term acute interventional benefits of +adjunct tele–yoga practice for clinical management of hospitalized COVID-19 patients. We could +establish a ~ 1.9-fold improvement in the clinical status at 14th day post-randomisation, in mild and +moderate hospitalized COVID-19 patients (Odds Ratio = 1.94, 95% CI = 1.18–3.18) as compared to those +with only standard of care. The odds of improvement with yoga intervention were higher at the 7th day +(Odds ratio = 3.61, 95% CI = 2.13–6.10. However, the effectiveness of the intervention was not found to be +sustained at 28th day post-randomization (Odds Ratio 1.70, 95% CI = 0.97–2.99), P = 0.07). Since, +patients had several coexisting diseases and were subjected to a diverse medication regimen, the +complementary effects of tele-yoga could have been influenced by the heterogeneity of the sample and +its treatment. However, when analyzed in the post hoc subgroup analysis, adjunct yoga was found to be +effective across all the strata of covariates. Concerning influence of the intervention on mortality related +outcomes, no benefit could be observed for the adjunct yoga interevention with respect to mortality (adj +HR 0.26; 95% CI, 0.05–1.30). +We could establish support for the primary end points with the observed secondary improvement in +crucial biomarkers in the tele-yoga group compared to the standard of care at 5th day post-randmization, +CRP (P = 0.001) and LDH (P = 0.029). Both CRP and LDH have been reported as prognostic markers of +deterioration in COVID 19 patiants including mild/non severe cases as well.25,26 We could also establish a +mediation effect of CRP modulation underlying effectiveness of tele-yoga intervention (~ 11% proportion +mediation on on the observed improved outcome of clinical status at day 14). This inflammation +reducing effect of yoga well aligns with the physiological modulation of vagal tone, one of the widely +reported effects of yoga and meditation.12,13 The anti-inflamamroty potentisl of yoga could serve as a +step forward in the fight against other serious forms of infectious diseases with a dominant inflammatory +component, as proposed for malaria, HIV/ AIDS, and SARS, among others. COVID-19. +Page 13/19 +We could not observe a significant effect of adjunct tele-yoga on perceived stress scale in COVID 19 +patients (P = 0.69). We speculate that the failure to obtain the desired effect on stress and sevral other +variables could be due to the primarily virtual mode of the delivery of the intervention and the short +duration of intervenion. However, the beneficial clinical outcomes observed in the study hold special +significance in the present era with reimerging and recurring viral infections.27,28 Overall the findings of +this study support the exploratory notions of several researchers and clinicians that certain meditation, +yoga asana (postures), and pranayama (breathing) practices may be effective adjunctive means of +treating SARS-CoV-2 infection.12 The findings also pave the foundation for the clinical implementation of +tele–yoga-based adjunct interventions in hospital settings for the management of infectious diseases. A +previous study on yoga had also reported it to be effective as an adjunct to anti-tuberculosis treatment +(ATT) in patients with pulmonary tuberculosis by reducing the symptom scores, sputum conversion on +microscopy, and improvement in the lung capacity and radiographic pictures.29 +This clinical exploration is one of the earliest to be reported amongst several other concomitant attempts +to establish the efficacy of aditional systems of medicine, against the combat of COVID-19, well reflected +by 67 such registered in the Clinical Trial Registry of India (CTRI).30 Hence, given the lack of available +findings from clinical trials on COVID 19 and Yoga based interventions, the findings of this trial could not +be presented with comparisons. +The study has several strengths. One of the strengths of the study is the inclusion of WHO criteria for +assessing the benefit on clinical status for patients hospitalized with mild and moderate coronavirus +disease 2019 (COVID-19). This is the first report wherein yoga-based intervention was provided in a tele– +mode to Covid 19 patients. This was done to prevent health care employees from being infected. +Importantly, the trial included inflammatory markers as study outcomes, wherein an anti-inflammatoty +mediating influence of yoga intervention could be established improving the outcomes of hospitalized +mild to moderate COVID patients. A key feature of the trial was the early implementation of treatment +within 7 days of symptom onset (median duration of 3 days) which has been considered important for +the treatment protocol, in particular antivirals like remdesivir. +The trial was limited to hospitalized Covid 19 patients which restricts the generalizability of the findings +to other populations involving home-base care. The assessments were limited to 28 days post +randomization, reporting long-term outcomes of trial participants should have been considered. Given the +nature of intervention, the study used an open-label design, which could have led to biases in patient care +and reporting of data. Though prespecified for days 14, and other than clinical status and subjective +outcomes, other laboratory parameters could not be routinely collected due to logistic challenges. +Overall we could observe clinically relevant effects among hospitalized patients with mild to moderate −  +19, contesting the use of tele-yoga as a complmentary treatment for patients with this disease. However, +the positive signal found in this small scale trial warrants the conduction of larger trials using tele-yoga +for the treatment of COVID-19. +Page 14/19 +Declarations +Data availability: +The datasets generated and/or analysed during the current study are not publicly available  due to +privacy or ethical restrictions but are available from the corresponding author on reasonable request. +Author Contributions: +Vijaya Majumdar and Manjunath N K take responsibility for the integrity of the data and the accuracy of +the data analysis. Concept and design: Nagarathna R, Mannjunath NK, Vijaya Majumdar. Acquisition, +analysis, or interpretation of data: Suryanarayan Panigrahi, Sarthak Sahoo, Adithi Giridharan, Mounika +Reddy, Rakshitha Nayak and Vijaya Majumdar, Drafting of the manuscript: Vijaya Majumdar and +Manjunath NK, Critical revision of the manuscript for important intellectual content: Manjunath NK, +Nagarathna R, Muralidhar Kanchi, Hongasandra R Nagendra. Statistical analysis: Vijaya Majumdar, +Obtained funding: Vijaya Majumdar, Manjunath NK, and Nagarathna R, Administrative, technical, or +material support. +Funding/Support: +This study was sponsored by Department of Science and Technology,under the scheme SATYAM of +Government of India +Conflict of Interest Disclosures:  +Authors declare no conflict of interest +Additional Contributions: +We thank the patients who participated in this study, their families, and all participating investigators as +well as their clinical and nursing staff. +References +1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet +Infect Dis. 2020 May;20(5):533-534. doi: 10.1016/S1473-3099(20)30120-1. Epub 2020 Feb 19. +Erratum in: Lancet Infect Dis. 2020;20:e215. +2. Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for +global health governance. JAMA 2020;323:709-710 +3. World Health Organization. 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Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic. +Lancet. 2021;398(10317):2126-2128. +29. Visweswaraiah, N. K., & Telles, S. (2004). Randomized trial of yoga as a complementary therapy for +pulmonary tuberculosis. Respirology (Carlton, Vic.), 9(1), 96–101. https://doi.org/10.1111/j.1440- +1843.2003.00528.x +Page 17/19 +30. Umesh C, Ramakrishna KK, Jasti N, Bhargav H, Varambally S. Role of Ayurveda and Yoga-Based +lifestyle in the COVID-19 Pandemic - A Narrative Review [published online ahead of print, 2021 Jul +19]. J Ayurveda Integr Med. 2021;10.1016/j.jaim.2021.07.009. doi:10.1016/j.jaim.2021.07.009 +Figures +Figure 1 +Trial Profile +Page 18/19 +Figure 2 +Clinical Status on the Coronavirus Disease (COVID) Outcomes Scale 14 Days post Randomization +Page 19/19 +Figure 3 +Biomarker levels at day 5 post randomization +Supplementary Files +This is a list of supplementary files associated with this preprint. Click to download. +SupplementrayDataCovidStudyfinal16.03.2022.docx diff --git a/subfolder_0/Effect of Residential Yoga Camp on Psychological Fitness of Adolescents A Cohort Study.txt b/subfolder_0/Effect of Residential Yoga Camp on Psychological Fitness of Adolescents A Cohort Study.txt new file mode 100644 index 0000000000000000000000000000000000000000..815fecc001587406847f9aaeb5c8de6d0a724d95 --- /dev/null +++ b/subfolder_0/Effect of Residential Yoga Camp on Psychological Fitness of Adolescents A Cohort Study.txt @@ -0,0 +1,827 @@ +Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): VC07-VC11 +7 +DOI: 10.7860/JCDR/2018/36839.11872 +Original Article +Psychiatry/Mental +Health Section +Effect of Residential Yoga Camp +on Psychological Fitness of +Adolescents: A Cohort Study +Astha Choukse1, Amritanshu Ram2, HR Nagendra3 +ABSTRACT +Introduction: Discovering and promoting ways that improve +adolescents’ psychological fitness has been a recurrent +concern in the field of health and psychology. Adolescence, as +a period of transition, is highly prone to have mental health risks +and unhealthy behaviour patterns. Thus, it is the right time to +promote healthy practices to prevent problems of health and +behaviour in adulthood. As Yoga provides practical solutions for +mental health, we anticipated that exposure to it should improve +psychological fitness among adolescents. +Aim: To evaluate the effectiveness of short term residential yoga +intervention on psychological constructs in adolescents. +Materials and Methods: A pre, post-yoga interventional study +was carried out in a 10 day residential camp. Three independent +cohorts of adolescents from India, in three batches (1, 2 and 3), +with sample size of 148 (87 boys and 61 girls), 167 (122 boys +and 45 girls) and 195 (121 boys and 74 girls), respectively were +examined. A holistic integrated yoga module with eight hours of +yoga sessions per day was given as an intervention. Emotional +Intelligence (EI), emotional regulation strategies, Clinical anger +and self-concept parameters were studied using psychometric +scales like Schutte Emotional Intelligence Scale (SEIS), Cognitive +Emotion Regulation Questionnaire (CERQ-short), Clinical Anger +Scale (CAS) and Self-concept Scale respectively. Authorised +scales and software were used for assessments and analyses. +Results: Significant (p<0.05) improvements in EI, emotional +regulation and anger management were observed in all the +three batches. However, no significant improvement was +found in self-concept in either of the cohorts. The observation +of the results of assessed outcome measures in all the three +batches confirms the positive effect of Yoga intervention on +psychological fitness. The pattern of changes was consistent +across all three batches. +Conclusion: Residential Yoga camp improves the psychological +fitness among adolescents. Even short term courses are +effective and induce positive behavioural signatures. +INTRODUCTION +According to World Health Organisation, 1.2 billion of the world +population is between the age of 10 and 19 years and are classified +as adolescents [1]. This group of individuals are undergoing a +stage of distinct and formative biological, physiological and social +transition [2]. +Especially in low and middle-income countries, many psychological +and substance-use disorders reach a peak in this stressful time +span of adolescence [3]. According to National Survey on Child +and Adolescent Well-being (NSCAW II) in USA, high rates of +mental health problems are seen in teens of all ages [4], increasing +health problems among young adults [5]. Academic pressures, +peer pressure, problems with bullying, addiction to social media +has serious implications for mental and physical well-being of +adolescents, leading to impaired performance and may contribute +to the overall growth retention [6-8]. Improving the transition during +adolescence is one of the priority areas to enhance health care for +young adults [9]. +Adolescence is the best time for teaching strategies of self-control +and self-regulation [3]. It is also a phase that is more amenable to +learning and more receptive to corrective changes if provided by +intervention programs to improve their mental health. +Yoga as holistic intervention in which each pupil can find his/her +unique trajectory of change and improvement is now considered +as an important intervention for promoting psychological health +[10]. Yoga shows a reduction in anxiety, depression, psychological +distress in high risk adolescents [11]. Studies also report positive +correlation of yoga with self-concept and well-being in adolescents +[12,13]. Residential yoga program for young adults has shown +positive effects on perceived stress and quality of life [14]. Meditation +sessions in schools have beneficial effects across physiological, +psychosocial, and behavioural outcomes [15]. Additional studies +of school-based yoga interventions also suggest positive effects of +yoga on several factors such as concentration, attention, mood, +anxiety, working memory, anger and self-esteem [16-21]. Many +reviews suggests that yoga is generally effective at improving +physical and mental health in children and adolescents [22-25]. +In the available yoga research studies on adolescents, the yoga +intervention of 3-4 months duration is used in the school setting as +part of curriculum or before/after school hours with yoga sessions +ranging from 2 to 3 hours per week for a homogeneous sample. +Most of them were conducted with special education, high-risk +samples, and small sample size. According to a literature review, +residential yoga intervention studies are very few [26]. +An important research question in this area relates to whether +yoga offers any benefits for student psychological fitness in a +setting different than school setting. Thus, the present study is to +explore effect of short term residential yoga intervention program +on psychological fitness of adolescents. An objective was also to +examine the effects of residential yoga on psychological fitness +across different age groups. The present study is a part of a mega +study to assess overall fitness among adolescents registered +in the Clinical Trials Registry of India bearing the trail number +CTRI/2018/02/011709. +Keywords: Anger, Emotional intelligence, Emotional regulation, Self-concept +Astha Choukse et al., Effect of Residential Yoga Camp on Psychological Fitness of Adolescents +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): VC07-VC11 +8 +MATERIALS AND METHODS +Design: It is a pre-post yoga interventional study carried out in a +residential setting (Residential Yoga Camp for high school children). +Three independent cohorts (Batch 1, 2 and 3) of adolescents +underwent yoga intervention program in the same setting with same +guidelines as consecutive studies during April 1-10 (batch 1), April +11-20 (Batch 2) and April 21-30 (Batch 3) in year 2016. The duration +of the study was 10 days with 8 hours per day of classroom yoga +sessions. All other components were kept consistent and similar +as far as possible like teachers, living conditions, daily routine and +dietary plan. This study was conducted in the campus of Swami +Vivekananda Yoga Anusandhana Samsthana (SVYASA) Yoga +University, Bengaluru, India. +Participants: The participants of the study included adolescent +children studying in English Medium Schools who registered for +a yoga camp in summer holidays. Healthy adolescents of both +genders, between the age of 9 and 16 years participated in the +study. The participants were divided into three batches depending +on the registration. Batch wise sample size was 148 (87 boys and +61 girls), 167 (122 boys and 45 girls) and 195 (121 boys and 74 +girls) in batch 1, 2, and 3 respectively. Since, the Age range 9-16 +is wide considering the rapid changes during adolescents, the +participants were divided into juniors (9-12 years) and seniors (13- +16 years) to evaluate changes. Age wise sample were (93 juniors +and 55 seniors), (90 juniors and 77 seniors) and (112 juniors and 83 +seniors) in batch 1, 2 and 3 respectively. +They were further randomly divided into smaller groups of 12-15 +participants which made it easy to implement the intervention. Each +smaller group was supervised by two teachers for better monitoring. +All teachers have bachelor degree in yoga and were trained on the +implementation of the intervention to ensure uniformity. +Since, the study was conducted as a yoga camp during summer +holidays, the sample was heterogeneous representative sample +in nature with subjects from different family backgrounds, socio- +economic status, cultures and traditions, faiths and different +academic status (school boards such as state, ICSC, CBSE etc.,). +Subjects with single parents, acute or chronic health problems, on +medication, having attended any residential yoga program in the +last three months were excluded. +Ethical +approval +was +obtained +from +the +Institutional +Ethical +Committee +of S-VYASA with reference number RES/IEC-SVYASA/64/2015. +A signed informed consent from parents and a signed informed +assent from all participants were obtained after explaining the study +in detail prior to screening. +Intervention: The modified version of Integrated Yoga Module +(IYM), based on Pancha kosha model (five layers of existence) as +explained in Taitairiya Upanishad, comprised of yogic techniques +that benefit each of the koshas (Gross body-Annamaya Kosha, +Energy body - Pranamaya Kosha, Emotional Body - Manomaya +Kosha, Intellectual Body - Vijnanamaya Kosha and Bliss Body- +Anandamaya Kosha). The module was designed referring to +various yogic texts on yoga for children and in consultation with +subject experts. The module was specially designed for the retreat +with suitably modified yogic techniques to address the needs of +psychological health development. +The yoga module included Asana, Pranayama, Relaxation, +Meditation and also Jnana Yoga (yama niyama concepts) and Bhakti +Yoga (prayers and chantings). The bhakti yoga sessions included +chanting and singing while jnana yoga sessions included lectures, +creativity like role-playing, story-telling, parables, journaling-diary +entry etc., to drive yama niyama concepts and yogic concept of +food. Few friendly competitions were kept between groups to +encourage participation and team building. +The 8 hour class room yoga sessions consisted of roughly 2 hours +of Asana practices, 2 hours of Jnana Yoga sessions, 1 hour each +of Pranayama (breathing exercises coupled with body movements), +Meditation, Relaxation and Bhakti Yoga. The sessions were +designed with a mix of events to make the program interesting. +Detailed schedule is given below in [Table/Fig-1]. +Assessment: Assessment of psychological fitness parameters +were done using following psychometric tools: +• +Schutte Emotional Intelligence Scale (SEIS): This self-reported +scale is based on Salovey and Mayer's (1990) original model +of EI. This is a 33-item scale with test-retest reliability of 0.78 +for total scale scores. Each item has a 5-point Likert's rating +from 1 (strongly disagree) to 5 (strongly agree). Some item has +reverse coding. The total score ranges between 33 to 165, +high score indicates more characteristic EI [27]. +• +Cognitive Emotion Regulation Questionnaire (CERQ-short): This +18 item self-report questionnaire comprises of nine domains +(Self-blame, +Other-blame, +Rumination, +Catastrophising, +Positive refocusing, Refocus on planning, Positive reappraisal, +Putting into perspective and Acceptance) independent from +one another. Each item has a 5-point Likert's rating from 1 +(almost never) to 5 (almost always). Each domain has different +scoring, high score represents often used of cognitive coping +strategy. Cronbach’s alpha reliability coefficient ranged from +0.73 to 0.81 [28]. +• +Clinical anger Scale (CAS): This 21 item scale is designed to +measure different symptoms of clinical anger. Each item has a +4-point Likert's rating from 0 (I feel fine) to 3 (I feel completely +miserable). The total score ranges between 0 to 63, high +score represents high clinical anger. This scale has reliability +coefficients of 0.94 (males and females together) [29]. +• +Self-Concept: This 30 item self-report scale comprises of five +domains that make up an adolescent’s self-concept: 1) Athletic +Competence; 2) Conduct/Morality; 3) Peer Acceptance; 4) +Physical Appearance; 5) Scholastic Competence. Each item +has a 5-point rating from 1 (strongly disagree) to 5 (strongly +Time +Session +Details +5am +- +Wake Up +5:30am to 5:45am +Session 1 +Morning prayer +5:45am to 6:45am +Session 2 +Asana practice (physical postures) +6:45am to 7:30am +Session 3 +Meditation (om meditation, cyclic meditation) +7:30am to 8:15am +- +Breakfast +8:15am to 9.00am +Session 4 +Social works (altruistic group activities) +9.00am to10:00 am +- +Bath and wash +10:00am to11:00am +Session 5 +Lectures on concepts of Yoga (yama niyama +concepts) +11:00am to12:00pm +Session 6 +Pranayama practice +12:00pm to 1:00pm +- +Lunch +1:00pm to 2:00pm +Session 7 +Relaxation (Deep relaxation technique, +Quick relaxation technique, Instant relaxation +technique) +2:00pm to 3:30pm +Session 8 +Indoor activities (parables, creativity, +chanting) +3:30pm to 4:30pm +Session 9 +Asana practice +4:30pm to 5.00pm +- +Evening tea, snacks +5.00pm to 6:15pm +- +Free time +6:15pm to 7:15pm +- +Dinner +7:15pm to 8:30pm +Session 10 +Happy assembly +8:30pm to 9.00pm +Session 11 +Tranquilling pranayama and meditation +9.00pm to 9.15pm +- +Milk, snacks +9.15pm to 9:30pm +Session 12 +Diary writing +9:30pm +- +Sleep +[Table/Fig-1]: Daily schedule of intervention. +www.jcdr.net +Astha Choukse et al., Effect of Residential Yoga Camp on Psychological Fitness of Adolescents +Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): VC07-VC11 +9 +agree). Some item has reverse coding. High score indicates +positive self-concept [30]. +Socio-Demography Measures: Children and parents completed a +short demographic questionnaire in order to obtain descriptive data +for the sample. Screening sheet was filled by parents and children. +Variables included are age group, gender, handedness, family type, +sibling hierarchy, father’s age, mother’s age etc. +Data collection was done on the first (pre-data) and last day (post- +data) of the program, in small group settings by trained staff. The +investigator and two teachers were available to clear doubts and +provide unbiased guidance during the data collection. +statistical Analysis +To maintain the confidentiality, the data sheets were coded and +names and other personal identifiers were omitted during data +entry. Analysis was done using SPSS (Version 19.0). Change over +time was evaluated using the paired sample t-test. The results of the +tests were deemed to be significant if probability values were less +than 0.05 whereas trends (p<0.1) have also been highlighted. +RESULTS +The recruited study sample included adolescents with a mean age +of 11.84±1.77, 12.22±1.82 and 12.06±1.82 in Batches 1, 2 and +3 respectively. Gender ratio in Batch 1 of 148 {87 (58.78%) boys +and 61 (41.22%) girls}, Batch 2 of 167 {122 (73.05%) boys and +45 (26.94%) girls} and Batch 3 of 195 {121 (62.05%) boys and 74 +(37.94%) girls}. All three batches were evaluated for the effects of +a ten day holistic IYM on SEIS, CERQ-short-form, CAS and Self- +Concept scale. +In the present study, overall scores of SEIS in Batch 1 (123.59 to +129.86 with p<0.001), Batch 2 (122.27 to 126.04 with p=0.002) +and Batch 3 (123.63 to 126.15 with p=0.032) increased significantly +in all three batches. Scores of CERQ kids in Batch 1 (51.83 to 57.11 +with p<0.001), Batch 2 (55.79 to 60.10 with p<0.001) and Batch +3 (54.15 to 58.62 with p<0.001) increased significantly in all three +batches. Self-Concept has not shown significant change in any of +the batches. Significant decrease was seen in the scores of CAS +in Batch 1 (13.59 to 10.94 with p<0.001), Batch 2 (16.23 to 14.09 +with p=0.008) and Batch 3 (14.61 to 12.51 with p=0.003) which +was a positive change [Table/Fig-2]. +The analysis was also carried out separately for juniors and seniors +in each batch as detailed below. +The sub-factor analyses within juniors in different batches indicate, +significant increase in scores of SEIS in Batch 1 juniors, and trend +of increase was seen in Batch 2 juniors and Batch 3 juniors. Scores +of CERQ kids in juniors increased significantly in all three batches. +Self-Concept has not shown significant change in juniors in any of +the batches. Significant decrease was seen in the scores of CAS +in Batch 1 juniors and decrease was seen in juniors of Batch 2 +and Batch 3 but not significant. Reduction in clinical anger was a +positive change [Table/Fig-3]. +The sub-factor analyses within seniors in different batches indicates, +there was a significant increase in the scores of SEIS in seniors +in Batch 1 and Batch 2 and non-significant increase was seen in +Batch 3 seniors. Scores of CERQ in seniors increased significantly +in all three batches. Self-Concept has not shown significant change +in seniors in any of the batches. Significant decrease was seen in +the scores of CAS in seniors in all the three batches. Reduction in +clinical anger was a positive change [Table/Fig-4]. +DISCUSSION +The present study demonstrated the positive effects of short +term integrated yoga module program on psychological fitness in +residential setting within summer break. Results suggest that yoga +is an acceptable practice in residential camp by adolescents. +Present study showed significant improvement in EI. Yoga practices +may significantly influence the process of self-awareness and +self-control [31]. Previous research indicates improved EI through +Variables +Batch 1 (n=148) Mean±SD +p-value +Batch 2 (n=167) Mean±SD +p-value +Batch 3 (n=195) Mean±SD +p-value +Pre- +Post- +Pre- +Post- +Pre- +Pos- +Emotional Intelligence +123.59±16.09 +129.86±19.30 +<0.001* +122.27±15.62 +126.04±17.98 +0.002* +123.63±17.40 +126.1518.98 +0.032* +Emotional regulation +strategies +51.83±10.68 +57.11±13.59 +<0.001* +55.79±10.15 +60.10±11.02 +<0.001* +54.15±10.47 +58.62±12.47 +<0.001* +Self-concept +103.36±12.99 +103.64±14.70 +0.766 +101.89±14.10 +101.58±14.66 +0.724 +103.04±13.06 +102.13±14.67 +0.315 +Clinical anger +13.59±10.44 +10.94±10.68 +<0.001* +16.23±10.77 +14.09±11.52 +0.008* +14.61±10.59 +12.51±10.54 +0.003* +Variables +Batch 1 (n=93) Mean±SD +p-value +Batch 2 (n=90) Mean±SD +p-value +Batch 3 (n=112) Mean±SD +p-value +Pre- +Post- +Pre- +Post- +Pre- +Post- +Emotional Intelligence +121.46±17.21 +128.77±20.33 +<0.001* +121.32±16.77 +124.21±16.76 +0.078 +120.52±18.50 +123.76±20.30 +0.068 +Emotional regulation +strategies +52.20±11.52 +58.65±13.31 +<0.001* +55.09±10.97 +59.02±10.87 +0.002* +52.48±10.66 +58.42±13.59 +<0.001* +Self-concept +103.51±12.86 +103.26±15.16 +0.836 +102.62±14.75 +100.72±15.10 +0.115 +104.02±14.26 +102.35±15.81 +0.209 +Clinical anger +14.74±10.56 +12.48±11.18 +0.023* +15.58±10.49 +15.31±11.68 +0.759 +14.17±10.60 +13.23±10.55 +0.308 +Variables +Batch 1 (n=55) Mean±SD +p-value +Batch 2 (n=77) Mean±SD +p-value +Batch 3 (n=83) Mean±SD +p-value +Pre- +Post- +Pre- +Post- +Pre- +Post- +Emotional Intelligence +127.26±13.29 +131.74±17.42 +0.026* +123.38±14.18 +128.18±19.21 +0.007* +127.82±14.88 +129.39±16.60 +0.265 +Emotional regulation +strategies +51.20±9.18 +54.53±13.79 +0.049* +56.61±9.11 +61.35±11.13 +<0.001* +56.41±9.82 +58.88±10.84 +0.040* +Self-concept +103.11±13.29 +104.31±14.02 +0.480 +101.03±13.36 +102.58±14.16 +0.218 +101.71±11.18 +101.82±13.07 +0.926 +Clinical anger +11.67±10.06 +8.36±9.32 +<0.001* +16.97±11.10 +12.01±11.06 +<0.001* +15.19±10.63 +11.53±10.50 +0.001* +[Table/Fig-2]: Paired sample t-test for three cohorts. +*indicates p<0.05; SD: Standard deviation +[Table/Fig-3]: Paired sample t-test for juniors. +*indicates p<0.05; SD: Standard deviation +[Table/Fig-4]: Paired sample t-test for seniors. +*indicates p<0.05; SD: Standard deviation +Astha Choukse et al., Effect of Residential Yoga Camp on Psychological Fitness of Adolescents +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): VC07-VC11 +10 +10 +20 minutes of meditation over eight weekly sessions in graduate +students [32]. Evidence suggests increased self-awareness, EI, and +social skills in response to sitting meditation in youth [15]. +Significant change was seen in overall emotion regulation and +strategies. Pranayama, breathing practices, chanting and meditation, +yama-niyama concept driven creativity and games especially +designed for emotional development may have accounted for +these positive changes and enhanced coping abilities in the present +study. Results of present study on emotion regulation is in line with +previous study done on 159 students with yoga based intervention +in classroom setting [33]. +Self-concept didn’t change although, some sub-domains of it did +change. Long and more periodic intervention maybe required to +change self-concept. +In the present study, significant reduction in CAS in Batch 1 (13.59 +to 10.94 with p<0.001), Batch 2 (16.23 to 14.09 with p=0.008) +and Batch 3 (14.61 to 12.51 with p=0.003) shows reduction in +cognitive, physiological, social, and behavioural symptoms due to +anger. In present study, specially designed yoga module given in +residential setting may have accounted for significant improvement +in anger management and other significant positive psychological +changes. Improved anger control through yoga module while +in one previous RCT, insignificant changes in anger control and +many of the psychological parameters were seen within groups +and between groups with semester long intervention in school +curriculum in adolescents [13]. In another RCT, no changes were +seen in emotional and behavioral functions within yoga group as +well as between groups [34]. Small sample size and inadequate +dose of intervention (only 18 hours in 12 weeks) may be reason for +no changes. All these limitations were well taken care in present +study in the form of well-organised integrated yoga module and the +intervention was repeated with three independent cohorts with large +sample sizes (Batch 1-148, Batch 2-167, Batch 3- 195) . Positive +findings of another study on psychological measures done in adults +with 5 day residential yoga program supports the positive findings +in the present study [35]. +The sub-factor analysis between age groups indicates similar +changes in EI in both juniors and seniors. Similar positive significant +changes were seen in emotion regulation in both juniors and seniors +and consistent in all three batches. Self-concept has not shown any +significant changes in both juniors and seniors in any of the batches. +Clinical anger scores were reduced in both age groups but more +(significant) in seniors showing better anger control in seniors. Results +of all parameters are consistent in all the three batches showing +the consistency and confirmed effect of the Yoga intervention. +Pranayama, meditation and Jnana Yoga activities may help them +to look for the positive side of events, think positive and respond +responsibly. Multi-component nature of yoga and intervening effect +of each technique on various koshas makes it complex to precisely +assign the effect on any particular parameter. According to sage +Patanjali, practice of yogic postures leads to expansion of mind and +ceasing of dualities [36]. Practice of pranayama gives better clarity +on thoughts. Meditation and Relaxation work on cellular activity or +metabolic activities. Jnana Yoga sharpens the mind while Bhakti +yoga calms down the mind. +The positive outcomes in the study are generally consistent with +previous studies of yoga, meditation in school settings, although +the use of different outcome measures and research designs +precludes a precise comparison [37,38]. The results showed +significant improvement in all assessed outcome measures except +self-concept in all three consecutive studies and reflects a positive +change. Since, this is residential setting and participants were from +many different cities (diverse data), it was not practically feasible to +have active control group. So, three independent cohorts with large +and matched sample size were done with same intervention to test +the repeatability and consistency of the effect. Consistent similar +trend of results in all three cohorts confirms the positive effect of +given integrated yoga module in adolescents. +The strength of the study lies in including heterogeneous +representative samples with relatively bigger sample size. Multiple +components in the yoga module can be seen as limitation as well +as the strength. Limitation in terms of not able to assign the effect +to any particular component of module. It is a strength because +of strictly following the comprehensive integrated holistic approach +of Yoga as said in the classical texts. The integrated approach to +yoga comprises of yogic postures (asanas), breathing techniques +(pranayama), relaxations (guided relaxation techniques), meditations +(guided meditations), knowledge points (Jnana Yoga) and prayers +and chanting (Bhakti Yoga). Guided relaxation techniques such as +deep relaxation technique, quick relaxation technique and instant +relaxation technique also include postures and body movements +and breathing techniques that provide flexion and extension +to muscles. Guided meditations include different postures and +concepts of focusing which warrants establishing certain physical +postures with hand gestures (mudras). +In Yogic parlance, concept of human existence comprises of five +layers-the gross body, the energy body, the emotional body, the +intellectual body and the bliss body. Integrated approach to yoga +is employing specific yogic techniques to address all the layers of +existence in order to get holisticity or overall health. +The integrated module of yoga especially designed for yoga camp +for adolescence was very well accepted by the children and received +complements from the parents too. Maintaining uniformity in +execution of intervention and overall conducting of program across +the three batches acts as a replication of the study. The similar +results/trends in each batch not only confirm the effectiveness +of the program in establishing the psychological fitness among +adolescents but also nullifies the lacuna arising due to absence of +active control group. +LIMITATION +The absence of control may act as a limitation of the study. However, +by repeating the intervention thrice with three different batches, this +limitation was tried to overcome. As there were no indigenous scales +available to study the psychological parameters in the Indian setting, +the psychometric scales that were developed by Westerners, used +in the study. This may also be considered as another limitation of +the study. +CONCLUSION +The 10 day Residential Yoga camp is effective in improving the +psychological fitness among adolescent children especially EI, +cognitive emotional regulation strategies and anger management. +The findings also highlight the potential of short term integrated yoga +in bringing significant improvements in psychological constructs +among adolescents. Further the study also demonstrates the +feasibility and effectiveness of residential integrated yoga program +for adolescents. +ACKNOWLEDGEMENTs +The authors would like to extend their heartiest thanks and +appreciation to the University and its faculty, for allowing the study +to be conducted during the residential summer camp. The authors +thank all the participants and parents for their support. The authors +also thank Mrs. Alakamani, PhD for her critical comments on the +manuscript. +REFERENCES + Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our +[1] +future: a Lancet commission on adolescent health and wellbeing. Lancet. +2016;6736(16). + B +[2] +lakemore S-J, Mills KL. Is adolescence a sensitive period for sociocultural +processing? Annu Rev Psychol. 2014;65(1):187-207. +www.jcdr.net +Astha Choukse et al., Effect of Residential Yoga Camp on Psychological Fitness of Adolescents +Journal of Clinical and Diagnostic Research. 2018 Aug, Vol-12(8): VC07-VC11 +11 +11 + Davidson LL, Grigorenko EL, Boivin MJ, Rapa E, Stein A. A focus on adolescence +[3] +to reduce neurological, mental health and substance-use disability. Nature. +2015;527(7578):S161-66. + Heneghan A, Stein REK, Hurlburt MS, Zhang J, Rolls-Reutz J, Fisher E, et al. +[4] +Mental health problems in teens investigated by U.S. child welfare agencies. 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A randomised controlled trial comparing the impact +[34] +of yoga and physical education on the emotional and behavioural functioning of +middle school children. Focus Altern Complement Ther. 2014;19(3):148-55. + Braun TD, Park CL, Conboy LA. Psychological well-being, health behaviours, +[35] +and weight loss among participants in a residential, Kripalu yoga-based weight +loss program. Int J Yoga Therap. 2012;(22):9-22. + Swami Satyananda Saraswati. Four Chapters on Freedom. Munger: Yoga +[36] +Publications Trust, Bihar School of Yoga; 1976. pp. 400. + Wisner BL, Jones B, Gwin D. School-based meditation practices for adolescents: +[37] +a resource for strengthening self-regulation, emotional coping, and self-esteem. +Child Sch. 2010;32:150-59. + Hagen I, Nayar US. Yoga for children and young people’s mental health and well- +[38] +being: research review and reflections on the mental health potentials of yoga. +Front Psychiatry. 2014;5:35. +PARTICULARS OF CONTRIBUTORS: +1. Research Scholar, Department of Yoga and Humanities, S-VYASA Yoga University, Bengaluru, Karnataka, India. +2. Scientist, CAM Program, HCG Enterprise Ltd., Bengaluru, Karnataka, India. +3. The Chancellor, S-VYASA Yoga University, Bengaluru, Karnataka, India. +NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: +Dr. Astha Choukse, +Research Scholar, S-VYASA Yoga University, # 19, Eknath Bhawan, Govipurum circle, Kempagowda Nagar, +Bengaluru-560019, Karnataka, India. +E-mail: asthachoukse@yahoo.co.uk +Financial OR OTHER COMPETING INTERESTS: None. +Date of Submission: Apr 17, 2018 +Date of Peer Review: May 02, 2018 +Date of Acceptance: Jun 28, 2018 +Date of Publishing: Aug 01, 2018 diff --git a/subfolder_0/Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents.txt b/subfolder_0/Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents.txt new file mode 100644 index 0000000000000000000000000000000000000000..78ac96c59e5f5902d501832b9f57e15aa04beb1a --- /dev/null +++ b/subfolder_0/Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents.txt @@ -0,0 +1,761 @@ +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +1/16 +Int J Yoga. 2019 May-Aug; 12(2): 139–145. +doi: 10.4103/ijoy.IJOY_29_18: 10.4103/ijoy.IJOY_29_18 +PMCID: PMC6521760 +PMID: 31143022 +Effect of Residential Yoga Camp on Psychosocial Fitness of +Adolescents +Astha Choukse, Amritanshu Ram, and HR Nagendra +Department of Yoga and Humanities, S-VYASA Yoga University, Bengaluru, Karnataka, India +CAM Department, HCG Enterprises Ltd., Bengaluru, Karnataka, India +Address for correspondence: Dr. Astha Choukse, S-VYASA Yoga University, Bengaluru Eknath Bhawan, No. 19, +Gavipuram Circle, Kempegowda Nagar, Bengaluru - 560 019, Karnataka, India. E-mail: +asthachoukse@yahoo.co.uk +Received 2018 May; Accepted 2018 Oct. +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. +Abstract +Background: +Adolescence is a key phase of socialization, where improved psychosocial fitness helps to promote +socioeconomic productivity in societies. Psychosocial fitness also has an impact on the academic +performance, overall health, and quality of life, throughout life. The present study evaluates the effect of +yoga intervention on psychosocial fitness among adolescents. +Materials and Methods: +A single group, pre and post yoga interventional study was carried out in three independent cohorts +(batches 1, 2, and 3), having sample size of 148, 167, and 195 respectively. A 7-day integrated yoga +intervention was given in a residential setting. Psychosocial assessments included social competence, +empathy, altruism, parent relationship, and peer friendship. Data were collected from the participants and +their parents using respective versions of the scales. While pre- and post-data were collected from all the +adolescent participants, pre- and post-data from parents were collected for 340 and 43 parents only. The +objective of the analyses was to evaluate the effect of the yoga program and check the consistency of these +effects. +Results: +Significant changes (P < 0.05) were seen in social competence, empathy, and altruism in batches 2 and 3, +whereas changes in batch 1 showed nonsignificant improvements. Analyses of the parental data indicated a +significant improvement in parent relationship (P = 0.035) and also nonsignificant improvement in all +other outcomes. +1 +1 +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +2/16 +Conclusion: +Results suggested that yoga intervention might help in improving psychosocial fitness in adolescents. It +also helped to demonstrate that administering yoga was acceptable and feasible in a residential setting. +Keywords: Adolescents, empathy, parent relationship, psychosocial fitness, social competence, yoga +Introduction +Adolescence is a time of tremendous growth, potential and socioemotional development[1] along with +considerable risk, during which social contexts exert powerful influences.[2] Psychosocial fitness is +defined as developing a sense of personal identity which will continue to influence behavior and +development for the rest of a person's life.[3] Psychosocial fitness among adolescents plays an important +role, considering the need for social integration and the search for self-assertion and independence.[4] It is +marked by a set of learned behaviors displayed by them in the interpersonal context and their performance +level for the demands of a social situation. Adolescence is a crucial period of socialization that demands +greater attention to the mental well-being, failing which may lead to mental health consequences that may +remain throughout life and reduce the capacity of societies' socioeconomic productivity.[5] Appropriate +psychosocial development of adolescent is an indicator of sound academic performance; physical health; +and adequate social, emotional, and psychological health. Psychosocial fitness ultimately contributes in +reducing the risk of psychosocial and behavioral problems, violence, crime, teenage pregnancy, and misuse +of drugs and alcohol.[6] Psychosocial fitness includes how one feels and perceives about their societal +relationships that has key factors such as empathy, social competence, altruism, and so forth. +Empathy, a key component of all social functioning, is an effective cognitive ability to adopt the +perspective of others in order to understand their feelings, thoughts, or actions.[7] Altruism is a +motivational state, thought, and action with the ultimate goal of increasing other's welfare without +considering one's own well-being.[8] Weak social competencies are thought to limit an adolescent's ability +to establish and maintain friendships. Low levels of perceived social competence and negative parental +interactions are associated with depressive symptoms.[9] During the adolescent period, their relationships +with family and peers undergo dramatic changes and shifts. Strong positive relationships with both family +and friends are vital for healthy social and emotional development.[10] The quality of the parent–child +relationship affects the adolescent's self-concept, which in turn affects the adolescent's integration into the +world of peers.[11] +Literature on interventional studies, promoting psychosocial fitness are not many and are not focused to +target adolescents, their caregivers, and community stakeholders.[6,12] A systematic review suggested that +a multimodal and multidisciplinary group-based approach was found to be an effective interventional +strategy.[13] One of the studies suggested psychosocial assets and well-being, which could be improved +among adolescent girls through a brief school day program.[14] +Since psychosocial fitness is largely to do with how we deal with the mind, yoga may play a role in its +enhancements. Yoga is a science of mind control, delineated in historical Indian texts, and comprises of +holistic multicomponent practices and considered as an effective intervention to promote the overall +fitness. A number of studies have been done on adolescent mental health involving yoga as an intervention +that has shown benefits[15,16,17] No studies thus far have assessed the psychosocial benefits of yoga on +adolescents. Further, adolescence being at the crucial developmental stage, highly vulnerable to biological, +psychological, social, and environmental factors and are in a period where they are more receptive to the +corrective measures. This warrants considering their physical and psychological aspects while developing +intervention programs/strategies to improve social health among adolescents. Considering the psychosocial +benefits seen by the practice of yoga in other populations, there is enough to warrant an exploration in the +adolescent population. +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +3/16 +The aim of the present study was to explore the efficacy of short-term integrated residential yoga +intervention on parameters of psychosocial fitness in adolescents. The objective was to evaluate the effects +of yoga through a single group pre- and post-design for each cohort. This included eliciting data from +adolescents and their parents and engaging in subgroup analyses of different age groups. +This study included secondary data of a registered study (CTRI/2018/02/011709) that evaluated physical, +psychological, and social fitness among adolescents. +Materials and Methods +Participants +The participants of the study included healthy adolescent children between the ages of 9 and 16 years, +studying in English-medium schools. Participants with single parents, acute or chronic health problems, on +medication, having attended any residential yoga program in the last 3 months were excluded from the +study. They were selected from children who were registered to attend three 7-day residential summer +yoga programs that naturally formed the three cohorts for the study. Children were screened for suitability +and once their parents provided consent along with the children's assent, were subjected for the +preassessment. Considering the rapid psychosocial changes during the adolescence, the participants were +further subdivided into juniors (9–12 years) and seniors (13–16 years). +Children from each batch were further randomly divided into smaller groups of 12–15 participants, with +two teachers, which made it easy to implement the intervention. Teachers included undergraduates in yoga +and were trained on the implementation of the intervention to ensure uniformity. +Since the selection of participants was from a summer yoga camp during the summer break, there was +good heterogeneity of the sample with respect to family backgrounds, socioeconomic strata, cultures, +traditions, faiths, and academic backgrounds. +Ethical approval was obtained from the Institutional Ethical Committee of S-VYASA with the reference +number RES/IEC-SVYASA/64/2015. +Assessment +The psychosocial fitness was assessed by the outcome measures of social competence, empathy, altruism, +parent relationship, and peer friendship. Data were collected from the adolescents before and after the +intervention. Data of empathy, altruism, and parental and peer relationship, from the parents, were +collected before and after 3 months of the intervention using the parent versions of the respective scales. +This would help comparing the opinions of the parents with that of their children. +The psychometric scales used are developed and validated by Child Trends[18,19] and they are (a) Social +Competence Questionnaire – 9-item scale with Cronbach's alpha of 0.79; (b) Teen Empathy – 4-item scale +with Cronbach's alpha 0.84; (c) Teen Altruism – 4-item scale with Cronbach's alpha 0.80; (d) Positive +parent relationship – 6-item scale with Cronbach's alpha 0.92; and (e) Peer friendship – 5-item scale with +Cronbach's alpha 0.91. +Design +The present study is a single group pre- and post-yoga interventional study carried out during a residential +yoga camp for the adolescents. Data were collected from both children, as well as parents, using respective +questionnaires. Three independent 10-day residential camps for personality development were organized +during the summer by VYASA organization. While the duration of camp was 10 days, the yoga +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +4/16 +intervention schedule was followed from day 2 to day 8 across the three camps. Eligible adolescents +underwent the same yoga intervention program with the instructors, living conditions, daily routine, and +dietary plan. +Intervention +The modified version of Integrated Yoga Module, based on Pancha Kosha model (five layers of existence) +as explained in Taittiriya Upanishad comprised of yogic techniques that benefit each of the Koshas (gross +body – annamaya kosha; energy body – pranamaya kosha; emotional body – manomaya kosha; intellectual +body – vijnanamaya kosha; and bliss body – anandamaya kosha). The module was based on various yogic +texts, books on yoga for children, and was modified in consultation with the subject experts with more +than 25 years of experience in conducting these camps. +The yoga module included Asana, Pranayama, Relaxation, Meditation, and also Jnana yoga (Yama Niyama +concepts) and Bhakti yoga (prayers and bhajans). The bhakti-yoga sessions included mantra chanting and +singing, whereas Jnana yoga sessions included lectures, creativity such as role playing, storytelling, +parables, journaling diary entry, and so forth to drive the Yama Niyama concepts and yogic concepts of +food. Few competitive activities were organized between groups to encourage participation and team +building. The sessions were administered in a manner that kept the program engaging and interesting to the +selected age group. Details of the intervention are summarized in Table 1. +Data extraction +Data collection was done for the children on the 1 day (predata) and 9 day (postdata) of the camp, in +small group settings by trained researchers. The investigators and two teachers were available to clear +doubts and provide unbiased guidance during the data collection. Data collection from the parents was +done on the 1 day (predata), when they came to drop their wards to the camp, and after 3 months +(postdata) as a follow-up data, by sending the questionnaire through E-mail. +All the recruited students completed the questionnaires before and after the intervention. A total of 340 +parental responses were collected before the intervention and only 43 parental responses were obtained +after 3 months as a follow-up data (postdata). Post 3 months data obtained from parents served to evaluate +if the yoga intervention had long-term and sustained effects on the social behavior. Only 43 pre- and post- +parental data were available that made it difficult to draw strong conclusions on the parental opinions. The +reasons for attrition in parental predata were (a) parents were not available at the commencement of the +camp, (b) refusal to participate, and (c) lack of English language fluency. Several parents did not respond +to the follow-up assessments despite repeated E-mail and reminders due to their preoccupations or +disinterest. Hence, the analyses that involved data from adolescents and their parents were from 43 +participants. +Data analyses +To maintain confidentiality, the data sheets were coded and personal identifiers were omitted during the +data entry. Analysis was done using SPSS Inc. SPSS for Windows, Version 16.0. Chicago, Change over +time was evaluated using the paired samples t-test. The results of the tests were deemed to be significant if +probability values were <0.05, whereas trends (P < 0.1) were also highlighted. +Results +The effect of a short-term residential yoga intervention was evaluated for its benefits on social +competence, empathy, altruism, parent relationship, and peer friendship by a single-arm, pre- and post- +study in three individual cohorts of adolescent children. The three cohorts comprised 148 (57.8% male) +st +th +st +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +5/16 +(62.8% juniors), 167 (73.1% male) (53.9% juniors) and 195 (62.1% male) (57.4% juniors), with a mean +age of 11.84 ± 1.77, 12.22 ± 1.82 and 12.06 ± 1.82, respectively. Demographic and anthropometric data are +presented in Table 2. +As seen in Table 3, comparing pre- and post-data for each of the cohorts showed that there were no +significant changes, observed in the first batch, whereas the subsequent batches showed statistically +meaningful changes in teen empathy. Social competence and altruism was significant in the third batch. An +interesting observation was that while all changes, although nonsignificant, were in the positive direction, +peer friendship had changed negatively. +Analysis of the junior subgroup, as shown in Table 4, indicates that empathy significantly improved in all +the three batches. Social competence improved significantly in the first batch and altruism improved +significantly in the third batch. It was interesting to note that unlike the overall result, peer friendship had +increased, although nonsignificantly in two of the three batches. All the other variables also showed a +nonsignificant positive change. +Analysis of the senior subgroup, as shown in Table 5, indicates that there were no significant positive +changes in any of the outcomes in batch 1, but social competence and empathy changed positively in the +subsequent batches. Altruism also showed a significant positive change in the third batch. Peer friendship +showed a significant reduction in the first batch, which was not seen in the subsequent batches. +Additional analyses compared (n = 340) predata of the outcomes between the adolescents and their parents +(200 juniors), as seen in Table 6. There were significantly lower altruism and peer friendship and +significantly higher parent relationship reported by parents when compared with their children. +Changes in empathy, altruism, parent relationship, and peer friendship were compared between the +responses received by the 43 adolescents and their parents, as shown in Table 7. It was interesting to note +that the adolescents reported a significant change (P = 0.003) in altruism and the parents reported a +significant change (P = 0.035) in parent relationship as a result of the yoga intervention. +Discussion +The objectives of this study were to evaluate the effects that a 7-day residential yoga intervention would +bring on measures of psychosocial fitness in three independent cohorts through a single group pre- and +post-study. The secondary objective was to compare if these effects were also observed by the parents. +Statistically significant increase in measures of empathy, social competence, and altruism were +inconsistent between the three cohorts and between the age groups, except for an increase in empathy, +which was seen across all the three cohorts among juniors. +Psychosocial fitness stems from empathy or being able to put oneself in another's situation in order to +understand their feelings. This in turn impacts one's behavior and makes them better connect with their +peers, parents, and surroundings at large. Altruism is also a resultant prosocial behavioral pattern of +increased empathy,[20,21] and these patterns of psychosocial behavior define an individual's social +competence. Building self-awareness is the key to developing skill of emotional appraisal and control, +whereby positive social competencies might be achieved. Yoga, being the science of holistic well-being, +comprises of practices that encourage internalization and development of self-awareness, and thereby, +increase the capacity of self-control.[22] Yoga practices through a sequence of awareness building and +relaxing practices evoke a deeper calming effect, which helps students get into a frame of mind, conducive +to learning and is distinct from the effects of physical exercise alone.[16] The results of our study may +suggest that 7 days of yoga practices may have only been adequate to show a change in empathy scores +and a longer intervention might have been required to show consistent impact on the downstream +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +6/16 +behavioral patterns. Other studies have also indicated that Karma Yoga,[23] yoga practices, mindfulness, +[24] and prayer[25] have an influence over the aspects of empathy, altruistic behavior, and social +competence in adolescents. +Variables of empathy, altruism, and peer and parental relationship are easily under or overestimated while +using a self-reported instrument. Thus, parallel data of these variables were also sought from the parents. It +is, however, known that the parents are not able to report accurately, certain aspects of their adolescent +children's behavior.[26] Comparison of the corresponding adolescent and parent data provided rich +information on the discrepancies of opinions held by each of them. Comparing baseline values between +parents and their children, it was interesting to note that apart from having an agreement in scores of +empathy, all other outcomes were significantly different. It was more interesting that parents opined that +their children had very positive parental relationship and a very-low peer friendship, but their children +thought otherwise. Noting these discrepancies, we further assessed the changes in these parameters +resulting from the yoga intervention in both these populations. +In the present study, adolescents reported only a trend of improvement (P = 0.095) in parental relationship +as a result of the yoga intervention, but the parents reported a significant (P = 0.035) improvement, 3 +months after the intervention. However, unlike what was expected, the parameters of peer friendship +reduced significantly (P = 0.031) in seniors of the first batch. +A positive parent–child relationship is an essential component of adolescent development. During this +transitional age, the concept and opinions of oneself grow stronger, taking precedence over that of their +parents[27] and conflicts with parental ideologies emerge. Retaining a healthy relationship with parents +and peers plays a crucial role in an individual's psychological and physical health.[28] Components of the +intervention also comprised activities that were geared to provide calmness and balance to the mind +(Pranayama, meditation) and promoted the quality of relationships and moral behavior (Yama Niyama) in +adolescents.[29] This effect, as observed by the parents, 3 months after the intervention could suggest a +sustained change in parental relationship as a result of yoga. The adolescent data, collected before and after +a 7-day intervention, might not have been adequate to appraise the change. Furthermore, not having the +exposure with the parents during this time might have made it nonconducive for its appraisal. The trend +seen in the present study is in line with a previous randomized controlled trial[30] evaluating changes in +socioemotional competencies, such as empathy and prosociality, as a result of a yoga program delivered +twice a week for 12 weeks to 125 low socioeconomic adolescents. +The point of reference for peer friendship during the predata was an established set of peers from their +native setting, whereas the postdata elicited had a point of reference of peers from within the camp. This +subtle disparity was appreciated more in seniors, which had resulted in a significant drop in scores of peer +friendship, whereas in juniors there was a higher degree of adaptability indicated by a nonsignificant +increase in peer friendship in the first and third batches. +This was the first time that an interventional study of this scale, in adolescents had been attempted. The +intervention being tested was also developed in a comprehensive manner, referring authentic Indian texts +of yoga, modern-day literature of its interpretations, and modifying it through several iterations with +subject experts in yoga, psychology, and adolescent health. An intervention that is focused on the holistic +psychosocial development of adolescents, administered in the group setting has shown to be more effective +in improving social skills, if there has been at least one medical health professional or an adolescent +psychologist involved in its development.[13] This ensured that while the premise of yoga is grounded to +its authentic roots, the practices themselves were able to elicit the interest of the selected age group. +Qualitative feedback elicited from the adolescents and parents on all aspects of the camp was very good. +Considering that other literature provided stronger evidence to the benefits of yoga among adolescents, an +attempt was also made to evaluate a residential camp setting as a way to impart these practices to this age +group. To provide a multidimensional intervention like yoga in such large numbers, the study employed +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +7/16 +close to 40 trainers who were rigorously trained and monitored for uniform quality of instruction. In +addition, capture of parental data along with corresponding data from their children was a novel endeavor, +although the results had not proven to be what was anticipated. +The inconsistency in the results demonstrate that yoga being a multimodal set of activities, is heavily +dependent on how well each person is able to internalize these practices and drive the change of mindset. +The absence of a control group heavily undermined the conclusions drawn in this study. Considering this, +the design was reworked at detecting the repeatability of the results. Contrary to our speculation, the +internal validity of the results, by virtue of the inconsistency of results, was also poor. Adolescent data +should have also been collected along with that of their parents, post 3 months to evaluate the sustained +changes in the relationships. The controlled environment of the camp setting might have only provided the +required information needed for the psychosocial improvement and evaluating the same after the +participants had been given an opportunity to express it in their existing relationships would have provided +a fairer comparison. Secondary qualitative data, in anticipation of a nonconclusive result, could have been +premeditated, which would have given a rich feedback on the changes needed in the module and its +implementation. Future studies, while having a more robust design, should not just be able to detect the +effects but also identify possible predictors and mechanisms associated with improvement in psychosocial +fitness. Long-term interventions, homogenous samples, and improved and focused interventions also +remain as improvements in the future researches in this field. +Conclusion +Adolescence is a phase of emotional and psychosocial transition and yoga, a technique of mind control, +which could potentially help in improving holistic personality. The efficacy of a 7-day yoga intervention in +improving psychosocial fitness was evaluated and showed that the feeling of empathy increased +significantly. There was a sporadic increase in altruism, social competence, and parent relationships in +some cohorts while peer relationship deteriorated. Parents providing data on their children's perceived +level of altruism, empathy, and relationship with parents and peers, before and after 3 months of +intervention highlighted the discrepancy in their understanding of their children and also their ability to +perceive the changes while the children could not. Design and implementation flaws, as a result of +resources, limit from stating the findings of these studies as conclusive evidence but helps to plan more +robust and intricate studies to assess the specific benefits of yoga and its mechanisms. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +Acknowledgment +The authors would like to extend their heartiest thanks and appreciation to the University and its faculty +for allowing the study to be conducted during the residential summer camp. The authors thank all the +participants and parents for their support. The authors also thank Mrs. Alakamani, PhD for her comments +on the manuscript. +References +1. Davidson LL, Grigorenko EL, Boivin MJ, Rapa E, Stein A. A focus on adolescence to reduce +neurological, mental health and substance-use disability. Nature. 2015;527:S161–6. 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Educ Res Eval. +2015;21:407–21. +Figures and Tables +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +10/16 +Table 1 +Summary of integrated yoga intervention program +Name of the intervention session +Duration +Prayer session +15 min +Asana sessions: Standing postures, sitting postures, prone postures, inverted postures, supine postures +2 h +Meditation session: Om meditation, cyclic meditation +45 min +Pranayama session: Conscious breathing, sectional breathing, full yogic breathing, dynamic (Bhastrika, +Kapalbhati), balancing (Anuloma-viloma), cooling (Shitli), tranquilizing (Bhramari) +1 h +Relaxation session: IRT, QRT, DRT +1 h +Lecture session: Yama Niyama concepts, physical adolescent health, emotional appraisal and control, +prosocial behavior +1 h +Chanting and singing session: 18 verses from Bhagavad Gita, devotional songs, patriotic songs +1 h +Creativity sessions: Karma yoga (altruistic group activities), role modeling, parables, storytelling, diary +writing, competitions +2 h +Game session: Yogic games, group awareness +1 h +Happy assembly: Cultural program +1 h +IRT=Instant relaxation technique, QRT=Quick relaxation technique, DRT=Deep relaxation technique +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +11/16 +Table 2 +Demographic and anthropometric measures +Variables +Mean±SD +Batch 1 +Batch 2 +Batch 3 +Age +11.84±1.77 +12.22±1.82 +12.06±1.82 +Father age +43.54±4.63 +43.61±5.61 +43.56±4.40 +Mother age +38.64±4.15 +38.12±3.87 +38.16±4.00 +Height +148.26±12.81 +149.51±12.75 +150.5±13.29 +Weight +43.42±13.20 +41.31±12.28 +44.03±12.35 +BMI +18.80±3.82 +17.75±3.99 +18.8±4.98 +SD=Standard deviation, BMI=Body mass index +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +12/16 +Table 3 +Comparison of pre- and post-data of the three cohorts +SD=Standard deviation +Measures +Batch 1 (n=148) +Batch 2 (n=167) +Batch 3 (n=195) +Mean±SD +P +Mean±SD +P +Mean±SD +Pre +Post +Pre +Post +Pre +Post +Empathy +14.70±3.344 +15.05±3.841 +0.207 +14.32±3.014 +15.28±3.116 +<0.001 +13.97±3.341 +14.90±3.284 +Social +competence +33.21±6.702 +33.70±7.866 +0.363 +33.19±5.381 +34.06±6.816 +0.055 +32.43±6.513 +33.48±6.463 +Altruism +13.15±3.786 +13.43±4.113 +0.355 +13.27±3.574 +13.78±3.419 +0.052 +12.87±3.498 +13.66±3.524 +Parent +relationship +23.61±4.827 +23.84±5.273 +0.606 +23.58±4.928 +23.89±4.885 +0.423 +23.66±4.168 +24.19±4.746 +Peer +friendship +20.62±4.278 +20.45±4.678 +0.663 +20.70±4.002 +20.43±4.109 +0.385 +20.03±4.323 +20.01±3.900 +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +13/16 +Table 4 +Comparison of pre- and post-data of the three cohorts of juniors +SD=Standard deviation +Measures +Batch 1 (n=93) +Batch 2 (n=90) +Batch 3 (n=112) +Mean±SD +P +Mean±SD +P +Mean±SD +Pre +Post +Pre +Post +Pre +Post +Empathy +14.41±3.275 +15.12±3.557 +0.033 +13.90±2.860 +14.78±3.042 +0.029 +13.87±3.424 +14.65±3.427 +Social +competence +32.40±6.823 +33.83±6.882 +0.029 +32.51±5.707 +33.04±7.228 +0.465 +31.89±6.616 +32.63±6.710 +Altruism +13.56±3.740 +13.82±3.776 +0.488 +12.82±3.740 +13.33±3.576 +0.199 +12.89±3.483 +13.63±3.521 +Parent +relationship +23.49±5.058 +24.10±4.632 +0.227 +23.48±5.383 +24.01±4.775 +0.361 +23.71±4.433 +24.21±4.973 +Peer +friendship +19.98±4.604 +20.62±3.785 +0.143 +20.16±3.940 +19.98±4.081 +0.682 +19.66±4.788 +19.71±4.060 +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +14/16 +Table 5 +Comparison of pre- and post-data of the three cohorts of seniors +SD=Standard deviation +Measures +Batch 1 (n=55) +Batch 2 (n=77) +Batch 3 (n=83) +Mean±SD +P +Mean±SD +P +Mean±SD +Pre +Post +Pre +Post +Pre +Post +Empathy +15.18±3.432 +14.93±4.311 +0.607 +14.81±3.133 +15.86±3.119 +0.001 +14.12±3.240 +15.23±3.070 +Social +competence +34.58±6.318 +33.49±9.363 +0.248 +33.99±4.890 +35.25±6.135 +0.010 +33.16±6.339 +34.63±5.965 +Altruism +12.45±3.795 +12.76±4.586 +0.544 +13.79±3.318 +14.31±3.168 +0.131 +12.84±3.539 +13.71±3.549 +Parent +relationship +23.82±4.448 +23.42±6.232 +0.640 +23.70±4.368 +23.75±5.040 +0.917 +23.59±3.806 +24.16±4.452 +Peer +friendship +21.71±3.436 +20.16±5.918 +0.031 +21.34±4.005 +20.96±4.105 +0.400 +20.53±3.569 +20.41±3.659 +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +15/16 +Table 6 +Agreement between the parents and adolescents (n=340) +Mean±SD +P +Parent data +Adolescent data +Empathy +13.90±3.052 +14.26±3.278 +0.131 +Altruism +12.31±3.339 +12.84±3.614 +0.023 +Parent relationship +27.10±5.084 +23.41±4.762 +<0.001 +Peer friendship +10.29±3.113 +20.45±4.177 +<0.001 +SD=Standard deviation +1/27/2021 +Effect of Residential Yoga Camp on Psychosocial Fitness of Adolescents +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521760/?report=printable +16/16 +Table 7 +Comparison of the change scores between parents and adolescents (n=43) +Outcome measures +Data description +Parent data set +Adolescent data set +Mean±SD +P +Mean±SD +P +Predata +Postdata +Predata +Postdata +Empathy +12.47±2.914 +12.93±2.772 +0.446 +14.12±3.52 +14.84±3.703 +0.171 +Altruism +10.35±3.101 +11±3.867 +0.372 +12.3±3.827 +13.65±3.484 +0.003 +Parent relationship +24.95±5.3 +27.05±3.879 +0.035 +23.19±4.36 +23.88±4.3 +0.095 +Peer friendship +9.51±2.53 +9.56±3.026 +0.929 +20.37±4.37 +20.58±3.923 +0.708 +SD=Standard deviation +Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/Effect of Yoga Program on Quality of Life in Adolescent Polycystic Ovarian Syndrome A Randomized Control Trial..txt b/subfolder_0/Effect of Yoga Program on Quality of Life in Adolescent Polycystic Ovarian Syndrome A Randomized Control Trial..txt new file mode 100644 index 0000000000000000000000000000000000000000..ee861e9c6a7c5c199ea86a28b91ac2e228babb51 --- /dev/null +++ b/subfolder_0/Effect of Yoga Program on Quality of Life in Adolescent Polycystic Ovarian Syndrome A Randomized Control Trial..txt @@ -0,0 +1,694 @@ +1 23 +Applied Research in Quality of Life +The Official Journal of the International +Society for Quality-of-Life Studies + +ISSN 1871-2584 + +Applied Research Quality Life +DOI 10.1007/s11482-012-9191-9 +Effect of Yoga Program on Quality of +Life in Adolescent Polycystic Ovarian +Syndrome: A Randomized Control Trial +Ram Nidhi, Venkatram Padmalatha, +Raghuram Nagarathna & Ram +Amritanshu +1 23 +Your article is protected by copyright and +all rights are held exclusively by Springer +Science+Business Media Dordrecht and The +International Society for Quality-of-Life Studies +(ISQOLS). This e-offprint is for personal +use only and shall not be self-archived in +electronic repositories. If you wish to self- +archive your work, please use the accepted +author’s version for posting to your own +website or your institution’s repository. You +may further deposit the accepted author’s +version on a funder’s repository at a funder’s +request, provided it is not made publicly +available until 12 months after publication. +Effect of Yoga Program on Quality of Life +in Adolescent Polycystic Ovarian Syndrome: +A Randomized Control Trial +Ram Nidhi & Venkatram Padmalatha & +Raghuram Nagarathna & Ram Amritanshu +Received: 24 February 2012 /Accepted: 13 September 2012 +# Springer Science+Business Media Dordrecht and The International Society for Quality-of-Life Studies +(ISQOLS) 2012 +Abstract Polycystic Ovarian Syndrome (PCOS) is a common female endocrine +disorder challenging feminine identity which is likely to impact their quality of life. +The aim of this study was to evaluate the effect of yoga on PCOS specific quality of +life in adolescent girls with PCOS. Ninety adolescent (15–18 years) girls from a +residential college in Andhra Pradesh, who satisfied the Rotterdam criteria, were +randomized into two groups. The yoga group (n037) practiced a holistic yoga +module while the control group (n035) practiced a matching set of physical exercises +(1 h/day, for 12 weeks). PCOS specific quality of life was measured at inclusion and +after 12 weeks. Mann-Whitney on difference score showed that the changes in all +domains were significantly different between the two groups (p<0.05) except for +infertility (p00.675). Wilcoxn signed ranks test showed yoga group observed greater +improvement in emotional disturbances (effect size; Y:1.52, E: 0.72), body hair +(effect size; Y: 1.02, E: 0.32), weight (effect size; Y: 0.96, E: 0.33) and menstrual +problem (effect size; Y: 1.24, E: 0.64) domain as compared to the exercise group. +Yoga program for 12 weeks is significantly better than physical exercise in improving +PCOS quality of life in adolescent girls with PCOS. +Keywords Adolescent PCOS . PCOSQ . Yoga +Introduction +Polycystic Ovarian Syndrome (PCOS) affects 2.2 % to as high as 26 % (Michelmore +et al. 1999; Chen et al. 2008) of the women of reproductive age. Recently we found a +Applied Research Quality Life +DOI 10.1007/s11482-012-9191-9 +Funding Agency Central Council for Research in Yoga and Naturopathy (C.C.R.Y.N.), ministry of health, +Government of India, New Delhi. +R. Nidhi (*): V. Padmalatha: R. Nagarathna: R. Amritanshu +Division of Yoga and Life Sciences, SVYASA University, #19, Eknath Bhavan, Gavipuram Cirlce +Kempegowdanagar, Bangalore 560 019, India +e-mail: nidhiyoga@gmail.com +Author's personal copy +9.13 % prevalence of PCOS in south Indian adolescent girls (Nidhi et al. 2011 Aug). Its +pathophysiology is most likely a combination of genetic disposition and environ- +mental factors and is not completely understood (Dunaif and Thomas 2001; Legro +and Strauss 2002). The three most bothersome symptoms commonly reported by +affected women are excess hair growth, irregular or absent menstruation, and infer- +tility (Kitzinger and Willmott 2002). As a result, PCOS women face challenges to +their feminine identity which is likely to impact their quality of life. (Elsenbruch et al. +2003). Adolescent PCOS girls who are at the height of feminine identity development +and awareness of body image, would have an equal or possibly higher disturbance in +quality of life as compared to adult women and hence cannot be overlooked. +Research has shown a lower Health Related Quality of Life (HRQol) in women +with PCOS when compared with healthy controls (Elsenbruch et al. 2003; Hahn et al. +2005; Coffey et al. 2006; Ching et al. 2007). One study measuring the HRQoL of +adult Indian women with PCOS found a high prevalence of psychological distress in +over 50 % of the women as measured by the Goldberg’s General Health +Questionnaire-28 (GHQ-28) (Sundararaman et al. 2008). +The first published data to focus specifically on adolescents with PCOS and their +HRQL were collected from a cohort of women in Boston, wherein the measure of +HRQL used was The Child Health Questionnaire–Child Self-Report Form (CHQ- +CF87) (Trent et al. 2002). Findings from this study demonstrated that adolescents +with PCOS had lower HRQoL than their healthy counterparts. +In 1998, Cronin et al. reported polycystic ovary syndrome health-related QoL +questionnaire (PCOSQ) (Cronin et al. 1998) which is the only specific measure for +assessing HRQoL in PCOS. Studies employing the PCOSQ consistently demonstrate +that women with PCOS experience impairments of functioning related to all mea- +sured domains: body hair, emotions, infertility, weight and menstrual problems +(Schmid et al. 2004; McCook et al. 2005; Coffey et al. 2006; Ching et al. 2007). +Though, there are variations which could be attributed to cultural differences. How- +ever there are fewer data in adolescents with PCOS although this population repre- +sents an enormous opportunity to intervene early. +Lifestyle interventions have been suggested as the first-line treatment for PCOS, +especially in adolescent age groups. A recent study on adolescents with PCOS, +comparing the effect of metformin with placebo, in a lifestyle modification program +combined with oral contraceptives (OC) suggested that the addition of metformin +does not add improvement to PCOSQ scores above those observed with lifestyle +modification and OC treatment (Harris-Glocker et al. 2010). +Also, recently Thomson et al. (Thomson et al. 2010) observed improvements in +quality of life (PCOSQ) and depression amongst overweight women with PCOS after +a 20 weeks energy-restricted diet with and without exercise (aerobic only or com- +bined aerobic-resistance exercise). +Experts agree that Complimentary and Alternative Medicine (CAM) treatments +may have beneficial effects in PCOS but well-designed studies are needed (Raja- +Khan et al. 2011).Yogic life style, a form of holistic mind-body medicine, is found to +be effective in improving the QOL in several chronic conditions such as chronic low +backache (Tekur et al. 2010), osteoarthritis of knee joint (Ebnezar et al. 2011), +fibromyalgia (da Silva et al. 2007), rheumatoid arthritis (Haslock et al. 1994) and +cancer (Raghavendra et al. 2008). +R. Nidhi et al. +Author's personal copy +However till the date there have been no published data on adolescent PCOS +assessing the effects of yogic interventions. Thus the present study was planned to +evaluate the effect of yoga on PCOS specific quality of life in adolescent girls with +PCOS. +Material and Methods +Participants +Adolescent girls aged 15–18 years and with a BMI>18.5 kg/m2 were enrolled from a +residential college in Anantapur, Andhra Pradesh, India. We used Rotterdam +diagnostic criteria (2/3 of the features) to identify subjects (Rotterdam ESHRE/ +ASRM-Sponsored_PCOS_Consensus_Workshop_Group 2004). 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 +(Kumarapeli et al. 2008). Clinical hyperandrogenism: Modified Ferriman and +Gallway (mFG) score of 6 or higher (Chen et al. 2008). Biochemical hyperandrogen- +ism: Serum testosterone level of >82 ng/dl in the absence of other causes of Hyper- +androgenism. Poly cystic 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 (Franks et al. 1997). +Exclusion criteria were: use of oral contraceptives/hormone treatment/insulin- +sensitizing agents within previous 6 weeks, smoking, hyperprolactinemia, thyroid +abnormalities, non-classic adrenal hyperplasia and prior experience of yoga. Those +who satisfied the Rotterdam’s criteria for PCOS were then randomly assigned to two +groups using a computer-generated random number table by the pre labelled sealed +envelope method. +The study was approved by the Institutional Ethical Committee of Swami Vive- +kananda Yoga 4 Anusandhana Samsthana (SVYASA) University. Signed Informed +consent was obtained from the college authorities, the student and one of the parents. +Design +This was a prospective, randomised, active interventional controlled trial in which 90 +participants were randomly divided into two study arms: one arm practiced yoga and +the other arm practiced conventional physical exercises for the same duration. +Methods +Based on random number table participants were assigned to two interventions. Pre +assessment was carried out a day before commencing the intervention and post +assessment was done the day after. Two different halls in the college premises were +allotted for yoga and control group practices. Both groups practiced their respective +set of practices, one hour daily, 7 days a week for 12 weeks (total 90 sessio ns), under +the supervision of trained instructors. The daily routine in the class consisted of +lecture (5 min) followed by physical practices (40 min), pranayama (5 min) and +Effect of Yoga Program on Quality of Life in Adolescent PCOS +Author's personal copy +relaxation (10 min). The instructors maintained the register of daily attendance and +the reason for absence if any. +Blinding and Masking +Double blinding was not possible as this was an interventional study. The medical +officer who assessed the questionnaires, ultrasonologist and the laboratory staff were +all blind to the groups. Also the statistician 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 on ovaries was +carried out by a certified postgraduate medical ultrasonologist using Philips HD +11XE ultrasound system. Vaginal ultrasound scanning was not acceptable to the girls +or the parents. +Fasting sample of venous blood (10 ml) was analyzed at certified laboratories. +Prolactin (PRL) estimates were done by Fully Automated Bidirectionally Interfaced +Chemi Luminescent Immuno Assay (Abbot Park, IL) with CV below 10 %. Thyroid +Stimulating Hormone (TSH) was measured by Ultra Sensitive Sandwich Chemi +Luminescent Immuno Assay (Immulite, USA) with CV below 7 %. +Polycystic Ovary Syndrome Questionnaire (PCOSQ), a questionnaire developed +to measure the health-related quality of life (HRQoL) of women with polycystic +ovary syndrome consists of a total of 26 items grouped into 5 domains: emotions (8 +items), body hair (5 items), weight (5 items), infertility (4 items), and menstrual +problems (4 items). Each question is associated with a 7-point scale in which 7 +represents optimal function and 1 represents the poorest function. Scoring is done by +dividing each domain total score by the number of items in the domain. A score of +less than 5 for any domain indicates significant adverse impact. +In year 2004, Jones et al. (Jones et al. 2004) showed that all PCOSQ dimen- +sions were internally reliable with Cronbach’s a scores ranging from 0.70 to 0.97. +Intra-class correlation coefficients to evaluate test & retest reliability were high (range +0.89±0.95, P<18 0.001). +Intervention +The specific modules of intervention were developed by a team of experts that +included a physiatrist, a gynaecologist and yoga therapy physician. Care was taken +to match the lectures, practical classes and the type of relaxation technique used in the +two modules. +Yoga Intervention +The concepts for the intervention were taken from traditional yoga scriptures (Patanjali +yoga sutras, Upanishads and Yoga Vasishtha) that highlight a holistic approach to health +management (Nagendra 2004). The practices consisted of asanas (yoga postures), +pranayama, relaxation techniques, meditation, and lectures on yogic lifestyle and +R. Nidhi et al. +Author's personal copy +stress management through yogic counselling. All girls received at least one session +(about one hour each) of individualized counselling that was aimed at cognitive +restructuring based on yoga philosophy. +Pranayama included yogic breathing practices to achieve a slow rhythmic pattern +of breathing with internal awareness. A prolonged easy, slow exhalation is the safest +way to get mastery over the mind (Nagendra 2000). +Meditation, considered to be a part of yoga, (antaranga yoga) is a valuable tool to +calm down uncontrollable surge of negative emotions that may contribute to poor +quality of life. Lectures and individual yogic counselling for stress management to +bring about a notional correction were focused on ‘happiness analysis’ (Swami +Lokeswarananda 1996). +Control Intervention +Table 1 shows the hour long module of practices for the control group that consisted +of a set of physical movements, non-yogic safe breathing exercises followed by +supine rest (without instructions) that were matched with the yoga module. One +session of counselling was ensured for the students in the control group also. Care +was taken by the counsellors not to introduce any of the yogic references during these +sessions while maintaining the objective of the session to keep up with those of the +yoga groups. +Data Analysis +All statistical analyses were performed using SPSS version 17.0. Kolmogorov– +Smirnov test was used to check for normal distribution. As our objective was to +compare the changes after yoga with that of exercise and the data were not normally +distributed, non-parametric analysis was done by using Mann–Whitney U test to +compare difference scores (delta 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 Decem- +ber 2009 and January 2011. Of 986 girls who agreed for clinical examination, 154 +girls with oligomenorrhea and/or hirsutism (as per the above said definitions) were +asked to come for ultrasound and hormonal investigations. After the laboratory +evaluations 90 girls who satisfied Rotterdam criteria of PCOS, were randomized into +2 groups. Of these, there were total 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 withdrawal were (a) sick leave and (b) +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 recruited, 82.2 % (74/90) were +of normal weight (BMI018.5 to 23) and only 17.78 % (16/90) were overweight +Effect of Yoga Program on Quality of Life in Adolescent PCOS +Author's personal copy +(BMI>23) and 31.11 % (28/90) had mFG score ≥6. A total of 66.67 % (60/90) girls +had their menstrual cycle length between 60 to 90 days. +Wilcoxon signed ranks test (Table 3) showed yoga group observed greater improve- +ment in emotional disturbances (Y: p<0.001, E: p<0.01), body hair (Y: p<0.001, +E: p>0.05), weight (Y: p<0.001, E: p>0.05) and menstrual problem (Y: p<0.001, +E: p<0.001) domain as compared to the exercise group. For infertility domain +exercise group (E: p<0.01) showed significant improvement as compared to the +non-significant change in yoga group (Y: p>0.05). Mann-Whitney on difference +Table 1 Matched practices between yoga and control groups +Yoga group +Time +Control group +Time +Group Lecture: +8min +Group Lecture: +15min +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) +10min Brisk Walk +15min +Prone Asanas +Prone Exercises +Cobra Pose (Bhujangasana) +1min +Prone Head Lift +1min +Locust Pose (Salabhasana) +1min +Prone Leg Rising +1min +Bow Pose (Dhanurasana) +1min +Tiger Leg Stretch +1min +Standing Asanas +Standing Exercises +Triangle Pose (Trikonasana) +1min +Spread Leg Side Bending +1min +Twisted Angle Pose (Parsva-konasana) +1min +Spread Leg Twisted Bending +1min +Spread Leg Intense Stretch (Prasarita +padottanasana) +1min +Spread Leg Forward Bend +1min +Supine Asanas +Supine Exercises +Inverted Pose (Viparita Karni) +1min +Straight leg raising +1min +Shoulder Stand (Sarvangasana) +1min +Straight Leg Supine Twist +1min +Plough Pose (Halasana) +1min +Cycling (Clockwise – Counter +Clockwise)Bended knee Crunches +1min +Sitting Asanas +Sitting Exercises +Sitting Forward Stretch +(Paschimottanasana) +1min +Spread Leg Forward Bend +1min +Fixed angle Pose (Baddha-konasana) +1min +Spread Leg Alternate Toe Touching +1min +Garland Pose (Malasana) +1min +Squat pose +1min +Guided relaxation (Savasana) +10min Supine Rest +10min +Breathing Techniques (Pranayama) +Normal Breathing +8min +Sectional Breathing (Vibhagiya- +Pranayama) +4min +Forceful Exhalation (Kapala Bhati) +2min +Right Nostril Breathing (Suryanuloma +Viloma) +2min +Alternate nostril breathing (Nadi suddhi) +2min +OM Meditation (OM Dhyana) +10min +R. Nidhi et al. +Author's personal copy +score showed that the changes in all domains were significantly different between the +two groups (p<0.05) except for infertility (p00.675). +Discussion +This is the first randomised controlled trial comparing the effect of a 12 weeks yoga +program with physical exercise on PCOS quality of life in adolescent PCOS. Present +Screened (n=986) +Unsuitable (n=832) +Randomized (n=90) +Control (n=45) +Yoga (n=45) +completed (n=37) +completed (n=35) +Drop Out +(n=10) +Drop Out (n=8) +Excluded (n=64) +Presence of Clinical Symptoms (n=154) +Clinical Examination +Laboratory Evaluation +Fig. 1 Trial profile +Table 2 Demography of girls recruited in the study +S.No. +Variables +Yoga (n042) +Control (n043) +1. +Age, yrs (mean ± S.D.) +16.22±1.13 +16.22±0.93 +2. +Ht, m (mean ± S.D.) +1.54±0.06 +1.56±0.05 +3. +Wt, Kgs (mean ± S.D.) +47.92±6.20 +51.14±7.39 +4. +BMI, Kgs/m2 (mean ± S.D.) +20.30±1.92 +21.22±2.99 +5. +No. of girls with BMI≤23 +37 +34 +No. of girls with BMI>23 +5 +9 +6. +mFG Score +4.60±2.02 +4.20±2.13 +No. of girls with mFG score <6 +30 +32 +No. of girls with mFG score ≥6 +15 +13 +7. +Menstrual Frequency in months (mean ± S.D) +1.41±0.8 +1.47±0.87 +No. of girls with cycle length of 45 to <60 days +9 +9 +No. of girls with cycle length of 60 to <90 days +14 +16 +No. of girls with cycle length of ≥90 days +19 +18 +Ht: Height, Wt: Weight, BMI: Body Mass Index, Mfg score: Modified Ferriman and Gallway Score for +hirsutism +Effect of Yoga Program on Quality of Life in Adolescent PCOS +Author's personal copy +study observed higher baseline values for weight domain as compared to the study by +Ladson et al. (Ladson et al. 2011) on PCOS adolescents (aged 13–18 years) from +United States. Although Ladson’s study enrolled girls with a BMI>27 kg/m2 in +comparison to the present study where 82.2 % of PCOS girls were of normal BMI +(≤23 kg/m2), the perception of Indian adolescents about their body weight and image +appears to be different from the American adolescents. This is perhaps not surprising +given that recent research has pointed out that measuring waist circumference along +with BMI is important, as WC is more indicative of the total body fat and the amount +of metabolically active visceral fat and therefore recognized as a more accurate +measure of the metabolic risk (Haslam et al. 2006). This is why the Indian +population with an increased possibility for hypertension, diabetes and +dyslipidemia have lower BMI thresholds to reflect the risk for this population +(Misra et al. 2009). Therefore central obesity, being considered unattractive in this +age group could cause poor body image in spite of low BMI. +The scores on infertility domain were lower in our study as compared to Ladson et +al. (2011) study. Unlike other RCT where the girls were recruited from a hospital or a +medical college because they were seeking help for their problem, subjects in our +study were screened from a girl’s college where they were not previously diagnosed +and hence they were not aware of the long term impact of PCOS on infertility. This +might have caused a drop in the scores for infertility domain. +The scores on the other three domains (emotion domain, body hair domain and +menstrual problem domain) in our study were similar to that of Ladson’s (Ladson et al. +2011) study. One of the limitations of the study could be the baseline differences for +emotional, body hair and weight domain with control group having higher values. As +this might have affected the hope for and trust in a personal change over the variables. +The mechanism of action for yoga can be traced to Hypothalamic-pituitary-adrenal +axis (HPA) and sympatho-adrenal activity. It has been shown that PCOS and the related +metabolic syndromes, such as hyperandrogenemia, hyperinsulinemia and insulin resis- +tance are associated with disturbed activity of the sympathetic nervous system (Mancia +Table 3 Changes in PCOSQ domains post intervention [Yoga (Y)037, Exercise (E)035] +Domains +Groups +Pre +(mean ± SD) +Post +(mean ± SD) +Within +grp +effect size +Wilcoxon +Signed +Ranks test +Between +grp +effect size +Mann-Whitney +on diff score (sig.) +Emotional +disturbances +Y +4.51±1.12 +2.51±1.00 +1.52 +0.000 +0.247 +0.001 +E +3.92±1.03 +3.03±1.04 +0.72 +0.001 +Body Hair +Y +3.33±1.40 +2.02±1.16 +1.02 +0.000 +0.128 +0.002 +E +2.70±1.31 +2.36±1.46 +0.32 +0.097 +Weight +Y +4.44±1.72 +2.92±1.53 +0.96 +0.000 +0.124 +0.018 +E +3.79±1.48 +3.27±1.27 +0.33 +0.071 +Infertility +Y +2.14±0.89 +1.83±0.90 +0.31 +0.085 +0.16 +0.675 +E +2.02±0.88 +1.58±0.61 +0.52 +0.002 +Menstrual +problem +Y +4.86±1.40 +2.51±1.17 +1.24 +0.000 +0.262 +0.008 +E +4.33±1.44 +3.20±1.36 +0.64 +0.000 +R. Nidhi et al. +Author's personal copy +et al. 2007). Increased sympathetic and decreased parasympathetic activity in PCOS +has been documented through heart rate variability, a measure of cardiac autonomic +control (Yildirir et al. 2006) and also through direct intra-neural recordings +(Sverrisdottir et al. 2008). There are evidences proving efficacy of yoga in reducing +cortisol levels (Kamei et al. 2000) and stress arousal by modulating sympathetic +nerve activity (Vempati and Telles 2002) and sympathetic activity (Vempati and +Telles 2002) in normal population. Also, it has been reported that, practicing inte- +grated yoga as a means to manage and relieve both acute and chronic stress helps +individuals overcome other co-morbidities associated with metabolic diseases and +leads to improved quality of life (Michalsen et al. 2005 Dec; Oken et al. 2006). +Therefore, we hypothesize that yoga may lead to significant improvement in quality of +life of young PCOS girls by modulating sympathetic activity in addition to its physical +activity effect. +As a non-pharmacological form of treatment, yoga based interventions are +effective in not only improving quality of life in PCOS but it may also prevent +the long term morbidities. In a recent study, mind-body based program focusing +on cognitive behaviour therapy, relaxation training, negative health behaviour +modification, and social support components was associated with increased +pregnancy rates for cycle 2 of IVF cycle (Domar et al. 2011 Jun). Also studies +shown the beneficial effects of yoga as an intervention in increased insulin sensitivity +in healthy male population (Chaya et al. 2008) and in reducing fasting blood glucose +and improving lipid profiles in obesity and diabetes (Singh et al. 2004). +Further, yoga is a cost-effective and enduring therapy. This treatment paradigm for +PCOS in adolescents is promising for long-term prevention and ameliorating its ill +effects. Pharmacological agents used extensively in the treatment of PCOS with +mixed results, short term benefits and side effects such as nausea, diarrhoea and +abdominal cramps, have triggered researchers and patients to seek help through +alternative non pharmacological therapies. Yoga a non-pharmacological intervention +is available as an adjuvant therapy or as a primary intervention to improve the +response of modern medicine. +Restriction to a highly selective age group and also the small sample size raises the +question of generalizability of the conclusions of this study. And hence more studies +are required on larger sample size and different age groups and ethnicities and also +follow up studies are required with an intention to test the prolonged effects of these +interventions. +Conclusion +Twelve weeks of a holistic yoga program in adolescent PCOS is significantly better +than physical exercise program in improving selected measures quality of life. +Acknowledgements +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 co-operation of the staff and administration of Sri +Sai College in recruiting the students and carrying out the study. +Effect of Yoga Program on Quality of Life in Adolescent PCOS +Author's personal copy +Declaration +NR contributed to conception and design, or acquisition of data, or analysis and interpre- +tation of data; PV have been involved in conception and revising the manuscript critically for important +intellectual content; RN contributed to conception, design and revising the manuscript and AR have +contributed to design, acquisition of data and analysis and all the authors have given final approval of +the version to be published. +Ethical Approval +The study was approved by the Institutional Ethical Committee of Swami Vivekananda +Yoga Anusandhana Samsthana (SVYASA) University (vide project # SVYASA0012/08). +Conflict of Interest +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 +Chaya, M. 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E., Rich, M., et al. (2002). Quality of life in adolescent girls with polycystic ovary syndrome. +Archives of Pediatrics & Adolescent Medicine, 156, 556–560. +Vempati, R. P., & Telles, S. (2002). Yoga-based guided relaxation reduces sympathetic activity judged from +baseline levels. Psychological Reports, 90(2), 487–494. +Yildirir, A., Aybar, F., et al. (2006). Heart rate variability in young women with polycystic ovary syndrome. +Annals of Noninvasive Electrocardiology, 11, 306–312. +Effect of Yoga Program on Quality of Life in Adolescent PCOS +Author's personal copy diff --git a/subfolder_0/Effect of Yoga on Psychological Functioning of Nursing Students A Randomized Wait List Control Trial.txt b/subfolder_0/Effect of Yoga on Psychological Functioning of Nursing Students A Randomized Wait List Control Trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..3120c89897388bcb7f6bccbbba5aaa37e0c94b4e --- /dev/null +++ b/subfolder_0/Effect of Yoga on Psychological Functioning of Nursing Students A Randomized Wait List Control Trial.txt @@ -0,0 +1,804 @@ +Journal of Clinical and Diagnostic Research. 2017 May, Vol-11(5): KC01-KC05 +1 +DOI: 10.7860/JCDR/2017/26517.9833 +Original Article +Complementary/alterna­ +tive medicine section +Effect of Yoga on Psychological +Functioning of Nursing Students: + +A Randomized Wait List Control Trial +INTRODUCTION +As per a systematic review conducted till 2010, reported sources +of stress in nursing students are related to their academic activities +and clinical practice [1]. However, perceived stress was associated +more with the clinical practice than the academic demands, resulting +in more psychological symptoms [2] and also gastrointestinal +symptoms [3]. Considerably, nursing students have more stress and +anxiety than other students [4], especially more in female students +[5]. So, there is a need for physical activity and stress management +in nursing students to maintain their health [6]. +In our study, the following psychological variables; mindfulness, +self-compassion, empathy, resilience, and satisfaction with life were +included. Mindfulness is being aware of the present moment to +one’s own experiences [7]. Being mindful aids in stress management +[8]. According to Neff, self compassion is being warm and caring +at times of hardship, being kind to self, accepting suffering or +unpleasant experiences as it is and being non judgmental [9]. +Moving ahead, empathy is an essential professional quality a +student nurse should possess to provide quality health care to +the patients. In this study, empathy on cognitive dimension was +measured. Empathy can be defined as, “a predominantly cognitive +attribute that involves understanding of the patient’s experiences, +concerns, and perspectives with a capability to communicate this +understanding and an intention to help [10]”. In Congruent with the +professional requirement, many studies have reported that nursing +students have higher levels of empathy than other undergraduate +students [11-13]. Nevertheless, female nursing students are +more empathetic than male students [12,13]. Also, higher level of +empathy and resilience was reported in older nursing students [14]. +According to the American Psychological Association, resilience can +be defined as, “the process of adapting well in the face of adversity, +trauma, tragedy, threats or even significant sources of stress [15]”. +Substantially, resilience aids in the retention of students in the +academic program [16], and in their academic success [17] and, +this helps them to cope effectively with adversities in the clinical +setting [18]. Satisfaction with life is a subjective judgment about his +or her life [19]. However, nursing students have reported higher level +of life satisfaction [5] than compared to other students [20]. +Indeed, physical fitness is associated with perceived physical and +psychological health. Nursing students have reported poor to +moderate levels of physical fitness and this needs to be addressed +through appropriate intervention [21,22]. Yoga is an effective +practice to reduce stress [23] and improve psychological well being +[24,25]. Hence, the present study was designed to evaluate the +effectiveness of eight week yoga intervention to reduce perceived +stress and to enhance psychological well being among nursing +students. +MATERIALS AND METHODS +The present study was a randomized WLC trial. Total of 100 students +{1st and 2nd year General Nursing and Midwifery (GNM) and 1st to +3rd year BSc Nursing} were recruited from Kempegowda Institute +of Nursing, Bengaluru, Karnataka, India. In this study, female +students aged between 17-30 years and who were willing to learn +yoga were included. However, students who were diagnosed with +severe neurological or psychiatric illness, those students receiving +treatment for hormonal imbalance, recently underwent surgical +intervention, and regularly practicing yoga was excluded. The +Monali Devaraj Mathad1, Balaram Pradhan2, Rajesh K Sasidharan3 +Keywords: Mindfulness, Nursing education, Perceived stress, Resilience, Self compassion +ABSTRACT +Introduction: Nursing students experience considerable +amount of stress to meet their professional demands. Yoga is +an effective practice to reduce stress and improve psychological +well being. However, improvement in psychological well being +aids in stress management. +Aim: To evaluate the effectiveness of eight week yoga +intervention on psychological functioning of nursing students. +Materials and Methods: This was a randomised Wait List +Control (WLC) trial, we recruited total 100 students from +Kempegowda Institute of Nursing, Bengaluru, Karnataka, India +and randomized them into two groups (yoga=50 and WLC=50 +students). The following instruments were used to collect the +data, Freiburg Mindfulness Inventory (FMI), Self-Compassion +Scale- Short Form (SCS-SF), Connor–Davidson Resilience Scale +(CD-RISC), Satisfaction with Life Scale (SWLS), Jefferson Scale +of Empathy HPS-Version (JSE-HPS), and Perceived Stress Scale +(PSS). Data was analysed using Repeated Measures Analysis +of Variance (RM-ANOVA) followed by post-hoc Bonferroni +correction for all psychological variables. +Results: The results of our study report that eight week yoga inter­ +vention was significantly effective in improving self compassion +and mindfulness among nursing students in experimental +group than compared to WLC group. Even though there were +improvements in resilience, satisfaction in life and perceived +stress, results were not statistically significant. +Conclusion: Overall, results of the present study have +demon­ +strated impact of eight week yoga intervention on the +psychological functioning of nursing students. Yoga intervention +can be inculcated in the nursing education to meet demands of +the profession. +Monali Devaraj Mathad et al., Effect of Yoga on Psychological Functioning of Nursing Students- A Randomized Wait List Control Trial +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2017 May, Vol-11(5): KC01-KC05 +2 +research study was carried out between May 2015 to July 2015. +After screening, students were randomly allocated into two groups. +Yoga group received yoga intervention for eight week {five days/ +week, one hour/day} and the WLC group continued their routine +work for the first eight week. After the completion of study, yoga +intervention was given to WLC group also. +Sample Size +A priori computation of sample size using G* Power version 3.1.9.2, +revealed 64 participants were required with an effect size 0.347 [26] +at an alpha value of 0.05 and with an actual power of 0.80. +Ethical Approval +Approval of Institutional Ethics Committee was obtained for this +study {RES/IEC-SVYASA/59/2015} and informed consent was +obtained from all the students who were recruited for the research +study. +Intervention +The yoga intervention was based on integrated approach to yoga +therapy as designed by S-VYASA [27]. Details of yoga intervention +are described in the [Table/Fig-1]. +Assessments +Data were collected using sociodemographic sheet and five self +reported questionnaires. +Sociodemographic sheet included name, age, religion, level of +education, and address. +FMI: The FMI is a self report questionnaire to measure mindfulness. +This scale consists of 14 items and is very sensitive to change in +mindfulness. Each item has a 4-point Likert rating from 1 (Rarely) +to 4 (Almost always). The total score will range between14 to 56, +high score represents high mindfulness. This scale has a sound +psychometric properties and reported Cronbach’s alpha is 0.86 [28]. +CD-RISC 10: This is a brief, self report questionnaire to measure +resilience. In this study, 10 items scale was used. Response to each +item will be from 0 (not true at all) to 4 (true nearly all the time). The +range of total score is from 0 to 40. High score corresponds to high +resilience. This scale has a robust psychometric properties [29], +with Cronbach’s alpha=0.85 [30]. +SCS-SF: This is a self report questionnaire to measure self- +compassion. In this study, we have used 12 items scale. Response +for each item will be between 1 (Almost never) to 5 (Almost always). +Scores can range from 12 to 60; one who scores high has high +level of self compassion. The SCS–SF is a reliable and valid tool to +assess self compassion with reported Cronbach’s alpha is ≥0.86. +This scale has a close correlation with the long form of SCS r ≥0.97 +for all samples [31]. +SWLS: This is a short 5-item questionnaire to measure global +cognitive judgments of satisfaction with one’s life. This scale +requires about one minute to complete the test. Each item must be +scored on a 7-point Likert rating between 1 (Strongly Disagree) to +7 (Strongly Agree). This scale has a good psychometric properties +and can be widely used among wide range of age groups with +average alpha coefficient 0.85 [19]. Satisfaction with life scale also +focuses on emotional well being or underlying psychopathology of +an individual as the evaluation is based on his own criteria [32]. +JSE-HPS: This is a 20 item scale designed to measure empathy +(cognitive). Each item should be scored on a 7-point Likert rating +between 1 (Strongly Disagree) to 7 (Strongly Agree). The total score +will range between 20 to 140. High score corresponds to high level +of empathy. This scale has reported robust psychometric properties +with Cronbach’s alpha 0.78 and 0.93 among nursing students of +southeastern part of USA [33]. +PSS: This is a self reported questionnaire to assess perception of +stress in one’s day-to-day life. This is a 10-item questionnaire. Each +item should be rated on 5-point Likert scale 0 (Never) to 4 (Very +Often). High score represents high level of perceived stress. This +scale has reported adequate psychometric properties [34,35]. +Statistical Analysis +Data were analysed using SPSS 16.0 version. RM-ANOVA +followed by post-hoc Bonferroni correction was performed for all +psychological variables with the level of significance at p<0.05. +RESULTS +The trial profile of the study is depicted in the [Table/Fig-2]. For this +study, 100 students were recruited, 50 participants in each group +and there were 10 dropouts in each group. Finally, for analysis there +were 80 students left. +The age of all participants in the yoga group was 19.65±1.48 and in +the WLC group was 19.35±1.03. Characteristics of the participants +are reported in the [Table/Fig-3]. It is apparent from this table that +majority of the students belong to Hindu religion and their mother +tongue was kannada. In this study, all the participants were females, +single and were residing in the college hostel. +Proceeding further, data was analysed using Repeated Measure +of Analysis of Variance (RM-ANOVA). Results are reported in the +Sl. No. +Intervention +Approximate +time for the +practice +Schedule +1 +Basic Instructions +15 minutes +First day +2 +Breathing practices- +Hands in and out breathing, +Hand stretch breathing, +Ankle stretch breathing, +Leg raising (Alternative and both legs). +breathing, +Tiger breathing, +Rabbit (Shashanka) breathing +10 minutes +Daily-first week +to 8th week +3 +Loosening practices- +Twisting, +Side bending, +Forward and backward bending +Jogging +10 minutes +Daily-first week +to 8th week +4 +Sun salutation +(Suryanamaskara) +10-12 minutes +Daily-first week +to 8th week +5 +Asanas (postures) +Standing posture- +Half wheel posture (Ardhacakrasana) +Foot palm posture (Padahastasana) +Half waist rotation posture +(Ardhakaticakrasana) +Tree posture (Vrkshasana) +Triangle posture (Trikonasana) +Sitting posture- +Diamond posture (Vajrasana) +Rabbit posture (Shashankasana) +Spinal twist posture (Vakrasana/ +Ardhamatsendrasana) +Camel posture (Ustrasana) +Posterior stretch (Paschimottanasana) +Supine asana +Fish posture (Matsyasana) +Shoulder stand posture (Sarvangasana) +Prone asana +Cobra posture (Bhujangasana) +Grasshopper posture (Shalabhasana) +Bow posture (Dhanurasana) +10-15 minutes +Daily-first week +to 8th week +6 +Quick Relaxation Technique (QRT) +3 minutes +Daily-first week +to 8th week +7 +Pranayama- +Kapalabhati +Nadishodana pranayama +Bhramari chanting +8-10 minutes +Daily-From 2nd +week +8 +Yogic games (Krida yoga) +8-10 minutes +Alternative days +9 +Meditation +5 minutes +Once in a +month +10 +Lecture session +10 minutes +Once in a +month +[Table/Fig-1]: List of yoga practices in the yoga module. +www.jcdr.net +Monali Devaraj Mathad et al., Effect of Yoga on Psychological Functioning of Nursing Students- A Randomized Wait List Control Trial +Journal of Clinical and Diagnostic Research. 2017 May, Vol-11(5): KC01-KC05 +3 +[Table/Fig-2]: Trial profile. +and self compassion among nursing students in yoga group than +compared to WLC group. Even though, we could not elicit statistical +significance the following improvements were witnessed among +participants of yoga group in contrast to WLC group. There was +improvement in resilience and perceived stress in yoga group but +not in WLC group. However, there was improvement in satisfaction +with life among both the groups. Contrary to our expectation, +decrease in the empathy was reported in both the groups, but +significant decrease was noticed in WLC group. +Characteristics of the +participants +N (%) +Yoga group +(40) +WLC group +(40) +Class/batch +1st year GNM +2nd year GNM +1st year BSc +2nd year BSc +3rd year BSc +17 (42.5%) +6 (15%) +5 (12.5%) +5 (12.5%) +7 (17.5%) +10 (25%) +10 (25%) +7 (17.5%) +7 (17.5%) +6 (15%) +Religion +Hindu +Christian +Muslim +29 (72.5%) +9 (22.5%) +2 (5%) +26 (65%) +14 (35%) +- +Mother tongue +Hindi +Kannada +Others +- +26 (65%) +14 (35%) +1 (2.5%) +23 (57.5%) +16 (40%) +[Table/Fig-3]: Characteristics of the participants. +For self compassion, within group comparison (ANOVA) did not +show significant improvement, F (1,78) = 1.894, p = 0.173. Whereas, +interaction between time x group reported significant improvement, +F (1,78) = 4.506, p = 0.037. Results of post-hoc analysis with +Bonferroni adjustment reported significant improvement within the +yoga group (p = 0.016), but there was no significant improvement +within the WLC group (p = 0.599). +Within group comparison (ANOVA) did not show significant increase +in satisfaction with life, F (1, 78) = 1.768, p = 0.187. Likewise, in +interaction between time x group also there was no significant +Psychological +Variables +Group +Pre +M ± +SD +Post +M± SD +% change +Within group +Between group +Group x +Time +Diff +p-value +pre vs pre +post vs post +Self-compassion +Yoga +3.03± +0.46 +3.19± +0.28 +5% +0.16 +0.016* +0.18 +0.01 +0.037* +WLC +3.22± +0.46 +3.18± +0.40 +-1% +-0.04 +0.599 +Satisfaction with life +Yoga +21.60± +5.02 +22.40± +5.29 +4% +0.80 +0.232 +0.75 +0.40 +0.711 +WLC +22.35± +5.07 +22.80± +4.78 +2% +0.45 +0.500 +Mindfulness +Yoga +37.09± +3.74 +39.46± +4.97 +6% +2.37 +0.005* +1.18 +2.68 +0.001** +WLC +38.28± +4.92 +36.78± +5.64 +-4% +-1.5 +0.073 +Resilience +Yoga +23.20± +5.83 +23.68± +5.92 +2% +0.48 +0.633 +1.13 +0.73 +0.196 +WLC +24.33± +6.05 +22.95± +5.47 +-6% +-1.38 +0.176 +Empathy +Yoga +97.50± +13.02 +93.37± +14.50 +-4% +-4.13 +0.074 +3.45 +3.87 +0.895 +WLC +94.05± +12.89 +89.50± +11.60 +-5% +-4.55 +0.049* +Stress +Yoga +20.80± +4.10 +19.33± +3.69 +7% +1.47 +0.059 +0.80 +1.22 +0.066 +WLC +20.00± +4.11 +20.55± +3.34 +-3% +-0.55 +0.474 +Table/Fig-4: Results of RM-ANOVA for all the psychological variables in the yoga group (n=40) and the WLC group (n=40). +*significant at the 0.05 level +**significant at the 0.01 level +[Table/Fig-4]. Meanwhile, normality test (Shapiro-Wilk) ensured that +there is no significant difference between yoga and WLC groups at +baseline for all the variables. This is evident from the [Table/Fig-4] +that eight week yoga intervention significantly improved mindfulness +Monali Devaraj Mathad et al., Effect of Yoga on Psychological Functioning of Nursing Students- A Randomized Wait List Control Trial +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2017 May, Vol-11(5): KC01-KC05 +4 +improvement, F (1, 78) = 0.139, p = 0.711. In post-hoc analysis +with Bonferroni correction did not show significant increase within +the yoga group (p = 0.232) and the WLC group (p = 0.500). +Similarly, within group comparison (ANOVA) for mindfulness did not +report significant improvement, F (1, 78) =0.547, p = 0.462. But, for +interaction between time x group showed significant improvement, +F (1, 78) = 10.945, p<0.001. Results of post-hoc analysis with +Bonferroni adjustment reported significant increase within the yoga +group (p = 0.005), but there was no significant improvement in the +WLC group (p = 0.073). +For resilience, within group comparison (ANOVA), F (1, 78) = 0.393, +p = 0.533 and interaction between time x group did not report +significant improvement, F (1, 78) = 1.700, p = 0.196. In post-hoc +analysis with Bonferroni correction also did not show significant +increase within the yoga group (p = 0.633) and the WLC group (p += 0.176). +Conversely, in within group comparison [ANOVA] significant +decrease in empathy was reported, F (1, 78) = 7.265, p = 0.009. +However, interaction between time x group did not report significant +improvement, F (1, 78) = 0.017, p = 0.895. Post-hoc analysis with +Bonferroni adjustment did not find significant increase within yoga +group (p = 0.074), but significant decrease in empathy within the +WLC group (p = 0.049) was reported. +Results of within group comparison (ANOVA) did not demonstrate +significant decrease in perceived stress, F (1, 78) = 0.720, p += 0.399. Similarly, time x group interaction also did not report +significant decrease, F (1, 78) = 3.482, p = 0.066. Findings of post- +hoc analysis with Bonferroni adjustment did not report significant +reduction in stress within the yoga group (p =0.059) and within the +WLC group (p = 0.474). +DISCUSSION +The results of our study have reported that eight week yoga +intervention was significantly effective in improving self compassion +and mindfulness among nursing students in yoga group than +compared to WLC group. The following studies are in line with +our results. Yoga practitioners showed significant improvement +in mindfulness [36-38]. Eight week yoga intervention significantly +improved mindfulness among healthy population in experimental +group than compared to WLC group [39]. Eleven week yoga +intervention (one hour per week) among medical students +significantly increased self-compassion but, improvement in +empathy and perceived stress were not statistically significant +[40]. Self compassion is considered as the potential mechanism +through which yoga intervention reduces perceived stress [26,41]. +Even, in our study there was a decrease in perceived stress among +participants of yoga group than WLC group, but results were not +statistically significant. Many studies have reported that, yoga is +effective in the management of stress [23,38,40,42-49]. +This result was contrary to our expectation, as there was a decrease +in empathy in the both groups. But in WLC group, there was a +significant decrease in empathy. Previous studies also reported +similar findings, that there was decline in empathy among nursing +students [50,51]. As our intervention was for eight week, this time +duration may be short to witness decline in empathy. Reason for +this result remains unclear. +Subsequently, there was improvement in satisfaction with life in the +both groups, but our results could not elicit statistical significance. +There is a significant association between satisfaction with life and +participation in physical activity [52]. During the phase of intervention +students of both the groups were participating in cultural and sports +activities. This may the reason for improvement in satisfaction with +life in both the groups. Earlier studies were in accord with our result. +In a RCT, six week yoga intervention one hour/week improved life +satisfaction and resilience to stress among university staff [53]. In +our study, also there was improvement in resilience in yoga group +but not in WLC group. +During the phase of yoga intervention students had to attend +their internal assessment tests, complete their annual academic +requirements and many students were participating in annual +cultural and sports competition. This may be the reason for mixed +results in our study. +LIMITATION +The scope of this study is limited in terms of assessment tools as +self reported questionnaires were used for data collection. However, +duration of intervention could have been for longer than eight week +with readings taken at multiple timelines and follow up report of the +study. This study could have been implemented in the beginning +of the academic program, to evaluate the effect of yoga on the +psychological functioning of nursing students. +CONCLUSION +Results of our study have demonstrated, eight week yoga intervention +significantly improved mindfulness and self-compassion among +participants in yoga group than compared to WLC group. Both +mindfulness and self compassion plays vital role in combating stress. +As nursing students are exposed to high levels of stress compared +to other students. It is essential to inculcate yoga intervention in the +nursing education to meet demands of the profession. +ACKNOWLEDGEMENTS +We would like to thank Principal, Kempegowda Institute of Nursing +for giving permission to conduct research in their college. +We thank and appreciate all the nursing students for their sincere +participation in our research study. +REFERENCES + Pulido-Martos M, Augusto-Landa JM, Lopez-Zafra E, Article R. 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The effectiveness of +[53] +yoga for the improvement of well-being and resilience to stress in the workplace. +Scand J Work Environ Health. 2011;37(1):70–76. +PARTICULARS OF CONTRIBUTORS: +1. Research Scholar, Department of Division of Yoga and Humanities, S-VYASA University, Bengaluru, Karnataka, India. +2. Assistant Professor, Department of Division of Yoga and Humanities, S-VYASA University, Bengaluru, Karnataka, India. +3. Assistant Professor, Department of Division of Yoga and Humanities, S-VYASA University, Bengaluru, Karnataka, India. +NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: +Ms. Monali Devaraj Mathad, +Research Scholar, S-VYASA University, #19, Eknath Bhavan, +Gavipuram Circle, Kempe Gowda Nagar, Bengaluru-560019, Karnataka, India. +E-mail: mathad.kwr@gmail.com +Financial OR OTHER COMPETING INTERESTS: None. +Date of Submission: Jan 03, 2017 +Date of Peer Review: Feb 02, 2017 +Date of Acceptance: Mar 09, 2017 +Date of Publishing: May 01, 2017 diff --git a/subfolder_0/Effect of Yoga on Sleep Quality and Neuroendocrine Immune Response in Metastatic Breast Cancer Patients.txt b/subfolder_0/Effect of Yoga on Sleep Quality and Neuroendocrine Immune Response in Metastatic Breast Cancer Patients.txt new file mode 100644 index 0000000000000000000000000000000000000000..92dc8893d45b5357957f87740ff6cb04469959a7 --- /dev/null +++ b/subfolder_0/Effect of Yoga on Sleep Quality and Neuroendocrine Immune Response in Metastatic Breast Cancer Patients.txt @@ -0,0 +1,512 @@ +Indian J Palliat Care. 2017 Jul-Sep; 23(3): 253–260. +doi: 10.4103/IJPC.IJPC_102_17 +PMCID: PMC5545949 +PMID: 28827927 +Effect of Yoga on Sleep Quality and Neuroendocrine Immune Response +in Metastatic Breast Cancer Patients +Raghavendra Mohan Rao, HS Vadiraja, R Nagaratna, K S Gopinath, Shekhar Patil, Ravi B Diwakar, +HP Shahsidhara, BS Ajaikumar, and HR Nagendra +Department of Complementary and Alternative Medicine, Healthcare Global, Bengaluru, Karnataka, India +Department of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, +India +Department of Surgical Oncology, HCG Bangalore Institute of Oncology Specialty Center, Bengaluru, +Karnataka, India +Department of Medical Oncology, HCG Bangalore Institute of Oncology Specialty Center, Bengaluru, +Karnataka, India +Department of Radiation Oncology, HCG Bangalore Institute of Oncology Specialty Center, Bengaluru, +Karnataka, India +Department of Research and Development, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, +Karnataka, India +Address for correspondence: Dr. Raghavendra Mohan Rao, Head CAM Program, Healthcare Global +Enterprises Ltd., No. 8, HCG Towers, P Kalinga Rao Road, Sampangiramnagar, Bengaluru - 560 098, +Karnataka, India. E-mail: raghav.hcgrf@gmail.com +Copyright : © 2017 Indian Journal of Palliative Care +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. +Abstract +Background: +Studies have shown that distress and accompanying neuroendocrine stress responses as important +predictor of survival in advanced breast cancer patients. Some psychotherapeutic intervention studies +have shown have modulation of neuroendocrine-immune responses in advanced breast cancer patients. +In this study, we evaluate the effects of yoga on perceived stress, sleep, diurnal cortisol, and natural +killer (NK) cell counts in patients with metastatic cancer. +Methods: +In this study, 91 patients with metastatic breast cancer who satisfied selection criteria and consented to +participate were recruited and randomized to receive “integrated yoga based stress reduction program” +(n = 45) or standard “education and supportive therapy sessions” (n = 46) over a 3 month period. +Psychometric assessments for sleep quality were done before and after intervention. Blood draws for +1 +1 +2 +3 +3 +3 +4 +5 +1 +2 +3 +4 +5 +NK cell counts were collected before and after the intervention. Saliva samples were collected for three +consecutive days before and after intervention. Data were analyzed using the analysis of covariance on +postmeasures using respective baseline measure as a covariate. +Results: +There was a significant decrease in scales of symptom distress (P < 0.001), sleep parameters (P = +0.02), and improvement in quality of sleep (P = 0.001) and Insomnia Rating Scale sleep score (P = +0.001) following intervention. There was a decrease in morning waking cortisol in yoga group (P = +0.003) alone following intervention. There was a significant improvement in NK cell percent (P = +0.03) following intervention in yoga group compared to control group. +Conclusion: +The results suggest modulation of neuroendocrine responses and improvement in sleep in patients with +advanced breast cancer following yoga intervention. +Keywords: Cortisol, immune, natural killer cell, sleep, yoga +Iඖගක඗ඌඝඋගඑ඗ඖ +The advancement and progression of breast cancer impose severe psychologic distress. There follows a +sequel of dejection, depression anxiety, and fear of dying and thoughts of impending treatments-related +side effects that are known to cause distress, impair sleep, and normal functioning.[1,2] Metastatic +breast cancer patients often have to cope with uncertainty about their future which is known to cause +severe stress.[3] This chronic stress is known to impair sleep and circadian rhythms. Impairment in +sleep in cancer patients could be due to pain, electrolyte disturbances, infection, or psychologic distress +and mood states.[4] Sleep is an important buffer of stress response. Both sleep quality and duration are +important attributes of sleep.[5] While good sleep acts as a buffer of stress response, impaired sleep is +known to exacerbate symptoms, distress, and fatigue.[6] Alteration in circadian patterns of sleep with +daytime sleepiness and fatigue is one of the early signs of sleep impairment.[4,6] This impairment in +sleep is primarily caused due to elevated stress hormones such as cortisol and change in circadian +rhythms of cortisol due to perceived stress.[7] This triad of stress, sleep impairment, and altered diurnal +cortisol rhythm is known exacerbate symptom distress, pain, fatigue, and lower antitumor immune +response in patents.[8] +This treatment-related distress coupled with daily hassles is intense enough to cause elevated cortisol +levels and hypothalamopituitary axes dysregulation.[8,9] Most distressed patients have had flat or +upward cortisol slopes that have shown to be an important predictor for survival.[7,8] +Moreover, the effects of this intense stressor are known to affect psychoneuroendocrine and +psychoneuroimmune axes causing maladaptive neuroendocrine responses and immunosuppression. +[10,11] This is evident in earlier studies wherein advanced breast cancer patients had low natural killer +(NK) cell counts due to their psychologic distress.[8,11] The study of changes in these pathways has +intrigued scientists to try psychologic and mind-body interventions that can modulate these pathways +and help patients cope with this stressor. +Several studies have shown that psychotherapeutic interventions modulate abnormal rhythms and +morning salivary cortisol peaks and improve sleep quality and reduce distress. Cognitive behavior +therapy,[12,13] supportive therapy,[14] and other mind-body therapies such as mindfulness-based +stress reduction,[15] Yoga, Tai Chi,[16] etc., have shown to reduce morning cortisol levels. In our +earlier study with stage I–III breast cancer patients undergoing radiotherapy, our integrated yoga +program showed decrease in cortisol levels following radiotherapy.[17] However, most of these studies +have shown changes in early cancer patients with exception of few on metastatic breast cancer patients +using psychotherapeutic interventions.[16] +Mඍගඐ඗ඌඛ +In this study, 91 patients with metastatic breast cancer were recruited to participate in a trial comparing +an integrated yoga program versus education and supportive therapy sessions on stress, sleep, diurnal +salivary cortisol rhythms, and NK cell counts. The recruitments were carried out from January 2004 to +June 2007 with referrals from medical and radiation oncology outpatient departments of a +comprehensive cancer care center. The Institutional Review Board of the participating institution +approved the study. The subjects were recruited if they satisfied the selection criteria and gave written +consent to participate in the study. +Selection criteria +Patients were included if they met the following criteria: +Women diagnosed with stage IV breast cancer within 6 months–2 years after diagnosis either +recurrent disease or progressive disease +Age between 30 and 70 years +Zubrod's performance status 0–2 (ambulatory >50% of time) +Minimum high school education +Willingness to participate in the study. +Exclusion criteria were +Duration of metastasis more than 1 year +Brain metastasis +Those undergoing chemotherapy/radiotherapy during the study except for treatment of bone +metastases with bisphosphonates/zoledronic acid +Those on hydrocortisone medications +A concurrent medical condition likely to interfere with yoga intervention or survival +Any major psychiatric, neurological illness, or autoimmune disorders +Those who are on hydrocortisone medications or have HIV +Pregnant and lactating mothers or planning to conceive during the study period +Those who are recruited for clinical trials involving investigational new drugs +Prior practice of yoga in the last 6 months +Prior chemotherapy other than treatment of bone metastases mentioned above in the last 2 weeks +History of any pathologic fractures. +In this study, 257 patients with advanced metastatic breast cancer patients were screened over a 3-year +period. One hundred and fifty-three patients were eligible, and 91 patients consented to participate in +this study. Patients were recruited to participate in a two-arm prospective randomized controlled trial +comparing the effects of an “integrated yoga based stress reduction program” (n = 45) versus standard +“education and supportive therapy sessions” (n = 46). +Sample size +Earlier study with Mindfulness-Based Stress Reduction Program (MBSR) had shown a modest effect +size (ES = 0.38) on EORTC QLC30 global quality of life measure.[18] We used G power to calculate +the sample size with α = 0.05 and β = 0.2 and an ES of 0.38 for repeated measures ANOVA between +factor effects. The sample size thus required was (n = 44) in each group. Second, earlier studies were +only on stage I–III breast cancer patients and not on metastatic breast cancer patients. +Randomization +A person who had no part in the trial randomly allocated consenting participants to either yoga or +supportive therapy groups using random numbers generated by a random number table at a different +site. 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. +Masking and blinding +Being a popular intervention, it was not possible to mask the yoga intervention from the subjects. +However, the investigators (treating oncologists) were blind to the intervention and subjects were asked +not to disclose the type of intervention (yoga or supportive therapy) to them. Second, the saliva and +blood samples were blinded from the technicians who analyzed the coded samples at a site different +from the study center. The samples and data were unblinded only at the conclusion of the study. +Outcome measures +Pittsburgh Insomnia Rating Scale is a widely used instrument in clinical and research practice.[19] It is +a scale with 65-items. It was designed to assess severity of insomnia in clinical settings. It is known to +assess subjective distress score (46 items) related to sleep, subjective sleep parameters (10 items) and +sleep-related quality-of-life (9 items). The items have to be scored according to symptoms experienced +in the previous week. The test-retest reliability and internal consistency for the scale was 0.93 (Veqar +and Hussain, 2016).[20] +Diurnal salivary cortisol measures +Saliva collection and storage: participants were trained to collect their saliva by chewing on a cotton +swab and dribble the saliva to a plastic holder resting inside a sterile centrifuge tube. Samples were +collected at 0600 h, 0900 h, and 2100 h for 3 consecutive days. The samples were stored in refrigerator +and delivered to study personnel after 3 days. Samples were then centrifuged to remove mucous, +freeze, and stored at −70°C in Eppendorf tubes for analysis. +Quantifications of salivary cortisol +Salivary cortisol levels were assessed using enzyme immunoassay method using kits manufactured by +Salimetrics Inc., USA. The test samples were run in duplicates and readings taken on a microplate +reader (Bio-Rad, USA). The tests were standardized under controlled laboratory conditions using +standards, positive, and negative controls provided along with the kit by the manufacturer. The plates +were read at 450 nm, and a standard curve was plotted on a graph for each run by plotting the log of +cortisol concentrations on “y” axis and log of optical density (O.D) reading on “x” axes and best fit line +determined by regression analyses. The values were then extrapolated with the graph using the mean +O.D readings of the duplicate wells and plotting their corresponding concentration on the graph. The +detection range with these kits was 0.012–3.0 Hgm/dl. The intra-assay coefficient ranged from 3.35% +to 3.65% and inter-assay coefficient from 3.75% to 6.41% with these samples. Mean cortisol levels for +specific time points over a 3-day period were extrapolated. +Natural killer cells (CD56%) measures +Blood sample collection: all subjects in metastatic breast cancer study were asked to provide blood +samples at the study start and at the end of intervention. About 5 ml of heparinized blood sample was +collected in vacuettes under sterile conditions. All the blood samples were collected between 8 am to +12 am to reduce diurnal variability. +Quantification of natural killer cells (CD56%) +The NK cell assay was done using reagents and antibodies from DAKO Corporation, USA in a Becton +Dickinson Flow Cytometer. Flow cytometer measures and analyses optical properties of single cells +passing through a focused laser beam, analysis of hundreds of cells per second provides a statistically +significant picture, when the cells pass through the laser beam they disrupt and scatter the laser light +which is detected as forward scatter (FSC) and side scatter (SSC). While FSC is related to cell size, the +SSC is an indicator of cells internal complexity. Cells are stained with monoclonal antibodies coupled +with fluorescent dye FITC, and the conjugated samples were acquired using flow cytometer, when +acquiring, blood cells are segregated into different populations-lymphocytes, monocytes, and +erythrocytes using cell quest pro software version 3.1. The cytometer processes the electronic signals +resulting from each cell and creates numeric value for each parameter. Each cell count acquired is taken +as one event. Before acquiring this is set based on the availability of the cells in the sample (it is set for +10,000 events). Once acquisition is done, the cells segregated are analyzed by encircling the cell +population in FSC/SSC plot. Stained cells are separated from the unstained cells by gating. The +cytometer processes the electronic signals resulting from each cell and creates numeric value for each +parameter thereby total number of NK cells and percentage NK cells are calculated. Absolute +lymphocyte count (ALC) was also estimated using this procedure. +Interventions +The intervention group received “integrated yoga program” and the control group received “supportive +counseling sessions” both imparted as individual sessions. The objectives of this yoga intervention as +described to participants were as follows: (i) to develop an opportunity to understand one's personal +responses to daily stress and explore ways and means to cope with them, (ii) to learn concepts and +techniques which bring about stress reduction and change in appraisal, and (iii) to enable the +participants to take an active part in their self-care and healing. +The yoga practices consisted of a set of asanas (postures done with awareness) breathing exercises, +pranayama (voluntarily regulated nostril breathing), meditation, and yogic relaxation techniques with +imagery. These practices were based on principles of attention diversion, awareness and relaxation to +cope with stressful experiences. +The sessions began with didactic lectures and interactive sessions on philosophical concepts of yoga +and importance of these in managing day-to-day stressful experiences (10 min) beginning every +session. This was followed by a preparatory practice (20 min) with few easy yoga postures, breathing +exercises, and pranayama and yogic relaxation. The subjects were then guided through any one of these +meditation practices for next 30 min which included focusing awareness on sounds and chants from +Vedic texts,[21] or breath awareness and impulses of touch emanating from palms and fingers while +practicing yogic mudras, or a dynamic form of meditation (cyclic meditation) which involved practice +with eyes closed of four yoga postures interspersed with relaxation while supine, thus achieving a +combination of both “stimulating” and “calming,” practice.[22] In meditation, participants try to +develop clarity in their thinking, learn to observe their own mind, decrease negative mind states and +develop positive mind states, and maintain equipoise in their emotions. These sessions were followed +by informal individual counseling sessions that focused on problems related to impediments in home +practice, clarification of participant's doubts, motivation, and supportive interaction with spouses. The +participants were also informed about practical day-to-day application of awareness and relaxation to +attain a state of equanimity during stressful situations and were given homework in learning to adapt to +such situations by applying these principles. +The subjects were given booklets and instructions on these practices and were encouraged to pursue +relevant themes and gain greater depth through proficiency in practice. Subjects were provided +audiotapes of these practices for home practice using the instructor's voice so that a familiar voice +could be heard on the cassette. Subjects were asked to attend yoga intervention at least two times/week +for 12 weeks. The control groups were imparted supportive counseling during their hospital visits. +Patients were exposed to at least 24 in person sessions with home practice on the remaining days. +Patients were asked to maintain a diary noting their daily activity, daily yoga schedule, duration of +practice, intake of medications, and distressing symptoms if any, etc. +Their homework was monitored on a day-to-day basis by their instructor who conducted weekly house +visits, and participants were also encouraged to maintain a daily log listing the yoga practices done, use +of audiovisual aids, duration of practice, experience of distressful symptoms, and diet history. There +were two instructors in all one being a physician in naturopathy and yoga and other a trained and +certified therapist in yoga from the yoga institute. They together supervised and imparted the yoga +intervention while trained social workers and counselors at the cancer hospital imparted supportive +therapy intervention. +Control intervention-supportive counseling sessions +Supportive counseling sessions as control intervention included two important components “education +and reinforcing social support.” The reasons why we chose to have education and supportive therapy +sessions as control intervention are 3-fold. +This was used as a control intervention to control for the nonspecific effects of the program that may be +associated with adjustments such as attention, support, and a sense of control. In fact, these didactic +educational interventions are known to improve quality of life of women with breast cancer[23,24] and +serve as an effective coping preparation in controlling chemotherapy-related side effects.[25] +Even though the use of education and supportive therapy is a form of enhanced usual care, if yoga +program does not provide any benefit over this intervention, then we will know that didactic +educational programs should be integrated within the standard of care. +Similar supportive sessions have been used successfully as a control comparison group to evaluate +psychotherapeutic interventions.[26,27] These sessions aimed at enriching the patient's knowledge of +their disease and treatment options, thereby reducing any apprehensions and anxiety regarding their +treatment and involved interaction with the patient's spouses. Subjects and their caretakers were invited +to participate in an introductory session lasting 60 min before starting any conventional treatment +wherein they were given information about each conventional treatment and management of its related +side effects, dietary advice, providing information about a variety of common questions and showing a +patient coping successfully. This counseling was extended over the course of their intervention during +their hospital visits (once in 10 days, 15 min sessions), and participants were encouraged to meet their +counselor whenever they had any concerns or issues to discuss. Subjects in the supportive therapy +group also completed daily logs or dairies on treatment-related symptoms, medication, and diet while +the goals of yoga intervention were stress reduction and appraisal change, the goals of supportive +therapy were education, reinforcing social support, and coping preparation. +Baseline assessments were done on 91 patients in case of metastatic breast cancer patients. A total of +66 patients contributed data to the current analyses. 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 [Figure 1]. Among the 66 study +completers, 46 out of 66 completers gave the saliva samples as per protocol. Fifteen subjects (yoga n = +5, control, n = 10) in the study were not comfortable in giving saliva samples. Subjects who missed +collecting saliva sample on consecutive days at the same time were excluded from the analysis (n = 5). +Open in a separate window +Figure 1 +Trial profile +Data analysis +Statistical procedures were conducted using SPSS version 10 (Sun Micro solutions, Gujarat, India) for +PC Windows 2000. The data of baseline and follow-up of both the groups were assessed with tests for +normality and homogeneity using Shapiro–Wilks test and one-way ANOVA. We used the analysis of +covariance (ANCOVA) to study the effects of intervention on outcome measures at follow-up +assessments using their respective baseline measure as a covariate. Paired samples’ t-test was done to +see within-group changes. All analyses were carried out with intention to treat principle to account for +missing values and dropouts. +Diurnal salivary cortisol +Mean cortisol levels for specific time points over a 3-consecutive days were extrapolated at 0600, +0900, 2100 hrs. The diurnal cortisol response was evaluated by calculating the area under curve for +time 0600, 0900 and 2100 h. This helps to limit the amount of statistical comparisons between groups +to minimize the correction of the α-error probability. With the AUC variables, the number of repeated +measurements is irrelevant and thus, the number of statistical comparisons only depends on the number +of groups to be compared. With the two AUC formulas, AUCg for baseline diurnal cortisol +measurements and AUCi increase in the AUC with respect to AUCg for postmeasure using trapezoidal +method,[28] different aspects of the time course of the repeated measurements could be assessed. The +slope of diurnal cortisol rhythm was analyzed using random coefficient modeling (i.e., “linear mixed +models”), which has been advocated by some researchers.[29] Slopes were compared at baseline and at +postmeasurements in both the groups. Alternatively, nonparametric Mann–Whitney U-test and +Wilcoxon-signed rank test were also done for variables with skewed distribution. +Rඍඛඝඔගඛ +Sociodemographic and medical characteristics of the study sample +The mean age of participants was 48.9 ± 9.1 years in yoga and 50.2 ± 9.2 years in control groups. +Twenty-Six subjects underwent surgery, chemotherapy, radiotherapy and chemotherapy, 11 subjects +received chemotherapy and radiotherapy and eight subjects underwent surgery and radiotherapy as +primary treatment. Participants in both groups were comparable with respect to sociodemographic and +medical characteristics. A goodness of fit test run on all these demographic variables did not show any +significant changes between yoga and supportive therapy groups (P > 0.05) [Table 1]. +Table 1 +Demographic and medical characteristics of the initially randomized sample +Insomnia Rating Scale +Insomnia Rating Scale symptom distress +Insomnia Rating Scale sleep parameters +Insomnia Rating Scale quality of life +Insomnia Rating Scale total scores +Diurnal salivary cortisol levels +ANCOVA on postmeasures using baseline symptom distress +scores as a covariate showed a significant difference between groups with better decrease in symptom +distress scores in yoga compared to control group [F (1,61) = 21.23, P < 0.001, ES-1.2, Percentage +change (PC) - 91.31%]. Paired-sample t-test done to assess within group change showed a significant +decrease in symptom distress scores in yoga group only (t = 3.1, P = 0.004) and not in the control +group (t = −1.32, P = 0.19) [Table 2]. +Table 2 +Comparison of Insomnia Rating Scale scores using analysis of covariance between yoga and +control groups with the respective baseline measure as a covariate +ANCOVA on postmeasures using baseline sleep distress +parameter scores as a covariate showed a significant difference between groups with better decrease in +sleep distress parameter scores in yoga compared to control group [F (1,61) = 5.75, P = 0.02, ES - 0.6, +PC - 111.43%]. Paired-sample t-test done to assess within group change showed a significant decrease +in sleep distress parameter scores in yoga group only (t = 2.5, P = 0.01) and not in the control group (t += −1.30, P = 0.20) [Table 2]. +ANCOVA on postmeasures using baseline sleep quality of life +scores as a covariate showed a significant difference between groups with better decrease in sleep +quality of life scores in yoga compared to control group [F (1,61) = 13.03, P = 0.001, ES - 0.9, PC - +20.25%]. Paired-sample t-test done to assess within group change showed a significant decrease in +sleep quality of life scores in yoga group only (t = 2.9, P = 0.006) and not in the control group (t = +0.78, P = 0.44) [Table 2]. +ANCOVA on postmeasures using baseline sleep total distress scores +as a covariate showed a significant difference between groups with better decrease in sleep total +distress scores in yoga compared to control group [F (1,61) = 22.40, P = 0.001, ES - 1.2, PC - 70.77%]. +Paired-sample t-test done to assess within group change showed a significant decrease in sleep total +distress scores in yoga group only (t = 3.3, P = 0.002) and not in the control group (t = −1.33, P = 0.19) +[Table 2]. +ANCOVA was used to assess between-group differences using baseline +cortisol value (for the corresponding time) as a covariate did not show any significant change. A liner +mixed effects model using R software showed no difference in precortisol slopes (P = 0.67, t = 0.41) +and postcortisol slopes (post: P =0.42, t = 0.8) between groups [Table 3]. Paired-samples t-test to assess +within group change following intervention showed a significant decrease in 0600 h. Cortisol (t = 2.28, +P = 0.031) in yoga group alone but not in the control group (t = −0.31, P = 0.76) [Table 3]. +Natural killer cell count and percentage +Absolute lymphocyte count +Adherence to intervention +Table 3 +Results of diurnal cortisol levels after intervention using paired t-test and analysis of covariance +ANCOVA was used to assess between-group differences using +baseline NK cell % value as a covariate showed significant improvement in NK cell % in yoga group +compared to control group [F (1, 31) = 5.43, P = 0.03, ES - 0.5, PC - 32.43%]. Other parameters such +as NK cell count did not show any significant difference between groups. Paired-samples t-test to +assess within group change following intervention showed a significant increase in NK cell % (t = +−3.10, P < 0.01) in yoga group alone but not in the control group (t = 1.03, P = 0.32) [Table 4]. +Table 4 +Comparison of mean values of natural killer cell and absolute lymphocyte count levels using +paired t-test and analysis of covariance +The baseline values of ALC were different in the two groups. There was no +significant change within or between groups in ALC [Table 4]. +In this study, the adherence was good with 80% attending 24 supervised +sessions. There was a significant decrease in 9 am salivary cortisol levels (t = −3.6, P = 0.001) in those +who attended >20 classes as compared to those attending <20 classes on independent samples t-test [ +Table 5]. +Table 5 +Comparison of change scores on salivary cortisol and natural killer cell counts using +independent samples t-test between those attending yoga classes (>20/<20 classes) in yoga +group +Dඑඛඋඝඛඛඑ඗ඖ +Sleep on Pittsburg Insomnia Rating Scale +In this study, there was a significant decrease in symptom distress (91.3%, ES = 1.2), sleep parameters +(111.4%, ES = 0.6), quality of life (20.3%, ES = 0.9), and overall insomnia score (70.8%, ES = 1.2). +Our results are consistent with earlier findings with mindfulness-based stress reduction intervention +that has shown improvement in overall sleep quality by 20.4%.[30] Insomnia has been related to poor +NK cell function, higher morning cortisol levels and abnormal diurnal rhythms in breast cancer +patients.[8] This is an important problem as it seems to worsen with age and psychological distress.[5] +This is also one of the important symptoms in the cancer care continuum expressed often by patients. +[4] Improving sleep duration, quality, and restoring the normal sleep rhythms are important to preserve +immune homeostasis and quality of life. The improvements seen with our intervention suggests that +yoga could be used as an adjunct to manage sleep disorders in cancer patients. +Diurnal salivary cortisol level +There was also a significant decrease in early morning salivary cortisol levels in the advanced breast +cancer study in yoga group only (40.9%, ES = 0.5). The decrease in morning salivary cortisol levels +suggests possible stress-reducing benefits of yoga intervention. Our results are similar to earlier studies +that have shown similar decreases in cortisol in early breast cancer study undergoing adjuvant +radiotherapy.[17] Our results are also similar to changes (16%–45%) in cortisol seen with behavioral +interventions in cancer populations.[13,31,32] While these earlier studies have measured one time +plasma cortisol, we chose to assess both morning and evening levels of free salivary cortisol as changes +in the rate of cortisol secretion over a day (diurnal cortisol rhythm) is considered as a robust measure +compared to onetime cortisol assessment.[8,33] Earlier studies with similar stress reduction +interventions such as MBSR have also shown decrements in cortisol in breast cancer patients who had +initially high cortisol levels suggesting that more distressed patients tend to benefit with stress +reduction intervention.[18] However, there was no difference in both high and low basal cortisol +groups in our study. +One of the major limitations in this study is the inequality in contact duration of interventions. +Supportive therapy interventions were used with an intention of negating the confounding variables +such as instructor-patient interaction, education, and attention.[27] 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 supportive sessions have been used +successfully as a control comparison group to evaluate psychotherapeutic interventions[26,27] and +have been effective in controlling chemotherapy-related side effects. +C඗ඖඋඔඝඛඑ඗ඖ +Future studies should unravel the putative mechanisms and aspects of hypothalamic-pituitary-adrenal +axes dysregulations and assess neuroendocrine responses to artificially induced stressors in the +laboratory. Future studies should use more sophisticated measurements of immune function such as NK +cell cytotoxicity, DNA repair mechanism, etc., to understand the psychoneuroimmune mechanisms +underlying such interventions. 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[PubMed] +[Google Scholar] +Articles from Indian Journal of Palliative Care are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/Effect of Yoga on homocysteine level, symptomatology and quality of life in industrial workers with Chronic Venous Insufficiency_ Study protocol for a randomized controlled trial - ScienceDirect.txt b/subfolder_0/Effect of Yoga on homocysteine level, symptomatology and quality of life in industrial workers with Chronic Venous Insufficiency_ Study protocol for a randomized controlled trial - ScienceDirect.txt new file mode 100644 index 0000000000000000000000000000000000000000..28c90dde0aa2ab43fa2c839f4dcf4df140380472 --- /dev/null +++ b/subfolder_0/Effect of Yoga on homocysteine level, symptomatology and quality of life in industrial workers with Chronic Venous Insufficiency_ Study protocol for a randomized controlled trial - ScienceDirect.txt @@ -0,0 +1,263 @@ +Get rights and content +Advances in Integrative Medicine +Volume 9, Issue 2, May 2022, Pages 119-125 +Study Protocol +Effect of Yoga on homocysteine level, symptomatology and +quality of life in industrial workers with Chronic Venous +Insufficiency: Study protocol for a randomized controlled trial +U. Yamuna, Vijaya Majumdar, Apar Avinash Saoji +Division of Yoga and Life Sciences, Swami Vivekananda Yoga, Anusandhana Samsthana, # 19, Eknath +Bhavan, Gavipuram Circle, KG Nagar, Bengaluru 560019, India +Received 11 November 2021, Accepted 8 February 2022, Available online 11 February 2022, Version of Record 9 +June 2022. +Show less +https://doi.org/10.1016/j.aimed.2022.02.002 +Abstract +Background and objectives +Chronic Venous Insufficiency (CVI) is often associated with prolonged standing at work. CVI +could lead to multiple symptoms and vascular inflammation. Yoga as therapy has helped in +mitigating several occupational hazards. The current study protocol is designed to assess the +effect of Yoga on CVI. +Materials and methods +Share +Cite +One hundred industry workers with CVI will be randomly allotted to Yoga and wait-list +control groups following an equal allocation ratio. Yoga group will receive a specially designed +Yoga module six days a week for three months. The Control group will continue with the +routine activities. Serum homocysteine, Venous Clinical Severity Scale (VCSS), Ankle Brachial +pressure index and psychological status will be assessed at baseline and the end of three +months of intervention. +Statistical analyses +Data will be tested for normality and appropriate tests will be used to assess the differences +between the groups. +Expected outcomes +Specifically designed Yoga module will help to reduce the vascular inflammation, symptoms +of CVI and enhance psychological functioning. +Introduction +Chronic Venous Insufficiency (CVI) is one of the peripheral venous diseases which involve the +retrograde flow of blood in the lower extremities of the venous system [1]. Pathophysiology of +CVI involves multiple factors such as valve incompetence, calf muscle dysfunction, and +venous stasis [2]. Valve incompetence causes blood stasis, increases venous blood pressure, and +leads to venous dilation, inflammation, and vein wall weakness [3], [4]. The clinical symptoms +of CVI result from increased venous pressure, venous dilation, and valve incompetence. The +common symptoms of CVI include itching, pain, heaviness in the legs, ache, skin color +changes [5]. Symptoms are not much severe at the initial stage of CVI, depending on age, +gender, body mass index. Manifestation of the disease may reach secondary conditions such as +leg ulcers and deep vein thrombosis [6]. General risk factors for CVI are age, obesity, strong +family tendency, gender, and occupations that demand prolonged standing at workplaces [6], +[7], [8]. However, studies on the gender-wise prevalence of CVI report conflicting outcomes. A +study conducted in the United Kingdom reported the prevalence of CVI being more in men +(40%) than women (32%) [9]. Another epidemiological study indicated the prevalence of CVI to +be higher in women than in men [10]. Though we see a general trend of higher prevalence of +CVI in men, however, women tend to manifest the disease their pregnancy given the increased +intrabdominal pressure. +Prolonged standing at the workplace is one of the main contributors to CVI. Pathogenesis +originates from the dilation of superficial veins and causes morphologic abnormalities [11]. +An extended period of standing increases pressure in the veins of the legs, thereby affecting +the pumping function of the calf muscle. Such changes lead to valve incompetence and +damage [12]. A study conducted on which industrial workers concluded that those who used to +stand for longer duration (>50% of working hours) had a higher prevalence of CVI compared +to those who spent less time standing [13].fl +Vascular inflammation is a key feature in the etiopathogenesis of CVI and the associated +complications. Hyperhomocysteinemia (HHcy), increased circulating homocysteine level [14], +[15] is a well-established marker of vascular inflammation. HHcy is also associated with +peripheral vascular disorders, deep vein thrombosis and coronary artery disorders [14]. In +CVI, HHcy is commonly manifested [16]. An increased concentration of homocysteine is also +associated with platelet activation, endothelial injury, and thrombosis. [17], [18]. Its plausible +role in endothelial dysfunction could underline the etiological link between HHcy with +vascular diseases and vascular inflammation, accompanied by accelerated vein wall leakage, +and increased recruitment of leukocytes to endothelium [19]. +Lifestyle modification-related activities like leg elevation exercise, walking, and weight loss are +recommended in CVI management [20]. Studies indicate a beneficial role of physical exercises +in reducing reflux blood volume [21] and venous hypertension [22]. However, a reported +review indicated insufficient evidence for the role of exercise in the management of CVI [23]. +Another Meta-analysis found improvements in calf muscle functions and venous +hemodynamics with physical exercise and recommended further clinical trials to ascertain the +role of exercise in CVI management [24]. +Though well recognized, the relevance of preventive measures has been seldomly given +enough attention. In 1997, Krijnen et al. reported beneficial impact of compression stockings +in diminishing subjective complaints and reducing diurnal leg swelling. However, we do not +find much evidence reporting the use of such measures to prevent or manage complications +of CVI. To this end, Canadian Centre for Health and Safety (CCOHS), (2016) has indicated the +importance of neutral alignment and minimizing lower extremity fatigue by using the proper +footwear and floor condition to prevent such injuries. Given the association with prolonged +standing with reduced blood supply, CCOHS advocates working in a standing position by +changing working positions frequently, avoiding extreme bending, stretching, twisting, pacing +work appropriately, and allowing workers reasonable rest periods. CCOHS also suggests using +right-sized footwear and accessories like stockings, socks, and movements to prevent and +manage CVI and other musculoskeletal issues due to prolonged standing at the workplace. +Yoga is an ancient Indian science of holistic living that has gained popularity for its +therapeutic and health-promoting effects in recent times. Yoga has been used for various +health issues such as respiratory, cardiovascular, musculoskeletal, metabolic, pain, and cancer +syndromes [25], [26]. A single case study demonstrated improvement of calf muscle pump +function, venous return, physical and mental health in CVO [27]. Yogic practices have shown +positive effects on the symptoms of venous insufficiency, which reduces the progression of the +disease. +Research studies reported that Yoga would have therapeutic benefits in reducing +inflammation, fatigue and joint rigidity. It improves the peripheral muscle strength and +strengthens the muscles of lower limbs, ankles and enhances hip and ankle strategies in an +individual [28], [29], [30], [31]. Regular yoga practice substantially minimizes inflammatory +response to stressful encounters, which has a high impact on an individual's quality of life. Afi +study reported the beneficial role of yogic postures and breathing exercises in activating +pump muscles, increasing range of movements: flexion of large muscles, maximum skin +stretch [32]. Few studies reported the positive effects of Yoga in managing pain and +lymphedema [33], [34], [35]. +In different occupational settings, Yoga is found to mitigate occupational health hazards. +Different occupational settings in which Yoga is applied include healthcare professionals [36], +[37], computer professionals [38], defense personnel [39], athletes [40], etc. These studies +indicate a possible beneficial role of Yoga in mitigating the possible occupational hazards and +enhance efficiency. +CVI is a common issue among workers who need to stand for a prolonged time. Few studies +with physical therapy have demonstrated the beneficial role of active physical intervention in +managing/preventing work-related CVI. Yoga, as a mind-body approach, could be a non- +invasive and cost-effective therapy for CVI management. However, only a single case study has +implemented Yoga as an intervention for CVI with beneficial effect [27]. A study reported that +yoga would reduce the homocysteine level and restore endothelial dysfunctions in women +with primary dysmenorrhea [41]. Like Yoga, regular exercise significantly lowered plasma +homocysteine in young overweight or obese women with Polycystic ovary syndrome (PCOS), a +group at increased risk of premature atherosclerosis [15]. Evidence-based research with large +sample size is necessary to understand the efficacy of Yoga in CVI management. In this study, +we would try to understand the impact of yoga intervention on CVI symptoms and quality of +life and elicit changes in the homocysteine level as a biomarker of vascular inflammation in +CVI. +Section snippets +Objectives +The main objectives of this study is to investigate the efficacy of Yoga on homocysteine level, +symptomatology, and quality of life in industrial workers with CVI which is associated with +prolonged standing at industrial workplaces.… +Trial design +The design of this trial is a parallel group, randomized controlled trial with two parallel +groups with a 1:1 allocation ratio testing the effect of Yoga in one group against another. Fig. 1 +illustrates the proposed trial profile.… +Study setting +The research study will be conducted at one of the manufacturing Industries located in Jigani, +Bangalore, from November 2021 to April 2022.… +Eligibility criteria +The participants will be selected based on the inclusion and exclusion criteria, depicted in +Table 1.… +Intervention +The specific yoga… +Research ethics approval +The trial has been reviewed and approved by the institutional ethics committee (IEC) of +Swami Vivekananda Yoga Anusandhana Samsthana (Deemed-to-be-university under Section 3 +of the UGC act, 1956) in the committee meeting held on 19th December, 2020. The +institutional ethics committee clearance certificate reference number is RES/IEC- +SVYASA/184/2021. The trial has been registered in the Clinical Trials Registry-India (CTRI). +The registration number for the trial is CTRI/2021/02/030944.… +Consent +Written… +Access to data +Only the principal investigator and the study coordinator will have access to the final trial +dataset.… +Dissemination policy +The knowledge that researchers get from this research will be shared with participants +through community meetings. Confidential information will not be shared. Data will be +published the results in a peer-reviewed scientific journal and presented at national/ +international conferences so that other interested people may learn from our research.… +Trial status +Recruitment and intervention is in progress.… +Fundingfi +No funding is yet received for the trial. We are trying to find funding sources for the study.… +CRediT authorship contribution statement +U. Yamuna: Writing – original draft and revised draft, Writing – review & editing. Vijaya +Majumdar: Conceptualization, Investigation, Methodology, Project administration, +Supervision, Writing – original and revised draft, Writing – review & editing. Apar Avinash +Saoji: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project +administration, Supervision, Visualization, Writing – original and revised draft, Writing – +review & editing.… +Conflict of interest +The authors report no conflict of interests.… +References (50) +A.A.M. Biemans et al. +Validation of the chronic venous insufficiency quality of life questionnaire in dutch +patients treated for varicose veins +Eur. J. Vasc. Endovasc. Surg. (2011) +S. Melnyk et al. +A new HPLC method for the simultaneous determination of oxidized and reduced +plasma aminothiols using coulometric electrochemical detection +J. Nutr. Biochem. (1999) +S.D. Ciezar-Andersen et al. +A systematic review of yoga interventions for helping health professionals and students +Complement. Ther. Med. (2021) +J. Park et al. +Frailty modifies the intervention effect of chair yoga on pain among older adults with +lower extremity osteoarthritis: secondary analysis of a nonpharmacological +intervention trial +Exp. Gerontol. (2020) +M. Ni et al. +Controlled pilot study of the effects of power yoga in Parkinson’s disease +Complement. Ther. Med. (2016) +T. Field +Yoga research review, complement +Ther. Clin. Pract. (2016) +H. Cramer et al. +Yoga therapy: efficacy, mechanisms and implementation +Complement. Ther. Med. (2018) +R.C. Sam et al. +The prevalence of hyperhomocysteinemia, methylene tetrahydrofolate reductase +C677T mutation, and vitamin B12 and folate deficiency in patients with chronic +venous insufficiency +J. Vasc. Surg. (2003) +S. Zhang et al. +Varicose veins: diagnosis, management, and treatment +J. Nurse Pract. (2014) +J.L. Beebe-Dimmer et al. +The epidemiology of chronic venous insufficiency and varicose veins +Ann. Epidemiol. (2005) +View more references +Cited by (0) +Recommended articles (6) +Research article +Approach of Persian medicine to health and disease +Advances in Integrative Medicine, Volume 9, Issue 1, 2022, pp. 3-8 +Show abstract +Research article +Efficacy and safety of saffron as adjunctive therapy in adults with attention- +deficit/hyperactivity disorder: A randomized, double-blind, placebo-controlled +clinical trial +Advances in Integrative Medicine, Volume 9, Issue 1, 2022, pp. 37-43 +Show abstract +Research article +Older adults' utilisation of a student naturopathic clinic in Auckland, New Zealand +Advances in Integrative Medicine, Volume 9, Issue 2, 2022, pp. 115-118 +Show abstract +Research article +An opportunity for integrative approaches: an examination of the perspectives of +women with Bile acid malabsorption (BAM) +Advances in Integrative Medicine, Volume 9, Issue 2, 2022, pp. 97-102 +Show abstract +Research article +A collaborative integrative and Ayurvedic approach to cirrhosis in the setting of +autoantibody negative autoimmune hepatitis: a case report +Advances in Integrative Medicine, Volume 9, Issue 2, 2022, pp. 136-141 +Show abstract +Research article +Learning technologies and health technologies in complementary medicine clinical +work and education: Examination of the perspectives of academics and students in +Australia and the United States +Advances in Integrative Medicine, Volume 9, Issue 1, 2022, pp. 22-29 +Hide abstract +The use of technologies continues to grow in healthcare provision, and learning technologies +now dominate tertiary education. Meanwhile, complementary medicine (CM) constitutes a +substantial component of contemporary healthcare, yet the education of existing and future +CM practitioners has received little empirical attention. In direct response, our study +examines the perceptions of CM students and faculty related specifically to health and +learning technologies in clinical CM work and education. +A cross-sectional online survey was administered to all current students (n = 4851) and +tenured, contracted and adjunct academics (n =530) at two CM education institutions – in the +US and in Australia. +Most student respondents (n = 134, 49%) reported that they either felt they were unsure if +they would use telehealth in clinical practice or that they would use it (n = 116, 43%). The +majority of all academic respondents did not believe it possible to conduct basic clinical +processes online such as reading a patient's body language (M3.8, SD 1.0), conducting quality +clinical training in CM settings (M3.2, SD 1.3) or learning rapport skills (M3.2, SD 1.2). Of +those academics who were also in clinical practice, only a small number reported conducting +virtual consultations in their CM work (n = 7,15.9%). +Our findings highlight a potential disparity of perceptions between academics and students +in these CM educational settings especially in relation to telehealth. Academics expressedfi +hesitancy to fully rely on technologies to develop practitioners in a field where ‘formation of +professional character’ is considered so important. +View full text +© 2022 Elsevier Ltd. All rights reserved. +Copyright © 2022 Elsevier B.V. or its licensors or contributors. +ScienceDirect ® is a registered trademark of Elsevier B.V. diff --git a/subfolder_0/Effect of a Ten-Day Yoga-Based Vacation Program on Short-Term and Working Memory in Schoolchildren..txt b/subfolder_0/Effect of a Ten-Day Yoga-Based Vacation Program on Short-Term and Working Memory in Schoolchildren..txt new file mode 100644 index 0000000000000000000000000000000000000000..446c51f57f065d11a670463f128b21b253b81c66 --- /dev/null +++ b/subfolder_0/Effect of a Ten-Day Yoga-Based Vacation Program on Short-Term and Working Memory in Schoolchildren..txt @@ -0,0 +1,310 @@ +See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/301204057 +Effect of a Ten-Day Yoga-Based Vacation Program on Short-Term and Working +Memory in Schoolchildren +Article · October 2015 +CITATION +1 +READS +183 +1 author: +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 12 April 2016. +The user has requested enhancement of the downloaded file. +Ayurveda Journal of Health +VOL. XIII, ISSUE 1, WINTER 2015 +37 +Abstract +Background: Memory is an important component of +cognition and good memory in schoolchildren helps +them to perform better in school. Yoga is known to +improve cognitive function in school children and +this study examines if yoga can improve memory in +schoolchildren. +Aim: To see the effect of a ten-day yoga-based vacation +program on short-term and working memory in +schoolchildren. +Methods: Sixty schoolchildren aged 10-11 years, who +attended a yoga-based training summer vacation +program were enrolled in this study. All students +underwent a 10-day intense yoga program consisting +of Àsanas (physical postures), prÀõÀyÀma (breathing +practices), meditation, relaxation techniques, and +yogic games. Short-term and working memory was +assessed by the digit forward–backward span test +before and at the end of the training program. +Results: A significant improvement in digit span +score (p < 0.001) was observed at the end of the 10- +day training program. +Conclusion: The 10-day yoga program was found to +significantly improve both short-term and working +memory in the schoolchildren who participated in +the program. The improvement in working memory +(23.24%) is greater than short-term memory (11.67%). +Keywords: Yoga, memory, children, digit forward, +backward. +Introduction +The term memory implies the capacity to encode, +store, and retrieve information.1 It is one of our most +important cognitive functions. It is essential for +Effect of a Ten-Day Yoga-Based Vacation +Program on Short-Term and Working +Memory in Schoolchildren +B.N. Hema,1 G.M. Kashinath,1 H.R. Nagendra1 +children to have a good memory +for better school performance and +an efficient memory is necessary +to excel in the current educational +system. Unfortunately there is a +lack of viable interventions in the +current education system that can +enhance memory.2 Hence there is a need for an +intervention which can help improve memory in +schoolchildren. This study evaluates the effect of +yoga on short-term and working memory. Short- +term memory allows for recall for a period of several +seconds to a minute without rehearsal. The capacity +of short-term memory is also very limited, and is +typically on the order of 4-5 items.3 Working memory +is a form of short-term memory that allows us to +hold an idea in our mind long enough to carry out +an action, such as calling a telephone number we +just looked up. +Yoga is an ancient science that was practiced by +our ancient sages for many higher purposes. A +modern form of yoga is currently very popular +around the world. In recent decades, scientific +research on yoga has revealed its potential role in +prevention, treatment, and management of many +health-related issues. It has been also reported that +yoga has the potential for improving cognitive +function including attention,4 concentration,5 +memory,6 and planning.7 The current study examines +the effect of the Personality Development Course +on memory in schoolchildren. The Personality +Development Course is a 10-day yoga-based summer +vacation program for schoolchildren conducted by +S-VYASA University, Bangalore. Previous studies +have shown that this program resulted in significant +improvements in planning8 and attention. This study +examines the effect of this program on short-term +and working memory. +1 +Division of Yoga and Life Sciences, Swami Vivekananda +Yoga Anusandhana Samsthana (S-VYASA University), +No. 19, Ekanath Bhavan, Gavipuram Circle, K.G. Nagar, +Bangalore - 590 019. +Ayurveda Journal of Health +VOL. XIII, ISSUE 1, WINTER 2015 +38 +Methods +SUBJECTS +Sixty school children (11-12 years old) attending the +10-day yoga training course during their summer +vacation were enrolled in this study. Children were +excluded from the study if they had any history of +neurological or psychiatric issues, used any +medication that affected the central nervous system, +or had any documented learning disabilities. +Intervention +The subjects participated in the 10-day yoga training +program for eight hours each day. The program +consisted of different sessions on physical postures +(yogÀsanas, 1½ hr), breathing practices (prÀõÀyÀma, +1 hr), internal cleansing practices, including eye- +cleansing techniques (kriyÀs, ½ hour), meditation and +devotional sessions (1½ hr), and guided relaxation +(½ hr). In addition to these particular practices, the +program also involved games (2 hr) and telling of +meaningful stories (1 hr) to promote a sense of values +and feelings of responsibility. +Assessment +DIGIT SPAN FORWARD AND BACKWARD +Digit Span (DS) is a sub-test in the Wechsler Adult +Intelligence Scale, 3rd ed (WAIS-III).9 It includes two +sub-sections (DS-Forward and DS-Backward), and +is considered a good tool to evaluate short-term +memory and working memory. DS-F evaluates short- +term memory by simply requiring participants to +repeat numbers. DS-B assesses working memory by +requiring participants to memorize numbers and to +repeat the numbers in the opposite order. For DS-F, +participants repeat numbers in the same order as +they were read aloud by the assessor. For DS-B, +participants repeat numbers in the opposite order +of that presented aloud by the assessor. Thus, In +both sub-tests, the assessor reads a series of number +sequences which the participant must repeat in either +forward or reverse order. DS-F has 16 sequences. +DS-B has 14 sequences. The primary measures of this +test are raw scores that reflect the number of +correctly repeated sequences until the discontinue +criterion (that is, failure to reproduce two sequences +of equal length) is met. The maximum raw score of +DS-F is 16. The maximum raw score of DS-B is 14. +Data Analysis +Data was analysed using SPSS software (version 10). +A paired sample t-test was used to analyze the pre +and post changes. +Results +Normal distribution of the data was confirmed by +Shapiro-wilk test and the paired sample test was +applied to see the pre/post-changes which show the +significant increase in digit span test scores (p < 0.001) +after 10 days of the yoga-based training. Figure 1 +shows that the mean digit span score significantly +increased after the children participated in the 10- +day yoga program. +Thus, the 10-day yoga program was found to +significantly improve both short-term and working +memory in the schoolchildren who participated in +the program. The improvement in working memory +(23.24%) is greater than that observed for short-term +memory (11.67%). +Discussion +fig. 1: Changes in digit span score before and after 10 days of +yoga training. The mean of the digit span score increases from +18.01 to 20.91 following the 10-day yoga program. *p < 0.001. +This study was designed to determine the influence +of a 10-day yoga training program on short-term +and working memory in 60 schoolchildren. The +training program resulted in a significant +improvement in both short-term and working +memory. Our results confirm previous studies that +have demonstrated that yoga is effective in +enhancing memory in schoolchildren. In one study, +a yoga-based education system was shown to +improve spatial memory.10 The results of the current +study are similar to earlier studies that have +examined the effect of yoga on memory. +Ayurveda Journal of Health +VOL. XIII, ISSUE 1, WINTER 2015 +39 +Yoga is well known to reduce anxiety11 and +provides deep relaxation at both the physical and +psychological levels.12 The findings that yoga improves +memory could be due to the reduction of anxiety and +the enhanced relaxation which is achieved by the +practice of yoga Àsanas and prÀõÀyÀma, mediation +and yogic game sessions. Although religious chantings +like OÛ, GÀytrÁ mantra, and m¦tyuðjaya mantra are +effective in improving cognitive function in the +children, these practices cannot be widely adopted in +the schools, because schools include children with +different religious backgrounds. Hence it is always +better to include just Àsanas, prÀõÀyÀma, meditation, +and yogic games within the conventional education +system as a yoga session. +The strength of this study is that it is the first +study to show that yoga improves short-term and +working memory in schoolchildren. It should be noted +that a limitation of this study was the lack of a control +group. None the less, the current study suggests that +introducing yoga into the school education curriculum +is beneficial for improving memory in schoolchildren. +Future studies will extend these findings to determine +the effect of intense yoga-based training programs +on immunological and stress markers. +Conclusion +A 10-day yoga program may help to improve short- +term and working memory in schoolchildren. Hence +it is important to introduce into the regular school +curriculum, a yoga session which includes, Àsanas, +prÀõÀyÀma, meditation, and some yogic games, in +order to help improve memory in schoolchildren. +References +1 +A.W. Robert, C.K. Frank, 2001, MIT Encyclopedia of +Cognitive Science: A Bradford Book, Massachusetts +London: The MIT Press Cambridge. +2 +B. +Pradhan, H.R. +Nagendra, +2009, +Effect +of Yoga Relaxation Techniques on Performance of Digit- +Table 1: Pre and Post Changes in the Digit Forward–Backward Span Test +Varibale +Pre-yoga +Post-yoga +p-Value +% Change +(Mean ± SD) +(Mean ± SD) +Digit forward +11.13 ± 1.35 +12.43 ± 1.80 +<0.001*a +11.67 +Digit backward + 6.88 ± 1.50 + 8.48 ± 1.77 +<0.001*a +23.24 +Digit forward–backward span +18.02 ± 2.44 +20.92 ± 3.13 +< 0.001*b +16.09 +a Wicoxon signed rank test, b paired sample t-test, and *significant change at< 0.001 level. +Dr. Kashinath G. Metri, BAMS, MD is Assistant +Professor at S-VYASA University Bengaluru, India. +He has a Bachelors in Ayurveda Medicine from Rajiv +Gandhi University Bengaluru, India and Doctor of +Medicine in Yoga and Rehabilitation from S-VYASA +University, Bengaluru, India. He has guided more +than 10 postgraduates of yoga in their research work +in yoga therapy and is currently guiding 15 post- +graduates. Dr. Metri has more than 10 articles +published in international peer-reviewed journals +in the field of Yoga and Ayurveda. +Email: kgmhetre@gmail.com Mob.: +91 9035257626 +letter Substitution Task by Teenagers, Int J Yoga, 2(1): +30-34. +3 +N. Cowan, 2001, The Magical Number 4 in Short-term +Memory: A Reconsideration of Mental Storage +Capacity, Behav Brain Sci., February, 24(1): 87-114; +discussion on pp. 114-85. +4 +Shirley Telles, P. Raghuraj, Dhananjay Arankalle, K.V. +Naveen, 2008, Immediate Effect of High-Frequency +Yoga Breathing on Attention, Indian Journal of Medical +Sciences, 62(1): 20-22. +5 +J.T. Hopkins, L.J. Hopkins, 1979, A Study of Yoga and +Concentration, Academic Therapy, 14(3): 341-45. +6 +K.V. Naveen, R. Nagaratna, H.R. Nmagendra, Shelrey +Telles, 1997, Yoga Breathing Through a Particular Nostril +Increases Special Memory Score without Latelization, +Physiological Effects, 81: 555-61. +7 +N.K. Manjunath, Shirley Telles, 2001, Improved +Performance in the Tower of London Test Following +Yoga, Indian J Physiol Pharmacol, 45(3): 351-54. +8 +A. Kadambini, 2005, Effect of Yoga on Performance in a +Planning Task in Tower of London Test, MSc thesis: S- +VYASA University. +9 +D.A. Wechsler, 1997, Wechsler Adult Intelligence Scale, +3rd ed, San Antonio: The Psychological Corporation. +1 0 +R. Rangan, H.R. Nagendra, G. Ramachandra Bhat, 2009, +Effect of Yogic Education System and Modern Education +System on Memory, Int J Yoga, 2. +1 1 +G. Kirkwood, H. Rampes, V. Tuffrey, J. Richardson, K. +Pilkington, 2005, Yoga for Anxiety: A Systematic Review +of the Research Evidence, Br J Sports Med, 39: 884-91. +1 2 +Ibid., J R Soc Med., 86: 5254-58. +View publication stats +View publication stats diff --git a/subfolder_0/Effect of anapanasati meditation on anxiety a randomized control trial.txt b/subfolder_0/Effect of anapanasati meditation on anxiety a randomized control trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..1aedaa050cc0bf9280049536e624843900c3e838 --- /dev/null +++ b/subfolder_0/Effect of anapanasati meditation on anxiety a randomized control trial.txt @@ -0,0 +1,465 @@ +ANNALS OF NEUROSCIENCES  VOLUME 26  NUMBER 1  JANUARY 2019 +www.annalsofneurosciences.org +32 +ANNALS +RES ARTICLE +Effect of anapanasati meditation on anxiety: a randomized +control trial +B. Sivaramappaa, Sudheer Deshpandeb, P Venkata Giri Kumara,*, H.R. Nagendraa +a S-VYASA Yoga University, Bengaluru, Karnataka, India +b VYASA, Eknath Bhavan, Bangalore, Karnataka, India +ABSTRACT +Background: Meditation has shown positive results in improving the psychological disorders +such as anxiety. There is a need to study the therapeutic benefits of Anapanasati meditation, a +mindfulness meditation technique. +Purpose: The study aims at investigating the effect of Anapanasati meditation on individuals +with moderate anxiety. +Methods: A total of 112 participants who were willing to participate in the study were recruit- +ed for the study. Anapanasati meditation was used as an intervention. The participants were +divided into two groups experiment and control groups. Experiment group had 56 persons +performing Anapanasati meditation and Control group had 56 persons not performing any +type of meditation. The experiment group practiced one hour of Anapanasati meditation daily +under the supervision of experts for six months and continued their daily routine and control +group was not given any intervention, but they continued their daily routine. State Trait Anxiety +Inventory (STAI) is used to assess the anxiety level. +Results: The STAI score before and after Anapanasati meditation was analysed for both experi- +ment and control groups using Paired Samples T test. The experiment group has shown signif- +icant reduction in the STAI (P < 0.05) score after the intervention whereas in the control group +the reduction in STAI score was not significant. +Conclusion: This study has shown that after six months of intervention, the subjects with + +moderate anxiety who practiced Anapanasati meditation had a significant decrease in their STAI +score and the control group has not shown significant change in the STAI score. +doi : 10.5214/ans.0972.7531.260107 +KEY WORDS +Anapanasati meditation +State Trait Anxiety Inventory +Mindfulness +*Corresponding author: +P Venkata Giri Kumar +S-VYASA Yoga University, Vivekananda +Road +Kalluballu Post, Jigani, Anekal, +Bengaluru – 560105, Karanataka, India +Contact no +91 9880658950 +E-mail: girikumar.pv@gmail.com +Introduction +Anxiety is an emotional state such as nervousness, tension, +worry or apprehension which a person perceives for various +reasons [1]. The research indicates that anxiety is closely as- +sociated to chronic allergy such as asthma, cognitive impair- +ment and dementia and many other chronic diseases such as +rheumatology [2–4]. Preoperative anxiety is commonly ex- +perienced by the patients waiting for surgery and in a study +authors suggested that listening to Tibetan music helps in +managing the preoperative levels [5]. The quality of life of the +individuals with chronic illness varies with comorbid anxiety +which emphasizes the importance of reducing the anxiety +levels [6]. Number of scales were developed for measuring +anxiety levels and State Trait Anxiety Inventory (STAI), Beck +Anxiety Inventory (BAI) and Hospital Anxiety And Depression +Scale-Anxiety (HADS-A) are widely used in assessing the anx- +iety levels in research and clinical studies [4]. +Meditation is a set of self-regulatory practices [7] or psy- +chosomatic practices [8] with a focus on training the attention +and awareness such that concentration will be developed. It +is well known that meditation, one of the limbs of Patanjali +Yoga [9], plays a significant role in improving the psycholog- +ical disorders and research suggests the use of mindfulness + +meditation for reducing depression and anxiety levels + +[10–12]. Recently there has been increasing research interest +on therapeutic benefits of meditation for psychological disor- +ders and studies on meditation have shown significant pos- +itive results in psychological disorders [11,13–16]. Despite +the therapeutic benefits of meditation, there are considerable +discrepancies on the effect of meditation on brain as studied +by Electroencephalogram [17]. +The earlier studies have considered different meditation +techniques but there were no studies done with Anapanasa- +ti meditation, a form of Mindfulness meditation. Anpanasati +meditation is the name of the meditation practice adopted +by Gautam Buddha and it is nothing but mere observation of +one’s own breath ie., inhaling and exhaling [18]. In this study +we aimed at studying the effect of Anapanasati meditation on +the individuals with moderate anxiety assessed with State +Trait Anxiety Inventory scale. +Methods +Subjects +The subjects were selected from Pyramid Valley Interna- +tional Bangalore and Pyramid Spiritual Science Academy, +Koramangala, Bangalore. A total of 112 subjects who were +www.annalsofneurosciences.org +ANNALS OF NEUROSCIENCES  VOLUME 26  NUMBER 1  JANUARY 2019 +33 +ANNALS +S +RES ARTICLE +willing to participate in the study were selected for the +study. The age group ranged between 20 and 65 years. +Inclusion Criteria +Males and females within the age group of 20 to 65 years were +included in the study. +Exclusion Criteria +Individuals who have been diagnosed with diabetes, cancer, +hypertension were excluded from the study. +Design +This is a prospective random control design. The participants +were divided into two groups experiment and control. The +subjects selected for study were randomly allotted into two +groups by using random number generator program. A total +of 56 participants were included in experiment group and 56 +participants were included in control group. The invigilators +coded and saved the answered questionnaires after the study. +A person not involved in group formation evaluated the coded +answer sheets. A person who was not involved in this study +decoded the answer sheets only after noting the scores before +and after data was completed. +State Trait Anxiety Inventory (STAI) [1], a self-report +questionnaire is used as the scale to study the effect of in- +tervention. STAI consists of two parts state anxiety and trait +anxiety each consisting of 20 questions which takes values +from 1 to 4. We have considered state anxiety part (STAI-S) +of the questionnaire for our study which indicates the cur- +rent state of anxiety in a specific situation when compared +to trait anxiety which is a general tendency of the individ- +ual. The score can range from 20 to 80 and the score in- +creases with anxiety levels [1]. The score greater than 40 +is considered to be clinically significant score for STAI scale +[4,5]. The subjects were asked to read each statement and +select the statement which reflects the true state of the in- +dividual at that moment. The informed consent was taken +from all the participants who were willing to participate in +the study. +Intervention +Anapanasati Meditation is given as intervention to partici- +pants in the experiment group and participants were asked +to practice meditation daily one hour along with their routine +duties and there was no intervention to Control Group but +they were asked to continue their daily routine. The Medita- +tion classes were conducted six days a week for six months +under the supervision of experts. It was ensured that there +was no interaction between the groups during the entire pe- +riod of six months. The tests were administered on the first +and last day of the study. The subjects were accommodated at +a quiet environment free from distractions to fill up the ques- +tionnaires. The subjects were asked to fill up the question- +naires with experts present for any clarification and without +consulting other subject while filling up the questionnaire. +Statistical Analysis +The data were analysed using SPSS Statistics Version 10. The +data was presented as mean ± standard deviation. The data +was assessed for normality using Kolmogorov-Smirnov test +and STAI score was found to be normal in both experimental +and control groups. P value <0.05 is considered statistically +significant for all comparisons and the data were reported to +two significant figures. The statistical tests used were Paired +Samples t-test for pre-post comparison within the groups. The +Cohen’s d effect size for assessing the effect of intervention was +computed as the ratio of the difference between means of ex- +periment and control groups to the pooled standard deviation. +Results +The STAI score before and after the Anapanasati intervention +was analysed for both Experiment and Control groups using +Paired Samples T test as shown in Table 1. The experiment +group has shown significant reduction in the STAI (P < 0.05) +score after the intervention whereas STAI score has increased +in the control group. The pre and post STAI scores across age +groups of Experiment and Control groups were tabulated in +Table 2. The Cohen’s d effect size was computed and it has +taken a value of 1.52. +Table 1: Paired Samples T Test +Group N +STAI (Pre) +STAI (Post) +P Value +CI +Experiment +5648.32 ± 6.57 +45.73 ± 3.28 +0.01* +[0.59, 4.58] +Control +5650.45 ± 4.55 +51.93 ± 4.76 +0.01* +[–2.61, –0.353] +Data is represented as mean ± standard deviation +STAI: State Trait Anxiety Inventory +N: Number of Participants +Pre: Pre data taken before intervention +Post: Post data taken after intervention +*P Value significance at 0.05 level +CI: 95% Confidence Interval of the difference between pre and post BDI scores +ANNALS OF NEUROSCIENCES  VOLUME 26  NUMBER 1  JANUARY 2019 +www.annalsofneurosciences.org +34 +ANNALS +RES ARTICLE +Fig. 1:  Comparing Pre and Post STAI Score across three different +ranges of score in experiment group. +Group 1: Participants in experiment group with STAI score less than 40 +Group 2: Participants in experiment group with STAI score between 40 + +and 60 +Group 3: Participants in experiment group with STAI score greater + +than 60 +Table 2: STAI vs Age in Experiment and Control Groups +Age Group +Experiment Group +Control Group +STAI Pre +STAI Post +P Value +STAI Pre +STAI post +P Value +<= 40 +44.0 ± 5.03 +45.14 ± 3.44 +0.625 +50.44 ± 4.22 +52.22 ± 4.43 +0.03* +> 40 +49.44 ± 6.56 +45.85 ± 2.75 +0.004* +49.44 ± 5.09 +51.69 ± 6.03 +0.17 +Data is represented as mean ± standard deviation +STAI: State Trait Anxiety Inventory Score +Pre: STAI score before intervention +Post: STAI score after intervention +*P Value significance at 0.05 level +results of the previous studies. The role of yoga in improving +the quality of life which gets influenced by negative emotions +and aggression is well understood [25–27] and meditation +being a limb of Yoga [9] has a significant role in improving the +quality of life and reducing the anxiety and depression levels. +The results of our study highlight the importance of medita- +tion in reducing the anxiety levels as measured by STAI. +We further analysed the data and observed that after +practicing Anapanasati meditation for six months the anxi- +ety has come down in older subjects with age greater than 40 +whereas the anxiety has increased in younger subjects with age +less than 40. The reason for such an increase in STAI score in +younger adults may due to lower sample size of younger group +which has only 7 subjects and warrants further focussed study +to establish the effectiveness across different age groups. The +STAI score was lying between 40 to 60 for majority of the par- +ticipants in both experiment and control groups. In experiment +group there were only 5 subjects with less than 40 and only +one subject with score greater than 60 (Fig 1). The STAI score +has moderately increased in the subjects who were having the +score less than 40 after intervention and the reason for such an +increase need to be understood from various factors such as +physiological, psychological and socio-economic status of the +individuals and not considering them in our study is a limita- +tion. The results of the current study confirm the effectiveness +of Anapanasati meditation but warrants further in depth study +to understand the effectiveness when anxiety is comorbid with +other physiological and psychological disorders. +This is the first time the effect of Anapanasati meditation +on anxiety was studied and the results were promising and +paved the way for in-depth studies to unravel the hidden po- +tential of the meditation. The study has been done with equal +sample size in both the groups and the baseline score of both +the groups is nearly same which is the strength of the study. +Despite the promising results there are many limitations in the +study which need to be addressed in future studies. The study +was done with moderately smaller sample size and there is a +need to do the study with larger sample size covering all age +groups. The STAI score was not covering the low, moderate +and high levels as majority of the participants were in moder- +ate group. There is a need to study the effect of Anapanasati +meditation with larger sample size covering the range of STAI +score such that the effect of meditation at various levels of +anxiety can be studied. The results confirm that Anapanasati + +Discussion +The present study focused on investigating the effect of Anap- +anasati meditation on the individuals with moderate anxiety +and STAI scale was used for assessing the anxiety level. STAI +scale is considered to be one of the best measures and litera- +ture review indicates that the number of citations with STAI +are more compared to other measures and originally the scale +was designed for normal population which was extended lat- +er for clinical studies [1]. In the present study at the end of the +six month period we have observed that the anxiety levels of +the subjects in Experiment group have reduced significantly +whereas in Control group the anxiety levels have moderate- +ly increased. The previous studies on Anapansati meditation +have shown that the stress parameter activation coefficient +and health parameter integral area as measured by Electro +Photonic Imaging (EPI) technique have reduced significant- +ly with meditation [19] and also Anapanasati meditation was +closely associated to attention task performance [20]. The +earlier studies on mindfulness meditation established the +effectiveness of meditation in reducing the anxiety and de- +pression levels [13,21–24] and our results with Anapanasati +meditation, a form of mindfulness meditation, match with the +www.annalsofneurosciences.org +ANNALS OF NEUROSCIENCES  VOLUME 26  NUMBER 1  JANUARY 2019 +35 +ANNALS +S +RES ARTICLE +meditation has reduced the STAI scores when compared to +control group who were not performing any meditation but +due to the lack of physiological, psychological and socio-eco- +nomic status of the participants it is difficult to understand +the reasons why the anxiety levels have increased in the +participants of control group. We have not measured gen- +eral anthropometric and clinical parameters such as height, +weight, blood pressure, pulse rate etc. and hence study lacks +the strength in assessing the therapeutic benefits of the in- +tervention. +Conclusion +In conclusion, the participants of Anapanasati meditation +have shown significant reduction in the anxiety score mea- +sured with State Trait Anxiety Inventory. There was no such +significant change in the STAI score of control group. Anap- +anasati meditation is a form of mindfulness meditation and +the results emphasize the need for its regular practice in + +improving the quality of life. +Acknowledgement +I am thankful to all who willingly participated in this study +and I sincerely acknowledge their whole-hearted participa- +tion. I thank all those who helped me to complete this study +and arrive at the results. +Authorship contribution +This article complies with International Committee of Medical +Journal editor’s uniform requirements for manuscript. +Ethical statement +Signed informed consent was obtained from all the subjects. +The institutional ethical committee of the parent institution +had cleared the project proposal with ethical approval num- +ber IEC/Vyasa/24/2014. +Source of funding +None +Conflict of interest +None +Received Date : 06-08-18; Revised Date : 19-10-18; +Accepted Date : 19-11-18 +References +1. +Mcdowell I, Health M, Scales R, York N: Excerpt from Ian McDowell, Measur- +ing Health: a Guide to Rating Scales and Questionnaire. Oxford University +Press, New York, 2006. 2006;(1). +2. +Mortamais M, Abdennour M, Bergua V, Tzourio C et al: Anxiety and 10-Year Risk +of Incident Dementia An Association Shaped by Depressive Symptoms: +Results of the Prospective Three-City Study. 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J. +Yoga 2008;1(2):76–82. diff --git a/subfolder_0/Effect of short duration integrated classroom yoga module on physical, cognitive, emotional and personality measures of school children.txt b/subfolder_0/Effect of short duration integrated classroom yoga module on physical, cognitive, emotional and personality measures of school children.txt new file mode 100644 index 0000000000000000000000000000000000000000..5c448e76381b4526ca60ca2c319304a77d7c5f83 --- /dev/null +++ b/subfolder_0/Effect of short duration integrated classroom yoga module on physical, cognitive, emotional and personality measures of school children.txt @@ -0,0 +1,1149 @@ +100 +© 2021 Yoga Mīmāṃsā | Published by Wolters Kluwer - Medknow +Original Article +Effect of short duration integrated classroom yoga +module on physical, cognitive, emotional and +personality measures of school children +Atul Sinha, Sony Kumari +Department of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana (Deemed to be University), Bengaluru, +Karnataka, India +INTRODUCTION +UNICEF estimated that an alarming 10%–20% of the world’s +2.2 billion child and adolescent population was afflicted by mental +health problems (Kieling et al., 2011). The National Mental Health +Survey (2016) in India found that 7.3% of adolescents suffered at +least one condition of mental morbidity (Gururaj et al, 2016). In the +USA 7.5% of adolescents met the DSM-IV criteria for one or more +mental health conditions (Kessler & Wang, 2008). These findings +suggested that young people needed social-emotional learning +(Butzer, Bury, Telles, & Khalsa, 2016). Further, the Association +for Supervision and Curriculum Development’s Commission on +the Whole Child (ASCD), felt the need to go beyond cognitive +development and educate the whole child defined as intellectually +Context: Despite evidence of therapeutic benefits of yoga on school children, many schools do not include yoga +in their daily schedule. Reasons cited are lack of time and resources. An efficacious short duration integrated +classroom yoga module (ICYM) can overcome such problems. +Aim: This study aimed to test the effect of such a yoga module on physical fitness, cognitive performance, emotional +wellbeing, and personality characteristic of school children. +Methods: The design was a randomized controlled trial with participants sourced from grades 7–10. The intervention +period was 2 months. The primary outcome measures were 4 tests from the EUROFIT physical fitness testing +battery, Stroop color-word naming task, Rosenberg self-esteem scale, WHO-5 wellbeing index, and Sushruta Child +Personality Inventory. Statistical analysis used a repeated measure analysis of variance. Secondary outcome +measure was a qualitative assessment. +Results: The yoga group showed significant differences compared to the control group in 2 of 4 physical fitness +variables, Stroop color-word naming task, and in the WHO-5 wellbeing index. +Conclusion: ICYM is a validated, feasible, and efficacious school-based short-duration integrated yoga module. +It can be considered for incorporation into the daily school schedule. +Key Words: Classroom yoga, cognitive performance, emotional wellbeing, physical fitness, short-duration yoga, +yoga in schools +Address for correspondence: +Mr. Atul Sinha, 103 Regent Place, 28/2 Thubrahalli, Whitefield Road, Bengaluru - 560 066, Karnataka, India. +E-mail: atulsin@gmail.com +Submitted: 04-Jun-2021 Revised: 23-Oct-2021 Accepted: 26-Oct-2021 Published: 22-Dec-2021 +How to cite this article: Sinha A, Kumari S. Effect of short duration +integrated classroom yoga module on physical, cognitive, emotional +and personality measures of school children. Yoga Mimamsa +2021;53:100-8. +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 +Access this article online +Quick Response Code: +Website: +www.ym-kdham.in +DOI: +10.4103/ym.ym_55_21 +Abstract +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] +Sinha and Kumari: Effect of ICYM on wellbeing of school children +Yoga Mīmāṃsā | Volume 53 | Issue 2 | July-December 2021 +101 +active, physically, verbally, socially, and academically competent; +empathetic, kind, caring and fair; creative and curious; disciplined, +self-directed and goal-oriented; free, critical thinker, confident and +cared for and valued (Hyde, 2012). +Growing modern research evidence suggests that yoga is +efficacious in developing the whole child. Traditional texts of +yoga too articulate a vision of education as laying the foundations +of character and personality through self-transformation +(Niranjanananda, 2009). +Many school-based studies have found that yoga was beneficial +for children. A meta-analysis by Galantino, Galbavy, & Quinn +(2008) found that yoga positively impacted physiological health +variables such as reaction time, motor speed, musculoskeletal +strength, and cardio-pulmonary measures. Another meta-analysis +by Zenner, Herrnleben-Kurz, & Walach (2014) showed that +cognitive performance, stress levels, resilience, and emotional +balance improved with mindfulness interventions. Serwacki +& Cook-Cottone (2012) reviewed 12 studies and reported that +yoga positively impacted cognitive efficiency, attentional control, +emotional balance, anxiety, reactivity, and negative behavior. A +study found that sattva (controlled illuminative energy) increased +while rajas (uncontrolled active energy) and tamas (uncontrolled +inert energy) reduced with yoga intervention, resulting in a tranquil +personality (Patil & Nagendra, 2014). +Many Indian studies have reported the beneficial effects of yoga +on physical, cognitive, and emotional measures of school children. +It had a beneficial effect on physical fitness (Purohit, Pradhan, & +Nagendra, 2016). It impacted cardiopulmonary health positively +(Shivakumar, Suthakar, & Urs, 2016). Yoga was significantly +associated with memory, attention, and executive function (Chaya, +Nagendra, Selvam, Kurpad, & Srinivasan, 2012; Verma, Shete, +& Singh Thakur, 2014). It improved self-esteem, self-adjustment, +and self-efficacy (Bhardwaj & Agrawal, 2013; Bhardwaj & +Bhardwaj, 2015; Das, Deepeshwar, Subramanya, & Manjunath, +2016). Yoga reduced anxiety (Gusain & Dauneria, 2016). +Despite awareness of the benefits of yoga, most schools either +have not incorporated yoga in the curriculum or have done so sub- +optimally, usually one session a week. The reasons cited are paucity +of time and resources such as yoga rooms and yoga instructors. We +argue that unless a solution is found to overcome these problems it +will be difficult to incorporate yoga into the daily school schedule. +We hypothesize that a short-duration integrated classroom yoga +module (ICYM) instructed by the class teacher will have a positive +impact on physical fitness, cognitive performance, emotional +wellbeing, and personality characteristics. Such a module can +overcome the cited problems and allow for yoga’s inclusion in the +daily school schedule. Traditional texts too support the practice +of yoga in the classroom (Satyananda, 1990, p 50-56, 110-132). +Studies conducted so far on classroom yoga suffer from +methodological infirmities, small sample sizes, and non-standard +interventions. Studies by Butzer et al. (2015), Chen & Pauwels +(2014), and Lawson, Lisa Cox, & Blackwell (2012), used once a +week intervention, yoga-based activities, and a modified form of +yoga respectively in uncontrolled pilot studies with small sample +sizes. These studies found directional improvements in stress +reduction, emotional wellbeing, and behavior. A study by Telles, +Gupta, Gandharva, Vishwakarma, Kala, & Balkrishna (2019) +used an 18-min pranayama intervention for 3 days and reported +a positive impact on attention and anxiety. It is evident that the +current research on short-duration classroom yoga is clearly +inadequate and there is a need for a methodologically sound study. +The present study aimed to evaluate the effect of a previously +validated ICYM (Sinha, Kumari, & Ganguly, 2021), on physical, +cognitive, emotional, and personality measures. These measures +were chosen since they formed the major components that defined +the whole child. Specific tests used were (i) EUROFIT physical +fitness testing battery since it was a comprehensive field test, +(ii) Stroop color-word naming task since it was a reliable test of +neurophysiological function, (iii) Rosenberg self-esteem scale +since self-esteem is associated with other mal-adaptations, (iv) +WHO-5 wellbeing index since it was a key desired outcome in +social-emotional learning, and (v) Sushruta Child Personality +Inventory (SCPI) measuring gunas, since it indicated a tranquil +personality. +METHODS +Participants +The study sourced participants from two urban campuses of +Samsidh Mount Litera Zee School, Bengaluru, INDIA. One +campus provided the yoga group and the other the control group. +All students from Grades 7–10 who met the inclusion criteria +participated in the study. +The sample size for physical fitness tests was restricted to 98 +(yoga = 48, control = 50) because the administration of the tests +required significant time and resources. Randomization was +achieved by setting quotas for each grade and drawing from +paper slips. For the cognitive performance test the sample size +was 253 (yoga = 143, control = 110). For the emotional wellbeing +tests the sample size was 244 (yoga = 137, control = 107). For +the personality characteristic test the sample size was 254 (yoga += 148, control = 106). Randomization was achieved since both +control and intervention groups were drawn from the same grades +of the two campuses. However, drawing the control group from +one campus and the experimental group from another campus +resulted in unequal randomization. The sample sizes for cognitive +performance, emotional wellbeing and personality characteristic +tests varied marginally due to nonavailability of students on +account of absenteeism or participation in other activities on +the days the tests were administered. The detailed participant +characteristics are given in Table 1. +The inclusion criteria were (i) participants from Grades 7–10, +(ii) of both genders. The exclusion criteria were (i) major +illness or surgery in the last two months, (ii) any mental health +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] +Sinha and Kumari: Effect of ICYM on wellbeing of school children +102 +Yoga Mīmāṃsā | Volume 53 | Issue 2 | July-December 2021 +issue, (iii) any condition contraindicating physical activity. +A signed informed consent was obtained from the school +principal (dated July 10, 20 19). The study was approved by the +Institutional Ethics Committee of S-VYASA University (RES/ +IEC-SVYASA/145/2019). +Design +The design of the study was a randomized controlled trial with +pre-post assessments. The intervention period was 2 months with +5 days a week of yoga practice. The study was conducted in July- +September 2019. The design profile is given in Figure 1. +Yoga intervention +The intervention used was the 12-min ICYM. The module was +systematically developed based on literature review, expert- +validated and efficacy confirmed in a pilot study (Sinha, Kumari +& Ganguly, 2021). Class teachers were given systematic training +to conduct the sessions. The detailed module is shown in Table 2. +Assessment +The primary outcome measures comprised (i) 4 tests from +the EUROFIT physical fitness testing battery (Kemper & Van +Mechelen, 1996), (ii) Stroop color-word naming task (Jensen & +Rohwer Jr., 1966), (iii) Rosenberg self-esteem scale (Rosenberg, +1965), (iv) WHO-5 wellbeing index (Topp, Østergaard, +Søndergaard, & Bech, 2015) and (vi) SCPI (Suchitra & Nagendra, +2013). The secondary outcome measure was a qualitative +assessment of the experience, benefits, and feasibility. +EUROFIT fitness testing battery +The EUROFIT fitness testing battery is a field test. Components of +fitness were identified by factor analysis ensuring test reliability. +Despite noncomparability with isometric tests, the coefficient of +correlation nevertheless ranged from 0.43 to 0.82, where a score +of .60 is considered good validity. Many Indian studies have +used this test (Telles, Singh, Bhardwaj, Kumar, & Balkrishna, +2013; Karkera, Swaminathan, Pais, Vishal, & Rai, 2014; Purohit, +et al., 2016). +Flamingo balance test +Participants balanced on a narrow wooden bar on one leg. The +number of falls in 60 s was recorded. +Sit and reach flexibility test +Participants sat on the floor with both legs stretched and touching +the base of a measuring table. They stretched fully and the +distance stretched was recorded from the measuring scale on +the tabletop. +Table 1: Age and gender of participants +T +otal +Yoga group +Control group +EUROFIT physical fitness tests +Sample size +98 +48 +50 +Age (years) +13.46 (1.105) +13.65 (1.021) +13.28 (1.161) +Age range +11-16 +12-16 +11-16 +Gender ratio (B:G) +49:49 +23:25 +26:24 +Stroop colour‑word task +Sample size +253 +143 +110 +Age (years) +13.15 (1.195) +13.42 (1.128) +12.79 (1.189) +Age range +11-16 +11-16 +11-15 +Gender ratio (B:G) +127:126 +70:73 +57:53 +Rosenberg self‑esteem scale and WHO‑5 well‑being index +Sample size +244 +137 +107 +Age (years) +13.06 (1.243) +13.34 (1.202) +12.70 (1.207) +Age range +11-16 +11-16 +11-15 +Gender ratio (B:G) +126:118 +75:73 +54:52 +SCPI +Sample size +254 +148 +106 +Age (years) +13.16 (1.215) +13.45 (1.139) +12.75 (1.210) +Age range +11-16 +11-16 +11-15 +Gender ratio (B:G) +129:125 +75:73 +54:52 +Age (years), values are group means (SD). SD, Standard deviation; SCPI, Sushruta Child Personality Inventory +Figure 1: Design profile +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] +Sinha and Kumari: Effect of ICYM on wellbeing of school children +Yoga Mīmāṃsā | Volume 53 | Issue 2 | July-December 2021 +103 +Sit-ups trunk strength +Participants were required to lie on their back with knees bent, +hands behind their heads, and perform sit ups. The number of +sit-ups in 30 s was recorded. +10 m × 5 m shuttle run agility test +Cones were kept at 10 m distance. The participants ran to the cone +and back five times. The timing of the run was recorded. +Stroop color-word naming task +The Stroop color-word task measures the participant’s control +over neuropsychological functions involved in color, word, and +an interference naming response. The reliabilities of the basic +scores are high ranging from 0.71 to 0.88. The scale has been +used extensively in Indian studies (Prakash Dubey, Abhishek, +Gupta, Rastogi, & Siddiqui, 2010; Telles et al., 2013; (Purohit & +Pradhan, 2017); Vanitha, Suresh, Chandrasekar, & Punita, 2017; +Suresh, Jagadisan, Kandasamy, & Senthilkumar, 2018). +The test consists of three pages. The first page tests how fast the +participant can read out words. The second page tests how fast the +participant can call out colors. The third page tests the speed with +which the participant can name the color of the ink and disregard +the word printed in that ink-color. The correct number of words, +colors, and ink-colors called in 45 seconds is recorded. +Rosenberg self-esteem scale +The Rosenberg self-esteem scale is a self-report scale that +measures global self-esteem. The scale demonstrates a coefficient +of reproducibility of 0.92 and test-retest reliability of 0.85 which +are considered excellent. The scale has been used extensively in +Indian studies (Schmitt & Allik, 2005; Sethi, Nagendra, & Ganpat, +2013; Jhambh, Arun, & Garg, 2014; Pal, Sharan, & Chadda, 2017; +Ramanathan, Bhavanani, & Trakroo, 2017). +WHO-5 wellbeing index +The WHO-5 wellbeing index is a self-report scale. It has 5 items +measuring emotional wellbeing. Experts have given this scale +a high rating on clinimetric validity. Predictive validity too is +high. Many Indian studies have used this scale (Chaturvedula & +Joseph, 2007; Agger, Raghuvanshi, Shabana, Polatin, & Laursen, +2009; Puri, Sapra, & Jain, 2013; Firdaus, 2017; (Sinha, Kumari +& Ganguly 2021). +Sushruta Child Personality Inventory +The SCPI is a self-report scale measuring personality characteristics. +The scale is based on the concept that the mind is always in a +dynamic equilibrium between three types of energies called gunas +namely sattva (controlled illuminative energy), rajas (uncontrolled +active energy) and tamas (uncontrolled inert energy). Wellbeing is +disturbed when rajas and tamas dominate (Deshpande, Nagendra +& Raghuram, 2008). The scale has a Cronbach alpha score of over +0.60 making it reliable. Validity was ensured by selecting items +which were supported by factor analysis. Patil & Nagendra (2014) +have used this scale in an Indian study. +Qualitative assessment +The qualitative assessment aimed to get insights into (i) the +Table 2: Integrated classroom yoga module: Set 1 and Set 2 practiced on alternate days +Set 1 +Set 2 +Yoga practice +Time +(min) +Description +Yoga practice +Time +(min) +Description +Dhyana (meditative +silence) +1 +Sit straight with eyes closed. +Attention on breathing. Watch your +thoughts flowing +Dhyana (meditative +silence) +1 +Sit straight with eyes closed. +Attention on breathing. Watch +your thoughts flowing +Asanas +Asanas +Katichakrasana +1 +20 rounds +Ardhakatichakrasana +1 +Hold for 7 counts on each side +Hastauthanasana/ +Padahastasana +1 +3 rounds backward‑forward +bending. On 4th round hold for 7 +counts on backward bend and then +on forward bend +Ardhachakrasana/ +Padahastasana +1 +3 rounds of backward‑forward +bending. On 4th round hold for 7 +counts on back bend and then on +forward bend +Tadasana +1 +3 rounds of up and down followed +by 1 round of holding for 10 counts +Gaumukhasana +(standing) +1 +Hold on each side to the count +of 10 +Vrikshasana +1 +Hold on each side for 10 counts +Garudasana +1 +Hold on each side for 10 counts +Pranayama +Pranayama +Yogic breathing +(abdominal) +1 +10 rounds +Yogic breathing +(abdominal) +1 +10 rounds +NadiShudhi +2 +6 rounds +NadiShudhi +2 +6 rounds +Bhramari +1 +6 rounds +Bhramari +1 +6 rounds +OM chanting +1 +6 rounds +OM chanting +1 +6 rounds +Dhyana +1 +Mentally recap the practices. +Attention on breathing +Dhyana +1 +Mentally recap the practices. +Attention on breathing +Affirmation +Affirmation +I am a powerful soul +0.5 +3 rounds +I am a loveful soul +0.5 +3 rounds +Closing +0.5 +Rub palms, massage eyes, face, +neck. With a few blinks open eyes +Closing +0.5 +Rub palms, massage eyes, face, +neck. With a few blinks open eyes +Total timing +12 +Total timing +12 +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] +Sinha and Kumari: Effect of ICYM on wellbeing of school children +104 +Yoga Mīmāṃsā | Volume 53 | Issue 2 | July-December 2021 +experience, (ii) perceived benefits, (iii) drivers and barriers to +continued practice. The methodology used was focus group +discussions conducted by a professional qualitative researcher. +Two groups of randomly selected (drawing from paper slips) +students and one group of class teachers participated in the study. +Data analysis +At the first level, pre-intervention and postintervention means of +the yoga group and control group were compared independently +using paired sample t-test. At the next level repeated measure +analysis of variance (RM-ANOVA) was carried out for each +variable. The within-subjects factor was time (preintervention and +post-intervention). The between-subjects factor was Groups (yoga +and control). The alpha level was set at p < 0.05. The assumptions +of sphericity measured by Mauchly’s test and homogeneity of +variance measured by Levene’s test were satisfied. The raw data +were analyzed using Statistical Package for Social Science (SPSS) +version 26, IBM, Armonk, NY, USA. +RESULTS +EUROFIT physical fitness testing battery +In the yoga group, the paired sample t-test was associated with +statistically significant pre-post differences in all the four tests +(p < 0.001). The effect size for flexibility (d = 0.78) and strength +tests (d = 0.91) were large. For balance (d = 0.53) and agility tests +(d = 0.53), they were medium. In the control group the difference +in means were statistically significant in balance (p < 0.001) and +flexibility tests (p < 0.007) only. The effect size for flexibility test +was small (d = 0.40) and for balance test medium [d = 0.56; Table 3]. +In the RM-ANOVA test, there was sufficient evidence to reject +the intervention effect null hypothesis for sit and reach flexibility +test (p < 0.001) and sit ups trunk strength test (p < 0.001). The +effect size for flexibility test was nearly large (ƞ2 +p = 0.243) and +for strength test medium (ƞ2 +p = 0.185). There was insufficient +evidence to reject the intervention effect null hypotheses for +Flamingo balance test (p < 0.465) and 10 m × 5 m shuttle run +agility test [p < 0.133; Table 4]. +Stroop color-word naming task +In the yoga group, the paired sample t-test was associated with +statistically significant pre-post differences in all three scores +(p < 0.001). The effect size for word (d = 0.62) and color scores +(d = 0.63) were medium. For color-word score, it was large +(d = 0.99). In the control group, the difference in means was +statistically significant in all the three scores (p < 0.001). The effect +size was small for word (d = 0.35) and color scores (d = 0.47). It +was medium for color-word score [d = 0.55; Table 3]. +In the RM-ANOVA test, there was sufficient evidence to reject +the intervention effect null hypothesis for Stroop color-word +score (p < 0.001). The effect size was small (ƞ2 +p = 0.06). There +was insufficient evidence to reject the intervention effect null +hypotheses for word (p < 0.07) and color scores [p < 0.074; +Table 4]. +Rosenberg self-esteem scale +In both the yoga and control groups, the paired sample +t-test was associated with statistically insignificant pre-post +differences [p > 0.05; Table 3]. +In the RM-ANOVA test, there was insufficient evidence to reject +the intervention effect null hypothesis [p < 0.057; Table 4]. +WHO-5 well-being index +In the yoga group, the paired sample t-test was associated with +statistically significant pre-post difference (p < 0.001) with small +effect size (d = 0.33). In the control group, the difference was +statistically insignificant [p < 0.097; Table 3]. +In the RM-ANOVA test, there was sufficient evidence to reject +the intervention effect null hypothesis (p < 0.001). The effect size +was small [ƞ2 +p = 0.055; Table 4]. +Sushruta Child Personality Inventory +In the yoga group, the paired sample t-test was associated with +statistically significant pre-post differences in rajas (p < 0.011) +and tamas (p < 0.004) scores with small effect sizes (d = 0.21; +d = 0.24) and insignificant difference in sattva score (p < 0.516). +In the control group, the pre-post difference was statistically +significant in sattva (p < 0.044) and tamas scores (p < 0.020) +with small effect sizes (d = 0.20; d = 0.23). It was statistically +insignificant for rajas score [p < 0.647; Table 3]. +In the RM-ANOVA test, there was insufficient evidence to +reject the intervention effect null hypotheses for all three scores +[p > 0.05; Table 4]. +Qualitative assessment +The variety in the module due to a mix of postures, breathing, +and meditation made the practice enjoyable. Students reported +improvements in fitness, stamina, and increased participation +in sports. Both students and teachers were most enthusiastic +while reporting cognitive benefits. Students reported better +concentration, grasp of concepts, and recall of lessons. Teachers +felt that the students had developed a more positive attitude +towards academics. Students credited the meditative practice +with instilling calmness, increased patience, and reduced stress. +Teachers felt that discipline had improved. Students reported that +they felt friendlier. Teachers noticed a greater social cohesion. +Both students and teachers felt that the short duration of the +practice, its convenience, and benefits made the ICYM acceptable +for continued practice. +DISCUSSION +The present study hypothesized that ICYM will impact fitness, +cognitive performance, emotional wellbeing, and personality +characteristic of school children. In the study, the yoga group +showed significant differences compared to the control group in +2 out of 4 EUROFIT tests, in the Stroop color-word score and +the WHO-5 emotional wellbeing index. The test of significance +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] +Sinha and Kumari: Effect of ICYM on wellbeing of school children +Yoga Mīmāṃsā | Volume 53 | Issue 2 | July-December 2021 +105 +(p-value) tells us that there is a statistical difference between the +means of the experimental group compared to the control group. +However, it does not tell us the extent of the difference. This is +measured by the effect size. It is a measure of how much variation +Table 4: Repeated measure analysis of variance table for variables of EUROFIT physical fitness +testing battery, STROOP colour‑word naming Task, Rosenberg Self‑Esteem Scale, WHO‑5 emotional +well‑being index, Sushruta Child Personality Inventory +T +est +Factor +Variable +F +df +Huyhn Feldt Ɛ +P +Partial eta squared +EUROFIT +Within ‑ subjects +(time) +Flamingo balance test +28.832 +1 +1 +0.001 +0.231 +Sit and reach flexibility test +1.208 +1 +1 +0.274 +0.012 +Sit ups trunk strength test +7.44 +1 +1 +0.008 +0.072 +10×5 m shuttle run agility test +11.36 +1 +1 +0.001 +0.106 +Group × time +Flamingo balance test +0.538 +1 +‑ +0.465 +0.006 +Sit and reach flexibility test +30.777 +1 +‑ +0.001 +0.243 +Sit ups trunk strength test +21.739 +1 +‑ +0.001 +0.185 +10×5 m shuttle run agility test +2.301 +1 +‑ +0.133 +0.023 +STROOP +Within ‑ subjects +(time) +Word score +57.109 +1 +1 +0.001 +0.185 +Colour score +73.985 +1 +1 +0.001 +0.228 +Colour‑word score +149.763 +1 +1 +0.001 +0.060 +Group × time +Word score +3.304 +1 +‑ +0.070 +0.013 +Colour score +3.229 +1 +‑ +0.074 +0.013 +Colour‑word score +16.079 +1 +‑ +0.001 +0.060 +Rosenberg/ +WHO‑5 +Within ‑ subjects +(time) +Rosenberg self‑esteem scale +1.801 +1 +1 +0.181 +0.007 +WHO‑5 emotional well‑being +index +1.286 +1 +1 +0.258 +0.005 +Group × time +Rosenberg self‑esteem scale +3.203 +1 +‑ +0.057 +0.013 +WHO‑5 emotional well‑being +index +14.166 +1 +‑ +0.001 +0.055 +SCPI +Within ‑ subjects +(time) +Sattva score +3.249 +1 +1 +0.073 +0.013 +Rajas score +4.317 +1 +1 +0.039 +0.017 +Tamas score +13.300 +1 +1 +0.001 +0.050 +Group × time +Sattva score +0.791 +1 +‑ +0.375 +0.003 +Rajas score +2.053 +1 +‑ +0.153 +0.008 +Tamas score +0.044 +1 +‑ +0.835 +0.001 +SCPI, Sushruta Child Personality Inventory +Table 3: Paired sample t-test - Means (Standard Deviation), Effect Size: EUROFIT physical fitness +testing battery, Stroop color-word naming task, Rosenberg self-esteem scale, WHO-5 emotional well- +being index, Sushruta child personality inventory +T +est +n +Yoga +Control +Yoga +Control +Pre +Post +P +Cohen’s +d +Pre +Post +P +Cohen’s +d +EUROFIT +Flamingo +balance test +48 +50 +7.50 (6.36) +4.75 (4.72) +0.001 +0.53 +11.98 (7.33) +8.36 (7.37) +0.001 +0.56 +Sit and reach +flexibility test +17.98 (6.64) +20.94 (7.40) +0.001 +0.78 +16.44 (5.48) +14.46 (6.49) +0.007 +0.40 +Sit ups trunk +strength test +19.29 (4.77) +23.19 (4.93) +0.001 +0.91 +9.82 (6.72) +8.80 (6.44) +0.233 +0.17 +10×5 m shuttle +run agility test +15.77 (1.98) +15.13 (1.68) +0.001 +0.53 +17.51 (2.04) +17.26 (2.16) +0.218 +0.18 +Stroop +Word score +143 +110 +87.87 (16.79) 93.64 (18.04) 0.001 +0.62 +90.64 (14.71) 94.17 (12.99) 0.001 +0.35 +Color score +59.22 (11.78) 65.43 (11.34) 0.001 +0.63 +59.95 (11.64) 64.04 (10.80) 0.001 +0.47 +Color‑word score +30.33 (10.04) +38.62 (8.48) +0.001 +0.99 +33.07 (8.49) +37.27 (8.96) +0.001 +0.55 +Rosenberg +Self‑Esteem Scale +137 +107 +28.55 (3.42) +28.66 (3.51) +0.702 +0.03 +28.66 (4.03) +27.90 (4.45) +0.068 +0.18 +WHO‑5 emotional +well‑being index +137 +107 +17.21 (4.04) +18.57 (3.17) +0.001 +0.33 +16.39 (4.68) +15.66 (4.85) +0.097 +0.16 +SCPI +Sattva score +148 +106 +13.62 (2.06) +13.74 (2.17) +0.516 +0.05 +12.75 (2.17) +13.10 (2.40) +0.044 +0.20 +Rajas score +8.93 (2.22) +8.42 (2.64) +0.011 +0.21 +7.57 (2.31) +7.47 (2.06) +0.647 +0.04 +Tamas score +6.95 (2.13) +6.39 (2.49) +0.004 +0.24 +6.68 (2.59) +6.18 (2.05) +0.020 +0.23 +Pre and post are group means (SD). SD, Standard deviation; SCPI, Sushruta Child Personality Inventory +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] +Sinha and Kumari: Effect of ICYM on wellbeing of school children +106 +Yoga Mīmāṃsā | Volume 53 | Issue 2 | July-December 2021 +in the dependent variable is due to the independent variable. In the +present study, the results showed that the effect size in the fitness +tests was medium to large while in the cognition and emotional +wellbeing tests they were small. We argue that small effect sizes in +some tests should not be dismissed since every little improvement +in children’s wellbeing is encouraging. +The qualitative assessment buttressed the benefits shown in +the quantitative study. Its findings were in consonance with +previous qualitative research that reported the perceived benefits +as kinesthetic awareness, improved self-image, stress reduction, +self-regulation of emotions, and social cohesion (Conboy, Noggle, +Frey, Kudesia, & Khalsa, 2013). +We now compare the results of the ICYM with studies that used +longer-duration yoga modules. A study by Purohit, et al. (2016), +found significant differences in the yoga group in 9 out of 11 +EUROFIT variables. It can be concluded that the impact of the +ICYM on physical fitness is somewhat in conformity with a +longer duration module. A study using the Stroop test (Purohit +& Pradhan, 2016), reported a significant improvement in the +yoga group with medium effect size. The ICYM also showed a +significant improvement albeit with a small effect size. Studies +using longer duration yoga modules have reported improvements +in self-esteem, self-efficacy, self-confidence, self-concept, mood +disturbance, tension-anxiety, negative affects with medium effect +sizes (Benson et al., 1994; Noggle, Steiner, Minami, & Khalsa, +2012; Bhardwaj & Bhardwaj, 2015; Bhardwaj & Agarwal, 2013; +Das et al., 2016). The ICYM was associated with a significant +improvement in emotional well-being with a small effect size. +Since ICYM is classroom yoga module we have compared the +results with other studies that used classroom yoga interventions. +An uncontrolled pilot study by Butzer, et al. (2015) reported +some behavior improvement and stress reduction. Another +uncontrolled study used a15-min yoga activity as intervention and +showed directional improvements in mental, social, and physical +wellbeing (Chen & Pauwels, 2014). A quasi-experimental study +by Lawson et al. (2012) used a 10-min modified yoga intervention +and found minimal improvements in fine motor skills and +academic measures. A study by Telles et al. (2019) used an 18-min +Pranayama intervention for 3 days and reported improvements +in attention and anxiety reduction. Though suffering from some +methodological infirmities like short periods of intervention, +non-standard modules, and teacher-reported assessments, they all +point to directional improvements in behavior, stress, emotional +wellbeing, cognition, and academic measures. The present study +used a validated classroom yoga module, randomized controlled +design and longer period of intervention to show improvements +that were directionally demonstrated by earlier studies. +The question arises as to why the ICYM positively impacted +physical, cognitive, and emotional measures. One possible reason +could be that the module itself had been developed methodically. +It was an integrated practice incorporating asana (physical +postures), pranayama (breathing practice), dhyana (meditation), +and mantra (chanting). The practices were specifically selected +for their impact on physical wellbeing, mental calmness, +stress reduction, and impact on concentration. They had been +sequenced in a manner that the physical postures involved full- +body movement namely sideways-forward-backward bending, +stretching, and balancing. The breathing exercises too included +full breathing, balancing breathing, and an inward focusing +practice. Chanting and meditation promoted calmness, stress +reduction, and concentration. The second possible reason was +that the convenience of the module made it possible to practice +daily. We speculate that the daily practice may have contributed +strongly to its efficacy. The third reason was that we know from +modern research that yoga is related with physical, cognitive, and +emotional benefits. This module may have worked because it is a +shorter version of a proven practice. +CONCLUSION +It may be concluded that the short duration ICYM can be +considered for inclusion in the daily school schedule when it is +not feasible for a longer duration module to be included. +The study has substantial strengths: (i) ICYM was a systematically +developed and validated module, (ii) the research design and +sample size were robust, (iii) the variables covered the major +domains defined as the whole child, (iv) the quantitative study +was supplemented with a qualitative assessment. +The limitations of the study were: (i) unequal randomization, (ii) +lack of follow-up assessments. Future studies could specialize +in assessing multiple variables within each benefit category. +Longitudinal studies could strengthen the findings of this study. +Classroom yoga modules for different age groups could be +developed and tested. +Acknowledgments +We would like to acknowledge the cooperation of the Samsidh +Mount Litera Zee School management, teachers, and especially +the enthusiastic young students. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +REFERENCES +Agger, I., Raghuvanshi, L., Shabana, S., Polatin, P., & Laursen, L. K. (2009). +Testimonial therapy. A pilot project to improve psychological wellbeing +among survivors of torture in India. Torture: Quarterly Journal on +Rehabilitation of Torture Victims and Prevention of Torture, 19(3), +204-217. +Benson, H., Kornhaber, A., Kornhaber, C., LeChanu, M. N., +Zuttermeister, P. C., Myers, P., … & Friedman, R. (1994). 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The effect of yoga +practices on cognitive development in rural residential school children in +India. National Journal of Laboratory Medicine, 6(2.80), 6-24. +Zenner, C., Herrnleben-Kurz, S., & Walach, H. (2014). Mindfulness-based +interventions in schools – A systematic review and meta-analysis. +Frontiers in Psychology, 5, 603. +[Downloaded free from http://www.ym-kdham.in on Monday, June 6, 2022, IP: 136.232.192.146] diff --git a/subfolder_0/Effect of two yoga-based relaxation techniques on memory scores and state anxiety.txt b/subfolder_0/Effect of two yoga-based relaxation techniques on memory scores and state anxiety.txt new file mode 100644 index 0000000000000000000000000000000000000000..3a07834df81197abdaeefd7e17fc7c52dad5f73e --- /dev/null +++ b/subfolder_0/Effect of two yoga-based relaxation techniques on memory scores and state anxiety.txt @@ -0,0 +1,399 @@ +BioMed +Central +Open Access +Page 1 of 5 +(page number not for citation purposes) +BioPsychoSocial Medicine +Short report +Effect of two yoga-based relaxation techniques on memory scores +and state anxiety +Pailoor Subramanya and Shirley Telles* +Address: Indian Council of Medical Research Center for Advanced Research in Yoga and Neurophysiology, SVYASA, Bangalore, India +Email: Pailoor Subramanya - pailoors@gmail.com; Shirley Telles* - shirleytelles@gmail.com +* Corresponding author +Abstract +Background: A yoga practice involving cycles of yoga postures and supine rest (called cyclic +meditation) was previously shown to improve performance in attention tasks more than relaxation +in the corpse posture (shavasana). This was ascribed to reduced anxiety, though this was not +assessed. +Methods: In fifty-seven male volunteers (group average age ± S.D., 26.6 ± 4.5 years) the immediate +effect of two yoga relaxation techniques was studied on memory and state anxiety. All participants +were assessed before and after (i) Cyclic meditation (CM) practiced for 22:30 minutes on one day +and (ii) an equal duration of Supine rest (SR) or the corpse posture (shavasana), on another day. +Sections of the Wechsler memory scale (WMS) were used to assess; (i) attention and +concentration (digit span forward and backward), and (ii) associate learning. State anxiety was +assessed using Spielberger's State-Trait Anxiety Inventory (STAI). +Results: There was a significant improvement in the scores of all sections of the WMS studied after +both CM and SR, but, the magnitude of change was more after CM compared to after SR. The state +anxiety scores decreased after both CM and SR, with a greater magnitude of decrease after CM. +There was no correlation between percentage change in memory scores and state anxiety for +either session. +Conclusion: 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). +Findings +Yoga includes practices such as physical postures, regu- +lated breathing, and meditation, among other techniques +[1]. Meditation practice reduces stress and increases calm- +ness [2], but many novices find it difficult to practice med- +itation initially [3]. In fact, meditation is the seventh of +eight steps traditionally described [Patanjali, circa 900 +B.C.] [1]. Some people find it easier to begin by practicing +yoga postures. Based on this a 'moving meditation' called +cyclic meditation was evolved which has cycles of yoga +postures alternating with guided relaxation while supine +[3]. Cyclic meditation practice improved the performance +in a P300 event related potential task [4] and also +improved the performance in a letter cancellation task [5]. +Published: 13 August 2009 +BioPsychoSocial Medicine 2009, 3:8 +doi:10.1186/1751-0759-3-8 +Received: 16 June 2009 +Accepted: 13 August 2009 +This article is available from: http://www.bpsmedicine.com/content/3/1/8 +© 2009 Subramanya and Telles; 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. +BioPsychoSocial Medicine 2009, 3:8 +http://www.bpsmedicine.com/content/3/1/8 +Page 2 of 5 +(page number not for citation purposes) +Both tasks require selective attention and concentration. +The benefits were ascribed to possible stress reducing +effects of cyclic meditation, as the practice reduces physi- +ological [6,7] and cortical [8] arousal. However the effects +of cyclic meditation on state anxiety have not been +assessed. +In the present study cyclic meditation was compared to an +equal duration of supine rest in the corpse posture (sha- +vasana), as both are supposed to increase relaxation. +Hence, the present study was designed to assess the effects +of cyclic meditation and shavasana on state anxiety and +the performance in memory tasks, to see whether they +would change after the practices. +There were 57 male participants, aged between 18 and 40 +years (group average age ± S.D., 26.6 ± 4.5 years), all with +normal health and not on medication. They were residing +at a yoga center. All of them had a minimum of 15 years +of education and could understand the tasks. Their expe- +rience of cyclic meditation and of relaxation in the corpse +posture (shavasana) was between 6 and 48 months (group +average 20.1 ± 14.9 months). The study had been +explained to the participants, whose signed informed con- +sent was taken. The Institutional Ethics committee +approval was obtained. +All participants were assessed before and after two practice +sessions, viz., cyclic meditation (CM) and supine rest (SR) +in shavasana. At random twenty-nine participants had CM +on the first day, and SR the next day. The remaining par- +ticipants had the reverse schedule. The time of day was +kept constant for both sessions of an individual. Sessions +were 22:30 minutes in duration. +Memory tasks were selected from the Wechsler memory +scale which has been standardized for use in an Indian +population. The following sections were selected (i) digit +span forward and backward, and (ii) verbal paired associ- +ate learning (easy and hard), with 10 items each. The ver- +bal +paired +associate +learning +task +involved +the +presentation of ten pairs of unrelated words as three trials. +After the three trials the examinee was presented with the +first word in each pair and he or she was asked to provide +the second word. Out of the ten pairs, six pairs were +semantically easy to remember (e.g., table-chair). Where +such associations existed, it was described as associate +learning, easy. Where there were no such associations the +task was described as associate learning, hard. There were +six pairs for the easy task and four pairs for the hard task. +Each correct answer was scored as '1' (for digit span for- +ward or backward), while for associate learning, each easy +answer was scored as '1' and difficult or hard answer as '2'. +This was based on the conventional scoring for Wechsler +memory scale [9]. Parallel worksheets were prepared, +changing the digits and words to eliminate serial testing +artifacts when retesting [10]. +State anxiety was assessed using the Spielberger's State- +Trait Anxiety Inventory at the beginning and end of the +CM and SR sessions, after the memory tasks. +Test sheets were blind scored by a person who was una- +ware about the participant's practice session or whether +the assessments were before or after a practice session. +During cyclic meditation participants kept their eyes +closed and followed pre-recorded instructions. The +emphasis was on carrying out the practice slowly, with +awareness and relaxation. The practice has been detailed +in earlier reports [4,6], but is described here in brief. The +practice begins with isometric contraction of the muscles +of the body while supine (1:00 min), followed by a stand- +ing posture (2:20 min), and two side bending postures +(3:50 min). This is followed once more by a standing pos- +ture (2:20 min), a forward bending posture (1:30 min) +and a backward bending posture (1:30 min). These yoga +postures are followed by 10:00 min of guided relaxation +while supine, with instructions to relax different parts of +the body while being aware of them. +Relaxation in the corpse posture (shavasana) or supine rest +was for the same duration, i.e., 22:30 min. This is a classic +yoga posture, intended for relaxation [11]. Here, partici- +pants lie flat on the ground with their legs apart, arms +away from the sides of the body, palms facing upwards +and the eyes closed. During the training, participants had +been instructed to attempt to remain relaxed while being +aware of body sensations during shavasana. +Data were analyzed using SPSS (Version 16.0). There were +separate repeated measures analyses of variance (ANO- +VAs) for each of the assessments, with two Within Sub- +jects factors [i.e., States (before, after) and Sessions (CM, +SR)]. Post-hoc analysis was with Bonferroni adjustment, +comparing after with before values. The percentage +change in each of the memory tasks {(where percentage +change was [(After-value/Before-value*100)-100]} was +tested for correlation with state anxiety using the Pearson +correlation test. +Digit span forward scores differed significantly between +Sessions (F = 4.1, p = 0.048), and between States (F = +286.4, p < 0.001), with a significant interaction between +them (F = 13.4, p < 0.001). Digit span backward scores +also differed between Sessions (F = 15.7, p < 0.001), and +States (F = 124.4, p < 0.001) with a significant interaction +between them (F = 37.9, p < 0.001). Similarly, associate +BioPsychoSocial Medicine 2009, 3:8 +http://www.bpsmedicine.com/content/3/1/8 +Page 3 of 5 +(page number not for citation purposes) +Change in scores (mean ± SD) of (a) Digit-span forward and backward, (b) Associate learning, easy and hard, and (c) State anx- +iety, before and after CM and SR +Figure 1 +Change in scores (mean ± SD) of (a) Digit-span forward and backward, (b) Associate learning, easy and hard, +and (c) State anxiety, before and after CM and SR. *** p < 0.001, after compared to before (post-hoc analysis). + a) +0 +1 +2 +3 +4 +5 +6 +7 +8 +9 +10 +CM +SR +CM +SR +Digit span forw ard +Digit span backw ard +Scores (in numbers) +Before +After +*** +*** +*** +*** +b) +0 +5 +10 +15 +20 +25 +CM +SR +CM +SR +Associate learning easy +Associate learning hard +Scores (in numbers) +Before +After +*** +*** +*** +*** +c) +STAI +0 +5 +10 +15 +20 +25 +30 +35 +40 +45 +50 +CM +SR +Sessions +Scores (in numbers) +Before +After +*** +*** + +Before +After +BioPsychoSocial Medicine 2009, 3:8 +http://www.bpsmedicine.com/content/3/1/8 +Page 4 of 5 +(page number not for citation purposes) +learning, easy scores differed significantly between Ses- +sions (F = 16.5, p < 0.001), and States (F = 237.9, p < +0.001), with the interaction between the two being signif- +icant (F = 37.1, p < 0.001). Also, for associate learning, +hard, the scores differed significantly between Sessions (F += 16.4, p < 0.001) and States (F = 268.5, p < 0.001), with +a significant interaction between them (F = 94.4, p < +0.001). +The state anxiety scores also differed significantly between +Sessions (F = 54.9, p < 0.001), and States (F = 175.5, p < +0.001), with a significant interaction between them (F = +178.8, p < 0.001). +A significant interaction between factors, suggests that the +two factors are not independent of each other, or one fac- +tor may be modified by the other factor. +Post-hoc analyses showed that following both CM and SR +there was a significant increase in digit span forward +scores (p < 0.001 in both cases), digit span backward +scores (p < 0.001 in both cases), associate learning, easy (p +< 0.001 in both cases) and associate learning, hard (p < +0.001 in both cases). State anxiety scores decreased after +both CM and SR (p < 0.001 in both cases). All values for +post-hoc analyses were Bonferroni adjusted (Figure 1). +The increase in scores for the digit span and associate +learning tasks following CM was greater [digit span for- +ward (27.7 percent), backward (33.5 percent), associate +learning, easy (20.7 percent), and associate learning hard +(37.7 percent)] than the increase following SR [digit span +forward (16.1 percent), backward (9.2 percent), associate +learning, easy (9.4 percent), and associate learning, hard +(10.6 percent)]. Also, there was a greater magnitude of +decrease in state anxiety after CM (22.4 percent) com- +pared to after SR (5.6 percent). The digit span tests assess +attention, concentration and primary working memory +[12]. Earlier studies have shown that CM practice +increases selective attention more than an equal duration +of supine rest [4,5]. The present results suggest that pri- +mary working memory also improves with CM practice. +Verbal paired associate learning assesses integration of +information and episodic memory. The present results +suggest an improvement in these aspects of memory after +both CM and SR, with a greater magnitude of increase +after CM. +Cyclic meditation involves movement, and such practices +(another example being Tai-Chi-Qui-Gong) have been +described as 'moving meditations' [13]. These techniques +are described as meditations because during these prac- +tices practitioners ideally assume a meditative state of +mind. This is characterized by interoception, awareness of +body sensations, and relaxation [14]. Hence though these +moving meditations differ from the classic description of +meditation, in which the practitioners remain seated, +keeping as still as possible, the mental state in both prac- +tices is supposed to be comparable. +The present results suggest that movement as a part of +cyclic meditation may actually facilitate performance in +attention and memory tasks more than an equal duration +of time in a conventional relaxation posture (shavasana). +A major drawback of the study is that participants were +residing at the yoga center, and though they were not spe- +cifically told about the previous studies, they had access to +them and this could have influenced their performance +and hence the outcome. An attempt would be made to +conduct the assessments on participants who are trained +in CM but have no access to the findings reported earlier. +Conflict of interests +PS and ST have no conflicts of interest in relation to this +article. +Authors' contributions +PS carried out the assessments, the data analysis and par- +ticipated in compiling the manuscript. ST conceived and +designed the study, and compiled the manuscript. Both +authors read and approved the final manuscript. +Acknowledgements +The authors gratefully acknowledge H.R. Nagendra, Ph.D. who derived the +cyclic meditation technique from an ancient yoga text. The funding from the +Indian Council of Medical Research (ICMR), Government of India, as part +of a grant (Project No. 2001-05010) towards the Centre for Advanced +Research in Yoga and Neurophysiology (CAR-Y&N) is also gratefully +acknowledged. +References +1. +Taimini IK: The science of yoga. 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Neuropsychologia 1976, 14:97-110. +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 +BioPsychoSocial Medicine 2009, 3:8 +http://www.bpsmedicine.com/content/3/1/8 +Page 5 of 5 +(page number not for citation purposes) +10. +Morris J, Kunka JM, Rossini ED: Development of alternate para- +graphs for the logical memory subtest of the Wechsler +memory scale-Revised. 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Delhi, India: +Motilal Banarsidass Publishers; 2001. diff --git a/subfolder_0/Effect of yoga on EUROFIT physical fitness parameters on adolescents dwelling in an orphan home A randomized control study.txt b/subfolder_0/Effect of yoga on EUROFIT physical fitness parameters on adolescents dwelling in an orphan home A randomized control study.txt new file mode 100644 index 0000000000000000000000000000000000000000..cc565799b3b2f0b07b5f04ebacf2391f822fdd3e --- /dev/null +++ b/subfolder_0/Effect of yoga on EUROFIT physical fitness parameters on adolescents dwelling in an orphan home A randomized control study.txt @@ -0,0 +1,902 @@ +Full Terms & Conditions of access and use can be found at +http://www.tandfonline.com/action/journalInformation?journalCode=rvch20 +Download by: [14.139.155.82] +Date: 27 July 2016, At: 23:55 +Vulnerable Children and Youth Studies +An International Interdisciplinary Journal for Research, Policy and Care +ISSN: 1745-0128 (Print) 1745-0136 (Online) Journal homepage: http://www.tandfonline.com/loi/rvch20 +Effect of yoga on EUROFIT physical fitness +parameters on adolescents dwelling in an orphan +home: A randomized control study +Satya Prakash Purohit, Balaram Pradhan & Hongasandra Ramarao +Nagendra +To cite this article: Satya Prakash Purohit, Balaram Pradhan & Hongasandra Ramarao +Nagendra (2016) Effect of yoga on EUROFIT physical fitness parameters on adolescents +dwelling in an orphan home: A randomized control study, Vulnerable Children and Youth +Studies, 11:1, 33-46, DOI: 10.1080/17450128.2016.1139764 +To link to this article: http://dx.doi.org/10.1080/17450128.2016.1139764 +Published online: 05 Feb 2016. +Submit your article to this journal +Article views: 63 +View related articles +View Crossmark data +Citing articles: 1 View citing articles +Effect of yoga on EUROFIT physical fitness parameters on +adolescents dwelling in an orphan home: A randomized +control study +Satya Prakash Purohit +a, Balaram Pradhana and Hongasandra Ramarao Nagendrab +aDivision of Yoga and Humanities, S-VYASA Yoga University, Bengaluru, India; bChancellor, S-VYASA Yoga +University, Bengaluru, India +ABSTRACT +Childhood parental loss, parental separation, poverty and rearing +in orphanages have negative impact on physical, psychological +and social well-being in orphans. Yoga has a profound knowledge +base and practical solutions for such traumatic consequences. The +aim of the study was to evaluate the effect of a Yoga program on +the physical fitness of adolescents staying in an orphanage. A total +of 72 apparently healthy adolescents participated from an orpha- +nage. They were randomized (based on their age and gender) and +allocated into two groups as Yoga group (n = 40; 14 girls, 26 boys +and age = 12.69 ± 1.35) and Wait-List Control group (WLC) (n = 32, +13 girls, 19 boys and age = 12.58 ± 1.52). The Yoga group (YG) +underwent 3 months of Yoga program in a schedule of 90 mins/ +day and 4 days/week, whereas the WLC group underwent day-to- +day activities. European physical fitness test battery (EUROFIT) was +assessed in both groups at the beginning and end of the program. +The group × time interaction analysis showed significant (p < 0.05) +positive differences in Flamingo left-leg balance (FLL), Flamingo +right-leg balance (FLR), left-hand tapping test (PTL), right-hand +tapping test (PTR), sit and reach (SAR), standing broad jump +(SBJ), sit-ups (SUP), bent arm hang (BAH) test, shuttle run (SHR) +in YG compared to WLC group. Further analysis done on group × +time interaction along with Bonferroni-corrected p-values showed +significant positive differences in FLL, FLR, PTL, PTR, SAR, SBJ and +SUP in YG compared to WLC group. The results suggested that the +3-month Yoga program was found useful for the young orphan +adolescents in improving their physical fitness. +ARTICLE HISTORY +Received 14 June 2015 +Accepted 31 December 2015 +KEYWORDS +Yoga; orphans; physical +fitness; EUROFIT; adolescents +Children who are under the age of 18 years and have lost one or both parents are +known as orphans and are categorized as double or single orphans, respectively. Single +orphans are categorized as maternal orphans, the children who have lost their mothers, +and paternal orphans, who have lost their fathers (George, 2011; UNICEF, UNAID, & +USAID, 2004). There is another category called social orphans, the children who live +without parents because of abandonment, or because their parents gave them up as a +result of poverty, alcoholism or imprisonment (Dillon, 2009). The total number of +CONTACT Satya Prakash Purohit +purohit.satya@gmail.com +Research Scholar, Division of Yoga and Humanities, +S-VYASA Yoga University, # 19, Eknath Bhavan, Gavipuram Circle, Bengaluru 560019, India +VULNERABLE CHILDREN AND YOUTH STUDIES, 2016 +VOL. 11, NO. 1, 33–46 +http://dx.doi.org/10.1080/17450128.2016.1139764 +© 2016 Taylor & Francis +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +orphans estimated is 143 million worldwide (UNICEF, UNAID, & USAID, 2004), +72 million in South Asia and East Asia (UNICEF, 2008) and 20 million in India +(Rajan & James, 2008). +Orphan children are considered to be one of the most disadvantaged groups, who live a +life full of stress, poverty and grief and are easily subjected to be abused, neglected and +exploited (Nayak, 2014). Poverty in early childhood is one of the major predictor of worse +developmental outcomes in later life (Heckman, 2006). Early parental loss and permanent +or long-term separation from parents affect neuroendocrine functions (Luecken & +Appelhans, 2006; Nicolson, 2004), basal salivary cortisol concentrations (Pfeffer, +Altemus, Heo, & Jiang, 2007), HPA axis mediation (Chrousos, 2009; Romero, Dickens, +& Cyr, 2009), which can induce chronic stress and later produce a negative impact on the +physical and mental health in developing children (Luecken & Roubinov, 2012). +The orphans are in need of supportive living environment because their biological +parents are unable to take care of them (UNICEF, 2008). There are many NGOs +working for orphans at local, national and international level through orphanages to +support basic needs and education. But there are many limitations associated with +orphanages. At orphanages, orphans are unable to get individualized nurturing (Ahmad +et al., 2005), are deprived of emotional fulfillment as they could have got from their +family and relatives and are away from the social customs, culture, tradition, norms and +regulation (Naqshbandi, Sehgal, & Hassan, 2012). A study also showed that post- +institutionalized children had motor system delays compared to the noninstitutiona- +lized children (Roeber, Tober, Bolt, & Pollak, 2012). +Whatever the external condition may be, the children have to evolve out from the +environment and prove themselves as the children of mainstream. For such a positive +change in them, they need to be physically and mentally fit. Physical fitness is being +considered as a powerful marker of health in childhood and adolescent and can be defined +as the ability to perform a given set of physical activity, which later translate into +cardiorespiratory fitness, muscular fitness, speed and agility (Ortega, Ruiz, Castillo, & +Sjöström, 2008). Effective intervention programs are found to be helpful for the promotion +of physical health for school children (Pelegrini, Silva, Petroski, & Glaner, 2011). +Yoga is also now considered as an important intervention for promoting physical +health. Regular practice of yoga promotes muscular strength (Bhavanani, Udupa, +Madanmohan, & Ravindra, 2011; Chen, Mao, Lai, Li, & Kuo, 2009; Dash & Telles, +2001), endurance (Chen et al., 2009; D’souza & Avadhany, 2014), flexibility (Bal & +Kaur, 2009; Chen et al., 2009), cardiopulmonary fitness (Bhutkar, Bhutkar, Taware, & +Surdi, 2011; Chen et al., 2009) and overall physical fitness (Telles, Singh, Bhardwaj, +Kumar, & Balkrishna, 2013) in children. +Thus, the present study is intended to evaluate the effect of yoga on physical fitness +of the young orphan adolescents. +Method +Participants +The study was conducted in an orphanage, a suburban area of Bangalore between the +months September 2014 and November 2014. A total of 135 resident young adolescent +34 +S. P. PUROHIT ET AL. +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +orphans were screened in the study, out of which only 80 were enrolled based on the +inclusion and exclusion criteria. Children were eligible for inclusions if they (a) were +orphans of any type, (b) aged between 11–16 years, (c) boys and girls, (d) apparently +healthy children with no chronic illness and (e) physically or mentally handicapped. +The approvals from the Institutional Review Board and the Institutional Ethics +Committee of Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) Yoga +University were obtained as per the guidelines. A signed informed consent from the +institution head and a signed informed assent was obtained from all participants after +explaining the study in detail. +Design +This was a randomized WLC pre-post study. Participants were randomized by a +statistician using a computerized random number table from www.randomizer.org +and assigned into two groups as Yoga group (YG) and WLC. The YG underwent the +Yoga program for 3 months. Participants in the WLC underwent day-to-day regular +activity (study). +Intervention +The YG was given integrated approach of yoga – 90 minutes, 4 days/week, 3 months. +Later the same intervention was served to WLC for same duration. The yoga +intervention was taught and supervised by two certified yoga teachers from S- +VYASA (one with master’s degree in yoga and the other with postgraduation +diploma in yoga therapy). The principle and concept of an integrated approach of +yoga is based on the research works of S-VYASA (Nagarathna & Nagendra, 2006). In +the beginning of the class there used to be yogic prayer, a small session on under- +standing of the yogic concepts and their relevance to lead a positive lifestyle. Yoga +intervention included loosening and breathing exercises, yoga postures, concentra- +tion and relaxation techniques and yogic games aimed to the multidimensional +strengthening of the body, mind and social skills. The various components of the +Yoga program are mentioned in the Table 1. +Assessments +The following explained data were collected by the research staffof S-VYASA during +the pre- and post-adjacent weeks to the intervention period for all the recruited +participants. The investigators and two physical education teachers were available to +answer questions and provide unbiased guidance during the assessment. The statis- +tician who generated the randomization sequence and subsequently analyzed the +data and the researchers who were carrying out the allocation and assessments were +blinded. +Demographic data +Age, gender, education, parental status, duration of staying in orphanage were collected +from the office record and through an interview. +VULNERABLE CHILDREN AND YOUTH STUDIES +35 +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +Table 1. List of practices in the Yoga program. +Order no. +Intervention components +No. of rounds +Approx. time (total 90 min) +Schedule +General justification +1 +Yogic prayer, session on basic concepts of +yoga and instructions for the class +10 min +4 days /week +(Wednesday, Thursday, +Saturday and Sunday) +Give directions and +motivation for living a life +with positivity and +enthusiasm with acceptance +and the importance of +different yoga activities/skills +2 +Preparatory practices +(a) +Warm-up: jogging, jumping, hop- +ping, forward and backward bend- +ing, side bends and twisting +(b) +Loosening: for toes, ankle, knee, +hips, fingers, wrist, elbow and neck +(c) +Stretching with breathing exercises: +hands in and out, hands stretch, +ankle stretch, hip stretch, back- +stretch, tiger stretch (spinal up- +downs), supine straight leg raising, +cycling, lumber stretch, rocking and +rolling +1 each +10 min +4 days /week +(Wednesday, Thursday, +Saturday and Sunday) +Preparatory practices of +asana and Pranayama. +Warm up the body, loosen +the joints and stretch the +muscles +3 +Sun salutation (Suryanamaskar) +10–12 +10 min +4 days /week +(Wednesday, Thursday, +Saturday and Sunday) +Gives an all-round benefit by +balancing physiological +systems and removing +mental rigidity (Tamas) +(Continued) +36 +S. P. PUROHIT ET AL. +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +Table 1. (Continued). +Order no. +Intervention components +No. of rounds +Approx. time (total 90 min) +Schedule +General justification +4 +Asana (postures) +A. Standing postures +(a) Half waist rotation posture (Ardhakati +Chakrasana) +(b) Foot palm posture (Padahastasana) +(c) Half wheel posture (Ardha Chakrasana) +(d) Triangle posture (Trikonasana) +(e) Tree posture (Vrikshasana) +(f) Eagle posture (Garudasana) +B. Sitting postures +(a) Diamond (Vajrasana) +(b) Rabbit posture (Shashankasana) +(c) Sleeping diamond posture (Supta +Vajrasana) +(d) Camel posture (Ustrasana) +(e) Posterior stretch (Paschimottanasana) +(f) Spinal twist posture (Ardha +Matsyendrāsana) +(g) Cow face posture (Gomukhasana) +C. Prone posture +(a) Cobra posture (Bhujangasana) +(b) Grasshopper posture (Salabhasana) +(c) Bow posture (Dhanurasana) +(d) Shoulder stand (Sarvangasana) +(e) Plough posture (Halasana) +D. Supine postures +(a) Fish posture (Matsyasana) +(b) Boat posture (Naukasana) +1 each +20 min (around 1 min each posture) +4 days /week +(Wednesday, Thursday, +Saturday and Sunday) +Culturing the body and mind +by improving strength, +stamina and flexibility +5 +Deep relaxation technique (DRT) +1 +10 min +4 days /week +(Wednesday, Thursday, +Saturday and Sunday) +Gives total rest to the body +muscles and mind +(Continued) +VULNERABLE CHILDREN AND YOUTH STUDIES +37 +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +Table 1. (Continued). +Order no. +Intervention components +No. of rounds +Approx. time (total 90 min) +Schedule +General justification +6 +Pranayama (voluntary regulation of breath) +(a) +Breathing with forceful exhalation +with +passive +inhalation +(Kapalabhati-3 types) +(b) +Breathing with rapid inhalation and +exhalation (Bhastrika) +(c) +Slow and rhythmic alternate nostril +breathing (Nadi Sodhana) +(d) +Exhalation, with a honeybee sound +(Bhramari) +(e) +Hissing in thought while exhaling +(Ujjai) +1 each +15 min +4 days (Wednesday, Thursday, +Saturday and Sunday) +Improves lung capacity, +balances vital energy, +regulates emotions by +reducing anxiety and stress +7 +Concentration techniques +(a) +Eye exercises (Netra Sakti Vikasana) +(b) +Practice to improve collective moti- +vation (Dhriti Sakti Vikasaka) +(c) +Activity to improve intellect (Dhi +shakti vikasaka) +(d) +Trataka +(e) +Palming +1 each +15 min +2 days /week +(Wednesday and Saturday) +Gives rest and rejuvenates +the ocular muscle. +Also improves concentration +and attention +8 +Yogic games (games for memory, awareness +and creativity) +15 min +2 days /week +(Thursday and Sunday) +Yogic games help in +reducing stress and the +feeling of loneliness by +improving the social skills/ +peer relationship and caring +attitude +38 +S. P. PUROHIT ET AL. +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +Anthropometric measures +(a) Height (in cms) was measured in standing position without footwear, to nearest to +0.1 cm. (b) The participants were weighed with a standard weighing (Wt) machine, to +nearest to 0.1 kg. (c) Body mass index (BMI) was calculated for each participant from +the height and weight of the individual by using formula BMI = Wt in kg/Ht in m2. +EUROFIT physical tests battery (Adam, Klissouras, Ravazzolo, Renson, & Tuxworth, +1988) +EUROFIT physical fitness test is a standardized battery, which was developed by the +Council of Europe’s Committee to help the teachers to access the physical health-related +fitness of the children of school age and it has been used in many European schools since +1988. The tests selected from the battery were (1) Flamingo left-leg balance (FLL), (2) +Flamingo right-leg balance (FLR), (3) left-hand plate tapping test (PTL), (4) right-hand +plate taping test (5) sit and reach (SAR), (6) standing broad jump (SBJ), (7) left-hand grip +strength (LHS), (8) right-hand grip strength, (9) sit-ups (SUP), (10) bent arm hang (BAH) +test and (11) shuttle run (SHR). Prior to the tests, participants were familiarized with the +test methods by giving them clear instructions with demonstration in a group and once +again students were taught individually at the time of taking data. +Data analysis +Data were analyzed using the Statistical Package for Social Science (Version 18.0). Gender +categorical variables were analyzed using χ2 test. The independent sample t-test was used +to check the difference between groups for demographic measures. Analysis of repeated +measure followed by Bonferroni post hoc was performed for the EUROFIT. +Results +Figure 1 shows the study profile. There were total eight dropouts from WLC. The +reasons for the dropouts were: two were suspended from all the extracurricular activ- +ities of the institution during the post-assessment due to their behavioral issues, two +were sick and other four were not willing to complete the task. The data of 40 +participants in YG and 32 in the control group were available for final analysis. The +baseline BMI of YG and WLC is 15.54 ± 1.94 and 16.23 ± 2.43, respectively, with +p = 0.039, independent t-test. +Table 2 displays the baseline mean age between groups (p = 0.78, independent t-test). +The distribution of gender (p = 0.624, χ2 test) was not significantly different between the +two groups. +Repeated measures of analysis of variance (ANOVA) showed that there were no +significant differences between the two groups’ mean score of baseline (p > 0.05) for all +EUROFIT’s measures except FLR and SBJ. Post hoc test with Bonferroni adjustment +(Table 3) showed significant reduction in the number of falls in FLL in 60 sec and +improvement in the number of tappings (PTL) in 25 sec, improvement in the explosive +power in SBJ, improvement in the number of SUP in 30 sec and improvement in LHS +and RHS in both groups. Whereas significant (p < 0.001) improvements in FLR, PTR, +VULNERABLE CHILDREN AND YOUTH STUDIES +39 +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +BAH and SHR were found only in YG, significant (p < 0.001) decrement was found in +SAR in WLC group. +The group × time interaction (Table 4) showed significant positive differences +(p < 0.05) in FLL, FLR, PTL, PRT, SAR, SBJ, SUP, BAH and SHR without Bonferroni +correction. Further analysis done with Bonferroni correction with corrected p-values +(0.004545455) found significant positive difference in FLL, FLR, PTL, PTR, SAR, SBJ +and SUP in YG compared to WLC group. This suggested that the performance of YG +was better than WLC. +Discussion +The current randomized two-armed WLC study was aimed to investigate the effect of +3 months of yoga intervention on EUROFIT outcome measures on orphan adolescents. +Table 2. Demographic data. +Variables +Yoga (n = 40) +WLC (n = 32) +p-Value +Gender +Male +14 (35%) +13 (40.6%) +0.624 (χ2 test) +Female +26 (65%) +19 (59.4%) +Orphan status +Double orphan (n) +10 (25.0%) +10 (31.3%) +0.755 (χ2 test) +Single orphan (n) +20 (50.0%) +16 (50.0%) +Social orphan (n) +10 (25.0%) +6 (18.8%) +Anthropometric variables +Age (years) +12.69 ± 1.35 +12.58 ± 1.52 +0.735 (Independent sample t-test) +Height (cm) +142.39 ± 11.10 +149.91 ± 10.92 +0.568 (Independent sample t-test) +Weight (kg) +31.72 ± 8.11 +33.82 ± 8.04 +0.281 (Independent sample t-test) +The baselines were matched between groups’ variables. +After 3 months +Participants screened for the study N = 135 +Participants recruited N = 80 +WLC (n = 40) +Pre Assessment +WLC (n = 32) +Post Assessment +YOGA (n = 40) +Pre Assessment +YOGA (n = 40) +Post Assessment +Randomization +Figure 1. The trial profile. +40 +S. P. PUROHIT ET AL. +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +Table 3. Comparison of EUROFIT physical fitness measures of Yoga group and Wait-List Control group. +Yoga (n = 40) +Wait-List Control (n = 32) +Pre +Post +Pre +Post +Mean±SD +95% C.I. +(LB to UB) +Mean±SD +95% C.I. (LB to UB) % Change +Mean ±SD +95% C.I. (LB to UB) +Mean±SD +95% C.I. (LB to UB) % Change +FLL (n) +13.25 ± 3.9 +12–14.5 +8.75 ± 3.45*** +7.65–9.85 +33.96 +11.97 ± 4.8 +10.24–13.7 +11 ± 4.37* +9.42–12.58 +8.09 +FLR (n) +13 ± 4.11 +11.69–14.31 +8.93 ± 3.92*** +7.67–10.18 +31.35 +10.78 ± 5.19 +8.91–12.65 +10.25 ± 5.21 +8.37–12.13 +4.93 +PTL (s) +16.18 ± 2.88 +15.26–17.1 +13.21 ± 2.84*** +12.3–14.12 +18.35 +15.61 ± 2.21 +14.81–16.41 +14.87 ± 2.37* +14.02–15.73 +4.75 +PTR (s) +14.61 ± 2.37 +13.85–15.37 +12.46 ± 2.25*** +11.74–13.18 +14.69 +14.24 ± 2.45 +13.36–15.12 +13.68 ± 2.25 +12.87–14.49 +3.94 +SAR (cm) +36.15 ± 6.4 +34.1–38.2 +39.84 ± 6.57*** +37.74–41.94 +10.20 +37.45 ± 5.61 +35.43–39.47 +35.73 ± 6.85* +33.27–38.2 +4.59 +SBJ (cm) +121.03 ± 24.58 +113.16– +128.89 +143.9 ± 27.68*** +135.05–152.75 +18.90 +132.88 ± 20.17 +125.6–140.15 +138.88 ± 24.13* +130.18–147.57 +4.52 +LHS (kg) +14 ± 5.15 +12.35–15.65 +18.6 ± 7.47*** +16.21–20.99 +32.86 +15.34 ± 6.19 +13.11–17.57 +18.81 ± 6.55*** +16.45–21.17 +22.61 +RHS (kg) +15.78 ± 6.41 +13.73–17.82 +18.5 ± 7.12*** +16.22–20.78 +17.27 +17.84 ± 6.8 +15.39–20.3 +19.81 ± 7.6*** +17.07–22.55 +11.03 +SUP (n) +8.18 ± 7.01 +5.93–10.42 +14.55 ± 5.67*** +12.74–16.36 +77.98 +9.03 ± 7.21 +6.43–11.63 +10.94 ± 6.78** +8.49–13.38 +21.11 +BAH (s) +15.28 ± 15.7 +10.26–20.3 +20.8 ± 20.81*** +14.14–27.45 +36.10 +14.64 ± 11.48 +10.5–18.78 +16.59 ± 12.25 +12.17–21 +13.28 +SHR (s) +16.37 ± 1.66 +15.83–16.9 +15.68 ± 1.38** +15.24–16.12 +4.21 +15.95 ± 1.53 +15.39–16.5 +16.12 ± 1.38 +15.63–16.62 +1.11 +Flamingo left-leg balance (FLL), Flamingo right-leg balance (FLR), left-hand plate tapping test (PTL), right-hand plate tapping test (PTR), sit and reach (SAR), standing broad jump (SBJ), left- +hand grip strength (LHS), right-hand grip strength (RHS), sit-ups (SUP), bent arm hang (BAH) test and shuttle run (SHR); *p < 0.05, **p < 0.01 and ***p < 0.001; pre compared with post. +VULNERABLE CHILDREN AND YOUTH STUDIES +41 +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +The result showed that the difference in percentage change between the YG and WLC +in FLL (25.87%), FLR (26.42%), PTL (13.6%), PTR (10.75%), SAR (14.79%), SBJ +(14.38%), LHS (10.25%), RHS (6.24%), SUP (56.87%), BAH (22.82%) and SHR +(5.32%), which indicates that the magnitude of change in these variables is higher in +YG compared to WLC group. +Our analysis using repeated measures ANOVA following post hoc analysis found +significant positive improvement in all 11 measures in YG, whereas in WLC group, 6 +measures improved positively and 1 improved negatively as displayed in Table 3. These +significant changes were appropriately confirmed by using the sign test and the bino- +mial test. +In the YG, changes in all 11 variables were in positive direction, in accordance with +the experimental hypothesis. Applying a sign test gives p = (½)11 = 0.000488, meaning +that, taking all physical fitness test together, yoga produced overall significant improve- +ments. In contrast, the control group only improved in 6 out of 11 outcome variables +for which the sign test gives p = 0.500, which is not significant. +The group × time interaction found 9 significant positive outcome variables, which +indicates that yoga intervention had better impact than WLC group. The null hypoth- +esis that Yoga is entirely equivalent to WLC can be tested overall on significant +outcome variables (9 out of 11) using binomial test, once again yielding p = 0.0327. +Hence, overall for all 11 variables considered as a group, the null hypothesis fails; Yoga +outperformed WLC, that is, the yoga intervention had definite benefits. +The Flamingo leg balance test (FLL and FLR) is a single leg balance test which +measures the static balance, the ability to maintain the center of gravity within a base of +support in a quiet upright position during standing or sitting (Yim-Chiplis & Talbot, +2000). The improvements in balance might be due to balancing postures such as +Vriksasana, Garudasana and Virabhadrasana, which are single-leg stance (Flamingo +balance) along with visual focus on a single point. Visual focus/concentration also plays +a role in the balance (Hart & Tracy, 2008) which was taken care up by Trataka practice. +In contrast, the balance is not improved in YG (Telles et al., 2013). This might be due to +the variation in the yoga training session duration. +Table 4. Group × time interaction analysis (Yoga group compared to Wait-List Control group). +Yoga +Control +F- +values +Exact p-values without Bonferroni- +corrected significance +p-Values after Bonferroni- +corrected p-value +FLL +−4.50 ± 2.15 +−0.97 ± 2.69 +38.319 +3.60 × 10−8*** +3.97 × 10−7*** +FLR +−4.08 ± 2.13 +−0.53 ± 1.61 +60.870 +4.23 × 10−11*** +4.65 × 10−10*** +PTL +−2.97 ± 2.36 +−0.74 ± 1.22 +23.409 +7.53 × 10−6*** +8.28 × 10−5*** +PTR +−2.15 ± 1.94 +−0.56 ± 1.38 +15.202 +2.19 × 10−4*** +0.00241* +SAR +3.69 ± 3.95 +−1.72 ± 4.41 +30.027 +6.32 × 10−7*** +6.95 × 10−6*** +SBJ +22.88 ± 16.79 +6.00 ± 10.08 25.040 +4.01 × 10−6*** +4.42 × 10−5*** +LHS +4.60 ± 4.09 +3.47 ± 3.53 +1.530 +2.20 × 10−1 +1.000 +RHS +2.73 ± 3.62 +1.97 ± 2.90 +0.921 +3.41 × 10−1 +1.000 +SUP +6.38 ± 4.06 +1.91 ± 3.92 +22.187 +1.22 × 10−5*** +0.00013*** +BAH +5.52 ± 9.22 +1.94 ± 4.73 +3.958 +5.06 × 10−2* +0.557 +SHR +−0.69 ± 1.09 +0.18 ± 1.65 +7.105 +9.54 × 10−3** +0.105 +Flamingo left-leg balance (FLL), Flamingo right-leg balance (FLR), left-hand plate tapping test (PTL), right-hand plate +tapping test (PTR), sit and reach (SAR), standing broad jump (SBJ), left-hand grip strength (LHS), right-hand grip +strength (RHS), sit-ups (SUP), bent arm hang (BAH) test and shuttle run (SHR); *p < 0.05, **p < 0.01 and ***p < 0.001. +42 +S. P. PUROHIT ET AL. +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +The plate-tapping task (PTL and PTR) measures the motor speed and motor speed is +determined by muscle strength, endurance and coordination (Hutson, 2014). The result +in this study showed alignment with the studies where Yoga practices healthy volun- +teers by a repetitive tapping performance (Dash & Telles, 1999; Telles, Sharma, Yadav, +Singh, & Balkrishna, 2014) and eye–hand coordination in computer users (Telles, Dash, +& Naveen, 2009) +SAR, which measures the trunk flexibility, improved in YG compared to WLC; the +results aligned with the study done among children (Chen et al., 2009) and young adults +(Bal & Kaur, 2009) following yoga. This improvement might be due to forward, back- +ward and side bending, tiger stretching and postures such as Padahastasana, +Paschimottanasana, Bhujangasana, Ustrasana, Vakrasana and Ardhamatsyandrasana +included in this study. +There was also a significant improvement in SBJ in YG compared to WLC and also +from baseline. This might be due to the improvement in calf muscle strength, which is +again due to stretching and strengthening of the muscle by applying body weight on the +legs by Vrikshasana, Trikonasana and Garudasana (D’souza & Avadhany, 2014). It was +also observed that stretching of the thigh muscles was due to Padahastasana and +Parvatasana and contraction of the thigh muscles was due to Ardha Chakrasana and +Bhujangasana (Cobra Pose). Inverted postures such as Halasana and Sarvangasana +might have helped by reversing the effect of gravity and promoting the blood circula- +tion and reducing the venous pressure in the leg. +There was also a higher magnitude of percent change in hand grip strength in LHS +and RHS in YG compared to WLC. This supports the findings of the Yoga study (Dash +& Telles, 2001; Madanmohan, Udupa, & Bhavanani, 2003). This might be again due to +more utilization of upper body muscles for weight-bearing postures in Suryanamaskar +(Bhutkar et al., 2011) and improved cardiorespiratory fitness of Suryanamaskar. It +might be due to reduced oxygen need in Pranayama. +The improvement in duration of time in the BAH in YG might be because of more +utilization of upper body muscles for weight bearing during the steps of Chaturanga +Dandasana, Bhujangasana and Parvatasana of Suryanamaskar (Bhutkar et al., 2011). +This might also be due to the aerobic effects of Suryanamaskar as it involves the static +stretching and slow dynamic components with an optimal stress on cardiorespiratory +system (Sinha, Ray, Pathak, & Selvamurthy, 2004). +The numbers of SUPs in 30 sec were improved in the Yoga compared to WLC +group, which was aligned with earlier studies (Dwyer, Sallis, Blizzard, Lazzarus, & Dean, +2001; Telles et al., 2013). Yogic activities such as straight leg raising, cycling, +Pavanamuktasana, Navasana and Suryanamaskar might strengthen the abdominal +muscles. This could also be due to the cardiorespiratory benefit of Suryanamaskar +(Bhutkar et al., 2011) and improvement of whole-body endurance and resting cardio- +pulmonary parameters (Bhavanani et al., 2011). +There was a significant decrease in time in SHR, which showed improvement in +speed and agility of the individuals in YG compared to WLC, which might be due to the +improvement in cardiopulmonary fitness (Bhutkar et al., 2011; Chen et al., 2009), speed +and agility (Bal & Kaur, 2009) in earlier studies in Yoga and also due the dynamic +practice of Suryanamaskar and Yogic games. +VULNERABLE CHILDREN AND YOUTH STUDIES +43 +Downloaded by [14.139.155.82] at 23:55 27 July 2016 +The strength of the study was that it adopted a randomized control design and the +sample size was as per the effect size form the study of same setting. The main +limitation of the study was it was conducted on the adolescents belonging to one +orphanage and the results were not able to rule out the effect of diet and other school +activities. +The study might be improvised in design by further conducting a multicentric +trial and developing a yoga module especially for orphans. In summary, intervention +of yoga over a 3-month period suggested the improvements in all EUROFIT mea- +sures and was useful for the young orphans, to be practiced for physical health on a +day-to-day basis. +Acknowledgments +We are thankful to the Department of Psychology, S-VYASA Yoga University, Bengaluru, for +providing the necessary support needed for the research. +Disclosure statement +No potential conflict of interest was reported by the authors. +ORCID +Satya Prakash Purohit +http://orcid.org/0000-0002-1944-1194 +References +Adam, C., Klissouras, V., Ravazzolo, M., Renson, R., & Tuxworth, W. (1988). Eurofit: European +test of physical fitness. 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PUROHIT ET AL. +Downloaded by [14.139.155.82] at 23:55 27 July 2016 diff --git a/subfolder_0/Effect of yoga on Human Aggression and Violent Behaviour A Review of the Indian Yoga Scriptures and Scientific Studies.txt b/subfolder_0/Effect of yoga on Human Aggression and Violent Behaviour A Review of the Indian Yoga Scriptures and Scientific Studies.txt new file mode 100644 index 0000000000000000000000000000000000000000..f62430a2692343ae87e1bb9892b45a070ea8ed83 --- /dev/null +++ b/subfolder_0/Effect of yoga on Human Aggression and Violent Behaviour A Review of the Indian Yoga Scriptures and Scientific Studies.txt @@ -0,0 +1,860 @@ + + +Instructions for authors, subscriptions and further details: +http://hse.hipatiapress.com +Effect of Yoga on Human Aggression and Violent Behaviour- +A Review of the Indian Yoga Scriptures and Scientific Studies + +A.G. Govindaraja Setty1, Pailoor Subramanya1 & B. Mahadevan2 + +1) Swami Vivekananda Yoga University (SVYASA), India +2) Indian Institute of Management, Bangalore, India + + +Date of publication: February 23rd, 2016 +Edition period: February 2016-June 2016 + + +To cite this article: Govindaraja Setty, A.G., Subramanya, P., & +Mahadevan, B. (2016). Effect of Yoga on Human Aggression and Violent +Behaviour- A Review of the Indian Yoga Scriptures and Scientific Studies. +Social and Education History 5(1), 83-104. doi:10.17583/hse.2016.1859 + +To link this article: http://dx.doi.org/10.17583/hse.2016.1859 + + +PLEASE SCROLL DOWN FOR ARTICLE + +The terms and conditions of use are related to the Open Journal System and +to Creative Commons Attribution License (CC-BY). +HSE – Social and Education History Vol. 5 No. 1 February 2016 pp. +83-104 + + + +2016 Hipatia Press +ISSN: 2014-3567 +DOI: 10.17583/hse.2016.1859 + +Effect of Yoga on Human Aggression and +Violent Behaviour – A Review of the Indian +Yoga Scriptures and Scientific Studies + +A.G. Govindaraja Setty +Swami Vivekananda Yoga +University (India) + +Pailoor Subramanya +Swami Vivekananda Yoga +University (India) +B. Mahadevan + + + + + +Indian Institute of Management, Bangalore (India) + +Abstract +______________________________________________________________ +Among the deviant human behaviors, aggression appears to be the most prevalent and +disturbing one, affecting one and all. Uncontrolled aggression/violent behavior could +cause a significant toll, equally affecting both involved and the non-involved. This +delinquent human behavior has been well addressed in Indian yogic scriptures. It +provides a theoretical framework to understand the causes, ill-effects, need for peace, +harmony, and ways to correct the aggression behavior. It is also claimed that yoga is a +way for inner bliss and external coherence; and with this time-tested technique, it is +possible to bring about a sense of inner peace and emotional stability, thus having +potential to correct aggressive behaviors. This review paper also brings out the studies +made to find out effect of yoga on human aggression/violent behavior. +_______________________________________________________________ +Keywords: Yoga, aggression, violence, violent behaviour +HSE – Social and Education History Vol. 5 No. 1 February 2016 pp. +83-104 + + + +2016 Hipatia Press +ISSN: 2014-3567 +DOI: 10.17583/hse.2016.1859 + +El Efecto del Yoga en la Agresividad +Humana y en el Comportamiento Violento +– Una Revisiónde las Escrituras Indias de +Yoga y Estudios Científicos + +A.G. Govindaraja Setty +Swami Vivekananda Yoga +University, Bangalore (India) + +Pailoor Subramanya +Swami Vivekananda Yoga +University, Bangalore (India) +B. Mahadevan + + + + + +Indian Institute of Management, Bangalore (India) + +Resumen +_____________________________________________________________ +Entre las conductas humanas desviadas, la agresión aparece como una de las más +frecuentes y alarmantes, afectando a todas las personas sin excepción. La conducta +agresiva/violenta incontrolada puede causar graves consecuencias, afectando tanto a las +personas directamente implicadas como a las no implicadas. Este comportamiento +humano delictivo ha sido abordado con profundidad en las escrituras indias yóguicas. +Ello aporta un marco teórico para entender las causas, efectos nocivos, la necesidad de +paz, harmonía y las formas para corregir las conductas violentas. También se afirma que +el yoga es una forma de alcanzar la paz interior y la coherencia exterior; y con esta +técnica probada en el tiempo es posible lograr un sentimiento de paz interna y de +estabilidad emocional, por lo que tiene potencial para corregir conductas agresivas. Esta +revisión bibliográfica pone de relieve los estudios llevados a cabo para identificar los +efectos del yoga en las conductas humanas agresivas/violentas. +_______________________________________________________________ +Keywords: Yoga, agresión, violencia, comportamiento violento +HSE – Social and Education History, 4(3) 85 + + + +Among the deviant human behaviors, aggression and violence +appear to be the most prevalent and highly disturbing, affecting one +and all in the society, hence considered a serious global health +problem (WHO, 2014). Some of the studies say that this aberrant +behavior normally surfacing in childhood becomes habitual and continues at +all age points of an individual and that in childhood it might lead to rejection +from family as well from fellow children, relational tribulations leading to +isolation during adolescence and criminal, illegal or unlawful behavior in +adulthood (Huesmann & Guerra, 1997) and the whole society looks down at +such an individual. Further, it could affect both the involved and the non- +involved; and unchecked aggression and violence exact a significant toll on +human societies. +Though normally men score slightly higher on aggression, this deviant +attitude is not gender-sensitive. Significant correlates of interpersonal +violence were found in younger age. Intensity of aggression is directly +attributable to one’s amount of frustration. Though aggressive behaviors +evolved as adaptations to deal with competition, they can have destructive +consequences. Family members have been the object of violence in more +than 50% of cases (Kumar, Akhtar, Roy & Baruah, 1999). Worldwide, mass +media reports, a number of violent acts affecting one and all, that are neither +country specific (Miron, 2001) nor religion specific (Cobban, 2005) and +world over findings regarding violence-related behaviors are remarkably +similar. The economic cost associated with violence-related injuries, +disabilities, and premature deaths is estimated to be in billions of dollars. +The gravity of the problem could be understood from the fact that 49 World +Health Assembly Geneva, declared violence as leading global public health +problem and urged members to assess the problem of violence in their +territories; and convey details to WHA, besides clearly defining their +approach to deal with it. Further, WHA requested the Director-General for +public health to address the problem of violence, promote research on +violence on priority and document them for the benefit of member nations. +“Aggression” and “violence” are generic terms. Oxford dictionary +defines “aggression” as “feelings of anger or antipathy, readiness to attack or +confront, resulting in hostile or violent behavior”. WHO defines “Violence” +as “intentional use of physical force or power, threatened or actual, against +A +86 Govindaraja et al – Effect of Yoga on Human Aggression + + +oneself, another person, or against a group or community or section of +people, which either results or has a high likelihood of resulting in injury, +death, psychological harm, mal-development or deprivation”. “Violent +behaviors” are latent perception variables towards violence, which are +guided by one’s own value systems. + +Aggression and Violence: Indian Scriptural Perspective + +Aggression and violence have been well addressed in Indian scriptures +(Vedas, Upanishads, Bhagavad Gītā, Brahma Sutras, Yoga Sutras, and +Bhakti (Devotion) Sutras), which are also considered as conventional yoga +texts. This traditional literature provides a theoretical framework to +understand the aggression and violence in conventional background. In +every Indian scripture, there is invariably a mention on aggression and +violence, ill effects, ways to avoid, and need for harmony and coherence. +These include teachings under ‘The doctrine of ahimsa’ (Rajapakse, 1988; +Phillips, 2010). ‘Ahimsa’ means and includes avoiding any harm (physical, +mental or emotional), to remain passive in any situation, without the desire +to harm anyone (Muktibodhananda, 2004). Himsa is brought out by three +ways namely, ‘violence done’, ‘violence got done’ and ‘violence sanctioned’ +(Adidevananda, 1998), wherein all the three bring endless agony. But when +a person is firmly established in ahimsa, in his/her presence, even cruel +persons renounce violence (Adidevananda, 1998). Indian yogic scriptures +recommend that personality of an individual gets nourished by a mix of both +‘relaxing’ and ‘stimulating’ practices by attaining a state of mental equipoise +(Telles & Reddy, 2000). +Prevalence of Aggression and Violent Behavior: Indian Scriptural +Perspective + +Indian scriptures answer the question, ‘does aggressive and violent behavior +indeed exist in us? If yes, in whom and in what ways?’‘Pretentiousness, +arrogance, overweening pride, wrath, rudeness, aggression, scant regard for +pain of others, insensitiveness to spiritual values are prevalent in those born +to demoniac (Asuri) heritage’; whereas, non-violence, truthfulness, freedom +HSE – Social and Education History, 4(3) 87 + + +from anger renunciation, tranquility, aversion to slander, compassion to +living beings, sensitivity to the pain of others, empathy, freedom from +sensuality, gentleness, modesty, steadfastness, are the qualities present in +those born to divine (Daivi) inheritance’ (Bhagavad Gītā 16.2,4) +(Tapasyānanda, 2003). + +Causes for Aggression and Violence, and Need to Address: Indian +Scriptural Perspective + +Indian scriptures clearly establish the causes for aggressive and violent +behavior and assert that we have propensity to be violent. Causes could +range from ‘sense objectivity, greed and illusion. Bhagavad Gītā (2.62) says, +if one dwells longingly on sense objects, inclination towards them is +generated; inclination develops into desire; desire begets anger, and finally +culminates in aggression. Bhāgavatam (4.8.3) says, hypocrisy and illusion +beget greed and deceitfulness, they, in turn, beget aggression and violence. +Insatiable lust, uncontrolled anger, born out of ‘rajas’ prompt men to engage +in violence (Bhagavad Gītā 3.37). ‘Rajas’ is passion-based leading to +craving for objective pleasures; and clinging to objects already possessed by +an individual. Tamas is ignorance-born and produces delusion leading to +negligence, indolence, scant regard for pain of others (Bhagavad Gītā 14.7- +8). The children (derivatives) of aggression and violence are ‘hostility’ and +‘harsh abusive words’ (verbal aggression) (Velanakar, 2013). +The gradual degradation of aggressive and violent personalities is also +brought out by Indian yoga scriptures. Aggression generates delusion, +delusion results in loss of memory, loss of memory brings about destruction +of discriminative intelligence, and loss of discriminataive intelligence spells +ruin to a man (Bhagavad Gītā 2.63). +Bhagavad Gītā (16.21) establishes in a pristine way that lust, aggression, +and greed lead to destruction of man’s spiritual nature. They form the +gateway to hell; hence surely be abandoned (Tapasyānanda, 2003). +Patañjali +Yoga +sūtra +(2.30) +says, +ahiṁsā +(non-violence), +satya +(truthfulness), asteya (non-stealing), brahmacharya (sexual self-restraint), +aparigraha (non-obsessively possessive) are five yamas (moral universal +commandments for self-control) (Prabhavananda, 2004). Patañjali Yoga +88 Govindaraja et al – Effect of Yoga on Human Aggression + + +Sūtra (2.35) says, when a yogi is resolutely committed to non-violence, there +is no hostility, wherever he is present (Prabhavananda, 2004). Manusmṛti +(5.43) says a Brahmin of virtuous disposition, whether dwells in (own) +house, with a teacher or in the forest, must never, in times of distress, cause +injury to any creature, which is not sanctioned by Vedas. Bhāgavatam +(4.18.14) says, you will get the divine feet of Bhagavān Nṛsiṁha (one of the +ten incarnations of Lord Vishnu), only on your abandonment of desire, +melancholy, aggression, pride, apprehension, and grief which are the causes +for vicious cycle of birth and death (Velanakar, 2013). + +Addressing Aggression and Violent Behavior: Yoga Way + +Practical lessons of Indian yogic scriptures could provide broad framework +and specific ways to fight against this delinquent behavior and answer the +question, can we as human beings, bring about a paradigm shift in our +personality by avoiding all these aggression and violent behavior. One of the +eighteen Indian mythologies, Bhāgavatam (1.18.22) says one who is in +divine love with the Supreme Lord can make non-violence and peace one’s +dharma and strive for the ultimate realization through dhyāna (Velanakar, +2013). The word ‘yoga’ implies non-duality, oneness with the Supreme +Soul; and the very notional duality causes fear, anger, lust and therefore +reaching oneness can address this delinquent behavior (Adidevananda, +1998). Violence is attributable to ignorance caused by pretentiousness, +impatience, lack of straight-forwardness, abhorrence, lack of self-control, +lack of devotion and scant regard for cleanliness (Bhagavad Gītā 13.7-11). +Bhāgavatam (6.4.14) further says, a person can transcend ‘Triguṇas’ +(personality traits) by appeasing and controlling the teeming aggression by +steady, indrawn, discriminating mind (Velanakar, 2013). Withdrawal of +mind is nothing but ‘prathyāhāra’ mentioned in ashtanga yoga texts. +According to yogic scriptures, early seers (spiritual masters or yogis or +prophets) of India devised and used yoga as a means to explore the external +and internal realms; and to attain ultimate knowledge described in sacred +Indian texts. These great masters or yogis prescribed yoga as a way of life to +be in tune with the highest reality; and the importance is on individualized or +one’s own confirmation and not merely on religious dogmas or doctrines. +HSE – Social and Education History, 4(3) 89 + + +They preached that yoga is both a way for internal bliss and external +coherence. "Yoga" is derived from a Sanskrit root word ‘Yuj’ (join), hence +"yoga" means and includes, joining of the body, mind and the ‘Self’(soul) +(Nagendra, 2000). +Addressing violent and aggressive behavior through yoga has been +suggested by many researchers on the ground that it is very effective and be +documented to promote research on violence on the lines suggested by +World Health Assembly, Geneva for the benefit of member States. Yoga is +an ancient science, originating in India, which includes diverse practices like +physical postures (asana), regulated breathing (pranayama), meditation and +lectures on philosophical aspects of yoga. The ultimate aim of yoga is to +remain unperturbed in success or failure and perfection of the personality of +its practitioner to remain equipoise in all conditions (Bhagavad Gītā 2.48). +The yoga texts suggest that the solution lies in developing health and +personality of the individuals brought out by a mix of both ‘relaxing’ and +‘stimulating’ practices which help in reaching a state of mental equipoise +(Telles, Reddy, & Nagendra, 2000) and supports the view that combination +of yoga postures interspersed with relaxation reduces arousal more than +mere relaxation (Sarang & Telles, 2006). +Asanas, which are physical movements, may give exercises to various +organs and systems and provide them an avenue to deal with character, +attitudes and tensions; can bring about healthy changes in several +psychopathological conditions (Krishna Rao, 2000). When yoga induced +non-violence in speech, thought and action is established, one’s aggressive +nature is relinquished; others abandon hostility in such a yogi’s presence +(Iyengar, 1993). Swami Vivekananda says, ‘the test of ahimsa is absence of +jealousy’ (Prabhavananda, 2004). Generosity, acceptance, patience, freedom +from self-importance, unpretending, ahimsa (non-violence), self-control and +straight-forwardness are the divine qualities one can nourish through yoga +(Bhagavad Gītā 13.7-11). +Yoga is an ancient science and an art and a way of life, aimed at +harmonious system of developing the body, mind and spirit. The Indian +scriptures claim that yoga, with its powerful, time-tested techniques, can +bring about a sense of inner peace, which can culminate in emotional +stability, harmony and clarity of mind (Nagendra, 2000). Bhagavad Gītā +90 Govindaraja et al – Effect of Yoga on Human Aggression + + +defines yoga as ‘samatvam yoga ucyate’, - ‘always being in a state of +unperturbed evenness’. Patañjali, who is quoted widely in yoga researches, +defines yoga as ‘Yogahcittavrittinirodah’, i.e., ‘Yoga is the cessation of +movements in consciousness’ which can lead to complete mastery over +mind. Sage Vasistha, (‘Yoga Vasistha’) defines yoga as a technique to slow +down or calm down the mind through deep internal awareness (Nagarathna +& Nagendra, 2003). +Thus, in its attempts to achieve these results, yoga offers varied +techniques like asanas (bodily postures), pranayama (regulated breathing), +and dhyāna (meditation) coupled with swadhyāya (sermons of philosophical +aspects of yoga). Violent/aggressive individuals normally do not respond or +react to oral methods only; instead, they are to be addressed through +psychodynamic psychotherapies like yoga, martial arts, out-door games +(Twemlow, Sacco, & Fonagy, 2008). +The way yoga leads to reduction of aggression is understandable: anger, +aggression and violence are said to be unrestrained speed in one’s mind +(Nagarathna & Nagendra, 2003) whereas, yoga is the art of slowing down +the mind, so that one has time to think and act. This modification is owing to +increased clarity of thoughts, calmness, serenity, and control over emotions, +carving out a happy living. The norms prescribed by Indian scriptures for +yogic life are characterized by peace, tranquility, harmony, love, happiness, +and efficiency, driven by discrimination, right thinking, right understanding, +and calculated actions. + +Causes as per Research Studies; Aggression Theories + +Research says there is no single cause for human aggression and violence. It +ranges from factors like racism (Rogers & Prentice-Dunn, 1981), religious +intolerance (Corrigan & Neal, 2010), sex-induced (Gurvinder & Dinesh, +2013), media influence (Gentile, Coyne, & Walsh, 2011), violent video +games (Adachi & Willoughby, 2011), prolonged television viewing +(Mitrofan, Paul, & Spencer, 2009), low self-esteem (Bushman & +Baumeister, 1998), food insecurity (Brinkman & Hendrix, 2011). +Aggression theories offer broader framework for these causes. Among +conventional theories, instinct theory (Sigmund Freud) says, aggression is +HSE – Social and Education History, 4(3) 91 + + +because of release of dammed up energy. For instance, hunting and fighting +instincts are found in frustrated ones. When aroused, they over-ride other +instincts like sympathy, paternal instinct and become expressive through +aggression and violence. Sigmund Freud calls these instinctive drives as +‘libido’, which are nothing but energy derived from Eros (life instinct) (Eron +& Huesmann, 1994). +Dollard and his associates (Yale University), offered ‘frustration and +aggression’ theory. When a person is frustrated, when his/her desires or +wishes are let down, he/she responds aggressively. Thus, frustration always +presupposes aggression (Dollard & Miller, 1939). +Theory of hormones and chromosomes got popularity from 1920’s. +Discovery of human chromosomes led to research linking excessive male +aggression with the presence of extra Y chromosome. Some researchers +suggest that Y chromosome is the cause for aggression; and doubling Y +chromosome doubles one’s aggression and violent behavior (Jarvik, Klodin, +& Matsuyama, 1973). +Among the recent theories, cognitive neoassociation theory suggests that +incidents involving aversion lead to negative affect (Berkowitz, 2012). +These in turn stimulate expressions, thought process, memories, and +response patterns like fight and flight. These fight and flight patterns give +way to reactions like anger and fear respectively. +Social learning theory proposes that aggressive responses are acquired in +similar ways, the people learn other intricate forms of social behaviors by +way of direct experience or by learning from others (Bandura, 1978). +‘Script theory’ says that ‘scripts’ are situation-guided ‘stored-up +behaviors’ (Huesmann, 1998). These stored up scripts could be retrieved +later and may guide the behavior of an individual. This explanation of script +theory is comparable to what yoga scriptures pronounce: consciousness has +four faculties. First is the mind (manas - receiving faculty). Being non- +judgmental, it keeps receiving the knowledge through senses, good or bad. +Such knowledge is passed on to next faculty - buddhi (intellect - +discriminating faculty). It qualifies the knowledge as good or bad, negative +or positive. Such qualified knowledge is passed on to third faculty namely +‘ahankara’ (ego). This faculty may choose to retain either the positive or +negative knowledge and reject the other. Having retained one of these two, it +92 Govindaraja et al – Effect of Yoga on Human Aggression + + +becomes part of the knowledge retained. Further, this retained knowledge is +passed on to the next faculty namely ‘chitta’ which ‘stores’ the knowledge +for future retrieval. +Excitation transfer theory proposes ‘transfer of arousal’. When two +disturbing events are disconnected by a short time period, arousal from first +event is erroneously attributed to second and the person wrongly behaves +aggressively to the second event (Bryant & Miron, 2003). +Social interaction theory advocates aggression as a function of social +influence (Felson & Tedeschi, 1993). For example, coercion is employed to +get something valuable, or to cause an intended change or outcome. + +Studies on Effect of Yoga on Aggression and Violent Behavior + +Earlier research studies on effect of yoga on human aggression and violent +behavior have considered varied sample sizes, intervention periods, diverse +age groups of both sexes, varied ethnic groups, nationality, on different +forms of aggression and violence (physical, verbal, covert), on normal as +well as high-risk individuals. With all this diversity, the outcomes appear to +be remarkably similar and encouraging. Even the Indian yoga scriptures do +not limit or prohibit the application of yoga to any particular age category, +gender or personality type and hence the scope is very wide as for as the +application is considered. + + +Studies on Effect of Yoga on Aggression and Violent Behavior of At- +Risk-Youth + +Aggression that manifests in childhood could lead to rejection from fellow +children in childhood, relational problems during adolescence and criminal +behavior in adulthood (Guerra, Rowell Huesmann, & Spindler, 2003). +Hence, it is desirable for the parents, elders and teachers to identify this +delinquent behavior at the earliest. In a pre and post quasi-experimental +control group design, 49 students (females 54.4%) in 9th to 12th grades of +school for at-risk youth, California, participated. The participants were +academically heterogeneous, 33.3% black, 33.3% Hispanic, 4.3% Native +HSE – Social and Education History, 4(3) 93 + + +American, 6.2% Asian, 2.1% white and 20.8% mixed races. The youth were +characterized by risk factors like aggression, academic failure, poor grades, +high truancy, repeated suspension and expulsion. Transformative life skills +(TLS – which includes asanas, pranayama and meditation) were taught by +certified yoga teachers for 3-4 days a week in the first semester for 30 +minutes per day. Yoga practitioners demonstrated significant decrease in +nervousness, depression, psychological anguish, intrusive views, physical +provocation, emotional stimulation; and significantly less likely to approve +revenge and overall less aggression, suggesting possibility for yoga-based +wellness program and TLS to favorably influence emotions among high-risk +youth (Frank, Bose, & Schrobenhauser-Clonan, 2014). +As a part of countrywide violence prevention effort, Niroga Institute +conducted transformative life skills (TLS) program (yogasanas, pranayama, +and meditation), daily 60 minutes for 18 weeks involving 472 students from +Alameda County Juvenile Justice Center. In another group 85 students +participated in control group, which did not get the TLS. Additionally, a +condensed 15 minutes TLS program was done in a large urban public high +school. The yoga intervention was by certified yoga teachers. The scales +used were perceived stress scale (PSS-10) and Tangney’s self-control scale- +13. At the end of the study period ‘at-risk-imprisoned adolescents’ reported +lessened perceived stress and escalated self-control and self-awareness. They +showed statistically significant improvement in stress resilience, self-control, +and self-awareness. PSS reduced by a mean change of 1.31; self-control +improved by a mean change of 1.68 (Ramadoss & Bose, 2010). Thus, these +two studies are suggestive of feasibility of yoga intervention to youth with +known background of risk factors like aggression, academic poor +performance. + +Studies on Effect of Yoga on Verbal Aggression + +Being one of the aggression expressions, ‘verbal aggression’ is use of +abusive words to insult/hurt another person. In one of the studies, effect of +yoga on verbal aggressiveness in 173 normal healthy adults was studied (age +17 - 62 years). Yoga group practiced integrated yoga module and control +group practiced moderate physical exercises for one hour a day, six days a +94 Govindaraja et al – Effect of Yoga on Human Aggression + + +week, for eight weeks. Self-administered verbal aggressive scale was used. +Significant reduction in verbal aggression in yoga group (P = 0.0) and non- +significant upsurge in control group was reported (Deshpande, Nagendra, & +Raghuram, 2008b). The aggression or violent behavior could manifest in any +of the three kinds namely, verbal, physical or covert. Irrespective of the kind +of aggression that manifests in an individual, yoga could offer a positive and +a constructive change. + +Studies of Effect of Yoga on Perceived Well-Being + +Yoga could be a preventive intervention and a way for improving children's +perceived well-being, which Berger studied as outcome measures. Pilot +study compared fourth and fifth-grade students. One program was offered +yoga for one hour a week for 12 weeks; other program was not offered yoga. +Outcome measures were emotional well-being assessed by Harter’s global +self-worth and physical appearance subscales; physical well-being was +assessed by flexibility and balance. Yoga group showed less negative +conduct scores and heightened comfort (Berger, Silver, & Stein, 2009). Thus +the outcomes suggest that yoga, besides being a way for refining +adolescents’ perceived well-being, can also be a preventive intervention. + + +Studies on Effect of Yoga on Correlates of Aggression and Violent +Behavior + +Some of the reports suggests that high levels of nervousness and aggression +do affect parameters like grip strength, dexterity scores and optical illusion. +In order to study these correlates a study was done, wherein, in the age range +12 to 16 years, equal number of subjects were there in each of the three +groups namely, community home girls trained in yoga for a period of six +months, community home girls who practiced physical exercises and girls +who attended their regular schools. Degree of optical illusion was +significantly higher in physical exercises group when compared to yoga +group and regular school group. Hand grip was significantly less in physical +exercises group compared to yoga group (Raghuraj & Telles, 1997). The +HSE – Social and Education History, 4(3) 95 + + +improved performance of the yoga group compared to physical activity +group suggests that yoga practice has a beneficial effect on these parameters, +which are considered to be the derivatives of aggression and violent +behaviors. + +Studies on Effect of Yoga on Personality Traits (Gunas as per Bhagavad +Gītā) + +A person with calmness, purity, without pride and self-importance, having +concern for others’ pain, is ‘sattvik’. A person with passions, cruelty, impure +at heart and is subject to elation and depression in success and failure, is +‘rajasic’. A person with unsteadiness, offensive, ego, deceitful, malevolent, +procrastination, and indolence is ‘tamasic’ (Bhagavad Gītā 18.26-28). In one +of the studies self-administered "Bhagavad Gītā Personality Inventory” was +used to measure these Gunas. In the age group of 18 to 71, 226 subjects of +both sexes participated. The yoga group practiced integrated yoga module +and control group practiced physical exercises daily one hour, six days a +week, for eight weeks. The outcomes demonstrated that the baseline scores +for all areas for both groups did not differ considerably. There were +noteworthy improvements in all domains in both groups. However, the +number of persons who showed progress in Sattva and decline in Tamas was +substantial in yoga group (Deshpande, Nagendra, & Nagarathna, 2009; +Deshpande, Nagendra, & Raghuram, 2008a). Thus, evidencing that yoga +could be a helpful tool in bringing out positive changes in personality traits, +irrespective of the age and gender. + +Studies on Effect of Yoga on Predictors of Aggression + +Variables like empathy, emotional quotient, general well being, and beliefs +about aggression are found to be good predictors of aggression levels. When +these variables are addressed through yoga, effect could be found in +aggression level as a correlate. A pre-post yoga intervention study measured +persistent attention, emotive intelligence (EQ), general wellbeing through +general health questionnaire, and Guna personality –sattva (purity), rajas +(craving) and tamas (brutality). Control group was not there. In the age +96 Govindaraja et al – Effect of Yoga on Human Aggression + + +group of 17 to 63 years 108 subjects participated. Yoga practitioners +demonstrated substantial changes in all variables (P < 0.001) excepting +‘sattva’. EQ and overall health variables compare considerably with each +other and negatively with tamas. EQ and tamas form positive and negative +forecasters of health. Sattva correlates positively with EQ signifying that a +sattvic personality demonstrates improved self-control. This recommends +that yoga practice may improve guna personality (traits) and can stabilize +EQ (Khemka, Hankey, & Ramarao, 2011). + +Studies on Effect of Yoga on Cognitive Functions + +When a person longingly dwells on sense objects, gradually preference +towards them develops. This preference develops desire; desire produces +anger and aggression. Aggression brings about delusion, and delusion leads +to loss of memory. Loss of memory culminates in destruction of +discriminative intelligence, which in turn, brings about complete devastation +to the person (Bhagavad Gītā 2.62-63). Thus, aggression and violent +behavior affect the cognitive functions like thinking, memory, analyzing, +perception and judgment. In one of the studies, effect of yoga on cognitive +functions and attitude towards violence (ATV) in 100 rural school children, +aged 13-15 years, of both sexes, in 8th and 9th grades was studied. The +subjects were divided into yoga and control groups. The yoga group +practiced yoga for one hour a day for 10 days and control group practiced +physical exercises. Digit letter substitution test was used to measure +cognitive function, whereas ATV scale was used to measure attitude towards +violence. The outcomes showed significant change in cognitive functions, +42% and 24% mean change in yoga and control groups respectively. But +there were no noteworthy results in ATV, 3% and 12.8% mean change in +yoga and control group respectively. However, yoga group experienced +other benefits like increased flexibility, improved digestion, good sleep, +relaxation and were cooperative with teachers/parents (Reddy, 2015). +Adolescence is the age when the aggression is at its peak and if +uncorrected, it could manifest at all age points of an individual, say research +studies. A study was done to find out the effect of yogic practices like +Suryanamaskara and pranayama on 30 adolescents’ logical memory, +HSE – Social and Education History, 4(3) 97 + + +aggression and anxiety levels. The yoga intervention was given for a period +of 25 days and the outcomes measured were logical memory, anxiety and +aggression levels by aggression scale. The Result showed statistically +significant decrease in post anxiety and aggression levels and improved +logical memory of participants (Singh, 2015). +In another study, yoga practitioners outdid physical exercise practitioners +on variables like trait anxiety, somatic anxiety, cognitive anxiety, aggression +and achievement impetus (Vengatesh, 2014). + +Studies on Effect of Yoga on Somatic Grievances of Women and Girls + +A study on physiological and psychological effects of hatha-yoga in healthy +women showed no considerable changes between the clusters regarding +endocrine parameters and BP. The yoga group had substantial reduction of +heart rate all through the yoga practice. The study accounted for substantial +variances between groups in psychological parameters. Yoga group +displayed distinctly higher scores in life fulfillment, morale, extravertedness, +lower scores in nervousness and aggression, frankness, emotionality and +somatic grievances. Substantial dissimilarities could be witnessed +concerning handling of stress and temperament (Schell, Allolio, & +Schonecke, 1994). The study suggests that the derivatives of high levels of +aggression and violent behavior like hypertension and high heart rate do get +improved with the intervention of yoga. + +Conclusion + +It is evident from various research studies that yoga intervention on subjects +of varied age, ethnicity, and nationality have shown remarkably similar +results and findings are quite encouraging to deal with the problem of +aggression through yoga. Researches on aggression and violence have +progressed to a stage where a unifying construction is needed in the sense +that different kinds of interventions (yoga, Transformative life skills, +counseling, addressing predictors of aggression and violent behavior) can be +blended to be more effective in addressing this delinquent human behavior. +Further, there is a need for standardizing the yogic intervention module and +98 Govindaraja et al – Effect of Yoga on Human Aggression + + +period of intervention, so that this delinquent human behavior is addressed +effectively and the results could be more evident. It also helps to +scientifically establish the basis for transformation claimed by Indian yoga +scriptures. Man is a social being. Sociability, that is one’s ability to cordially +blend with the fellow beings in the societal structure, is one of the important +facets of health according to World Health Organization. Indian yoga +scriptures deal extensively with this subject. There is a need to use this +ancient wisdom, claimed by Indian scriptures. This would provide a new and +effective framework to deal with the problem of human aggression and +violent behavior. Research is scarce particularly concerning the effects of +yoga on domains like human beliefs and attitude towards aggression and +violence, normative beliefs supporting aggression, perception towards +alternatives for violent methods normally adopted by aggressors, and +perceptions towards social norms for aggression and alternatives. +The yoga scriptures (including scientific researches) claim that +irrespective of the age, this ancient science of yoga can be taught. The +detailed yoga protocol intervention to suit different age groups can be well +defined and standardized and the results can be documented for the benefit +of all, which helps in understanding the methods researched to be effective +in correcting aggressive and violent behavior, and understanding the nature, +causes, +contributive +factors, +neuro-psychological +changes, +gender +differences, forms of aggression (latent and manifest), relationship between +select behavioral-characteristics as predictors of aggression. This could be +one of the valuable, cost effective, alternative (or complementary) methods +that involve no drugs and no invasive treatments to correct this delinquent +human behavior. +Excepting the theory of hormones and chromosomes, most of the +aggression theories deal only with the mind as the root instrumental cause +for aggression and violent behavior. Yoga deals comprehensively with this +subject. 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Retrieved from +http://shodhganga.inflibnet.ac.in/bitstream/10603/20569/3/03_declarati +on.pdf +WHO. (2014). WHO-World Health Statistics 2014. +104 Govindaraja et al – Effect of Yoga on Human Aggression + + +A.G. Govindaraja Setty, Phd Scholar. Swami Vivekanda Yoga +University, India. Orcid: http://orcid.org/0000-0002-3621-8699 +Pailoor Subramanya, Assistant Director - Research & Head-PhD. Swami +Vivekanda Yoga University, India. +B. Mahadevan, Professor, Indian Institute of Management, Bangalore, +India +Contact Address: Swami Vivekananda Yoga University (SVYASA) +#19, Eknath Bhavan, Gavipuram Circle, K.G.Nagar +Bangalore – 560019, Karnataka, India. +E-Mail: saphalyayoga@yahoo.co.in + + diff --git a/subfolder_0/Effect of yoga on cognitive functions in climacteric.txt b/subfolder_0/Effect of yoga on cognitive functions in climacteric.txt new file mode 100644 index 0000000000000000000000000000000000000000..a43363b0fe3831403497023f658455f0d2491d3c --- /dev/null +++ b/subfolder_0/Effect of yoga on cognitive functions in climacteric.txt @@ -0,0 +1,1098 @@ +Effect of yoga on cognitive functions in climacteric +syndrome: a randomised control study +R Chattha,a R Nagarathna,b V Padmalatha,c HR Nagendrad +a Division of Yoga and Life Sciences Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore, India b Division of Yoga +and Life Sciences, SVYASA, Bangalore, India c Maiya Multispeciality Hospital, Bangalore, India d SVYASA, Bangalore, India +Correspondence: Dr V Padmalatha, FRCOG (Lon), MRCP (Ire), Consultant Obstetrician and Gynecologist, Maiya Multispeciality Hospital, +Bangalore, India. Email lathavenkatram@yahoo.com +Accepted 13 March 2008. Published OnlineEarly 23 May 2008. +Objective To assess the efficacy of an integrated approach of yoga +therapy (IAYT) on cognitive abilities in climacteric syndrome. +Design A randomised control study wherein the participants were +divided into experimental and control groups. +Settings Fourteen centres of Swami Vivekananda Yoga Research +Foundation, Bangalore, India. +Sample One hundred and eight perimenopausal women between +40 and 55 years with follicle-stimulating hormone level equal to or +greater than 15 miu/ml. One hundred and twenty perimenopausal +women were randomly allotted into the yoga and the control +groups. +Methods The yoga group practised a module comprising +breathing practices, sun salutation and cyclic meditation, whereas +the control group practised a set of simple physical exercises, +under supervision (1 hour/day, 5 days/week for 8 weeks). +Main outcome measures Assessments were made by vasomotor +symptom checklist, six-letter cancellation test (SLCT) for attention +and concentration and Punit Govil Intelligence Memory Scale +(PGIMS) with ten subtests. +Results The Wilcoxon test showed significant (P < 0.001) +reduction in hot flushes, night sweats and sleep disturbance in +yoga group, with a trend of significant difference between groups +at P = 0.06 on Mann–Whitney test in night sweats. There was no +change within or between groups in the control group. The SLCT +score and the PGIMS showed significant improvement in eight of +ten subtests in the yoga group and six of ten subtests in the control +group. The yoga group performed significantly better (P < 0.001) +with higher effect sizes in SLCT and seven tests of PGIMS +compared with the control group. +Conclusions Integrated approach of yoga therapy can improve hot +flushes and night sweats. It also can improve cognitive functions +such as remote memory, mental balance, attention and +concentration, delayed and immediate recall, verbal retention and +recognition tests. +Keywords Climacteric, cognitive abilities, yoga. +Please cite this paper as: Chattha R, Nagarathna R, Padmalatha V, Nagendra H. Effect of yoga on cognitive functions in climacteric syndrome: a randomised +control study. BJOG 2008;115:991–1000. +Introduction +Climacteric is a physiologic transition characterised by deple- +tion of the ovarian follicles, decreasing estradiol and inhibin +production, leading to an increase in follicle-stimulating hor- +mone (FSH), loss of menstrual cycle, accompanied by men- +opausal symptoms.1 Because the average life span of women +in India has touched 62 years, the problems of menopause +have attained a greater attention.2 Altered levels of neurotro- +phic ovarian steroid (17beta-estradiol) have been recognised +as one of the factors influencing degenerative processes that +lead to ageing.3 Senescence is characterised neurologically by +a decline in cognitive function.4 Cognitive decline during +ageing is seen in memory abilities,5 focusing, attention6,7 +and information processing.8 Numerous studies indicate that +estrogen is essential for optimal brain function. Estrogens +have been reported to influence verbal fluency, verbal mem- +ory tests and performance on spatial tasks and fine motor +skills.9–12 This decline is the result of degenerative processes +initiated by dysregulation of the hypothalamic–pituitary– +gonadal (HPG) axis with menopause and andropause that +leads to alterations in the concentration of all serum HPG +hormones. Estrogen is known to enhance the activity at neu- +ronal synapses, thus exerting its direct neuroprotective and +neurotrophic effects on brain tissue, by maintaining the integ- +rity of the nigral-dopamine system.13 These dopamine- +producing neurons that are involved in cognitive functions +start dying when estrogen levels are low.14 The protective effect +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +991 +DOI: 10.1111/j.1471-0528.2008.01749.x +www.blackwellpublishing.com/bjog +Menopause +of estrogens on neuronal cells may also be due to their ability +to alter free radical production and/or free radical action on +cells.15 It has been shown that estrogen deprivation is likely to +initiate or enhance degenerative changes caused by oxidative +stress and to reduce the brain’s ability to maintain synaptic +connectivity and cholinergic integrity leading to the cognitive +decline seen in aged individuals.16 +The hippocampus has long been presumed the primary site +of action of estrogens on cognition; and explicit memory is +considered the cognitive function most vulnerable to meno- +pausal loss of estrogen. Keenan et al. hypothesised that the +prefrontal cortex and its neural circuitry are prime mediators +of estrogen’s role in cognition. The prefrontal cortex is critical +for intact working memory, and estrogen enhances perfor- +mance on working memory tasks.17 Neuroimaging techniques +like positron emission tomography and magnetic resonance +imaging proved that estrogen-induced increase in cerebral +blood flow were particularly noticed in the hippocampus, +para hippocampus, gyrus and temporal regions, which are +a part of memory circuit.18 Murphy et al.19 reported that +age-related loss of brain tissue in hippocampus and parietal +lobes was significantly greater in women than in men. Thus, +estrogen strongly influences mood and cognition, and the +decline of this hormone at menopause can produce signifi- +cant emotional and cognitive problems in women.9 +No doubt hormone replacement therapy (HRT) reverts the +cognitive, vasomotor and psychological impairments and is +cardio-protective, but holds a risk of cancer of endometrium +and breast, as well as three-fold risk of venous thromboem- +bolism.20 Due to these serious adverse effects of HRT, there +has been a gap in the management of menopausal symptoms +emphasising the need to develop and explore the efficacy +of alternative therapeutic avenues that have demonstrated +promise in alleviating menopausal symptoms since 2006.21 +Cognitive-behavioural intervention was shown to be effective +in treating anxiety, depression, hot flushes and cardiac com- +plaints, improving partnership relations and overall score of +sexuality in a pilot study on 30 women with climacteric syn- +drome.22 There are very few studies on yoga treating used for +climacteric syndrome. There are several studies (two pilot +studies and one three-armed study) that shows that yoga im- +proves the menopausal symptoms,23–25 but there are no stud- +ies on the effect of yoga on cognitive functions in climacteric. +Yoga is an ancient Indian science and way of life that +includes the practice of specific postures, regulated breathing +and meditation.26 Yogasanas and pranayamas are today rec- +ognised as techniques that can improve muscle strength, +flexibility, blood circulation and oxygen uptake as well as +hormone functions27 at the gross level. Meditation (intrinsic +yoga techniques called Dharana, Dhyana and Samadhi) has +been described as training in awareness, produces definite +changes in perception, attention and cognition.28 It has been +shown that processing of sensory information at the thalamic +level is facilitated during the practice of pranayama (breathing +exercises)29 and meditation.30 Integrated approach of yoga +that combines physical postures, pranayama and meditation +together with the notional correction based on philosophy of +yoga was found to improve both cognitive (visual perception) +and motor functions (hand steadiness)31 in college students +following 10 days of yoga practice. This improvement was +believed to be due to improved eye hand coordination, atten- +tion, concentration and relaxation. With these promising +benefits of yoga, we could hypothesise that yoga may decrease +the cognitive dysfunction and the clinical symptoms of +climacteric. +Thus, the aim of the study was to assess the efficacy of the +integrated approach of yoga therapy (IAYT) on cognitive +functions in perimenopausal women. +Methods +Participants +The sample size was calculated from an earlier study that +compared the effect of two different drugs in menopausal +women (as there are no studies on yoga). Using the pre-post +mean and SD values from the vasomotor outcome variables +from that study, an effect size of 0.52 was calculated.32 Using +this value of effect size and the values for ‘alpha’ and power at +0.05 and 0.8, respectively, a sample size of 108 was derived. +Of a total of 201 women experiencing menopausal symp- +toms screened, 120 women (married or single) who satisfied +the inclusion criteria of (a) age between 40 and 55 years and +(b) serum FSH level equal to or higher than 15 miu/ml on +the sixth day of the menstrual cycle if she was menstruating +regularly or at the time of recruitment if she had stopped +menstruating or had irregular cycles were selected for the +study. Women who had undergone hysterectomy with retained +ovaries were also included. Exclusion criteria were (a) women +who were practising yoga for a month or more, (b) women +with no knowledge of English, (c) women with less than high +school education, (d) women taking HRT, (e) women who +underwent any surgery in past 3 months, (f) those with gynae- +cological problems like endometriosis, fibroids, ovarian cysts, +prolapsed uterus etc., (g) women with other medical disor- +ders (like hypertension, diabetes mellitus, hypo/hyperthyr- +oidism) and (h) those on psychiatric medication. +Source of participants +The study was conducted at the Yoga University, Swami +Vivekananda Yoga Research Foundation (SVYASA) in Bangalore +city. The subjects were recruited through advertisements and +giving talks about the benefit of these practices in women’s +organisations, clubs and organisations such as lioness clubs. +They were also contacted through banners, newspaper adver- +tisements and circulation of pamphlets apart from references +through word of mouth. Some women were recruited through +Chattha et al. +992 +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +gynaecological clinics as they consulted the doctor for their +menopausal symptoms. In all, they were recruited from 14 +different areas of Bangalore and classes were conducted at 14 +nodal centres of SVYASA in different parts of the city. +Ethical clearance and consent +The institutional review board and ethical committee of the +University Swami Vivekananda Yoga Research Foundation, +Bangalore, sanctioned formal approval. The research staff +answered queries and the participants then made an informed +independent decision about participating in the study. +Design +This was a prospective, randomised controlled trial (RCT) +wherein 120 participants were randomly divided into two +groups: one group practised integrated approach of yoga ther- +apy (IAYT) and the other practised a set of physical exercises. +The women who satisfied the inclusion criteria were regis- +tered in different nodal centres by using pre-labelled enve- +lopes to avoid selection bias; roll numbers were allotted and +these numbers were randomly divided into two groups using +a computer-generated random number table (http://www. +randomizer.org) prepared for the specific number of partic- +ipants available in the centre. Participants were assessed for +the cognitive tests before and after 8 weeks of intervention. +Both the yoga and control groups were given their respective +set of practices for 1 hour of intervention per day, 5 days per +week for 8 weeks, by specially trained instructors for both +yoga and non-yogic physical exercise groups. +Blinding +As this is an interventional study, this could not be a double- +blind study, but attempts were made to blind and mask wher- +ever feasible to reduce the bias. The statistician who did the +randomisation of the serial numbers of participants and the +final analysis was blind to the source of the data. The answer +sheets for the six-letter cancellation test (SLCT) and Punit +Govil Intelligence Memory Scale (PGIMS) were coded and kept +away for final analysis and were decoded only after complete +analysis. The memory tests were administered by a psychologist +(who was not involved in interacting with the participants) to +the whole group before randomisation. Care was taken to +arrange the timings and venue of the classes for the two groups +suitably to avoid interaction and exchange of information and +techniques among the participants of the two groups. +Assessments +Biochemical assessment +Serum FSH was used for initial screening of the subjects to +satisfy one of the inclusion criteria. Blood samples were +Figure 1. Trial profile. +Yoga in climacteric syndrome +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +993 +collected in ‘Anand Diagnostic Laboratory’, Bangalore, on the +sixth day of menstruation if the woman was menstruating +regularly or at the time of recruitment itself if the woman +had stopped menstruating or had irregular cycles. Estimation +of FSH was carried out by electrochemiluminescence method +using Roche Elecsys 2010 FSH kit. As per the standardisation, +the normal range for the FSH values during follicular phase +for regularly menstruating Indian women was 3.5–12.5 miu/ +ml. For the present study, a value of >15 miu/ml was consid- +ered the inclusion criterion.33 +Vasomotor symptoms checklist +A checklist of three of the major symptoms of climacteric +(vasomotor symptoms checklist [VCL] 1, hot flushes; VCL +2, night sweats and VCL 3, sleep disturbances), with severity +scoring ranging from 0 to 3 (0 being absence of that symptom +and 3 being severely suffering from that symptom), was used +to assess the vasomotor symptoms for all participants. +Six-letter cancellation test +Six-letter cancellation test (SLCT) for adults is a paper-and- +pencil test that uses a letter cancellation task that measures +cognitive functions such as selective and focused attention, +visual scanning as well as activation and inhibition of rapid +responses. It consists of a test worksheet that specifies six +target letters to be cancelled and has a ‘working section’, +which consists of letters of the alphabet, arranged randomly +in 22 rows and 14 columns. The participants are asked to +cancel as many of the six target letters as possible in a specified +time of 90 seconds.34 The total number of cancellations and +wrong cancellations are scored, and the net scores are cal- +culated by deducting wrong cancellations from the total at- +tempt. This test has been evaluated for its reliability and +validity based on standard criteria. Reliability has been ascer- +tained based on (a) temporal stability and (b) internal con- +sistency.35 The content validity of this test is adequate for the +purpose for which it is intended.36 The normal value for +healthy Indian adults for SLCT is 38 ± 6.34 +Tests of memory +PGIMS is a battery of ten memory tests, which measures the +remote memory, recent memory, mental balance, two tests for +attention and concentration (for digit memory and reverse +digit memory), delayed recall, immediate recall, retention +for similar pairs, retention for dissimilar pairs, visual retention +and recognition test. The participant is supposed to write the +responses to the questions asked by the administrator. Of the +ten tests, eight tests are verbal, one test pertains to geometrical +drawing and one on recognising objects. The reliability of this +scale has been tested, and the norms for adults (>20 years) +with no psychiatric/neurological illnesses are available. PGIMS +is incorporated as one of the important tests to evaluate cog- +nitive functions and organic brain dysfunctions. Administra- +tion takes 15–20 minutes per participant. The test retest +reliability on 40 subjects ranged between 0.70 and 0.84 for +organic psychotic groups, 0.48 and 0.84 for neurotic group. +On the whole, however, an increase of four points was +observed on repeated testing. For these two groups, split-half +reliability was found to be 0.91 and 0.83, respectively.37 +Yoga intervention +The yoga module used for the experimental intervention called +integrated approach of yoga therapy (IAYT) for perimeno- +pausal women was developed specifically for the purpose culled +out from original scriptures (Patanjali yoga sutras and Mandu- +kya karika) that highlight the concepts of a holistic approach to +health management at physical, mental, emotional and intel- +lectual levels with techniques to improve mental equilibrium +and cognitive abilities. All these practices are aimed at one +common effect, i.e. ‘to develop mastery over modifications of +the mind’ (chitta vritti nirodhah—Sage Patanjali) through +‘slowing down the rate of flow of thoughts in the mind’ +(manah prashamana upayah yogah—Sage Vasishta). +1 Sun salutation that includes a flow of 12 postures combined +with breathing and chanting.38 +2 Yogic breathing practices combined with simple body +movements aimed to bring about a slow rhythmic breath- +ing pattern that is the safest way to get mastery over the +mind.39 The principles involved in the technique of breath- +ing were (a) slow down the rate of breathing while synchro- +nising the body movements with breathing, (b) ensure that +exhalation was longer than inhalation and (c) practice with +full awareness of the touch of the flow of air through the +nostril down the air passages. +3 Cyclic meditation (CM): Meditation is considered to be +a part of yoga that works directly at the mind level (Antar- +anga yoga), which is a valuable tool to reach a state of alertful +rest (calming down or silencing the internal dialogue). CM +is a 35-minute practice that includes a combination of acti- +vating and pacifying practices to reach deeper quietitude and +equilibrium than meditating in a single posture.40 +4 The study group got lectures on physiology of menopause, +healthy lifestyle including diet, exercise and yogic stress +management techniques. Also, they were given yogic con- +cepts to achieve a notional correction to help the partici- +pant (a) recognise her ability to tap the inner energy, which +is made of immense bliss that could keep up her youthful +feeling and allay the fears, (b) to restore her inbuilt freedom +to change the responses to situations and (c) learn to touch +the bed of silence, which is the source of all creativity that is +essential for promotion of any cognitive function.41 +Control intervention +The control group practised a set of exercise programme +comprising easy (nonsweating) body movements supervised +by physical trainers for the same duration of 1 hour daily, 5 +Chattha et al. +994 +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +days a week for 8 weeks. The exercise involved the stretching +of the arms, legs and spinal twists, strengthening the muscles +around knee joints, shoulder joints, neck and wrist joints. +Lectures and individual counselling was given on conven- +tional modern medical concepts about healthy lifestyle +including diet, exercise and physiology of menopause and +stress management techniques. Details are given in Table 1. +Data extraction +Data of 108 (leaving the 12 dropouts of 120) participants were +scored as per the instructions in the manual by a psychologist +and were analysed by the statistician using SPSS version +10.0 (SPSS Inc., Chicago, IL, USA). The test of normality +was carried out using Kolmogorov–Smirnov test as the sam- +ple size was above 50. Because the data were not normally +distributed, nonparametric tests were used: Mann–Whitney +test for between group comparison and Wilcoxon signed- +ranks test for within group comparison. The baseline values +for all the variables in both the groups were compared using +Mann–Whitney test. Effect sizes were calculated to measure +the magnitude of difference of parameters between the two +groups.42 Correlations were checked by Spearman’s correla- +tion coefficient, as the data were non-normal. For the design +of this study (one within-subjects and one between-subjects +factor), there were no ancillary analyses. +Results +The flowchart describes the trial profile (Figure 1). Of the 120 +participants, there were 12 dropouts, 5 in the yoga and 7 in +the control group due to (a) husband’s ill health, (b) transfer +to other cities and (c) unexpected events in the family. +Table 2 shows demographic data. At baseline, the data +were not significantly different between the two groups for +FSH and body mass index (P = 0.11 and 0.07, respectively, +Mann–Whitney test), for SLCT (P = 0.528) and all subtests +of PGIMS (P value for test I, 0.39; II, 0.49; III, 0.24; IV (i), +0.43; IV (ii), 0.01; V, 0.625; VI, 0.59; VII, 0.72; VIII, 0.98; IX, +0.92 and X, 0.06). +Table 3 shows the results of VCL. The scores on all three +symptoms in VCL reduced significantly in yoga group with +a nonsignificant change in control group (except night +sweats). Mann–Whitney test showed a trend of significant +(P = 0.06) difference between groups in night sweats only. +Table 4 shows the results of the SLCT and PGIMS. The +values of SLCT improved in both groups. Mann–Whitney test +showed significantly greater improvement (P < 0.001) in yoga +group (effect size 1.16) than the control group (effect size 0.6). +The results for the different cognitive functions of the +PGIMS tests are as follows: +• PGIMS-I (remote memory): Both groups showed signifi- +cant increase (P = 0.001, Wilcoxon test). There was greater +improvement (P < 0.001, Mann–Whitney test) in the yoga +(effect size 0.84) than in the control group (effect size 0.58). +• PGIMS-II (recent memory): There was no change observed +in this test because the effect sizes were very low (0.01, +Mann–Whitney test) in both groups. +• PGIMS-III (mental balance): Yoga group showed significant +increase (P < 0.001, Wilcoxon test), whereas the control +group showed no change (P = 0.39). There was greater im- +provement (P < 0.001, Mann–Whitney test) in the yoga +group (effect size 1.66) than in the control group (effect size +0.17). +• PGIMS-IV (i) (attention and concentration): Both groups +showed significant increase with greater improvement (P < +0.001, Mann–Whitney test) in the yoga (effect size 0.74) +than in the control group (effect size 0.34). +• PGIMS-IV (ii) (attention and concentration): Both groups +showed significant increase (P = 0.001, Wilcoxon test). +There was significant difference between (P < 0.001, Mann– +Whitney test) yoga (effect size 0.61) and control groups +(effect size 0.63). +Table 1. Practices used for the two intervention groups +Experimental group +Control group +1 +Lectures on IAYT, diet, emotion culture, +concepts and management of stress +according to yogic practices (15 minutes) +Lectures on importance of exercise, role of diet in +menopause, stress, stress physiology (15 minutes) +2 +Breathing exercises: (10 minutes) +Loosening practices: (10 minutes) +Hasta  +ay +ama s +´vasanam (hands in and out breathing) +Twisting +Hasta vist +ara s +´vasanam (hands stretch breathing) +Forward and backward bending +Gulpha vist +ara s +´vasanam (ankle stretch breathing) +Side bending +Vy +aghra s +´vasanam (tiger breathing) +Spinal twist +Setu bandha s +´vasanam (bridge posture breathing) +Toe walking +3 +Suryanamaskara (sun salutation) (10 minutes) +Brisk walk (10 minutes) +4 +Avartan dhyanam (CM) (25 minutes) +Supine rest (25 minutes) +Yoga in climacteric syndrome +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +995 +• PGIMS-V (delayed recall): The yoga group showed signifi- +cant increase (P < 0.001, Wilcoxon test), whereas the control +group showed no improvement (P = 0.36). There was greater +improvement (P < 0.001, Mann–Whitney test) in the yoga +(effect size 1.47) than in the control group (effect size 0.18). +• PGIMS-VI (immediate recall): The yoga group showed sig- +nificant increase (P < 0.001, Wilcoxon test), but the control +group showed significant change (P = 0.015). There was +greater improvement (P < 0.001, Mann–Whitney test) in +the yoga (effect size 1.51) than in the control group (effect +size 0.42). +• PGIMS-VII (verbal retention of similar pairs): There was no +change in both the groups (P = 0.18 in yoga group, P = 0.25 +in control group in Wilcoxon test). There was no difference +between the groups (P = 0.56, Mann–Whitney test). +• PGIMS-VIII (verbal retention of dissimilar pairs): Both +groups showed significant increase (P < 0.001 in yoga group, +P = 0.009 in control group in Wilcoxon test). The magnitude +of change within group was more in the control group (effect +size 1.23) than that in the yoga group (effect size 0.90). +• PGIMS-IX +(visual +retention): +There +was +significant +increase in the yoga group (P < 0.001, Wilcoxon test), +whereas no change in the control group (P = 0.39). There +was greater improvement (P = 0.01, Mann–Whitney test) +in the yoga (effect size 0.70) than in the control group +(effect size 0.14). +• PGIMS-X (recognition): Both groups showed significant +increase (P = 0.001, Wilcoxon test). There was greater +improvement (P = 0.001, Mann–Whitney test) in the yoga +(effect size 0.58) than in the control group (effect size 0.28). +Table 2. Demographic data +Serial number +Variables +Yoga +Control +1 +Age (mean  SD) +49  3.6 +48  4 +Number between 40–45 (years) +13 +14 +Number between 46–50 (years) +22 +23 +Number between 51–55 (years) +19 +17 +2 +W/H +14/40 +9/45 +3 +Body mass index (mean  SD) +28  3.4 +29  4 +4 +V/NV +43/11 +45/9 +n +FSH (mean  SD) miu/ml +n +FSH (mean  SD) miu/ml +5 +A: premenopausal +14 +43.88  21.64 +16 +37.94  17.52 +B: irregular menstruation +17 +47.16  23.45 +20 +38.72  14.94 +C: menopausal +9 +83.65  43.59 +7 +56.9  20.77 +D: postmenopausal +14 +59.5  18.67 +11 +66.81  21.14 +6 +FSH (miu/ml) mean  SD +56  29.9 +47  21.5 +V/NV, vegetarian/non-vegetarian; W/H, working/housewives.A, women having regular menstruation; B, irregular menstrual cycles, C, menopause +attained between 1 year and 3 years ago; D, menopause attained more than 3 years ago. There is no significant difference between groups in +all the variables at baseline. +Table 3. Results of vasomotor symptom checklist (VCL) +Variables +Y +C +Y +C +Y +C +Significant +Y and C P** +Effect size +Y and C +Pre mean + SD +Post mean + SD +Pre mean + SD +Post mean + SD +Significant P* +Effect size +pre-post +VCL 1 +1.02  1.02 +0.50  0.77 +0.78  0.84 +0.70  0.74 +,0.001 +0.39 +0.65 +0.10 +0.08 +0.26 +VCL 2 +0.83  1.06 +0.43  0.69 +0.85  0.90 +0.65  0.73 +,0.001 +0.04 +0.62 +0.27 +0.06 +0.31 +VCL 3 +0.74  0.99 +0.44  0.72 +0.85  0.98 +0.74  0.91 +001 +0.18 +0.49 +0.14 +0.08 +0.36 +C, control group; VCL 1, hot flushes; VCL 2, night sweats; VCL 3, disturbed sleep; Y, yoga group.Mean  SD and P values for within and between +groups and effect sizes are calculated for vasomotor symptoms before and after 8 weeks of intervention. VCL: There is significant improvement +in yoga group and nonsignificant improvement in control group except night sweats. +*Wilcoxon P value. +**Mann–Whitney P value. +Chattha et al. +996 +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +Discussion +Cognitive functions and vasomotor symptoms were assessed +in this randomised control prospective two-arm interven- +tional study on 108 perimenopausal women (age 40–55 +years). Mann–Whitney test to compare the two groups +showed that there was significantly better improvement in +the yoga group compared with the control group in hot +flushes and attention task in SLCT. In PGIMS, there was +significant improvement within both groups with significant +difference between groups, the effect sizes being better in the +yoga group than in the control group in PGIMS-I (remote +memory), III (mental balance), IV (i and ii) (attention and +concentration [i and ii]), VI (immediate recall) and X tests +(recognition test). There was significant improvement only +in yoga group and not in control group with significant dif- +ference between groups in PGIMS-V (delayed recall) and +PGIMS-IX (visual retention). In PGIMS-VIII (verbal retention- +ii), both groups improved with higher effect size in control +group and significant difference between groups. The PGIMS- +II (recent memory) and PGIMS-VII (verbal retention-i) tests +showed no change in both the groups. +Comparison with other studies +The preferred option for complementary and alternative +medicine (CAM) by women43 has triggered interest into +research on these therapies. Of the four studies (two on +cognitive behavioural therapy (CBT) and two on relaxation +response), only one was a well-designed RCT on 33 women +taking relaxation response training compared with a reading +group, demonstrated a significant reduction in hot flush +intensity, tension-anxiety and depression in perimenopausal +women after 10 weeks of intervention.44 Our recent rando- +mised control study in the Indian population has shown the +Table 4. Results of SLCT and PGIMS +Variable +Groups +Pre +mean  SD +Post +mean  SD +Within +group, P* +Effect size +pre-post +Between +Y and C, P** +Effect size +Y and C +Normative +data +SLCT +Y +27.43  6.91 +35.31  6.72 +,0.001 +1.16 +,0.001 +0.8 +30  6 +C +26.48  6.37 +30.19  6.63 +,0.001 +0.6 +PGIMS-I +Y +5.43  0.66 +5.87  0.34 +,0.001 +0.84 +,0.001 +1.55 +5.78  0.52 +C +5.52  0.67 +5.17  0.54 +0.001 +0.58 +PGIMS-II +Y +4.94  0.23 +4.94  0.23 +0.83 +0.00 +0.080 +0.01 +4.91  0.29 +C +5  0.51 +4.93  1.15 +0.439 +0.08 +PGIMS-III +Y +4.93  1.15 +6.52  0.72 +,0.001 +1.66 +,0.001 +1.36 +5.69  2.64 +C +5.19  0.93 +5.33  0.7 +0.394 +0.17 +PGIMS-IV (i) +Y +5.39  1.04 +6.2  1.14 +,0.001 +0.74 +,0.001 +0.94 +8.46  1.91*** +C +5.24  1.11 +4.83  1.3 +0.014 +0.34 +PGIMS-IV (ii) +Y +3.57  1.09 +4.19  0.95 +,0.001 +0.61 +,0.001 +0.58 +C +4.17  1.15 +3.56  0.74 +0.001 +0.63 +PGIMS-V +Y +8.11  0.88 +9.33  0.78 +,0.001 +1.47 +,0.001 +1.20 +6.99  1.53 +C +8.02  0.9 +8.17  0.8 +0.363 +0.18 +PGIMS-VI +Y +9.26  1.51 +11.13  0.89 +,0.001 +1.51 +,0.001 +0.93 +7.41  1.98 +C +9.41  1.5 +9.98  1.21 +0.015 +0.42 +PGIMS-VII +Y +4.93  0.26 +4.98  0.14 +0.18 +0.24 +0.56 +0.10 +4.36  0.78 +C +4.91  0.29 +4.96  0.19 +0.257 +0.20 +PGIMS-VIII +Y +11.48  2.67 +13.46  1.59 +,0.001 +0.90 +,0.001 +0.73 +11  3.59 +C +9.28  2 +11.85  2.18 +0.009 +1.23 +PGIMS-IX +Y +10.85  2.46 +12.35  1.76 +,0.001 +0.70 +0.01 +0.26 +8.2  3.28 +C +11.43  2.46 +11.76  2.1 +0.39 +0.14 +PGIMS-X +Y +8.13  2.37 +9.37  1.89 +,0.001 +0.58 +0.001 +0.37 +8.36  1.61 +C +7.57  1.53 +8.59  1.4 +,0.001 +0.28 +C, control group; Y, yoga group.Mean  SD and P values are calculated for PGIMS (ten subtests) using Wilcoxon P value and Mann–Whitney +P value. Variables: PGMIS-I, remote memory; PGIMS-II, recent memory; PGIMS-III, mental balance; PGIMS-IV (i), attention and concentration (i); +PGIMS-IV (ii), attention and concentration (ii); PGIMS-V, delayed recall; PGIMS-VI, immediate recall; PGIMS-VII, verbal retention (i); PGIMS-VIII, +verbal retention (ii); PGIMS-IX, visual retention; PGIMS-X, recognition test. There was greater improvement in the yoga group than the control +group in SLCT: improvement in yoga is better than control group and in all subtests of memory except II and VII and the control showed better +effect size than yoga group in VIII test. +*Wilcoxon P value. +**Mann–Whitney P value. +***This score is given in the PGIMS manual combining both attention and concentration (i) and (ii).37 +Yoga in climacteric syndrome +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +997 +reduction in vasomotor and other menopausal symptoms 8 +weeks after the supervised practice of the integrated approach +of yoga therapy as measured by Greene climacteric scale (GCS) +with a significant difference between groups with higher effect +sizes in the yoga group than the control group in all factors of +GCS.45 +There are no studies on changes in cognitive functions with +nonpharmacological therapies. In comparison, the present +study on IAYT that combined both body and mind level +practices of self-management (lifestyle change) has shown +significant improvement in both frontal lobe and memory +functions for the first time through a nonpharmacological +intervention. A study on the interaction of HRT and physical +activity (PA) showed a beneficial relationship between PA and +cognitive performance in postmenopausal women irrespective +of HRT use.46 These studies tend to point out that the self- +corrective techniques that the person puts in by applying her +mind, be it a PA or IAYT, influences the cognitive functions. +Mechanism +SLCT measures the attention capacity, a frontal lobe function. +A self-control study on the effect of CM (that has been incor- +porated in the IAYT for the experimental group in the present +study) has shown significant increase in SLCT scores imme- +diately after CM, suggesting enhanced efficiency and shorter +time in cortical neural processing.47 +Electrophysiological studies during cognitive functions of +the brain have reported that P300 (a specific positive wave +that occurs at the 300th millisecond in the tracing of evoked +potential) is generated from hippocampus and other associ- +ated areas.48 Estrogen receptors have been detected in the +pyramidal cells nuclei of the ventral hippocampus and other +specific brain areas that are involved in learning, memory and +cognition. Cyclic changes in synaptic genesis and spine den- +sity of the hippocampus have been shown to be induced by +estrogen,18 which gets depleted in this age; hence, memory +functions may undergo a declining change. However, con- +trary to our expectation, estrogen replacement therapy +(ERT) per se may not improve the cognitive functions.46 A +study on the effect of CM observed that there was reduction in +the peak latencies of P300 after CM compared with the prev- +alues that suggest enhanced efficiency and shorter time in +processing. Also, the P300 peak amplitudes after CM were +higher compared with the prevalues, suggesting an increased +in attentional resources.49 Thus, it may be hypothesised that +the improvement in the cognitive functions observed in this +study is due to the effect of yoga in bringing about better +information processing in the subtle layers of the frontal lobe. +This in turn could be due to the alertful rest that CM may +offer and may not be related to estrogen-mediated response. +CM developed on a subtle principle suggested by a rarely used +authentic scripture (Mandukya karika) that includes stimula- +tion–relaxation combination for achieving deeper degree of +rest. This principle is made practical by knitting yoga postures +interspersed with periods of supine relaxation and has been +shown to provide deeper degree of rest than simple supine +rest or the commonly used meditative techniques.50 +Novelty, limitations and suggestions for +future work +This is the first RCT that has looked at cognitive functions +after yoga practice in climacteric. An objective measure, serum +FSH level, was used as the inclusion criterion rather than only +the subjective symptoms of menopausal rating scale. Control +group also had the supervised practices for the same duration +as the experimental group. +One limitation of the study with regard to external validity +was that because the tests were in English, the sample was +restricted to women with knowledge of the English language. +Thus, our sample should be taken to be fairly representative of +women in urban India. +Other limitations were that the estradiol levels were not +measured. Although we have used FSH levels as the only objec- +tive inclusion criterion,51 it will be interesting to see the effect of +long-term practice of IAYT on FSH and estradiol levels. +Suggestions for future work +Functional studies to look at the changes in neurohormonal +changes in the brain during IAYT in climacteric would throw +light on the mechanism. +Conclusions +Thus, the present study has shown that the practice of IAYT +for 8 weeks improves the cognitive functions like attention, +concentration, mental balance, verbal retention and recogni- +tion abilities in menopausal women compared with physical +exercises. +The control group practices that comprised of physical +exercises also showed improvement in many of the memory +functions similar to earlier studies on the efficacy of PA in +perimenopausal women.46 Thus, the present study shows the +superiority of yoga over PA in improving the cognitive func- +tions that could be attributed to emphasis on correctness in +breathing, synchronising breathing with body movements, +relaxation and mindful rest. +Funding +This study was funded by the parent institution: Swami +Vivekananda Yoga Research Foundation, Bangalore, India. +Contribution to authorship +R.C.: Involved in designing, conducting and writing the man- +uscript. R.N.: Regular supervision of the study in all phases +Chattha et al. +998 +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology +including the manuscript writing. V.P.: Gynaecologist who +assessed the clients for recruitment, contributed in all phases +of the study by regular supervision and guidance. Inputs for +the manuscript writing. H.R.N.: Guidance and advice on the +yoga component of the design, training the therapists and +writing the manuscript. +Details of ethics approval +Formal approval was sanctioned in their letter SVYASA/ +PHD/ETHICS/04-3011 dated 30 November 2004 by the insti- +tutional review board and ethical committee of the University +Swami Vivekananda Yoga Research Foundation, Bangalore. +Acknowledgements +We extend our gratitude to Dr Ravi Kulkarni, Biostatistician, +for helping in the statistical analysis of this study. We are +thankful to all the yoga teachers and physical trainers who +took the classes for this project. We are grateful to the Anand +Diagnostic Laboratory. We are thankful to the subjects for +their cooperation during the study. j +References +1 Blake J. Menopause: evidence-based practice. Best Pract Res Clin +Obstet Gynaecol 2006;20:799–839. +2 WHO (World Health Organization Scientific Group). The World Health +Report. Shaping the Future. Geneva, Switzerland: World Health Orga- +nization, 2003. +3 Danilovich N, Harada N, Sairam MR, Maysinger D. Age-related neuro- +degenerative changes in the central nervous system of estrogen-deficient +follitropin receptor knockout mice. Exp Neurol 2003;183:559–72. +4 Atwood CS, Meethal SV, Liu T, Wilson AC, Gallego M, Smith MA, et al. +Dysregulation of the hypothalamic-pituitary-gonadal axis with meno- +pause and andropause promotes neurodegenerative senescence. +J Neuropathol Exp Neurol 2005;64:93–103. +5 Craik FIM, Byrd M. 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Generators of the late cognitive +potentials in auditory and visual oddball tasks. Electroencephalogr Clin +Neurophysiol 1998;106:156–64. +49 Sarang SP, Telles S. Changes in P300 following two yoga relaxation +techniques. Int J Neurosci 2006;116:1419–30. +50 Telles S, Nagarathna R, Nagendra HR, Desiraju T. Alterations in auditory +middle latency evoked potentials during meditation on a meaningful +syllable ‘OM’. Int J Neurosci 1994;76:87–93. +51 Phillips E. Everything You Need To Know About The Menopause. +London, UK: Rodale International Ltd, 2004. +Chattha et al. +1000 +ª 2008 Swami Vivekananda Yoga Anusandhana Samsthana Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology diff --git a/subfolder_0/Effect of yoga program on executive functions of adolescents dwelling in an orphan home_ A randomized controlled study.txt b/subfolder_0/Effect of yoga program on executive functions of adolescents dwelling in an orphan home_ A randomized controlled study.txt new file mode 100644 index 0000000000000000000000000000000000000000..04c95cda2a4132bbf321b0f3f9df6053d95ac233 --- /dev/null +++ b/subfolder_0/Effect of yoga program on executive functions of adolescents dwelling in an orphan home_ A randomized controlled study.txt @@ -0,0 +1,862 @@ +Original article +Effect of yoga program on executive functions of adolescents dwelling +in an orphan home: A randomized controlled study +Satya Prakash Purohit*, Balaram Pradhan a +Division of Yoga and Humanities, SVYASA Yoga University, #19, Eknath Bhavan, Gavipuram Circle, 560 019, Bengaluru, India +a r t i c l e i n f o +Article history: +Received 21 August 2015 +Received in revised form +15 February 2016 +Accepted 21 March 2016 +Available online 20 April 2016 +Keywords: +Yoga +Orphans +Adolescents +Cognitive function +Executive function +a b s t r a c t +Executive function (EF) is important for physical and mental health of children. Studies have shown that +children with poverty and early life stress have reduced EF. The aim of the study was to evaluate the +effect of Yoga program on the EF of orphan adolescents. Seventy two apparently healthy orphan ado- +lescents +randomized +and +allocated +into +two +groups +as +Yoga +group +(n +¼ +40; +14 +girls, +age ¼ 12.69 ± 1.35 yrs) and Wait List Control (WLC) group (n ¼ 32, 13 girls, age ¼ 12.58 ± 1.52 yrs). Yoga +group underwent three months of Yoga program in a schedule of 90 min per day, four days per week +whereas the WLC group followed the routine activities. They were assessed by Stroop Color-Word Task, +Digit Symbol Substitution Test (DSST), Digits Span Test and Trial Making Test (TMT) at the beginning and +end of the program. +The repeated measures ANOVA showed significant difference in time and group interactions (p < 0.05) +for all subtests of Stroop Color-Word Task and Digit Span Test and part-A of TMT whereas there were no +significant difference found in DSST and TMT (part-B). +The post-hoc test with Bonferroni adjustment also showed significant improvements (p < 0.001) +within the Yoga group in all test scores while in wrong score of DSST did not exhibit significant reduction. +Whereas the WLC group, showed significant improvement (p < 0.05) in Stroop Color, Color-Word score, +net score of DSST, Digit Span forward and Digit Span Total. +Three months Yoga program was found useful for the young orphan adolescents in improving their +executive functions. +Copyright © 2016, Center for Food and Biomolecules, National Taiwan University. Production and hosting +by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http:// +creativecommons.org/licenses/by-nc-nd/4.0/). +1. Introduction +Globally two hundred million children failed to reach their po- +tential in cognitive development because of interrelated factors like +poverty, inadequate care and poor health.1 Orphans are among such +disadvantaged children living in the community with poverty, se- +vere grief and easily subjected to abuse, negligence and exploita- +tion.2 Prevalence of orphans was 143 million worldwide,3 72 +million in South and East Asia,4 and 20 million in India.5 +Adverse childhood events have a negative effect on latter life +cognitive performance.6 Socio-economic conditions of one's early +life or childhood are positively correlated with intelligence, aca- +demic achievement and other developmental outcomes in later +life.7,8 Previous studies with older Post Institutionalization (PI) +children have shown reduced performance on cognitive flexibility,9 +working memory performance,9e11 and inhibitory control.11e13 It is +also reported that PI children have attention deficits and hyperac- +tivity symptoms, which persist into adolescence.14,15 +The higher order of cognitive processes, such as cognitive flex- +ibility, working memory, and inhibition control which allow in- +dividuals to engage in planning, to be conscious and goal-directed +problem solving are called Executive Function (EF).16,17 In children, +EF is related to emotion regulation,18 conscience and moral devel- +opment,19 also math and literacy ability.20 EF is very important +factor for physical and mental health,21 making friendship,22 and +for success in school.23,24 Furthermore EF predicts school readi- +ness,20 later academic performance.25 Developments in such +cognitive functions are important in early life because deficiency in +these functions caused at childhood predict similar problems in the +* Corresponding author. Tel.: þ91 080 2263 9961, þ91 7676745174 (mobile). +E-mail addresses: purohit.satya@gmail.com (S.P. Purohit), balaramp13@gmail. +com (B. Pradhan). +Peer review under responsibility of The Center for Food and Biomolecules, +National Taiwan University. +a Tel.: þ91 080 2263 9961, þ91 9483711185(mobile). +Contents lists available at ScienceDirect +Journal of Traditional and Complementary Medicine +journal homepage: http://www.elsevier.com/locate/jtcme +http://dx.doi.org/10.1016/j.jtcme.2016.03.001 +2225-4110/Copyright © 2016, Center for Food and Biomolecules, National Taiwan University. Production and hosting by Elsevier Taiwan LLC. This is an open access article +under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). +Journal of Traditional and Complementary Medicine 7 (2017) 99e105 +later years.21,26 It is believed that the higher order cognitive func- +tions may play an important role in balancing emotional arousal, +cognitive +processing,27 +and reducing the impact of adverse +circumstances.28 +Various activities are suggested to improve children's EF. The +best evidences exist are computer based training programs for +enhancing memory and reasoning,29,30 task-switching computer- +based training,31 traditional martial arts,32 aerobics,33 and Yoga.34 +Yoga is an ancient Indian science and the way of life which in- +cludes practice of specific postures, breathing regulation, and +meditation.35 Earlier studies on Yoga including physical postures, +Yogic breathing, meditation and guided relaxation technique have +been shown its efficacy in improving delayed recall of spatial in- +formation and verbal memory,36 in reducing planning and execu- +tion time,34 and cognitive processes37 in adults. It is also proved +that there was an improvement in cognitive performance of 7e9 +year-old school children from a socioeconomically disadvantaged +background in South India after three months of Yoga.38 Yogic life +style has also a positive impact in planning ability.39 There is also +evidence of the positive impact of Yoga on cognitive functions in +children with attention deficit and hyperactive disorder.40e43 In +addition, Yoga is an effective method to improve various cognitive +functions of remote memory, mental balance, attention, concen- +tration, attention span, processing speed, attention alternation +ability, delayed and immediate recall, executive functions, verbal +retention, and recognition tests in healthy young subjects.44,45 +However, recent reviews stated that most of the Yoga studies on +children were open, unblinded, small sample sizes, short in- +terventions. Also many of the randomized studies have not +mentioned the process of randomization or have used inappro- +priate statistical analysis.46,47 Thus, understanding the effect of +Yoga on cognitive functions of orphans may be necessary in +providing avenues for promoting the mental strength to overcome +various tragedies in their upcoming life. In sum, the present study +was intended to evaluate the effect of Yoga on cognitive perfor- +mances of young orphan adolescents. +2. Material and methods +2.1. Participants +Out of 135 registrants, 80 were chosen for the study based on +the inclusion and exclusion criteria. Children were eligible for in- +clusion by following criteria: a) orphan(s) of any type, b) aged be- +tween 11 and 16 years, c) boys and girls, d) apparently healthy +without any chronic illness, physical, or mentally handicap. The +study was conducted between September 2014 and November +2014 in an orphanage, within a suburban area of Bangalore. +2.2. Ethical clearance +The study was approved (RES/IEC-SVYASA/32/204) by the +Institutional Ethics Committee of SVYASA (Swami Vivekananda +Yoga Anusandhana Samsthana) University. Both signed informed +consent from the institution head and signed informed assent from +all participants were obtained, upon explaining the study details. +2.3. Design +It was a randomized wait-list controlled pre-post study. After +the initial process of screening, participants were randomized by a +statistician using a random number table from www.randomizer. +org and assigned into two groups: Yoga group and Wait List Con- +trol (WLC) group. The Yoga group underwent the Yoga program for +3-months whereas the WLC group underwent routine activity. +2.4. Blinding +The statistician (who did the randomization and analyzed the +data) and the researchers (who carried out the allocation & as- +sessments) were blinded. +2.5. Intervention +The Yoga group received a combined approach of Yoga activities +of 90 min, 4 days per week, for 3-months. Later the same inter- +vention was served to WLC for the same duration. The Yoga pro- +gram was conducted by two certified Yoga teachers from SVYASA +(one with a master's degree in Yoga and other with a post- +graduation diploma in Yoga therapy). The principle and concept +of an integrated approach of the Yoga program was based on the +research works of SVYASA.48 The details of the intervention (Yoga +program) are given in Table 1. +2.6. Assessments +The socio-demographic data was collected from the office of the +orphan home as it was collected as a routine documentation by +them. The final demographic data after post assessment in Yoga +group was taken on 40 participants where the males were 14(35%), +female were 26(65%), whereas in WLC male were 13 (40.6%), female +were 19 (59.4%) out of 32 participants. The cognitive functions tests +(Table 2) were collected by the research staffs of SVYASA during the +prior and following weeks adjacent to the intervention period for +all recruited participants. The investigators were available to clear +all possible doubts and provide unbiased guidance during the +assessment. There were four executive function tests, included in +the study, as detailed below. +2.6.1. Stroop color and word test49 +The children's version Stroop test measures the EF, which +involves in both word and color naming responses. The test was +in the form of a booklet containing three pages of word and +color conditions. The first page tests how fast the participant can +read words; name the colors in the second page; name which +color the words were printed in, ignoring the name of the word +in the third page. The test extracts three basic scores, namely +Stroop Word (STROOP_W) score, Stroop Color (STROOP_C) score +and +Stroop Color-Word (STROOP_CW) score. +The task was +administered individually and test instructions were explained +before starting the test. Errors of the participants were indicated +and asked to be corrected by the examiner before continuing. +The participants were given 45 s for each page and the +time taken to complete the task was recorded by using a stop +watch. +2.6.2. Trial making test (TMT)50 +This test was used to access the visual search, scanning, pro- +cessing speed, mental flexibility, and EF. It has two parts, part-A +(TMT_A) and part-B (TMT_B). In TMT_A, participants have to +draw lines sequentially connecting 25 encircled numbers distrib- +uted on a sheet of paper; And in TMT_B the task is similar except +the participant must alternate the sequence between numbers and +letters (e.g.1, A, 2, B, 3, C, etc.). The score on each part represents the +amount of time required to complete the task. Participants were +administered part A and B of the TMT and Total time in seconds for +both part A and B was recorded. +2.6.3. Wechsler intelligence scale for children51 +It was used in order to assess working memory and mental +tracking processes. Both forward and backward spans were +S.P. Purohit, B. Pradhan / Journal of Traditional and Complementary Medicine 7 (2017) 99e105 +100 +calculated. For Digits Span Forward (DS_F), the participant was +supposed to repeat digits of the strings exactly as read by the +examiner. Two trials were administered of each string length. In +Digits Span Backward (DS_B), the procedures are identical to DS_F +except that the participant was required to repeat the string of +digits in a reverse order. Scoring for each correctly reproduce digit +span was scored as “one” and otherwise as “zero”. The total score +(DS_T) was calculated in addition of the DS_F and DS_B scores. +2.6.4. Digit Symbol Substitution Test (DSST)51 +DSST was used in order to access various cognitive components +as scanning, matching, switching, and writing operations which are +reflective of several higher cognitive functions such as perception, +encoding and retrieval processes, transformation of information +stored in active memory and decision making.52 It has a worksheet +with a specified row of six different symbols matched with six +different digits with pairs, which were to be canceled and had a +working section consisting of different pairs arrange randomly in +22 rows and 14 columns. Participants were asked to cancel the +correct pairs as much as possible in 90 s with any possible strategy. +The total number of canceled pairs in the test (DSST_T), wrong +targets (DSST_W) and net scores (DSST_N) (total attempted- +wrongly attempted) was calculated for the analysis. +2.7. Data analysis +Data were analyzed using the Statistical Package for Social Sci- +ence (Version 18.0). Gender categorical variables were analyzed +Table 1 +List of practices in the yoga program. +Order no. +Intervention components +No. of rounds +Approx. time +(Total 90 min) +Schedule +1 +Yogic prayer, Session on basic concepts of yoga and +instructions for the class +10 min +4 days/week (Wednesday, Thursday, +Saturday and Sunday) +2 +Preparatory practices: +a) Warm up: jogging, jumping, hopping, forward & +backward bending, side bending, twisting +b) Loosening: for toes, ankle, knee, hips, fingers, +wrist, elbow and neck +c) Stretching with breathing exercises: hands in and out, +hands stretch, ankle stretch, hip stretch, backstretch, tiger +stretch (spinal ups- down), supine straight leg raising, cycling, +lumber stretch, rocking and rolling +One each +10 min +4 days/week (Wednesday, Thursday, +Saturday and Sunday) +3 +Sun salutation (Suryanamaskar) +10e12 +10 min +4 days/week (Wednesday, Thursday, +Saturday and Sunday) +4 +Asana (Postures): +A. Standing postures +a) Half waist rotation posture (Ardhakati Chakrasana) +b) Foot palm posture (Padahastasan) +c) Half wheel posture (Ardha chakrasana) +d) Triangle posture (Trikonasana) +e) Tree posture (Vrikshana) +f) Eagle posture (Gasudasana) +B. Sitting postures +a) Diamond (Vajrasana) +b) Rabbit posture (Shasahankasana) +c) Sleeping diamond posture (Suptavajrasana) +d) Camel posture (Ustrasana) +e) Posterior stretch (Paschimotasana) +f) Spinal twist posture (Ardhamatsyendrasana) +g) Cow face posture (Gomukhasana) +C. Prone posture: +a) Cobra posture (Bhujangasana) +b) Grasshopper posture (Salabhasana) +c) Bow posture (Dhanurasana) +d) Shoulder stand (Sarvangasana) +e) Plow posture (Halasana) +D. Supine postures +a) Fish posture (Matsyasana) +b) Boat posture (Naukasana) +1 each +20 min (around 1 min +each posture) +4 days/week (Wednesday, Thursday, +Saturday and Sunday) +5 +Deep relaxation technique (DRT) +1 +10 min +4 days/week (Wednesday, Thursday, +Saturday and Sunday) +6 +Pranayama (voluntary regulation of breath): +a) Breathing with forceful exhalation with +passive inhalation (Kapalabhati-3 types) +b) Breathing with rapid inhalation & exhalation (Bhastrika) +c) Slow & rhythmic alternate nostril breathing (Nadisodhana) +d) Exhalation, with a honey bee sound (Bharamari) +e) Ujjayi (Hissing in thought while exhaling) +1 each +15 min +4 days (Wednesday, Thursday, +Saturday and Sunday) +7 +Concentration Techniques: +a) Eye exercises (Netra shakti vikasana) +b) Practice to improve collective motivation (Dhruti shakti vikashaka) +c) Activity to improve intellect (Dhi shakti vikasaka) +d) Trataka +e) Palming +1 each +15 min +2 days/week (Wednesday and Saturday) +8 +Yogic games (games for memory, awareness and creativity) +15 min +2 days/week (Thursday and Sunday) +S.P. Purohit, B. Pradhan / Journal of Traditional and Complementary Medicine 7 (2017) 99e105 +101 +using Chi squared test. The Independent Sample ‘t’ test was used to +check the difference between groups for demographic measures. +Analysis of repeated measure followed by Bonferroni post-hoc was +performed for all the cognitive functions and Anthropometric +outcome measures. +3. Results +The trial profile of the study is shown in Fig. 1. There were no +dropouts from Yoga group but eight from WLC. Among eight, two +were sick, two were suspended during the post assessment due to +their behavioral issues and other four were not willing to complete +the task. There were 40 data from Yoga group and 32 from the WLC +were available for the final analysis. The baseline mean age be- +tween groups was matched (p ¼ 0.78, Independent ‘t’ test). The +distribution of gender (p ¼ 0.624, Chi2 test) was not significantly +different between the two groups. +Repeated measures of ANOVA showed that there were no sig- +nificant differences between the groups mean score of baseline +(p > 0.05) for all the cognitive functions tests except Stroop_CW, +DS_F and DS_T. +There were significant difference (p < 0.001) found in times +(pre-post) score for STROOP_C [F (1,70) ¼ 39.165, p < 0.001], +STROOP_W [F (1,70) ¼ 32.540, p < 0.001], STROOP_CW [F +(1,70) ¼ 16.880, p < 0.001]; DSST_T [F (1,70) ¼ 17.968, p < 0.001], +DSST_N F (1,70) ¼ 19.366, p < 0.001]; DS_F [F (1,70) ¼ 44.796, +p < 0.001], DS_B [F (1,70) ¼ 29.228, p < 0.001], DS_T [F +(1,70) ¼ 64.221, p < 0.001]; TMT_A [F (1,70) ¼ 5.113, p < 0.001] and +TMT_B [F (1,70) ¼ 15.100, p < 0.001]. +The group by time interaction showed (Table 2) significant dif- +ferences (p < 0.05) in STROOP_C, STROOP_W, STROOP_CW; DS_F, +DS_B, DS_T; TMT_A. This suggests performance of the Yoga group is +better than WLC, whereas there were no significant differences +found in, DSST_T, DSST_W, DSST_N, and TMT_B. +Within the Yoga group, post-hoc test with Bonferroni adjust- +ment showed (Table 2) significant improvements (p < 0.001) in +score for STROOP_C (12.95%), STROOP_W (17.69%), STROOP_CW +(19.98), DSST_T (15.02%), DSST_N, (16.89%), DS_F (33.81%), DS_B +(43.51 %), DS_T (37.86 %), TMT_A, (19.52%) and TMT_B (19.43%). +There was no significant improvement in DSST_W (12.94 %). +Within WLC group, post-hoc test with Bonferroni adjustment +showed (Table 2) significant improvement in STROOP_C (p < 0.05, +5.14%), STROOP_CW (p < 0.01, 5.24%); DSST_N (p < 0.05, 10.91%), +DS_F (p < 0.05, 9.92 %), DS_T (p < 0.01, 11.50 %), whereas there were +no significant improvement in STROOP_W (3.78 %), DSST_T (8.18 %), +DSST_W (23.64 %), DS_B (14.04 %), TMT_A (5.98 %), TMT_B (9.73 %). +4. Discussion +The present study was intended to study the effect of three +months of Yoga as compared to a WLC group on the CF of orphan +adolescents. The effect of the Yoga program provides evidence on +improving cognitive functions in orphan adolescents. The result +showed that the EF of the yoga group improved significantly +(p < 0.05) in the following domains; STROOP_W, STROOP_C, +STROOP_CW, DS_F, DS_B, DS_T, TMT_A, and TMT_B whereas WLC +group exhibited improvement STROOP_C, DSST_N, DS_F, DS_T as +compared to their baseline. The group by time interaction analysis +showed significant differences (p < 0.05) in STROOP_C, STROOP_W, +STROOP_CW; DS_F, DS_B, DS_T; TMT_A. This suggests performance +of the Yoga group is better than WLC. +Present study demonstrated that yoga has moderate effect +(g ¼ 0.29) on overall cognition, executive functions (g ¼ 0. 27), +attention and processing speed measures (g ¼ 0.34). These effect +sizes are comparable with a recent meta-analysis study of ran- +domized controlled trials on Yoga,53 where the overall observed +effect size of Yoga on cognition was (g ¼ 0.33), executive function +(g ¼ 0.27), attention and processing speed (g ¼ 0.29). +Earlier findings of studies on Yoga were aligned with the present +study in Stroop,54 DSST,55 DSF and DSB,56e59 TMT.45,58 Two recent +studies have demonstrated 12 weeks of yoga sessions were posi- +tively associated with acute increase in thalamic GABA levels, +improvement in mood and anxiety scales,60 and reduction in +depressive symptoms.61 When yoga postures performed with a gap +in between, provides relaxation to body, then ultimately enhances +cognition. Previous studies on yoga techniques which consisted of +sequence of yoga postures interspersed with relaxation techniques, +found improvement in selective attention,62 and inhibition of the +cortical region.63 Suryanamakara, an important part of intervention +given, +performed +with +rhythmic +breathing +develop +internal +awareness which might have influenced the cognitive outcome +measures in the present study. +Yoga breathing techniques have influence on brain cortex area. +For example, high frequency yoga breathing practice (Kapalabhati) +enhances blood flow to pre frontal cortex,64 and cortical electrical +activity measured through electroencephalogram.65 Pre-frontal +Table 2 +Comparison of the tests executive functions of yoga and wait-list control group. +Yoga (n ¼ 40) +WLC (n ¼ 32) +Group*time +interaction +Pre +Post +Pre +Post +Mean ± SD +95% C.I. +(LB to UB) +Mean ± SD +95% C.I. +(LB to UB) +Mean ± SD +95% C.I. +(LB to UB) +Mean ± SD +95% C.I. (LB to UB) +STROOP_W +62.18 ± 22.36 +54.95 to 69.40 +73.18 ± 21.67*** +65.84 to 80.51 +69.44 ± 23.59 +61.36 to 77.52 +72.06 ± 25.13 +63.86 to 80.27 +.001 +STROOP_C +48.65 ± 10.57 +45.20 to 52.10 +54.95 ± 11.86*** +51.13 to 58.77 +53.47 ± 11.38 +49.61 to 57.33 +56.22 ± 12.44* +51.95 to 60.49 +.017 +STROOP_CW +27.90 ± 7.12 +25.67 to 30.13 +33.43 ± 8.71*** +30.75 to 36.10 +32.78 ± 6.99 +30.29 to 35.27 +34.50 ± 8.20** +31.51 to 37.49 +.034 +DSST_T +33.95 ± 8.40 +31.31 to 36.59 +39.05 ± 8.42*** +36.20 to 41.90 +33.22 ± 8.37 +30.26 to 36.18 +35.94 ± 9.77 +32.75 to 39.13 +.201 +DSST_W +2.13 ± 2.03 +1.53 to 2.72 +1.85 ± 2.62 +1.17 to 2.53 +1.72 ± 1.69 +1.05 to 2.38 +1.31 ± 1.42 +0.55 to 2.08 +.843 +DSST_N +31.83 ± 8.52 +29.16 to 34.49 +37.20 ± 8.94*** +34.20 to 40.20 +31.22 ± 8.38 +28.24 to 34.20 +34.63 ± 10.22* +31.27 to 37.98 +.327 +DS_F +7.03 ± 1.51 +6.58 to 7.47 +9.40 ± 2.05*** +8.82 to 9.98 +8.19 ± 1.31 +7.69 to 8.69 +9.00 ± 1.50* +8.36 to 9.64 +.002 +DS_B +3.28 ± 1.18 +2.86 to 3.69 +4.70 ± 1.57*** +4.24 to 5.16 +3.56 ± 1.46 +3.10 to 4.02 +4.06 ± 1.32 +3.55 to 4.58 +.011 +DS_T +10.30 ± 2.20 +9.60 to 11.00 +14.20 ± 3.05*** +13.34 to 15.06 +11.69 ± 2.28 +10.90 to 12.48 +13.03 ± 2.25** +12.07 to 13.99 +.000 +TMT_A +46.28 ± 15.27 +41.81 to 50.75 +37.25 ± 10.40*** +33.23 to 41.26 +41.45 ± 12.69 +36.44 to 46.45 +43.92 ± 15.18 +39.43 to 48.42 +.000 +TMT_B +89.98 ± 32.80 +78.66 to 101.30 +72.50 ± 21.10*** +63.99 to 81.00 +95.99 ± 39.45 +83.33 to 108.65 +86.65 ± 32.90 +77.14 to 96.16 +.242 +STROOP_W ¼ Stroop Word, STROOP_C ¼ Stroop Color, STROOP_CW ¼ Stroop Color Word, DSST_T ¼ Digit Symbol Substitution Total Score, DSST_W ¼ Digit Symbol Sub- +stitution Wrong Score, DSST_N ¼ Digit Symbol Substitution Net Score, DS_F ¼ Digit Span Forward, DS_B ¼ Digit Span Backward, DS_T ¼ Digit Span Total, TMT_A ¼ Trial Making +Test A, TMT_B ¼ Trial Making Test B, YG ¼ Yoga Group, WLC ¼ Wait-List Control Group. +*p < 0.05, **p < 0.01, ***p < 0.001; pre compared with post. +S.P. Purohit, B. Pradhan / Journal of Traditional and Complementary Medicine 7 (2017) 99e105 +102 +cortex is associated with memory, attention, and EF.66,67 Yoga +breathing (Pranayama) regulated the autonomic functions by +dominating sympathetic68e70 or parasympathetic tone71,72 based +on the types of techniques. Different yoga breathing techniques +were found to be important contributors for significant improve- +ment in various cognitive domains.57,73,74 Kapalabhati and Bhastrika +Pranayama had influence on auditory working memory, and central +neural processing and sensory-motor performance.75 Bhramari +Pranayama may enhance inhibition response and cognitive control +in healthy participants.76 +Trataka is a yogic technique in which a person practices focusing +and defocusing on a chosen object.48 This improves the concen- +tration of mental thought process which channelizes action toward +given task/test. A recent study on Trataka for one month showed +there were beneficial effects by enhancing cognitive functions tests +and TMT_B in elderly participants.58 The mechanisms in Trataka +practice involve Dharana (focusing) and Dhyana (defocusing) which +also contributes in enhancing cognitive measures. +Strengths of the study arise from randomized design with use of +well-validated measures of EF while the raters and statistician were +blinded and the main limitation of the study includes, it was con- +ducted on adolescents belonging to one orphanage and the results +were not able to rule out the effect of diet and other school +activities. Improvement observed in WLC group may be due to test- +retest effect, uncontrolled physical activities in schools, time and +growth effect. +The study can be improvised in design by further reducing the +age range of participants, developing a Yoga Module especially for +orphans and also comparing the Yoga intervention with other kinds +of complementary alternative therapies such as Ayurveda, Natu- +ropathy for promotion of positive health for orphans. +5. Conclusion +Evidence for the effectiveness of three months yoga on EF was +demonstrated in this study, which may be a useful tool for the +young orphans, to be practiced for cognitive health on a daily basis. +The sustained effect of Yoga on EF seen in the present study may +have potential implications on learning, classroom behavior and in +handling the adverse circumstances and stand as a preventive +measure for mental health problems. +Conflict of interest +None declared. +3 months day to +day activities +Participants enrolled for the +study (n=135) +Excluded (n=55) +Based on the inclusion +and exclusion criteria +Participants recruited (n= 80) +Allocation +Randomization +Yoga group (n=40) +Wait–list controlled +group (n=40) +Retained (n=40) +No dropouts +Retained (n=32) +Dropout due to various reasons +(n=8) +3 months Yoga +Program +Retained (n=40) +Retained (n=32) +Analysis +Fig. 1. Trial profile. +S.P. Purohit, B. Pradhan / Journal of Traditional and Complementary Medicine 7 (2017) 99e105 +103 +Sources of support +Not funded. +Acknowledgment +We are thankful to the department of Psychology, SVYASA Yoga +University, Bangalore for providing the necessary support needed +for the research. We also thank Dr. Rajashree and Ms. Soubhagya +Laxmi and Ms. Jinsook, who helped me during various phases of the +work. We also would like to thank all the participants involved in +this project. +References +1. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. +Developmental potential in the first 5 years for children in developing coun- +tries. Lancet. 2007;369:60e70. +2. Nayak BK. Orphan problems and community concern in Ethiopia. Int J Manag +Soc Sci Res. 2014;3:8e15. +3. UNICEF, UNAID, USAID. Children on the Brink 2004: A Joint Report of New Orphan +Estimates and a Framework for Action; 2004:1e46. July www.unaids.org. +4. UNICEF. 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Immediate effect of specific nostril manipulating yoga +breathing practices on autonomic and respiratory variables. Appl Psychophysiol +Biofeedback. 2008;33:65e75. +73. Bhavanani AB, Madanmohan, Udupa K. Acute effect of Mukh bhastrika (a yogic +bellows type breathing) on reaction time. Indian J Physiol Pharmacol. 2003;47: +297e300. +74. Telles S, Raghuraj P, Maharana S, Nagendra HR. Immediate effect of three yoga +breathing techniques on performance on a letter-cancellation task. Percept Mot +Ski. 2007;104(3 Pt 2):1289e1296. +75. Sharma VK, M R, S V, et al. Effect of fast and slow pranayama practice on +cognitive functions in healthy volunteers. J Clin Diagn Res. 2014;8:10e13. +76. Rajesh SK, Ilavarasu JV, Srinivasan TM. Effect of Bhramari Pranayama on +response inhibition: evidence from the stop signal task. Int J Yoga. 2014;7: +138e141. +S.P. Purohit, B. Pradhan / Journal of Traditional and Complementary Medicine 7 (2017) 99e105 +105 diff --git a/subfolder_0/Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.txt b/subfolder_0/Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.txt new file mode 100644 index 0000000000000000000000000000000000000000..7b64142b5bbed31d482b4344aac3d633c43a2608 --- /dev/null +++ b/subfolder_0/Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia.txt @@ -0,0 +1,766 @@ +Effect of yoga therapy on facial emotion +recognition deficits, symptoms and +functioning in patients with schizophrenia +Behere RV, Arasappa R, Jagannathan A, Varambally S, +Venkatasubramanian G, Thirthalli J, Subbakrishna DK, Nagendra HR, +Gangadhar BN. Effect of yoga therapy on facial emotion recognition +deficits, symptoms and functioning in patients with schizophrenia. +Objective: Facial emotion recognition deficits have been consistently +demonstrated in schizophrenia and can impair socio-occupational +functioning in these patients. Treatments to improve these deficits in +antipsychotic-stabilized patients have not been well studied. Yoga +therapy has been described to improve functioning in various domains +in schizophrenia; however, its effect on FERD is not known. +Method: Antipsychotic-stabilized patients randomized to receive Yoga +(n = 27), Exercise (n = 17) or Waitlist group (n = 22) were assessed +at baseline, 2nd month, and 4th month of follow-up by raters blind to +group status. Assessments included Positive and Negative Syndrome +Scale (PANSS), Socio-Occupational Functioning Scale (SOFS), and +Tool for Recognition of Emotions in Neuropsychiatric DisorderS +(TRENDS). +Results: There was a significant positive correlation between baseline +FERD and socio-occupational functioning (r = 0.3, P = 0.01). +Paired samples t test showed significant improvement in positive and +negative symptoms, socio-occupational functioning and performance +on TRENDS (P < 0.05) in the Yoga group, but not in the other two +groups. Maximum improvement occurred at the end of 2 months, and +improvement in positive and negative symptoms persisted at the end of +4 months. +Conclusion: Yoga therapy can be a useful add-on treatment to improve +psychopathology, FERD, and socio-occupational functioning in +antipsychotic-stabilized patients with schizophrenia. +R. V. Behere1, R. Arasappa1, +A. Jagannathan2, S. Varambally1, +G. Venkatasubramanian1, J. +Thirthalli1, D. K. Subbakrishna3, +H. R. Nagendra4, B. N. Gangadhar1 +Departments of 1Psychiatry, 2Psychiatric Social Work, +3Biostatistics, National Institute of Mental Health and +Neurosciences, Bangalore and 4Swami Vivekananda +Yoga Anusandhana Samsthana (SVYASA) University, +Bangalore, India +Key words: schizophrenia; treatment; outcome +B. N. Gangadhar, Professor, Department of Psychiatry, +National Institute of Mental Health and Neurosciences, +Bangalore-560029, India. +E-mail: bng@nimhans.kar.nic.in +Accepted for publication August 20, 2010 +Significant outcomes +• Yoga as an add-on therapy improved psychopathology, emotion recognition deficits, and socio- +occupational functioning in antipsychotic-stabilized patients with schizophrenia in comparison with +Physical Exercise and Waitlist groups. +• The maximum change in variables occurred at the end of 2nd month of follow-up in the Yoga group +and the benefits obtained persisted at the end of 4th month of follow-up. +• Facial emotion recognition deficits were associated with poorer socio-occupational functioning at +baseline. +Acta Psychiatr Scand 2011: 123: 147–153 +All rights reserved +DOI: 10.1111/j.1600-0447.2010.01605.x + 2010 John Wiley & Sons A/S +ACTA PSYCHIATRICA +SCANDINAVICA +147 +Introduction +Schizophrenia is a clinical syndrome characterized +by abnormalities in cognition, perception and +behaviour. Recently, deficits in the sphere of +social cognition are being increasingly recognized +in schizophrenia (1). Facial emotion recognition +deficits (FERD) are an important component of +impairment in social cognition (2). FERD have +been consistently demonstrated in patients with +schizophrenia (3, 4). These deficits have been +demonstrated for negative emotions of fear and +anger (5, 6). +Facial emotion recognition deficits can lead to +impairment in interpersonal communication and +may underlie difficulties in social adjustment (7). +These deficits are also associated with poor work +and global functioning, suggesting that affect +recognition is an important aspect of psychosocial +and occupational functioning in stable out-patients +(8). Hence, interventions to improve FERD can +enhance the socio-occupational functioning in +schizophrenia. +Studies +have +shown +that +FERD +could +be +improved by behavioural interventions like cogni- +tive +enhancement +training +(9). +Recently, +we +reported that risperidone treatment can improve +FERD in drug-naı¨ve subjects +(10). However, +FERD have been described as a residual deficit in +schizophrenia and have been documented in anti- +psychotic-stabilized patients (11). The scope of the +current conventional treatments for residual defi- +cits is limited. Yoga is a traditional Indian system +used in alternative and complementary medicine. +In a randomized controlled trial, it has been found +to improve negative symptoms and functioning in +antipsychotic-stabilized patients with schizophre- +nia (12). +To date, there have been no studies on the effect +of yoga as an add-on treatment for FERD. +Aims of the study +To study the effect of yoga as an add-on treatment +on emotion recognition deficits, psychopathology, +and socio-occupational functioning in antipsy- +chotic-stabilized patients with schizophrenia. +Material and methods +Sample +Patients with a diagnosis of schizophrenia (DSM +IV), who were on regular follow-up and willing to +give consent for the study, were recruited from the +Outpatient services of the Department of Psychi- +atry, NIMHANS. A qualified psychiatrist con- +firmed +the +diagnosis +independently +based +on +clinical interview, information obtained from care- +givers, and supportive information from case +records. A total of 91 patients were included in +the study with their age ranging from 18 to +60 years and Clinical Global Impression (CGI) +score £3 (as assessed by the treating psychiatrist). +These patients were on stabilized antipsychotic +medications for 6 weeks or longer, as decided by +the treating psychiatrist, before being recruited +into the study and continued the same medication +until the completion of the study. Patients with +comorbid psychiatric disorders, medical or neuro- +logical illness +were excluded. The study was +approved by the ethics committee of the institute. +Procedure +Using computer-generated random numbers, 91 +patients were allocated to three treatment groups: +Yoga (n = 34), Exercise (n = 31), and Waitlist +(n = 26). The numbers were not necessarily equal. +The variations in these numbers were not signifi- +cantly different from chance. The randomization +was performed by one of the authors in the study +(Dr JT). The raters were blind to the status, and +the raters were not involved in imparting yoga +therapy or exercise. +Yoga and Exercise groups received the yoga and +exercise training respectively from a trained yoga +instructor for a period of a month. For the next +2 months, they practiced yoga or exercise at home. +The patients caregivers were instructed to monitor +the yoga therapy at home and keep a log of the +yoga sessions practiced. Patients in the Waitlist +group did not receive any add-on intervention. +Patients in all the three groups continued to receive +stable dose of antipsychotic medications until the +end of the study. As per study protocol, only those +Limitations +• Baseline matching of Waitlist and Yoga groups on parameters such as negative symptoms and Tool +for Recognition of Emotions in Neuropsychiatric DisorderS Accuracy Score may have improved the +methodology of the study. +• A longer duration of supervised yoga therapy by the trained yoga therapist may have produced more +robust results. +• The findings need to be replicated in a larger sample of patients. +Behere et al. +148 +patients who completed all assessments at the end +of the study duration were included in the final +data analysis. Those patients who dropped out or +those who required a change in dosage of antipsy- +chotics +during +the +study +duration +were +not +included. During follow-up assessments, number +of drop-outs was 7 in Yoga group, 14 in Exercise +group, and 4 in Waitlist group. Hence, the number +of patients who completed the study and included +in the final analysis was 27 in Yoga group, 17 in +Exercise group, and 22 in Waitlist group. The +drop-outs were not significantly different from the +final study sample in their baseline clinical and +demographic characteristics. The patients who +dropped out either had not practiced yoga at +home or did not come for follow-up assessments +because of logistical reasons. It is interesting to +note that none of the patients were excluded from +the initial sample for reason of change in dosage of +antipsychotic medication. +The yoga module developed by Swami Viveka- +nanda Yoga Anusandhana Samsthana (SVYASA) +was used. The techniques have been reported in an +earlier study (12); briefly, it consisted of loosening +exercises, breathing practices, +suryanamaskara, +sitting, supine, and prone posture asanas along +with pranayama and relaxation techniques. Med- +itation was not included in the module. The +exercises were adapted from the National Fitness +Corps – Handbook for Middle High and Higher +Secondary Schools. It consisted of brisk walking, +jogging, and exercises in standing and sitting +postures and relaxation. For further details regard- +ing the yoga and exercise techniques, please see +Appendix 1. +Patients socio-demographic data were collected +using semistructured data sheet. Their psychopa- +thology was assessed by Positive and Negative +Syndrome Scale (PANSS) (13). Socio-occupational +functioning was assessed by Socio-Occupational +Functioning Scale (SOFS) (14). Their emotion +recognition abilities were assessed using Tool for +Recognition +of +Emotions +in +Neuropsychiatric +DisorderS (TRENDS) (15). This is a culturally +sensitive, ecologically valid tool, consisting of 52 +static (still) and 28 dynamic (video clip) images (i.e. +totally 80 images) of six basic emotions – happy, +sad, fear, anger, surprise, disgust, and a neutral +expression emoted by four experienced actors (one +young man, one young woman, one older man, +and one older woman). The performance on +TRENDS was assessed by calculating the total +number of images that were correctly indentified +out of a maximum of 80 and termed the TRENDS +Accuracy Score (TRACS). Patients were assessed +at the baseline, 2nd and 4th month of follow-up. +All assessments were made by raters who were +blind to the group status. +Statistical analysis +One-way anova was used to assess differences in +baseline clinical and demographic variables among +the three groups. The paired-samples t test was +used to assess the change in variables after the +study period in the individual groups. Pearsons +correlation analysis was performed to look at the +association between the clinical variables. +Results +On one-way anova, the subjects in all three groups +were comparable on age, sex, and duration of +illness. The three groups differed significantly on +baseline negative symptoms (F = 4.8, P = 0.01) +and baseline TRACS (F = 3.2, P = 0.05) with the +Yoga group having greater negative symptom +score and lower TRACS (Table 1). +Change in variables between baseline and 2nd +month follow-up and baseline and 4th month +follow-up in the individual groups was examined +using paired-samples t test (Table 2). In the Yoga +group, there was significant change in positive and +negative symptoms and TRACS. The improvement +continued to remain significant even after the 4th +month assessments. The improvement in positive +and negative symptoms and SOFS score remained +significant after applying Bonferroni correction for +multiple comparisons. There were no significant +changes in variables in either the Exercise or the +Waitlist groups. The maximum change in variables +occurred at the 2nd month of follow-up. On +correlation analysis, it was observed that lower +baseline scores on TRACS correlated with poorer +Table 1. One-way anova ⁄ chi-square analysis of baseline clinical and demographic variables in patient groups +Variable +Yoga (Mean € SD) +Exercise (Mean € SD) +Waitlist (Mean € SD) +F ⁄ (v2) +P +Age (years) +31.3 € 9.3 +30.2 € 8.0 +33.6 € 9.9 +0.74 +0.5 +Duration of illness (months) +126.2 € 101.6 +86.6 € 93.1 +121.6 € 108.6 +0.82 +0.4 +Sex (M : F) +18 : 9 +14 : 3 +15 : 7 +1.4 +0.5 +Mean dosage of antipsychotic and +[range] (CPZ equivalents in mg ⁄ day) +335.0 € 205.3 [400] +297.9 € 150.9 [300] +340.0 € 172.4 [675] +0.21 +0.8 +Effect of yoga therapy on patients with schizophrenia +149 +socio-occupational functioning as measured by +SOFS (r = 0.3, P = 0.01). There was no signifi- +cant correlation between TRACS and positive or +negative symptoms. There was no significant cor- +relation between change in negative symptoms and +change in TRACS. +Discussion +This is the first study to explore the effect of yoga +therapy on FERD. The results of this study show +that yoga therapy as an add-on to antipsychotic +treatment can be beneficial in improving positive +symptoms, negative symptoms, FERD, and socio- +occupational functioning. The results of this study +support the findings of an earlier study that +demonstrated yoga as an add-on therapy to benefit +several dimensions of outcome in schizophrenia (12). +Although there was a significant difference in +negative symptoms and TRACS between groups at +baseline, +there +was +no +significant +correlation +between +change +in +negative +symptoms +and +change in TRACS, suggesting that change in +negative symptoms alone might not have resulted +in improvement in emotion recognition scores. In +the Exercise and Waitlist groups, the negative +symptoms and FERD did not improve, supporting +the current understanding that these are residual +deficits in schizophrenia. The possibility of anti- +psychotic medication confounding the results was +minimized by ensuring stable antipsychotic dos- +ages for 6–8 weeks prior to study and throughout +the study duration. Hence, the finding of signifi- +cant improvement in these parameters in antipsy- +chotic-stabilized patients is of important clinical +relevance. +The correlation between FERD and socio-occu- +pational functioning supports findings of earlier +studies (7). Impairment in facial emotion recogni- +tion abilities can impair the ability to interact in +social +situations and +hence +can +affect +socio- +occupational functioning (16). However, interven- +tions to improve these deficits are limited. We +recently reported risperidone to improve FERD in +antipsychotic-naı¨ve schizophrenia (10). Structured +interventions such as cognitive enhancement ther- +apy have also been described to improve these +deficits (9). However, these interventions can be +time-intensive, requiring trained mental health +professionals. Yoga therapy is a popular alterna- +tive system of medicine, and resources to obtain +this training are widely available in a developing +country like India, where mental health resources +are sparse. After an initial training period, patients +can continue practice at home, which can reduce +dependence on mental health resources. Interest- +ingly, benefits of yoga therapy that occurred at the +2nd month of follow-up continued to persist even +at the 4th month. One genuine concern is the +monitoring of yoga practice at home. Although +patients and caregivers were instructed to maintain +a logbook of yoga practice, many of the patients +did not maintain the logbook as per our expecta- +tion. A longer duration of supervised yoga therapy +by the trained yoga therapist may have produced +more robust results. +Integration of conventional psychiatric treat- +ments with mind body practices is an emerging +field. An example of this is the recent study that +integrated yoga breath intervention with exposure +therapy in post-traumatic stress disorder and +depression in survivors of Tsunami (17). Hence, it +is important that yoga therapists should receive +training in mental health disorders to sensitize +them to the needs of the psychiatric population. +The mental health professionals should work in +close association with the yoga therapists, so that +they are readily available to handle the needs of the +patients, if they may arise. In this context, it is +interesting to note that in our study, none of the +Table 2. Paired–samples t test comparing change in variables from baseline to 2nd month$ and 4th month# of follow-up in individual patient groups +Group +Variables +Baseline +2nd month +4th month +t$ value +P$ value +t# value +P# value +Yoga +Positive symptoms +15.1 € 11.7 +11.9 € 4.7 +12.1 € 5.4 +3.5 +0.002* +2.8 +0.008* +Negative symptoms +17.8 € 4.9 +14.7 € 3.9 +14.7 € 3.8 +5.1 +<0.001* +3.5 +0.002* +TRACS +49.4 € 11.4 +54.1 € 11.7 +54.6 € 14.4 +2.3 +0.03* +1.8 +0.09 +SOFS score +30.8 € 7.4 +25.1 € 6.4 +25.7 € 7.9 +4.4 +<0.001* +0.38 +0.7 +Exercise group +Positive symptoms +14.9 € 4.3 +13.5 € 4.7 +14.1 € 5.4 +1.5 +0.2 +0.6 +0.6 +Negative symptoms +14.8 € 3.9 +13.9 € 3.3 +13.5 € 4.4 +0.94 +0.4 +1.5 +0.2 +TRACS +51.3 € 10.7 +51.2 € 10.7 +52.8 € 10.4 +0.03 +0.9 +0.65 +0.5 +SOFS score +26.2 € 5.1 +23.9 € 4.7 +22.0 € 6.8 +1.9 +0.07 +1.3 +0.2 +Waitlist group +Positive symptoms +14.7 € 6.3 +12.9 € 5.2 +11.8 € 5.6 +1.7 +0.1 +2.02 +0.06 +Negative symptoms +14.3 € 3.7 +13.7 € 3.7 +13.7 € 3.6 +0.61 +0.6 +0.65 +0.52 +TRACS +56.9 € 9.4 +58.4 € 8.9 +53.4 € 16.4 +0.74 +0.5 +0.99 +0.3 +SOFS score +27.1 € 6.6 +24.9 € 6.1 +25.2 € 5.4 +2.1 +0.05* +0.27 +0.8 +SOFS, Socio-Occupational Functioning Scale; TRACS, TRENDS Accuracy Score; TRENDS, Tool for Recognition of Emotions in Neuropsychiatric Disorders. +*Significance at P < 0.05. +Behere et al. +150 +patients had worsening of positive symptoms +during the duration of yoga therapy. Further, +none of the patients required increase in dose of +antipsychotics. This probably suggests that yogas- +anas and breathing techniques can be practiced by +patients with schizophrenia without worsening of +psychotic experiences. +In conclusion, yoga as an add-on treatment +improves positive and negative symptoms, and +emotion +recognition +abilities +in +antipsychotic- +stabilized patients with schizophrenia, which in +turn might improve their socio-occupational func- +tioning. Further systematic studies are needed to +study the beneficial effects of yoga in patients with +schizophrenia and their potential neurobiological +mechanisms. +Acknowledgement +This study was supported by AYUSH grant awarded to Dr BN +Gangadhar vide letter no. Z.31018/1/2006-Y&N/R&P(Ay)/ +EMR. The authors thank the anonymous reviewers for the +thorough review of the manuscript that has helped immensely +in improving the quality of the manuscript. +Declaration of interest +There is no conflict of interest to declare by any of the authors +in relation to this manuscript. None of the authors are +associated with any pharmaceutical companies by way of +being on speakers list of pharmaceutical companies, receiving +grants from industry or being members of pharmaceutical +advisory boards. +References +1. Brune M. Emotion recognition, theory of mind, and social +behavior in schizophrenia. Psychiatry Res 2005;133:135– +147. +2. Grady CL, Keightley ML. Studies of altered social cogni- +tion in neuropsychiatric disorders using functional neu- +roimaging. Can J Psychiatry 2002;47:327–336. +3. Mandal MK, Pandey R, Prasad AB. Facial expressions of +emotions and schizophrenia: a review. Schizophr Bull +1998;24:399–412. +4. Bediou B, Krolak-Salmon P, Saoud M et al. 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Behere RV, Venkatasubramanian G, Arasappa R, Reddy N, +Gangadhar BN. Effect of risperidone on emotion recog- +nition deficits in antipsychotic-naive schizophrenia: a +short-term follow-up study. Schizophr Res 2009;113:72– +76. +11. Kucharska-Pietura K, David AS, Masiak M, Phillips ML. +Perception of facial and vocal affect by people with +schizophrenia in early and late stages of illness. Br J Psy- +chiatry 2005;187:523–528. +12. 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;116:226–232. +13. Kay SR, Opler LA, Lindenmayer JP. The Positive and +Negative Syndrome Scale (PANSS): rationale and stan- +dardisation. Br J Psychiatry Suppl 1989;7:59–67. +14. Saraswat N, Rao K, Subbakrishna DK, Gangadhar BN. The +Social Occupational Functioning Scale (SOFS): a brief +measure of functional status in persons with schizophrenia. +Schizophr Res 2006;81:301–309. +15. Behere RV, Raghunandan VN, Venkatasubramanian G, +Subbakrishna +DK, +Jayakumar +PN, +Gangadhar +BN. +TRENDS: a Tool for Recogniton of Emotions in Neuro- +psychiatric DisorderS. Indian J Psychol Med 2008;30: +32–38. +16. Hooker C, Park S. Emotion processing and its relationship +to social functioning in schizophrenia patients. Psychiatry +Res 2002;112:41–50. +17. Descilo T, Vedamurtachar A, Gerbarg PL et al. Effects of a +yoga breath intervention alone and in combination with an +exposure therapy for post-traumatic stress disorder and +depression in survivors of the 2004 South-East Asia tsu- +nami. Acta Psychiatr Scand 2010;121:289–300. +Appendix: Yoga therapy and physical exercise modules +Appendix A: The integrated yoga therapy module; duration: 1 h +I. Shithileekarana vyayama (loosening exercises) +(1) Jogging-2 min +(2) Mukha dhouti (cleansing through a single blast breath) +30 s +(3) Twisting – 1 min +(4) Hand stretch breathing – 2 min +(5) Forward and backward bending – 1 min +(6) Tiger Breathing: nine rounds 1 min +(7) Cycling – 1 min +(8) Sashankasana (moon posture) breathing – 1 min +(9) Dandasana (staffposture) – 30 s +II Asanas: +II A. Suryanamaskar (sun salutation) (12 rounds) – 6 min +Effect of yoga therapy on patients with schizophrenia +151 +II B. Instant relaxation technique (IRT) 1 min +Shavasana (corpse posture) – this involves progressively +tensing all the muscles of the body in 15 s, relaxing all of +them instantaneously and staying relaxed for 45 s +II C. Sitting posture asanas: +II C.1. Vakrasana (twist posture) – 30 s +II C.2. Prasarita pada paschimatanasana (stretching of back +with stretched legs) – 1 min +II C.3. Ustrasana (camel posture) – 1 min +II D. Prone posture asanas: +II D.1. Bhujangasana (cobra posture) – 1 min +II D.2. Shalabhasana (locust posture) – 1 min +II D.3. Dhanurasana (bow posture) – 1 min +II E. Supine posture asanas: +II E.1. Sarvangasana (shoulder stand) – 3 min +II E.2. Matsyasana (fish posture) – 1 min +III Breathing exercises: +III A. Kapalabhati (cleansing breath exercise): 60–80 rounds – +2 min +III B. Sectional (abdominal, thoracic, clavicular, and full +yogic) breathing: each five rounds – 4 min +III C. +Nadi-shuddi +pranayama +(balancing +breath): +nine +rounds – 2 min +III D. Nadanusandhana (feeling of inner sound while chanting +A, U, M) each nine rounds – 10 min +IV Quick relaxation technique (QRT) – 3 min. This involves +adopting +Shavasana +and +three +phases +of +observing +abdominal movements, synchronizing them with deep +breathing, and feeling of energy and collapsing all the +muscles +Appendix B: Physical exercises: adopted from the National +Fitness Corps – Handbook for Middle High and Higher Secondary +Schools (29); duration: 1 h* +I Brisk walking – 10 min +II Jogging – 5 min +III Exercise in standing posture – 20 min +III A. Position: attention +(1) Raising the arms forward to the shoulder level palms facing +each other, fingers together +(2) Bending arms, bringing fists in the armpits with elbows +pushed backward +(3) Returning to position one +(4) Returning to position of attention +Yoga therapy for the management of patients with schizo- +phrenia +III B. Position: attention +(1) Raising the arms forward to the shoulder level, fingers +together +(2) Flinging arms sideward to the shoulder level, palms facing +the ground heel raise +(3) Returning to position one +(4) Returning to position of attention +III C. Position: attention +(1) Stepping the left leg forward and raising the arms forward, +palms are kept facing each other and fingers are kept +together +(2) Flinging arms sideward at the shoulder level, palms facing +the ground and lounging left leg forward +(3) Returning to position one +(4) Returning to position of attention +III D. Position: attention +(1) Raising arms forward to the shoulder level palms facing +each other with the fingers together +(2) Raising the arms upward, palms facing each other and with +fingers together heels are raised +(3) Returning to position one +(4) Returning to position of attention +III E. Position: attention +(1) Raising arms sideward, shoulder level, palms facing the +ground, fingers together +(2) Squatting on toes, flinging arms upwards, palms facing +each other +(3) Returning to position one +(4) Returning to position of attention +III F. Position: attention +(1) Jumping feet astride, raising arms sideward, palms facing +the ground +(2) Flinging arms upward above head with a clap and jumping +feet together +Behere et al. +152 +(3) Returning to position one +(4) Returning to position of attention +III G. Position: attention +(1) Hands forward upward rise to shoulder level, palms facing +each other, heels raise +(2) Half squat, chest firm (hands bent at elbows) palm +downward, middle fingers1 ⁄ 2¢¢ distance from each other +(3) Hands sideward raise, knees straight +III H. Position: attention +(1) Hands forward raised, half-knee bent (no gap between +knees) +(2) Back to position +(3) Hands sideward raised, half-knee bent +(4) Back to position. +IV. Sitting posture exercises – 20 min +IV A. Position: cross-legged sitting, hands slanting +(1) Hands rise over had slowly without bending at elbows, +palms touching each other, fingers extended upward +(2) Elbows bend, palms touching head +(3) Same as 1 +(4) Back to position +IV B. Position: cross-legged sitting, hands slanting +(1) Hands sideward, upward, elbows bend, palms touch the +head +(2) Trunk bend, head downward +(3) Same as 1 +(4) Back to position +IV C. Position: cross-legged sitting, hands slanting +Chest firm (i.e. elbow bent palms downward and in front of +the chest) +(1) Elbows backward press (chest expanding action) +(2) Hands forward sideward backward press +IV D. Position: cross-legged sitting, hands sideward slanting. +1–3: hands upward, downward swing, clap over head +*The therapist would give 2 min time in between the different +exercises with a non-specific instruction, just relax now. +Effect of yoga therapy on patients with schizophrenia +153 diff --git a/subfolder_0/Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes_ An Exploratory Study.txt b/subfolder_0/Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes_ An Exploratory Study.txt new file mode 100644 index 0000000000000000000000000000000000000000..f049c972b48db8250b0759579eba0be1152b23d3 --- /dev/null +++ b/subfolder_0/Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes_ An Exploratory Study.txt @@ -0,0 +1,256 @@ +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +1/11 +Int J Yoga. 2017 Sep-Dec; 10(3): 167–170. +doi: 10.4103/0973-6131.213471: 10.4103/0973-6131.213471 +PMCID: PMC5793012 +PMID: 29422748 +Effectiveness of Music Therapy on Focused Attention, Working +Memory and Stress in Type 2 Diabetes: An Exploratory Study +Indira Tumuluri, Shantala Hegde, and HR Nagendra +Division of Humanities, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, +India +Department of Clinical Psychology, Neuropsychology Unit, NIMHANS, Bengaluru, Karnataka, India +Address for correspondence: Dr. Shantala Hegde, Department of Clinical Psychology, National Institute of +Mental Health and Neurosciences-Deemed University, Bengaluru - 560 029, Karnataka, India. E-mail: +shantala.hegde@gmail.com +Received 2016 Jul; Accepted 2016 Nov. +Copyright : © 2017 International Journal of Yoga +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. +Abstract +Cognitive deficits are reported in diabetes mellitus type 2 (DM2). Previous research has shown that music- +based intervention can not only reduce hyperglycemia but also target cognitive functions as well as stress. +The aim of this exploratory study was to understand the effect of active participation in music therapy +(MT) on the cognitive deficits of DM2 patients. MT of twenty sessions was carried out with three +participants with DM2. Serum cortisol, perceived stress, Color Trail Test (1 and 2), and verbal n-back (1 +and 2) tests were used to measure the outcomes. Feedback was taken for the subjective ratings and +satisfaction of the participants. Stress and cortisol reduced and focused attention and working memory +improved in varying degrees. Subjectively, participants reported having benefitted from the intervention. +This is the first attempt to investigate the effect of music-based intervention on cognitive function in DM2 +patients using case study approach. +Keywords: Cortisol, focused attention, music therapy, perceived stress, working memory +Introduction +Type 2 diabetes (T2D) is a complex metabolic disorder leading to cognitive deficits and increased risk for +multiple clinical conditions such as dementia and stroke and several other micro- and macro-vascular +diseases.[1] High levels of psychological stress are also considered as one of the causal and maintaining +factors of this condition.[2] There is growing evidence of the effectiveness of music not only to improve +cognitive functions in conditions such as traumatic brain injuries,[3] stroke,[4] and dementia[5] but also in +the reduction of stress,[6,7] anxiety,[8] and cortisol production,[9] and increase in dopamine levels.[10] +With lifelong dependency on medication and likely physical side effects, there is a need to explore +intervention methods that can facilitate not only reduction of stress but also target cognitive dysfunction in +1 +1 +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +2/11 +T2D. Research on the effects of music therapy (MT) on stress has been reported. MT has reduced stress in +the students caused by a stressor[7] and anxiety and stress of T2D patients.[8] It is in the recent times with +evidence from neuro-musicology and music cognition that active as well as passive engagement in music +has shown to have positive effects on cognitive functions. There is no study hitherto examining the effects +of MT on not only stress but also cognitive functions. The aim of the present study was to examine the +effect of active participation in MT on the cognitive functioning of diabetes mellitus type 2 (DM2) +patients. In the first place, we sought to understand the influence of active participation in MT on memory +and focused attention, second, on cortisol and perceived stress, and finally on the subjective rating and +satisfaction. It is found that active music therapy (AMT) is more beneficial than passive listening.[11] +Singing improved the executive function of the children.[12] AMT is actively participating in MT by +singing or chanting or reciting. The objective of this exploratory study was to examine the effect of using +case series study design with pre-post evaluation. +Methods +The present study included three participants diagnosed with DM2 confirmed with the HbA1c levels. +Sociodemographic details of the participants are provided in Table 1. Written informed consent was taken +from the participants after the study was approved by the Institutional Ethics Committee, Swami +Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India. MT was administered in +addition to their treatment as usual, i.e., regular medication for DM2. Levels of stress were measured +objectively by measuring serum cortisol, and the subjective evaluation of stress was measured using +Cohen's perceived stress scale (PSS). Each item was rated on a 5-point scale ranging from never (0) to +almost always (4). Positively worded items were reverse scored, and the ratings were summed, with higher +scores indicating more perceived stress. PSS-10 scores were obtained by reversing the scores on the four +positive items: For example, 0 = 4, 1 = 3, and 2 = 2, and then summing across all 10 items. Items 4, 5, 7, +and 8 are the positively stated items. Rensis's 10-point Likert scale was used to understand the rate of +satisfaction. Verbal working memory and focused attention were measured using verbal n-back 1 and 2 +tasks (Rao et al., 2004) and Color Trail Tests (CTT) 1 and 2 (D’Elia and Satz). In n-back 1, the participant +responds to the repeated (9) consonants from thirty randomly ordered consonants common to multiple +Indian languages. In n-back 2, the participant responds whenever a consonant is repeated after an +intervening consonant. In CTT-1, the participant points out the randomly spread numbers from 1 to 25, odd +numbers in pink circles and even numbers in yellow ones in ascending order. In CTT-2, the participant +points out in ascending order the randomly arranged numbers from 1 to 25, leaving number 1, others +repeated once in pink and once in yellow circles. The main measure in this test is the time necessary to +complete the task. A semi-structured interview was carried out to know the participants’ experience with +the intervention. The interviews were video recorded. The serum tests were done by the National +Accreditation Board for Testing and Calibration Laboratories-accredited laboratory, Metropolis Health +Care Ltd. All measurements were administered pre- and post-intervention. Serum cortisol was measured +both the times (pre and post) in between 4.30 and 5 p.m. The experiment was carried out daily (excluding +Saturdays and Sundays) for 45 min. The protocol of MT is given in Table 2. +Detailed protocol of music therapy +The devotional songs were set for each day of the week. Every week, the same devotional songs were +repeated for familiarity. The participants’ individual songs were not repeated. The same piece of flute +music was played for all the sessions. There were total 20 sessions. +Results +The number of sessions attended by the participants were 16, 14, and 10 by cases 1, 2, and 3, respectively. +The period between the pre- and post-test is 1 month, weekly five sessions. +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +3/11 +In all the three cases, the cortisol level reduced after the therapy. PSS showed improvement in two cases +and no improvement in other case [Table 3]. Focused attention as assessed using the Color Trails Test 1 +nominally improved in one case and deteriorated in two cases at postintervention. The performance +improved in two cases and showed no improvement in the other case in CTT2. In verbal n-back test 1, the +performance improved in two cases and did not improve in the other case. Performance on the verbal n- +back 2 did not improve in any case [Refer to Table 4a and b]. All the three patients enjoyed the +intervention and rated it as 9.5 satisfactory on 10-point Likert scale [Table 3]. Video interviews provided +the report of the benefits of active participation of the participants in MT. +Discussion +The present study aimed at exploring the effects of AMT on cognitive functions and perceived levels of +stress. In this study, all the three participants showed significant cognitive impairments in the domains of +focused attention and verbal working memory compared to age, education, and gender-matched Indian +norms[13] The 15 percentile score (1 standard deviation below the mean) was taken as the cutoff score. +[14] In the critical review study of, “Is Type II Diabetes Associated with an Increased Risk of Cognitive +Dysfunction?,” it was observed that patients with T2D had moderate degrees of cognitive impairment in +verbal memory. It was reported that a study which evaluated 28 T2D patients aged <55 years showed +poorer performance on the measures of memory and attention.[15] These deficits are due to neural slowing +and increased cortical atrophy,[16] with higher levels of HbA1c in the present study. As a result, the +cognitive task completion required greater time and had difficulty for the participants compared to the +normative performance expected for the Indian males in this group. The participants differed in the way +they responded to active music participation. Not all the three participants had consistent improvement on +all cognitive tasks. The group singing in lead and follow manner may have improved the verbal working +memory as group singing enhanced the mood of patients with chronic pain[17] and improved the mental +health and well-being of the participants of singing.[18] The inconsistent improvement in this study may +be due to the subjective emotional state at the time of measurement, or the cognitive functions perhaps +require much more focused intervention, or the intensity and duration of the present intervention was not +sufficient to bring about significant changes in the cognitive functions. However, the reduction in the +cortisol level shows that AMT is feasible to relieve stress as listening to music reduced cortisol +production[9] and relieved stress.[6,7] The interviews also provided the following subjective positive +responses to the AMT. +The video interviews were taken after 12 sessions +Interviews were transcribed +The gist of the interviews are provided below. +Case 1 +It is a very good experience. I am feeling relaxed. The sessions are enjoyable. The therapy is very useful. +My singing improved. I love relaxation with flute music. I like the interactive sessions most. This therapy +should be spread. I feel the difference after the therapy. +Case 2 +I am very happy to participate. The sessions are very interesting. I like the sequence of the songs. I enjoy +group singing. I feel calm after the session. It helps me to sleep. The songs are well coordinated. Nirvana +Shatakam singing is the most liked part for me. It makes me deeply relaxed and calm. +Case 3 +th +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +4/11 +I feel much more relaxed. Blood sugar (fasting) reduced from 400 to 270. I like the singing and interaction +part. +The satisfaction of the participants and their willingness to attend AMT in future give support to the +administration of MT to other DM2 patients. The subjective reports and the PSS scores show that active +participation in music is a mood-elevating strategy which can enhance positive feelings. To substantiate its +role in cognitive functions, there is a need for long-term follow-up of cases with more focused intervention +with selected chants and musical content. +Conclusion +This is an exploratory study dealing with three cases +The results are inconsistent +In spite of poor cognitive performance, the positive subjective response and reduced PSS scores +provide a support to continue MT further +The lower level of cognitive functions may be due to higher levels of HbA1c +A randomized controlled trial study with larger cohort will be required to establish the findings +further. +Financial support and sponsorship +Liability release. +Conflicts of interest +There are no conflicts of interest. +References +1. McCrimmon RJ, Ryan CM, Frier BM. Diabetes and cognitive dysfunction. Lancet. 2012;379:2291–9. +[PubMed: 22683129] +2. Mooy JM, de Vries H, Grootenhuis PA, Bouter LM, Heine RJ. Major stressful life events in relation to +prevalence of undetected type 2 diabetes: The Hoorn study. Diabetes Care. 2000;23:197–201. [PubMed: +10868831] +3. Thaut MH, Gardiner JC, Holmberg D, Horwitz J, Kent L, Andrews G, et al. Neurologic music therapy +improves executive function and emotional adjustment in traumatic brain injury rehabilitation. Ann N Y +Acad Sci. 2009;1169:406–16. [PubMed: 19673815] +4. Särkämö T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S, Mikkonen M, et al. Music listening +enhances cognitive recovery and mood after middle cerebral artery stroke. Brain. 2008;131(Pt 3):866–76. +[PubMed: 18287122] +5. Sakamoto M, Ando H, Tsutou A. Comparing the effects of different individualized music interventions +for elderly individuals with severe dementia. Int Psychogeriatr. 2013;25:775–84. [PMCID: PMC3605862] +[PubMed: 23298693] +6. Thoma MV, La Marca R, Brönnimann R, Finkel L, Ehlert U, Nater UM. The effect of music on the +human stress response. PLoS One. 2013;8:e70156. [PMCID: PMC3734071] [PubMed: 23940541] +7. Labbé E, Schmidt N, Babin J, Pharr M. Coping with stress: The effectiveness of different types of +music. Appl Psychophysiol Biofeedback. 2007;32:163–8. [PubMed: 17965934] +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +5/11 +8. Mandel SE, Davis BA, Secic M. Effects of music therapy and music-assisted relaxation and imagery on +health-related outcomes in diabetes education: A feasibility study. Diabetes Educ. 2013;39:568–81. +[PubMed: 23771840] +9. Khalfa S, Bella SD, Roy M, Peretz I, Lupien SJ. Effects of relaxing music on salivary cortisol level after +psychological stress. Ann N Y Acad Sci. 2003;999:374–6. [PubMed: 14681158] +10. Ashby FG, Isen AM, Turken AU. A neuropsychological theory of positive affect and its influence on +cognition. Psychol Rev. 1999;106:529–50. [PubMed: 10467897] +11. Rao TI, Nagendra HR. The effect of active and silent music interventions on patients with type 2 +diabetes measured with electron photonic imaging technique. Int J Humanit Soc Sci. 2014;3:7–14. +12. Moreno S, Bialystok E, Barac R, Schellenberg EG, Cepeda NJ, Chau T. Short-term music training +enhances verbal intelligence and executive function. Psychol Sci. 2011;22:1425–33. +[PMCID: PMC3449320] [PubMed: 21969312] +13. Rao SL, Subbakrishna DK, Gopukumar K. NIMHANS Neuropsychology Battery-2004. Bangalore: +NIMHANS; 2004. +14. Heaton RK, Grant I, Butters N, White DA, Kirson D, Atkinson JH, et al. The HNRC 500 – +Neuropsychology of HIV infection at different disease stages. HIV Neurobehavioral Research Center. J Int +Neuropsychol Soc. 1995;1:231–51. [PubMed: 9375218] +15. Strachan MW, Deary IJ, Ewing FM, Frier BM. Is type II diabetes associated with an increased risk of +cognitive dysfunction? A critical review of published studies. Diabetes Care. 1997;20:438–45. [PubMed: +9051402] +16. McEwen BS. Stress and hippocampal plasticity. Annu Rev Neurosci. 1999;22:105–22. [PubMed: +10202533] +17. Kenny DT, Faunce G. The impact of group singing on mood, coping, and perceived pain in chronic +pain patients attending a multidisciplinary pain clinic. J Music Ther. 2004;41:241–58. [PubMed: +15327342] +18. Clift S, Nicol J, Raisbeck M, Whitmore C, Morrison I. Group singing, wellbeing and health: A +systematic mapping of research evidence. [Last cited on 2010 Oct 01];Univ Melb Refereed E J. 2010 2:1– +15. Available from: http://www.education.unimelb.edu.au/__data/assets/pdf_file/0007/1105927/clift- +paper.pdf . +Figures and Tables +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +6/11 +Table 1 +Details of the participants +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +7/11 +Table 2 +Daily practice +Open in a separate window +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +8/11 +Table 3 +Pre-and post-scores on the perceived stress scale, cortisol, and visual analog scale +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +9/11 +Table 4 +Raw scores of verbal n-back 1 and 2 tests +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +10/11 +Table 4a +Raw scores of Color Trails Tests +1/27/2021 +Effectiveness of Music Therapy on Focused Attention, Working Memory and Stress in Type 2 Diabetes: An Exploratory Study +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793012/?report=printable +11/11 +Table 4b +Pre-and post-intervention percentile scores on the cognitive tests +Articles from International Journal of Yoga are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/Effects of a Holistic Yoga Program on Endocrine Parameters in Adolescents with Polycystic.txt b/subfolder_0/Effects of a Holistic Yoga Program on Endocrine Parameters in Adolescents with Polycystic.txt new file mode 100644 index 0000000000000000000000000000000000000000..69d9672e0fe261de2605ba431309c75c12fe38a9 --- /dev/null +++ b/subfolder_0/Effects of a Holistic Yoga Program on Endocrine Parameters in Adolescents with Polycystic.txt @@ -0,0 +1,698 @@ +International Journal of Yoga  Vol. 5  Jul-Dec-2012 +112 +depression and anxiety. Indeed, it has a significant effect +on adult women, resulting in diminished quality of life, +altered feminine identity, and dysfunction in the family +and work environment.[4‑6] Further, the risk of adolescents +with PCOS, who are at the height of identity development +and awareness of body image, having a more significant +disturbance in quality of life, cannot be overlooked. +Studies prove that PCOS women show high prevalence of +anxiety.[7] Kerchner et al.,[8] documented a prevalence of +11.6% of anxiety syndromes in PCOS women. Also, there +is evidence to support the concept that anxiety is a risk +factor for the development of depressive disorders[9,10] and +suicide attempts[10,11] which have an increased prevalence +in PCOS patients.[12] Therefore, it is necessary to include +assessment of anxiety symptoms while diagnosing +adolescents with PCOS. +Lifestyle interventions are the first‑line effective treatment +for PCOS. Small changes in lifestyle are known to improve +INTRODUCTION +Polycystic ovarian syndrome (PCOS) is the most prevalent +female endocrine disorder with estimates ranging from +2.2% to as high as 26%.[1,2] In a recent survey, we have +found a 9.13% prevalence of PCOS in south Indian +adolescent girls.[3] +Patients with PCOS face challenges to their feminine +identity including irregular menstrual cycles, hirsutism, +acne, acanthosis nigricans, obesity, and infertility all likely +to impact quality of life and mood and potentially precipitate +Context: Yoga techniques practiced for varying durations have been shown to reduce state anxiety. This was never assessed +in adolescents with polycystic ovarian syndrome (PCOS). +Aims: To compare the effect of a holistic yoga program with the conventional exercise program on anxiety level in adolescents +with PCOS. +Settings and Design: Ninety adolescent (15‑18 years) girls from a residential college in Andhra Pradesh, who satisfied the +Rotterdam criteria, were randomized into two groups. +Materials and Methods: Anxiety levels were assessed at inclusion and after 12 weeks of intervention wherein yoga group +practiced a holistic yoga module while the control group practiced a matching set of physical exercises (1 h/day, for 12 weeks). +Statistical Analysis Used: Mann‑Whitney U test was used to compare difference scores (delta change) between the two groups +Results: Changes in state anxiety after the intervention were nonsignificantly different between the two groups (P=0.243), +while changes after the intervention were significantly different between the two groups (P=0.002) for trait anxiety. +Conclusions: Twelve weeks of a holistic yoga program in adolescents with PCOS is significantly better than physical exercise +program in reducing anxiety symptoms. +Key words: Anxiety; polycystic ovarian syndrome; yoga. +Abstract +Effect of holistic yoga program on anxiety symptoms in +adolescent girls with polycystic ovarian syndrome: +A randomized control trial +Ram Nidhi, Venkatram Padmalatha1, Raghuram Nagarathna, Ram Amritanshu +Divison of Yoga and Life science, SVYASA University, 1Consultant Obstetrician and Gynecologist, Rangadore Memorial Hospital, Bengaluru, India +Addrses for correpondence: Ms. Nidhi Ram, +#19, Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bangalore ‑ 560 019, India. +E‑mail: nidhiyoga@gmail.com +Original Article +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.98223 +113 +International Journal of Yoga  Vol. 5  Jul-Dec-2012 +Nidhi, et al.: Effect of yoga on anxiety in adolescents with PCOS: RCT +symptoms and psychological well being. Two studies +have investigated the effect of exercise on psychological +outcomes in PCOS. A small, non‑randomized study in +overweight and obese women with PCOS reported that a +six‑month, self‑directed brisk walking program improved +body image distress scores.[13] Recently, Thomson et al.,[14] +observed improvements in quality of life and depression +in overweight women with PCOS after 20  weeks +following an energy‑restricted diet with and without +exercise  (aerobic  only or combined aerobic‑resistance +exercise). +Yogic life style, a form of holistic mind‑body medicine, +developed thousands of years ago, is simple and +can be practiced by all. There is mounting evidence +that Yoga reduces anxiety symptoms. A study on +cyclic meditation on healthy male volunteers shows +reduction in state anxiety as assessed by Spielberger’s +inventory.[15] Also, a two‑month (90 min twice a week) +yoga intervention showed a significant decrease in +state and trait anxiety in women suffering from anxiety +disorders.[16] However, till date, the effects of a yoga +practice have not been assessed in adolescents with +PCOS. The present study was planned to assess the +effect of yoga on anxiety level in adolescent girls with +PCOS. +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 (2/3 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.[17] +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. +Poly cystic 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.[18] +Exclusion criteria were use of oral contraceptives/hormone +treatment/insulin‑sensitizing agents within previous +six weeks, smoking, hyperprolactinemia, thyroid +abnormalities, non‑classic adrenal hyperplasia, prior +experience of yoga and those who did not consent for the +study. +The study was approved by the Institutional Ethical +Committee of Swami Vivekananda Yoga Anusandhana +Samsthana (SVYASA) University. Signed informed consent +was obtained from the college authorities, the students and +one of the parents. +Power calculation +Effect size of 0.61 was obtained by using the post +intervention mean difference between the two groups +from the study by Tang et  al. on obese PCOS women +that compared six months of metformin and lifestyle +modification with a placebo, as there were studies on yoga +for PCOS.[19] A sample size of 86 with 43 subjects in each +arm was calculated keeping this effect size of 0.61, with +Type 1 error at 0.05 powered at 0.8. +Design +This was a prospective, randomized, active interventional +controlled trial in which 90 participants were randomly +divided 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 +design of the study were elucidated. They were asked to +report one week later after obtaining the signed consent +from their parents. After obtaining the written consent, +a clinical examination was performed. All girls with +oligomenorrhea and/or hirsutism (as per the above said +definitions) were asked to come for the ultrasound scan +and blood tests. Those who satisfied the Rotterdam’s +criteria for PCOS were then randomly assigned to two +groups using a computer‑generated random number table +by the pre labeled sealed envelope method. Based on +random number table, participants were assigned to two +interventions. Anthropometric measurements (BMI, waist +and hip circumference), details of menstrual frequency +and anxiety levels were documented. +Two different halls in the college premises were allotted +for yoga and control group practices. Both groups practiced +their respective set of practices, 1 h 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 min) followed by physical practices (40 min), +pranayama (5 min) and relaxation (10 min). The instructors +maintained the register of daily attendance and the reason +for absence if any. +International Journal of Yoga  Vol. 5  Jul-Dec-2012 +114 +Nidhi, et al.: Effect of yoga on anxiety in adolescents with PCOS: RCT +Blinding and masking +Double blinding was not possible as this was an +interventional study. The medical officer, ultrasonologist +and the laboratory staff were blind to the groups. Also +the statistician 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 on ovaries was carried out by a certified +postgraduate medical ultrasonologist using Philips HD +11XE ultrasound system. Vaginal ultrasound scanning was +not acceptable to the girls or the parents. +Fasting sample of venous blood (10 ml) was analyzed at +certified laboratories. +Hormone estimates including total testosterone (TT) +and prolactin (PRL) were done by fully automated +bidirectionally interfaced chemiluminescent immunoassay. +Thyroid stimulating hormone (TSH) was measured by ultra +sensitive sandwich chemiluminescent immunoassay. The +intra‑ and inter‑assay coefficients of variation were 4.0 and +5.6% for testosterone. +The state‑trait anxiety inventory (STAI) is the most widely +used, cross‑cultural anxiety measure. It was originally +developed as a research instrument to investigate anxiety +in normal adults and has also been successfully used to +measure anxiety in junior and senior high school students. +The STAI is comprised of separate self‑report scales for +measuring two distinct anxiety concepts: It consists +of 2  forms (Y1 and Y2) each comprising of 20  items +rated on a 4 point scale.[20] +Form Y1 assesses state anxiety, defined as ‘a transitory +emotional state that varies in intensity, fluctuates over +time and is characterized by feelings of tension and +apprehension and by heightened activity of the autonomic +nervous system’. It evaluates how the respondents +feel right now at this moment. Form Y2 evaluates +trait anxiety, which is ‘a relatively stable individual +predisposition  to  respond to situations perceived as +threatening’. +The overall median alpha co‑efficient is 0.92 and the +tool has adequate concurrent, convergent, divergent and +construct validity.[20] +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 +technique used in the two modules. +Yoga intervention +The concepts for the intervention were taken from +traditional yoga scriptures (Patanjali yoga sutras, +Upanishads and Yoga Vasishtha) that highlight a holistic +approach to health management.[21] The practices +consisted of asanas (yoga postures), pranayama, relaxation +techniques, meditation, and lectures on yogic lifestyle +and stress management through yogic counseling. All +girls received at least one session (about 1 h each) of +individualized counseling that was aimed at cognitive +restructuring 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, non‑yogic safe breathing exercises followed +by supine rest (without instructions) that were matched +with the yoga module. One session of counseling was +ensured for the students in the control group also. Care +was taken by the counselors not to introduce any of the +yogic concepts during these sessions [Table 1]. +Data analysis +All statistical analyses were performed using SPSS +version 17.0. Kolmogorov–Smirnov test was used to check +for normal distribution. As our objective was to compare +the changes after yoga with that of exercise and the data +was not normally distributed, non‑parametric analysis was +done by using Mann‑Whitney U test to compare difference +scores (delta 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 for clinical examination, 154 girls +with oligomenorrhea and/or hirsutism (as per the above +said definitions) were asked to come for ultrasound and +hormonal investigations. After the laboratory evaluations, +90 girls who satisfied Rotterdam criteria of PCOS were +randomized into two groups. Of these, there were total +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 withdrawal were (a) sick leave +and (b) unexpected events in the family. The final analysis +was done on 72 participants, 37 in the yoga group and 35 +in the control group. +115 +International Journal of Yoga  Vol. 5  Jul-Dec-2012 +Nidhi, et al.: Effect of yoga on anxiety in adolescents with PCOS: RCT +Table  2 shows the demographic data. Of the 90  girls +recruited, 82.2% (74/90) were of normal weight (BMI=18.5 +to 23) and only 17.78% (16/90) were overweight (BMI> +23) and 31.11% (28/90) had mFG score ≥6. Maximum +66.67% (60/90) numbers of the girls had their menstrual +cycle length between 60 and 90 days. +Mann‑Whitney U test on difference score showed that +the changes in state anxiety after the intervention were +non‑significantly different between the two groups +(P=0.243), although yoga group (‑12.27) observed a greater +reduction than the exercise group (‑8.55) [Table 3, Figure 2]. + + + + + + + + + +([HUFLVH +23 +37 +5 +34 +9 +mFG score +No. of girls with mFG score <6 +No. of girls with mFG score ≥6 +4.60 ± 2.02 +30 +15 +4.20 ± 2.13 +32 +13 +Menstrual frequency in months +(mean±S.D) +1.41 ± 0.8 +1.47 ± 0.87 +No. of girls with cycle length of +45 to <60 days +No. of girls with cycle length of +60 to <90 days +No. of girls with cycle length of +≥90 days +9 +14 +19 +9 +16 +18 +Mann‑Whitney U test on difference scores of trait +anxiety showed that changes after the intervention were +significantly different between the two groups (P=0.002; +Figure 3) with yoga group (‑14.97) observing a higher +reduction than the exercise group (‑7.42). +DISCUSSION +This is the first randomized controlled trial comparing +the effect of a holistic yoga program with physical +exercise on state and trait anxiety in adolescents with +PCOS. +International Journal of Yoga  Vol. 5  Jul-Dec-2012 +116 +Nidhi, et al.: Effect of yoga on anxiety in adolescents with PCOS: RCT +Present study observed higher values for state and trait +anxiety as compared to Spielberger‘s[20] normative data on +377 high school juniors (190 males, 187 females) at Long +Beach, New York, Senior High School. These normal female +students had a mean±SD of 37.57±11.76 with an α of +0.92 for A‑state while in the present study mean±SD was +55.67±10.85. The mean±SD for A‑trait was 41.61±11.29 +with an α 0.92 while in the present study mean±SD was +58.00±8.09. +The baseline scores in our study were higher than healthy +Indian girls who had A‑trait score of 22.5±5.6 (our PCOS +girls=41.61±11.29) as reported by Deb et al.,[22] in their +study on 240 healthy adolescent girls from Kolkata city, +West Bengal, India. +The values reported by Spielberg et al. and Deb et al. are +from normal high school girls, whereas the data presented +by this study are girls from the same age group with PCOS +and hence have higher anxiety levels. +The changes in trait anxiety were significantly different +between the two groups after 12 weeks of intervention and +5 days of detraining, wherein yoga group (−14.97) observed +a higher reduction than the exercise group (−7.42). +The results observed in this study may have occurred +because of the calmness of mind achieved after the yoga +practice. There are evidences proving efficacy of yoga +in reducing stress arousal by modulating sympathetic +nerve activity[23] and reducing anxiety levels.[24] Also, the +mental silence facilitates greater awareness by altering +the individual’s cognitive appraisal and perceived +self‑efficacy with regard to stressors and thus reduces +anxiety symptoms.[25] The cognitive‑behavioral effects are +thought to result from the yogic practitioner’s increased +awareness of how thoughts and emotions arise in response +to various environmental events, thereby allowing them to +achieve more clear perception, reduced negative emotions, +and improved vitality and coping.[26] +Yoga not only reduces trait anxiety in adolescents with +PCOS but also may prevent the long‑term sequelae such as +CVD, diabetes etc. Further, yoga as a self corrective therapy +is potentially more cost‑effective and enduring. Hence we +recommend yoga as both a primary intervention and/or as +adjunct to standard medical care. +This study was performed on a captive adolescent +population with a highly selective age group, which raises +the question of generalizability of the conclusions of this +study. However, the fact that this was a randomized control +trial with a large sample participating in each arm provides +evidence for this intervention being effective. +CONCLUSION +Twelve weeks of a holistic yoga program in adolescents +with PCOS is significantly better than physical exercise +program in reducing anxiety symptoms. Thus, we +recommend yoga to be incorporated as complimentary in +management of adolescents with PCOS as this may help +in reducing the progression of the disease. +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 co‑operation of the staff and administration of Sri +Sai College in recruiting the students and carrying out the study. +Ethical approval +The study was approved by the Institutional Ethical Committee +of Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA) +University (vide project # SVYASA0012/08). +REFERENCES +1. +Chen X, Yang D, Mo Y, Li L, Chen Y, Huang Y. Prevalence of polycystic +ovary syndrome in unselected women from southern China. Eur J Obstet +Table 3: Changes in state and trait anxiety post intervention +Variable +Yoga (n=37) +Exercise (n=35) +Mann-Whitney +on diff score +(sig.) +Pre +(mean±SD) +Post +(mean±SD) +Diff score +(mean±SD) +Pre +(mean±SD) +Post +(mean±SD) +Diff score +(mean±SD) +State +57.79±10.46 +45.52±7.82 +12.27±14.33 +53.55±10.98 +45.00±7.19 +8.55±12.56 +0.243 +Trait +61.36±7.02 +46.39±7.28 +14.97±9.87 +54.64±7.77 +47.21±6.99 +7.42±7.57 +0.002 +Figure 3: Trait anxiety +117 +International Journal of Yoga  Vol. 5  Jul-Dec-2012 +Nidhi, et al.: Effect of yoga on anxiety in adolescents with PCOS: RCT +Gynecol Reprod Biol 2008;139:59‑64. +2. +Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and +associates; clinical and biochemical features in young women. Clin Endocrinol +1999;51:779‑86. +3. +Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Prevalence of Polycystic +Ovarian Syndrome in Indian Adolescents. J Pediatr Adolesc Gynecol +2011;24:223‑7. +4. +Paulson J. 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Social anxiety disorder in the primary care setting. J Clin +Psychiatry 2006;67:31‑7. +11. +Stein MB. An epidemiologic perspective on social anxiety disorder. J Clin +Psychiatry 2006;67:3‑8. +12. Mansson M, Holte J, Landin‑Wilhelmsen K, Dahlgren E, Johansson A, +Landon M. Women with polycystic ovary syndrome are often depressed or +anxious‑a case control study. Psychoneuroendocrinology 2008;33:1132‑8. +13. Liao LM, Nesic J, Chadwick PM, Brooke‑Wavell K, Prelevic GM. Exercise +and body image distress in overweight and obese women with polycystic +ovary syndrome: A pilot investigation. Gynecol Endocrinol 2008;24:555‑61. +14. Thomson RL, Buckley JD, Lim SS, Noakes M, Clifton PM, Norman RJ, +et al. Lifestyle management improves quality of life and depression in +overweight and obese women with polycystic ovary syndrome. Fertil Steril +2010;94:1812‑6. +15. Subramanya P, Telles S. Effect of two yoga‑based relaxation techniques +on memory scores and state anxiety. Biopsychosoc Med 2009;3:8. +16. Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression +and anxiety of women. Complement Ther Clin Pract 2009;15:102‑4. +17. Kumarapeli V, Seneviratne RD, Wijeyaratne CN, Yapa R, Dodampahala SH. +A simple screening approach for assessing community prevalence and +phenotype of polycystic ovary syndrome in a semiurban population in +Sri Lanka. Am J Epidemiol 2008;168:321‑8. +18. Franks S, Gharani N, Waterworth D, Batty S, White D, Williamson R, +et  al. The genetic basis of polycystic ovary syndrome. Human +Reproduction. 1997;12:2641‑8. +19. Tang T, Glanville J, Hayden CJ, White D, Barth JH, Balen AH. Combined +lifestyle modification and metformin in obese patients with polycystic ovary +syndrome. A randomized, placebo‑controlled, double‑blind multicentre study. +Hum Reprod 2006;21:80‑9. +20. Spielberger CD, Gorsuch RL, Lushene RD. STAI: Manual for the State‑Trait +Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1970. +21. Nagendra HR, Nagarathna R. Breath‑the bridge‑Breathing Practices. In: R N, +editor. Bangalore, India: Swami Vivekananda Yoga Prakashan; 2004. +22. Deb S, Chatterjee P, Walsh K. Anxiety among high school students in India: +Comparisons across gender, school type, social strata and perceptions of +quality time with parents. Aust J Educ Dev Psychol 2010;10:18-31. +23. Vempati RP, Telles S. Yoga‑based guided relaxation reduces sympathetic +activity judged from baseline levels. Psychol Rep 2002;90:487‑94. +24. Telles S, Gaur V, Balkrishna A. Effect of a yoga practice session and a yoga +theory session on state anxiety.Percept Mot Skill. 2009;109:924-30. +25. Smith JC. Meditation, biofeedback, and the relaxation controversy. +A cognitive‑behavioral perspective. Am Psychol 1986;41:1007‑9. +26. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness‑based +stress reduction and health benefits: A meta‑analysis. J Psychosom Res +2004;57:35‑43. +How to cite this article: Ram N, Padmalatha V, Nagarathna R, +Amritanshu R. Effect of holistic yoga program on anxiety symptoms +in adolescent girls with polycystic ovarian syndrome: A randomized +control trial. Int J Yoga 2012;5:112-7. +Source of Support: 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, Conflict of Interest: 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 +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/Efficacy of a validated yoga protocol on dyslipidemia in diabetes patients NMB-2017 India trial.txt b/subfolder_0/Efficacy of a validated yoga protocol on dyslipidemia in diabetes patients NMB-2017 India trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..ef4982db98ce9037eb9335bd754b92922f260279 --- /dev/null +++ b/subfolder_0/Efficacy of a validated yoga protocol on dyslipidemia in diabetes patients NMB-2017 India trial.txt @@ -0,0 +1,756 @@ +medicines +Article +Efficacy of a Validated Yoga Protocol on Dyslipidemia +in Diabetes Patients: NMB-2017 India Trial +Raghuram Nagarathna 1,*,†, Rahul Tyagi 2,†, Gurkeerat Kaur 2, Vetri Vendan 1, +Ishwara N. Acharya 3, Akshay Anand 2,*, Amit Singh 1 and Hongasandra R. Nagendra 1 +1 +Swami Vivekananda Yoga Research Foundation, Bengaluru 560105, India; vetriyoga@gmail.com (V.V.); +dramits90@gmail.com (A.S.); chancellor@svyasa.edu.in (H.R.N.) +2 +Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and +Research, Chandigarh 160012, India; rahul15tyagi@gmail.com (R.T.); Kaurgurkeerat6@gmail.com (G.K.) +3 +Central Council for Research in Yoga & Naturopathy (CCRYN), Delhi 110058, India; +acharyaishwar@gmail.com +* +Correspondence: rnagaratna@gmail.com (R.N.); akshay1anand@rediffmail.com (A.A.) +† +These authors contribute equally to the article. +Received: 15 August 2019; Accepted: 8 October 2019; Published: 11 October 2019 + + +Abstract: Background: Dyslipidemia is considered a risk factor in Type 2 diabetes mellitus (T2DM) +resulting in cardio-vascular complications. Yoga practices have shown promising results in alleviating +Type 2 Diabetes pathology. Method: In this stratified trial on a Yoga based lifestyle program in +cases with Type 2 diabetes, in the rural and urban population from all zones of India, a total of +17,012 adults (>20 years) of both genders were screened for lipid profile and sugar levels. Those who +satisfied the selection criteria were taught the Diabetes Yoga Protocol (DYP) for three months and +the data were analyzed. Results: Among those with Diabetes, 29.1% had elevated total cholesterol +(TC > 200 mg/dL) levels that were higher in urban (69%) than rural (31%) Diabetes patients. There was +a positive correlation (p = 0.048) between HbA1c and total cholesterol levels. DYP intervention +helped in reducing TC from 232.34 ± 31.48 mg/dL to 189.38 ± 40.23 mg/dL with significant pre post +difference (p < 0.001). Conversion rate from high TC (>200 mg/dL) to normal TC (<200 mg/dL) was +observed in 60.3% of cases with Type 2 Diabetes Mellitus (T2DM); from high LDL (>130 mg/dL) to +normal LDL (<130 mg/dL) in 73.7%; from high triglyceride (>200 mg/dL) to normal triglyceride level +(<200 mg/dL) in 63%; from low HDL (<45 mg/dL) to normal HDL (>45 mg/dL) in 43.7% of T2DM +patients after three months of DYP. Conclusions: A Yoga lifestyle program designed specifically to +manage Diabetes helps in reducing the co-morbidity of dyslipidemia in cases of patients with T2DM. +Keywords: diabetic yoga protocol; DYP; dyslipidemia; T2DM; diabetes mellitus +1. Introduction +1.1. Prevalence, Burden of Type 2 Diabetes Mellitus and Dyslipidemia +Type 2 diabetes mellitus (T2DM) is a chronic hyperglycemic metabolic disorder that occurs due +to a complex interaction of several prevailing lifestyle factors including diet, obesity, and physical +inactivity against a background of genetic and epigenetic factors [1]. These contribute to insulin +resistance and relative insulin deficiency over time [2], resulting in complications such as cataracts, +retinopathy, neuropathy, and nephropathy [3]. +Recent worldwide findings show that the prevalence of Diabetes in adults in developing countries +when compared to developed countries has increased from 4.3% to 9.0% in men and 5.0% to 7.9% in +women in the last 35 years [4]. In India, it has been estimated that around 66.8 million people have +diabetes [5]. As expected, not until very recently was the prevalence in the rural population known. +Medicines 2019, 6, 100; doi:10.3390/medicines6040100 +www.mdpi.com/journal/medicines +Medicines 2019, 6, 100 +2 of 11 +A recent study of rural dwelling reported that 8.03% of the recruited population from western Uttar +Pradesh was suffering from Diabetes and amongst them 9.91% were females and 6.79% were males [6]. +Interestingly, a study assessed the mean expenditure in the management of T2DM and revealed the +Indian rupee 853.47 to be the estimated average monthly expenses per individual. This expenditure +increases with the duration of the disease and is concomitant with an increase in the complications +associated with it [7]. In light of the increased expenditure on screening, diagnosis, monitoring, +and management of T2DM, the combined health budget of developing countries is affected [5]. +Diabetes and pre-diabetes together affects almost one fourth of the Indian population, which is clearly +traceable to the rapidly changing lifestyle [8,9]. +Hypertension and hyperlipidemia are the most common co-morbidities associated with T2DM. +Both these co-morbidities hasten the occurrence of renal and cardiovascular complications at an alarming +rate [10]. Myocardial infarction remains the most common cause of death in T2DM patients [11,12] as +well as the prime cause of deaths worldwide [10,13]. Briefly, the factors responsible for an increase +in cardio-vascular diseases (CVD) are diabetes, hypertension, abnormal cholesterol and triglyceride +levels, high levels of low density lipoprotein (LDL), low levels of high density lipoprotein (HDL), +and obesity [14]. Murray and Lopez predicted that between 1990–2020, CVD will cause devastating +effects on human health and as expected, the diabetes population with dyslipidemia will be severely +affected [15]. A cross sectional study conducted on 297 Indian subjects reported a direct correlation +between the blood levels of glycated hemoglobin (HbA1c) and total cholesterol, LDL, and triglycerides +besides an inverse relation with HDL levels [16,17]. Furthermore, it was shown that T2DM associated +with decreased HDL and increased production of triglycerides, LDL, and very low lipoproteins (VLDL) +levels is presumably due to impaired catabolism [18]. +1.2. Lifestyle Interventions +Studies continue to reveal that even though T2DM is widely prevalent in India, there is a lack +of access to healthcare, awareness, counseling, and treatments. +Studies have recommended an +improvement in lifestyle for managing all modifiable risk factors for the secondary prevention of +complications in patients with T2DM [19]. +1.3. Why This Yoga Study +In pursuit of better and cost-effective intervention of T2DM, Yoga has emerged as a natural and +widely therapeutic option. Supporting evidence has shown that Yoga can positively impact T2DM +patients by reducing fasting blood glucose (FBG) and HbA1c levels, and helps in improving the +lipid profile and hypertension of T2DM patients [20]. It has been shown that Yoga has re-emerged +as an integrated approach and found to be effective in the prevention and treatment of T2DM and +dyslipidemia to the extent that it reduces overall healthcare costs by reducing future medications +and hospitalizations [21,22]. However, a standardized protocol based on a Yoga lifestyle research is +needed for effective community health translation [23,24]. Therefore, we examined the effect of the +Diabetes Yoga lifestyle protocol on the lipid profile of a large sample population of patients with T2DM +across India. +2. Materials and Methods +2.1. Study Design +This was a stratified translational research study in randomly selected cluster populations from +all zones of rural and urban India. Study was approved by the Institutional Ethics Committee of the +Indian Yoga Association (IYA) vide Res/IEC-IYA/001 dated 16 December 2016. The current study was +registered in the Clinical Trial Registry of India (CTRI) vide CTRI/2018/03/012804. +Medicines 2019, 6, 100 +3 of 11 +2.2. Screening and Recruitment of Participants +The study participants were recruited after obtaining signed informed consent as per the guidelines +outlined by the Institutional Ethical Committee of Indian IYA. Detailed methodology adopted has been +previously reported [25,26]. In brief, baseline assessment was carried out by a nationwide door to door +screening in urban and rural districts under the flagship of the Niyantrita Madhumeha Bh¯ +arat (NMB) +Abhiy¯ +an (Diabetes Control Program), funded by the Ministry of Health and Family Welfare, the ministry +of AYUSH, Government of India, New Delhi, and conducted by IYA. The Diabetes Yoga Protocol (DYP) +was validated by the Quality Council of India. Subjects were recruited based on the Indian Diabetic +Risk Score (IDRS). T2DM individuals and those with a high risk on the Indian diabetes risk score, +detected during screening at the randomly selected clusters of villages (rural) and census enumeration +blocks (urban), were recruited and enrolled. They adopted a three months Yoga lifestyle protocol under +the supervision of a trained Yoga teacher. Subjects adhered to five days a month for three months and +attendance was recorded. Compliance was also ensured by WhatsApp reminders for the Yoga sessions. +2.3. Selection Criteria +All subjects who satisfied the selection criteria and signed the informed consent were included +in the study. Medication to T2DM was not considered to be exclusion criteria. However, detailed +medication records were not available. Known/self-reported/newly detected Diabetics or high risk +subjects of all genders between age ranges of 20–70 were selected for analysis. For newly detected +T2DM, the HbA1c level (6.5%) in high risk (>60 on IDRS) population was considered. Subjects with +other co-morbidities including cancer, serious cardiac illness, chronic liver, pulmonary, neurological, +renal diseases, lower back pain, and surgical interventions were excluded. Willingness to register in +the trial was mandatory for inclusion. +2.4. Assessments +All assessments were carried out at the baseline and after three months of DYP intervention. +2.5. Anthropometric Assessments +Anthropometric assessments included height, weight, waist circumference, and hip circumference +carried out at the time of screening of the subjects and at follow up. +2.6. Biochemical Assessments +Biochemical assessments included fasting blood glucose, glycated hemoglobin (HbA1c), +total cholesterol, triglycerides, LDL, VLDL, and HDL. Assessments were carried out by accredidated +diagnostics lab using standard diagnostic tools and procedures acceptable for public utility. +2.7. Intervention +DYP was designed by the Delphi method and focused group discussion by experts from Yoga +traditions of the Indian Yoga Association and researchers on Diabetes [26]. The practices were taught +by a certified Yoga instructor volunteers in nine day camps (2 h daily) in their respective villages or +wards. Subsequently, they were asked to continue the practices daily (one hour) at home, through +the use of DVDs. Weekly follow up classes were conducted at the same venues for three months. +The detailed methodology is provided in Supplementary Table S1. +2.8. Statistical Analysis +The statistical analysis was carried out using SPSS 21.0 software (IBM Corp., Armonk, NY, USA). +The normality was tested by using the Kolmogorov–Smirnov test. The comparisons were made by +using paired samples t-test for normally distributed data. Significance level of various proportions +Medicines 2019, 6, 100 +4 of 11 +were analyzed by the Chi square test. McNemar’s test was performed to assess the conversion. p value +< 0.05 was considered to test the level of significance. +3. Results +In this nationwide study, a total of 17,012 participants with high risk on the IDRS (>60) and +known Diabetes were recruited. Out of the total, 5150 had HbA1c > 6.5%. Data was collected at +two time points (i.e., before and after the Yoga intervention). Out of the 5150 T2DM patients with +HbA1c >6.5%, 1745 individuals were found to have serum total cholesterol (TC) level > 200 mg/dL +(borderline and hypercholesterolemia range). Post data on cholesterol values were available for +analysis in 694 individuals after three months of a Yoga lifestyle regime. In the absence of medication +details, the comparisons were carried between ≥200 and <200 cases with T2DM. Detailed study profile +has been provided in Figure 1. +Medicines 2019, 6, x FOR PEER REVIEW +4 of 11 + +3. Results +In this nationwide study, a total of 17,012 participants with high risk on the IDRS (>60) and +known Diabetes were recruited. Out of the total, 5150 had HbA1c > 6.5%. Data was collected at two +time points (i.e., before and after the Yoga intervention). Out of the 5150 T2DM patients with HbA1c +>6.5%, 1745 individuals were found to have serum total cholesterol (TC) level > 200 mg/dL (borderline +and hypercholesterolemia range). Post data on cholesterol values were available for analysis in 694 +individuals after three months of a Yoga lifestyle regime. In the absence of medication details, the +comparisons were carried between ≥200 and <200 cases with T2DM. Detailed study profile has been +provided in Figure 1. + + +Figure 1. Study profile. +3.1. Effect of Diabetes Yoga Protocol on Diabetes Population with Dyslipidemia +The DYP reduced the TC levels in 4% of T2DM patients with TC > 200 mg/dL; TC reduced +significantly (p ≤ 0.001; t = 22.93) from 232.34 ± 31.48 (pre yoga intervention) to 189.38 ± 40.23 (post +yoga intervention). Other variables of lipid profile including triglycerides (Tg), LDL, and VLDL were +also found to be significantly reduced after Yoga intervention. Interestingly, the HDL increased +significantly in those with low (<45 mg/dL) baseline values and decreased significantly in those with +high (>45 mg/dL) baseline values (Table 1). Total cholesterol reduced significantly in all age groups. +Figure 1. Study profile. +3.1. Effect of Diabetes Yoga Protocol on Diabetes Population with Dyslipidemia +The DYP reduced the TC levels in 4% of T2DM patients with TC > 200 mg/dL; TC reduced +significantly (p ≤0.001; t = 22.93) from 232.34 ± 31.48 (pre yoga intervention) to 189.38 ± 40.23 (post +yoga intervention). Other variables of lipid profile including triglycerides (Tg), LDL, and VLDL +were also found to be significantly reduced after Yoga intervention. Interestingly, the HDL increased +significantly in those with low (<45 mg/dL) baseline values and decreased significantly in those with +high (>45 mg/dL) baseline values (Table 1). Total cholesterol reduced significantly in all age groups. +Medicines 2019, 6, 100 +5 of 11 +Table 1. Pre post changes in lipids in those with high Total Cholesterol in type 2 diabetes patients in different age groups. +MBG +TC +Tg +LDL +VLDL +HDL +<45 mg/dL +HDL +>45 mg/dL +Cho:HDL +Ratio +LDL:HDL +Ratio +Mean (SD) +Mean (SD) +Mean (SD) +Mean (SD) +Mean (SD) +Mean (SD) +Mean (SD) +Mean (SD) +Mean (SD) +Overall +pre +152.3 (64.3) +239.4 (31.6) +201.0 (117.5) +142.0 (31.3) +35.7 (15.0) +34.9 (4.92) +55.1 (13.5) +4.66 (1.35) +2.91 (1.21) +post +142.8 (52.7) +189.8 (40.5) +173.6 (98.8) +108.4 (34.9) +30.9 (14.9) +44.2 (12.0) +49.1 (11.8) +4.03 (1.24) +2.26 (0.94) +20–30 years +pre +143.87 +(51.05) +230.35 +(27.04) +204.90 +(109.25) +140.03 +(28.33) +35.95 (15.37) +42.7 (10.7) +61.0 (17.3) +4.55 (1.44) +2.80 (1.07) +post +137.02 +(50.06) +175.57 +(48.42) +161.68 +(74.36) +98.44 (40.75) +31.65 (15.02) +49.1 (15.5) +50.3 (10.1) +3.73 (1.23) +2.03 (0.93) +31–40 years +pre +147.41 +(58.54) +229.66 +(29.48) +189.97 +(98.71) +141.61 +(31.29) +36.37 (15.56) +38.6 (4.48) +58.7 (14.1) +4.60 (1.31) +2.89 (1.01) +post +139.68 +(53.35) +189.60 +(40.64) +176.40 +(94.97) +107.72 +(36.06) +33.07 (15.60) +46.1 (10.4) +47.9 (10.8) +4.18 (1.36) +2.36 (1.00) +41–50 years +pre +150.18 +(62.72) +232.28 +(29.28) +207.05 +(124.08) +139.40 +(29.82) +36.54 (16.17) +39.9 (4.44) +57.4 (11.6) +4.67 (1.28) +2.87 (1.03) +post +140.64 +(50.94) +185.62 +(40.46) +163.86 +(89.86) +105.81 +(34.39) +30.77 (13.70) +45.3 (11.1) +51.4 (12.5) +3.98 (1.24) +2.22 (0.90) +51–60 years +pre +151.55 +(57.77) +231.95 +(28.19) +204.57 +(120.29) +140.07 +(27.82) +36.38 (15.53) +38.1 (5.64) +61.2 (18.5) +4.66 (1.48) +2.92 (1.39) +post +139.17 +(52.35) +189.24 +(38.78) +168.79 +(96.36) +106.40 +(32.93) +30.59 (13.13) +45.9 (11.3) +50.7 (12.0) +3.99 (1.15) +2.24 (0.94) +>60 years +pre +145.31 +(59.76) +230.49 +(26.58) +199.30 +(113.65) +140.39 +(29.50) +35.40 (15.03) +37.6 (6.3) +59.0 (13.8) +4.77 (1.26) +3.03 (1.45) +post +138.32 +(46.60) +182.81 +(37.36) +169.85 +(96.50) +103.92 +(33.32) +32.01 (15.88) +47.5 (14.4) +46.9 (11.3) +4.11 (1.23) +2.33 (0.93) +Medicines 2019, 6, 100 +6 of 11 +3.2. DYP Is Beneficial for TC in Diabetes of All HbA1c Categories in Both Genders of Urban and Rural +Population +3.2.1. Dyslipidemia Higher in Rural Population +Total cholesterol values were >200 mg dL in 29.1%; of these TC was significantly higher in the rural +diabetes population (31%) than their urban counterparts (28%) (Supplementary Table S1). However, +after DYP intervention, the reduction in hyperlipidemia was significantly better (p < 0.001.) in the +rural diabetes population than in urban areas (5% vs. 3%, respectively). +3.2.2. DYP Reduces Dyslipidemia Equally in Both Genders +The percentage of T2DM subjects with TC level >200 mg/dL was less when compared to those +with cholesterol levels <200 mg/dL in both genders. Mean TC level was found to be similar in both the +genders with T2DM (Supplementary Table S1). +3.2.3. Hyperlipidemia Increases with Increasing HbA1c +The data showed that the levels of HbA1c and mean blood glucose levels were found to be +positively correlated (p = 0.048) with the TC levels. This reveals that, with the increase in HbA1c levels, +the percentage of T2DM subjects with cholesterol level > 200 mg/dl increased gradually (Figure 2). +Moreover, after yoga intervention, the cholesterol levels were significantly reduced in all HbA1c +categories (Supplementary Table S1). +Medicines 2019, 6, x FOR PEER REVIEW +6 of 11 + +3.2. DYP Is Beneficial for TC in Diabetes of All HbA1c Categories in Both Genders of Urban and Rural +Population +3.2.1. Dyslipidemia Higher in Rural Population +Total cholesterol values were >200 mg dL in 29.1%; of these TC was significantly higher in the +rural diabetes population (31%) than their urban counterparts (28%) (Supplementary Table S1). +However, after DYP intervention, the reduction in hyperlipidemia was significantly better (p < 0.001.) +in the rural diabetes population than in urban areas (5% vs. 3%, respectively). +3.2.2. DYP Reduces Dyslipidemia equally in Both Genders +The percentage of T2DM subjects with TC level > 200 mg/dL was less when compared to those +with cholesterol levels < 200 mg/dL in both genders. Mean TC level was found to be similar in both +the genders with T2DM (Supplementary Table S1). +3.2.3. Hyperlipidemia Increases with Increasing HbA1c +The data showed that the levels of HbA1c and mean blood glucose levels were found to be +positively correlated (p = 0.048) with the TC levels. This reveals that, with the increase in HbA1c +levels, the percentage of T2DM subjects with cholesterol level > 200 mg/dl increased gradually (Figure +2). Moreover, after yoga intervention, the cholesterol levels were significantly reduced in all HbA1c +categories (Supplementary Table S1). + +Figure 2. Relationship of HbA1c and hyperlipidemia. +3.2.4. Effect of DYP on the Conversion of Hyperlipidemia in Diabetes Patients (Table 2) +A highly significant percentage of patients with Diabetes who had abnormal lipid levels were +converted to normal levels after three months of yoga practice: 60.3% in total cholesterol, 73.7% in +LDL, 63% in triglycerides, and 43% in those with low HDL (45 mg/dL). +Figure 2. Relationship of HbA1c and hyperlipidemia. +3.2.4. Effect of DYP on the Conversion of Hyperlipidemia in Diabetes Patients +A highly significant percentage of patients with Diabetes who had abnormal lipid levels were +converted to normal levels after three months of yoga practice: 60.3% in total cholesterol, 73.7% in +LDL, 63% in triglycerides, and 43% in those with low HDL (45 mg/dL) (Table 2). +Medicines 2019, 6, 100 +7 of 11 +Table 2. Shift in those with high lipid levels after yoga in diabetes patients. +Pre +Post +Sig * +DM (A1c > 6.5%) +Above Normal Range +Below Normal Range +Variable +N +n +% +n +% +p +TC > 200 mg/dL +642 +242 +37.7 +400 +60.3 +<0.001 +LDL >130 mg/dL +392 +103 +26.3 +289 +73.7 +<0.001 +Tg > 200 mg/dL +433 +160 +37.0 +273 +63.0 +<0.001 +HDL < 45 mg/dL +835 +470 +56.3 +365 +43.7 +<0.001 +* McNemar’s test: p ≤0.001. +4. Discussion +4.1. Summary +We assessed the effect of a validated yoga lifestyle protocol on the lipid profile of 5150 patients with +T2DM. There was a positive correlation between cholesterol with HbA1c values. A higher proportion +of rural subjects, diabetic females with high A1c, and urban patients with high A1c were found to have +higher cholesterol levels at the baseline, indicating vulnerability to serious complications. +Exposure to DYP resulted in a significant reduction in total cholesterol, LDL, VLDL, and triglyceride +levels. However, HDL was the least affected in the rural region. DYP reduced the cholesterol levels, +better in males than females; and DYP was equally beneficial in all age groups in both the urban and +rural population in different ranges of HbA1c levels. +4.2. Comparisons +Prior to the current study, Shantakumari et al. evaluated the impact of three months Yoga +intervention on the dyslipidemic profile in 100 T2DM subjects and found similar findings [27]. +However, the sample size (n-100) was smaller and represented only a south Indian population whereas +the current pan-India study had a large sample size (5150) using a validated common yoga protocol. +The outcomes of this DYP study showed an improvement in overall lipid profile (i.e., decrease in +total cholesterol, triglycerides and LDL levels) among the T2DM subjects. Similarly, Mohammed +et al. reported reduced total cholesterol, triglycerides, and LDL cholesterol in 158 Yoga practicing +Type 2 Diabetes and dyslipidemia patients in comparison to the sulphonyl urea treatment group; +the mean TC of 240.36 mg/dL (High) was reduced to 214.11 mg/dL (borderline) after four months +of yoga intervention with a 10% reduction [28]. However, in our study, DYP intervention helped +hyperlipidemia subjects to attain normal levels (189.38 mg/dl) of cholesterol from the baseline levels +of 232.34 mg/dL with an 18% reduction. A recent systemic review of controlled Yoga trials on adult +Diabetics recommended additional high quality studies due to methodological limitations in previous +studies [29]. A recent meta-analysis reporting significant improvements in the lipid profile remained +limited to non DYP protocols [30], highlighting the importance of validated protocols to further our +deeper mechanistic understanding while retaining the reproducibility. Therefore, a specific Diabetes +Yoga Protocol was employed in this nationwide study focused on T2DM patients of all age groups +across India. We found a positive correlation (p < 0.05) between increasing levels of HbA1c and TC +(Figure 2). Earlier studies have also shown similar results with high HbA1c as an important predictor +of high serum lipid levels in T2DM subjects [17,31,32], warranting glycemic control as an important +factor needed to control dyslipidemia and prevent major cardiovascular events [33]. +4.3. Mechanism of action of Yoga +Yoga mediated reduction in the dyslipidemia has yet not been explored to the current scale in the +Diabetic subjects. We describe the underlying mechanism based on existing studies. Mechanistically, +Medicines 2019, 6, 100 +8 of 11 +insulin resistant cells inhibit lipase activity, the enzyme that catabolizes the lipids resulting in increased +triglycerides, LDL, and cholesterol levels in the body [32]. In addition, the accumulation of lipids +increases the risk of other co-morbidities like atherosclerosis, cardiovascular, and coronary artery +diseases. Dyslipidemia also causes endothelial damage, which results in the loss of physiological +vasomotor activity [34]. Furthermore, factors like dyslipidemia also contribute to increased blood +pressure [35], which leads to the activation of the RAAS pathway where the aldosterone hormone is +secreted due to over activation of the HPA axis in T2DM subjects [36]. Available evidence shows that +Diabetes neuropathy affects the longest fiber of the parasympathetic system, leading to sympathetic +imbalance, thus leading to hypertension [37]. However, the existing evidence also indicates that there +is a persistent increase in the HPA (hypothalamus pituitary adrenal) axis activity in Diabetic patients +with Diabetes neuropathy [38]. A number of studies depict that there is mitochondrial dysfunction and +decreased activity of mitochondrial enzymes in T2DM subjects due to insulin resistance. Measurement +of oxidative phosphorylation in vivo by P-NMR has also shown impaired ATP synthesis in insulin +resistant subjects [39]. Furthermore, PPARδ (peroxisome proliferate activator receptor) is a lipid +activated nuclear factor that has an important role in the regulation of glucose, lipid, and lipoprotein +metabolism. Pre-clinical evidence has shown that PPAR can reduce or prevent obesity induced insulin +resistance and T2DM [40]. Moreover, PPAR agonists are believed to be potent activators of lipid +metabolism, thus explaining its beneficial actions on insulin sensitivity and adiposity [41]. Regardless +of this pharmacological context, it has also been described that Yoga improves the lipid profile in +T2DM subjects by increasing hepatic lipase and pancreatic lipase activity [27,42]. It has also been +described that Yoga helps to maintain a balance between sympathetic and parasympathetic balance [43]. +Specifically, the Pranayama practices (as part of most of Yoga protocols), also included in the DYP, +are believed to decrease the blood sugar level by increasing the utilization and mechanism of glucose +in liver adipose tissue and peripheral organs [44]. Blood supply to muscles is also improved with +Pranayama, which enhances the insulin receptor expression in muscles and increases the glucose uptake +by cells, thus reducing the blood sugar levels [45]. We argue that asanas included in the DYP may +improve the accessibility of various enzymes to target and stimulate their substrates. This might +contribute toward the reduction of LDL and TG. +4.4. Limitations +The study duration was one of the limitations as the analysis could not extend beyond three +months. Yet, the drop offrate in the study could be ascribed to challenges in adopting a Yoga lifestyle, +general laziness, inability to perform Yoga due to health limitations, and relative interest in other forms +of physical exercises. In certain places, climatic and political conditions also led to drop outs. +4.5. Strengths +One of the strengths of this study was the inclusion of a large sample size and the use of a validated +Diabetes Yoga Protocol. Longitudinal studies may examine the long term effects of DYP. +5. Conclusions +DYP significantly attenuated the hyperlipidemic state of T2DM patients. The potential of DYP +to halt the conversion of hyperlipidemic into CVD among Diabetics can be probed by a longitudinal +intervention study. There is not only a need to understand the mechanism governing the effects of DYP, +but also in scaling it into a public intervention national program. Although the available evidence +proves the significance of the beneficial impact of Yoga on the cholesterol levels, Tg, LDL, and VLDL, +a standardized approach may further alleviate the fatal consequences of Diabetes. This may reduce +vulnerability to heart diseases. +Supplementary Materials: The following are available online at http://www.mdpi.com/2305-6320/6/4/100/s1, +Table S1: Effect of Yoga intervention on the lipid profile in different ranges of HbA1c in urban and rural subjects. +Medicines 2019, 6, 100 +9 of 11 +Author Contributions: R.N. and H.R.N. Conceptualization, R.N., V.V. and I.N.A. Data Curation and acquisition, +Funding Acquisition, Supervision R.N. and A.S. Formal Analysis, Investigation, Methodology, Validation and +Writing—review and editing. R.T. and G.K. Formal Analysis, Writing—Original draft, Writing-review and editing. +A.A. Writing- concept of manuscript and editing. +Funding: This research was funded by Central Council for Research in Yoga and Naturopathy (CCRYN) (Ref F.No. +16-63/2016-17/CCRYN/RES/Y&D/MCT/ Dated: 15.12.2016). +Acknowledgments: We acknowledge the support of the Ministry of Health and Family Welfare and Ministry of +Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa Rigpa and Homoeopathy (AYUSH), Government of India, +New Delhi, and CCRYN for funding this project. We thank the advisory research committee, senior research +fellows Subzar, Sanjay, Radhika, Sunanda Rathi, Yoga volunteers, and the President of Indian Yoga Association for +their contribution to this project. We also thank Kanupriya for her contributions in this manuscript. +Conflicts of Interest: The authors declare no conflict of interest. +Abbreviations +CCRYN +Central Council for Research in Yoga and Naturopathy +CTRI +Clinical Trial Registry of India +CVD +Cardio-vascular diseases +DYP +Diabetes yoga protocol +FBG +Fasting blood glucose +HbA1c +Glycated hemoglobin +HDL +High density lipoprotein +IDRS +Indian Diabetic Risk Score +LDL +Low density lipoprotein +NMB +Niyantrita Madhumeha Bh¯ +arat +T2DM +Type 2 diabetes mellitus +TC +Total Cholesterol +Tg +Triglycerides +VLDL +Very Low Lipoproteins +References +1. +Esser, N.; Legrand-Poels, S.; Piette, J.; Scheen, A.J.; Paquot, N. Inflammation as a link between obesity, +metabolic syndrome and type 2 diabetes. Diabetes Res. Clin. Pract. 2014, 105, 141–150. [CrossRef] [PubMed] +2. +Wu, Y.; Ding, Y.; Tanaka, Y.; Zhang, W. Risk factors contributing to type 2 diabetes and recent advances in the +treatment and prevention. Int. J. Med. 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This article is an open access +article distributed under the terms and conditions of the Creative Commons Attribution +(CC BY) license (http://creativecommons.org/licenses/by/4.0/). diff --git a/subfolder_0/Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.txt b/subfolder_0/Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.txt new file mode 100644 index 0000000000000000000000000000000000000000..61908ed248752d6c71ab165ae40bd4f66a666615 --- /dev/null +++ b/subfolder_0/Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.txt @@ -0,0 +1,1659 @@ +Integrative Cancer Therapies +January-March 2016: 1­ +–13 +© The Author(s) 2016 +Reprints and permissions: +sagepub.com/journalsPermissions.nav +DOI: 10.1177/1534735415624141 +ict.sagepub.com +Creative Commons CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial +3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) 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). +Research Articles +Introduction +Moderators of Mind-Body Interventions +Despite the large number of behavioral intervention studies +for individuals diagnosed with cancer, the overall efficacy of +these treatments in addressing patient symptom burden has +been heavily debated.1-5 Though an estimated 20%-40% of +cancer patients experience depression, the typical cancer +patient enrolled in psychosocial trials tends to be not +depressed.4,6 Thus, the frequently used “all-comers” approach +to patient recruitment may result in negligible treatment gains +for quality of life (QOL) indicators such as depression. In fact, +a recent meta-analysis of 61 trials demonstrated that +624141 ICTXXX10.1177/1534735415624141Ratcliff et alIntegrative Cancer Therapies +research-article2016 +1Center for Innovations in Quality, Effectiveness and Safety, Michael E. +DeBakey VA Medical Center, Houston, TX, USA +2Baylor College of Medicine, Houston, TX, USA +3VA South Central Mental Illness Research, Education, and Clinical +Center, Houston, TX, USA +4The University of Texas MD Anderson Cancer Center, Houston, TX, +USA +5University of Rochester Medical School, Rochester, NY, USA +6Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India +Corresponding Author: +Lorenzo Cohen, Integrative Medicine Program, The University of Texas +MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 460, Houston, +TX 77030, USA. +Email: lcohen@mdanderson.org. +Examining Mediators and +Moderators of Yoga for +Women With Breast +Cancer Undergoing Radiotherapy +Chelsea G. Ratcliff, PhD1,2,3, Kathrin Milbury, PhD4, Kavita D. Chandwani, +MD, MPH, DrPH5, Alejandro Chaoul, PhD4, George Perkins, MD4, Raghuram +Nagarathna, PhD6, Robin Haddad, MPH4, Hongasandra Ramarao Nagendra, PhD6, +N. V. Raghuram, BS6, Amy Spelman, PhD4, Banu Arun, MD4, Qi Wei, MS4, and +Lorenzo Cohen, PhD4 +Abstract +Hypothesis. This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in +women with breast cancer receiving radiotherapy.Methods. Women undergoing 6 weeks of radiotherapy were randomized +to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms +and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol +slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were +assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results. Baseline depressive symptoms + +(P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high +baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). +Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) +and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across +the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic +stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion. Yoga may provide the greatest +mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. +Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience. +Keywords +breast cancer, QOL, yoga, moderation, mediation +Submitted Date: 8 September 2015; Revised Date: 19 November 2015; Acceptance Date: 20 November 2015 + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +2 +Integrative Cancer Therapies  +psychological distress moderated the efficacy of psychosocial +treatments regarding mood management for cancer patients.7 +Furthermore, a meta-analysis of trials targeting depressed +cancer patients indicated that psychotherapeutic and pharma- +cological interventions are effective in reducing depressive +symptoms with sustained effects.8 +Although these meta-analyses have been instrumental in +identifying the importance of examining moderators of treat- +ment efficacy, they have rarely included trials of complemen- +tary medicine interventions such as yoga and meditation. +Such exclusion is surprising in light of the rapid proliferation +of Eastern-influenced behavioral interventions in oncology +research and practice.9-17 Yoga in particular has gained popu- +larity in the cancer setting, and several systematic reviews +and meta-analyses have examined the QOL benefits associ- +ated with cancer patients’ and survivors’ yoga practice.14-17 +For instance, a meta-analysis of 13 randomized controlled +trials (RCTs) of yoga in cancer patients and survivors revealed +large effects for psychological health; medium effects for +fatigue, general QOL, and psychosocial well-being; and +small effects for sleep disturbances and physical function.17 It +is important to note that the reviewed trials did not select for +elevated symptom burden (ie, used an “all-comer” approach). +Thus, yoga may lead to even greater grains in at-risk partici- +pants. However, with the exception of some limited evi- +dence,18 it is largely unknown if patients with elevated +distress derive greater QOL benefit from a yoga intervention +compared with their less-distressed counterparts. +The benefits of yoga are multifaceted, targeting not only +psychological but also physical and spiritual dimensions of +QOL.17 Thus, participant characteristics beyond psycho- +logical distress may moderate the efficacy of a yoga inter- +vention. Sleep disturbances, potentially caused by the +cancer process itself or cancer treatments, are commonly +experienced among women with breast cancer19-21 and are +associated with impaired QOL in cancer patients even when +controlling for depression and fatigue.20,22,23 Because yoga +is an effective treatment to improve sleep in cancer patients +and survivors,9,24,25 it may be particularly efficacious for +patients reporting high levels of sleep disturbances. In fact, +a multicenter RCT involving 410 survivors with moderate +to high sleep disturbances demonstrated that an 8-session +yoga intervention improved self-reported and actigraphy- +assessed sleep relative to standard care.9 However, to the +best of our knowledge, sleep disturbances have not yet been +examined as a yoga intervention moderator. +Mediators of Mind-Body Interventions +In addition to lacking a clear understanding of for whom +mind-body interventions are most helpful, no cohesive the- +oretical framework has been proposed to explain how and +why yoga interventions produce change.26,27 A recent sys- +tematic review reports that few potential mechanisms of +yoga have been explored to date, and no mechanisms of +yoga have been tested in cancer populations.28,29 The excep- +tion is one study on mindfulness-based stress reduction for +cancer patients, which includes some yoga. This study +found that increasing mindfulness partially mediated the +intervention’s beneficial effects on stress and posttraumatic +avoidance.30 However, in light of the growing RCTs exam- +ining yoga in cancer and the limited exploration of media- +tors of this intervention, further examination of yoga +mediators guided by a conceptual model is needed. +We propose a stress response model as a way to under- +stand how yoga produces change in cancer patients. A diag- +nosis of cancer and its treatment are typically experienced +as stressful, or even traumatic, events, and yoga interven- +tions are generally conceptualized within the framework of +a stress reduction program. Thus, practicing yoga may +improve health outcomes in cancer patients via modulating +the stress response.28 Put another way, yoga may affect +posttraumatic stress symptoms, such as cognitive interfer- +ence and avoidance, while also increasing posttraumatic +growth or benefit finding. Importantly, both constructs of +trauma response (ie, posttraumatic stress symptoms and +benefit finding) have been consistently and prospectively +associated with psychological and physical QOL outcomes +in various cancer samples.31-39 +With this model in mind, we previously examined the +effects of yoga versus usual care on intrusive thoughts/ +avoidance behaviors and benefit finding in a small pilot trial +in women with breast cancer undergoing radiotherapy.10 +Differences between groups in benefit finding did not +emerge until the last 3-month assessment time point, pre- +cluding the examination of benefit finding as an interven- +tion mediator. Surprisingly, the yoga group reported +increased intrusive thoughts 1 month after the end of radio- +therapy compared with the women in the usual care group, +with subsequent reduction at the 3-month time point, and +nonsignificant +reductions +in +avoidance +behaviors. +Interestingly, intrusive thoughts at 1 month were positively +associated with benefit finding at 3 months. There is some +evidence to suggest that heightened levels of intrusive +thoughts experienced during the aftermath of a traumatic +event may help individuals more effectively adjust to the +stressor and ultimately to find benefit in the traumatic expe- +rience.40 Thus, the increase in intrusive thoughts associated +with yoga may have led to better, more mindful processing +of the cancer experience, ultimately fostering finding mean- +ing in the cancer experience. +Moreover, within a trauma response model, cortisol +rhythmicity may represent one biological pathway by which +mind-body interventions improve health and well-being. +Both types of trauma response (posttraumatic stress symp- +toms and benefit finding) are associated with hypothalamic- +pituitary-adrenal axis function in cancer patients, which in +turn is associated with behavioral symptoms (eg, fatigue, + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +Ratcliff et al +3 +sleep disturbance, and depression), making changes to cor- +tisol rhythmicity a potential mechanism of yoga.41-44 +Although previous studies have shown group main effects +of a yoga intervention on diurnal cortisol and speculated a +mediating effect, no empirical evidence exists to date.28 +The Present Study +The goal of the current study was to examine moderators +and mediators of a previously reported 3-arm yoga RCT for +women diagnosed with breast cancer undergoing radiother- +apy.45 We focused only on mediators and moderators of the +primary outcome variable: health-related QOL. First, we +hypothesized that, compared with active and waitlist con- +trol groups, the yoga program would be especially benefi- +cial at improving posttreatment QOL for women with +elevated pretreatment depressive symptoms and sleep dis- +turbance. Second, we hypothesized that the beneficial QOL +effects of the intervention would be mediated by improved +trauma responses (ie, short-term increases in intrusive +thoughts and reduction in avoidance behaviors and increased +benefit finding) as well as better stress hormone regulation +(ie, a steeper cortisol slope). +Method +Participants +Women were recruited prior to radiotherapy treatment +(XRT), with inclusion criteria being the following: ≥18 +years old; ability to read, write, and speak English; diag- +nosed with stage 0 to III breast cancer; and scheduled to +undergo daily adjuvant XRT for 6 weeks at MD Anderson +Cancer Center. Patients with lymphedema, metastatic bone +disease, deep-vein thrombosis, documented diagnosis of a +formal thought disorder, and extreme mobility problems or +those who had practiced yoga in the year before diagnosis +were excluded. The protocol was approved by the institu- +tional review board. +Procedures +Details of the study procedures have been reported else- +where.45 Briefly, after receiving written informed consent, +self-report and saliva samples (for cortisol data) were col- +lected from participants at baseline before randomization, +during the last week of XRT, and 1, 3, and 6 months later. +Participants were randomly assigned to 1 of 3 groups: +(1) yoga (YG); (2) stretching control (ST); or waitlist con- +trol (WL) using a form of adaptive randomization,46 accord- +ing to age, stage of disease, time since diagnosis, type of +surgery, and chemotherapy (neoadjuvant or adjuvant). +Participants in the WL group received usual care, completed +all assessments on the same timeline as the active groups, +and were offered yoga classes at the end of their study par- +ticipation. All participants were asked to refrain from par- +ticipating in any other yoga classes while on study. +Participants in the YG and ST groups attended up to three +60-minute classes per week during their 6 weeks of XRT. +Each participant received an audio CD and a written manual +of the program to encourage at-home practice. +The integrated yoga program, described previously,10 +included the following: (1) preparatory warm-up synchro- +nized with breathing; (2) selected postures, or asanas (for- +ward-, backward-, and side-bending asanas in sitting and +standing positions, cobra posture, crocodile, and half- +shoulder-stand with support); (3) deep relaxation (supine +posture); (4) alternate-nostril breathing or pranayama; and +(5) meditation. The program was taught by Vivekananda +Yoga Anusandhana Samsthana–trained teachers with spe- +cific oncology training. +The stretching program included exercises recom- +mended specifically for women undergoing or recovering +from breast cancer treatment.47,48 The exercises approxi- +mated the gross movements of the yoga exercises and were +taught by cancer center physiotherapists. +Measures +Primary Intervention Outcome: Health-Related QOL.  Overall +QOL was assessed by the Medical Outcomes Study 36-item +Short Form survey (SF-36) and was the primary outcome of +the clinical trial published previously.45 The SF-36 assesses +physical functioning, physical impediments to role func- +tioning, bodily pain, general health perceptions, vitality, +social functioning, emotional impediments to role function- +ing, and mental health and includes an overall physical and +mental component scale (PCS and MCS).49,50 To reduce the +number of analyses, only the component scales are included +in outcome analyses. Higher scores reflect better QOL. +Proposed Moderators.  Depressive symptoms were assessed +using the Centers for Epidemiological Studies–Depression +measures (CES-D),51 a well-validated measure focusing on +affective components of depression. Lower scores reflect +fewer depressive symptoms. In this study sample, the inter- +nal reliability was high (Cronbach’s α = .89). +Sleep disturbances were assessed using the Pittsburgh +Sleep Quality Index (PSQI),52 a questionnaire that assesses +sleep disturbances over a 1-month period. We report on the +total score, with lower scores reflecting fewer sleep distur- +bances. Acceptable internal reliability was found in this +study sample (Cronbach’s α = .70). +Proposed Mediators: Posttraumatic Responses.  Posttraumatic +stress symptoms were measured by the Impact of Event +Scale (IES), a scale that assesses the 2 most common catego- +ries of responses to traumatic events: intrusion (intrusively + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +4 +Integrative Cancer Therapies  +experienced ideas, images, feelings, or bad dreams) and +avoidance behaviors (conscious efforts to avoid certain +ideas, feelings, or situations).53 We report on the intrusive +thoughts and avoidance behaviors subscales and the total +score. Lower scores reflect fewer symptoms. Adequate +internal reliability was found for the total scale (Cronbach’s +α = .85) as well as intrusive (Cronbach’s α = .85) and avoid- +ance (Cronbach’s α = .79) subscales. +Participants’ ability to find benefit was measured by the +Benefit Finding Scale (BFS),54,55 a scale assessing accep- +tance of life’s imperfections, change in priorities, and devel- +opment of a sense of purpose in life as a result of having +been diagnosed with cancer. Higher scores reflect greater +benefit finding. In this study sample, the internal reliability +was high (Cronbach’s α = .94). +Cortisol Rhythmicity.  Cortisol was obtained via 5 saliva sam- +ples (waking, 45 minutes later, approximately 8 and 12 +hours after waking, and at bedtime) for 3 consecutive days +at each assessment. Participants chewed on a cotton swab +(Salivette) and placed it in a plastic tube (Sarstedt), which +was then frozen at −80°C for later time-resolved immuno- +assay with fluorescence detection performed at the Univer- +sity of Dresden. Values <0.0001 and >70 nmol/L were +classified as missing. If patients missed a collection point, +they were told to leave the tube empty. Reliability for each +collection time point within a day across the 3 days and the +5 assessment time points ranged from 0.20 to 0.87, with +only 6 out of 25 α values (5 samples a day at 5 time points) +dropping below 0.50. Reliability was directly related to the +sample size, which dropped off by the 6-month follow-up. +A steeper, more-negative cortisol slope indicates better cor- +tisol regulation. +Covariates.  Patients also completed basic demographic +information (eg, age, marital status, education). Medical +information was obtained from electronic medical records. +Data Analyses +Hypothesis 1: To evaluate whether the intervention was +more effective in regard to health-related QOL (SF-36 +MCS and PCS) for participants with high depressive symp- +toms (Hypothesis 1A) or greater sleep disturbance +(Hypothesis 1B) at baseline, we used an ANCOVA frame- +work to first examine the Group × Baseline moderator +effect using PROC MIXED in SAS v9.2. This was fol- +lowed by a Group × Time × Baseline moderator ANCOVA +to see if the moderator effect varied by time. We controlled +for the respective baseline outcome as well as randomiza- +tion factors (age, stage of disease, time since diagnosis, +type of surgery, and chemotherapy type). We also con- +trolled for baseline SF-36 general health scores in all anal- +yses as a result of imbalances across groups. We treated +time as a categorical variable and the intercept as a random +effect. We specified an unstructured covariance structure. +For significant 3-way interactions, we decomposed the +interaction according to high and low (mean ± ½SD) base- +line depressive symptoms or sleep disturbance and com- +pared the least-squared means (LSM) for each group at +each time point using a general linear model analysis, con- +trolling for baseline levels of the outcome variable and +illustrating the interaction by plotting the LSM. +Hypothesis 2: We were interested in determining media- +tors of significant group effects on health-related QOL. The +original trial45 demonstrated group differences in SF-36 +PCS at 1 and 3 months, and a subscale of the SF-36 PCS +(physical functioning) at those time points and 6 months. +We chose to examine mediators of SF-36 PCS at 1, 3, and 6 +months, rather than the physical functioning subscale +because the SF-36 PCS is a more comprehensive index of +physical health–related QOL. +To determine the mediator variables, we regressed each +proposed mediator (ie, IES, BFS, and cortisol slope) on +group, time, and the Group × Time interaction using the +model and covariates described above. Where there was a +group or Group × Time effect on the proposed mediator +variable, we chose the time point associated with the largest +group or Group × Time effect as the mediator. If a proposed +mediator variable did not significantly differ by group, it +was not further examined. Only primary outcome variables +assessed after our chosen mediators were included as +dependent variables in the mediation models to enable a +predictive relationship between the mediator and the depen- +dent variable to be established.56 +To test for mediation, we calculated indirect effects using +Hayes and Preacher’s bias-corrected bootstrap procedure +via the MEDIATE macro for SPSS, which is designed to +estimate indirect effects of multicategorical independent +variables.57 Indicator coding of the grouping variable was +used, with WL functioning as the reference group. D1 codes +the effect of YG compared with WL controlling for ST, and +D2 codes the effect of ST compared with WL controlling +for YG. Indirect effects were determined significant when +the mean of the indirect effect across all 5000 bootstrap +samples was associated with a bias-corrected confidence +interval that did not include 0.57 +Results +Attrition and Adherence +Out of 294 eligible women approached, 191 consented to +participate; 13 dropped out before, and 15 after, randomiza- +tion, for a baseline sample size of 163 (YG = 53; ST = 56; +WL = 54). Measurements were obtained for 80% of the sam- +ple at 6 months (n = 131; YG = 43, ST = 42, WL =46; see +original clinical trial45 for CONSORT). Out of a maximum + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +Ratcliff et al +5 +possible 18 classes, 87% of YG and 85% of ST participants +attended ≥12 classes (YG = 13.8; ST = 14.7). Only 3 patients +in each group attended fewer than half the classes. There +were no significant differences in demographic, medical, or +baseline self-report scores between those who attended +≥75% of classes compared with those who did not. For the +YG group, self-reported practice outside of class was high +(≥twice per week) at 1 month posttreatment and then +declined at 3 and 6 months (71%, 55%, and 45%, respec- +tively). For the ST group, self-reported practice outside of +class (≥twice per week) was lower at 1 month and then +increased somewhat at 3 and 6 months (53%, 69%, and 60%, +respectively). WL participants were offered the YG program +after data collection was complete, but no data were col- +lected from the WL during or after yoga. +There were also no group, demographic, or baseline self- +report differences between those who completed the +6-month follow-up assessment and those who did not (Ps > +.14), with the exception that older adults were more likely +to complete the 6-month assessment. +Baseline Sample Characteristics +The 3 groups were similar on all medical and demographic +variables (Table 1). There were no statistically significant +differences among the groups on any of the self-reported +variables at baseline, apart from the SF-36 general health +subscale. Women in YG reported lower baseline general +health compared with those in ST (P = .01). Depending on +the time point, 21% to 34% of participants did not provide +saliva samples. There were no differences between patients +providing samples and those who did not based on group +assignment, medical, demographic, or outcome measures. +We present the baseline and follow-up means of self- +reported variables in Table 2. +Hypothesis 1: Baseline Depressive Symptoms +and Sleep Disturbance as Moderators of +Intervention Outcomes +There were no significant Group × Baseline Depressive +Symptom (CES-D) interaction effects on mental health– +related QOL (SF-36 MCS). However, there was a signifi- +cant Group × Time × Baseline CES-D interaction effect on +SF-36 MCS (F(6, 324) = 2.40; P < .03), suggesting that the +effect varied by time. We decomposed the interaction +according to high and low (mean ± ½SD) baseline CES-D +scores. There were no statistically significant differences in +SF-36 MCS scores between groups for those with low or +high baseline depressive symptoms at any assessment point +(Figure 1A). However, women with high baseline depres- +sive symptoms in YG had a trend toward higher SF-36 +MCS scores at 3 months compared with WL (P = .107), and +their 1-, 3-, and 6-month SF-36 MCS scores were no differ- +ent from those of women scoring low on baseline depres- +sive symptoms. There were no significant Group × Baseline +CES-D or Group × Time × Baseline CES-D interaction +effects on physical health–related QOL (SF-36 PCS). +There was no significant Group × Baseline sleep distur- +bance (PSQI) interaction effects on mental health–related +QOL (SF-36 MCS). However, there was a significant Group +× Time × Baseline PSQI interaction effect on SF-36 MCS +(F(6, 318) = 3.40, P < .01). We decomposed the interaction +according to high and low (mean ± ½SD) baseline PSQI +scores. There were no significant differences in SF-36 MCS +scores between groups for those with low baseline sleep +disturbances at any assessment point (Figure 1B). However, +among the women with high baseline sleep disturbances, +there was a significant Group × Time effect (F(6, 83) = 3.52; +P = .003). Specifically, women with high sleep disturbances +in YG reported higher 3-month SF-36 MCS scores than +their counterparts in WL (t(83) = 3.15; P = .002) and higher +6-month SF-36 MCS scores than their counterparts in ST +(t(83) = 2.56; P = .012), and their SF-36 MCS scores at each +time point were no different from that of women reporting +low sleep disturbance at baseline. There were no significant +Group × Baseline sleep disturbance (PSQI) or Group × +Time × Sleep disturbance (PSQI) interaction effects on +physical health–related QOL (SF-36 PCS). +Hypothesis 2: Mediators of Intervention Effect +on QOL +Posttraumatic Stress Symptoms.  Results revealed no signifi- +cant Group × Time interaction effect on IES total scale, +intrusive thoughts, or avoidance behaviors subscales scores +(Ps > .5). Additionally, there were no main effects of group +or time on the IES total scale or intrusive thoughts subscale +(Ps > .2). There was a main effect of group (F(2,132) = 3.17; +P = .05), but not time (P = .6), for the IES avoidance sub- +scale. Specifically, YG was associated with greater IES +avoidance scores (LSM = 11.31; SE = 0.82) compared with +WL (LSM = 8.52; SE = 0.76; P = .01). IES avoidance scores +did not differ between ST (LSM = 10.16; SE = 0.79) and +YG or WL (Ps > .1). Figure 2A presents LSMs of IES +avoidance for groups across time. +The time point at which groups differed most on IES +avoidance was at 6 months (F(2, 112) = 3.23; P = .04; Cohen’s + +d = 0.40), with women in YG (LSM = 11.29; SE = 1.18; + +P = .02) and ST (LSM = 10.14; SE = 1.19; P = .09) reporting +greater IES avoidance scores compared with women in WL +(LSM = 7.34; SE = 1.69). Using the 6-month time point for +the mediator does not enable examining a temporal relation- +ship between the mediator and outcome, and there were no +significant group differences at earlier time points, precluding +examination of IES avoidance as an intervention mediator. + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +6 +Integrative Cancer Therapies  +Benefit Finding.  Results revealed no significant Group × +Time interaction effect on BFS scores (P = .9). However, +there was a main effect of group (F(2,132) = 4.60; P = .01) and +a main effect of time (F(3,335) = 3.12; P = .03) on benefit +finding. Specifically, YG was associated with greater bene- +fit finding (LSM = 46.21; SE = 1.28) compared with ST +(LSM = 42.24; SE = 1.23; P = .03) and WL (LSM = 41.05; +SE = 1.19; P < .01). Benefit finding did not differ between +ST and WL (P = .5). Figure 2B presents LSMs of benefit +finding for groups across time. +Women in YG reported higher levels on benefit finding +relative to WL at 1, 3, and 6 months and relative to ST at 3 +and 6 months (Ps < .05), with no differences between ST +and WL. Groups differed most on benefit finding at 3 +months (F(2, 103) = 3.12; P = .05; Cohen’s d = 0.38), with +women in YG reporting greater benefit finding scores (LSM += 46.32; SE = 1.85) compared with ST (LSM = 40.90; SE = +1.78; P = .04) and WL (LSM = 40.57; SE = 1.69; P = .02). +Therefore, 3-month benefit finding was examined as a +mediator of group’s effects on physical health–related QOL +Table 1.  Baseline Characteristics of Study Participants, by Group. +Yoga +Stretch +Waitlist +  +n = 53 (33%) +n = 56 (34%) +n = 54 (33%) +Disease stage, n (%) +  0 +5 +10 +6 +11 +7 +13 +  I +16 +30 +18 +32 +17 +31 +  II +15 +28 +14 +25 +15 +28 +  III +17 +32 +18 +32 +15 +28 +ER/PR status (n = 156), n (%) +  ER+/PR+ +32 +62 +33 +62 +31 +61 +  ER+/PR− +7 +13 +7 +13 +6 +12 +  ER−/PR+ +1 +2 +0 +0 +3 +6 +  ER−/PR− +12 +23 +13 +25 +11 +21 +Surgery, n (%) +  Mastectomy (without reconstruction) +12 +23 +17 +31 +12 +22 +  Mastectomy (with reconstruction) +6 +11 +3 +5 +5 +9 +  Breast conserving +35 +66 +36 +64 +37 +69 +Chemotherapy, n (%) +  Yes +36 +68 +34 +61 +34 +63 +Hormone treatment (n = 156), n (%) +  Yes +33 +62 +38 +70 +34 +67 +Marital status (n = 151), n (%) +  Married and living together +31 +67 +37 +71 +34 +64 +  Not cohabiting +15 +33 +15 +29 +19 +36 +Ethnicity (n = 150), n (%) +  Black/African American +9 +19 +9 +17 +7 +13 +  White/Caucasian +32 +68 +28 +55 +37 +71 +  Latino/Hispanic/Mexican +4 +9 +8 +16 +5 +10 +  Asian/Oriental/Pacific Islander +2 +4 +4 +8 +1 +2 +  Other +0 +0 +2 +4 +2 +4 +Employment status (n = 140), n (%) +  Employed part-/full-time +15 +33 +21 +43 +18 +39 +  Employed, taken time off +11 +25 +10 +20 +5 +11 +  Not employed +19 +42 +18 +37 +23 +50 +Education (n = 152), n (%) +  Some college or lower +27 +57 +26 +50 +32 +60 +  College and higher education +20 +43 +26 +50 +21 +40 +Income (n = 149), n (%) +  >$75 000 +31 +67 +26 +51 +26 +50 +  <$75 000 +15 +33 +25 +49 +26 +50 +Age (mean, SE) +52.38 +1.35 +51.14 +1.32 +52.11 +1.34 +Abbreviations: ER = Estrogen receptor; PR = Progesterone receptor + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +Ratcliff et al +7 +Table 2.  Raw Means and SDs of Measures at Baseline and Follow-up.a +Yoga +Stretch +Waitlist +  +Mean +SD +Mean +SD +Mean +SD +Primary outcome +variables +SF-36 PCS +  Baseline +41.9 +9.6 +43.4 +8.6 +44.5 +9.4 +  Post-XRT +42.3 +9.2 +44.5 +8.1 +44.1 +8.4 +  1 Month +47.0* +8.1 +46.9 +9.1 +45.4** +7.6 +  3 Months +48.2* +7.3 +47.6 +8.8 +45.8** +7.8 +  6 Months +46.9b +9.3 +47.5 +8.6 +46.6 +7.5 +SF-36 MCS +  Baseline +42.1 +12.4 +45.6 +10.3 +42.2 +12.9 +  Post-XRT +47.2 +13.5 +49.7 +8.9 +46.8 +11.5 +  1 Month +46.2 +13.1 +47.1 +11.2 +49.0 +10.1 +  3 Months +46.5 +12.6 +49.8 +10.2 +46.9 +12.2 +  6 Months +46.8 +12.7 +50.8 +9.5 +48.8 +9.9 +Moderator variables +CES-D +  Baseline +15.5 +10.5 +11.9 +5.9 +14.9 +10.2 +  Post-XRT +12.2 +9.7 +10.3 +7.5 +12.4 +9.6 +  1 Month +13.1 +10.7 +11.6 +9.6 +12.3 +8.3 +  3 Months +13.9 +10.8 +9.6 +8.8 +12.9 +10.5 +  6 Months +13.9 +11.8 +10.4 +9.3 +11.5 +9.0 +PSQI +  Baseline +8.3 +3.9 +8.5 +4.0 +8.2 +3.7 +  Post-XRT +6.7 +3.1 +8.3 +4.0 +7.3 +3.7 +  1 Month +7 +3.8 +7.5 +4.2 +5.9 +3.6 +  3 Months +6.5 +3.1 +7.2 +3.3 +6.5 +3.8 +  6 Months +7 +3.5 +7.2 +3.9 +6.4 +4.1 +Mediator variables +IES total +  Baseline +22 +15.2 +20.1 +13.3 +20.4 +13.3 +  Post-XRT +17.3 +13.9 +17.8 +15 +15.8 +12.1 +  1 Month +17.1 +13.5 +16.9 +13 +14.4 +12.1 +  3 Months +18.2 +13 +17.1 +15.7 +15.7 +13.7 +  6 Months +18.7 +16.6 +16.4 +12.8 +11.9 +10.6 +IES intrusive thoughts +  Baseline +10.4 +8.5 +8.9 +7.3 +8.7 +7.6 +  Post-XRT +6.5 +6.3 +7.5 +7.2 +6.8 +6.4 +  1 Month +5.8 +6.5 +6.9 +6.4 +5.8 +6.5 +  3 Months +6.9 +6.3 +7.4 +8.7 +5.8 +5.9 +  6 Months +7.2 +8.0 +6.8 +6.3 +4.6 +4.9 +IES avoidance +  Baseline +11.6 +8.7 +11.2 +7.9 +11.8 +8.8 +  Post-XRT +11.1 +8.9 +10.4 +9 +9 +7.6 +  1 Month +11.3 +8.2 +10 +7.9 +8.6 +7.8 +  3 Months +11.3 +8.4 +9.7 +8.7 +9.9 +9.5 +  6 Months +11.6* +10.4 +9.7 +8.4 +7.3** +7.0 +BFS +  Baseline +42.5 +13.4 +44.1 +16 +44.3 +13.8 +  Post-XRT +46.3 +14.1 +45.9 +16.7 +42.9 +15.1 +  1 Month +44.4* +16.1 +43.8 +17.2 +41.6** +13.7 +  3 Months +43.9* +17.7 +42.7** +18.1 +40.8** +16.3 +  6 Months +41.8* +16.9 +42.1** +17.4 +38** +16.4 +Cortisol slope +  Baseline +−0.104 +0.04 +−0.118 +0.04 +−0.113 +0.04 +  Post-XRT +−0.104* +0.04 +−0.084** +0.05 +−0.084** +0.05 +  1 Month +−0.098* +0.04 +−0.090 +0.05 +−0.065** +0.05 +  3 Months +−0.086 +0.06 +−0.091 +0.04 +−0.078 +0.05 +  6 Months +−0.090 +0.06 +−0.095 +0.04 +−0.099 +0.04 +Abbreviations: SF-36, 36-item Short Form; PCS, physical component scale; MCS, mental component scale; XRT, radiotherapy treatment; CES-D, Centers for Epidemiological +Studies–Depression; PSQI, Pittsburgh Sleep Quality Index; IES, Impact of Event Scale; BFS, Benefit Finding Scale. +aMeans with asterisk and double asterisk differ at P < .05 based on multilevel modeling analyses. +bThough groups did not differ significantly on physical health–related quality of life (SF-36 PCS) at 6 months, the original trial found that women in the yoga group reported +significantly higher scores on the physical functioning subscale of the SF-36 PCS at 6 months compared with the waitlist control group. + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +8 +Integrative Cancer Therapies  +Figure 2.  Group differences on posttraumatic response +across time: these figures represent the least-squared means +(adjusted for the baseline level of the outcome variable, baseline +SF-36 general health subscale, and randomization factors) of a +multilevel modeling analysis for each of the mediators over time. +Abbreviations: SF-36, 36-item Short Form; IES, Impact of Event +Scale; XRT, radiotherapy treatment. +(SF-36 PCS) at 6 months because the physical health sub- +scale of the SF-36 PCS was the only outcome associated +with group differences assessed after 3 months. +Hayes and Preacher’s bias-corrected bootstrap test of +indirect effect57 revealed that group did indirectly affect +physical health–related QOL (SF-36 PCS) at 6 months via +benefit finding at 3 months (Figure 3). First, YG resulted in +higher 3-month benefit finding compared with WL (the a1 +pathway; P = .04), whereas ST and WL did not differ in +3-month benefit finding (the a2 pathway; P = .84). Second, +holding group constant, those who reported higher benefit +finding at 3 months reported higher 6-month physical +health–related QOL (the b pathway, P = .04). Third, relative +to WL, women in YG reported higher 6-month physical +health–related QOL in part because of the positive effect of +YG on 3-month benefit finding. Indeed, a bootstrap esti- +mate of the indirect effect of YG compared with WL on +6-month physical health–related QOL via 3-month benefit +finding revealed a 95% bias-corrected and accelerated +(BCa) confidence interval that did not cross zero (B = 0.77; +SE = 0.58; CI = 0.01 and 2.58). Thus, 3-month benefit find- +ing partially mediated the effect of YG on 6-month physical +health–related QOL. Conversely, the BCa confidence inter- +val for the indirect effect of ST compared with WL did cross +zero and was, therefore, not significant (B = 0.07; + +SE = 0.43; CI = −0.84 and 0.88). Thus, the effect of ST on +6-month physical health–related QOL was not mediated by +3-month benefit finding. +Cortisol.  Results revealed no significant group or time effect +on cortisol slope (P > .3). There was a trend for a Group × +Time interaction effect (F(6,189) = 1.83; P = .096). Specifi- +cally, YG was associated with a steeper cortisol slope +Figure 1.  The least-squared means of mental health–related +QOL (SF-36 MCS) are from a multilevel modeling analyses +controlling for baseline MCS score, baseline SF-36 general +health subscale, and randomization factors. Figures illustrate +a Group × Time interaction for those with (A) high and low +baseline depressive symptoms (mean ± ½SD) on the Center +for Epidemiologic Studies (CES-D) and (B) high and low baseline +sleep disturbances (mean ± ½SD) on the Pittsburgh Sleep +Quality Index (PSQI). Higher SF-36 MCS scores represent +greater QOL. +Abbreviations: CES-D, Centers for Epidemiological Studies– +Depression; QOL, quality of life; SF-36, 36-item Short Form; +MCS, mental component scale; YG, yoga group; ST, stretching +control group; WL, or waitlist control group; XRT, radiotherapy +treatment; PSQI, Pittsburgh Sleep Quality Index. + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +Ratcliff et al +9 +compared with ST and WL (Ps < .03) immediately after +radiotherapy (post-XRT), and YG was associated with a +steeper cortisol slope compared with WL at 1 month (P = +.02). Figure 2C represents LSMs of cortisol slope for groups +at each time point. Because the effects of group and Group +× Time on cortisol slope did not reach significance, it was +not examined as a mediator. +Exploratory Analyses: Changes in IES and +Outcomes +Because women in WL reported unexpectedly lower IES +avoidance scores over time compared with women in YG, +we explored the association between changes in IES avoid- +ance and QOL outcomes by regressing group, change in +IES avoidance at 6 months (the time point associated with +significant group differences), and the interaction on QOL +outcome variables (physical and mental health–related +QOL (SF-36 PCS and MCS), depressive symptoms (CES- +D), and sleep disturbance (PSQI)) at the final follow-up +time point (ie, 6 months). There were significant interaction +effects for mental health–related QOL (P = .05) and depres- +sive symptoms (P = .04). Pearson correlations within each +group revealed no association between change in IES avoid- +ance scores and 6-month mental health–related QOL or +depressive symptoms for YG or ST, whereas a greater +increase in IES avoidance scores was associated with worse +6-month mental health–related QOL (r = −0.31; P = .03) +and higher depressive symptoms (r = 0.42; P < .01) for the +WL group. +Discussion +The present study hypothesized that participating in a yoga +intervention during radiotherapy would be particularly ben- +eficial for women with high baseline depressive symptoms +and sleep disturbances on posttreatment QOL compared +with their counterparts participating in stretching or waitlist +control groups. We also hypothesized that trauma responses +(ie, change in posttraumatic stress symptoms and increased +benefit finding) and better stress hormone regulation (ie, +steeper cortisol slope) would mediate the effect of yoga on +primary outcomes. Results partially supported each of the +hypotheses. +Consistent with previous research suggesting that cancer +patients with higher distress derive greater benefit from +psychosocial interventions,18,58-61 the yoga intervention pro- +vided the greatest mental health–related benefits for women +with elevated sleep disturbance and, to a lesser extent, +depressive symptoms prior to the start of radiotherapy. This +effect varied by time, with differences emerging especially +3 and 6 months after radiotherapy. Thus, yoga was espe- +cially helpful for those women with disturbed sleep and +depressive symptoms at the start of radiotherapy. In fact, the +women in the yoga group who had sleep disturbances at +study entry had mental health scores at 3 and 6 months after +Figure 3.  Yoga indirectly affects physical health–related QOL (SF-36 PCS) at the 6-month follow-up via increased benefit finding +(BFS) at 3 months. Values on each path are unstandardized path coefficients taken from bootstrapping analyses controlling for age, +stage of disease, time since diagnosis, type of surgery, chemotherapy type, and baseline benefit finding (BFS), physical health–related +QOL (SF-36 PCS), and the SF-36 general health subscale. The a1 and a2 paths correspond to the mean differences in 3-month BFS +between YG relative to WL and ST relative to WL, respectively. Thus, YG resulted in 3-month BFS scores that were a1 = 5.55 units +higher than WL (P = .04), and ST resulted in BFS that were a2 = 0.54 points higher than WL (P = .84). The b pathway corresponds to +the relation between 3-month BFS and 6-month SF-36 PCS when group is held constant. Thus, for every 1 point increase in 3-month +BFS, individuals reported an average b = 0.14-point increase in 6-month SF-36 PCS (P = .04). The relative indirect effects of group can +be determined by multiplying the a and b paths. Thus, relative to WL, YG resulted in SF-36 PCS scores that were a1b = 0.77 units +higher as a result of the positive effect of YG on BFS, which corresponds to a significant indirect effect of YG versus WL on 6-month +SF-36 PCS via 3-month BFS (B = 0.77; SE = 0.58; 95% bias-corrected and accelerated [BCa] CI = 0.01 and 2.58). Conversely, there was +no significant indirect effect of ST versus WL on 6-month SF-36 PCS via 3-month BFS (B = 0.07; SE = 0.43; BCa CI = −0.84 and 0.88). +Abbreviations: QOL, quality of life; SF-36, 36-item Short Form; PCS, physical component scale; BFS, Benefit Finding Scale; YG, yoga +group; ST, stretching control group; WL, or waitlist control group. +*P < .05. + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +10 +Integrative Cancer Therapies  +radiotherapy equivalent to those of women who did not +have sleep disturbances at study entry. A similar pattern was +seen for the benefits of yoga for those with high depressive +symptoms at baseline. +Regarding our mediation hypotheses, yoga led to +increased benefit finding across the follow-up period rela- +tive to the stretching and waitlist control groups, where +there was consistent decrease over time. Importantly, we +found that yoga indirectly affected physical health–related +QOL assessed 6 months after radiotherapy via increased +benefit finding reported 3 months after radiotherapy. In +other words, part of the effect of yoga on physical health– +related QOL at the long-term follow-up can be attributed to +the increased benefit finding experienced by yoga partici- +pants midway through the follow-up period. Of note, the +longitudinal nature of the data enabled the time-lagged +mediation analyses, which are critical for determining +mechanisms of effect. This is a particular strength of the +present article because such mediation analyses are often +lacking in intervention study designs. +Surprisingly, women in the waitlist group reported less +avoidance behaviors (eg, “I tried not to think about it;” “I +stayed away from reminders about it”) 6 months following +radiotherapy compared with women in the yoga group, who +reported little change in avoidance behaviors from baseline, +and there was no evidence of a decrease in intrusive thoughts +over time for any group. This finding was counter to our +hypotheses and that of other studies, which have found +mind-body practices in general, and yoga in particular, to be +associated with reductions in avoidance-related coping.62,63 +However, exploratory analyses suggested that the typical +deleterious effect of avoidance behaviors on QOL64,65 was +not found for those in either of the active groups (yoga or +stretching) but remained for those in the waitlist group. This +finding was somewhat consistent with our previous pilot +trial, in which the yoga group reported short-term increases +in intrusive thoughts relative to the waitlist control group.10 +Furthermore, a meta-analysis by Helgeson et al66 found that +increased intrusive or avoidant thoughts about a stressor +were associated with increase in benefit finding, which was +in turn associated with greater well-being. Thus, it could be +that yoga may not reduce posttraumatic stress symptoms (ie, +cognitive interference or avoidance) in the acute phase, but +this in turn may facilitate improved long-term adjustment. +There are several limitations to recognize in this study. +The majority of participants were white, non-Hispanic, +married, and highly educated. Thus, future research is +needed to test the generalizability of these findings to more +diverse populations. Participants also were not blinded to +study condition, and no measure of treatment expectation +was collected, which could have biased the findings because +of the subjective nature of the outcomes. In addition, +although these data suggest that women with elevated lev- +els of depressive symptoms and sleep disturbances show a +greater treatment response, these findings need to be inter- +preted with caution because the patients were not selected +based on pretreatment symptomatology. The study may +have also been underpowered for the mediation analyses. In +a study of empirical power simulations, Fritz and +MacKinnon67 indicated that very large sample sizes are +required for tests of mediation to be conducted with at least +80% power. Thus, the sample size of the present study +likely limits our ability to determine mediators with full +power, and the same limitation may be true for moderation +analyses. Additionally, the reduced reliability of cortisol +slopes assessed at later follow-up points (because of a +smaller sample size) may have limited our power to detect +the effects of cortisol slopes as a mediator in particular. +Finally, we followed participants for only a 6-month period, +so the long-term effectiveness of yoga in patients with +breast cancer remains to be determined. To address these +limitations, we are conducting an ongoing yoga trial using a +quasi-double-blinded design, with patients not knowing the +details of the intervention groups at baseline and then only +knowing the specifics of their assigned group. Additionally, +assessors are blind to group assignment. Treatment expecta- +tions are also being measured, and patients complete a +1-year follow-up assessment. +In conclusion, the current study provides a greater under- +standing of who will benefit most from a yoga intervention +and how a yoga intervention produces change. These results +suggest that future studies of the effect of yoga on cancer +patients may benefit from screening for participants who +report poor sleep or depressive symptoms because yoga may +buffer the negative effect of poor sleep or low mood on men- +tal health–related QOL indices in the months following +treatment for cancer. Additionally, these findings imply that +yoga may improve physical health–related QOL by increas- +ing one’s ability to find benefit in the cancer experience. +Finally, yoga appears to increase women’s endorsement of +symptoms typically associated with posttraumatic stress (ie, +intrusive thoughts and/or avoidance behaviors) but disasso- +ciates the typically harmful link between these symptoms +and QOL. Based on these results, we recommend that future +research continues to identify pretreatment psychosocial +factors that predict intervention response, seeks mechanisms +by which interventions work, and begins implementing tar- +geted, tailored, evidence-based mind-body interventions to +optimize recovery and QOL in patients affected by cancer. +Authors’ Note +Chelsea G. Ratcliff and Kathrin Milbury contributed equally to the +article and are both considered first authors. +Declaration of Conflicting Interests +The author(s) declared no potential conflicts of interest with +respect to the research, authorship, and/or publication of this +article. + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from +Ratcliff et al +11 +Funding +The author(s) disclosed receipt of the following financial support +for the research, authorship, and/or publication of this article: This +work was supported by the National Cancer Institute (Grant +Numbers R21CA102385, R01CA138800, R25CA10618), the +National Cancer Institute Cancer Center Support (Grant Number +A016672), the National Center for Complementary and Integrative +Health (Grant Number 5 K01 AT007559-02), a National Cancer +Institute cancer prevention fellowship for Chelsea G. 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Psychol Sci. 2007;18:233-239. + at UNIV OF TX MD ANDERSON on April 11, 2016 +ict.sagepub.com +Downloaded from diff --git a/subfolder_0/Gas Discharge Visualization Characteristics of an Indian Diabetes Population.txt b/subfolder_0/Gas Discharge Visualization Characteristics of an Indian Diabetes Population.txt new file mode 100644 index 0000000000000000000000000000000000000000..9ba0ff5d3095dc9e9af2a25c9c051c149aceeab1 --- /dev/null +++ b/subfolder_0/Gas Discharge Visualization Characteristics of an Indian Diabetes Population.txt @@ -0,0 +1,24 @@ +GAS DISCHARGE VISUALIZATION CHARACTERISTICS OF AN INDIAN DIABETES +POPULATION +Bhawna Sharma, Alex Hankey, and Hongasandra Ramarao Nagendra + +Abstract +Instruments measuring subtle energy levels in human subjects are becoming increasingly +popular in complementary medicine. Gas Discharge Visualization is an instrument measuring +fingertip electron emission, variations in which correspond to changing health levels in +different organs and organ systems. Its characteristics in diabetes have not previously been +determined. The purpose of this study is to compare Gas Discharge Visualization parameters +of diabetes patients those of healthy individuals. ds: Data taken from 138 diabetes patients, +divided into three groups according to duration of patholgy, was compared with data from 84 +healthy subjects. Three GDV subscales were analysed: GDV Screening, Diagram, and Right Left +Symmetry. Significant differences were observed between the two groups in the +cardiovascular, endocrine, immune and urogenital systems. Dividing the diabetes group +according pathology duration revealed systematic increases in values in all organs and organ +systems. Also, our Bangalore based subjects seemed to have different norms from those +originally used to calibrate the instrument. Differences between diabetic and healthy groups +increase with increasing duration of the disease. Population norms require further +investigation. +Keywords: gas discharge, visualization, characteristics of diabetes, population + + + diff --git a/subfolder_0/Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic Cross-National Survey..txt b/subfolder_0/Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic Cross-National Survey..txt new file mode 100644 index 0000000000000000000000000000000000000000..d50d2adacf91a514d129fb59e00951ebc3bac67d --- /dev/null +++ b/subfolder_0/Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic Cross-National Survey..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. The corresponding author +had full access to all the data in the study and had final responsibility for the decision to submit for publication. +Conflicts of Interest +None declared. +Multimedia Appendix 1 +Supplementary table. +[DOCX File , 20 KB-Multimedia Appendix 1] +References +1. +Listings of WHO’s response to COVID-19. World Health Organization. URL: https://www.who.int/news-room/detail/ +29-06-2020-covidtimeline [accessed 2021-05-10] +JMIR Form Res 2021 | vol. 5 | iss. 6 | e23630 | p. 9 +https://formative.jmir.org/2021/6/e23630 +(page number not for citation purposes) +Manjunath et al +JMIR FORMATIVE RESEARCH +XSL•FO +RenderX +2. +Srivastava N, Baxi P, Ratho R, Saxena S. Global trends in epidemiology of coronavirus disease 2019 (COVID-19). In: +Saxena S, editor. Coronavirus Disease 2019 (COVID-19). Medical Virology: From Pathogenesis to Disease Control. +Singapore: Springer; Apr 03, 2020. +3. +Leaune E, Samuel M, Oh H, Poulet E, Brunelin J. 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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/Holistic Approach for Prevention of Heart Disease and Diabetes.txt b/subfolder_0/Holistic Approach for Prevention of Heart Disease and Diabetes.txt new file mode 100644 index 0000000000000000000000000000000000000000..77968a9a624c878c2c4f9c191860d0911436284c --- /dev/null +++ b/subfolder_0/Holistic Approach for Prevention of Heart Disease and Diabetes.txt @@ -0,0 +1,569 @@ +Holistic Approach for Prevention of Heart Disease and Diabetes + +Gundu H. R. Rao1, and H. R. Nagendra2. +Emeritus Professor1, Laboratory Medicine and Pathology, University of Minnesota, +Rajiv Gandhi University of Health Sciences. Vice Chancellor2, Chairman, Swami +Vivekananda Yoga Anusandhana Samsthana, Bangalore. + + +Abstract + +South Asians have a very high incidence of hypertension, metabolic syndrome, +Coronary Artery Disease (CAD) and Type-2 Diabetes (T2D). Currently, there are +approximately 60 million diabetics in India. According to a World Health +Organization (WHO) estimate, T2D will increase by 200% in India, in the next two +decades. Once this disorder is diagnosed, there is no better alternative than, to +effectively mange the risk factors. Those recognized with this disorder, will have to +take medication life long. This puts a tremendous economic burden, as well as great +burden on the liver. Therefore, it is essential to develop early diagnosis and better +management, of these metabolic disorders. Many studies done in the west, have +demonstrated that life style management is as effective, as medical management for +this disease. In view of these findings, in South Asian Countries, greater emphasis +should be given to the holistic management of those who are “at risk”, for +developing hypertension, obesity, metabolic syndrome, heart disease and type-2 +diabetes. Life style management should include; smoking cessation, Yoga, exercise +and change in the diet. Preliminary studies done at Isha foundation, Coimbatore +and Swami Vievekananda Yoga Anusandhana Samsthana, Bangalore, suggest Yoga, +sathwik diet or a well balanced diet, effectively reduces the diabetes burden. +However, these studies have to be confirmed by appropriately designed randomized +clinical trials. There is a great need to develop alternative therapies, to reduce the +use of large doses of modern medicine. We have initiated a survey, to find out, as to +what other traditional therapies (Unani/Siddha) have been found to be beneficial, in +the effective management of these diseases. Results of these surveys and validation +of those therapies, that are found to be effective including yoga, diet etc., will +provide us with holistic, alternate or complementary therapies for the management +of heart disease and T2D. + +Introduction + +According to practitioners of Traditional Medicine, Modern Medicine as we know today, +has failed to prevent chronic non-communicable diseases such as hypertension, obesity, +metabolic syndrome, type-2 diabetes, heart disease and stroke On the other hand, +complementary and alternative medicine (CAM), practitioners claim, that their approach +to the management of these diseases are superior to modern medicine, as their approach +to therapy is holistic. Irrespective of who is right or wrong, we have to come with an +integrated, comprehensive management of these diseases. Recent studies in the third +world countries show, that these diseases are increasing rapidly to epidemic proportions. +China for example, has over 90 million diabetics, whereas in India there are +approximately 60 million and the incidence of this disease is rising rapidly. Furthermore, +in these countries, there is probably equal number of individuals with pre-diabetic state. +More than 36 million people die each year from Non Communicable Diseases (NCDs), +this constitutes 63 per cent of global deaths, including nine million, who die before the +age of 60. More than 90 per cent of these early deaths are in developing countries and +most could be prevented. Heart disease causes the most NCD deaths (17 million per +year). Need of the hour therefore, is to come up with some novel ideas, to combat these +metabolic diseases with accessible, acceptable and affordable therapeutic management +strategies. +Role of South Asian Society on Atherosclerosis and Thrombosis + +South Asians (Indians, Pakistanis, Bangladeshis and Sri Lankans) have the highest +incidence of hypertension, metabolic syndrome, type-2 diabetes and coronary artery +disease, compared to any other ethnic group in the world (1, 2). In addition, according to +WHO, India ranks number one in the list of countries, with highest incidence of type-2 +diabetes (3). To create awareness, develop educational and preventive programs, we +started a society (South Asian Society on Atherosclerosis and Thrombosis: +www.sasat.org) in 1993. SASAT is not only organizing conferences in India, publishing +books on these subjects in India, but also working proactively in developing prevention +strategies. SASAT is affiliated with the North American Thrombosis Forum (USA) and +the International Union of Angiology (IUA). Now it is extending an invitation for the +American College of Cardiology ACC) to work with us in India, on creating awareness +about NCDs, developing early diagnosis of risks for NCDs, education, research and +prevention projects. According to our vision and mission, all acute vascular events are +preventable. Early detection of the risks that promote these complex diseases and better +management of the NCD risks with the traditional therapies including holistic practices, +seem to be the most cost effective solution we have at this time, for significantly reducing +health care burden of these cardio-metabolic disorders. + + +In the early nineties, we the members of SASAT, presented to the WHO panel, a +comprehensive, integrated approach, for the prevention of these disease. Our main +emphasis was, that we should treat all CVD prevention and treatment efforts, across the +Globe equally. Having said that, we feel that we should start the prevention program at +the earliest possible stage in the development of human life. Seminal studies at the +Holdsworth Memorial Mission Hospital Mysore, India, have demonstrated that 30% of +the children born in India are of low birth weight (LBW). This hospital has kept detailed +records of every child born since 1934. Based on the available data, Medical Research +Council (MRC) of UK (www.mrc.soton.ac.uk/index.asp?/page-97) under the leadership +of Prof Caroline Fall of Southampton, has conducted a series of studies. In summary, +these studies have shown that the children with LBW are predisposed to develop, +significantly more risk for obesity, hypertension, metabolic syndrome, type-2 diabetes +and CVDs than those children born with normal weight (4-7). + + +According to recent survey, greater than 30% of children in New Delhi Schools in India +are obese. This survey also observed that the parents of these children also had unhealthy +life style (personal communication). Studies from the St. Paul Heart Institute, Minnesota +(www.stphc.com), have demonstrated that obese children develop endothelial +dysfunction, the earliest signs of vascular disease. These studies further demonstrate that +changes in life style and healthy diet significantly altered the blood flow dynamics in +these children in favor of normalcy. There is a great need for developing an indigenous +hand-held device, to monitor endothelial dysfunction in school children, so that we could +initiate large-scale study, to detect and manage the early signs of vascular disease. Our +mission should be, to find the disease of the vessel at the earliest and treat the disease of +the artery, than to focus on the management or risk factors for the prevention of these +diseases (8). + +SASAT initiated few years ago, a “21 State” survey under the leadership of Dr Rajeev +Gupta of Jaipur, called "India Heart Watch", to explore the role of life style on the +incidence of various risks for these complex diseases. SASAT is also working with India +Heart Alliance, another NGO, which is concentrating on “Workforce Wellness” program, +as a means for developing risk reduction strategies. Several studies in the USA have +demonstrated that a well-organized work place wellness program reduces the cost of +health care for the workers by at least 30%. According to the employee insurance scheme +(EIS) of India, it costs more than 2400 Crores of rupees to provide health care for the 40 +million employees. If we can initiate and implement a robust workplace wellness +program with the EIS of India, we could achieve a 30% savings ($800 Crores). + +Definition of the Terminologies: + +Before going into the discussions on the management of chronic disorders by holistic +approach, we will have to define the term holistic and shed some light on areas that are +pertinent this topic. What is holistic approach? According to Hippocrates, the scholar and +philosopher, "The physician treats, but nature heals." Therefore, “holistic” means in +terms of therapy, treating the whole body, mind, spirit and all the external and +environmental influences, that is associated with day-to-day living. Whereas, if one asks +a wellness expert, he or she will say that absence of disease is not wellness and describes +optimal health as a state of being, that includes: Spiritual Wellness, Emotional Wellness, +Social Wellness and Intellectual Wellness. In modern medicine, symptoms are viewed as +disease, and treatments are aimed at suppressing rather than eliminating those +symptoms. In the holistic view, symptoms are regarded as the body's expression of +imbalance (Eg: Ayurvedic Concept of Tri-Doshas) and appropriate attempts are made to +achieve normal homeostasis. + +Continuing our discussions on definitions, let us look at the terms; alternate medicine, +complementary medicine, integrated medicine etc. An alternate therapy used in place of +the current modern medicine or biomedicine, is termed “Alternate Medicine”. Any +therapy that can be used in addition to, or along with modern medicine is called, +“Complementary Medicine”. If a combination of traditional therapy and modern +medicine are used, then it is called “Integrative Medicine”. Not all therapeutic modalities +of complementary and alternate medicine (CAM) are holistic in their approach. This is +true of the modern biomedicine also. Let us consider for example the management of +heart disease or diabetes and look at the approach of an allopathic doctor or a traditional +therapist. Allopath based on the symptoms manifested, will diagnose the risk factors +associated with these symptoms or disorders, such as diet, physical inactivity, blood +pressure, altered lipid or blood glucose levels and try to manage these risk factors. If we +consider the approach of a Vaidya, he or she will look at the physiological imbalances, +Dosha’s (Vata Pitta, and Kafa) associated with the individual, recommend panchakarma +procedure, to cleanse the body and try to restore the balance of the doshas with dietary +changes and herbal medicines (rasayanas). Similarly, a Yoga therapist, will recommend +an integrated approach, to the management that may include, physical exercises like +asanas, breathing practices (pranayama), various kriyas, meditation and sathwik diet. +What is wrong with this approach? In spite of the fact that these traditional therapies are +in existence for thousands of years, they do not have documented evidence about their +efficacy and safety. Since they are ancient therapeutic practices that we have inherited +over centuries, there is a strong feeling that they do not need any evidence-based +scientific proof. In view of this deficiency or lack of documentation of clinical data, on +the efficacy and patient safety of traditional medicine, regulatory agencies of European +Union and USA have banned the marketing of herbal medicine in Europe and USA. + +Holistic Approach to Common Disorders + +Let us consider the holistic approach for the management of the most common disorders +in India such as hypertension, obesity, metabolic syndrome and coronary artery disease. +According to studies done at the Holdsworth Memorial Mission Hospital, Mysore and +KEM Hospital in Pune, 30% of children born in India, are of low birth weight (LBW). +Children born with low birth weight have been followed for their predisposition, to the +above-mentioned disorders, with the “Mysore Cohort”. Results of these studies have +demonstrated, that LBW children develop metabolic disease, at much higher frequency +than those born with normal weight. If we want to develop preventive strategies using +holistic approach, we should start intervention, even before the conception of a child. We +should pay attention to the maternal nutrition, both micro and macronutrients. We also +have to develop a robust nutritional program for the neonatal babies as well as infants (9). + +Risk Factors for Cardio-metabolic Disorders + +Framingham studies initiated in the USA over 50 years ago identified risk factors that are +associated with the promotion of atherosclerosis, thrombosis and stroke. They include, +smoking, high blood pressure, altered blood lipids such as increased triglycerides, +cholesterol and decreased high-density lipoproteins and elevated blood glucose (10). +Since then several other risk promoters, have been added to this growing list of risk +factors. Based on this information, drug manufacturers developed a variety of drugs that +modulate the levels of these risk factors. Currently there is an on going debate, about the +superiority or otherwise of risk factor management, versus management of the vessel wall +disease. This debate becomes more relevant when one considers, that in spite of the drug- +induced tight management of known risk factors, significant number of individuals +experience acute vascular events. This is true of even much publicized interventions such +as, use of coronary stents, for the management of blocked arteries. Therefore, we the +members of SASAT strongly believe in the benefits of developing better prevention +strategies than just management of the risk factors or disease of the vessel. + +Factors that Influence Life Style Disorders +Use of Tobacco and Tobacco Products +Number one public health problem related to life style is, smoking or use of any kind of +tobacco product. According to Global Public Health estimates, by 2030, 80 percent of +more than eight million tobacco-related deaths projected annually, will occur in low-and +middle-income countries. The enormity of this health care burden reflects in not just +steady population growth, but also the tobacco industry's aggressive efforts to target and +market to vulnerable populations. To reduce health disparities in a single act, the United +States should join the global community in ratifying the first international public health +treaty, the World Health Organization (WHO) Framework Convention on Tobacco +Control (FCTC). Tobacco addiction, the leading cause of preventable premature deaths in +the world, will claim as many as a billion lives in this century. To counter this human +catastrophe, 153 countries, including India and other neighboring countries, have ratified +the FCTC since 2003. The fact that even the so-called most advanced country, the USA, +has not joined the FCTC indicates, the enormity of such public health issues and the +powerful influence of industries. We have to establish a robust awareness program to +educate the public about the health consequences of using tobacco and its products. + + Excess Salt Consumption +Cardiovascular diseases are the leading causes of death and disability worldwide. +Elevated blood pressure (BP), cholesterol and smoking, are the major risk factors. +Among these, raised BP is the most important cause, accounting for 62% of strokes and +49% of coronary heart disease. This observed risk is throughout the range of BP, starting +at systolic 115 mm Hg. There is strong published evidence, that our current consumption +of salt in excess, is the major factor increasing BP and thereby CAD. In addition, a high +salt diet may have direct harmful effects, independent of its effect on BP, for example, +increasing the risk of stroke, left ventricular hypertrophy and renal disease. The American +Heart Association (www.aha.org) recommends consuming less than 1500 mg of sodium +a day. Several countries have initiated salt reduction programs. We should create an +awareness program regarding the health consequences of excess consumption of salt. +Excess Sugar Consumption +The third most important lifestyle related risky habit is, excess consumption of sugar. +Consumption of sugar, which is helping to drive the obesity crisis and causing millions of +deaths worldwide each year, should be controlled like other threats to public health. The +researchers and experts in the field of endocrinology, sociology, and public health, argue +that the quantities of sugar consumed by most are sufficient to alter metabolism, raise +blood pressure, muddy the signaling of hormones, alter glucose metabolism, increase the +incidence of type-2 diabetes, significantly damage the liver. Worldwide consumption of +sugar has tripled in the last five decades and helped fuel the obesity, metabolic syndrome; +which can lead to diabetes, heart disease, and stroke. It is important to remember that +every type of carbohydrate that you eat is eventually converted into a simple form of +sugar known as glucose either directly in the gut or after it passes through the liver. +Simple truth is, all the rotis, bread, pasta, cereal, rice, wheat, ragi, jawar, sorghum, +potatoes, desserts, candies and soft drinks eventually end up as glucose. +Excess Carbohydrate Consumption +When we eat excess carbohydrates, the pancreas pumps out insulin, exactly as tailored by +our DNA blue print dictates. Hence, the individual variations exist in the metabolism of +nutrients (variations in the Doshas). If the liver and muscle cells are loaded with sugar, +these cells start to become resistant to the response of insulin. The insulin receptor +number on these cells starts to decrease. Since glucose cannot get into muscle or liver +cells, it remains in the blood stream. In view of this excess glucose in the blood, the +pancreas pumps more insulin and induces resistance in insulin receptor response. Both +excess sugar and insulin in blood is toxic. Bioinformatics reveal that the body expresses +hundreds of insulin dependent genes and produces a variety of proteins, modulatory +functions of which, is not clear at the time of this writing. Similarly, excess sugar +glycates variety of proteins, including hemoglobin and alters normal physiology of +vascular system. Although elevated glucose in the blood and the levels of HbA1c are the +gold standards, to monitor type-2 diabetes, exact role for glucose induced alterations in +the proteins and their effect on the progress of diabetes induced clinical complications are +not very well understood. Average Indian meal, has greater than 70% carbohydrates; we +should seriously work on creating an improved, balanced diet for healthy life style. +Excess Fat Consumption +Fat is one of the three major nutrients (along with proteins and carbohydrates), which +supply calories to the body. Fat provides essential fatty acids, which are not made by the +body and therefore, must be obtained from food. When you exercise, body uses up the +calories from carbohydrates in the first 20 minutes and then it begins to depend on fat for +source of energy. Eating too much saturated fat (in general the type of fat that solidifies at +room temperature; butter & ghee) is one of the major risk factors for heart disease. These +are the biggest dietary cause of high HDL cholesterol (bad cholesterol). When selecting a +fat or oil for cooking, limit saturated fat to less than 10% of calories. Foods made with +hydrogenated oils (Dalda, Crisco, Vanaspathi etc) should be avoided as they contain high +levels of trans fatty acids, which are linked to heart disease. Too much fat also increases +the risk of CAD, because of its high calorie content, which increases the chance of +becoming obese. + +Excess Weight as Modulator of CVD Risk +Excess weight and obesity are also considered as leading causes of hypertension and +type-2 diabetes. According to population-based studies, two-thirds of obese people are at +risk for hypertension. A study conducted in Portugal, demonstrated a significant +correlation between excess body weight and blood pressure in children as well as +adolescent populations (11). They recommended using BMI and waist circumference as +test parameters for monitoring excess body weight. According to a CDC study waist +circumference and elevated triglyceride levels help identify people at risk for developing +metabolic syndrome. Obesity affects a number of hormonal functions including, renin- +angiotensin-aldosterone system. This system controls the level of sodium and water in +the body. Increased renal sodium re-absorption results in an altered blood pressure. +Several central and peripheral abnormalities lead to the development of high arterial +pressure in these individuals. Perturbation of vessel wall and blood cell integrity produce +an altered state of homeostasis and initiates endothelial dysfunction. Obesity as a leading +cause of hypertension can also be the initiator of endothelial dysfunction, metabolic +syndrome. This syndrome is a common cause for complex chronic disorders such as +dyslipidemia, hypertension, and insulin resistance. + +Prevalence of Metabolic Syndrome + +Metabolic Syndrome (MS) is basically the clustering of various altered metabolic +conditions such as insulin resistance, high triglycerides, dyslipidemia, high blood +pressure, abdominal obesity and impaired glucose metabolism (12). There is considerable +confusion about the definition of this syndrome proposed by various professional +organizations (NCEP-ATP111, IDF, WHO, CDC, etc) to identify who is at risk for +developing this syndrome and whether or not this syndrome is a risk factor for diabetes +and CVDs. Clinicians are encouraged to follow first the known classical risk factors and +then take into consideration the abdominal obesity and MS, and this combined risk is +defined as cardio metabolic risk. In a recent survey of school children in New Delhi, +India, the prevalence of overweight or obesity was greater than 35%. The prevalence of +MS in Indians was 23.2%, 18.3%, and 25.2% according to the WHO, ATP111, and IDF +definitions respectively. The prevalence of MS for the age group 60-69 was, WHO 47.9%, +ATP111 33.5%, and IDF 43.7% respectively. Subjects with diabetes and obesity seem to +have a much higher prevalence of MS >70%. + +Prevalence of Type-2 Diabetes + +Indians have a high incidence of type-2 diabetes and cardiovascular disease, despite a low +prevalence of obesity. Based on preliminary collaborative studies done in Chennai, India, +by the researchers at Madras Diabetes Research Foundation and the staff at the +University of Minnesota, a hypothesis was developed to explain excess burden of T2D in +this population. They hypothesized that the excess of risk may be due to a high +propensity towards the abdominal fat accumulation in the Asian subjects. They +compared waist measurements and BMI data from the CURES (Chennai Urban Rural +Epidemiological Study) survey of southern Indians, with those from three US ethnic +groups (Caucasians; 1809, African Americans; 1993 and Mexican Americans; 2116) +from NHANES III (Third National Health And Nutritional Examination Survey) data. A +total of 15,733 subjects from CURES ad 5,975 from NHANES111 met the inclusive +criteria (age 20-39, no diabetes). Mean waist measurements were 89.8cm for US men +86.4cm for US women 78.4cm for Indian men and 77.6cm in Indian women. BMIs were +25.9kg/m2 in US men 26.5kg/m2 in US women, 21.8kg/m2 in Indian men and 22.4kg/m2 +in Indian women. To account for between-population differences in body size and +general adiposity, they divided the waist circumference by the BMI. The waist to BMI +ratio was significantly higher for Indian men and women compared to all US race/sex +groups. Results of these studies, demonstrate that the Indian population has excess +visceral fat deposits, relative to overall body distribution. + +Goals of Medical Nutrition Therapy (MNT) + +MNT for pre-diabetes emphasize the importance of lifestyle in decreasing the risk for +type- diabetes by increasing physical activity and promoting food choices that facilitate +moderate weight loss (13). Life style modifications reported to produce weight loss of +10% or 10 -12 Kg over 3-6 months. Change in life style and the related loss can be +sustained for 2-4 years. However. One should keep in mind that for CVD fitness and to +reduce risk for CVD one need to work out a minimum of 30 minutes a day with moderate +physical activity. Sixty minutes per day of physical activity is needed for preventing +weight gain and sixty to 90 minutes to avoid gain after weight loss. There is no gold +standard when it comes to what is the correct diet for diabetics. Adults should balance +their diet and consume 45-65% as carbohydrates for their daily energy needs, 20-35% +from fat and 10-35 from proteins. Jus to give an example of how complex is the +management of diet; let us examine the fat intake and its benefits and ill effects. Alpha +linolenic acid has many health benefits especially in the inhibition of inflammatory +process associated with CVD, autoimmune disease, diabetes and bowl disease. It also +serves as precursor for the n-3 fatty acids, EPA and DHA. In reality all seafood are +beneficial with regard to Omega-3 fatty acid content. A high n-6 to n-3 ratio in daily diet +appears to promote inflammation and oxidation. Original focus of researchers in this +approach was related to beneficial effects on cardiovascular and endocrine systems. +However, recent studies in neurosciences is suggesting, that one consequence of such a +diet, is increased inflammation and this may have adverse effect on brain and nervous +system and increase mental illness. Average Americans consume a diet with n-6 to n-3 +ratio as high as 17:1, which is pro-inflammatory. A beneficial ratio is close to 2:1(14). +Integrated Management of Life Style Disorders: +Life style disorders such as hypertension, obesity, metabolic syndrome, type-2 +diabetes, heart disease and stroke are very complex diseases. Understanding the +risk factors, anticipating the clinical complications associated with these risk factors +and effective management of these risks involves a team of specialists, health care +workers, internists, endocrinologists, dieticians, and experts in various allied health +fields. Just take the example of diabetes-mediated complications, such as +vasculopathy, neuropathy, nephropathy and retinopathy, all leading to the end +organ failure. Hypertension, obesity, metabolic syndrome and thrombotic complications +are chronic, complex disorders, which have reached epidemic proportions in industrial +nations as well as developing countries. In order to manage these public health problems, +one has to understand the underlying causes, diagnose the risks that promote the progress +of these diseases and effectively manage the risks, to reduce or prevent acute vascular +events leading to mortality or morbidity. According to experts, 30% of the children born +in some of the developing countries are of low birth weight. This is real, unacceptable +and preventable. There are 1.3 billion obese people worldwide. This also is real, +unacceptable and preventable. Creating awareness, developing educational, diagnostic +and prevention strategies are the most cost effective and proven paths available. Just a +few years ago by creating awareness and developing effective advocacy programs, use of +palm oil in the US fast food industry was virtually eliminated. Similarly awareness +programs, and life style modifications drastically reduced CVD mortality and morbidity +in USA and Finland (16, 17). More and more countries have started preventive work at +local and national level. An Italian study with a sample size of 52,300 documented an +increase in the prevalence of excess weight in adults and a positive association between +weight gain and chronic disease. Authors conclude that to reduce the prevalence of +chronic disease, a policy promoting a healthier life style is desirable (17). +Comprehensive preventive measures, such as exercise, dietary interventions, body weight +control and pharmacotherapy are cheaper compared to the cost of treating and +management of consequences from these chronic conditions (17-22). + +Sedentary Life VS. Physical Activity + +Of all the risk promoters associated with these metabolic disorders, sedentary lifestyle is +one of the major contributors to the initiation and progress of these diseases. Physical +inactivity is now the fourth leading independent risk factor for death, caused by +non-communicable chronic disease. Physical activity has numerous positive effects +
 on health of individuals. Regular to moderate-intensity physical activity reduces the risk +for acute vascular events significantly. The available data clearly indicates benefit effect +of physical exercise, Globally; across all countries, cultures, gender, age and ethnicity. +Physical activity is the most effective single therapy among all lifestyle interventions +including diet, various therapies, and psychosocial changes and practices. Studies of +short-term exercise program as well as long-term have shown improvement in endothelial +function, metabolic and cardiovascular parameters. For those who can afford, a robust +fitness program will be very useful. However, just brisk walking several times a week is +better than living a sedentary life (19-22). +Holistic Approach Through Integrated Yoga Therapy +Yoga practices of all kinds have been claimed to have positive effects on the health of an +individual (23-25). S-vyasa, the Yoga University (www.svyasa.org) in Bangalore, has +been participating in a National program called “Stop Diabetes”. They also have an +integrated yoga therapy that is customized for hypertensive subjects, obese individuals, +diabetics and post myocardial infarction (MI) and stroke patients. Two major studies +published widely of over 4000 patients have demonstrated patients randomized to +exercise-based cardiac rehabilitation post-MI, have a statistically significant all–cause +and cardiac mortality, compared to those receiving conventional therapy only. Similarly +the Isha Foundation (www.ishafoundation.org) near Vellaingiri Mountains in Coimbatore +District has special program for diabetics, “Isha-Yoga and Isha-Diet”. The diet at this +center is pretty close to a balanced diet and seems to be doing good for the followers of +this special diet. They have incorporated boiled peanuts as major source of protein, +reduced the fat and carbohydrate content, included sprouted legumes, fruits and +vegetables. Manchanda et al., at New Delhi, India demonstrated retardation of coronary +atherosclerosis with Yoga life style intervention. Based on the results of their study (n- +42), they concluded that Yoga lifestyle intervention retards progression and increases +regression of coronary atherosclerosis in patients with severe coronary artery disease (23). +Yoga an ancient science of physical and mental activity, has gained popularity +throughout the world. In spite of this popularity, health care providers have been slow to +recognize the merits of this approach. In addition, there is lack of data from well thought +out randomized clinical studies with populations at high risk for hypertension, obesity, +metabolic syndrome, type-2 diabetes, heart disease and stroke. A review of Yoga +programs (1980-2007) for the four leading risk factors (overweight, high blood pressure, +high blood glucose and elevated blood cholesterol) of chronic diseases, concluded that +future studies should be designed and conducted, to identify programs best suited for +diverse populations as well as for specific chronic health conditions. They also +recommended that duration, intensity frequency and the types of yoga practices (asanas, +pranayama, kriyas and meditation) and their sequences, should be clearly described in the +clinical protocols. Authors also stressed the need to standardize and compare various +components of integrated yoga therapy programs for the research purpose (25). +Lifestyle Modifications +Lifestyle modifications address several CAD risk factors at once and in general free of +side effects. Vestfold Heartcare Study Group demonstrated the influence of life style +measures and five-year coronary risk by a comprehensive lifestyle intervention programs +in patients with coronary heart disease. The Diabetes Prevention Program Research +Group conducted one of the largest studies on the beneficial effects of lifestyle. In this +study, of the 3234 patients recruited, 1082 were placebo, 1073 took 850 Mg Metformin +twice a day and 1073 were administered intensive lifestyle intervention (Protocol of the +study: http://www.bsc.gwu.edu/dpp). Based on the results of their study, the authors +concluded that lifestyle changes and treatment with metformin, both reduced the +incidence of diabetes in persons at high risk. The lifestyle intervention was more effective +than metformin (15). +Designing, conducting and validating the beneficial effects of lifestyle interventions is +hard. Interventions that work in some societies may not work in the others, because of the +complexities that exist in the social, economic, cultural and dietary diversities that exist. +It is difficult to standardize each of the components of holistic and lifestyle interventions. +Since smoking, bad diet, excess weight, salt and sugar consumption are leading +promoters of risks associated with the development of hypertension, MS, T2D, and +vascular diseases, a concerted effort should be made, to develop strategies that can reduce +or prevent the development of these conditions at all stages in life, including during +intrauterine growth, in the nutrition of new born babies, young children, adolescents and +adults (15-18, 26-29). + +Life style disorders such as hypertension, obesity, metabolic syndrome, heart disease and +stroke are complex diseases (28, 29). In a country like India, where the prevalence of +these diseases have reached epidemic proportions, providing modern health care to all +seems a herculean task. In addition, there is a growing disbelief in the role of modern +medicine in the area of prevention. Modern medicine by and large is based on the +management of symptoms and the risk factors associated with these symptoms. As such +concentrates heavily, on the risk factor management. Therefore, in order to provide +community at large, an easily accessible, acceptable and affordable health care, we need +to develop a fusion between what is best in the traditional Indian Medical System and the +modern medicine. For lack of a better terminology, we will call Indian Integrated +Medicine. In our enthusiasm to provide a holistic therapy, we should not ignore the fact, +that some of our traditional systems lack clinical data, to support their claims. For +instance the one of the best-cited study of Dean Ornish, used only 28 subject to show the +benefit of low fat diet (26, 27). We need to develop robust data on the benefits of holistic +approach. Till we have such an evidence-based data, it is our suggestion, that these +methods be used as complementary medicine and not as an alternate medicine. + +Discussion +The goals and objectives in caring for patients with diabetes mellitus should be to +eliminate symptoms and prevent, or at least slow, the development of complications. +Micro-vascular (ie, eye and kidney disease) risk reduction could be accomplished, +through control of glycemia and blood pressure; macro-vascular (ie, coronary, cerebro- +vascular, peripheral vascular) risk reduction can be achieved through control of lipids, +hypertension, smoking cessation, and aspirin therapy; metabolic and neurologic risk +reduction, through control of glycemia. Pathogenesis of cardio-metabolic disorders are +modulated and promoted by a variety of altered metabolic pathways and effective +management of these disorders, requires appropriate goal setting, dietary and exercise +modifications, medications, appropriate self-monitoring of blood glucose, regular +monitoring for complications, and laboratory assessment. If we can manage this complex +treatment plan with our holistic approach, it is great, if not, we need to consider +integrated approach of using what is best in the modern medicine and the traditional +systems. Majority of CAM programs at the Academic Health Centers in the USA have +adopted this approach in the management of diseases. +For example, the Center for Spirituality and Healing at the University of Minnesota, has +been offering complementary healing techniques using Spiritual Healing Practices of East +and West. Although we have over hundred Medical Colleges in India, there are hardly +any colleges, which have a designated department for CAM programs and offer holistic +therapies as one of the choices. Since 1979, over 19, 000 individuals have completed the +8-week mindfulness-based stress reduction (MBSR), at the Center for Mindfulness in +Medicine, at the University of Massachusetts. This center is one of the oldest and largest +Academic Medical-Center based stress reduction program in the world. Department of +AYUSH, Government of India, should take leadership in establishing post-graduate +education and research programs, similar to the post graduate programs in Biomedicine +established by the Indian Medical Council (AIIMs). The expert committee of the Rajiv +Gandhi University of Health Sciences (RGUHS), Karnataka, has recommended +establishment of such a platform in the State of Karnataka. We sincerely hope the +development of an Independent Institute for Complementary and Alternate Medicine, so +that the traditional healing therapies as well as holistic approaches to the management of +chronic diseases could be tested, standardized, promoted and implemented. + References: + +1. Rao GHR, Kakkar V. V: Coronary Artery Disease in South Asians: Epidemiology, +Risk Factors, and Prevention. JP Medical Publishers, India. 2001. +2. Rao GHR, Thanikachalam, S: Coronary Artery Disease: Risk Promoters, +Pathophysiology and Prevention. JP Medical Publishers, India. 2005. +3. Rao, GHR, Mohan V: Type-2 Diabetes in South Asians: Epidemiology, Risk +Factors and Prevention. JP Medical Publishers, New Delhi, India. 2006 +4. Veena SR, Geetha S, Leary et al: Relationship of maternal and paternal birth weight +to features of the metabolic syndrome in the adult offspring: An intergenerational +study in South India. Diabetologia 2007, 50(1): 43-54. +5. Victoria CG, Adair L, Fall C: Maternal and child under nutrition: Consequences for +adult health and human capital. Lancet 2008, 371(9609): 340-57. +6. Fall C: Maternal Nutrition: effects of health in the next generation. Ind. J. Med. +Res. 2009, 130 (5): 593-99. +7. Yagnik CS: Fetal Origins of health and disease: Commentary: Fetal Origins of +Cardiovascular risk-nutritional and non-nutritional. Ind J. Epi. 2001, 30:57-59. +8. Divani AA, Luft AR, Flaherty JD, Rao GHR: Direct diagnosis is superior to risk +prediction tools for management of vessel wall disease. Frontiers in Neurology +2012 (In Press). +9. Mohan KL, Escott-Stump S: Krausse’s Food and Nutrition. Saunders Elsevier +2008, St Louis MO. +10. www.framighmaheartstudy.org/risk/index/html +11. Souza MG, Rivera IR, Silva MA et al: Relationship of obesity with high blood +pressure in children and adolescents. Arq Bras Cardiol. 2010 (Pub Med 20428712). +12. Ashner P: Metabolic syndrome as a risk factor for diabetes. Exp. Rev. Cardiovasc +Ther. 2010, 8:407-12. +13. Franz M: Medical Nutrition Therapy for Diabetes Mellitus and Hypoglycemia of +non-diabetic origin. In: Krausse’s Food and Nutrition, Saunders-Elsevier, 2008. St +Louis MO. +14. Davis BC, Kris-Eitherton PM: Achieving essential acid status in vegetarians. +Current knowledge and practical implications. Am. J. Clin. Nutr. 78:6405, 2003. +15. Diabetes Prevention Program Research Group: Reduction in the incidence of +Type-2 diabetes with lifestyle intervention or metformin. N Engl J. Med. 2002, +346:393-403. +16. Pax XR, Li GW, Hu YH et al: Effect of diet and exercise in preventing NIDDM +in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. +Diabetes Care.1999, 22:623-34. +17. Tuomilchto J, Lindstrom J, Erikson JG et al: Prevention of type-2 diabetes +mellitus by changes in life style among subjects with impaired glucose tolerance. N +Engl J. Med. 2001, 344: 1990-92. +18. Blair SN, Kohl HW, Gordon NF et al: How much of physical activity is good +enough? Ann Rev Pub Health. 1992, 13: 99-120. +19. Matherson GO, Khigl M, Dvorak et al: Responsibility of sport and exercise +medicine in preventing and managing chronic disease: applying knowledge and +skill overdue. Br J. Sports Med. 2011,45(16): 1272-82. +20. Roth FW, Gordon SE, Carlson CJ: Waging war on modern chronic disease: +primary prevention through exercise biology. J. Appl Physiol 2000, 88(2): 774-82. +21. Sugathan TN: Prevention of non-communicable diseases (NCDs). 2010, 131: 14- +16. +22. Rastogi T, Vaz M, Spiegelman D. et al: Physical activity and risk for coronary +artery disease in India. Ind. J. Med. 2004, 33:759-67. +23. Manchanda SC, Narang R, Reddy KS: Retardation of coronary atherosclerosis +with yoga lifestyle intervention. Assoc. Phy. India. 2000, 48 (7): 687-94. +24. Joliffe JA, Rees K, Taylor RS: Exercise-based rehabilitation for coronary artery +disease. Cochrane Database Rev. 2000, (4) CD001800. +25. Yang K: A review of yoga programs for four leading risk factors for chronic +diseases. eCAM 2007, 4(4): 487-91. +26. CDC Report: Achievements in public health 1990-1999. Declines in death from +heart disease and stroke. www.cdc.gov/mmwr/preview/mmwrhtm/mm4830al/htm +27. Puska P: Coronary artery disease and stroke in developing countries: time to act. +Int. J. Epi. Assoc. 2001, 30:1493-94. +28. Calza S, Decark A, Ferraroni M et al: Obesity and prevalence of chronic disease +in the 1999-2000 Italian National Survey. MC Public Health 2008, 8:140-49. +29. Lee YH, Jeong HS, Kim NS et al: The effect of an exercise program on +anthropometric metabolic and cardiovascular parameters in obese children. Korean +Circ. 2010, 40:179-84. + + + +Conflict of Interest: The authors do not have any conflicts of interest, financial or +otherwise. +Acknowledgements: This article is based on a series of invited lectures given to the +students of s-VAYSA, Bangalore, in the summer of 2009. First author, Dr Rao thanks +members of the SASAT family, Vice Chancellor s-VYASA, Vice Chancellor, RGUHS +and the University of Minnesota, for the support and encouragement of his activities. diff --git a/subfolder_0/Immediate effect of Indian music on cardiac autonomic control and anxiety A comparative study.txt b/subfolder_0/Immediate effect of Indian music on cardiac autonomic control and anxiety A comparative study.txt new file mode 100644 index 0000000000000000000000000000000000000000..1b7ef9eb88ddbd44b8b7da4ba4ce601fe7e84039 --- /dev/null +++ b/subfolder_0/Immediate effect of Indian music on cardiac autonomic control and anxiety A comparative study.txt @@ -0,0 +1,914 @@ +93 +© 2015 Heart India | Published by Wolters Kluwer - Medknow +Immediate Effect of Indian Music on Cardiac Autonomic +Control And Anxiety: A Comparative Study +Karuna Nagarajan, Thaiyar M. Srinivasan, Nagendra Hongasandra Rama Rao +Department of Research, Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusansadha Samsthana (S-VYASA) University, +Bangalore, Karnataka, India +A B S T RA CT +Background: Many studies have shown that music experience is the key to develop future therapies in order to +prevent the development of cardiovascular disorders. Aims: The present study aimed to evaluate the effects of +heart rate variability (HRV) on exposure to Indian raga Bhupali with that of two control groups of pop music and +no music or silence in a sample of healthy subjects. Materials and Methods: Autonomic functioning, anxiety level, +and subjective feeling were assessed in 28 healthy subjects, both male and female [group mean age ± standard +deviation (SD), 19.68 ± 2.57] during three sessions. The three sessions were the musical session intervention with +the Indian raga Bhupali, pop music with steady beats, and “no music session.” Assessments were made before +(5 min), during (10 min), and after (5 min) in each of the three states on 3 separate days. Results: During the Indian +raga, there was a significant decrease in the low frequency (LF) power (P < 0.01) and increase in the high frequency +(HF) power (P < 0.01) in the frequency domain analysis of the HRV spectrum. There was also a significant decrease +in the mean heart rate (HR) (P < 0.01) and a significant increase in the NN50 (P < 0.05) and RMSSD (P < 0.05) in +the time domain analysis of HRV. Both frequency and time domain measures are indicative of parasympathetic +activity. The anxiety level significantly (P < 0.001) decreased post the Indian raga session and significantly (P < 0.01) +increased post the pop session. The subjective assessment of perceived feeling using the visual analog scale +(VAS) comparing Indian raga with pop and silence sessions showed a significant difference of feeling positive (P +< 0.01). Conclusions: Exposure to the Indian raga Bhupali reduced sympathetic activity and/or increased vagal +modulation with reduced anxiety levels and subjective assessment of perceived feeling showed positive changes. +Key words: Aesthetic mood, Heart Rate Variability (HRV), Indian raga Bhupali +Address for correspondence: +Ms. Karuna Nagarajan, Division of Yoga and Life Sciences, +Swami Vivekananda Yoga Anusansadha Samsthana (S-VYASA) +University, # Ekanth Bhavan, Gavipuram Circle, KG Nagar, +Bangalore - 560 019, Karnataka, India. +E-mail: karuna.nag6@gmail.com +INTRODUCTION +Music powerfully modulates social, emotional processes, +cognitive status, and mood, thus contributing to healing.[1] The +Greeks, Hebrews, and Persians used music systematically as a +therapy.[2] Music therapy can be used effectively as a preventive +measure, and it can be used as a supplement to the main treatment +after the onset of the pathological condition. The appropriate +type of music, with specific tonal quality, played at a suitable +time helps to drive out negative feelings such as dependency +and loneliness. Music creates an atmosphere of harmony and +well-being.[3] Musical compositions are complex blends of +expressively organized sound consisting of five elements, viz., +rhythm, melody, pitch, harmony, and interval. These five elements +Access this article online +Quick Response Code: +Website: +www.heartindia.net +DOI: +10.4103/2321-449X.172350 +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 +How to cite this article: Nagarajan K, Srinivasan TM, Rama Rao NH. +Immediate Effect of Indian Music on Cardiac Autonomic Control And +Anxiety: A Comparative Study. Heart India 2015;3:93-100. +O riginal Article +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +94 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +to modify emotions, to let go emotions, to match their current +emotion, to rejoice or pacify themselves, and to relieve stress +and rejuvenate.[10] +It was reported that positive emotions are related to speeded-up +recovery from cardiovascular reactivity generated by negative +emotions for resilient individuals. Research has also shown that +positive emotions may have beneficial physical and psychological +health outcomes by serving a defensive role and thus, providing a +useful remedy to the problems associated with negative emotions +and illness.[11] +The Indian raga Bhupali, which belongs to Kalyan thaat, equivalent +to the Lydian mode[12] of Western music was used in our study. This +raga uses ri, dha teevra or sharp notes, which instill the shringara rasa +or aesthetic mood of love within the listener.[7] This raga is sung +in the evening. Listening to the right raga at the right time is said +to smoothen the natural transitions and attune the body and mind +to the circadian cycle.[2] Our proposal is that autonomic changes +observed in other studies in response to listening to music are +mainly elicited by changes in emotional and psychological states +and these states can be favorably changed by the combination of +notes or swaras used in the raga as mentioned above in the article. +The biological effects of Indian music, leading to its therapeutic +efficacy are not entirely known. In this study, we aimed at further +studying some biological correlate of listening to the particular +Indian raga, which instills a positive aesthetic mood within the +listener. Previous studies have demonstrated that the autonomic +nervous system may serve as a way by which music can be +effectively used for the therapeutic application. This is explored +by the assessment of heart rate variability (HRV). Therefore, the +objective of this study was to assess the effects of exposure to +the Indian raga Bhupali on HRV with that of two control groups +of pop music and no music or silence in a sample of healthy +subjects. Secondarily, we correlated autonomic responses to +musical stimuli with that of the state anxiety level before and +after each music style. No previous studies have investigated the +short-term effects of the Indian raga Bhupali and pop music on +HRV. The understanding of physiological responses induced by +music experience is a key to develop future therapies in order to +prevent the development of cardiovascular disorders. +Heart rate variability and emotions +HRV is a measure of the continuous interplay between +sympathetic and parasympathetic influences on the heart rate +(HR) that yields information about cardiac autonomic flexibility +and thereby represents the capacity for regulated emotional +responding.[13] +In one of the studies, it was documented by McCraty that anger +in a normal sample elicited an increase in the low frequency and +low frequency (LF)/high frequency (HF) ratio components of +HRV, suggesting disruption in sympathovagal discharge caused +are vital when selecting music to invoke both psychological and +physiological responses within the listener.[4] +Indian musicological analysis +Indian music therapy is about the correct intonation and +precise use of the basic elements such as nada (sound), shruti +(musical interval), swara (note), raga (melody) tala (beat), and +laya (rhythm).[3] The four elements noteworthy in this context +are swara or note, Indian raga or melody, rasa or aesthetic mood, +and thaat or mode. +Sa, ri, ga, ma, pa, dha, and ni are the seven notes or swaras of the +Indian musical scale. Each of the notes or swaras either lowered +or raised in pitch, are known as komal (flat note) or teevra (sharp +note). Shadja (Sa) and Panchama (Pa) are two steady or natural notes +having no distortion or displacement. Rishabha (ri), Gandhara (ga), +Madhyama (ma), Dhaivata (dha), and Nishada (ni) are accepted as +having two forms as stated above, namely, one high and one low. +It is total of 12 notes.[5] +Rasa or aesthetic mood is comprehended when an emotion is +awakened in such a manner that it has none of its cognitive +tendencies, and it is experienced in an impersonal contemplative +mood.[6] Raga is the sequence of selected notes (swaras) that lend +an appropriate rasa or aesthetic mood in a selective combination. +Depending on its tonal quality, a raga could induce or intensify joy +or sorrow, excitement or peace, and it is this quality, which forms +the foundation for therapeutic application.[6] Thaat or mode is a +certain array of the seven notes with a change in shuddha (pure), +komal (flat), and teevra (sharp). Every raga has a fixed number of +komal (soft) or teevra (sharp) notes, from which the thaat can be +identified.[7] The shringara rasa or aesthetic mood of love is able +to bring out the beauty and harmony that is present in everything +and every moment. It creates the frame of mind, which enables +us to focus on generating a lovely ambience within oneself and +with one’s friends and family.[8] +The ragas are classified according to the combination of shuddha +(natural), komal (flat), and teevra (sharp) notes or swaras used +and consequently the particular rasas or moods they are able +to produce. Ragas with shuddha or pure notes ri, ga, dha depict +the aesthetic mood or the rasa of love; komal or flat ri, dha create the +rasa of compassion and calmness; komal or flat ga, ni creates the +rasa of courage or self-assurance within the listener.[7] Listening to +Indian ragas, which depict the mood of love, compassion, peace, +and courage, may be used for dissolving negative thoughts and +thereby bringing balance in the mental and emotional states.[5] +The aesthetic mood of calmness is the culmination of other rasas +such as love, compassion, and courage and is transcendental in +nature.[6] The consolidation and evocation of rasa, then, represent +the function of all Indian fine arts, especially music and dance.[9] +Many studies have suggested that the most common purpose of +musical experiences is to persuade emotions: People use music +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +95 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +by increase in the sympathetic contribution. Appreciation, on +the other hand, elicited an increase in the medium frequency +component and a slight increase in the LF component, suggesting +more parasympathetic than sympathetic activation during the +positive emotion.[14] +The activation of the sympathetic branch of the autonomic +nervous system (ANS) increases HR while the activation +of the parasympathetic branch, primarily intervened by the +vagus nerve, slackens it. Variation in the HR can be caused +by a variety of factors including breathing, emotions, and +various physical and behavioral changes. The HR changes +in response to internal body rhythms, many of which reveal +various homeostatic control systems. In general, high HRV +represents a flexible ANS that is responsive to both internal +and external stimuli and is associated with fast reactions and +adaptability. Diminished HRV, on the other hand, represents a +less transient, less flexible ANS that is less able to respond to +stimuli change. It follows that HRV may provide a promising +index of an athlete’s ability to respond to both physical and +emotional stress and thus, of the capacity to perform physically +at maximal levels.[13] +Hypothesis +We hypothesized that the participants who listened to Indian +raga Bhupali would be influenced by the aesthetic mood of the +song that depicts shringara rasa or love. This state of mind would +bring about relaxation. Further, that it would increase cardiac +parasympathetic activity, which is exclusively responsible for +the HF peak of the HR power spectrum. This would also be +correlated with lower scores of state anxiety. We also predicted +that pop music which is much liked by teenagers may be exciting +and cause an increase in cardiac sympathetic activity responsible +for the LF peak of the HR power spectrum. The study also +had another control condition of no music or silence which we +predicted may not help to silence or relax the mind. +MATERIALS AND METHODS +Subjects +Twenty-eight undergraduate college students, both male and +female, with age ranging from 18 years to 24 years (19.68 ± +2.57 years) were recruited for the study. They were all students +of the Residential Yoga University. All of them were of normal +health based on routine case history and clinical examination. +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 +Each subject was assessed in three sessions, into which they +are randomly assigned. Two of them are musical sessions and +one session was without music. One musical session was an +intervention session with the Indian raga Bhupali, based on +popular composition. The second — control session — was with +pop music with steady beats. The third — control session was +silence or “no music session.” All the three sessions consisted +of three states, i.e., “pre” (5 min), “during” (10 min), and “post” +(5 min) for HRV. The allocation of participants to the three +sessions was random using a standard random number table. +The assessments were made on three different days for each +recording, not necessarily on consecutive days but at the same +time of the day (i.e., the self-as-control design). The design is +presented schematically in Figure 1. +Interventions +Baseline HRV was recorded for 5 min. Subsequently, HRV was +recorded for 10 min while the individual was exposed to the +Indian raga Bhupali and again it was recorded for 5 min post +exposure to music. +Indian raga +We used two pieces of melody in the raga Bhupali. The songs +are popular classical-based film music — a.Jyoti Kalash Jhalake +played in the confluence of three instruments, the sitar (Sunil +Das), flute (Rakesh Chaurasia), and santoor (Ulhas Bapat) and +b.Pankh Hoto Uda Aatire flute rendition by Praveen Gorkhindi. +Pop music +The term “pop” is originally derived from an abbreviation of +“popular.” It borrows elements from other preexisting musical +styles, which include urban, dance, Latin, rock, and country.[15] In +general, college students prefer them since it invokes the feeling +of excitement. +We used Electro pop beat — a. “Can’t Keep Me Away” +by Chinchilla Music Production and b. K-391 - Sky City 2013 +by K-391. Both the pieces of music use synthesizers and various +electronic musical instruments. +Assessment +HRV was recorded by using Biopac MP 100 (Biopac Systems +Inc., 42 Aero Camino, Goleta, CA 93117, USA) and analyzed +by Kubios HRV 2.00 software (Biosignal Analysis and Medical +Imaging Group, University of Eastern Finland). The HRV +power spectrum was obtained using Fast Fourier Transform +(FFT) analysis. The energy in the HRV series in the following +Pre 5 min +During Indian raga 10 min +Post 5 min +D1 (5 min) +D2 (5 min) +Pre 5 min +During pop music 10 min +Post 5 min +D1 (5 min) +D2 (5 min) +Pre 5 min +During no music or silence 10 min +Post 5 min +D1 (5 min) +D2 (5 min) +Figure 1: Schematic representation of study design — D1 indicates +during1; D2 during 2 +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +96 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +specific frequency bands studied viz., low frequency (LF) band +(0.05-0.15 Hz) and high frequency (HF) band (0.15-1.50 Hz) +and the LF/HF ratio. The low frequency and high frequency +band values were expressed as normalized units. The following +components of time domain HRV were analyzed: (i) Mean +HR (average number of times your heart beats in one minute), +(ii) RMSSD (root mean square of successive differences) and +(iii) NN50 (the number of interval differences of successive +NN intervals greater than 50 ms). Secondarily, we correlated +autonomic responses to musical stimuli with the anxiety level +before and after each music style and also for “silence” or +“no music” session. The State and Trait Anxiety Inventory +(STAI) was used to assess anxiety.[16] The STAI consists of +40 items divided into two components X1 and Y1, these +two components assess state and trait anxiety respectively in +both clinical and non clinical populations. We have used X1 +component of STAI to assess state anxiety. Scores for both +scales range between 20 (low anxiety) and 80 (high anxiety).[17] +The perceived feeling was measured using the visual analog scale +(VAS). The VAS consists of a horizontal 10-cm line with one +end representing the maximum and the other end representing +the minimum of the variable to be measured.[18] The right +anchor of the scale was identified as “feeling very good” and +the left anchor was labeled “feeling not good” as in Figure 2. +Participants indicated their state of feeling by marking a point +after the experimentation. +Data analysis +Data were analyzed using SPSS for Windows, Version 16.0. +Chicago, SPSS Inc. Released 2007. There were separate repeated +measures of analyses of variance (ANOVAs) for each of the +assessments, with four within-subjects factors [i.e., states (before, +during 1, during 2, and after) and sessions (raga, pop, and silence)]. +Post hoc analysis was with Bonferroni adjustment, comparing after +with before values. +RESULTS +Cardiac measures +The group mean values ± standard deviation (SD) and the +percentage change pre versus post for frequency domain +measures of HRV spectrum for LF, HF, and LF/HF, and time +domain measures of mean HR, RMSSD, and NN50 in three +sessions (raga, pop, and silence) in pre, during, and post states are +given in Tables 1 and 2, respectively. Figures 3 and 4 shows the +trend of percentage change shown in frequency domain measures +and time domain measures of HRV spectrum respectively, +recorded post the Indian raga session and two control sessions +of pop music and silence. +Analysis of variance +The significant changes in both frequency and time domain +measures in thre sessions are given in Table 3. +Post hoc analyses with bonferroni adjustment +Post hoc analyses with Bonferroni adjustment were performed +and all comparisons were made with the respective “pre” states +summarized in Table 4. +In summary, there was a significant decrease in LF (P < 0.01) +and mean HR (P < 0.01) after the raga session compared to the +preperiod. There was a significant increase in HF (P < 0.01), NN50 +(P < 0.05), and RMSSD (P < 0.05) after the raga session compared +to the preperiod. There was a significant decrease in HF (P < 0.05) +and NN 50 (P < 0.05) during the pop session compared to the +prestates. The anxiety level significantly (P < 0.001) decreased post +the raga session as summarized in Table 5. There was a significant +increase in state anxiety level (P < 0.01) after the pop Session. +The subjective assessment of perceived feeling using the VAS +comparing raga with pop and silence sessions showed a significant +positive difference (P < 0.01) as summarized in Table 6. +Figure 3: The trend of percentage change shown in the frequency +domain measures of heart rate variability spectrum recorded post the +Indian raga session and two control sessions of pop music and silence +Figure 4: The trend in arrows and percentage change shown in time +domain measures of heart rate variability spectrum recorded post the +Indian raga session and two control sessions of pop music and silence +Figure 2: Visual analog scale +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +97 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +Psychological stress measures +The anxiety level before and after the sessions of raga, pop, and +silence or no music was assessed using the STAI. +VAS — Visual analog scale +The perceived feeling was measured using VAS for all the +participants following raga, pop, and Silence. Repeated measures +of ANOVA were performed with one “within-subjects” factor, +i.e., raga, pop, and silence sessions. +DISCUSSION +The present study examined the changes in subjective and +psychophysiological responses to the Indian raga Bhupali, pop +music, and no music conditions. The perceived relaxation induced +by Indian raga was shown in both frequency domain and time +domain measures of HRV. +The LF (normalized units) component significantly decreased +and correspondingly HF component significantly increased +Table 2: Time domain measures for 3 sessions in 4 states for mean HR, RMSSD, and NN50, and the percentage +change (pre versus post)a +Measures +Sessions +Pre +During 1 +During 2 +Post +% change +Mean HR +Raga +80.71±11.04 +79.789.99 +79.10±9.74 +77.68±9.86** +3.76 ↓ +Pop +80.32±10.64 +80.61±10.65 +80.86±10.81 +79.54±11.50 +0.98 ↓ +Silence +79.89±8.65 +79.03±8.42 +78.61±8.46 +78.68±7.96 +1.52 ↓ +RMSSD +Raga +50.46±28.28 +54.61±31.30 +58.89±35.46 +59.89 ±29.36* +18.68 ↑ +Pop +56.11±34.23 +49.50±28.41 +47.32±21.99 +47.5 23.39 +15.28 ↓ +Silence +51.36±34.51 +50.46 ±39.24 +50.89±35.35 +50.21±28.97 +2.22 ↓ +NN50 +Raga +84.32±67.46 +98.25±73.26 +102.61±73.01 +108.28±69.29* +28.41 ↑ +Pop +93.86±62.81 +78.86±62.45 +84.11±64.76* +85.4359.92 +8.98 ↓ +Silence +92.61±68.70 +81.71±69.04 +91.96±63.16 +86.86±66.76 +6.2 ↓ +SD: Standard deviation, HR: Heart rate, aValues are group mean ± SD, *P < 0.05, **P < 0.01, ***P < 0.001, ↑: Increase, ↓: Decrease +Table 3: Summary of ANOVA showing statistically significant results +Variables +Factor +F value +DF +Huynh-Feldt epsilon +Level of significance +HF +Session +3.493 +(2,54) +1.000 +P<0.05 +HF +Sessions*states +3.420 +(4.99, 134.721) +0.832 +P<0.01 +LF +Sessions +3.579 +(2,54) +1.000 +P<0.05 +LF +Session*states +3.792 +(5.21,140.70) +0.869 +P<0.01 +Mean HR +States +7.922 +(2.249, 60.719) +0.750 +P<0.01 +Mean HR +Session*states +2.461 +(69.054, 131.368) +0.811 +P<0.01 +NN50 +Session*states +3.795 +(6,162) +1.000 +P<0.01 +ANOVA: Analysis of variance, HF: High frequency, LF: Low frequency, HR: Heart rate +Table 4: Significant results of post hoc analysis where +the arrows show the direction of changes +Variable +Session +During 1 +During 2 +Post +LF +Raga +NS +NS +P>0.01 ↓ +HF +Raga +NS +NS +P<0.01 ↑ +HF +Pop +NS +P<0.05 ↓ +NS +Mean HR +Raga +NS +NS +P< 0.01 ↓ +NN 50 +Raga +NS +NS +P<0.05 ↑ +NN 50 +Pop +NS +P>0.05 ↓ +NS +RMSSD +Raga +NS +NS +P<0.05 ↑ +NS: Not significant, ↑: Increase, ↓: Decrease, HF: High frequency, +LF: Low frequency +Table 1: Frequency domain measures for 3 sessions in 4 states for LF, HF, and LF/HF with a percentage change for +(pre versus post)a +Measures +Sessions +Pre +During 1 +During 2 +Post +% change +Low frequency +(LF) Power +(n.u.) +Raga +50.29±19.95 +42.44±19.09 +43.60±16.0 +42.82±18.79** +14.85 ↓ +Pop +47.11±19.50 +53.49±18.79 +54.62±17.65 +48.12±18.06 +2.13 ↑ +Silence +49.72±20.31 +50.81±21.46 +50.56±19.54 +54.20±19.81 +8.98 ↑ +High frequency +(HF) Power +(n.u.) +Raga +49.52±19.97 +57.34±19.13 +56.20±15.93 +57.06±18.81** +15.21 ↑ +Pop +52.65±19.58 +48.35±19.04 +44.74±17.34* +51.69±17.99 +1.82 ↓ +Silence +50.15±20.29 +48.89±21.39 +49.32±19.49 +45.41±19.53 +9.45 ↓ +LF/HF Ratio +Raga +1.57±1.99 +.89±.83 +.71±.60 +.89±.99 +43.31 ↓ +Pop +2.46±7.03 +1.75±1.29 +1.89±2.35 +1.57±2.38 +36.18 ↓ +Silence +2.64 ±6.91 +3.1±8.32 +2.93±8.51 +2.54±5.94 +10.72 ↓ +SD: Standard deviation, aValues are group mean ± SD, *P < 0.05, **P < 0.01, ***P < 0.001, ↑: Increase, ↓: Decrease +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +98 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +immediately after listening to the Indian raga Bhupali. This was +indicative of reduced arousal and a shift in the autonomic balance +toward parasympathetic dominance. There was a decrease in +the LF/HF ratio, which was not statistically significant. The +LF/HF ratio is correlated with sympathovagal balance.[19] The +LF component of the HRV is mainly related to sympathetic +activation when expressed in normalized units,[20] whereas afferent +vagal activity is a major contributor to the HF component. +Apart from this, there was a significant decrease in the HF +component during pop music, indicative of an increase in cardiac +sympathetic activity.[21] +In the time domain measures, there was a significant increase in +RMSSD and NN50. These indices reflect short-term variation +and are correlated with the HF power or the parasympathetic +activity.[22] There was a significant decrease in the mean HR. +As described above, most of the changes immediately after +listening to Indian raga were indicative of reduced activity in the +different subdivisions of sympathetic nervous system though +some variables are regulated by several factors. The HR, for +example, is regulated by twofold innervations (sympathetic and +parasympathetic), as well as humoral factors.[23] +This makes the decrease in HR complex to interpret (i.e., it could +be due to increased vagal tone or due to sympathetic withdrawal). +This also applies to HRV components. On the contrary, there was +a significant decrease in NN50 of the frequency domain measure +during pop session, which reflects sympathetic activation. +Collectively, the results suggest that the immediate effect of +listening to Indian raga Bhupali is associated with changes in the +autonomic nervous system suggesting vagal control. +This was also correlated with significant reduction in the anxiety +level assessed using the STAI and subjective feeling of the +session. Cardiac vagal tone has been proposed as a stable +biological marker for the ability to sustain attention and regulate +emotion.[24] +Possible mechanism +Previous studies have demonstrated particular profiles of +autonomic responses on different styles of music. This has +prompted the need to explore the effects of Indian raga, which +has the effect of instilling positive emotions within the listener +before it can be proposed as an effective music therapy. +The factors which reflect an emotional and effective response +to music are soothing and relaxing music, urban factors such +Table 5: State Trait Anxiety (STAI) in conditions of Indian raga, pop music, and silencea +Variable +Indian Raga +Pop music +Silence +Pre +Post +% change +P value +Pre +Post +% change +P Value +Pre +Post +% change +P value +STAI 28 +34.00±10.50 +28.32±7.12 +↓16.71 +0.000*** +31.11±7.98 +35.43±8.66 +13.89↑ +0.003** +33.39±9.16 +32.61±11.68 +2.34↓ +0.637 +*P < 0.05, **P < 0.01, ***P < 0.001, ↑ = Increase, ↓: Decrease, SD: Standard deviation, aValues are group mean ± SD +Table 6: Scores on visual analog scale following raga, +pop, and silencea +Sessions +Raga +Pop +Silence +Mean±SD +8.14±1.32 +6.46±2.20** +6.64±1.98** +SD: Standard deviation, aValues are group mean ± SD +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +99 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +as rhythm and percussion, sophisticated factors, which include +classical music, an intense factor such as loudness, forceful and +energetic music, and campestral factor comprising country +and folk songs.[25] We were confident that this stimulus had a +stress-reducing capacity independent of individual preferences +because of the combination of the notes, the aesthetic mood +it instills while listening, the slow tempo, and the popularity of +the piece of music we used. The point to be noted here is that +using researcher-selected music stimuli have been shown to have +greater effects on stress reduction than music stimuli selected by +the subjects themselves.[26] +In general, rock music is preferred by contemporary college +students and heavy metal is mostly preferred by adolescent boys. +Concerns have been raised regarding psychological, emotional, +behavioral, and physical effects associated with this music +preference.[27] Study taking self-report reasons for pop music +preference revealed that characteristics such as the melody, mood, +rhythm, and lyrics of a selection were the important reasons for +preference.[28] But the results in one of the studies indicated that +the dominant factor affecting emotional response was the music +type (either relaxing or stimulating) and not preference.[29] In one +of the studies, the stimulating music aroused feelings of vigor +and tension more than the calming music while sedative music +eased tension. Favorite music, regardless of music type, lowered +subjective tension. Physiological responses (HR, respiration, +and blood pressure) were greater during stimulating music than +during calming music. Music preference did not, however, affect +the physiological responses.[30] +Passive listening to music accelerates breathing rate and increases +blood pressure, HR, and the LF: HF ratio (thus suggesting +sympathetic activation) proportional to the tempo and perhaps +to the complexity of the rhythm.[31] Slow tempo with soothing +notes may have had helped in parasympathetic activation, which +is shown in our study. Pop music with steady beats may have +increased sympathetic activation. +Comparison with previous studies +of music and heart rate variability +There was a differential influence of music-listening on +autonomic activity; it was observed that music resulted in a faster +autonomic recovery after stress compared to the control groups. +[32] The results showed that acute exposure to classical baroque +music reduced the sympathetic tone of the heart while excitatory +heavy metal music decreased the variability of the HR.[33] The +techno music with steady beats was associated with a significant +increase in HR, systolic blood pressure, and significant changes +in self-rated emotional states.[29] The effect of trophotropic +(relaxing) music on HR and HRV was investigated. The results +showed that relaxing music (Bach, Vivaldi, and Mozart) resulted +in a significant reduction of HR. The significance of these +results might be relevant for the use of music in coronary heart +disease is also discussed.[34] Listening to soft music and inhaling +Citrus bergamia essential oil (aroma therapy) was found to be an +effective method of relaxation, as indicated by a shift of the +autonomic balance toward parasympathetic activity in young +healthy individuals.[35] In comparison, our results correlated with +previous studies where the soothing effect of Indian raga showed +similar effects as that of Vivaldi, Mozart, and Bach. Pop music +with steady beats increased sympathetic activation. +CONCLUSION +The present study results suggested the importance of the +aesthetic mood of music in altering autonomic responses and +reducing the anxiety levels. This has also helped in recognizing +the mechanism through which Indian music may affect the +physiological change by instilling a particular aesthetic mood +within the listener. The Indian raga Bhupali may be effectively +used in cardiac regulation and may also facilitate recovery +from poststress anxiety suggestive of applications in clinical +settings. In general, knowledge of musical elements will help +the participants to appreciate and willfully submit to the musical +composition. In our study, the participants were from different +ethnic groups and not all of them had musical training or the +knowledge of the elements of Indian music. In spite of this +factor, the musical stimulus has brought about positive changes. +The study may be extended to various other Indian ragas in +the above applied areas by identifying sensitive physiological +variables. +Respiratory rate is also influenced by the autonomic nervous +system but we did not measure the respiratory rate during the +sessions. This accounted for a limitation in our study. +Acknowledgements +The authors gratefully acknowledge Dr. Hariprasad V R, Dr. +Kashinath Metri and Dr Raghavendra Bhat for their guidance +and Dr. Balram Pradhan for his help in Statistical Analysis. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +REFERENCES +1. +Perez-Lloret S, Diez J, Domé MN, Delvenne AA, Braidot N, +Cardinali DP, et al. Effects of different “relaxing” music styles on +autonomic nervous system. Noise Health 2014;16:279-84. +2. +Christopher SC, Sharma H. Ayurvedic Healing: Contemporary +Maharishi Ayurveda Medicine and Science. USA and UK: Singling +Dragon and imprint of Jessica Kingsley Publishers; 2012. p. 291. +3. +Sharma M. Special Education Music Therapy. New Delhi: S B Nangia +for APH Publishing Corporation; 2007. p. 120. +4. +Murrock CJ, Higgins PA. The theory of music, mood and movement +to improve health outcomes. J Adv Nurs 2009;65:2249-57. +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] +Nagarajan, et al.: Autonomic variables with Indian melody +100 +Heart India, Vol 3 / Issue 4 / Oct-Dec 2015 +5. +Chaitanya DB. An Introduction to Indian Music. Government of +India: Bigamudre Chaitanya Deva Publications Division, Ministry of +Information and Broadcasting; 1973. p. 13, 24. +6. +Karuna N, Srinivasan TM, Nagendra HR. Review of Rāgās and its +Rasās in Indian music and its possible applications in therapy. Int J +Yoga - Philosop Psychol Parapsychol 2013;1:21-8. +7. +Shobhana N. Bhatkhande’s Contribution to Music: A Historical +Perspective. Bombay: Popular Prakashana; 1989. p. 159. +8. +Marchand P, Johari H. The Yoga of the Nine Emotions: The Tantric +Practice of Rasa Sadhana. India: Inner Traditions/Bear & Co.; 2006. p. 34. +9. +Radhakamal M. “Rasas” as Springs of Art in Indian Aesthetics. J +Aesthet Art Crit 1965;24:91-6. +10. +Juslin PN, Västfjäll D. Emotional responses to music: The need to +consider underlying mechanisms. Behav Brain Sci 2008;31:559-621. +11. +Tugade MM, Fredrickson BL, Barrett LF. Psychological resilience and +positive emotional granularity: Examining the benefits of positive +emotions on coping and health. J Pers 2004;72:1161-90. +12. +Bec JH. Encyclopedia of Percussion. New York: Taylor & Francis +Group; 2007. p. 184. +13. +Leah L, Evgeny V, Bronya V, Paul L, Marsha B, Robert P. Heart Rate +variability biofeedback as a strategy for dealing with competitive +anxiety: A case study. Biofeedback 2008;36:109-15. +14. +Newell ME. The Connection between Emotion: Brain Laterization, and +Heart Rate Variability. Bethsda, MD: Uniformed Services University +of Health Sciences; 2005. p. 20814-4799. +15. +Rojek C. Pop Music, Pop Culture. USA: Polity Press; 2011. p. 2. +16. +Laux L, Glanzmann P, Schaffner P, Spielberger CD. Das State-Trait- +Angstinventar. Theoretische Grundlagen und Handanweisungen. +Weinheim: Beltz; 1981. +17. +Spielberger CD, Gorsuch RL, Lushene RE. STAI, Manual for the +State-Trait-Anxiety-Inventory. Palo Alto: Consulting Psychologist +Press; 1970. +18. +Wewers ME, Lowe NK. A critical review of visual analogue scales in the +measurement of clinical phenomena. Res Nurs Health 1990;13:227-36. +19. +Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular +neural regulation explore in the frequency domain. Circulation +1991;84:482-92. +20. +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. Circulation 1996;93:1043-65. +21. +Billman GE. The LF/HF ratio does not accurately measure cardiac +sympatho-vagal balance. Front Physiol 2013;4:26. +22. +Kim DH,  Lipsitz LA,  Ferrucci L, Varadhan R, Guralnik JM, +Carlson  MC, et al. Association between reduced heart rate +variability and cognitive impairment in older disabled women in +the community: Women’s Health and Aging Study I. J Am Geriatr +Soc 2006;54:1751-7. +23. +Andreassi JL. Psychophysiology: Human Behavior and Physiological +Response. Mahwah, NJ: Lawrence Earl Baum Associates; 2007. +24. +Porges SW, Doussard Roosevelt J, Maita AK. Vagal tone and the +physiological regulation of emotions. Monogr Soc Res Child Dev +1994;59:167-86. +25. +Rentfrow PJ, Goldberg LR, Levitin DJ. The structure of musical +preference: A five-factor model. J Pers Soc Psychol 2011;100:1139-57. +26. +Pelletier CL. The effect of music on decreasing arousal due to stress: +A meta-analysis. J Music Ther 2014;41:192-214. +27. +Milton EB, Michael WF, Chi-en H,  David M, Fleetwood KL, +Gregory TD. Schwab effects of listening to heavy metal music on +college women: A pilot study. Coll Stud J 2008;42:24-35. +28. +Boyle JD, Hesterman HL, Ramsey DS. Factors influencing pop music +preferences of young people. J Res Music Educ 1981;29:47-55. +29. +Gerra G, Zaimovic A, Franchini D, Palladino M, Giucastro G, Reali N, +et al. Neuroendocrine responses of healthy volunteers to ‘techno- +music’: Relationships with personality traits and emotional state. Int +J Psychophysiol 1998;28:99-111. +30. +Iwanaga M, Kobayashi A, Kawasaki C. Heart rate variability with +repetitive exposure to music. Biol Psychol 2005;70:61-6. +31. +Bernardi L, Porta C, Sleight P. Cardiovascular, Cerebrovascular, and +respiratory changes induced by different types of music in musicians +and non-musicians: The importance of silence. Heart 2006;92:445-52. +32. +Thoma MV, La Marca R, Brönnimann R, Finkel L, Ehlert U, Nater +UM. The effect of music on the human stress response. PLoS One +2013;8:e70156. +33. +da Silva SA, Guida HL, Dos Santos Antonio AM, de Abreu LC, +Monteiro CB, Ferreira C, et al. Acute auditory stimulation with +different styles of music influences cardiac autonomic regulation in +men. Int Cardiovasc Res J 2014;8:105-10. +34. +Escher J, Evéquoz D. Music and heart rate variability. Study of the +effect of music on heart rate variability in healthy adolescents. Praxis +(Bern 1994) 1999;88:951-2. +35. +Peng SM, Koo M, Yu ZR. Effects of music and essential oil inhalation +on cardiac autonomic balance in healthy individuals. J Altern +Complement Med 2009;15:53-7. +[Downloaded free from http://www.heartindia.net on Thursday, July 28, 2016, IP: 14.139.155.82] diff --git a/subfolder_0/Immediate effect of hot chest pack on cardio-respiratory functions in healthy volunteers A randomized cross-over study.txt b/subfolder_0/Immediate effect of hot chest pack on cardio-respiratory functions in healthy volunteers A randomized cross-over study.txt new file mode 100644 index 0000000000000000000000000000000000000000..3c2cabb9fe14a11a2163ad6b2ac9615153b4d0e3 --- /dev/null +++ b/subfolder_0/Immediate effect of hot chest pack on cardio-respiratory functions in healthy volunteers A randomized cross-over study.txt @@ -0,0 +1,1103 @@ +Accepted Manuscript +Title: Immediate Effect of Hot Chest Pack on +Cardio-Respiratory Functions in Healthy Volunteers: A +Randomized Cross-Over Study +Author: Thoudam Manjuladevi A. Mooventhan N.K. +Manjunath +PII: +S2212-9588(17)30057-5 +DOI: +https://doi.org/doi:10.1016/j.aimed.2017.12.006 +Reference: +AIMED 140 +To appear in: +Received date: +16-6-2017 +Revised date: +28-12-2017 +Accepted date: +29-12-2017 +Please cite this article as: Manjuladevi T, Mooventhan A, Manjunath NK, +Immediate +Effect +of +Hot +Chest +Pack +on +Cardio-Respiratory +Functions +in +Healthy Volunteers: A Randomized Cross-Over Study, Adv. Integr. Med. (2017), +https://doi.org/10.1016/j.aimed.2017.12.006 +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. +Page 1 of 22 +Accepted Manuscript +1 + +Immediate Effect of Hot Chest Pack on Cardio-Respiratory Functions in Healthy Volunteers: A +1 +Randomized Cross-Over Study +2 +Thoudam Manjuladevi,1 A. Mooventhan,2 NK Manjunath3 +3 +1Department of Yoga and Naturopathy, The School of Yoga and Naturopathic Medicine, S- +4 +VYASA University, Bengaluru, Karnataka, India +5 +2Senior medical officer, Department of Yoga, Center for Integrative Medicine and Research +6 +(CIMR), All India Institute of Medical Sciences (AIIMS), New Delhi, India +7 +3Professor, Division of Yoga and Life Sciences, and Head, Department of Research and +8 +Development, S-VYASA University, Bengaluru, Karnataka, India +9 +Corresponding Author: +10 +Dr. A. Mooventhan, + +11 +Senior medical officer, Department of Yoga, Center for Integrative Medicine and Research +12 +(CIMR), All India Institute of Medical Sciences (AIIMS), New Delhi, India +13 +Mobile: +91 9844457496 +14 +E-mail: dr.mooventhan@gmail.com +15 +Number of words +16 +• Abstract +: 238 +17 +• Text + +:2304 +18 +Figures + +: 2 +19 +Tables + +: 2 +20 + +21 +Page 2 of 22 +Accepted Manuscript +2 + +Immediate effect of hot chest pack on cardio-respiratory functions in healthy volunteers: A +1 +randomized cross-over study +2 +ABSTRACT: +3 +Background: Chest pack is one of the common hydrotherapeutic procedures. Though hot chest +4 +pack (HCP) is commonly employed to improve various cardio-respiratory problems, there is no +5 +scientific report validating its effect on either cardiovascular or respiratory functions. The current +6 +study is first of its kind, conducted to evaluate the effect of cardio-respiratory functions in +7 +healthy volunteers. +8 +Materials and Methods: Thirty healthy female volunteers with the age range of 18-24 years +9 +were recruited and randomly divided into 2-groups. Subjects of both the groups underwent 20- +10 +minutes each of HCP (study session) and supine rest (control session) sessions in 2-different +11 +orders. In the first group, 15 subjects underwent HCP on day-1 and SR on day-2, while in the +12 +second group the order of intervention was reversed. Assessments were taken before and after +13 +each session. Statistical analysis was performed using statistical package for the social sciences, +14 +version 16. +15 +Results: A significant reduction in systolic blood pressure was observed both in study and +16 +control sessions. However, a significant reduction in diastolic blood pressure, mean arterial +17 +pressure, pulse rate, rate pressure product (RPP) and double product (Do-P) along with a +18 +significant improvement in peak expiratory flow rate was observed only in the study session +19 +unlike control session. Moreover, reduction in RPP and Do-P was better in study session than in +20 +the control session. +21 +Page 3 of 22 +Accepted Manuscript +3 + +Conclusion: Results of this study suggest that 20 minutes of HCP might be effective in +1 +improving cardio-respiratory functions of healthy volunteers. +2 +Keywords: Blood pressure; Cardiovascular functions; Chest Pack; Hydrotherapy; Naturopathy; +3 +Respiratory functions. +4 +BACKGROUND: +5 +Cardiovascular functions are controlled by neural factors as well as other factors like temperature +6 +and hormones. Of these, the autonomic nervous system (ANS) which is a part of neural factor +7 +plays a major role in maintaining and regulating cardiac functions, e.g. systolic blood pressure +8 +(SBP), diastolic blood pressure (DBP) and heart rate (HR). Imbalances in these lead to +9 +cardiovascular disorders such as hypertension, ischemia and infarction.[1] Cardiovascular +10 +diseases (CVD) are the main cause of mortality worldwide[2] and the leading cause of death for +11 +both men and women.[3] CVD is strongly associated with lifestyle, especially the use of tobacco, +12 +unhealthy diet habits, physical inactivity and psychosocial stress. The World Health +13 +Organization has stated that over three-quarters of the deaths from CVD could be prevented with +14 +adequate changes in lifestyle.[2] Thus, lifestyle modifications are important factors in the +15 +treatment, prevention and rehabilitation of cardiovascular disorders.[1] +16 +Naturopathy is a science of health and healthy living[4] emphasizing on the holistic approach as +17 +compared to the compartmental approach,[5] achieved by inculcating healthy lifestyle in +18 +accordance with the laws of Nature.[4] The said objective is achieved by proper use of different +19 +constituents of naturopathy like hydrotherapy, diet therapy, fasting therapy, mud therapy, helio +20 +therapy, and air therapy individually or in combination.[6] Various studies have evaluated the +21 +usefulness of Naturopathy intervention (alone or in combination with other therapies) for various +22 +Page 4 of 22 +Accepted Manuscript +4 + +diseases +including +bronchial +asthma,[5,7,8] +systemic +lupus +erythematosus,[9] +cervical +1 +spondylosis,[10] rheumatoid arthritis alone[11] and with type 2 diabetes and primary +2 +hypertension,[12] +type +2 +diabetes +mellitus,[13] +metabolic +syndrome,[14,15] +acquired +3 +immunodeficiency syndrome[16] etc. +4 +In hydrotherapy, water in any of its forms (like ice, water, and steam/hot air) is used +5 +externally/internally for the promotion of health or the treatment of various diseases.[6,17,18] +6 +Previous studies have reported ice application to head and spine in healthy individuals, resulting +7 +in a significant reduction in SBP, DBP, pulse pressure (PP), mean arterial pressure (MAP), rate +8 +pressure product (RPP), double product (Do-P)[18] and HR while significantly improving heart +9 +rate variability (HRV) towards vagal dominance.[6] Whereas, head-out warm water immersion +10 +was shown to increases HR and decreases SBP and DBP.[19] Likewise, Sauna therapy (hot air) +11 +was reported to produce increase in left ventricular ejection fraction, improvement in flow +12 +mediated dilation and increase in number of circulating CD34+ cells and reduction in plasma +13 +levels of nor-epinephrine and brain natriuretic peptide.[20] Also through sauna therapy increase in +14 +endothelial nitric oxide synthase activity and improve cardiac function in heart failure cases has +15 +been observed.[21] Sauna therapy was also reported to cause reduction in total and low density +16 +lipoprotein (LDL) cholesterol concentration while at the same time increasing high density +17 +lipoprotein (HDL) cholesterol.[22] +18 +Chest pack, a commonly employed hydrotherapeutic procedures, has been reported to be +19 +effective in relieving cough and expectoration through reducing pulmonary congestion by +20 +bringing the blood to the surface and its powerful action upon the pulmonary mucous +21 +membrane.[23] Though chest pack is commonly applied over both the lung and the heart,[23] +22 +previous study has reported the effect of cold chest pack mainly on lung functions[8] and not on +23 +Page 5 of 22 +Accepted Manuscript +5 + +cardiovascular functions. Though HCP was reported to be useful for various cardio-respiratory +1 +problems,[23] its physiology is not well understood and the findings need further validation +2 +through scientific studies. And, to the best of our knowledge, there is no known study reporting +3 +the effect of HCP on either cardiovascular or respiratory function. Hence, the present study was +4 +conducted to evaluate the effect of HCP on cardio-respiratory functions in healthy volunteers. +5 +MATERIALS AND METHODS: +6 +Study Design: +7 +The study used randomized cross over trail design. Thirty healthy female volunteers were +8 +recruited and randomly divided into 2 groups using computerized randomization. Subjects of +9 +both the groups underwent 20-minutes of HCP (study session) and supine rest (SR) (control +10 +session) in 2 different orders. In the first group, 15 subjects underwent HCP on day-1 and SR on +11 +day-2, while the order was reversed (SR on day-1 and HCP on day-2) in the second group. +12 +Baseline and post-test assessments were performed before and after each session (Figure 1). +13 +Subjects: +14 +Thirty healthy female volunteers between 18-24 years of age were recruited from a residential +15 +University in South India based on the following inclusion and exclusion criteria. Female +16 +subjects with the age range of 18-30 years and willing to participate in the study were included in +17 +the study. Subjects with the history of any systemic and mental illness, those that regularly use +18 +medication for a disease and those who underwent chest pack or any other hydrotherapy +19 +treatments in the past 1-week were excluded from the study. Study was conducted at Anvesana +20 +research laboratories, S-VYASA University, Bengaluru, India. The study was approved by the +21 +institutional ethics committee and written informed consent was obtained from all the subjects. +22 +Page 6 of 22 +Accepted Manuscript +6 + +Intervention: +1 +Study session: Subjects underwent HCP, a cotton cloth approximately 2.5-m long and 0.5 m +2 +wide was soaked in water at 40oC and wrung out completely. It was then wrapped over the chest, +3 +covering both front and back, followed by a wrapping of woolen flannel of the same dimensions +4 +and maintained for a duration of 20 minutes (Figure 2).[8] +5 +Control session: Subjects underwent supine rest for the duration of 20 minutes. +6 +Outcomes variables: +7 +The primary (cardiovascular functions) and secondary outcome (respiratory function) variables +8 +(mentioned below) were taken before and after each intervention session as mentioned below: +9 +Cardiovascular Variables: SBP and DBP were assessed using a sphygmomanometer (diamond +10 +BPMR-120 Mercurial BP Delux, Pune, India). Pulse rate (PR) was assessed by placing fingers +11 +over the radial artery of the left hand. Assessments such as PP, MAP, RPP, and Do‑P were +12 +derived using following formulas: PP was calculated as (SBP - DBP); MAP as (DBP + 1/3 PP); +13 +RPP as (HR × SBP/100); and Do‑P as (HR × MAP/100).[18] +14 +Respiratory Variable: Peak expiratory flow rate (PEFR) was recorded using the Mini-Wright +15 +(CE0120) peak flow meter (Clement Clarke International Limited, Edinburgh Way, UK) as per +16 +the standard method of Wright and Mckerrow.[24] Briefly, the subjects were instructed to take a +17 +maximal inspiration and blow into the mouth piece of the device rapidly and forcefully while +18 +standing. The values of PEFR achieved in 3 successive attempts were recorded and highest of the +19 +3 values was taken for the analysis.[5,8] The investigator was kept blinded for the study and +20 +control sessions. +21 +Page 7 of 22 +Accepted Manuscript +7 + +Sample size: +1 +Thirty healthy female volunteers with the age varied from 18-24 years were recruited. Sample +2 +size was not calculated based on any previous study or pilot study which is one of the limitations +3 +of the study. +4 +Randomization: +5 +Subjects were randomly divided into 2 groups [i.e. 1) first group and 2) second group] using +6 +computerized randomization. +7 +Blinding/masking: +8 +Since the same subjects underwent both study and control sessions, it was not possible to blind +9 +the intervention from the participants. However, the investigator was blinded for the study and +10 +control sessions. +11 +Statistical Analysis: +12 +Data were checked for the normality using Kolmogorov-Smirnov test. Statistical analysis of +13 +within and between sessions was performed using students paired samples-t-test (when data that +14 +was normally distributed) and Wilcoxon signed ranks test (when data that was not normally +15 +distributed) with the use of Statistical Package for the Social Sciences (SPSS) for Windows, +16 +Version 16.0. Chicago, SPSS Inc. p-value<0.05 was considered as significant. +17 + +18 + +19 + +20 +Page 8 of 22 +Accepted Manuscript +8 + +RESULTS: +1 +The demographic and baseline characteristics of the first and second groups were matching and +2 +no significant changes existed between the groups (Table 1). Results of the study showed a +3 +significant reduction in SBP both in study and control session. However, a significant reduction +4 +in PR, DBP, MAP, RPP and Do-P along with a significant improvement in PEFR was observed +5 +only in the study session, while no such significant changes were observed in the control session. +6 +Moreover, the reduction in RPP and Do-P was better in the study session than control session +7 +(Table 2). None of the subjects reported any serious adverse effects during the study period. +8 +DISCUSSION: +9 +Parameters such as SBP, DBP, PP and MAP are known as the best predictors of CVD risks.[25] +10 +PEFR has been used in many studies as one of the most important variables to evaluate the +11 +pulmonary functions.[5,8] Results of this study showed a significant reduction in SBP both in +12 +study and control sessions. It suggests that both 20 minutes of HCP and SR is effective in +13 +reducing SBP. Significant reduction in SBP followed by 20 minutes of HCP might be due to its +14 +effects on either baroreceptor reflex or reduction of HR/PR. Because, SBP = cardiac output (CO) +15 +× peripheral resistance, wherein CO = HR × stroke volume and thus HR forms one of the +16 +determinants of SBP.[1,18] However, the reduction in SBP followed by 20 minutes of SR is not +17 +clear since there was no significant reduction in HR and thus needs to be explored in the future +18 +studies. +19 +Results of this study also showed a significant reduction in PR, DBP, MAP, RPP and Do-P along +20 +with a significant improvement in PEFR only in the study session, while no such significant +21 +changes were observed in the control session when compared with its respective baseline, +22 +Page 9 of 22 +Accepted Manuscript +9 + +suggesting that 20 minutes of HCP was effective in improving various cardiorespiratory +1 +variables unlike SR. Significant reduction in DBP and MAP in HCP session, unlike in SR +2 +session, can be attributed to the reduction in centrally mediated peripheral resistance or +3 +vasodilatation through local thermal mechanisms. Also, Reduction in RPP and Do‑P seen in the +4 +study session might be due to the reduction in PR and BP. RPP and Do‑P are the important +5 +indirect indicators of myocardial oxygen consumption and load on the heart. Reduction of these +6 +variables in the study session suggests a strain lowering effects on the heart. Besides, when HR +7 +variability (HRV) analysis is not available, the RPP can be employed as a simple measure of +8 +overall HRV.[18,26] Hence, a significant reduction in both RPP and Do-P after 20 minutes of HCP +9 +application compared with SR again indicates its strain lowering effect and better autonomic +10 +regulation of the heart. +11 +Significant reduction in cardiovascular variables along with significant improvement in PEFR in +12 +the study session unlike control session, suggests that the 20 minutes of HCP was effective not +13 +only in improving cardiovascular functions but also effective in improving respiratory functions. +14 +The improvement in the respiratory functions might attribute through increasing the blood to the +15 +surface there by reducing the pulmonary congestions and/or through its powerful action upon the +16 +pulmonary mucous membrane as stated in a hydrotherapy text.[23] +17 +In a previous study, 30 minutes of cold chest pack was reported to increase the pulmonary +18 +function in patients with bronchial asthma by means of increasing PEFR.[8] Similarly, in the +19 +present study, 20 minutes of HCP has resulted in improving pulmonary functions (increased +20 +PEFR). Though the temperature of the water used for the chest pack was different in these +21 +studies, better improvement in pulmonary function was observed in both the studies. Hence, a +22 +Page 10 of 22 +Accepted Manuscript +10 + +comparative study on hot and cold chest pack is needed in future to address the efficacy of these +1 +treatments with one another. +2 +Acute myocardial infarction is thought to result from thrombosis or plaque rupture because of +3 +coronary artery spasm. Alternating heat exposure (sauna bath) followed by rapid cooling by cold +4 +water might induce vasospasm by stimulation of the alpha-adrenergic receptors in patients with +5 +coronary risk factors.[27] Hence, cold applications to chest, immediately after the prolong intense +6 +HCP, might cause adverse effects, which need to be studied in future. Thus it is not advisable to +7 +use very cold application immediately after prolong hot application to chest. Also, hot +8 +application in case of early pregnancy is a potential concern because of evidence suggesting that +9 +hyperthermia might be teratogenic.[28] Hence, very hot application for a prolong time should be +10 +avoided in pregnancy. +11 +Results of the present study suggest that the HCP can be given to healthy volunteers who would +12 +like to improve their cardio-respiratory functions and for the people who are at risk of +13 +developing cardiovascular and pulmonary diseases to prevent the occurrence of these diseases. +14 +Since the application of HCP improves various cardiovascular functions including reduction in +15 +BP and cardiac work load (as indicated by reduction in RPP and Do-P), it might be useful in +16 +people with high blood pressure, coronary artery disease and cardiac failure. Similarly, +17 +improvement in pulmonary function followed by the application of HCP suggests that it might be +18 +useful for the people with persistent cough due to pulmonary congestions, bronchial asthma, +19 +chronic obstructive pulmonary diseases etc. However, further studies (clinical trials) are required +20 +to warrant the beneficial effect of HCP on the above mentioned clinical conditions. +21 +Page 11 of 22 +Accepted Manuscript +11 + +Strength of the study: To our knowledge this is the first study to evaluate the effect of HCP on +1 +cardio-respiratory functions in healthy volunteers. None of the subjects reported any adverse +2 +effects during the intervention. Limitations of the study: Study was conducted on healthy female +3 +volunteers that limit the scope of this study in its application to healthy male subjects and in +4 +pathological conditions including cardio-respiratory problems considering the body composition +5 +and physiological changes of male and female as well as healthy and ill peoples are different. +6 +Missing sample size calculation and the small sample size utilized in the study can be construed +7 +as a limitation. Assessment of other cardio-respiratory parameters, namely slow and forced vital +8 +capacities, diffusion capacity, lung volumes, total lung capacity, HRV, peripheral arterial +9 +resistance, continuous BP monitoring, and baroreceptor sensitivity would have given a better +10 +understanding of the state of the pulmonary functions and the cardiovascular functions +11 +respectively. The present study assessed only the immediate effects of HCP on cardio-respiratory +12 +functions. Assessing HCP’s long-term application effects and its underling mechanisms could +13 +elevate this technique as a potential preventive and curative therapy. Hence, further studies are +14 +required (Randomized control trials) on a large sample size with longer duration and advanced +15 +techniques to evaluate its precise physiological and therapeutic effects with underlying +16 +mechanisms. +17 +CONCLUSION: +18 +Results of this study suggest that 20 minutes of HCP might be effective in improving cardio- +19 +respiratory functions of healthy volunteers. +20 +SOURCE OF FUNDING: Nil +21 +CONFLICT OF INTEREST: None declared +22 +Page 12 of 22 +Accepted Manuscript +12 + +ACKNOWLEDGEMENT: We thank for their help in editing the manuscript. +1 +REFERENCES: +2 +1. Muralikrishnan K, Balakrishnan B, Balasubramanian K, Visnegarawla F. Measurement +3 +of the effect of Isha Yoga on cardiac autonomic nervous system using short-term heart +4 +rate variability. J Ayurveda Integr Med. 2012;3:91-6. +5 +2. Naumann J, Sadaghiani C, Bureau N, Schmidt S, Huber R. Outcomes from a three-arm +6 +randomized controlled trial of frequent immersion in thermoneutral water on +7 +cardiovascular risk factors. BMC Complement Altern Med. 2016;16:250. +8 +3. Chaddha A. Slow breathing and cardiovascular disease. Int J Yoga. 2015;8:142-3. +9 +4. Rajiv Rastogi. Current Approaches of Research in Naturopathy: How Far is its Evidence +10 +Base?. J HomeopatAyurv Med 2010; 1: 107. +11 +5. Murthy SN, Rao NSN. Efficacy of Naturopathy and Yoga Treatment in Bronchial +12 +Asthma. Indian J Allergy Asthma Immunol 2009;23:37-42. +13 +6. Mooventhan A, Nivethitha L. Effects of ice massage of the head and spine on heart rate +14 +variability in healthy volunteers. J Integr Med 2016;14:306-10. +15 +7. Sathyaprabha TN, Murthy H, Murthy BT. Efficacy of Naturopathy and Yoga in +16 +Bronchial Asthma-A self controlled matched scientific study. Ind J PhysiolPharmacol. +17 +2001;45:80-86. +18 +8. Manjunath NK, Shirley T. Therapeutic application of cold chest pack in bronchial +19 +asthma. W J Med Sci. 2006;1:18-20. +20 +Page 13 of 22 +Accepted Manuscript +13 + +9. Mooventhan A, Nivethitha L. Effects of acupuncture and massage on pain, quality of +1 +sleep and health related quality of life in patient with systemic lupus erythematosus. J +2 +Ayurveda Integr Med. 2014;5(3):186-9. +3 +10. Rastogi R, Bendore P. Effect Of Naturopathy Treatments And Yogic Practices On +4 +Cervical Spondylosis-A Case Report. Indian J PhysiolPharmacol. 2015;59(4):442-5. +5 +11. Shetty GB, Mooventhan A, Anagha N. Effect of electro-acupuncture, massage, mud, and +6 +sauna therapies in patient with rheumatoid arthritis. J Ayurveda Integr Med. +7 +2015;6(4):295-9. +8 +12. Mooventhan A, Shetty GB. Effect of Integrative Naturopathy and Yoga in a Patient with +9 +Rheumatoid Arthritis Associated with Type 2 Diabetes and Hypertension. AncSci Life. +10 +2017;36(3):163-166. +11 +13. Bairy S, Kumar AM, Raju M, Achanta S, Naik B, Tripathy JP, et al. Is adjunctive +12 +naturopathy associated with improved glycaemic control and a reduction in need for +13 +medications among type 2 Diabetes patients? A prospective cohort study from India. +14 +BMC Complement Altern Med. 2016;16(1):290. +15 +14. Mooventhan A, Shetty GB. Effect of integrative naturopathy and yoga therapies in +16 +patient with metabolic syndrome. Int J Health Allied Sci 2015;4:263-6. +17 +15. Gowda S, Mohanty S, Saoji A, Nagarathna R. Integrated Yoga and Naturopathy module +18 +in management of Metabolic Syndrome: A case report. J Ayurveda Integr Med. +19 +2017;8(1):45-48. +20 +Page 14 of 22 +Accepted Manuscript +14 + +16. Joseph B, Nair PM, Nanda A. Effects of naturopathy and yoga intervention on CD4 count +1 +of +the +individuals +receiving +antiretroviral +therapy-report +from +a +human +2 +immunodeficiency virus sanatorium, Pune. Int J Yoga. 2015;8(2):122-7. +3 +17. Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on +4 +various systems of the body. N Am J Med Sci. 2014 May;6(5):199-209. +5 +18. Mooventhan A. Immediate effect of ice bag application to head and spine on +6 +cardiovascular changes in healthy volunteers. Int J Health Allied Sci 2016;5:53-6. +7 +19. Digiesi V, Cerchiai G, Mannini L, Masi F, Nassi F. Hemorheologic and blood cell +8 +changes in humans during partial immersion with a therapeutic method, in 38 o C water. +9 +Minerva Med. 1986;77:1407–11. +10 +20. Ohori T, Nozawa T, Ihori H, Shida T, Sobajima M, Matsuki A, et al. Effect of repeated +11 +sauna treatment on exercise tolerance and endothelial function in patients with chronic +12 +heart failure. Am J Cardiol. 2012;109:100–4. +13 +21. Sobajima M, Nozawa T, Shida T, Ohori T, Suzuki T, Matsuki A, et al. Repeated sauna +14 +therapy attenuates ventricular remodeling after myocardial infarction in rats by increasing +15 +coronary vascularity of non-infarcted myocardium. Am J Physiol Heart Circ Physiol. +16 +2011;301:H548–54. +17 +22. Pilch W, Szyguła Z, Klimek AT, Pałka T, Cisoń T, Pilch P, et al. Changes in the lipid +18 +profile of blood serum in women taking sauna baths of various duration. Int J Occup Med +19 +Environ Health. 2010;23:167–74. +20 +Page 15 of 22 +Accepted Manuscript +15 + +23. Kellogg JH. Rational Hydrotherapy. 2nd edition. Pune: National Institute of Naturopathy. +1 +2005. +2 +24. Wright, B.M. and C.B. Mckerrow, 1959. Maximum forced expiratory flow as a measure +3 +of ventilatory capacity. British Med J. 1959;2:1041-7. +4 +25. Nivethitha L, Mooventhan A, Manjunath NK. A pilot study on evaluating cardiovascular +5 +functions during the practice of Bahir Kumbhaka (external breath retention). Advances in +6 +Integrative Medicine. 2017; 4: 7-9. +7 +26. Bhavanani AB, Madanmohan, Sanjay Z. Immediate effect of chandranadi pranayama +8 +(left unilateral forced nostril breathing) on cardiovascular parameters in hypertensive +9 +patients. Int J Yoga 2012;5:108‑11. +10 +27. Imai Y, Nobuoka S, Nagashima J, Awaya T, Aono J, Miyake F, et al. Acute myocardial +11 +infarction induced by alternating exposure to heat in a sauna and rapid cooling in cold +12 +water. Cardiology. 1998;90:299–301. +13 +28. Crinnion WJ. Sauna as a valuable clinical tool for cardiovascular, autoimmune, +14 +toxicantinducedAnd other chronic health problems. Altern Med Rev. 2011;16:215–25. +15 + +16 + +17 + +18 + +19 + +20 + +21 +Page 16 of 22 +Accepted Manuscript +16 + +Figure 1: Trial Profile +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 +Assessed for Eligibility (n=41) +Recruited Subjects (n=30) +Exclusion (n=11): Did +not fulfill the criteria +Randomization (n=30) +First Order (n = 15) +Second Order (n=15) +Day 1 +Day 2 +Day 2 +Day 1 +Baseline +(n=15) +Baseline +(n=15) +Baseline +(n=15) +Baseline +(n=15) +HCP (n=15) +SR (n=15) +SR (n=15) +HCP (n=15) +Post-test +(n=15) +Post-test +(n=15) +Post-test +(n=15) +Post-test +(n=15) +Data Analysis (n=30) +Page 17 of 22 +Accepted Manuscript +17 + + +1 +Note: HCP = Hot Chest Pack; SR = Supine Rest +2 + +3 +Figure 2: Hot chest pack given to the study subjects (n = 30) +4 + +5 + +6 + +7 + +8 +Page 18 of 22 +Accepted Manuscri +TABLES: +Table 1: Demographic Variables of the First Group (n = 15) and Second Group (n = 15) +Variables +First Group (n = 15) +Second Group (n = 15) +p value (Independent samples-t-test) +Age (years) +20.60±1.50 +20.13±1.46 +0.395 +Gender +Female (n = 15) +Female (n = 15) +_ +Height (meter) +1.61±0.07 +1.61±0.05 +0.816 +Weight (kilogram) +52.80±5.20 +52.00±4.86 +0.666 +Body mass index (kilogram/meter2) +20.43±1.38 +20.18±1.73 +0.665 +Peak expiratory flow rate (l/min) +302.00±64.28 +336.00±48.67 +0.114 +Systolic blood pressure (mmHg) +117.33±7.77 +113.33±7.43 +0.161 +Diastolic blood pressure (mmHg) +77.07±7.81 +73.47±9.75 +0.274 +Pulse rate (beats/minute) +77.20±7.09 +73.80±5.21 +0.146 +Page 19 of 22 +Accepted Manuscri +Pulse pressure (mmHg) +40.27±7.55 +39.87±8.47 +0.892 +Mean arterial pressure (mmHg) +90.49±6.94 +86.76±8.12 +0.187 +Rate pressure product +90.76±11.87 +83.62±7.95 +0.063 +Double product +70.04±9.96 +64.07±7.89 +0.079 +Note: First group = Subjects underwent hot chest pack on day-1 and supine rest on day-2; Second group = Subjects underwent supine +rest on day-1 and hot chest pack on day-2. + + + + + + + + + +Page 20 of 22 +Accepted Manuscri +Table 2: Baseline and Post-test Assessments of Study (Hot Chest Pack) and Control (Supine Rest) Sessions +Between SessionAnalysis +Variables +Assessment +Hot Chest Pack Session (n= 30) +with Within Group Analysis +Supine Rest Session (n= 30) +with Within Group Analysis +t/z value +p value +Baseline +321.33±54.76 +324.33±50.97 +-0.493 +0.626* +Post-test +343.67±46.94 +334.00±55.12 +1.501 +0.144* +PEFR (l/mint) + +t = -3.999 +p < 0.001* +t = -1.607 +p = 0.119* + +Baseline +113.73±8.05 +114.13±8.72 +-0.251 +0.803* +Post-test +109.33±9.00 +111.33±7.51 +-1.246 +0.213¶ +SBP (mmHg) + +t = 4.199 +p < 0.001* +z =-2.325 +p = 0.020¶ + +Baseline +76.20±8.21 +75.33±8.29 +-0.599 +0.549¶ +Post-test +73.13±7.57 +74.47±7.78 +-0.651 +0.515¶ +DBP (mmHg) + +z = -2.626 +p = 0.009¶ +z = -1.231 +p = 0.218¶ + +Page 21 of 22 +Accepted Manuscri +Baseline +76.47±7.00 +76.67±7.46 +-0.145 +0.886* +Post-test +74.13±7.24 +76.57±6.34 +-1.610 +0.118* +PR +(beats/mint) + +t = 2.251 +p = 0.032* +t = 0.080 +p = 0.937* + +Baseline +37.53±7.50 +38.80±9.61 +-0.622 +0.539* +Post-test +36.20±6.73 +36.87±9.17 +-0.362 +0.720* +PP (mmHg) + +t = 1.149 +p = 0.260* +t = 1.540 +p = 0.134* + +Baseline +88.71±7.35 +88.27±7.12 +0.328 +0.745* +Post-test +85.20±7.42 +86.76±6.36 +-1.095 +0.282* +MAP (mmHg) + +t = 4.017 +p < 0.001* +t = 1.838 +p = 0.076* + +Baseline +87.10±11.37 +87.54±11.11 +-0.232 +0.818* +Post-test +81.02±10.50 +85.32±9.81 +-2.026 +0.043¶ +RPP + +z = -3.644 +p < 0.001¶ +t = 1.319 +p = 0.197* + +Page 22 of 22 +Accepted Manuscri +Baseline +67.91±9.17 +67.85±9.93 +0.036 +0.972* +Post-test +63.12±8.21 +66.50±7.89 +-2.151 +0.040* +Do-P + +t = 4.273 +p < 0.001 +t = .957 +p = 0.347 + +Note: All values are in Mean ± Standard Deviation. *= Paired samples-t-test; ¶=Wilcoxon Signed Ranks Test. PEFR = Peak +expiratory floe rate; SBP = Systolic blood pressure; DBP = Diastolic blood pressure; PR = Pulse rate; PP = Pulse pressure; MAP = +Mean arterial pressure; RPP = Rate pressure product; Do-P = Double product. + diff --git a/subfolder_0/Immediate effect of stimulation in comparison to relaxation in healthy volunteers.txt b/subfolder_0/Immediate effect of stimulation in comparison to relaxation in healthy volunteers.txt new file mode 100644 index 0000000000000000000000000000000000000000..9fe526f5c018cec58d5650531734b0ff770ae6b8 --- /dev/null +++ b/subfolder_0/Immediate effect of stimulation in comparison to relaxation in healthy volunteers.txt @@ -0,0 +1,621 @@ +Indian Journal of Traditional Knowledge +Vol. 9 (3), July 2010, pp 606-610 + + + + + + +Immediate effect of stimulation in comparison to relaxation in healthy volunteers +Sushil SK*, Nagendra HR & Nagarathna R +Swami Vivekananda Yoga Anusandhana Samsthana, 19 Eknath Bhavan, Gavipuram Circle, Bangalore 560 019, Karnataka +E-mail: hariomsushil@gmail.com +Received 14 March 2008; revised 20 October 2009 +In this self-control, cross over study carried out over two consecutive days, 43 healthy male volunteers aged 20-45 yrs +practiced 20 minutes Kapalbhati and 20 minutes Breath Awareness. Subjects were assessed before and after both practices +for State Anxiety, sustained attention (Six Letter Cancellation and Digit Letter Substitution tests), and verbal and spatial +memory. After Kapalbhati, scores reduced significantly on State Anxiety, and increased on both sustained attention, and +verbal and spatial memory; statistical significance was high on all variables (p<0.001). After Breath Awareness, changes +were also significant (p<0.001) on all variables except State Anxiety (p>0.05). +Keywords: Yoga, Kapalbhati, Anxiety, Attention, Memory +IPC Int. Cl.8: A61P25/00 +Modern business trends both reduce physical activity +and increase mental strain, making for life-styles +that are tamasic, yet hyperactive. Minimal physical +activity results in lethargy, yet rajasic influences of +ambition fueled by strong desire drive attached +modes of action. This combination creates stress and +fatigue. One solution is a two fold process of sadhana +contained in Mandukya Upanishad: laye sambodhayet +chittam (when the mind becomes lethargic, stimulate +and awaken it); and vikshiptam samyet punah +(when it speeds up and distractions set in, calm it). +A +pranayama +process +combining +Kapalbhati +(stimulating) and breath awareness (calming) can +achieve this, removing stress of all kinds, and +developing attention span and memory1. Studies +suggest that yoga breathing increases spatial rather +than verbal scores without a lateralized effect2. In +one study, the yoga group showed significant +increases in spatial memory test scores, while verbal +memory test scores remained the same in all +subjects3. Improvement in spatial memory scores +following yoga can be related to reduced anxiety, +which improves performance on memory tasks4. +Practicing yoga may help in memory development by +deepening +perception, +reducing +distractibility/ +increasing the attention span, activating dormant areas +and sifting useful memories from useless ones for our +overall development. kapalbhati, breathing practices +and pranayama techniques are known to develop +and to improve memory5. Study of a student group +(mean age 20.7 yrs), showed that forced left +nostril breathing increased spatial performance on a +cognitive task6. +Kapalbhati is a pranayama technique, which +invigorates the entire brain and awakens dormant +centers responsible for subtle perception7. The Hath +Ratnavali defines it as fast rotation of the breath from +left to right / right to left, or exhalation and inhalation +through both nostrils together. Kapalbhati helps +eliminate CO2, cleans air passages, stimulates +abdominal organs, and improves autonomic balance8. +Increased blood circulation and O2 levels revitalize +and activate brain cells concerned with memory and +other functions, increasing concentration, improving +memory, and stimulating intellectual faculties9. Other +studies found unilateral forced nostril breathing to +improve spatial and verbal performance, and that +30-45 seconds kapalbhati increases breath holding +time (important for yoga sadhana)10,11. For anxiety +and depression, alternating fast and slow breathing +practices for 20-30 minutes, starting with kapalbhati +(fast breathing) before pranayama (slower breathing), +stops persistent worry12. Relaxation with Guided +Imagery (RGI) script yields short term reduction in +State-Trait Anxiety Inventory (STAI) scores, as +shown in each of three tests on nursing students13. +A previous study has investigated the effect of +stimulants on psycho-motor performance. Subjects +—————— +* Corresponding author +SUSHIL et al.: EFFECT OF STIMULATION IN HEALTHY VOLUNTEERS + + +607 +were served either a hot drink without coffee or a hot +drink with coffee before taking the digit letter +substitution (DLS) or six letter cancellation (SLC) +tests. Results indicated significant increases in scores +on both tests following coffee administration, +confirming coffee's stimulating effects on psycho- +motor functions, and suggesting that that improved +test performance14. No previous study has assessed +kapalbhati on measures of anxiety, sustained +attention, or verbal and spatial memory, nor has it +been compared with breath awareness for its effects +on these variables. Hence, the reasons for this study +being carried out. + +Methodology + +Subjects +Forty three healthy males aged 20-45 yrs +(mean 28 yrs) volunteered from groups completing +SVYASA one month residential yoga courses. They +were divided into 2 groups labeled kapalbhati (KB) +and Breath Awareness (BA). + +Inclusion Criteria +Subject health was verified by routine clinical +examination and general health questionnaire (GHQ) +scores (<4). None was taking medication. Aims and +methods of the study were explained to them; all gave +written informed consent. + +Designs +This was a crossover self-control study. The KB +group did kapalbhati on the first day and breath +awareness the second day; for the BA group, the order +was reversed. + +Assessments +Assessments were made before and after KB and +BA practice at the same time on two consecutive +days. + +Instruments +STAI is a self-report instrument, for study of state +and trait anxiety. State anxiety (STAI A-State) +reflects transitory emotional states characterized +by subjectively perceived feelings of tension, +apprehension, and heightened ANS activity. Intensity +may fluctuate over time15. The test consists of a +worksheet with 4 statements describing different +states of anxiety, said to be the most common in +measuring present anxiety. Subjects select score +numbers against each statement indicating frequency +of occurrence of these states: almost never, +sometimes, often, and almost always. STAI-A scores +have a direct interpretation: high scores mean more +state anxiety; low scores mean less. The six letter +cancellation (SLC) test and digit letter substitution +(DLS) test require visual selectivity and repetitive +motor response. They assess selective, focused and +sustained attention, visual scanning and activation and +inhibition of rapid responses, helping isolate major +components +of +performance +like +detection, +perception, recognition, processing and integration. +Both have been standardized for Indian populations16. +They are valid for the study of immediate effects14. +The SLC test consists of a worksheet containing +22 rows × 14 columns randomly arranged letters of +the alphabet, and specifying 6 target letters to be +canceled. Subjects strike out as many target letters as +possible in the specified time (90 seconds). The DLS +test consists of a worksheet containing 12 rows × 8 +columns randomized digits, with a key specifying +pairings between digits 1-9 and Roman letters. +Subjects substitute as many target digits as possible +in the specified time of 90 seconds16. These 2 tests +are standard measures of attention span, hence +their selection. The verbal memory test consists of +4 different sets of 10 nonsense syllables, e.g. ZOC +enough to be presented both pre and post the KB and +BA interventions. The spatial memory test consists +of 10 line drawings of easily described geometrical +or other shapes, that are simple and reproducible +(not square or circle). As for verbal memory, 4 similar +sets of drawings are used, one each, pre and post +KB and BA interventions3,17. Each test is projected +on a laptop for the subjects allowing 10 seconds +for each slide. Immediately after the slides, subjects +are shown a mathematical problem on the screen +(e.g. 3+5-2+4-2-5+6-3). Subjects are then asked to +recall and write down (or draw in the case of spatial +memory) as many of the 10 test items as they can +within 60 seconds. + +Test Reliability and validity +Reliability refers to consistency of measurement, +reflected in score reproducibility. Validity concerns +how well a test measures what it purports to. The +STAI and sustained attention tests have been +evaluated for them based on standard criteria. A-State +anxiety scores have high degrees of internal +consistency15. Their point–biseral r (Pb) correlations +are 0.60 and 0.73, respectively15. For the SLC test, +reliability is ascertained based on temporal stability +and internal consistency18. In the first, the correlation +INDIAN J TRADITIONAL KNOWLEDGE, VOL 9, NO. 3, JULY 2010 + + +608 +coefficient was calculated using unpublished pilot +data collected on 29 healthy male volunteers. +Spearman’s correlation coefficient was calculated +between data collected before and after a 23 min +non-specific intervention: subjects read a book of +their choice, while remaining seated. The net score +variable for which correlation was calculated +remained stable (r=.781, p=.002). As the SLC test +consists of one variable, internal consistency cannot +be calculated. Content validity of this test is adequate +for its intended purpose. Corresponding data on +the DLS test are unfortunately not available. The tests +of verbal and spatial memory developed at SVYASA +clearly test the intended variable and are valid; +their reliability is currently being more precisely +evaluated. + +Interventions +Instructions were delivered by audiotape for the +20 minutes performance of both practices; one minute +practice was followed by one minute relaxation, +repeated 10 times. Subjects sat with their spine +straight. For kapalbhati, instructions were as follows: +Sit straight keeping your head, neck, spine erect. Take +a deep inhalation, exhale forcibly, blast out the air +using abdominal muscle, inhale passively relaxing the +abdominal muscles, and repeat these movements as +quickly as possible starting with 60 strokes per +minutes and increasing gradually up to 80 strokes per +minute. There is no holding of breath. The rapid +active exhalation with passive effortless inhalation is +accomplished by flapping movement of the abdomen, +continued at a uniform speed of 80 strokes per +minute. It is continued for 1 minute, slowing down +gently at the end. Following each minute's KB +practice, relaxation instructions were given as +follows: Relax … relax …yourself. Allow your +abdominal muscles to relax; relax your whole body +and mind, enjoy the deep silence of the mind, relax… +relax…! Breath awareness practice was performed +similarly: one minute practice was followed by one +minute relaxation, repeated ten times. Instructions +were as follows: Sit comfortably, relax yourself, +become aware of your breathing, just observe your +breathing pattern, simply observe, do not manipulate, +just go on observing, maintain your awareness +towards breathing, just observe, now relax, relax +yourself totally from toes to head, allow relaxation +to continue all your body and mind..! The same +relaxation instructions were used as in the KB session. + +Data analysis +Statistical analysis was done using SPSS (version +10.0). Data were assessed for normality using the +Kolmogorov-Shapiro Test. Paired ’t’ tests and RM +ANOVA tests were used to assess significance within +and between groups, respectively. + +Results +The Kolmogorov–Shapiro tests of normality +showed pre data of SAS, SLC and DLS tests were +normally distributed for both groups, while pre-data +of the two memory tests were not normally +distributed. The group means values, standard +deviation values, p values and percentage change +values of both groups, i.e. of kapalbhati and breath +awareness are given below (Table 1). The STAI +A-State (SAS) test of relatively labile state anxiety, +Table 1— Pre-post changes in measured variables +KB +BA +Test +N=43 +Mean +± SD +P- +value +Post-pre +% change +Mean +± SD +P-value +Post-pre +% change +Pre +8.16 +2.44 +7.79 +2.05 +SAS +Post +7.33 +2.01 +0.001 +11.32 +7.56 +2.11 +0.142 +3.04 +Pre +40.65 +9.93 +39.86 +11.27 +SLC +Post +50.28 +9.62 +0.001 +23.69 +45.77 +12.81 +0.001 +14.83 +Pre +56.53 +11.15 +54.67 +9.64 +DLS +Post +64.95 +12.1 +0.001 +14.89 +58.35 +9.77 +0.001 +6.73 +Pre +3.05 +1.84 +3.67 +2.04 +MMR- VBL +Post +4.07 +2.27 +0.001 +33.44 +2.33 +1.71 +0.001 +-36.51 +Pre +4.56 +1.14 +4.81 +1.72 +MMR- SP +Post +6.12 +1.28 +0.001 +34.20 +4.00 +1.46 +0.001 +-16.84 +SAS-Stai A State, SLC-Six Letter Cancellation, DLS-Digit Letter Substitution, MMR VBL-Verbal, & MMR SP-Spatial Memory +Legend: Table 1 presents Pre-Post Mean ± Standard Deviations, significance p values and percentage changes in value for all measured +variables (state anxiety, sustained attention, and verbal and spatial memory) before and after Kapalbhati (KB) and Breath Awareness +(BA). The contrasting increase and decrease in memory scores are of great significance. +SUSHIL et al.: EFFECT OF STIMULATION IN HEALTHY VOLUNTEERS + + +609 +was significantly reduced after kapalbhati practice +(p<0.001), but the reduction after breath awareness +practice did not reach significance (p=0.142>0.05) +(Paired ’t’ test). Between groups results were +significantly different (p<0.02), as given in Table 2 +below. Scores on the SLC and DLS tests of sustained +attention were significantly increased for both groups +(p<0.001) (Paired ’t’ test). In contrast, scores on both +the verbal (MMR VBL) and spatial memory (MMR +SP) tests showed significant but opposite changes. For +the kapalbhati group, both significantly increased +(p<0.001), but for the breath awareness group, both +significantly decreased (p<0.001) (Paired ’t’ test). + +Discussion +It has previously been established that Kapalbhati +practice causes autonomic activation: increased +heart rate and systolic blood pressure were observed +as an immediate effect during 3 continuous kapalbhati +sessions of 5 minutes each19. This suggests that +practice +of +kapalbhati +increases +sympathetic +activity20. The study found reduction in anxiety score +after practice of kapalbhati (11.32%, p<0.001), but +the 3.04% reduction following breath awareness did +not reach significance (p=0.142). The difference in +anxiety reduction between kapalbhati and breath +awareness was significant (p<0.023). This result +therefore suggests that, although it temporarily +increases sympathetic activation, kapalbhati is more +effective than breath awareness in reducing subjects' +anxiety levels. This might be thought surprising, +because previous work suggests that yoga practice +reduces anxiety, because of its ability to reduce +psycho-physiological arousal21. This is clearly not the +reason in the study. However, a different study +supports the idea that practices producing arousal +may, in the end, be more beneficial: cyclic meditation, +which combines stimulating and calming techniques, +practiced with a background of relaxation and +awareness, in the end reduces physiological arousal +more effectively than supine rest in shavasana, which +is only calming22. For the SLC and DLS tasks, the +results suggest that kapalbhati augments attention, +both +enhancing +performance, +and +reducing +distraction. The study found increases in sustained +attention scores after practice of both kapalbhati +(23.69% & 14.89% for SLC & DLS tasks, +respectively) (both p<0.001), and breath awareness +(14.83% & 6.73% for SLC & DLS, respectively) +(both p<0.001), but, again, significantly more after +kapalbhati than breath awareness (both SLC & DLS +p<0.001). These results support the idea that +kapalbhati is more effective in increasing subjects' +sustained attention span than breath awareness. +Since Kapalbhati increases psycho-physiological +arousal, this finding is consistent with the study on +effects of drinking coffee, which suggested that +coffee's +stimulating +effects +on +psycho-motor +function, improve test performance14. With regard +to memory, one study of a group trained in yoga +found significant increase in spatial memory +test scores, while verbal memory test scores +remained the same3. Another study reported +effects on memory of 4 pranayama techniques: +right nostril breathing, left nostril breathing, +alternate nostril breathing and breath awareness +without manipulation of nostrils2. All 4 groups +showed a significant increase in spatial test +scores (mean 84%), while the control group +showed no change. It was suggested that yoga +breathing increases spatial memory scores without a +lateralized effect2. It has also been suggested that +improvements in spatial memory scores may be due +to anxiety reduction, which is known to improve +performance on learning and memory tasks4 e.g. a +study of undergraduates (mean age 20.7 yrs) +showed that forced left nostril breathing increased +spatial performance on a cognitive test of mental +rotation, manipulation and twisting of 2 and +3 dimensional objects6. In this light, the present +study's findings that verbal and spatial memory +scores both increased significantly after kapalbhati +practice (33.44% & 34.20%, respectively, both +p < 0.001), but decreased significantly after +breath awareness practice (-36.51% & -16.84% +respectively, p<0.001), is very important. It was +found that kapalbhati does not produce a lateralized +effect. Also, the opposite changes in kapalbhati +and +Breath +Awareness +demonstrate +that +the +hypothesis that all mind-body techniques have +similar effects is erroneous23. +Table 2 —Significance of p values between groups +Test +Significance +SAS +0.023 +SLC +0.007 +DLS +0.01 +MMR-VBL +0.001 +MMR-SPL +0.001 +SAS-Stai A State, SLC-Six Letter Cancellation, +DLS-Digit Letter Substitution, MMR VBL-Memory Verbal, +MMR SP-Memory Spatial +INDIAN J TRADITIONAL KNOWLEDGE, VOL 9, NO. 3, JULY 2010 + + +610 +Conclusion +The study suggests that both kapalbhati and breath +awareness reduce anxiety and improve sustained +attention. However, kapalbhati was significantly more +effective in doing so than breath awareness. In +contrast, they act oppositely on verbal and spatial +memory: whereas kapalbhati significantly increases +both, scores on these variables significantly declined +after breath awareness. This suggests that breath +awareness is intrinsically dulling to the mind, though +further experiment is needed determine whether +verbal instructions yield better results than the +repeated audio tape instructions used in the +experiment. This would be a significant experiment, +because breath awareness and related techniques are +considered important components of many systems of +psycho-spiritual development. + +Acknowledgement +This work forms part of the first author's +(SSK) +dissertation +to +be +submitted +to +the +Swami Vivekananda Yoga Anusandhana Samsthana +(SVYASA University) in partial fulfillment of his +PhD. SSK is grateful to the authorities of the +University for the opportunity given to him. The +authors are grateful to Ravi Kulkarni of SVYASA's +division of physical sciences for his assistance in +statistical analysis of data, and to Alex Hankey for +editorial assistance. + +References +1 +Nagendra HR & Nagarathna R, New perspectives in +stress management, (Vivekananda Kendra Yoga Prakashna +Bangalore), 1998. +2 +Naveen KV, Nagarathna R, Nagendra HR & Telles S, Yoga +breathing through a particular nostril increases spatial +memory scores without lateralized effects, Psychol Rep, 81 +(1997) 555-561. +3 +Manjunath NK & Telles S, Spatial and verbal memory task +scores following yoga and fine art camps for school children, +Indian J Physiol Pharmacol, 48 (2004) 353-356. +4 +Saltz E, Manifest anxiety: Have we missed the data?, +Psychol Rev, 77 (1970) 568 – 573. +5 +Nagendra HR & Telles S, Yoga & Memory, (Vivekananda +Kendra Yoga Prakashna, Bangalore), 1999, 27. +6 +Jella SA & Shannahoff – Khalsa DS, The effects of unilateral +forced nostril breathing on cognitive performance, Int J +Neurosci, 73 (1993) 61-68. +7 +Muktibodhananda, Hath yoga pradipika, (Yoga Publication +Trust, Munger, Bihar), 2001 187, 220-222. +8 +Nagendra HR & Mohan T, Yoga in Education, (Vivekananda +Kendra Yoga Anusandhana Samsthana, Bangalore), 2003. +9 +Lysenbeth & Andrevan, Pranayama-The yoga of breathing, +(Unwin Paperbacks, London), 1985. +10 Block RA, Arnott DP, Quigley B & Guch WC, Unilateral +nostril +breathing +influences +lateralized +cognitive +performance, Brain Cogn, 9 (1989) 181-90. +11 Bhole MV, Effect of kapalbhati on breath holding time, +Yoga Mimansa, 18 (3&4) (1956) 21-26. +12 Nagarathna R & Nagendra HR, Yoga practices for anxiety +and depression, (Swami Vivekananda Yoga Prakashna, +Bangalore), 2004. +13 King Jane Valerie, A holistic technique to lower anxiety: +Relaxation with guided imagery, J Holistic Nursing, 6 (1988) +16-20. +14 Natu MV & Agarawal AK, Testing of stimulant effects of +coffee +on +the +psychomotor +performance, +Indian +J +Pharmacol, 29 (1997) 11-14. +15 Spielberger CD, Gorsuch RL & Lushene RE, State –Trait +Anxiety Inventory, (Preliminary Test Manual, for Form B & +X), (Florida State University, Tallahassee, Florida), 1968. +16 Lezak MD, Neuropsychological assessment, 3rd edn, +(Oxford University Press, New York), 1995. +17 Baddelay AD, Your Memory – A user’s guide, (Avery, New +York), 1993. +18 Singh AK, Tests measurements and research methods in +behavioral science, (Bharati Bhavan, Patna), 2002. +19 Stancak AJV, Kuna MS, Vishnudevananda S & Dostalek, E, +Kapalbhati– Yogic cleansing exercise and cardiovascular and +respiratory changes, Homeost Health, 33 (3) (1991) 126-134. +20 Raghuraj P, Ramakrishnan AG, Nagendra HR & Telles S, +Effect of two selected yogic breathing techniques on heart +rate variability, Indian J Physiol Pharmacol, 42 (4) (1998) +467-472. +21 21 Telles S, Rajesh B & Srinivas, Automatic and respiratory +measures in children with impaired vision following yoga +and physical activity programs, Int J Rehabilitation Health, 4 +(2) (1999) 117-122. +22 Telles S, Reddy SK & Nagendra HR, Oxygen Consumption +and respiration following two yoga relaxation techniques, +Appl Psychophysiol Biofeed, 25 (4) (2000) 221- 227. +23 Herbert B & Miriam ZK, The Relaxation Response, (Avon +Books), 2000. + + + + diff --git a/subfolder_0/Immediate effect of two yoga-based relaxation techniques on attention in children.txt b/subfolder_0/Immediate effect of two yoga-based relaxation techniques on attention in children.txt new file mode 100644 index 0000000000000000000000000000000000000000..c34871b6edf2defeb3a32fb45f2a664c6532fec6 --- /dev/null +++ b/subfolder_0/Immediate effect of two yoga-based relaxation techniques on attention in children.txt @@ -0,0 +1,202 @@ +3/9/2017 +Immediate effect of two yoga­based relaxation techniques on attention in children +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997234/?report=printable +1/4 +Int J Yoga. 2010 Jul­Dec; 3(2): 67–69. +doi:  10.4103/0973­6131.72632 +PMCID: PMC2997234 +Immediate effect of two yoga­based relaxation techniques on attention +in children +Balaram Pradhan and HR Nagendra +Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore ­ 560 019, India +Address for correspondence: Dr. H. R. Nagendra, Swami Vivekananda Yoga Anusandhana Samsthana, # 19, K.G. Nagar, Bangalore ­ 560 +019, India. E­mail: hrnagendra@rediffmail.com +Copyright © International Journal of Yoga +This is an open­access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, +distribution, and reproduction in any medium, provided the original work is properly cited. +Abstract +Aims: +To investigate the effect of two yoga­based relaxation techniques, namely, cyclic meditation (CM) and +supine rest (SR), using the six letter cancellation task (SLCT). +Materials and Methods: +The subjects consisted of 208 school students, (132 boys, 76 girls) in the age range of 13 – 16 years. The +subjects were assessed on SLCT before and immediately after both yoga­based relaxation techniques. +Results: +After both practices, the total and net scores were significantly increased, although the magnitude of change +was more after CM than after SR in the net scores (14.5 versus 11.31%). The net score change in the CM +session was significantly larger than the change in the SR, whereas, there was no significant change in the +wrong cancellation score. After either practice, the total and net scores were significantly increased, +irrespective of gender and age. +Conclusions: +Both CM and SR led to improvement in performance, as assessed by SLCT, but the change caused by CM +was larger than SR. +Keywords: Cancellation, meditation, relaxation, yoga +INTRODUCTION +A yoga practice derived from an ancient Indian yoga text (Mandukya Karika) called cyclic meditation (CM) +is a technique that combines ‘stimulating’ and ‘calming’ practices, based on a statement in an ancient yoga +text suggesting that such a combination may be especially helpful to reach a state of mental equilibrium, +which consists of the practice of physical postures interspersed with relaxation, which has been used for +stress relief.[1] After this practice there was a significant reduction in oxygen consumption when compared +to an equal period of supine rest in shavasana.[2,3] +Recent studies on CM have suggested that sympathetic activation occurs predominantly during the yoga +posture phases of CM, whereas, following CM, the parasympathetic nervous system becomes dominant.[4] +The results support the idea that a combination of yoga postures with supine rest (in CM) reduces the energy +expenditure compared to supine rest alone and[5] CM enhances the cognitive processes underlying the +3/9/2017 +Immediate effect of two yoga­based relaxation techniques on attention in children +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997234/?report=printable +2/4 +generation of P300.[6] CM brings about a greater improvement in the performance of the cancellation task. +[7] To avoid the effect of memory during repeated administration, parallel worksheets have been prepared, +by changing the sequence of letters randomly in the working section, which was not taken care of in the +earlier study.[8] +Hence, the present study aims to evaluate the SLCT performance on school students, following two yoga­ +based relaxation practices. +MATERIALS AND METHODS +Subjects +Two hundred and eight school students were selected in the present study with an age range between 13 and +16 years (M=13.84; SD=0.98). All of them were healthy and proficient in English. They were trained for +practicing both CM and SR for seven days. The participants were excluded from the study if they had a +history of neurological or psychiatric disturbances, were younger than age 12 or older than 16 years of age, +under medication, had a history of learning disability, or were not proficient in English. After a complete +description of the study, the participants had given their written informed consent. +Procedure +The participants were assessed in two types of sessions, namely, CM and SR. For half the subjects, the CM +session took place on one day with SR the next day. The other subjects had the order of the sessions +reversed. The subjects were alternately allocated to either schedule, to prevent the order of sessions +influencing the results. Each session had a duration of 22 minutes and 30 seconds. Assessments were made +immediately before and after each session. +Instrument +The six­letter cancellation task consisted of a test worksheet that specified the six target letters to be cancelled +and had a ‘working section’ that consisted of letters of the alphabet arranged randomly in 14 rows and 22 +columns. The participants were asked to cancel as many six target letters as possible, which were printed at +the top of working section of the test sheets, in the specified time, that is, 1 minute 30 seconds. They were +told that there were two possible strategies, that is, (i) doing all six letters at a time, or (ii) selecting any one +target letter out of the six. They were asked to choose whichever strategy suited them. They were also told +that they could follow a horizontal, vertical or a random path according to their choice.[8] The scoring was +done by a person who was unaware when the assessment was made, whether the participant was engaging +in CM or SR, and whether the assessment was ‘pre’ or ‘post’ the session. The total number of cancellations +and wrong cancellations were scored and the net scores were calculated by deducting the wrong +cancellations from the total cancellations attempted. As this test was administered before and immediately +after the intervention, parallel work sheets were prepared by changing the sequence of the letters randomly in +the working section. Hence, the subjects were divided in two sessions in equal numbers and altered the next +day. Both the sessions received one set of worksheets before a session and parallel worksheets after the +session. The SLCT was used in a similar design in an Indian population, indicating the validity of the task, to +study the immediate effects.[8] +Throughout the CM practice, the subjects kept their eyes closed and followed pre­recorded instructions. The +instructions emphasized carrying out the practice slowly, with awareness and relaxation. The practice began +by repeating a verse (40 seconds) from the yoga text, the Mandukya Karika;[9] followed by isometric +contraction of the muscles of the body, ending with supine rest (1:00 minute); slowly coming up on the left +side and standing at ease (called tadasana) and ‘balancing’ the weight on both feet, called centering (2:00 +min); then the first actual posture, bending to the right (ardhakaticakrasana, 1 minute 20 seconds); a gap of 1 +minute 10 seconds in tadasana, with instructions about relaxation and awareness; bending to the left +(ardhakaticakrasana, 1 minute 20 seconds); a gap as before (1 minute 10 seconds); forward bending +(padahastasana, 1 minute 20 seconds); another gap (1 minute 10 seconds); backward bending +(ardhacakrasana, 1 minute 20 seconds); and slowly coming down in the supine posture with instructions to +relax different parts of the body in sequence (10 minutes). The postures were practiced slowly, with +awareness of all the sensations that are felt. The total duration of the practice was 22 minutes 30 seconds.[2] +3/9/2017 +Immediate effect of two yoga­based relaxation techniques on attention in children +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997234/?report=printable +3/4 +During SR, or the ‘corpse posture’ the subjects lay supine with legs apart and arms away from the sides of +the body and with their eyes closed. This practice lasted 22 minutes 30 seconds, so the duration was the +same as for CM. +Data analysis +Statistical analysis was done using SPSS (Version 10.0). The total number of wrong attempts and the net +score data were analyzed using the repeated measures analyses of variance (RMANOVA). There was one +Within Subjects Factor, that is, States with two levels (pre and post) and one Between Subjects Factor, that +is, Groups with two levels (CM or SR session). Post­hoc tests with Bonferroni adjustment were used to +detect significant differences between the mean values. +RESULTS +The group mean values and standard deviation for total scores, scores for wrong cancellations, and net score +in CM and SR sessions are given in Table 1. +DISCUSSION +The performance in the letter cancellation task improved immediately after the two yoga­based relaxation +sessions, namely, CM and SR. However, the magnitude of change in the net scores after CM was 14.5% and +after SR was 11.31%. The net score change in the CM session was significantly larger than the change in the +SR session. There was no significant change in the wrong cancellation score after CM and SR. +In the present study, the change in the net score had a similar trend as in an earlier study that had an identical +design.[7] However, in the earlier study, there was a 24.9% improvement in the net score after CM and +11.6% after SR. This difference of change could be due to the fact that the mediator in the previous study +had an average experience of 15.3±13.3 months, while in the present study the subjects had undergone only +a seven­day training program. These results revealed that the average duration of the practitioners had an +influence on the outcome measures. For example, the progressive relaxation technique found slight +differences in the first and second weeks, but major differences were observed in the fourth and fifth weeks +in the ‘Smith Relaxation State Inventory’ before and after the session.[10] +Cancellation tasks involve sustained attention, concentration, visual scanning, and activation and inhibition +of rapid responses.[11] Both the yoga­based relaxation techniques bring enhancement in the performance +task. Another study, Sahaja Yoga Meditation can lead to additional improvement in executive functions, +such as, manipulation of information in the verbal working memory, added improvement in the attention +span, and visual­motor speed in patients with depression.[12] +Yoga practice has been understood to help in reducing anxiety, based on a reduction in the levels of +psychophysiological arousal. In the earlier studies, both CM and SR, practiced for an equal period, found +improvement in the metabolic cost,[2,3,5] autonomic function,[4] and attention measure, using P300.[6] +Further study is required for an understanding of the mechanisms involved while forming the task and the +effect of age and gender groups. +REFERENCES +1. Nagendra HR, Nagarathna R. New perspectives in stress management. Bangalore, India: Swami +Vivekananda Yoga Publications; 1997. +2. Telles S, Reddy SK, Nagendra HR. Oxygen consumption and respiration following two yoga relaxation +techniques. Appl Psychophysiol Biofeedback. 2000;25:221–7. [PubMed: 11218923] +3. Sarang SP, Telles S. Oxygen consumption and respiration during and after two yoga relaxation +techniques. Appl Psychophysiol Biofeedback. 2006;31:143–53. [PubMed: 16838123] +4. Sarang SP, Telles S. Effect of two yogic relaxation techniques on heart rate variability. Int J Stress Manag. +2006;13:460–75. +5. Sarang SP, Telles S. Cyclic meditation a moving meditation reduces energy expenditure more than supine +rest. Indian J Psychol. 2007;24:17–25. +3/9/2017 +Immediate effect of two yoga­based relaxation techniques on attention in children +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997234/?report=printable +4/4 +6. Sarang SP, Telles S. Change in P300 following two yoga­based relaxation techniques. Int J Neurosci. +2006;116:1419–30. [PubMed: 17145677] +7. Sarang SP, Telles S. Immediate effect of two yoga­based relaxation techniques on performance in a letter­ +cancellation task. Percept Mot Skills. 2007;105:379–85. [PubMed: 18065059] +8. Natu MV, Agarawal AK. Testing of stimulant effects of coffee on the psychomotor performance: An +exercise in clinical pharmacology. Indian J Physiol Pharmacol. 1997;29:11–4. +9. Chinmayanada . Swami Mandukya Upanishat. Bombay: Sachin Publishers; 1984. +10. Matsumoto M, Smith JC. Progressive muscle relaxation, breathing exercise, and ABC relaxation theory. +J Clin Psycol. 2001;57:1551–7. +11. Lezak M, Howieson DB, Loring DW. Neuropsychological assessment. New York: Oxford University +Press; 2004. +12. Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Effect of Sahaja Yoga on neuro­cognitive +functions in patients suffering from major depression. Indian J Physiol Pharmacol. 2006;50:375–83. +[PubMed: 17402267] +Figures and Tables +Table 1 +Total score, scores for wrong cancellation, and net score in an SLCT pre and post the CM and SR sessions. +Values are in group mean and standard deviation +Cyclic meditation +Supine rest +Pre +Post +Pre +Post +Total score for cancellation +39.07±12.21 44.84±13.24 +38.67±12.16 42.87±13.16 +Score for wrong cancellation +0.53±1.39 +0.68±1.62 +0.66±1.96 +0.58±1.78 +Net score for cancellation +38.54±12.32 44.13±13.26 +38.01±12.2 +42.31±13.26 +P<0.001, RMANOVA with Post­hoc test Bonferroni adjustment, compared with respective pre score; +P<0.05, RMANOVA with Bonferroni adjustment between sessions, compared with post score of CM and SR; +Total scores differed significantly between States (F=222.92, P<0.001) and there was a significant interaction between +session and state (F=6.79, P<0.01). Also, the net scores differed significantly between states (F=218.58, P<0.001) and there +was a significant interaction between session and state (F=4.62, P<0.033). Post­hoc analyses showed that for both CM and +SR, there was a significant increase in total scores (P<0.001 in both sessions) and net scores (P<0.001 in both sessions) +compared to the respective pre­values. Also there was a significant change in post mean (P<0.024) values of CM and SR in +both total and net scores +Articles from International Journal of Yoga are provided here courtesy of Medknow Publications +***@ +*** +***@ +*** +*** +@ diff --git a/subfolder_0/Immediate effects of right and left nostril breathing on verbal and spatial scores.txt b/subfolder_0/Immediate effects of right and left nostril breathing on verbal and spatial scores.txt new file mode 100644 index 0000000000000000000000000000000000000000..e5e686e057d91c91d36f44d3df214d4441026f28 --- /dev/null +++ b/subfolder_0/Immediate effects of right and left nostril breathing on verbal and spatial scores.txt @@ -0,0 +1,12 @@ + + + + + + + + + + + + diff --git a/subfolder_0/Impact of Fresh Coconut on Dietary Intake A Randomized Comparative Trial.txt b/subfolder_0/Impact of Fresh Coconut on Dietary Intake A Randomized Comparative Trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..5ba3b402903bf0eb174dd72e1b5663f379ca1ed0 --- /dev/null +++ b/subfolder_0/Impact of Fresh Coconut on Dietary Intake A Randomized Comparative Trial.txt @@ -0,0 +1,580 @@ +Nagashree R Shankar et al +64 +Impact of Fresh Coconut on Dietary Intake: +A Randomized Comparative Trial +1Nagashree R Shankar, 2NK Manjunath, 3Ramesh Mavathur, 4V Venugopal, 5P Sreedhar, 6Anju Sood, 7HR Nagendra +IJERHS +ORIGINAL ARTICLE +10.5005/jp-journals-10056-0012 +ABSTRACT +Context: Controversies exist about health effects of coconut. +Fresh coconut consumption on human health has not been +studied substantially. Indians enjoy fresh coconut consump- +tion and thus there is a need to understand the effects of fresh +coconut. +Objective: To compare the effects of increased saturated fatty +acid (SFA) intake (provided by fresh coconut) vs monounsatu- +rated fatty acid (MUFA) intake (provided by a combination of +groundnut oil + groundnuts) on dietary intake in healthy adults. +Materials and methods: Eighty healthy volunteers were random- +ized into two groups and provided with 100  +gm of fresh coconut/day +(diet C) or a combination of 45  +gm groundnuts and 22  +gm groundnut +oil/day (diet G) for 90 days. 24-hour recall was collected. One-day +fatty acid analysis of the diets were measured. +Results: Significant decrease was seen in intake of calories, +protein, fat, SFA, MUFA, poly unsaturated fatty acid (PUFA), +cholesterol, sodium, calcium, and phosphorus in diet C and +calories, fat, SFA, PUFA, phosphorous, and sodium in diet G. +On comparing both the diets, we found a significant increase in +iron and no significant change was seen in carbohydrate intake. +No change was observed in MUFA levels on diet G but signifi- +cant decrease on diet C compared with subject’s usual diets. +Conclusion: Daily consumption of 100  +gm of coconut, rich in +SFA, for 3 months had numerous positive effects on dietary +intake, similar to that of MUFA fats, which are deliberated as +good fats. The results of this work have particular relevance +in suggesting that individuals wishing to use fresh coconut +everyday can do so safely. +Keywords: Coconut, Diet, Groundnut, Monounsaturated fatty +acid, Saturated fats. +How to cite this article: Shankar NR, Manjunath NK, Mavathur R, + +Venugopal V, Sreedhar P, Sood A, Nagendra HR. Impact of +Fresh Coconut on Dietary Intake: A Randomized Comparative +Trial. Int J Educ Res Health Sci 2016;2(4):64-68. +Source of support: Coconut Development Board, Kochi, +Government of India, India and SVYASA University, Bengaluru, +India. +Conflict of interest: None +INTRODUCTION +Indian diets are relatively rich in inclusion of coconut +in the daily diet. India is the 3rd largest producer of +coconuts in the world, and more than half of this (52%) +is consumed in raw form as either fresh or dry coconut.1 +Recent survey shows that regular consumers are advised +by clinicians and nutritionists to either reduce or com- +pletely eliminate consumption of coconut as they are rich +in fat and particularly saturated fatty acid (SFA) (92%).2 +Increased consumption of fat is known to increase total +calorie intake and thus might increase the risk of devel- +oping obesity. Obesity in turn is a cause for host of dis- +eases, namely type II diabetes,3 cardiovascular diseases +(CVD), hypertension,4 and cancer.5 Such studies are the +basis for dietary recommendations that advise reduced +consumption of fat, specifically SFA,6 as SFA can increase +plasma total cholesterol and can lead to higher risk + +of CVD.7 However, fresh coconuts are a bundle of nutri- +tion and are known as functional foods.8 Even though +they are rich in SFA, they are also rich in fiber, protein, +and a number of vitamins, minerals, electrolytes, and are +made of 40 to 50% moisture.9 Furthermore, the coconut +SFA composition is unique in that it consists of over 50% +of medium-chain SFA (MCSFA), whose properties and +metabolism appear to differ from longer chain SFA com- +monly found in animal products.10,11 Medium-chain SFA +are rapidly oxidized in the liver to acetyl CoA, and do not +enter or alter the lipid pool in the liver, thus remaining +neutral with respect to regulation of plasma cholesterol +or low-density lipoprotein levels.12 There are no studies +conducted on the impact of SFA-rich fresh coconut +consumption on diet. The current study was therefore +undertaken to study the effects of daily consumption of +fresh coconut on dietary intake in comparison to mono- +unsaturated fatty acid (MUFA), in the form of groundnuts +and groundnut oil, in healthy adults. +MATERIALS AND METHODS +Study Design and Subjects +The study was carried out from October 2015 to January +2016 among 80 healthy adults who were recruited fol- +lowing the advertisement of the study within SVYASA +University. Of these, 58 completed the study (27 from +coconut group and 31 from groundnut group). Subjects +were aged 23.8 ± 4.8 years and had no known metabolic, +1Holistic Nutritionist and Visiting Faculty, 2Joint Director, 3Head of +Molecular Bio Lab, 4Assistant Professor, 5Yoga Therapist, 6Visiting +Faculty, 7Chancellor +1-7Department of Yoga and Life Sciences, Swami Vivekananda +Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India +Corresponding Author: Nagashree R Shankar, Holistic +Nutritionist and Visiting Faculty, Department of Yoga and Life +Sciences, Swami Vivekananda Yoga Anusandhana Samsthana +Bengaluru, Karnataka, India, e-mail: gaurirokkam@gmail.com +Impact of Fresh Coconut on Dietary Intake: A Randomized Comparative Trial +International Journal of Education and Research in Health Sciences, October-December 2016;2(4):64-68 +65 +IJERHS +endocrine, or hematological diseases, were not on any +medications, and had high physical activity level. Subjects +were nonsmokers and were teetotallers, residing on a +residential campus of a Yoga University. The study proto- +col was approved by the Institutional Ethics Committee, +SVYASA, Bengaluru. This study has been registered with +Clinical Trial Registry of India (CTRI/2016/07/007071). +Signed informed consent was obtained from the volun- +teers. 24 hour recall was collected on day 1 and day 90. +Fatty acid analysis of both the meals were measured +using Gas chromatography (GC-FID). Body weight was +measured using a digital scale. Hemoglobin was mea- +sured using HemoCueHb 201+ system and the results +were documented immediately. +Dietary Information +The subjects were randomized into two groups: Coconut +group (diet C) and groundnut group (diet G). The ran- +domization was done using a computer-generated random +number table. Both the groups received a balanced diet +based on Yogic principles of food (Satvic, Rajasic, and +Tamasic) blended with modern medical nutrition (calorie +requirements, composition of balanced meal). The meal +consisted of higher percentage of Sattvic foods with lesser +Rajasic and least Tamasic foods.13,14 The percentage energy, +amount of fat, carbohydrates, and proteins and the fatty +acid composition were based on recommended dietary +allowance (RDA) and both the diets were identical in the +standard diet. Subjects consumed this standard diet and +intervention for a period of 90 days. Group C consumed +100 gm of fresh coconut per day and group G consumed +45 gm of groundnuts and 22 gm of groundnut oil per day. +A combination of groundnut and oil was used, to make the +two study interventions isocaloric and ensure macronutri- +ent composition was identical, as close as possible. Coconut +group subjects consumed around 2689 kcal, 392 gm of +carbohydrates (58.3% E), 77 gm of proteins (11.4% E), and +91 gm (30.3% E) of fat, while groundnut group subjects con- +sumed 2699 kcal, 384 gm of carbohydrates (57% E), 88 gm +proteins (13% E), and 90 gm fats per day (30% E). Fresh +coconut was generally added in snacks to garnish boiled or +sprouted grams or/and in chutney (a sauce in the cuisines +of the Indian subcontinent, a side dish made with coconut, +coriander, roasted bengal gram, green chillies, and salt). +Groundnuts were added to snacks or powdered and added +to a dish in meals. Groundnut oil was used during cooking +of G meals. The dietary intake of SFA was 2.6 times higher +in the coconut group as compared with the groundnut +group (58 vs 22%) as indicated in Table 1. Subjects were +trained and requested to abstain from consuming anything +other than the food and snacks provided by the coconut +project kitchen, setup exclusively for the study. +Statistical Analysis +The statistical analysis was done using Statistical Package +for the Social Sciences version 10. Each variable was first +assessed for normality distribution using Kolmogorov- +Smirnov test. When the data were normally 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 vari- +able 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 the group C and group G at baseline +as well as at day 90 using an independent sample t test. +RESULTS +Fatty acid composition per 100 gm of the one-day meals +(breakfast, lunch, snack, and dinner) of both coconut +diet and groundnut diet was obtained through gas +chromatography-flame ionization detector and is pre- +sented in Table 1. +The mean nutrient intakes obtained through 24-hour +recall for all subjects at baseline and on the 90th day of +dietary intervention phase are presented in Table 2. The +diets were isocaloric and identical in macronutrients +composition. +Based on RDA intakes and tables of food composi- +tion (Nutritive value of Indian foods, National Institute +of Nutrition, Indian Council of Medical Research, India, +2012), there was a significant decrease in intake of calo- +ries, protein, fat, SFA, MUFA, poly unsaturated fatty acid +(PUFA), cholesterol, sodium, calcium, phosphorus, and +stress levels on diet C and calories, fat, SFA, PUFA, phos- +phorous, sodium, and stress levels on diet G, compared +with the subject’s usual diets. Similarly, there was a sig- +nificant increase in iron on both the diets, compared with +the subject’s usual diets. There was no significant change +seen in intake of carbohydrates on both the diets and no +change observed in MUFA levels on diet G but significant +Table 1: Fatty acid composition of the one-day meal +through GC-FID +FA % +Diet C +Diet G +12:0 +27.3 +14:0 +11.7 +16:0 +14.3 +14.4 +18:0 +4.4 +4.7 +18:1 +17.9 +40.6 +18:2 n–6 +23.1 +36.7 +18:3 n–3 +1.2 +0.8 +Total SFA +58.9 +21.5 +C: Coconut; G: Groundnut; FA: Fatty acid; SFA: Saturated fatty +acid; GC-FID: Gas chromatography-flame ionization detector +Nagashree R Shankar et al +66 +Table 2: Twenty four hours recall data +Variable +Coconut group +Groundnut group +Independent t-test +Mean (SD) +Mean (SD) +Paired t-test Mean (SD) +Mean (SD) +Paired t-test +Pre test +Post test +p-value +Pre test +Post test +p-value +t-value +p-value +Energy (Kcal) +2701.0 (875.9) +2121.91 (712.6) 0.003* +2670.8 (897.02) 2306.9 (562.6) +0.030* +–0.124 +0.283 +Protein (mg) +76.50 (25.6) +61.8 (22) +0.010* +75.13 (24.1) +72.66 (19.89) +0.590 +–1.928 +0.059 +Fat (mg) +91.93 (35.7) +50.32 (29.2) +0.001* +87.64 (38.32) +65.71 (19.19) +0.004* +–2.860 +0.006* +Carbohydrate (mg) 392.99 (123.7) +350.1 (113.1) +0.098 +397.0 (124.9) +352.18 (83.8) +0.047 +–0.076 +0.940 +Calcium (mg) +846.01 (312.28) 700.12 (327.5) +0.019* +813.0 (334.04) +820.0 (330.2) +0.921 +–1.356 +0.181 +Phosphorus (mg) +1745 (591.5) +1410.5 (481.01) 0.005* +1759.5 (560.5) +1562.3 (400.77) 0.045* +–1.288 +0.203 +Iron (mg) +25.03 (9) +34.34 (19.3) +0.027* +25.22 (8) +36.27 (15) +0.001* +–392.000 0.696 +Sodium (mg) +4777.8 (1.7) +3120.2 (1.46) +0.001* +5037.6 (2.15) +3642.3 (1.44) +0.004* +–1.326 +0.191 +Sat Fat (mg) +25.89 (11.6) +16.9 (5.11) +0.001* +22.19 (12.22) +15.73 (6.39) +0.010* +    +0.756 +0.453 +MUFA (mg) +19.59 (8.40) +9.59 (5.33) +0.001* +19.86 (9.9) +19.64 (6.8) +0.920 +–6.067 +0.001* +PUFA (mg) +39.41 (16.65) +20.767 (11.3) +0.001* +39.412 (16.65) +20.76 (11.38) +0.001* +–2.489 +0.016* +Cholesterol (mg) +83.78 (44) +18.49 (10.3) +0.001* +56.37 (41.8) +14.41 (12.27) +0.001* +    +0.954 +0.348 +Data is represented as Mean & Standard deviation. *p  +<  +0.05 comparing the Day 90 values with the Day 1 respectively +decrease on diet C, compared with subject’s usual diets. +Body weight decreased significantly in coconut group +subjects (p = 0.04) and not in groundnut group subjects +(p = 0.06). Hemoglobin levels in both groups increased +similarly (p = 0.001). +DISCUSSION +In this carefully controlled diet study, we seek to shed +light on the impact of SFA from fresh coconut (diet C) in +comparison with MUFA from groundnuts and ground- +nut oil combination (diet G) on some key nutrients in + +the diet before and after intervention. A significant +decrease in calorie consumption was seen in group G + +and a highly significant decrease in group C, after the +intervention. This was reflected in reduction in body +weight. This is in agreement with previous findings +(St-Onge & Jones). The reason of this decrease in calo- +ries might be both dietary fiber and MCFA present in +coconut, which seems to induce satiety and satiation.15-17 +Mechanisms underlying the effect of fiber are reduc- +tion of energy density of a meal and prolonging the +intestinal phase of nutrient processing and absorption. +Also, coconut fiber shows highest water retention and +swelling capacity when compared with other dietary +fibres.18 Although exact mechanisms by which MCFA +may induce satiety have not been established, hormones +like cholecystokinin, peptide YY, gastric inhibitory +peptide, neurotensin, and pancreatic polypeptide have +been proposed.19 +The interesting observation is that the carbohydrate +intake did not change in either of the groups. This is a +valuable finding as lower calorie intake and weight loss +were achieved without decreasing the carbohydrate + +quantity. The addition of dietary fiber and MUFA +can achieve this desired result. So it is the quality of +carbohydrate which matters and not the quantity as +demonstrated by many studies earlier.20 +Consumption of protein decreased in both groups but +significantly in group C, after intervention. This could be +due to subjects adhering to vegetarian diet prescription +for the period of intervention, who otherwise would +eat nonvegetarian food on weekends (54% of subjects +ate nonvegetarian food) before intervention. Significant +decrease of protein in coconut group could be also for +the fact that they consumed almost 8 gm of protein less +in their standard diet/day. Consumption of fat decreased +significantly in both groups and more so in group C. Both +the diets were designed to give 30% calories from fats +but due to decreased consumption of food gradually, the +consumption of fats could have decreased. A satvic diet +by design is low on visible fats. Deep fried foods were not +prepared nor served during the intervention period. For +the same reason that they switched to vegetarian satvic +diet during intervention, SFA could have decreased sig- +nificantly in both the groups and more so in group C in +spite of coconut (SFA-rich) intervention. It was obvious +that MUFA decreased in group C after intervention as +group G got groundnuts rich in MUFA as intervention. +Poly unsaturated fatty acid decreased significantly on +both groups and the oil used in standard diet cooking +was sunflower oil for both groups. It was around 50 ml/ +person/day. Fall in PUFA could be due to food consump- +tion in commercial canteens before intervention, junk, +and deep fried food consumption (higher levels of fat). +Cholesterol was significantly low in both the groups as +they were on plant-based diets. There are concerns in +increasing dietary fiber due to its negative effect on the +bioavailability of minerals like calcium, iron, zinc, and +magnesium. This is due to the property of dietary fiber +to bind nonspecifically and reduce their absorption.21,22 +Impact of Fresh Coconut on Dietary Intake: A Randomized Comparative Trial +International Journal of Education and Research in Health Sciences, October-December 2016;2(4):64-68 +67 +IJERHS +However, reports from MCFA-rich diets showed +increased absorption of calcium and magnesium.23 This +was also observed in another study with increasing con- +centrations of dietary fiber from coconut flour which did +not affect mineral availability from all test foods.24 This is +in agreement with our findings on iron which increased +significantly, which is well reflected in significant increase +in hemoglobin levels in both groups. Conversely, we +saw significant decrease in calcium levels in group C, +after intervention. Few studies report a negative balance +of calcium due to increased fiber and increased fecal +excretion.25 +A positive effect was observed in significant decrease +in sodium levels in both the groups and more so on + +group C. Phosphorous levels significantly decreased +in both the groups, and more so in C group. The theo- +retically planned major nutrients of the diet has been +reflected in the post intervention 24-hour recall data, +accurately. The only concern is the decrease of calcium +in diet after intervention. +LIMITATIONS +The main limitation of the study was that there was + +no way to be certain that the participants did not eat + +anything other than the food and snacks provided +from the study kitchen on Sundays, except for their self- +reported data. +CONCLUSION +Fresh coconut, even though rich in saturated fatty acids +in comparison to a combination of groundnut and +groundnut oil when consumed over a period of 90 days, +had positive effect on the dietary intake - major nutrients +and energy consumption, after intervention. The results +of this work have particular relevance in suggesting that +individuals wishing to use fresh coconut in their diets +can do so safely but more studies need to be conducted +with larger sample sizes and longer duration. +ACKNOWLEDGMENTS +The authors would like to thank the SVYASA project +kitchen, especially the manager and staff of kitchen for +working together to share the main kitchen space and +endless hours of tasty food preparation. Also want to +thank 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 deserves a big thanks for analyzing all our +samples. Lastly, the authors would like to thank the +research participants for their time and dedication, +making this study possible. Statisticians at SVYASA +and NIMHANS were of great help. Guidance from + +Dr Sukanya, Yoga therapist, SVYASA, was of immense +help during paper writing. +REFERENCES + +1. 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Raghavarao KS, Raghavendra SN, Rastogi NK. Potential of +coconut dietary fiber. Indian Coconut J 2008;6:2-7. + 19. Marie-Pierre S-O, H JPJ. Recent advances in nutritional sci- +ences physiological effects of medium-chain triglycerides: +potential of obesity. Clin Trials 2002 Mar;132(3):329-332. + 20. Volk BM, Kunces LJ, Freidenreich DJ, Kupchak BR, Saenz C, +Artistizabal JC, Fernandez ML, Bruno RS, Maresh CM, +Kraemer WJ, et al. Effects of step-wise increases in dietary +carbohydrate on circulating saturated fatty acids and pal- +mitoleic acid in adults with metabolic syndrome. PLoS One +2014 Nov;9(11):e113605. + 21. Torre M, Rodriguez AR, Saura-Calixto F. Effects of dietary +fiber and phytic acid on mineral availability. Crit Rev Food +Sci Nutr 1991;30(1):1-22. + 22. Kritchevsky D. Dietary fiber and disease. Bull N Y Acad Med +1982 Apr;58(3):230-241. + 23. Bach AC, Babayan VK. Medium-chain triglycerides: an +update. Am J Clin Nutr 1982 Nov;36(5):950-962. + 24. Trinidad TP, Mallillin AC, Valdez DH, Loyola AS, Askali- +Mercado FC, Castillo JC, Encabo RR, Masa DB, Maglaya AS, +Chua MT. Dietary fiber from coconut flour: a functional +food. Innov Food Sci Emerg Technol 2006 Dec;7(4): +309-317. + 25. Shah M, Chandalia M, Adams-Huet B, Brinkley LJ, +Sakhaee K, Grundy SM, Garg A. Effect of a high-fiber diet +compared with a moderate-fiber diet on calcium and other +mineral balances in subjects with tupe II diabetes. Diabetes +Care 2009 Jun;32(6):990-995. diff --git a/subfolder_0/Impact of Yoga on Blood Glucose Level among Patients with Type 2 Diabetes Mellitus A Multicentre Controlled Trial.txt b/subfolder_0/Impact of Yoga on Blood Glucose Level among Patients with Type 2 Diabetes Mellitus A Multicentre Controlled Trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..6973df06ef6170fadeaa97cc5e75eeaaaaca9639 --- /dev/null +++ b/subfolder_0/Impact of Yoga on Blood Glucose Level among Patients with Type 2 Diabetes Mellitus A Multicentre Controlled Trial.txt @@ -0,0 +1,573 @@ +Journal of Stem Cells +ISSN: 1556-8539 +Volume 13, Number 1 +© 2018 Nova Science Publishers, Inc. + + + + +Impact of Yoga on Blood Glucose Level among Patients with +Type 2 Diabetes Mellitus: A Multicentre Controlled Trial + + + +Amit Singh1,, Padmini Tekur1, +R. Nagaratna1,2, and H. R. Nagendra1 +1Division of Yoga and Life Sciences +2Holistic Health Center, SVYASA University, +Bengaluru, India + + + + Corresponding Author E-mail: dramits90@gmail.com +Abstract + +Background: Type 2 Diabetes Mellitus (T2DM) is a meta- +bolic condition characterized by chronic hyperglycemia. It +is a highly prevalent medical problem across the globe and +a leading cause of morbidity and mortality. Optimal blood +glucose control is the primary goal of T2DM management. +Yoga is a mind-body intervention found to be effective in +various kinds of metabolic disorders including T2DM. +Aim: This study intended to assess the impact of 3 months +Integrated Yoga (IY) intervention on fasting and post- +prandial blood glucose level among patients with T2DM. +Methods: Total 251 patients with T2DM within the age +range of 30-60 years (with average age; 46.04 ± 14.02 +years) were enrolled in the study. Participants were divided +into a yoga group (n=137) and a control group (n=114). +Subjects in the yoga group received IY intervention +consisted of Asanas, Surynamaskara, Pranayama and +meditation every day for one hour/day, 6 days in a week for +three months. Control group subjects followed their daily +routines. Subjects on insulin therapy, with diabetic +complications, uncontrolled hypertension, under steroid +medication, or previous exposure to any form of yoga were +excluded from the study. Fasting and post-prandial blood +glucose level were assessed before and after 3 months for +both the groups. +The results: Significant decrease in both fasting and +postprandial blood glucose levels was observed in IY group +after 3 months compared to baseline. No improvement was +seen in the control group. +Conclusion: IY intervention helps in controlling blood +glucose levels among patients with T2DM. + +Keywords: Yoga, T2DM, Blood glucose + + +Introduction + +Type 2 Diabetes Mellitus (T2DM) is a highly +prevalent metabolic disorder characterized by chronic +hyperglycemia [1]. It is one among the major public +health problems and a leading cause of morbidity and +mortality worldwide +Amit Singh, Padmini Tekur, R. Nagaratna et al. +50 +The global prevalence of T2DM in 2010 was +found to be 6.4%, which was estimated to increase by +7.7% by the year 2030. In Asia, 1 in 7 (15%) adults +reported to have either elevated fasting glucose or +impaired glucose tolerance. For every year 5 to 12% +of these persons develop Type 2 diabetes. At present +India is at second rank in having maximum number of +T2DM patients in the world, this is expected to +increase by 50% by the year 2030 [2]. +Uncontrolled diabetes mellitus leads severe +complications such as diabetic retinopathy, diabetic +nephropathy, diabetic neuropathy and diabetic foot3. +T2DM also cause micro-vascular and micro-vascular +complications leading to cardiovascular disease, +stroke, and cognitive impairment [3]. +Optimal blood glucose control is the primary goal +of diabetes management. Further, optimal blood +glucose control in T2DM is associated with decreased +risk of diabetic complications [4]. +Conventional management of T2DM includes +oral hypoglycaemic agents (OHA), insulin and +lifestyle modification [5]. Despite taking regular +OHA, the majority of T2DM patients showed poor +blood glucose control, and a significant number of +patients did not respond to OHA [6]. +Stem cell therapy is also one of the most +advanced approaches to treat T2DM [7]. It includes +transplant of beta cell producing stem cells like +embryonic stem cells. These are found to form +functional pancreatic cells after transplant in +rodents. Similar finding was observed in case of +bone marrow harbours cells transplant in subjects +with T2DM [8]. These observations suggest the +promising role of stem cell therapy in the cure of +T2DM. +Yoga is one among complementary and +integrative medicines [9]. The practice of yoga has +beneficial effects on several health domains. Yoga +improves physical and mental health [10]. Earlier +studies on yoga showed its potential role in +improving blood glucose control, cardiac risk +factors, nerve conduction among T2D patients [11]. +Several RCTs have assessed the impact of yoga on +blood glucose control and found yoga an effective +intervention to improve blood glucose [12]. But +literature showed lack of evidence from multi- +centric trials on impact of yoga on blood glucose +control in T2DM. +We conducted a multi-centric trial to assess the +impact of 3 months IY intervention on fasting and +post-prandial blood glucose level among patients with +T2DM. + + +Methodology + +Study Participants + +Total 800 subjects’ from 6 districts of South India +were screened for the study criteria. From all districts +total 320 subjects fulfilled the study criteria. 6 +districts were randomly divided for either integrated +yoga intervention or for control (3 for each IY and the +control). Finally, there were 162 participants in IY +group and 150 participants in the control group +completed pre-assessments. 5 patients from the yoga +group and 4 patients from the control group did not +come from PPBS assessments hence, they were +excluded from the study. 150 participants in the yoga +group and 145 in the control group had a pre +assessment and were followed up for 3 months. Anti- +diabetic medication was kept constant through the +entire study. + + +Inclusion Criteria + +Subjects with T2DM, within the age range 30-60 +years +Willing to participate in the study, both male and +female participants were considered for the study. + + +Exclusion Criteria + + +Subjects with uncontrolled diabetes or +hypertension + +Subjects who had any kind of major surgery +in the past one year + +Subjects on any type of anti-psychotic or +steroid medication + +Subjects taking insulin + +Subjects who had previous exposure to any +form of yoga in the past one year + +Yoga for T2DM +51 + +CONSORT Diagram: Recruitment of the participants. + + +Ethical Consideration + +The study was approved by the Institutional +Ethical Committee of Swami Vivekanand Yoga +Anusandhan Samsthan (SVYASA-A deemed to be a +University), Bengaluru, India. +A written Informed Consent Form was duly +signed by all of the participants before the +intervention. + + +Assessments + +Subjects in both groups were assessed for fasting +and post-prandial blood glucose level. +Fasting Blood Sugar (FBS) Level + +Fasting blood glucose was measured from a +blood sample collected early in the morning (between +6-7am) on empty stomach for all the subjects. + + +Postprandial Blood Sugar (PPBS) Level + +Participants were asked to have breakfast and +after 2 hrs of breakfast once again blood sample was +collected for PPBS assessment. All the subjects were +asked to take their regular anti-diabetic medication as +usual. +The blood test was done in an authenticated +laboratory using the hexokinase method [13]. +Amit Singh, Padmini Tekur, R. Nagaratna et al. +52 +Intervention + +Participants in the IY group received one hour of +IY intervention (See Table 1) every day, 6 days a +week for the period of 3 months. All the practices +mentioned in the yoga module were used in the +previous research studies and found useful in T2DM +[14, 15]. + +Table 1. Details of special yoga technique for T2DM + +Number +Name +Posture +Practices +1. +Breathing practices (5 minutes) +Standing +Hands Stretch Breathing +Sitting +Rabit breathing +Tiger Stretch Breathing +2. +Loosening practices +Shitihilikarana vyayamah (5 minutes) +Standing +Padahastasana-Ardhachakrasana vyayama +Trikonasana vyayama +Kati parivartana vyayama (Spinal Twist) +Sitting +Chakkichalana +Bhunamanasana +Supine +Pawanmuktasana Kriya +Prone +Dhanurasana Swing +3. +Relaxation(5 minutes) +Instant Relaxation Technique +4. +Surya Namaskara (5 minutes) +12 steps +5. +Asanas (10 minutes each) +Standing +Ardhakatichakrasana +ParivrittaTrikonasana +Sitting +Vakrasana +Ardhamatsyendrasana +Prone +Bhujangasana +Dhanurasana +Supine +Pawanmuktasana +Matsyasana +Relaxation(10 minutes) +Deep Relaxation Technique +6. +Kriyas +Kapalabhati, +Vaman Dhouti (Once a week) +7. +Pranayama (10 minutes) +Nadishuddhi +Bhramari pranayama +Om chanting +8. +Meditation (20 minutes) +Cyclic Meditation + + +Data Analysis + +Data was presented as mean and standard +deviation. The data were analysed using SPSS +version 20 (IBM, Chicago, 2016). The paired sample +t test was used for within group comparison +and between group comparison was performed +using an independent sample t test. P value more than +0.05 was considered as statistically significant +change. + +Blinding +Statistician and data collector were blinded as for +groups and data scoring person was blinded as for +groups + + +Results + +Total 137 in yoga group and 114 in the control +group completed the study. +Yoga for T2DM +53 +Within Group Changes + +In the yoga group, a significant decrease in FBS +(p>0.001, -32.68%) & PPBS (p>0.001, -34.77%) was +observed after 3 months of IY compared to the +baseline. The Control group showed no significant +improvement in FBS and PPBS after 3 months. +Between Group + +Postintervention FBS & PPBS comparison +between the groups showed significant difference +suggestive of significantly lower FBS and PPBS in +Yoga group compared to the control group. + +Table 2. Prepost changes in mean & SD across the groups + +Variables +Yoga group (n = 137) +Control group (n = 114) +Between group +Comparison +Baseline +Post +% change Baseline +Post +% change +FBS +142.99 ± 32.20 +96.26 ± 11.92**a +-32.68 +137.62 ± 34.33 +133.59 ± 50.86 +-2.98 +>0.001b +PPBS +203.65 ± 45.92 +132.83 ± 22.24** a +-34.77 +190.97 ± 53.83 +189.29 ± 78.11 +-0.87 +>0.001b +FBS-Fasting blood glucose level; PPBS-Post-prandial blood glucose level. **-Statistical significance at 0.001 level; a – Paired +sample t test, b - Independent t test. + + +Figure 1. Prepost changes in FBS and PPBS the Yoga group. + + +Figure 2. Prepost changes in FBS and PPBS the Control group. +Amit Singh, Padmini Tekur, R. Nagaratna et al. +54 +Discussion + +The present study was intended to assess the +impact of yoga on fasting and postprandial blood +glucose level among T2DM patients. After three +months of IY intervention significant decrease in +fasting and postprandial blood glucose was observed. +The control group did not show any changes. Group +comparisons of post FBS & PPBS showed significant +difference suggestive of superiority of yoga inter- +vention. +Blood sugar control is a primary goal of +treatment and in the present we found yoga +intervention as an effective intervention to control +the blood glucose level among T2DM patients. Thus, +yoga can also be a potential preventive measure for +T2DM complication. +The findings of the present study are supported +by previous studies. A study by Lorenzo et al. 2008 +reported significant decrease in blood glucose +concentration following three months of Hath yoga +intervention [16]. A similar study by Robi et al. 1992 +found a significant decrease in fasting blood glucose +level following three months of the yoga intervention +in T2DM patients [17]. +Similarly, we also reported a significant decrease +in FBS and PPBS values after three months of IY +intervention compared to baseline. This study +reconfirms the usefulness of the yoga intervention in +management of T2DM by showing its efficacy in +reducing FBS and PPBS. However the present study +differs from the previous study in term of sample +size, frequency of yoga session in a week and type of +yoga module used. +Several other treatment methods have been tested +for their efficacy in the cure of the disease, stem cell +therapy is one of these. Some studies have reported +the promising role of stem cell therapy in the cure of +T1DM and T2DM [18, 19]. The addition of the yoga +intervention to such therapies may enhance the +treatment outcome. +Changes in FBS and PPBS found in this study +may attributed increased physical activity during +asanas, suryanamaskar, and loosening practices, +which is connected with increased insulin sensitivity +and glucose uptake; slow breathing practice during +pranayama is associated with reduced HPA axis +activation which is related to increased insulin +sensitivity. +Excess production of large sized of adipocytes is +thought to be one of the important causes of insulin +resistance in T2DM [20]. Large sized of adipocytes +are involved in insulin resistance in T2DM. Impaired +Production of large sized adepcytes, which may be +via correcting the impairment in proliferation of +differential capacity of mesenchymal cells [22, 23] in +the present study IY module include lot of practice +which increase the physical activity, which might +have enhanced the mesanchymal cell proliferation and +thus coto decrease insulin resistance. +Despite several RCTs available suggesting the +significant impact of yoga in T2DM, the present study +is unique in its type by being a multicentre trial with +large sample size and 3 months intervention. The +present study suggests the yoga as an adjunct +intervention in management of T2DM. +This study has got a few limitations such as lack +of monitoring diet control, other physical activities, +and non-randomized study. + + +Conflict of Interest + +The authors declare no conflict of interest. + + +Ethical Compliance + +The authors have stated all possible conflicts of +interest within this work. The authors have stated all +sources of funding for this work. If this work involved +human participants, informed consent was received +from each individual. If this work involved human +participants, it was conducted in accordance with +the 1964 Declaration of Helsinki. If this work +involved experiments with humans or animals, it was +conducted in accordance with the related institutions’ +research ethics guidelines. + + +References + +[1] +Inzucchi, S. E., & Sherwin, R. S. (2011). Type 2 +diabetes mellitus. Cecil Medicine. 24th ed. Phila- +delphia, Pa: Saunders Elsevier. +Yoga for T2DM +55 +[2] +IDF, G. (2011). ISPAD guideline for diabetes in +childhood and adolescence. International Diabetes +Federation, 131. +[3] +MacKnight, C., Rockwood, K., Awalt, E., & McDowell, +I. (2002). Diabetes mellitus and the risk of dementia, +Alzheimer’s disease and vascular cognitive impairment +in the Canadian Study of Health and Aging. Dementia +and geriatric cognitive disorders, 14(2), 77-83. +[4] +American Diabetes Association. (2015). Standards of +medical care in diabetes—2015 abridged for primary +care providers. Clinical diabetes: a publication of the +American Diabetes Association, 33(2), 97. +[5] +Gray A., Raikou M., McGuire A., Fenn P., Stevens R., +Cull C, Stratton I, Adler A, Holman R, Turner R. Cost +effectiveness of an intensive blood glucose control +policy in patients with type 2 diabetes: economic +analysis alongside randomised controlled trial (UKPDS +41). BMJ. 2000 May 20;320(7246):1373-8. +[6] +Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. +Factors associated with poor glycemic control among +patients with type 2 diabetes. Journal of Diabetes and +its Complications. 2010 Mar 1;24(2):84-9. +[7] +Lumelsky N., Blondel O., Laeng P., Vlesco I., Ravion +R., McKay R. Differentiation of embryonic stem cells to +insulin-secreting structures similar to pancreatic islets. +Science 2001; 292: 1398–94. +[8] +Zorina T. D., Subbotin V. M., Bertera S., et al. +Recovery of endogenous cells function in the NOD +model of autoimmune diabetes. Stem Cells 2003; 21: +377–88. +[9] +Barnes, P. M., Bloom, B., & Nahin, R. L. (2008). Com- +11. plementary and alternative medicine use among +adults and children: United States, 2007. Natl Health +Stat Rep, 12, 1-23. +[10] +US RAY, S. M., Purkayastha, S., Asnani, V., Tomer, +O., Prashad, R., Thakur, L., & Selvamurthy, W. (2001). +Effect of yogic exercises on physical and mental health +of young fellowship course trainees. Indian J Physiol +Pharmacol, 45(1), 37-53. +[11] +Siu, P. M., et al. (2015). “Effects of 1-year yoga on +cardiovascular risk factors in middle-aged and older +adults with metabolic syndrome: a randomized trial.” +Diabetol Metab Syndr 7: 40. +[12] +Aljasir, B., Bryson, M., & Al-shehri, B. (2010). Yoga +practice for the management of type II diabetes +mellitus in adults: A systematic review. Evidence-Based +Complementary and Alternative Medicine, 7(4), 399- +408. +[13] +Bondar, R. J., & Mead, D. C. (1974). Evaluation of +glucose-6-phosphate dehydrogenase from Leuconostoc +mesenteroides in the hexokinase method for determ- +ining glucose in serum. Clinical chemistry, 20(5), 586- +590. +[14] +Hegde, S. V., Adhikari, P., Kotian, S., Pinto, V. J., +D’Souza, S., & D’Souza, V. (2011). Effect of 3-month +yoga on oxidative stress in type 2 diabetes with or +without complications: a controlled clinical trial. +Diabetes care, 34(10), 2208-2210. +[15] +Venugopal, V., Rathi, A., & Raghuram, N. (2017). +Effect of short-term yoga-based lifestyle intervention on +plasma glucose levels in individuals with diabetes and +pre-diabetes in the community. Diabetes & Metabolic +Syndrome: Clinical Research & Reviews, 11, S597- +S599. +[16] +Gordon, L., Morrison, E. Y., McGrowder, D. A., +Young, R., Garwood, D., Zamora, E., & Sanz, E. C. P. +(2008). Changes in clinical and metabolic parameters +after exercise therapy in patients with type 2 diabetes. +Archives of Medical Science, 4(4), 427-437. +[17] +Monroe, R., Power, J., Kumar, A., & Nagarathna, R. +(1992). Yoga Therapy for NIDDM: A Controlled Trial. +[18] +Soria, B., Skoudy, A., & Martin, F. (2001). From stem +cells to beta cells: new strategies in cell therapy of +diabetes mellitus. Diabetologia, 44(4), 407-415. +[19] +Aguayo-Mazzucato, C., & Bonner-Weir, S. (2010). +Stem cell therapy for type 1 diabetes mellitus. Nature +Reviews Endocrinology, 6(3), 139. +[20] +Weyer C., Foley J. E., Bogardus C, Tataranni P. A., +Pratley +RE. +Enlarged +subcutaneous +abdominal +adipocyte size, but not obesity itself, predicts Type II +diabetes independent of insulin resistance. Diabetologia +2000; 43: 1498–1506. +[21] +Rangwala S. M., Lazar M. A. Transcriptional control of +adipogenesis [In Process Citation]. Annu Rev Nutr +2000; 20: 535–559. +[22] +Valero, M. C., Huntsman, H. D., Liu, J., Zou, K., & +Boppart, M. D. (2012). Eccentric exercise facilitates +mesenchymal stem cell appearance in skeletal muscle. +PloS one, 7(1), e29760. +[23] +Ravussin, E., & Smith, S. R. (2002). Increased fat +intake, impaired fat oxidation, and failure of fat cell +proliferation result in ectopic fat storage, insulin +resistance, and type 2 diabetes mellitus. Annals of the +New York Academy of Sciences, 967(1), 363-378. +Reproduced with permission of copyright owner. Further reproduction +prohibited without permission. diff --git a/subfolder_0/Impact of Yoga on Mental Health and Sleep Quality Among Mothers of Children With Intellectual Disability..txt b/subfolder_0/Impact of Yoga on Mental Health and Sleep Quality Among Mothers of Children With Intellectual Disability..txt new file mode 100644 index 0000000000000000000000000000000000000000..d4fc4675789eda01603e50588295ce5106a6bbed --- /dev/null +++ b/subfolder_0/Impact of Yoga on Mental Health and Sleep Quality Among Mothers of Children With Intellectual Disability..txt @@ -0,0 +1,90 @@ +Ullas—Yoga Improves the Mental Health +128 ALTERNATIVE THERAPIES, VOL. 27 NO. S1 +Impact of Yoga on Mental Health and Sleep +Quality Among Mothers of Children With +Intellectual Disability +Karpakam Ullas, MSc; Satyapriya Maharana, MSc, PhD; +Kashinath G. Metri, MD, PhD; Ashish Gupta, MD; HR Nagendra, ME +ORIGINAL RESEARCH +ABSTRACT +Objectives • Caring for a child with Intellectual Disability +Disorder (IDD) is a tremendously stressful task for any +mother, leading to poor mental health and compromised +quality of life. Anxiety, depression, stress, and poor sleep +quality are frequently observed in mothers with Intellectual +Disability Disorder child. This study assessed the impact of +a 1-month yoga intervention on anxiety, depression, stress +and sleep quality in mothers of children with intellectual +disabilities. +Methods • We selected 53 mothers of children with +intellectual disabilities between the age of 30 and 50 years +(mean age, 40.2 ± 7.1 years). Of these mothers, 28 received +1.5 hours of integrated yoga practice consisting of physical +postures, breathing techniques, relaxation techniques and +meditation every other day for 1 month. The remaining + +25 mothers, who served as the control group, participated +in a group discussion session twice a week for 1 month. +Main outcome measures • All mothers were assessed for +anxiety and depression with the Hospital Anxiety and +Depression Scale (HADS), stress with the Perceived Stress +Scale (PSS), and sleep quality with the Pittsburgh Sleep +Quality Index (PSQI) at baseline and at 1 month. + +Results • Significant improvements in anxiety (-24.8%; + +P < .001), depression (-15.9%; P < .001), sleep quality +(-25.1%; P < .05) and stress (-11.4%; P < .001) were observed +after 1 month compared with baseline in the yoga group. In +a similar fashion, a significant decrease in anxiety (-12.3%; +P < .001), depression (-8.6%; P < .001) and sleep quality +(-5.6%; P < .001) was seen in the control group as well. The +between-group comparison of post-intervention scores +revealed a significantly better improvement in anxiety + +(P < .001), depression (P < .001), perceived stress (P < .001) +and sleep quality (P = .012) in the yoga group compared +with the control group. +Conclusions • Our study indicates that yoga can be used +as an effective intervention to improve psychopathology +and sleep quality in mothers of children with intellectual + +disabilities. We recommend future randomized controlled +trials with larger sample sizes and of longer duration to +study the long-term effects of yoga. (Altern Ther Health +Med. 2021;27(S1):128-132). +Karpakam Ullas, MSc; Satypriya Maharana, MSc, PhD; +HR Nagendra, ME; Swami Vivekananda Yoga Anusandhana +Samsthana +(S-VYASA +University), +Bengaluru, +India. +Kashinath G Metri, MD, PhD; Department of Yoga Central +University of Rajasthan, India. Ashish Gupta, MD, The +Brooklyn Hospital Center, Brooklyn, New York. +Corresponding author: Kashinath G Metri, MD +E-mail address: kgmhetre@gmail.com +INTRODUCTION +Every couple wishes for a healthy baby, but sometimes +children are born with a disability. In India, approximately +1.8% to 2.1% of the total population has some kind of disability +and thus the numbers run into millions.1 Intellectual disability +is one such disability defined as “a group of developmental +conditions characterized by significant impairment of +cognitive functions, which are associated with limitations of +learning, adaptive behaviour and skills” +.2 The prevalence rates +for IDD varies alot 1.7 cases/1000 to 32 cases/1000.3 Caring for +such a child is tremendously demanding and can result in +chronic stress.4 Parents of a mentally-challenged child +experience 4 times more stress than the parents of a normal +child.2 Further, mothers of children with mental disabilities +experience a greater degree of stress compared with fathers of +children with mental disabilities.6,7 Mothers of mentally- +challenged children have to be with the child around the clock. +Apart from basic care, the mother may have to handle the +child’s aggression and behavioral problems. The lack of leisure +time, extra effort required for care and the disturbed behavior +of the child are the major sources of stress in mothers of +children with mental disabilities.8 diff --git a/subfolder_0/Implicit measure for yoga research Yoga implicit association test.txt b/subfolder_0/Implicit measure for yoga research Yoga implicit association test.txt new file mode 100644 index 0000000000000000000000000000000000000000..1228ebc8840a7acd2cc5586d50d6c91dffcdb17f --- /dev/null +++ b/subfolder_0/Implicit measure for yoga research Yoga implicit association test.txt @@ -0,0 +1,630 @@ +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 +120 +Implicit measure for yoga research: Yoga implicit association test +Judu V Ilavarasu, Sasidharan K Rajesh, Alex Hankey1 +Department of Psychology, and 1Department of Biofield Energy Lab, Division of Yoga and Physical Sciences, Swami Vivekananda Yoga +Anusandhana Samsthana, Bangalore, Karnataka, India +Address for correspondence: Dr. Judu V Ilavarasu, +19, Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore - 560 019, Karnataka, India. +E-mail: judu@svyasa.org +Original Article +INTRODUCTION +Yoga research is indeed a multidisciplinary venture and +has adopted tools from various disciplines such as biology, +medicine, psychology, psychiatry, sociology, etc. The +strength of any field lies in the strength of its methods and +measurement tools used. Effects of yoga can be studied at +various levels using the various methods. T +ools of medicine +and psychology are majorly used in yoga research. For self- +report of subjective feelings and thoughts questionnaires +are chiefly used. However, there are many constructs, +which are difficult to self-report and might have influence +of social desirability (a voluntary or an involuntary mode +of response to project socially desirable). Do I say what I +actually think? Am I influenced by my conditioning, unaware +of myself? Often people tend to deliberately distort their +responses to questionnaires or give the wrong response quite +unknowingly. T +o address such questions, implicit measures +were successfully utilized.[1] In this article, we present a tool, +extensively used in the west, especially in psychology since +last 15 years and which has attained a status of state-of-the-art +tool in the field. We propose to review this tool and highlight +its utility in the field of yoga, with an example of a study +conducted by us. The objective of this paper is not to present +a detailed review of the field but to spotlight the most relevant +aspect of the field, which can be utilized in yoga research. +Implicit cognition +Implicit cognition is a broad term, which encompasses all +those cognitive processes that happen, without any or much +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.133889 +Context: The implicit association test (IAT), a new tool for yoga research is presented. Implicit measures could be used in +those situations where (1) The construct is difficult to self-report, (2) there is a threat of social desirability. Clinically, we can +assess cognitive dissonance by evaluating incongruence between implicit and explicit measures. Explicit preferences are +self-reported. Implicit preferences are what we inherently believe, often without our conscious awareness. +Aims: The primary objective of this study is to provide a bird’s eye view of the field, implicit cognition, with emphasis on the +IAT and the secondary objective is to illustrate through an example of our study to develop an implicit tool to assess implicit +preference toward yoga. +Settings and Design: A total of 5 independent samples of total 69 students undergoing short and long-term yoga courses in +a Yoga University were assessed for their implicit and explicit preferences towards yoga. +Materials and Methods: The yoga-IAT (Y-IAT), explicit self-rating scale was administered through computers using the Inquisit +program by Millisecond Software. Experimental and scoring materials are provided. +Statistical Analysis Used: Data were extracted using recommended scoring algorithm and descriptive statistics highlighting +basic psychometric properties of Y-IAT are presented along with its congruence with explicit self-measure. +Results: A moderate preference toward yoga was detected, with a lower implicit-explicit congruence, reflecting possible +confound of social desirability in the self-report of preference toward yoga. +Conclusions: Implicit measures may be used in the yoga field to assess constructs, which are difficult to self-report or may +have social desirability threat. Y-IAT may be used to evaluate implicit preference toward yoga. +Key words: Implicit association test; implicit explicit congruence; misattribution; yoga. +ABSTRACT +Ilavarasu, et al.: Implicit measure for yoga research +121 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +awareness about them, but still influence our behaviors. +More precisely implicit processes are characterized +the process, which happens with a lack of awareness, +less cognitive resource, short time and independent of +proximal goal.[2] Implicit measures are those, which can +measure such influences of implicit processes. Some +commonly used related terms are unconscious, automatic, +uncontrolled, implicit and subliminal. For an overview of +how implicit social cognition functions, the recent book, +Banaji et al.,[3] should interest naive readers. +Implicit measures +There are many tools used in psychology, which are +categorized under implicit measures. They are the implicit +association test (IAT),[4] priming[5] Go/No-go association +task,[6] the extrinsic affective simon task,[7] etc. For a +detailed review of the most popular tools, refer the paper +on implicit measures in social cognition by Fazio and +Olson[8] One of the common goals of implicit measures +is to assess those preferences and attitudes, which may +be inhibited due to choice or ignorance. In this paper, we +focus on one of the well-researched tools, the IAT. Since +its inception in 1998, many papers have been published +using this tool in diverse fields and over 50 papers were +only on various aspects of its validity and psychometrics. +The next popular tool is the priming tool, though equally +powerful, but compared with the IATs it has lower internal +consistency and effect size.[9] Hence, we focus on the IAT. +The IAT +The IAT was first reported in 1998 by Greenwald et al.[4] +It is a reaction time task, which requires a certain way of +categorization of the shown stimuli on the computer screen. +This test measures automatic preferences. These tests +require about 5-10 min to complete and have high effect +size compared with priming measures. Even for personality +domains, like self-esteem, IATs were found to have internal +consistencies above 0.80 and test retest reliability ranging +from 0.60 to 0.70. IAT’s ease of administration, higher effect +size and reliability are some of the features, which captured +the attention of many researchers. IATs can be constructed +and delivered very easily using any stimulus presentation +software. Some of the commercial software are Empirisoft, +E-Prime, Inquisit, Paradigm, SuperLab, etc.[10] Affect 4.0[11] +is a free software, which is capable of doing the same thing. +Structure and procedure of IAT +The structure of IAT can be illustrated using flower-insect +IAT. The traditional IAT has seven blocks [Table 1] in +which subjects have to respond to the shown stimuli. +In the IAT subject responds to a series of items that are to be +classified into four categories: In general, two representing +concept discrimination (also known as targets) such as +flowers versus insects and two representing attribute +discrimination (also known as attributes) such as good +versus bad. Targets are those which we are interested in +evaluating, here implicit evaluation toward flowers versus +insects. Attributes are those qualities with which we want +to find the target’s association strength. The subjects are +asked to respond rapidly without making much error. +The right hand side key is to respond for right hand side +categories (target or attribute) and vice-versa for left hand +key. The position of the target would change to produce +congruent and incongruent blocks. Congruent blocks are +those in which conceptually associated pairs are present +like flowers with good and insects with bad. The feedback +on error may[12] or may not be given.[13] Feedback of error +is indicated by “X” which prompts the subject to give +the correct response. From latencies of congruent and +incongruent blocks, IAT scores are calculated. The logic +of the test is subjects respond more rapidly in the block +where the target and attribute are strongly associated +(flowers and good) than when they are weakly associated +(insects and bad). +IAT scoring +Psychometrics of IAT has witnessed great streamlining. +The latest algorithm provided by Greenwald et al.[14] is +now widely used in all studies. Summary of steps is as +follows:[15] +1. Delete trials greater than 10,000 ms +2. Delete subjects for whom more than 10% of trials have +latency less than 300 ms +3. Compute the “inclusive” standard deviation for all trials +in Stages 3 and 6 and likewise for all trials in Stages 4 +and 7 +4. Compute the mean latency for responses for each of +Stages 3, 4, 6 and 7 +5. Compute the two mean differences (mean Stage +6 – mean Stage 3) and (mean Stage 7 - mean Stage 4) +Table  1: IAT structure +Block +No. of +trials +Task +Response key assignment +Left key +Right key +1 +20 +Target +discrimination +Flowers +Insects +2 +20 +Attribute +discrimination +Good +Bad +3 +20 +Initial combined +task (practice) +Flowers, good +Insects, bad +4 +40 +Initial combined +task (test) +Flowers, good +Insects, bad +5 +20 +Reversed target +discrimination +Insects +Flowers +6 +20 +Reversed combined +task (practice) +Insects, good +Flowers, bad +7 +40 +Reversed combined +task (test) +Insects, good +Flowers, bad +IAT = Implicit association test +Ilavarasu, et al.: Implicit measure for yoga research +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +122 +6. Divide each difference score by its associated +“inclusive” standard deviation +7. D = The equal-weight average of the two resulting +ratios. +Finally, the score is reduced to a D value. Since mean +differences are divided by the standard deviation, it is +like Cohen’s D value. Hence, IAT D is also a measure of +effect size. However, a slight point of difference is that +in the calculation of the IAT D score, inclusive standard +deviation is used that means standard deviation of both +practice and test blocks are used. The D score ranges +from −2 to +2 through 0. Negative score means negative +preference toward one of the target objects. This could be +reversed also by suitably designing the IAT. In general, a +score below 0.35 means weak preference, a score up to +0.65 means moderate preference and above 0.65 means +high implicit preference. The sign indicates the direction +of preference, i.e., toward which target. The IAT D scores +might be influenced by order of taking the congruent +and incongruent tasks, recent experience, social setup, +familiarity with the stimuli, etc.[1] +Variations of IATs +In recent times, many variations of the IAT have emerged. +Firstly to overcome the relative preference assessment, +single category[16] and single target[17] IATs are developed. +In these IATs, the target to be assessed need not have an +opposite counterpart. These are useful where constructs +are unipolar. In an attempt to make IAT brief, yet reliable, +the brief-IAT[18] was developed. Another variation is +personalized IAT,[19] in which participants themselves +can choose the category labels and corresponding +stimuli, which need to be presented during the test. This +personalized IAT is reported to give higher congruence +with explicit measures, especially in socially desirable +constructs like personality domains. Finally multifactor +IAT, in which multiple factors like big five can be +simultaneously evaluated.[20] The stimuli in these IATs +can be given as words or as pictures. The picture IATs are +shown to have low effect size compared with word IATs, +however, average latency of response and average errors +are less.[21] These various versions of IATs have their own +unique advantages and a researcher has a range of choice. +Implicit tools for yoga research +For convenience, yoga research can be classified into +clinical and non-clinical. Majority of yoga research has +published on clinical aspects because the primary interest +in yoga is due to concerns about health and harmony at +physical and mental levels. The other side is non-clinical, +in which we can categorize all studies related to physical, +mental and cognitive development due to yogic practices. +This also encompasses higher dimensions of spiritual +unfoldment. We shall discuss how implicit tools can be +used in these two broad aspects of yoga research. +The clinical use of implicit tools is well demonstrated. The +Chapter 23 of the handbook of implicit social cognition[22] +describes them elaborately. Here are some of the relevant +aspects useful for yoga research. Clinically, relevant aspect +of implicit cognition is dissociation of impulsive process +and reflective process. Impulsive processes are automatic +and associative in nature, where implicit memory plays a +key role. On the other hand, reflective processes are more +controlled. Taking to unhealthy life-style, natural rhythm +and regulation of the body is compromised and the system +goes uncontrolled, leading to clinical conditions. Examples +of obesity, depression, obsessive compulsive disorder, +narcissism, etc., demonstrate some of these aspects. The +unhealthy and uncontrolled mind becomes the precursor +for unhealthy body. +Yoga is the process of reverse engineering in which more of +automatic or implicit processes are brought under conscious +control by deliberate practice. According to Integrated +Approach of Yoga Therapy,[23] based on the five sheath +model of existence, the cause of disease is Aadhi. We term +Aadhi as implicit misattribution effect. Implicit is something +that happens automatically without the awareness of the +person, hence very subtle hard to perceive, but very strong. +Misattribution is attributing some quality or notion about +something, which is not true. The effect is that which is +caused by such implicit misattributions. Hence, Aadhi is the +effect which is caused by automatic (implicit) wrong notions +(misattributions). Implicit misattribution can happen when +we wrongly cognize something and believe it completely. +Such strong wrong belief is predominantly an implicit +process and about which a person has least awareness and +control. Yoga involves systematic training of body and mind +along with notional corrections, which reverses the process +of implicit misattribution effects through building up the +strength of rational discriminating process, which helps +in recognizing the weaker reasons behind such implicit +misattributions. Gradually the process of desensitization +happens that optimizes the process of regulation at the +mental level (manomaya kosha), at pranic level (pranamaya +kosha) and at the physical level (annamaya kosha). Hence +understanding implicit processes might give deeper insights +to yoga therapy. One important concept, which emerges +from IATs is the correlation between implicit and explicit +measures.[24] This is called congruence between implicit +and explicit measures. It has been reported that for socially +sensitive measures, the implicit explicit congruence would +be low, indicating, possible cognitive dissonance. Hence this +congruence between implicit and explicit measures could be +considered as a marker of state of psychological well-being. +Higher the congruence, the greater is the psychological +harmony and vice versa. +Ilavarasu, et al.: Implicit measure for yoga research +123 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +Recent development in stress research is the introduction +of the perseverative cognition theory. According to this, +greater cause of stress is constant rumination and repeated +processing of worrying thoughts, both anticipatory and +retrospective. This can happen unconsciously also, +terming it as unconscious perseverative cognition, which +is believed to be a major determinant of stress.[25] The +unconscious influence can be studied using IAT tools.[26] +For a non-clinical application in yoga, implicit measures +can be used in situations where there is a serious threat of +self-presentation bias, or social desirability. One example is +an assessment of triguna. Triguna is a personality concept +according to Indian Psychology. Sattva, rajas and tamas, +are its three factors. When questionnaires to assess triguna +are administered in a yoga population, the participants by +virtue of their knowledge of the concept triguna, may bias +their responses in order to be socially desirable. In those +conditions, we may use implicit tools for assessment. +Likewise other constructs, which are difficult to self-report +or where social desirability is a concern, implicit measures +may be utilized as a potential solution. +YOGA-IAT: ASSESSMENT OF IMPLICIT ATTITUDE TOWARDS +YOGA +Overview of the experiment +We present the yoga-IAT (Y-IAT) to evaluate a person’s +inherent preference towards yoga. Can we assess a +person’s preference towards yoga, without asking them +to self-report? The Y-IAT was constructed in the same +fashion as described in an earlier section. However, the +only difference was we chose one category instead of two. +Hence this is a single target IAT. +MATERIALS AND METHODS +Subjects +The study was conducted in a Yoga University, in southern +India. It was conducted over a period of 7 months (August +2012-February 2013) and five independent samples were +taken. The samples constituted of students of both long +and short term yoga courses. The total sample size was 69 +(27 males) with a mean age 27.17 ± 7.14 (n = 48, as the +age and explicit preference were not obtained in one of the +batches of 21 subjects) and range (18-47 years). We present +the results combining data of all the five independent +samples. +Methods +The whole experiment was administered through +computers using Inquisit 3.0 stimulus presentation +software.[27] The assessments were performed in a batch of +three to four participants. The procedure and requirement +for the test were explained to the participants. After +informed consent, the subjects typed demographic details +and took the Y-IAT and later an explicit rating scale to rate +their preference toward yoga on a five- point likert scale +(very strongly dislike, strongly dislike, neutral, strongly +like, very strongly like; −2 to +2). The order of taking +congruent and incongruent tasks in the Y-IAT was balanced +across the subjects.[14] The whole test session lasted for +about 5-10 min. +In the Y-IAT, a series of words related to yoga were shown +to subjects on the computer screen. Each stimulus had an +inter trial interval of 250 ms. The subjects had to respond +by pressing the appropriate response key on the keyboard, +to indicate whether the shown stimulus was on the left +hand side or right hand side. “E” key was assigned to the +left hand response and “I” key was allotted for right hand +response. The subjects had to respond as quickly as possible +without making much error. If an error occurred, they had +to correct it and proceed further. The target words, related to +yoga were: Yama, Niyama, Asana, Pranayama, Pratyahara, +Dharana, Dhyana and Samadhi. Attribute category +words were, for “Good” category: Good, Superb, Pleasure, +Beautiful, Joyful, Glorious, Lovely and Wonderful; and for +“Bad” category: Hurt, Sorrow, Painful, Poison, Accident, +Fearful, Bad and Dirty. Selection of these words related +to yoga category was based on the assumption that any +student of yoga course would know these eight fundamental +words from the Patanjali’s Yoga Sutras. However, mental +representations of these words in various individual may +vary. The single category Y-IAT had five blocks; the first +block (20 trials) was attribute practice, in which subjects +had to categorize words, which were of categories “Good” +and “Bad”. Next block was the combined practice block, +which also included category “Yoga.” In this block, subjects +had to categorize words related to one of the earlier +mentioned categories. There were 20 trials in this block. +The third block was the test block, same as second block +with 40 trials. In the fourth block, the target word changed +position from left hand side to the right hand side or vice- +versa. This block is called practice block for reversed target +and had 20 trials. The fifth block had a similar structure +that of the fourth one with 40 trials [Inquisit script for Y +-IAT +is available with author on request]. +RESULTS +R statistical software was used for analysis.[28] Scoring of +Y-IAT were done using the improved scoring algorithm[14] +(R script for scoring Y-IAT available with author on +request). Mean latencies for each block were measured. +The block in which “Yoga” is paired with “Good” is called +compatible block and the block in which “Yoga” is paired +with “Bad” is called incompatible block. D score is obtained +by the difference of mean latencies of incompatible and +Ilavarasu, et al.: Implicit measure for yoga research +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +124 +compatible blocks and then whole divided by the pooled +standard deviation. The positive score indicates the +positive implicit evaluation toward yoga and negative +score suggests negative implicit evaluation toward yoga. +We discarded seven subjects from analysis because the Y +-IAT +showed a negative D score. As negative scores could strongly +influence the mean, we removed them. An additional reason +to consider these negative scores as outliers is: We assume +that all those participants who came for yoga courses must +be having a positive inclination toward yoga. Their explicit +scores support this assumption. Hence, any negative score +would mean that the subject does not belong to the intended +population. Further three subjects were removed for their +high response error rate (>20%).[16] After removing these +10 outliers, we observed an average D score of 0.346 ± +0.25, ranging from 0.001 to 0.896. The mean latency was +1024.17 ± 300.10 ms. They had an average error rate of +4.38% (after treating outliers). The mean explicit score was +1.26 ± 0.59 showing strong positive preference toward yoga. +The implicit-explicit correlation was found to be: r = 0.18 +(t = 1.14, df = 37, P = 0.264). This correlation reflects low +implicit-explicit congruence. +DISCUSSION +The objective of the current study was to find out whether +we can assess implicit preference toward yoga using the +IAT paradigm. The selection of the sample was appropriate +as they expressed strong explicit preference toward yoga. +The results showed moderate implicit preference towards +yoga in this study sample. These preliminary results +suggest that we can measure implicit preference toward +yoga. Nearly 90% of the participants had shown various +degrees of positive implicit preference toward yoga. The +low correlation is an indication of possible extraneous +influence through self-presentation biases; hence, it +becomes further interesting to study the influence of social +desirability factors on implicit preference towards yoga. In +the current study, no measure of self-presentation bias was +taken, so we could not find its mediating effect. +Y-IAT’s application is restricted to those who are familiar +with yoga, as the category label and stimuli used were +words related to yoga. Moreover, IATs may not be able +to reflect the actual preference always, as they may be +clouded by the person’s strong belief. For instance, if we +happened to wrongly believe something, those wrong +notions would be reflected in implicit assessment. +However, this discrepant information is highly valuable +both clinically and for general research. +We suggest further studies to evaluate discriminant +validity, i.e., to find out if a sample of non-yoga subjects, +show negative or weak preference toward yoga. Predictive +validity should also be attempted as the current study does +not predict the outcome of yoga practice or adherence +to yoga practice. As a further step, an attempt should be +made to reproduce and generalize the results in different +samples. Specifically for Y-IAT, other psychometric +properties need to be evaluated. Another general +requirement for implicit cognition studies in yoga research +is a development of normative pool of visual and verbal +stimuli. The international affective picture system[29] +and the affective norms for English text[30] are databases +that provide a set of normative emotional stimuli for +experimental investigations of emotion and attention. +Development of such databases for yoga studies would +help develop evidences, which can be compared across +experiments. Mechanism of cognitive refinement brought +about by yogic practices is intricate and definitely involves +unconscious or implicit factors. Realizing this necessity of +the hour, resorting to implicit tools is highly encouraged. +Development of Y-IAT will have application in academic +settings especially in yoga universities to assess the growth +of students and their inherent interest toward yoga. We +can also evaluate if explicit score or implicit score predicts +better the future academic performance. Furthermore, IATs +can be used to assess those constructs, which are difficult +to self-report. Therefore this IAT paradigm, which promises +to overcome self-presentation biases, can be used in the +field of yoga. +CONCLUSION +In this article, we have attempted to present before the yoga +researchers a new tool for exploration, the IAT. Necessary +details of the use of this tool in yoga research were +discussed using Y-IAT. Relevant materials are provided to +design new experiments and scoring them. We emphasize +that Implicit measures would find immense application in +the field of yoga, where no work has been done using this +tool. Promotion and wide use of implicit tools can bring +new evidences to yoga research. +ACKNOWLEDGMENT +We thank Swami Vivekananda Yoga Anusandhana Samsthana +Yoga University, Bangalore for financial support. +REFERENCES +1. +Project implicit, 2011. Available from: http://www.projectimplicit.net/index. +html. [Last cited on 2013 Jun 12]. +2. +De Houwer J, Teige-Mocigemba S, Spruyt A, Moors A. Implicit measures: +A normative analysis and review. Psychol Bull 2009;135:347-68. +3. +Banaji MR, Greenwald AG. Blindspot: Hidden Biases of Good People. +New Delhi: Penguin; 2013. +4. +Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences +in implicit cognition: The implicit association test. J Pers Soc Psychol +1998;74:1464-80. +Ilavarasu, et al.: Implicit measure for yoga research +125 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +5. +Van den Bussche E, Van den Noortgate W, Reynvoet B. Mechanisms of +masked priming: A meta-analysis. Psychol Bull 2009;135:452-77. +6. +Nosek BA, Banaji MR. The go/no-go association task. Soc Cogn 2001;19:625-66. +7. +De Houwer J. The extrinsic affective Simon task. Exp Psychol 2003;50:77-85. +8. +Fazio RH, Olson MA. Implicit measures in social cognition. Research: Their +meaning and use. Annu Rev Psychol 2003;54:297-327. +9. +Bosson JK, Swann WB Jr, Pennebaker JW. Stalking the perfect measure of +implicit self-esteem: The blind men and the elephant revisited? J Pers Soc +Psychol 2000;79:631-43. +10. Encyclopedia of psychology, 2013. Available from: http://www.psychology. +org/links/Resources/Software/. [Last cited on 2013 Jun 12]. +11. +Spruyt A, Clarysse J, Vansteenwegen D, Baeyens F, Hermans D. Affect +4.0: A free software package for implementing psychological and +psychophysiological experiments. Exp Psychol 2010;57:36-45. +12. Teachman BA, Allen JP. Development of social anxiety: Social interaction +predictors of implicit and explicit fear of negative evaluation. J Abnorm Child +Psychol 2007;35:63-78. +13. Cunningham WA, Preacher KJ, Banaji MR. Implicit attitude measures: +Consistency, stability, and convergent validity. Psychol Sci 2001;12:163-70. +14. Greenwald AG, Nosek BA, Banaji MR. Understanding and using the implicit +association test: I. An improved scoring algorithm. J Pers Soc Psychol +2003;85:197-216. +15. Lane KA, Banaji MR, Nosek BA, Greenwald AG. Understanding and Using +the Implicit Association Test: IV. What We Know (So Far). In: Wittenbrink +B, Schwarz N, editors. New York: Guilford Publication; 2007. +16. Karpinski A, Steinman RB. The single category implicit association test as +a measure of implicit social cognition. J Pers Soc Psychol 2006;91:16-32. +17. Bluemke M, Friese M. Reliability and validity of the single-target IAT (ST- +IAT): Assessing automatic affect towards multiple attitude objects. Eur J Soc +Psychol 2008;997:977-97. +18. Sriram N, Greenwald AG. The brief implicit association test. Exp Psychol +2009;56:283-94. +19. Olson MA, Fazio RH. Reducing the influence of extrapersonal associations +on the implicit association test: Personalizing the IAT. J Pers Soc Psychol +2004;86:653-67. +20. Banse R, Greenwald AG. Personality and implicit social cognition research: +Past, present and future. Eur J Pers 2007;21:371-82. +21. Foroni F, Bel-Bahar T. Picture-IAT versus word-IAT: level of stimulus +representation influences on the IAT. Eur J Soc Psychol 2010;40:321-37. +22. Gawronski B, Payne BK. Handbook of Implicit Social Cognition: Measurement, +Theory, and Applications. New York: Guilford Publication; 2010. +23. Nagarathna R, Nagendra HR. Integrated Approach of Yoga Therapy for +Positive Health. Bangalore: Swami Vivekananda Yoga Prakashana; 2008. +24. Hofmann W, Gschwendner T, Nosek BA, Schmitt M. What moderates +implicit-explicit consistency? Eur J Soc Psychol 2005;16:335-90. +25. Brosschot JF, Pieper S, Thayer JF. Expanding stress theory: Prolonged activation +and perseverative cognition. Psychoneuroendocrinology 2005;30:1043-9. +26. Brosschot JF, Verkuil B, Thayer JF. Conscious and unconscious perseverative +cognition: Is a large part of prolonged physiological activity due to +unconscious stress? J Psychosom Res 2010;69:407-16. +27. Inquisit 3.0. Seattle, WA: Millisecond Software; 2011. +28. R Development Core Team. R: A language and environment for statistical +computing. Vienna: R Foundation for Statistical Computing; 2013. +29. Lang PJ, Bradley MM, Cuthbert BN. International Affective Picture System +(IAPS): Affective Ratings of Pictures and Instruction Manual. Technical +Report A-8. Gainesville, FL: University of Florida; 2008. +30. Bradley MM, Lang PJ. Affective Norms for English Text (ANET): Affective +Ratings of Text and Instruction Manual. (Technical Report No D-1). +Gainesville, FL: University of Florida; 2007. +How to cite this article: Ilavarasu JV, Rajesh SK, Hankey A. Implicit +measure for yoga research: Yoga implicit association test. Int J Yoga +2014;7:120-5. +Source of Support: Swami Vivekananda Yoga Anusandhana +Samsthana, Bangalore, India, Conflict of Interest: None declared +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. 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For suggestions and comments do write back to us. diff --git a/subfolder_0/Influence of Yoga Practice on Memory in Children.txt b/subfolder_0/Influence of Yoga Practice on Memory in Children.txt new file mode 100644 index 0000000000000000000000000000000000000000..8dab0356fd86fd41314eb1f8147b23fd55a2771e --- /dev/null +++ b/subfolder_0/Influence of Yoga Practice on Memory in Children.txt @@ -0,0 +1,8 @@ + + + + + + + + diff --git a/subfolder_0/Mentally retarded children A scope for yogic rehabilitation module_unlocked.txt b/subfolder_0/Mentally retarded children A scope for yogic rehabilitation module_unlocked.txt new file mode 100644 index 0000000000000000000000000000000000000000..24614b501915d7fe389850f5e8f6e99d45cb8a34 --- /dev/null +++ b/subfolder_0/Mentally retarded children A scope for yogic rehabilitation module_unlocked.txt @@ -0,0 +1,187 @@ +98 +© 2016 CHRISMED Journal of Health and Research | Published by Wolters Kluwer - Medknow +Mentally retarded +children: A scope for +yogic rehabilitation +module +Sir, +Mental retardation (MR) has a varied phenomenology in +different parts of the world with an overall prevalence +of 1–3% in the global scenario.[1,2] MR produces +psychological, social, and financial distress to the whole +family, particularly parents, as they are usually the only +constant caretakers.[3] As mothers of mentally retarded +children (MRC), being the primary caregivers for their +children suffer more psychological distress than other +members of their families.[4] Previous research has +reported that psychiatric morbidities such as depression +and anxiety are common among mothers of MRC. +Overall 35–53% of mothers of MRC have symptoms +of depression.[5] The psychological burden that these +parents carry is very painful. The guilt of having born +such child, the social stigma that attaches themselves to +the family, the shame of a retarded child misbehaving +in public and the frustration and helplessness felt at +not being able to “cure” the child is all very painful +and disturbing the mental health of the parents of +MRC.[6] Thus, the parents of MRC suffered from “chronic +sorrow” throughout their lives.[7] +It becomes important to detect MR as early as possible, +and impart the appropriate skills to the parents in +bringing up and looking after their MRC, especially so +with regard to severely MRC who are likely to require +life‑long supervision. For many MRC, medications are +ineffective or have unwanted side effects, prompting +them to seek about complementary and alternative +medicine. Yoga is useful in the rehabilitation of the +MRC.[8] A controlled study on ninety MRC, randomly +assigned the children to two groups (yoga, control) so +that there were equal numbers of mild, moderate, and +severely MRC in both groups. The study assessed the +effects of integrated approach of yoga therapy (IAYT) +developed at the holistic therapy health home in +Bengaluru, for a year. The moderately retarded among +the yoga group performed significantly better on +testing with the Binet–Kamat test (for general mental +ability), Seguin form board (for co‑ordination), and +in the Vineland social maturity scale (to assess social +adjustment and behavior), compared to their initial +performance, as well as to that of the control group. +Moreover, the mild and severely regarded subjects of +the yoga group had also showed no deterioration in +any score, whereas the mildly retarded subjects of the +control group showed negative scores on retesting. +Thus, 9 months of yogic practices were associated with +improvement, in general, mental ability, psychomotor +coordination, and intelligent and social behavior of +MRC.[8] It was also reported that 10 days training in +yoga, school children (in the age range of 9–13 years), +show considerable improvement in static motor +performance, whereas a control group, which did +not practice yoga, did not change. This improvement +in static motor performance can be attributed to +better eye‑hand co‑ordination, improved fine motor +control, concentration and also an overall state of +well‑being and relaxation.[9] These studies suggest that +considerable plasticity and scope for improvement in +motor performance is still present in MRC. This offers +interesting scope for extending motor rehabilitation +program using yoga as an intervention in MRC. +Yogic practices based on IAYT module for effective +management of MRC can be given as below:[8] +Shithilikarana Vyayama  (loosening and stretching +practices)[8] +• Jogging +• Supta Pawanmuktasana (leg lock pose) +• Suryanamaskara (salutations to the sun). +Sukshma Vyayama (strengthening exercises)[8] +• Buddhi Tatha Dhrti Shakti Vikasaka (developing the +mind and will power) +• Smarna Shakti Vikasaka (developing the memory) +• Medha Shakti Vikasaka (developing the intellect) +• Netra Shakti Vikasaka (improving the eye‑sight) +• Kapola Shakti Vikasaka (rejuvenating the cheeks) +• Karna Shakti Vikasaka (developing the power of +hearing) +• Mani Bandha Shakti Vikasaka  (developing the +wrists) +• Kara Tala Shakti Vikasaka (developing the palms) +• Anguli Mula Shakti Vikasaka (developing the finger +joints) +• Purna Bhuja Shakti Vikasaka (developing the arms) +• Griva Shakti Vikasaka (developing the neck). +Letter to Editor +[Downloaded free from http://www.cjhr.org on Thursday, July 28, 2016, IP: 14.139.155.82] +Letter to Editor +CHRISMED Journal of Health and Research /Vol 3/Issue 1/Jan-Mar 2016 +99 +Asana (postures)[8] +• Ardhakati Chakrasana (the half wheel pose) +• Shashankasana (hare pose)/Yoga Mudra (attitude of +psychic union) +• Ushtrasana (camel pose) +• Bhujangasana (cobra pose) +• Shalabhasana (locust pose) +• Viparitakarani Asana (inverted pose) +• Sarvangasana (shoulder stand pose) +• Matsyasana (fish pose) +• Ardha Shirshasana  (half headstand pose)/ +Shirshasana (headstand pose) +• Shavasana (corpse pose). +Pranayama (breathing practices)[8] +• Nadi Shodhana Pranayama  (psychic network +purification). +Dharana and Dhyana (concentration and meditation +practices)[6] +• OM Meditation (OM chanting). +Kriya (cleansing practices)[8] +• Jala Neti. +It is strongly recommended that well‑designed studies +with the use of IAYT in the management of MRC may +give positive results. +Acknowledgment +Authors acknowledge SVYASA University for granting +permission to carry out this work. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +Pise Vishvanath, Tikhe Sham Ganpat1, +Balram Pradhan, Manmath Manohar Gharote2, +Nagendra Hongasandra Ramarao +Department of Yoga and Management Studies, S‑VYASA +University, Bengaluru, Karnataka, 1Department of Yoga, +Morarji Desai National Institute of Yoga, New Delhi, +2Department of Yoga, The Lonavla Yoga Institute, Lonavla, +Pune, Maharashtra, India +E‑mail: rudranath29@gmail.com +REFERENCES +1. +World Health Organization. Mental Health Around the World, World +Health Day 2001. Geneva: WHO; 2001. +2. +Nagarkar A, Sharma JP +, Tandon SK, Goutam P +. The clinical profile of +mentally retarded children in India and prevalence of depression in +mothers of the mentally retarded. Indian J Psychiatry 2014;56:165‑70. +3. +Schwartz C, Tsumi A. Parental involvement in the residential care +of persons with intellectual disability: The impact of parents’ and +residents’ characteristics and the process of relocation. J Appl Intellect +Disabil 2003;16:285‑93. +4. +Pelchat D, Lefebvre H, Perreault M. Differences and similarities +between mothers’ and fathers’ experiences of parenting a child with +a disability. J Child Health Care 2003;7:231‑47. +5. +Emerson E. Mothers of children and adolescents with intellectual +disability: Social and economic situation, mental health status, +and the self‑assessed social and psychological impact of the child’s +difficulties. J Intellect Disabil Res 2003;47(Pt 4‑5):385‑99. +6. +Noland RL, editor. Counseling Parents of the Mentally Retarded: +A Source Book. Springfield: Thomas; 1970. +7. +Olshansky S. Chronic sorrow: A response to having a mentally +defective child. Soc Casework 1962;43:190‑3. +8. +Uma K, Nagendra HR, Nagarathna R, Vaidehi S, Seethalakshmi R. +The integrated approach of yoga: A therapeutic tool for mentally +retarded children: A one‑year controlled study. J Ment Defic Res +1989;33(Pt 5):415‑21. +9. +Telles  S, Hanumanthaiah  B, Nagarathna  R, Nagendra  HR. +Improvement in static motor performance following yogic training +of school children. Percept Mot Skills 1993;76 (3 Pt 2):1264‑6. +Access this article online +Quick Response Code: +Website: +www.cjhr.org +DOI: +10.4103/2348-3334.172400 +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. +[Downloaded free from http://www.cjhr.org on Thursday, July 28, 2016, IP: 14.139.155.82] diff --git a/subfolder_0/Mindfulness (Vipassana) Meditation.txt b/subfolder_0/Mindfulness (Vipassana) Meditation.txt new file mode 100644 index 0000000000000000000000000000000000000000..1c505d26d88bb0aae98f3086ec2d96e2582b786a --- /dev/null +++ b/subfolder_0/Mindfulness (Vipassana) Meditation.txt @@ -0,0 +1,23 @@ +Mindfulness (Vipassana) Meditation: Effects On P3b Event-Related Potential +And Heart Rate Variability. +Delgado-Pastor LC1, Perakakis P, Subramanya P, Telles S, Vila J. + +ABSTRACT + +The concept of mindfulness is based on Vipassana, a Buddhist meditation technique. The present +study examines the physiological indices of attention and autonomic regulation in experienced +Vipassana meditators to test the claim that mindfulness is an effective therapeutic tool due to its +effects on increasing awareness of present experience and emotional self-regulation. Ten male +experienced Vipassana meditators underwent two assessment sessions, one where they practiced +Vipassana meditation and another where they rested with no meditation (random thinking). Each +meditation/no-meditation session lasted 30 min and was preceded and followed by an auditory +oddball task with two tones (standard and target). Event-related potentials to the tones were +recorded at the Fz, Cz, and Pz locations. Heart rate variability, derived from an EKG, was recorded +continuously during the meditation/no-meditation sessions and during a 5-minute baseline before +the task. The Vipassana experts showed greater P3b amplitudes to the target tone after meditation +than they did both before meditation and after the no-meditation session. They also showed a larger +LF/HF ratio increase during specific Vipassana meditation. These results suggest that expert +Vipassana meditators showed increased attentional engagement after meditation and increased +autonomic regulation during meditation supporting, at least partially, the two claims concerning +the clinical effectiveness of mindfulness. + diff --git a/subfolder_0/Mindfulness and impulsivity in diabetes mellitus.txt b/subfolder_0/Mindfulness and impulsivity in diabetes mellitus.txt new file mode 100644 index 0000000000000000000000000000000000000000..b6e532066648296ec2c5a9a43d434ae8658f2c57 --- /dev/null +++ b/subfolder_0/Mindfulness and impulsivity in diabetes mellitus.txt @@ -0,0 +1,348 @@ +The International Journal of Indian Psychology | ISSN 2348-5396 +Volume 2, Issue 1, Paper ID: B00252V2I12014 +http://www.ijip.in | Oct to Dec 2014 + + +© 2014 Jeevitaa S, Krishna R, Kashinath G M, Nagaratna R, Nagendra H R; licensee IJIP. This is an Open Access +Research +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. +Mindfulness and Impulsivity in Diabetes Mellitus +Jeevitaa S*, Krishna R**, +Kashinath G M***, Nagaratna R****, Nagendra H R***** +ABSTRACT: + +Background: Diabetes is a highly prevalent disease worldwide, characterized by increased +blood sugar levels. Growing evidences revealed the strong association of diabetes and +psychological disorders like anxiety, depression, schizophrenia, etc. Mindfulness is the +awareness which arises out of intentionally attending in an open and discerning way to whatever +is arising in the present moment, is positively associated with healthy condition. Impulsivity is a +predisposition toward rapid, unplanned reactions to internal or external stimuli without regard to +the negative consequences of these reactions to the impulsive individual or to others which is +negatively associated with the individual’s health. +Aim: This study was intended to see the association of mindfulness, impulsivity with diabetes. +Method and material: Two hundred subjects (100= diabetic and 100=non diabetic) from local +communities were enrolled in this study. All the subjects were administered Mindfulness, +attention and awareness scale (MAAS) and Barrat impulsivity scale. +The results: There was a significant low MAAS score and significantly higher Barrat +impulsivity scores in the diabetic group than in a non diabetic group. +Conclusion: Diabetic people have more impulsivity and less mindfulness state than non diabetic +people. + +Keywords: Mindfulness, impulsivity, diabetes, psychosomatic diseases +INTRODUCTION +Diabetes is one of the vastly prevailing diseases worldwide, characterized by chronically +persistent elevated blood sugar levels. The prevalence of diabetes is increased from 285 to 381 +million in very last three years. This figure is expected to be double by the year 2030. Over 62 +million, which is approximately 7.1 % of Indian population, is diabetic. +*Msc (Yoga), Yoga Therapist, SVYASA, Bangalore) +**Msc (Yoga), Yoga Therapist, SVYASA, Bangalore) +***BAMS,MD (Y & Rehab.) Assistant professor SVYASA, Bangalore ) +****Phd (yoga), Assistant Registrar, SVYASA, Bangalore,) +*****Chief Medical Officer, Holistic Health Center, MBBS, MD (Gen Med), FRCP, UK) +Mindfulness and impulsivity in diabetes mellitus + +© The International Journal of Indian Psychology | 96 +Many scientific investigations reported the strong association and diabetes and psychological +disorders like anxiety, eating disorder, depression, emotional distress and psychological stress, +which significantly contributes to reduced psychological well-being. The cause of these +psychological issues could be because of self monitoring blood sugar, dietary restriction, taking +insulin injections and lack of family support . +Psychological stress is believed to be affecting both etiology and the control of diabetes. +Diabetes is associated with psychiatric illnesses also and this association is bidirectional. +Mindfulness is the awareness which arises out of intentionally attending in an open and +discerning way to whatever is arising in the present moment. Mindfulness is positively +correlated with healthy condition, which help the patient to deal with their stress, pain and other +chronic conditions. Though mindfulness based intervention proven to be effecting in chronic +diseases like rheumatoid arthritis, diabetes, chronic fatigue syndrome, fibromyalgia etc ., though +there are no studies showing the relation of mindfulness with chronic diseases keeping this as +background this study was aimed to see the association of mindfulness with diabetes which is a +chronic disease. + Impulsivity is a predisposition toward rapid, unplanned reactions to internal or external stimuli +without regard to the negative consequences of these reactions to the impulsive individual or to +others19. Impulsivity is commonly found in patient with many psychiatric disorders. Impulsivity +leads to agitated mind, reduced performance, sleep deprivation, incapability to make the +judgment, poor discrimination, which further leads to psychological conditions like anxiety, +depression, bipolar, schizophrenia and psychiatric disease etc. it is well know that people with +depression and aggressive behavior personalities are more impulsive. . Impulsivity is found as +co-morbidity in psychiatric conditions, including personality disorders, substance use, and +bipolar disorder. + Considering these facts, this study was aimed to see the association of diabetes with +mindfulness and impulsivity. +METHODS AND MATERIAL +Two hundred subjects (100 diabetic and 100 non-diabetics) between the age range of 40 to 60 +years with matching age and gender, from Bansal Hospital, Uniglobe Asia Travels, Delhi and +non-diabetic subjects from local communities from Delhi were enrolled in this study. Subjects in +diabetes group were having minimum 3 years diabetes history. Subjects with known +neurological disorders, under psychiatric medication, with history depression & Pregnancy were +excluded from the study. + + +Mindfulness and impulsivity in diabetes mellitus + +© The International Journal of Indian Psychology | 97 +DEMOGRAPHIC DATA + + + + + + + +ASSESSMENTS +All the subjects were administered Mindfulness, attention and awareness (MAAS) scale and +Barrat’s impulsivity scale for assessment mindfulness and impulsivity respectively. +Mindfulness, awareness and Attention scale (MAAS). It is a set of 8 questions, describing +common mindful or non-mindful behaviors and preferences. 4-point Linker-type scale (Strongly +disagree to strongly agree) primarily designed to know mindfulness. +This is a valid tool to measure mindfulness, attention and awareness and has been used in +scientific studies +Barratt Impulsiveness Scale : It is having 30 items with four facets and four domains. It +measures attention, motor, cognitive impulsivity. Items are Attention domain with first order +factors containing 5 items and cognitive instability containing 3 items. Motor domain of first +order factor contains 7 items and perseverance factor of 4 items, Non-planning domain +containing self control as a first order factor of 6 items and Cognitive Complexity of 5 items. +DATA ANALYSIS +Analysis of the data was done using SPSS version 10. Independent sample t-test was applied to +see the between group difference. + + + + + + +Population +Gender +Age (Mean ± SD) +Diabetic [N=100] +Male: 58 +52.01 ± 6.51 +Female: 42 +52.14 ± 6.25 +Non-diabetic [N=100] +Male: 45 +51 ± 5.89 +Female: 55 +50.4 ± 5.4 +Mindfulness and impulsivity in diabetes mellitus + +© The International Journal of Indian Psychology | 98 +RESULTS +Mindfulness: Independent sample the test showed significant decrease in MAAS score in +diabetic subjects than in no-diabetic (p- 0.00). +Table2: Independent sample t test shown significant difference in MAAS score in between +groups +The table shows Independent Samples Test + + +Levene's Test for Equality +of Variances +t-test for Equality of Means +F +Sig. +T +df +Sig. +(2- +tailed) +Mean +Difference +Std. +Error +Difference +95% Confidence Interval +of the Difference +Lower +Upper +Mindfuln +ess +Equal +variances +assumed +38.480 +.000 +-6.270 +198 +.000 +-3.370 +.537 +-4.430 +-2.310 +Equal variances not +assumed + + +-6.270 +154.78 +0 +.000 +-3.370 +.537 +-4.432 +-2.308 + +Impulsivity: There was significantly higher more in diabetic subjects than in non-diabetic. +Table3: Independent sample t test shown significant difference in Barrat impulsivity score in +between groups + +Levene's Test for +Equality of +Variances +t-test for Equality of Means +F +Sig. +T +df +Sig. (2- +tailed) +Mean +Difference +Std. Error +Difference +95% Confidence +Interval of the +Difference +Lower +Upper +Impulsivity +Equal +variances +assumed +0.155 +0.695 +3.47 +198 +0.001 +3.02 +0.8703 +1.3038 +4.7362 +Equal +variances +not +assumed + + +3.47 +197.7 +0.001 +3.02 +0.8703 +1.3038 +4.7362 + +DISCUSSION +This study was aimed to find the relationship of mindfulness and impulsivity with diabetes. End +of the study, we could able to see that patients with diabetes have more impulsivity and less +mindfulness than non-diabetic people. +Earlier studies reported that increased impulsivity is associated with mental disorders like ADHD +, anxiety , depression and other Neuro-degenerative diseases like Parkinson’s diseases , +Alzheimer’s disease, etc. as anxiety and depression are frequently observed psychological +conditions in diabetes which may be the reason for the association of impulsivity with diabetes. +Though there are no direct studies showing an association of mindfulness with chronic disease, +Mindfulness and impulsivity in diabetes mellitus + +© The International Journal of Indian Psychology | 99 +studies on mindfulness based stress reduction programs have shown a significant positive role of +mindfulness based intervention in the management of chronic conditions like cardiac disease, +stroke, arthritis, lung diseases etc . This indirectly suggests that poor mindfulness is positively +associated with progression of chronic disease. As diabetes is also one of the chronic diseases +which may be the reason of decreased mindfulness in diabetes. +Probably this is the first study which shows the significant correlation between impulsivity and +mindfulness with diabetes and it study suggests to consider the intervention which improves the +mindfulness and reduces the impulsivity in the management of diabetes. +There is need of replication of this study in larger samples and we have shown test the +interventions which can reduce the impulsivity and improves the mindfulness have any impact +on the primary outcome variation in diabetes and quality of life of diabetic people. +CONCLUSION +Patients suffering with diabetes have less mindfulness and more impulsivity than non-diabetic. +REFERENCE +1. Shlomo Melmed, Kenneth Polonsky, P. Reed Larsen, Henry Kronenberg, Williams +textbook of endocrinology (12th ed.). Philadelphia: elsevier/saunders. Pp. 1371–1435. +Isbn 978-1-4377-0324-5 +2. Fikri zaki muhammadi, "Simple treatment to curb diabetes". Bali dialy. January 20, +2014. +3. Wild S, Roglic G, Green A, Sicree R, King H . "Global prevalence of diabetes: estimates +for the year 2000 and projections for 2030". Diabetes care.2004. 27(5): 1047–53. +4. Gale, Jason. "India’s diabetes epidemic cuts down millions who escape poverty". +Bloomberg. 2012. +5. Ramen Goel. Diabetes can be controlled in 80% in India. Bihar Prabha. 6 feb, 2014 +6. Richard R. Rubin and Mark Peyrot. Psychological issues and treatments for people with +diabetes. Journal of Clinical Psychology. 2001;57(4): 457–478 +7. Daniel P. Chapman, Geraldine S. Perry, Tara W. Strine The Vital Link Between Chronic +Disease and Depressive Disorders. Preventing Chronic Disease. Public research .Practice +and Policy. January 2005. Volume 2( No. 1) +8. Allison B Grigsbya, Ryan J Andersona, Kenneth E Freedlanda, Ray E Clousea, B, Patrick +J Lustman.There is high prevalence of anxiety in diabetes. Journal of psychosomatic +research. 2002; 53.( 6):1053–1060. +9. Cox, Daniel J.; Gonder-Frederick, Linda. Major developments in behavioral diabetes +research. Journal of Consulting and Clinical Psychology, 1992;60(4):628-638 +10. Methew smith Psychological well-being and diabetes. Practical Diabetes International +2006;23( 3): 142–142 + +Mindfulness and impulsivity in diabetes mellitus + +© The International Journal of Indian Psychology | 100 + +11. Richard R, Rubin, Mark Peyrot. Psychological issues and treatment for people with +diabtes. Journal of clinical psychology. 2001;57(4):457-478 +12. Cox, Denil , Gonder F, Linda. Major development in behavioural diabetes research. +Journal of consulting an d clinical psychology. 1992;60(4):628-638 +13. Yatan Pal Singh Balhara. Diabetes and psychiatric disorders. Indian J Endocrinol Metab. +2011; (4): 274–283 +14. Shauna L., Shapiro. The Integration of mindfulness and psychology. Journal of Clinical +Psychology. Special Issue: Mindfulness. 2009;65(6):555–560 +15. Fulwiler, Carl E. and de Torrijos, Fernando. "Mindfulness and Health," Psychiatry +Information in Brief: 2011;8(2). +16. Monika Merkes. Mindfulness stress reduction for the people with chronic disease. +Australian Journal of primary health. 2010;16(3): 200-210 +17. F. Gerard moeller,Ernest S. Barratt,Donald M, Dougherty,Joy M. Schmitz,Alan C. +Swann, Psychiatric aspects of impulsivity. Am j psychiatry 2001;158:1783-1793. +18. Von Diemen L, Szobot CM, Kessler F, Pechansky F…, Adaptation and construct +validation of the Barratt Impulsiveness Scale (BIS 11) to Brazilian Portuguese for use in +adolescents. Rev Bras Psiquiatr. 2007;29(2):153-6. +19. Pikó b, Pinczés T.Impulsivity - Aggression - Depression: Study of adolescents' problem +behavior in light of their personality traits.Psychiatr hung. 2014;(29,1):48-55. +20. Swann AC ,Janicak Pl, calabrese JR, Bowden CL, Dilsaver SC, Morris dd, Petty F, Davis +ll: Structure of mania: subgroups with distinct clinical characteristics and course of illness +in randomized clinical trial participants. journal of affective disorders, december 2001; +67, (1–3):123–132. +21. Nicholas T. Van Dam , Mitch Earleywine, Ashley Borders.Measuring mindfulness. An +Item Response Theory analysis of the Mindful Attention Awareness Scale Personality +and Individual Differences. November 2010;49 (7), 805–810. +22. Patton JH, Stanford ms, Barratt ES., Factor structure of the barratt impulsiveness scale. J +clin psychol. 1995;51(6):768-74. +23. Maggie E. Toplak, Ashley Pitch, David B. Flora, Linda Iwenofu, Karen Ghelani, Umesh +Jain. The Unity and Diversity of Inattention and Hyperactivity/Impulsivity in ADHD: +Evidence for a General Factor with Separable Dimensions. Journal.2009;37(8):1137- +1150 +24. Ernest S. Barratt. Anxiety and impulsiveness related to psychomotor efficiency; +Perceptual alzd Motor Skills 1959; 9:191-198. +25. Beth S. Brodsky, Maria Oquendo, Steven P. Ellis, Gretchen L. Haas, Kevin M. Malone, +J. John Mann. The Relationship of Childhood Abuse to Impulsivity and Suicidal +Behavior in Adults with Major Depression. Am J Psychiatry 2001; 158:1871-1877. +Mindfulness and impulsivity in diabetes mellitus + +© The International Journal of Indian Psychology | 101 +26. Roshan Coolsa, Roger A Barkerb, Barbara J Sahakianc, Trevor W Robbins. l-Dopa +medication remediates cognitive inflexibility, but increases impulsivity in patients with +Parkinson’s disease. Neuropsychologia2003;41(11):1431–1441 +27. Rochat, Lucien Delbeuck, Xavier , Billieux, Joël d'Acremont, Mathieu , Van der Linden, +Anne-Claude Juillerat, Van der Linden. Assessing Impulsivity Changes in Alzheimer +Disease. Martial .Alzheimer Disease & Associated Disorders: July/September 2008;22(3 +):278-283. +28. Lorig, Kate R. RN, DrPH; Sobel, David S. Stewart, Anita L, Brown, Byron +William,Bandura, Albert; Ritter, Philip , Gonzalez, Virginia M, Laurent, Diana D, +Holman, Ha. Evidence Suggesting That a Chronic Disease Self-Management Program +Can Improve Health Status While Reducing Hospitalization: A Randomized Trial +Medical Care: January 1999;37 (1):5-14. diff --git a/subfolder_0/OXYGEN CONSUMPTION AND RESPIRATION FOLLOWING TWO YOGA RELAXATION.txt b/subfolder_0/OXYGEN CONSUMPTION AND RESPIRATION FOLLOWING TWO YOGA RELAXATION.txt new file mode 100644 index 0000000000000000000000000000000000000000..d4a668ac00d406183a2cbe1bb175bdaeb3386638 --- /dev/null +++ b/subfolder_0/OXYGEN CONSUMPTION AND RESPIRATION FOLLOWING TWO YOGA RELAXATION.txt @@ -0,0 +1,32 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/Orphan children and yogic approach..txt b/subfolder_0/Orphan children and yogic approach..txt new file mode 100644 index 0000000000000000000000000000000000000000..1a6159a6cd1b59d3de6075deb352685c5ae68ae5 --- /dev/null +++ b/subfolder_0/Orphan children and yogic approach..txt @@ -0,0 +1,137 @@ +64 +© 2018 International Journal of Yoga - Philosophy, Psychology and Parapsychology | Published by Wolters Kluwer - Medknow +Orphan Children and Yogic Approach +Based on previous research findings, yoga program +for orphans may include[6‑9] warm‑ups, loosening +and stretching practices, Surya Namaskara, yoga +postures  (asanas) which include standing, sitting, prone +and supine asanas, Pranayama, and trataka. +To address the problems of orphan children, it is +recommended setting up of a National Policy and Support +Services for Orphans, Child Guidance Counsellors in +those schools having more number of orphans, and yoga +as a social skills training for orphan children. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +Shambhu Dayal Sharma, Rajesh S K1, +Pailoor Subramanya2 +  +Division of Yoga and Humanities, S‑VYASA, 1Division of Yoga +and Physical Sciences, S‑VYASA, 2Division of Yoga and Life +Sciences, S‑VYASA, Bengaluru, Karnataka, India  + +  +Address for correspondence: Dr. Pailoor Subramanya, +Division of Yoga and Life Sciences, S‑VYASA, +Bengaluru, Karnataka, India. +E‑mail: pailoors@gmail.com +References +1. +Musisi S, Kinyanda E, Nakasujja N, Nakigudde J. A comparison +of the behavioral and emotional disorders of primary +school‑going orphans and non‑orphans in Uganda. Afr Health +Sci 2007;7:202‑13. +2. +Ehud  M, An  BD, Avshalom  S. Here and now: Yoga in Israeli +schools. Int J Yoga 2010;3:42‑7. +3. +Atwine  B, Cantor‑Graae  E, Bajunirwe  F. Psychological +distress among AIDS orphans in rural Uganda. Soc Sci Med +2005;61:555‑64. +4. +Makame  V, Ani  C, Grantham‑McGregor  S. Psychological +well‑being of orphans in Dar El Salaam, Tanzania. Acta Paediatr +2002;91:459‑65. +5. +Carmody  J, Baer  RA. Relationships between mindfulness +practice and levels of mindfulness, medical and psychological +symptoms and well‑being in a mindfulness‑based stress reduction +program. J Behav Med 2008;31:23‑33. +6. +Ferreira‑Vorkapic  C, Feitoza  JM, Marchioro  M, Simões J, +Kozasa E, Telles S, et al. Are there benefits from teaching yoga +at schools? A Systematic review of randomized control trials of +yoga‑based interventions. Evid Based Complement Alternat Med +2015;2015:345835. +7. +Purohit  SP, Pradhan  B. Effect of yoga program on executive +functions of adolescents dwelling in an orphan home: +A  randomized controlled study. J  Tradit Complement Med +2017;7:99‑105. +Letter to Editor +Orphan children are more likely to be emotionally +needy, insecure, poor, exploited, abused, or neglected, +and they show high resilience in coping.[1] The children +who have lost one parent (single orphan) or both parents +(double orphan) usually live in stressful conditions.[2] +Many of the studies show that orphans are highly +prone to psychological distress, depressive disorders of +vegetative symptoms, anxiety, a sense of uselessness, +hopelessness, and suicidal tendency. Hence, only material +support and sustenance  (in the form of food, clothing, +and shelter) may not be enough/effective to address these +issues in orphans.[3] In addition to this material support, +they also need additional support to ensure psychological +well‑being.[4] Thus, our search for effective interventions +leads to the solution through yoga, as many studies +show that yoga can lead to psychological well‑being and +symptom reduction.[5] This is understandable from the +attention and acceptance of Yoga in the light of positive +role that yoga can play in prevention and management of +psychological conditions. +There is a progressive trend toward the use of yoga as +a mind‑body complementary and alternative medicine +intervention to improve specific physical and mental +health conditions. Yoga is a holistic system of varied +mind‑body practices that can be used to improve mental +and physical health, and it has been utilized in a variety +of contexts and situations.[6] A study assessing the +impact of yoga intervention on a group of Israeli school +children residing in the region affected by the Second +Lebanon War reveals that yoga may be beneficial as an +intervention on children in postwar stress situations. The +participation in yoga was both enjoyable and beneficial +to children living in stressful conditions.[2] A study on +effectiveness of 3‑month yoga for orphans reported that +yoga enhances their executive function and may have +potential implications on learning, classroom behavior, +and in handling the adverse circumstances and stand +as a preventive measure for mental health problems.[7] +Furthermore, an evidence‑based yoga review suggests +that certain postures, breathing techniques, concentration, +and meditation practices help in effective rehabilitation +of orphans.[8] A study aimed to assess the effect of a 12- +week yoga program on the minimum muscular fitness +of adolescents dwelling in an orphanage suggests that +yoga has considerable benefits to improve muscular +fitness and may be recommended as an effective training +activity.[9] +[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146] +Letter to Editor +65 +International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology  ¦  Volume 5  ¦  Issue 2  ¦  July‑December 2017 +8. +Sharma  SD, Pailoor  S, Tikhe  SG. Rehabilitation in orphan +children: Role of evidence‑based yoga. Yoga Mimamsa +2015;47:3‑5. +9. +Purohit SP, Pradhan B, Mohanty S, Nagendra HR. Effect of yoga +program on minimum muscular fitness of orphan adolescents by +using kraus‑weber test: A  randomized wait‑list controlled study. +Indian J Posit Psychol 2015;6:389. +Access this article online +Quick Response Code: +Website: www.ijoyppp.org +DOI: 10.4103/ijny.ijoyppp_21_17 +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. +How to cite this article: Sharma SD, Rajesh SK, Subramanya P. Orphan +children and yogic approach. Int J Yoga - Philosop Psychol Parapsychol +2017;5:XX-XX. +© 2018 International Journal of Yoga ‑ Philosophy, Psychology and Parapsychology | Published +by Wolters Kluwer ‑ Medknow +[Downloaded free from http://www.ijoyppp.org on Wednesday, January 27, 2021, IP: 136.232.192.146] diff --git a/subfolder_0/Oxygen consumption during pranayamic type of very slow-rate breathing.txt b/subfolder_0/Oxygen consumption during pranayamic type of very slow-rate breathing.txt new file mode 100644 index 0000000000000000000000000000000000000000..0e70f9eb88442d42936df5a1a91baa77e8de3222 --- /dev/null +++ b/subfolder_0/Oxygen consumption during pranayamic type of very slow-rate breathing.txt @@ -0,0 +1,15 @@ + + + + + + + + + + + + + + + diff --git a/subfolder_0/PHYSICAL FITNESS IN ADOLESCENT COMPETITIVE YOGA PRACTITIONERS vikas.txt b/subfolder_0/PHYSICAL FITNESS IN ADOLESCENT COMPETITIVE YOGA PRACTITIONERS vikas.txt new file mode 100644 index 0000000000000000000000000000000000000000..65cdc0380ac7d8f6c928b9e3fabaa3a685d026d7 --- /dev/null +++ b/subfolder_0/PHYSICAL FITNESS IN ADOLESCENT COMPETITIVE YOGA PRACTITIONERS vikas.txt @@ -0,0 +1,513 @@ +Running head: PHYSICAL FITNESS IN ADOLESCENT COMPETITIVE YOGA +PRACTITIONERS +PHYSICAL FITNESS IN ADOLESCENT COMPETITIVE YOGA PRACTITIONERS-A +CROSS SECTIONAL COHORT STUDY +Author Note +Vikas Rawat., Rajesh S.K., and Raghuram Nagarathna., Swami Vivekananda Yoga +Anusandhana Samsthana, Bangalore, India. +We thank Dr. Judu Ilavarsu, for his valuable suggestions and the management of +SVYASA Yoga University for financial support. +Correspondence regarding this article may be sent to Vikas Rawat., PhD Scholar, Swami +Vivekananda Yoga Anusandhana Samsthana, Bangalore, India. Pin: 560019. +E-mail: vikasrawat.svyasa@gmail.com +Abstract +The benefits of physical fitness are widely acknowledged and extend across many domains of +wellness and health. Aim of this study was to investigate differences in physical fitness in +healthy individuals, who regularly practice yoga and non-experienced participants. This study +compared hundred and ten competitive yoga children with equal number, age, gender, weight- +matched healthy yoga motivated children who were naive. Sample consists of 50 boys and 60 +girls in each group. Anthropometric measurements, spinal flexibility, hand grip strength and +ventilatory function were recorded. Independent-samples t-tests were performed to determine +whether statistically significant between groups. Yoga practitioners scored significantly higher +on all domains of Physical fitness except on Left handgrip strength when compared with non +practitioners. This study has shown children who practice yoga has seem to have higher physical +fitness than non practitioners. Hence we recommend that yoga be introduced at school level in +order to improve physical fitness and ventilatory functions of students. +Key words: physical fitness, yoga, flexibility, handgrip, PEFR +INTRODUCTION +Emerging society has considered physical fitness as one of the important indicators of health. +Being physically fit has been defined as "the ability to carry out daily tasks with vigor and +alertness, without undue fatigue and with ample energy to enjoy leisure-time pursuits and to +meet unforeseen emergencies" (PCPFS, 1952). Physical fitness refers to the maximum capacity +that people have or achieve while they perform physical activity that can be measured as the +level of strength and flexibility of the muscular groups in different body parts. Further ventilator +function is useful for assessment of physical fitness in children. Previous findings showed a +positive relationship between physical fitness, during adolescence and arterial properties later in +life (Twisk, Kemper, & Mechelen, 2002) academic achievement (Chomitz et al., 2009) & +improved emotionality (Folkins, 1981). Recent study in India which has concluded that basic +levels of health-related fitness are low among school children and reasons attributed to this trend +were increasing affluence, and academic competitiveness, which forces the child to devote very +little time to physical activity (Raja, Gupta, Bodhke, & Girish, 2014). +Yoga in its original form consists of a system of physical, psychological and ethical practices +(Nagarathna & Nagendra, 2001). The popularity of yoga is evident with emerging interest and +research in the therapeutic applications. Further, estimated prevalence of practicing Yoga has +increased in many countries (Barnes, Powell-Griner, McFann & Nahin, 2004; Siegel & Barros, +2009). Earlier studies have shown positive effects of Yoga training in enhance minimum +muscular fitness (Gharote, 1976), skeletal muscle strength and endurance of students +(Mandanmohan, Jatiya, Udupa & Bhavanani, 2003). Further, recent study has shown yoga +training improves lung function, increases the vital capacity, timed vital capacity, maximum +voluntary ventilation, breath holding time and maximal inspiratory and expiratory pressures +(Vedala, Mane & Paul, 2014). Furthermore recent literature suggests that yoga improves +children’s physical and mental well-being (Hagen & Nayar, 2014). +Previous studies has yoga training enhance an individual's physical fitness. Hence aim of this +study was to investigate differences in physical fitness in healthy individuals, which would be +indicated by higher strength, flexibility and ventilator function in comparison with who regularly +practice yoga and non-experienced participants. It was hypothesized that children who regularly +practiced yoga had better physical fitness compared to non-experienced children. +METHODS +Participants +This study evaluated 110 +competitive yoga children who had practiced yoga at least once +weekly for a minimum of two months within the past 6 months (Thomas, Friedmann, Ross, & +Bevans, 2012), and 110 age, gender, weight-matched healthy yoga motivated children who were +naive (control group). The participants in the yoga group were recruited from an International +Yoga competition (HIMALAYA) organized by S-VYASA Yoga University. The control group +was recruited from the children who registered for Yoga based Personality Development Camp +(YPDC) in summer holidays in the serene campus of SVYASA University. Children with a +history of asthma, a recent history of respiratory infection with or without persistent cough +within the past two weeks and those with any major disability or illness were excluded from the +study. +Consent and ethical clearance +Signed informed consent was obtained from the parent or guardian of the child at the time of +registration after they had read the proposal of this simple non interventional study that involved +non-invasive data collection. All procedures were reviewed and accepted by the institutional +ethical committee of SVAYSA University. The children were explained in detail about the +nature of the study and the voluntary nature of participation and were not provided with any +incentives for their participation. +Measurements +Anthropometric data +After completing a form that contained details of age, gender, class of study, interest in yoga, the +weight (KG) was recorded using a standard electronic weighing scale with minimal clothing. +They were asked to remove the shoes and step up onto the weighing scale and stand still over the +center of the scale with body weight evenly distributed between both feet. Standing height (cm) +was measured without shoes using a standard scale. +Hand grip strength +Hand grip strength of both hands was measured using hand grip dynamometer (Lafayette +Instrument, U.S.A). Subjects were encouraged to perform maximal contractions keeping their +arm extended at shoulder level, horizontal to the ground ((Madanmohan, Mahadevan, +Balakrishnan, Gopalakrishnan & Prakash, 2008)). The test was repeated three times at intervals +of 15 seconds independently in both hands and the maximum value obtained was recorded. +Ventilatory Function +A mini Peak expiratory flow meter (Clement Clarke) was used to check the ventilatory function +of children. The purpose and technique of performing PEFR was explained along with a +demonstration of the correct manner of performing the test. The student was made to give the +test in the standing position after ensuring that he/she was able to perform the test correctly by +maintaining an airtight seal between their lips and the mouthpiece of the instrument (Holcroft, +Eisen, Sama & Wegman, 2003). The highest value of the three readings was recorded as the final +PEFR value. +Flexibility +Sit-and-reach test (SAR) used to measure spinal flexibility has been shown to have positive +correlation with hamstring flexibility (Baltaci, Un, Tunay, Besler & Gerçeker, 2003). The subject +sits on the floor with his legs extended towards the SAR apparatus with the sole of the foot +touching the board. Participant then bends forward to his maximum capacity pushing the +indicator with his fingers keeping the elbows straight (Tekur, Singphow, Nagendra, & +Raghuram, 2008). The distance covered is then measured in centimeters. +Data analysis +All statistical analyses were performed using the Statistical Package for Social Sciences (version +16.0). Levene’s test for equality of variances was used for all variables to determine the variance. +Independent-samples t-tests were performed to determine whether statistically significant +differences existed in anthropometry, spinal flexibility, hand grip strength and ventilatory +function between Yoga and control groups.. +Results +Except for weight and PEFR, the assumption of homogeneity of variance was met for all other +variables. Table 1 and 2 show comparison between the two groups and the gender differences +respectively. There was no significant difference in the age, height and weight between the two +groups(Table1). A sub group analysis (Table 2) also showed non-significant difference in the +age, height and weight between boys and girls in the two groups. The lung capacity as measured +by PEFR was significantly better (p=0.002) in children who practiced yoga. Spinal flexibility as +measured by SAR was significantly better in yoga than non yoga group (p=.001). Muscular +fitness as measured by hand grip strength, Girl’s yoga practitioner has scored significantly higher +when compared with non practitioners. Further there was no significant difference in handgrip +strength between boys groups. +Table 1: Comparison of demographic details and Physical fitness between +yoga and non-yoga practitioners +Variable +Group +N +Mean +SD +Sig. (2-tailed) +t +P +Age +Yoga +110 +12.87 +1.31 +0.29 +0.77 +Control +110 +12.82 +1.47 +Weighta +Yoga +110 +39.24 +7.89 +0.008 +0.99 +Control +110 +39.23 +10.43 +Height +Yoga +110 +149.10 +8.51 +1.19 +0.235 +Control +110 +147.63 +9.81 +PEFRa +Yoga +110 +291.91 +38.94 +3.15 +0.002 +Control +110 +272.82 +50.19 +SAR +Yoga +110 +39.23 +7.05 +12.32 +<0.001 +Control +110 +27.97 +6.51 +HGS +Right +Yoga +110 +22.27 +6.00 +2.084 +0.038 +Control +110 +20.55 +6.23 +HGS +Left +Yoga +110 +21.75 +6.06 +1.726 +0.086 +Control +110 +20.31 +6.36 +a Adjusted because variances were not equal. +Abbreviations: PEFR- peak expiratory flow rate, SAR- sit and reach , HGS- +hand grip strength. Note: Fitness was better on children who practiced yoga +than those who did not. +Table 2: gender Comparison of anthropometric and physical fitness variables +between yoga and non yoga practitioners +Variable +Group +N +Mean +SD +Sig. (2-tailed) +t +P +Age +Boys +Yoga +50 +12.90 +1.22 +-.666 +.507 +Control +50 +13.06 +1.19 +Girls +Yoga +60 +12.85 +1.40 +.833 +.407 +Control +60 +12.62 +1.66 +Height +Boys +Yoga +50 +151.32 +8.93 +.000 +1.000 +Control +50 +151.32 +9.24 +Girls +Yoga +60 +147.25 +7.73 +1.735 +.085 +Control +60 +144.55 +9.25 +Weight +Boys +Yoga +50 +39.226 +8.19 +-1.235 +.220 +Control +50 +41.440 +9.67 +Girlsa +Yoga +60 +39.243 +7.71 +1.090 +.278 +Control +60 +37.380 +10.76 +PEFR +Boys +Yoga +50 +299.60 +40.956 +2.151 +.034 +Control +50 +280.20 +48.885 +Girlsa +Yoga +60 +285.50 +36.286 +2.335 +.021 +Control +60 +266.67 +50.846 +Sit and +reach +Boys +Yoga +50 +38.60 +7.832 +6.448 +.000 +Control +50 +29.35 +6.445 +Girls +Yoga +60 +39.76 +6.336 +11.140 +.000 +Control +60 +26.82 +6.389 +HG- +Right +Boys +Yoga +50 +25.12 +6.467 +.550 +.584 +Control +50 +24.44 +5.887 +Girls +Yoga +60 +19.90 +4.383 +3.223 +.002 +Control +60 +17.32 +4.398 +HG-Left +Boys +Yoga +50 +24.80 +6.386 +.197 +.845 +Control +50 +24.56 +5.810 +Girls +Yoga +60 +19.22 +4.431 +3.072 +.003 +Control +60 +16.77 +4.304 +aAdjusted because variances were not equal; PEFR- peak expiratory flow rate +DISCUSSION +This cross sectional cohort study compared the physical fitness of 110 adolescent students (50 +boys, 60 girls) in age range of 12 to 13 years who were adept yoga competitors with yoga naïve +healthy students who were motivated to learn yoga. The results indicated that Yoga practitioners +did exhibit higher physical fitness compared to non practitioners. Subgroup gender analysis also +showed that girls who practiced yoga had higher levels of physical fitness compared to non +practitioners. Further, boy’s yoga practitioners have shown higher levels of physical fitness on +all domains except handgrip strength compared to non practitioners. +Comparisons +These results are consistent with previous research showing long-term effect of yoga practice on +minimum muscular fitness (Gharote, 1975), lung function (Vedala, Mane & Paul, 2014), skeletal +muscle strength and endurance of children (Mandanmohan, Jatiya, Udupa & Bhavanani, 2003). +Study investigated the effect of yoga exercise on the health-related physical fitness of unhealthy +school-age children. Result has shown significant improvement in BMI, flexibility, muscular +strength, and cardiopulmonary fitness following seventh week training and 2 weeks of self- +practice at home (Chen et al, 2009). This 12-week community-based yoga intervention was +feasible and provides preliminary evidence for the benefits of yoga on HRQL, physical fitness +and Physical activity level in pediatric cancer out-patients (Wurz , Chamorro-Vina , Guilcher , +Schulte & Culos-Reed, 2014). +Mechanisms +In normal exercises, flexibility program or even in sports, one aims to develop the strength of the +muscle through contraction of the muscle. In Yoga, in contrast, the muscle is stretched – fast or +slow – in a systematic manner. In Yoga further, all skeletal muscles undergo stretch, thus, +providing a global control (Srinivasan, 2011) while in exercises, only certain muscles pertaining +to that sport are activated in preference to most others. +Basic yogic postures involve sustained isometric contraction of the shoulder, chest and arm +muscles +which may be possible reason for +improvement in the +handgrip +strength +(Mandanmohan, Jatiya, Udupa & Bhavanani, 2003). Further most of the forward bending posture +helps to enhance spine flexibility and hamstring muscle. Consequent improvement in the spine +flexibility and hamstring muscle muscles can explain the significant increase in measure of sit +and reach in yoga practicing children. Furthermore one of main component of yoga practice is +pranayama. Previous report suggests short term and long term pranayama practice enhance +ventilatory functions as measured by spirometry (Joshi, Joshi, & Gokhale, 1992; Murthy,et al. +1983). This may be variation in airway resistance and strength of expiratory muscle measure +shown in PEFR difference in yoga trained children. +Limitations +Potential limitations of this research must also be considered. It may be difficult to generalize the +results of this study as both groups were motivated to do yoga. Secondly, we have used only +PEFR using a mini PEFR instrument; it would have been ideal to compare all measures of lung +function using a spirometer. Further nutritional status and physical activity level which can +influence the physical fitness were not measured. +Strengths +To our knowledge, this is the first study that has compared physical fitness in yoga trained +children as compared to untrained ones. The majority of the current researchers have mainly +focused on the effects of short-term and long-term yoga programs. The present study is, perhaps, +the first in which physical fitness of children compared between yoga practitioners and non +practitioners. Although motivation remains an important factor (Manjunath & Telles, 1999) that +may influences the performance, this didn’t appear to be a factor in the current study as both +groups were motivated to practice yoga. +Conclusion +Alarming health trends are emerging, signifying that schools need to renew and inflate their role +in providing and encouraging physical activity for our nation’s young people. Importantly, +physical inactivity regulates the risk features of lifestyle-related chronic diseases and conditions +and may track through adulthood. This study has shown children who practice yoga have seem to +have higher physical fitness than non practitioners. Hence we recommend that yoga be +introduced at school level in order to improve physical fitness and ventilatory functions of +students. Environmental factors such as availability of play ground, tools and financial constrain +are not an issue for yoga practice. +Reference +Baltaci, G., Un, N., Tunay, V., Besler, A., & Gerçeker, S. (2003). Comparison of three different +sit and reach tests for measurement of hamstring flexibility in female university students. British +journal of sports medicine, 37(1), 59-61. +Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R. L. (2004). Complementary and +alternative medicine use among adults: United States, 2002. Advance data, (343), 1-19. +Chen, T. L., Mao, H. C., Lai, C. H., Li, C. Y., & Kuo, C. H. (2009). The effect of yoga exercise +intervention on health related physical fitness in school-age asthmatic children. Journal of +Nursing, 56(2), 42-52. +Chomitz, V. R., Slining, M. M., McGowan, R. J., Mitchell, S. E., Dawson, G. F., & Hacker, K. +A. (2009). Is there a relationship between physical fitness and academic achievement? Positive +results from public school children in the northeastern United States. The Journal of school +health, 79(1), 30-37. +Folkins, C. H., & Sime, W. E. (1981). Physical fitness training and mental health. The American +psychologist, 36(4), 373-389. +Gharote, M. L. (1976). Physical fitness in relation to the practice of selected yogic +exercises. Yoga Mimamsa, XVIII(1), 14-23. +Hagen I., & Nayar U.S. (2014). Yoga for Children and Young People's Mental Health and Well- +Being: Research Review and Reflections on the Mental Health Potentials of Yoga. Frontiers in +Psychiatry, 5:35. +Holcroft, C. A., Eisen, E. A., Sama, S. R., & Wegman, D. H. (2003). Measurement +characteristics of peak expiratory flow. Chest, 124, 501-510. +Joshi, L. N., Joshi, V. D., & Gokhale, L. V. (1992). Effect of short term “Pranayam” practice on +breathing rate and ventilatory functions of lung. Indian Journal of Physiology and +Pharmacology, 36(2), 105-108. +Madanmohan., Mahadevan, S. K., Balakrishnan, S., Gopalakrishnan, M., & Prakash, E. S. +(2008). Effect of six weeks yoga training on weight loss following step test, respiratory +pressures, handgrip strength and handgrip endurance in young healthy subjects. Indian Journal +of Physiology and Pharmacology, 52(2), 164-170. +Mandanmohan., Jatiya, L., Udupa, K., & Bhavanani, A. B. (2003). Effect of yoga training on +handgrip, respiratory pressures and pulmonary function. Indian journal of physiology and +pharmacology, 47(4), 387-392. +Manjunath, N. K., & Telles, S. (1999). Factors influencing changes in tweezer dexterity scores +following yoga training. Indian Journal of Physiology and Pharmacology, 43(2), 225-229. +Murthy, K. J. R., Sahay, B. K., Sunita, M., Raju, P. S. R., Yogi, R., Reddy, M. V., Annapurna, +N., et al. (1983). Effect of yoga on ventilatory functions in normal healthy volunteers. Lung +India, 1(5), 189-192. +Nagarathna, R., & Nagendra, H.R. (2001). Integrated Approach of Yoga Therapy for positive +health. Bangalore: Swami Vivekananda Yoga Prakashana; +President's Council on Physical Fitness and Sports. Exercise programs for adults. Washington, +DC: US Government Printing Office, 1965 +Raja K., Gupta S., Bodhke S., & Girish N.(2014). Fitness levels in school going children of 8-14 +years from Udupi. International Journal health Health Allied Science,3:95 +Siegel, P., & Barros, N. F. de. (2009). Yoga in Brazil and the National Health +System. Complementary Health Practice Review. 4, 93-107. +Srinivasan, T.M.(2011). Yoga Saagara Saaram. Bangalore: Swami Vivekananda Yoga +Prakashana +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. Journal of alternative and complementary medicine (New +York, N.Y.), 14(6), 637-644. +Thomas, S., Friedmann, E., Ross, A., & Bevans, M. (2012). Frequency of Yoga Practice Predicts +Health: Results of a National Survey of Yoga Practitioners.Evidence-Based Complementary and +Alternative Medicine, 2012, 1-10. +Twisk, J. W. R., Kemper, H. C. G., & Mechelen, W. van. (2002). The relationship between +physical fitness and physical activity during adolescence and cardiovascular disease risk factors +at adult age. The Amsterdam Growth and Health Longitudinal Study. International journal of +sports medicine, 23 Suppl 1, S8-S14. +Vedala, S.R., Mane, A.B., & Paul, C.N. ( 2014) Pulmonary functions in yogic and sedentary +population. International Journal of Yoga; 7:155-9 +Wurz, A., Chamorro-Vina, C., Guilcher, G. M. T., Schulte, F., & Culos-Reed, S. N. (2014). The +feasibility and benefits of a 12-week yoga intervention for pediatric cancer out-patients. Pediatric +blood & cancer. n. pag. diff --git a/subfolder_0/PROGRESSIVE INCREASE IN CRITICAL FLICKER FUSION FREQUENCY FOLLOWING YOGA TRAINING.txt b/subfolder_0/PROGRESSIVE INCREASE IN CRITICAL FLICKER FUSION FREQUENCY FOLLOWING YOGA TRAINING.txt new file mode 100644 index 0000000000000000000000000000000000000000..70c0b87f996c3e321edd8310e0924a7459aed575 --- /dev/null +++ b/subfolder_0/PROGRESSIVE INCREASE IN CRITICAL FLICKER FUSION FREQUENCY FOLLOWING YOGA TRAINING.txt @@ -0,0 +1,10 @@ + + + + + + + + + + diff --git a/subfolder_0/Perceptions of benefits and barriers to Yoga practice across rural and urban India Implications for workplace Yoga.txt b/subfolder_0/Perceptions of benefits and barriers to Yoga practice across rural and urban India Implications for workplace Yoga.txt new file mode 100644 index 0000000000000000000000000000000000000000..69e9e0c9a95b1f6765622d3445227919b772c409 --- /dev/null +++ b/subfolder_0/Perceptions of benefits and barriers to Yoga practice across rural and urban India Implications for workplace Yoga.txt @@ -0,0 +1,1694 @@ +Work xx (20xx) x–xx +DOI:10.3233/WOR-203126 +IOS Press +1 +Perceptions of benefits and barriers +to Yoga practice across rural and urban +India-Implications for workplace Yoga +Amit Mishraa, Shreyas A. Chawatheyb, Priya Mehrac, R. Nagarathnaa,∗, Akshay Anandc,1, +S.K. Rajesha, Amit Singha, Suchitra Patila, Madhava Sai Sivapuramd +and Hongasandra Ramarao Nagendraa +aS-VYASA Bengaluru, Karnataka, India +bKamineni Institute of Medical Sciences, Narketpally, Telangana, India +cNeurosciences Research Lab, Post Graduate Institute of Medical Education and Research, Chandigarh, India +dDepartment of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research +Foundation, Chinna-Avutapalli, India +Received 14 July 2019 +Accepted 1 January 2020 +Abstract. +BACKGROUND: Even though Yoga is useful for prevention of obesity, diabetes and hypertension it is not universally +practiced. The purpose of the study was to determine the benefits and barriers confronted by the community members while +incorporating Yoga into routine practice and at workplace. +OBJECTIVE: This study explored the motivators and barriers to Yoga practice by estimating how these elements can be +useful for development and incorporation of Yoga as a workplace activity and as a profession. +METHODS: A nationwide multi-centered prospective study was conducted recruiting individuals of different age groups +and geographical zones in India. Participants of Yoga intervention group were administered a questionnaire with 19 items on +benefits (YBS) and 18 items on barriers for Yoga practice (BFYS). Data was analyzed using SPSS v21 software. +RESULTS: Majority of the participants perceived Yoga improves “physical fitness", “relaxes mind and body”, improves +“stamina”, across age groups. “Lifestyle”, “Family commitments”, “Physical over-exertion”, “No Encouragement from +family”, “Occupational commitments” and “Few places to do Yoga” were perceived barriers across various geographical +zones. Despite knowing the benefits of Yoga, these barriers prevented individuals from integrating it into their daily routine. +CONCLUSIONS: The present study may be considered as a starting point for development of Yoga as a workplace activity +and a profession based on the perceptions of its various benefits and barriers faced by a large study population spanning an +entire nation. +Keywords: Yoga, mindfulness, barriers, benefits, workplace +∗Address for correspondence: Dr. +R. +Nagarathna, +Medical +Director, S-VYASA University, Bengaluru, Karnataka, India. +E-mail: rnagaratna@gmail.com +1Co-corresponding author: Dr. Akshay Anand, Professor, +Neurosciences Research Lab, B Block, PN Chuttani Building, +Post Graduate Institute of Medical Education and Research +(PGIMER), Chandigarh-160012, India. Email: akshay1anand@ +rediffmail.com. +1. Introduction +Yoga has become an important form of health pro- +moting and fitness activity in the West with a rapid +increase in the number of yoga practitioners in these +countries. In the USA, the prevalence of persons prac- +ticing Yoga among adult population has increased +1051-9815/20/$35.00 © 2020 – IOS Press and the authors. All rights reserved +Corrected Proof +2 +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +from 5.1% in 2002 to 9.5% in 2012 [1] with involve- +mentofsocialsupport[2].InIndiaalso,thenumberof +yoga practitioners is on the rise with the rediscovery +of its health benefits [3]. However, some contempo- +raries still view yoga as a religious practice which has +posed challenges in accepting Yoga in its wider con- +text [4]. Yoga, developed by ancient Indians, offers +several mind-body techniques to achieve mindful- +ness that helps in “mastery over the modifications of +the mind” (chitta vrtti nirodha) which is necessary to +leadahealthylifestyle.Thephysicalpracticesinclude +salutation to the Sun (Suryanamaskar), a chrono- +logically arranged set of postures and Asanas that +involve effortless maintenance in the final stretched +posture, regulated breathing (Pranayama), relaxation +techniques, and meditation [5]. +Integration of Yoga into the mainstream health +practices remains challenging as there is incomplete +and insufficient information about the community’s +perception of its benefits and barriers to health. In a +qualitative study conducted by Atkinson et al authors +reported lack of time, interest, awareness, motiva- +tion and education as common barriers for Yoga in +a general population [6]. Harris et al (2019) reported +whole body benefits, the return of connection and +feeling healthy in mind as the primary benefits of +yoga in 26 post-stroke adults; the perceived barriers +included physical limitations due to stroke, cogni- +tive challenges, environmental access, and financial +limitations [7]. Perception about Yoga associated +potential barriers confronted for Yoga practice in peo- +ple with chronic lower back pain indicated there are +mixed perceptions of people, and that a clarification +of what yoga is, how it can be beneficial, and what +it requires one to do physically may help promote its +use [8]. A pilot trial has shown Yoga improves quality +of work in people with depression and chronic pain +[9]. +Although the acceptance of Yoga among people is +increasing as they are becoming more aware of its +benefits, it requires nationwide efforts to integrate it +into daily lives of people as they often face many +barriers. There is also growing acceptance of Inte- +grative medicine across the world which impacts its +perception and practice. However, this is also driven +by personal experience of health professionals and +their willingness to prescribe Yoga as an adjunct ther- +apy to their patients which seems to depend on their +personal acceptance and whether they themselves +perform Yoga or not [10]. This has a strong bearing +on how benefits and barriers of Yoga are perceived by +the community and the employers. +While there have been multiple published studies +from India and elsewhere about perceptions of bene- +fits and barriers related to the practice of Yoga [5, 6, +11–14] there are no studies from all zones of India. +Hence, we wanted to study this perception through +a nationwide cross-sectional survey on Yoga based +lifestyle modifications planned for prevention and +management of diabetes. +2. Methods +2.1. Materials and methods +The present study was a part of a Pan-India survey +in rural and urban areas in all zones of India. This +study was named in Hindi as Niyantrita Madhumeha +Bharata (NMB) (Control of Diabetes in India) using +Yoga based lifestyle modification for prevention and +management of diabetes mellitus. +This study was funded by the Ministry of Health +and Family Welfare and the Ministry of AYUSH, +Government of India, New Delhi, coordinated by +Indian Yoga Association (IYA) and conducted by +Swami Vivekananda Yoga Anusandhana Samsthana +(S-VYASA, Bengaluru), a member organization of +IYA. The study was approved by the Institute Eth- +ical Committee of Indian Yoga Association (vide +Res/IEC-IYA/001 dt 16.12.16). Written informed +consent was obtained from all participants for +responding to the questionnaires mentioned in this +study. +Details of the IYA Yoga Protocol for Type 2 Dia- +betes Mellitus is given in Table 1 [15]. The present +study is from the Phase two of a nationwide study, +Niyantrita Madhumeha Bharata-2017 (NMB-2017), +In Phase one of the study door-to-door survey was +conducted in 65 randomly selected districts of 29 +states/Union Territories (UTs) of India (Fig. 1); those +on a high risk as per Indian Diabetes Risk Score +(IDRS) and all those with diabetes were recruited +for participation in a multi-centric cluster study on +yoga-based lifestyle modification protocol. All those +in the yoga arm of rural and urban clusters who satis- +fied the selection criteria and gave informed consent +to participate were administered a validated mod- +ule of yoga based life style standardized by the IYA +(Indian Yoga Association). Introductory camps lasted +for 9 days, two hours per day. Thereafter, they were +advised to practice the same protocol daily (one hour) +at home with weekly monitoring for 3 months. The +entire methodology is detailed explained in the two +articles as cited [16, 17]. +Corrected Proof +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +3 +Table 1 +IYA common Yoga protocol for type 2 diabetes mellitus (to be practiced 7 days / week) +S No +Name of the practice +Duration +1 +Starting Prayer: Asatoma Sat Gamaya +2 mins +2 +Preparatory SukshmaVyayamas and Shithililarana Practices +6 mins +1. Urdhvahastashvasan (Hand Stretch Breathing 3 rounds at 90◦, 135◦, 180◦each) +2. Kati-Shakti Vikasaka (3 rounds each) +a) Forward and Backward Bending | b. Twisting +3. Sarvangapushti (3 rounds clockwise, 3 rounds anti-clockwise) +3 +Surya Namaskara (SN) +9 mins +1. 10 step fast Suryanamaskara 6 rounds +2. 12 step slow Suryanamaskara 1 round +(To be avoided by those with knee pain, cardiac problems, renal problem, low back pain, +retinopathy and the elderly who are weak and not flexible; instead they can do Chair SN) +Modified version Chair SN: 7 rounds +4 +Asanas (1 minute per asana) +15 mins +1. Standing (1 minute per asana) +Trikonasana, PravrittaTrikonasana, PrasaritaPadhastasana +2. Supine +JataraParivartanasana, Pavanamuktasana, Viparitakarani +3. Prone +Bhujanagasana, Dhaurasana followed by Pavanmuktasana +4. Sitting +Mandukasana, Vakrasana /Ardhamatsyendrasana, Paschimatanasana, ArdhaUshtrasana +At the end, relaxation with abdominal breathing in supine position (vishranti), 10-15 rounds (2 +minutes) +5 +Kriya +3 mins +1. Agnisara: 1 minute | 2. Kapalabhati +(@ 60 breaths per minute for 1 minute followed by rest for 1 minute) +6 +Pranayama +9 mins +1. Nadishuddhi (for 6 minutes, with antarkumbhaka and jalandharbandha for 2 sec) +2. Bhramari (3 minutes) +7 +Meditation (For stress management for deep relaxation and silencing the mind) Cyclic +Meditation (Those who are willing to practice techniques of relaxation evolved by their own +institutes may do so) +15 mins +8 +Resolve (I am completely healthy) +1 min +9 +Closing Prayer: Sarve bhavantu Sukhinaha +1 min +Total +60 mins +2.1.1. Questionnaire development and +administration +Two scales were developed for the purpose of this +study by the psychology Dept. of S-VYASA based on +earlier studies [13] and experience at the S-VYASA +University. The yoga benefit scale has 18 items. +Participants were expected to reply on a four-point +Likert’s scale ranging from one ‘Strongly Disagree’ +to four ‘Strongly Agree’ (Supplementary Fig 1). The +second scale, the ‘barriers for practicing Yoga scale’ +(BFYS), was designed to understand the barriers that +posed challenges to the individual towards adherence +to Yoga. BFYS has a list of 19 probable barriers +that Yoga practitioners face as challenges. Partici- +pants were expected to reply on a five-point Likert’s +scale with five options ranging from zero ‘Never’ +to four ‘Always’. (Supplementary Fig 2). The scale +wastranslatedintofourmajorIndianlanguages(Kan- +nada, Hindi, Telugu and Tamil) by a psychologist and +checked by reverse translation method. +All the individuals who were recruited after tak- +ing informed consent, to the Yoga group of NMB +study were guided by trained volunteer researchers, +for answering the questionnaire. +3. Results +Initial screening was conducted on 162,330 adults +through door to door visits and 92,613 individuals +were found to be either ineligible with low IDRS +scores or did not wish to continue to participate in +further stages of the study. Remaining 69,717 eligible +individuals with high IDRS attended detailed assess- +ment camps. Out of these, 12,466 individuals were +recruited for this study. These subjects were random- +ized into intervention (6,531) or control arms (5,935). +Afterthefollow-upofthreemonths,theanalyzeddata +in the intervention group was 5,932 and it was 5,322 +in the control group, with a total of 11,254 partici- +pants. The ‘Yoga Benefit Scale’ (YBS) and ‘Barrier +Corrected Proof +4 +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +Fig. 1. Survey conducted in 6 Zones of India. +for Yoga Scale’ (BFYS) were administered to the +intervention (Yoga) group for three months among +3,658 out of 5,932 participants (Fig. 2). +Most of the participants agreed that Yoga entails +several positive changes, with most of the respon- +dents agreeing that it improves physical fitness, +relaxes the mind and the body alike and improves +stamina, across age groups (Table 2). “Lifestyle”, +“Family commitments”, “Physical over-exertion”, +“No Encouragement from family”, “Occupational +commitments” and “Few places to do Yoga” were +seen as significant barriers across various zones. +3.1. Perceptions of benefits of yoga across age +groups +The belief that Yoga improves several health- +related outcomes, was agreed by most survey +respondents. +There +were +a +notable +difference +(p < 0.001) between the younger and the older age +groups in the spiritual factor, “being Closer to Higher +Power” (Agreed by 78.9% of participants in the age +group <45 years vs. 85.3% of participants in the +age group of 45 and above). Similarly, significantly +higher number of elderly people agreed to the item +“Improvementinpresentmomentawareness”(91.4% +of responders <45 years vs 93.7% of responders >45 +years. p = 0.013); “Breathing rate” (81% of <45 years +age vs 87.6% of age >45 years agreed; p < 0.001); +“Stamina” (96.8% of <45 years age vs 97.7% of +>45 years agreed; p = 0.026). Thus, higher percent- +age of individuals above 45 years agreed that yoga +provides spiritual and a few other benefits to the +practitioner, with significant differences between age +groups. (Table 2) although overall more than 90% had +agreed to the benefits on all 3 factors. +3.2. Perceptions of yoga benefits across different +zones in india +The number of participants varied based on the +zones as not all participants responded to all the items +in the questionnaire. +Corrected Proof +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +5 +Fig. 2. Schematic of the study design and participant number. +The North zone showed highest number of par- +ticipants who agreed and/or strongly agreed, across +all items on YBS. This is followed by respondents +from the Central zone. In contrast, the East and North +East zone responders disagreed with many of these +perceived benefits of yoga (Table 3). +A considerable difference could be seen in the +opinion of the participants belonging to East zone +as compared to the overall average, wherein the +respondents showed significantly lesser agreement +for various benefits of Yoga including: “Physical +fitness” (94% in east zone vs 96.82% national aver- +age), “Improvement in social acceptance”(88.7% +vs 94.98%), “Rush of thoughts” (86.6%vs 92.6%), +“Stress and tension” (89.8% vs 94.8%), “Well-being” +(88.5% vs 95.1%), “Relaxation” (90.2% vs 95.6%), +“Mental alertness” (90.4% vs 97.5%), “Oneness +with Nature” (87.3% vs 94%), “Awareness of higher +power” (54.8% vs 83.4%), “Awareness about the +present moment” (87.1% vs 92.5%), “Breathing rate” +(41% vs 85.1%), “Contentment” (89.6% vs 95.3%), +“Improvement in interpersonal relationships” (90.0% +vs 94.8%), “Decreased fatigue” (91.7% vs 94.9%), +“Control over emotional reactions” (84.6% vs +93.6%), “Stamina” (94.2% vs 96.7%). These differ- +ences were significant (p < 0.001) (Table 2). +The North East zone had a fewer number of respon- +dents compared to average who agreed that yoga +improved “Social interaction” (84.5% vs 93.4% aver- +age), “Mental alertness” (85.2% vs 93.5% average), +and “Rush of thoughts” (81.3% vs 92.6%). +3.3. Barriers to the practice of yoga +3.3.1. Social barriers in yoga practice +Majority of respondents believed they did not +face any barrier for practicing yoga, though a group +of respondents believed they were confronted with +some barriers to a greater extent as compared to oth- +ers. Importantly, the barriers of “Discipline”, “Few +places to do Yoga”, “Occupational commitments” +and “Family commitments” emerged as the most +significant barriers across age groups in the descend- +ing order of frequency among responses. The “45 +and above” age group particularly had a greater per- +ception of these being a barrier to practice yoga. +These differences of perception between the young +and the elderly groups were statistically significant +(Table 5). Moderate barriers included “Wander- +ing mind”, “Oversleeping”, “Doubt about results”, +“Excessive yoga”, “Non encouragement from fam- +ily”, “Unstable mind” and “Fickle mind” (Table 5). +Corrected Proof +6 +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +Table 2 +Perception about benefits of Yoga across age groups. Table depicts various perceived benefits of Yoga and participant responses +Benefits +Age +Disagree +Agree +p-value +N +% +N +% +Physical fitness +Below 45 +41 +3.1. +1258 +96.9 +0.078 +Above 45 +41 +2.0 +1992 +98.0 +Total +82 +24 +3250 +97.6 +Acceptance by others +Below 45 +63 +4.9 +1228 +95.1 +0.356 +Above 45 +74 +3.7 +1927 +96.3 +Total +137 +4.1 +3155 +95.9 +Muscle strength +Below 45 +81 +6.3 +1202 +93.7 +0.131 +Above 45 +94 +4.6 +1926 +95.4 +Total +175 +5.3 +3128 +94.7 +Stress and tension +Below 45 +58 +4.5 +1218 +95.4 +0.141 +Above 45 +84 +4.2 +1933 +95.8 +Total +142 +4.3 +3151 +95.7 +Rush of thoughts +Below 45 +90 +7.0 +1184 +93.0 +0.264 +Above 45 +124 +6.2 +1886 +93.8 +Total +214 +6.5 +3070 +93.5 +Wellbeing +Below 45 +54 +4.3 +1209 +95.7 +0.577 +Above 45 +84 +4.3 +1911 +95.7 +Total +138 +4.3 +3120 +95.7 +Relaxation +Below 45 +52 +4.1 +1229 +97.9 +0.273 +Above 45 +71 +3.5 +1939 +96.5 +Total +123 +3.7 +3168 +96.3 +Social interaction +Below 45 +75 +5.9 +1202 +94.1 +0.746 +Above 45 +131 +6.5 +1876 +93.4 +Total +206 +6.2 +3078 +93.8 +Mental alertness +Below 45 +79 +6.1 +1196 +93.9 +0.215 +Above 45 +124 +6.1 +1886 +93.9 +Total +203 +6.2 +3082 +93.8 +Environment positivity +Below 45 +83 +6.5 +1195 +93.5 +0.078 +Above 45 +107 +5.8 +1908 +94.2 +Total +190 +5.8 +3103 +94.2 +Higher power +Below 45 +269 +21.1 +1002 +78.9 +<0.001* +Above 45 +294 +14.7 +1705 +85.3 +Total +563 +17.2 +2707 +82.8 +Present moment awareness +Below 45 +108 +8.6 +1161 +91.4 +0.013* +Above 45 +127 +6.3 +1874 +93.7 +Total +235 +7.2 +3035 +92.8 +Breathing rate +Below 45 +239 +19.0 +1024 +81.0 +<0.001* +Above 45 +246 +12.4 +1741 +87.6 +Total +485 +15.0 +2765 +85.0 +Contentment +Below 45 +50 +4.0 +1221 +96 +0.654 +Above 45 +86 +4.3 +1910 +95.7 +Total +136 +4.2 +3131 +95.8 +Relationships +Below 45 +59 +4.6 +1214 +95.4 +0.679 +Above 45 +83 +4.1 +1929 +95.9 +Total +142 +4.3 +3143 +95.7 +Decreased fatigue +Below 45 +58 +4.8 +1148 +95.2 +0.360 +Above 45 +81 +4.3 +1781 +95.7 +Total +139 +4.5 +2929 +95.5 +Emotions reaction +Below 45 +64 +5.0 +1200 +95 +0.115 +Above 45 +84 +4.3 +1908 +95.7 +Total +148 +4.5 +3108 +95.5 +Stamina +Below 45 +41 +3.2 +1222 +96.8 +0.026* +Above 45 +46 +2.3 +1945 +97.7 +Total +87 +2.7 +3167 +97.3 +*Indicates p-value is less than 0.05 and a presence of significant association. +Corrected Proof +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +7 +Table 3 +Perception of yoga benefits in different zones of India +Factor +Percentage of individuals in different zones on Yoga benefit scale (YBS) +North +East +West +South +Central +North east +All India +Physical +98.4 +74.1 +66.5 +77.1 +18.3 +65.4 +69.6 +Psychological +97.5 +77.1 +66.8 +79.0 +17.6 +77.1 +74.4 +Spiritual +88.9 +24.8 +42.5 +56.7 +15.0 +54.6 +51.6 +Table 4 +Perception of barriers for Yoga practice (BFYS) in different zones of India +Factor +North +East +West +South +Central +North East +All India +Physical +76.5 +7.9 +52.2 +67.7 +4.0 +61.0 +50.0 +Psychological +48.0 +10.7 +30.3 +40.7 +1.9 +18.3 +33.9 +Social +45.3 +8.7 +19.8 +45.2 +5.6 +63.1 +35.9 +Thus, social and mental barriers are noteworthy in +hindering the practice of yoga in various age groups +as per the results from this study. +3.4. Perception of barriers to yoga in different zones +“Lifestyle”, “Family commitments”, “Physical +over-exertion”, “No Encouragement from family”, +“Occupational commitments” and “Few places to do +Yoga” were significant barriers across various zones. +Similarly, a number of barriers were found signifi- +cant by respondents from the East zone, including +“Lifestyle” (6.8% vs 3.4% Average), “procrastina- +tion” (4.7% vs 2.7% Average) and “Oversleeping” +(6.3% vs 4.1% Average) while the North East zone +had significant barriers as “Family commitments” +(14.3% vs 8.1% Average), “Physical Overexertion” +(14.2% vs 3.4% Average) “Mental overexertion” +(13.3% vs 3.5% Average) (Table 4). Further, the +Central Zone had a very peculiar finding with Zero +responders considering a number of items to be a +“Strong barrier” to yoga practice (Table 4). This may +be due to fewer number of respondents from Central +zone. +It is also interesting to note that even though in +the North zone, a majority of respondents perceive a +number of benefits of doing Yoga, many respondents +perceived “Doubt about benefits of yoga” as a barrier, +which is higher than the national average (2.4% vs +2.0%) (Table 4). On an average 82% of responders +across zones believed they have no barrier “due to +disease” (Table 4). +3.5. Perceptions of barriers to yoga in different +age groups +Interestingly, barrier to practice of yoga “Due to +disease” was not considered significant by major- +ity of the respondents across younger and older Age +Groups with 81.9% respondents finding no barrier +due to disease (Table 5). +4. Discussion +This nationwide study on assessment of percep- +tion of rural and urban Indians on benefits and +barriers to yoga practice has shown that the major- +ity of the participants agreed that Yoga entails a +number of positive changes, with most of the respon- +dents agreeing that it improves physical fitness, +relaxes the mind and the body and further improves +stamina, across age groups (Table 2). “Lifestyle”, +“Family commitments”, “Physical over-exertion”, +“No Encouragement from family”, “Occupational +commitments” and “Few places to do Yoga” were +significant barriers across various zones. +Further, this is the first nationwide study with a +large sample size from both rural and urban com- +munity that has documented the data on benefits +and barriers to yoga practice. Previous studies have +focused on certain specific population groups such +as University students [14], chronic pain patients [5] +and community dwelling healthy adults [6, 12, 13]. +Our results show that the participants of this study +had a positive perception and attitude towards mul- +titude of health benefits endowed by the regular +practice of yoga. The participants agreed to the bene- +ficial effects of Yoga and reported that it helped them +in increasing muscle strength, maintaining a positive +attitude and, to a lesser extent, in regulating breathing +rate and connection with higher consciousness. +Considering the responses from the current sam- +ple, most of the variables studied as potential barriers +were not considered as “strong barrier” and most of +Corrected Proof +8 +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +Table 5 +Age group-related distribution of perceived barriers to yoga. Table depicts various perceived barriers to practice of yoga and participant +responses +Barrier +Age +No barrier +Moderate barrier +Strong barrier +p-value +N +% +N +% +N +% +Lifestyle +Below 45 +808 +75.7 +234 +22.0 +25 +2.3 +0.585 +45 and above +1237 +75.5 +366 +22.4 +36 +2.2 +Total +2045 +75.6 +600 +22.2 +61 +4.5 +Wandering mind +Below 45 +698 +65.5 +328 +30.8 +39 +3.7 +0.206 +45 and above +1038 +63.8 +545 +33.4 +48 +2.9 +Total +1736 +64.4 +873 +32.3 +87 +3.3 +Discipline +Below 45 +702 +64.4 +244 +22.4 +144 +13.2 +0.011* +45 and above +1052 +61.3 +380 +22.2 +284 +16.6 +Total +1754 +62.8 +624 +22.3 +428 +14.9 +Costs +Below 45 +805 +73.7 +251 +22.9 +37 +3.4 +0.061 +Above 45 and above +1260 +73.4 +412 +24.0 +45 +2.6 +Total +2065 +73.5 +663 +23.6 +82 +2.9 +Family commitments +Below 45 +667 +61.8 +334 +30.9 +79 +7.3 +0.018* +45 and above +972 +57.1 +600 +35.2 +131 +7.7 +Total +1639 +58.9 +934 +33.6 +210 +7.5 +Over exertion physical +Below 45 +802 +74.6 +219 +20.4 +54 +5.0 +0.116 +45 and above +1199 +71.0 +395 +23.4 +94 +5.6 +Total +2001 +72.8 +614 +21.9 +148 +5.3 +Fickle mind +Below 45 +771 +71.8 +274 +25.6 +29 +2.7 +0.691 +45 and above +1176 +69.7 +467 +27.7 +44 +2.6 +Total +1947 +70.7 +741 +26.7 +73 +2.6 +Over eating +Below 45 +806 +75.1 +230 +21.4 +37 +3.5 +0.742 +45 and above +1257 +74.6 +384 +22.7 +45 +2.7 +Total +2063 +74.8 +614 +22.3 +82 +2.9 +Non encouragement +Below 45 +769 +71.9 +261 +24.4 +40 +3.7 +0.111 +45 and above +1127 +67.0 +475 +28.2 +79 +4.7 +Total +1896 +68.9 +736 +26.8 +119 +4.3 +Irregular social interaction +Below 45 +826 +77.1 +291 +20.4 +26 +2.4 +0.529 +45 and above +1261 +75.0 +383 +22.8 +37 +2.2 +Total +2087 +75.8 +602 +21.9 +63 +2.3 +Excessive Yoga +Below 45 +760 +71.2 +274 +25.7 +34 +3.3 +0.001* +45 and above +1075 +64.1 +537 +32.1 +65 +3.9 +Total +1835 +67.7 +811 +28.9 +99 +3.6 +Due to disease +Below 45 +883 +83.2 +160 +15.1 +18 +1.7 +0.602 +45 and above +1341 +81.1 +284 +17.2 +28 +1.7 +Total +2224 +81.9 +444 +16.3 +46 +1.7 +Doubt about results +Below 45 +762 +71.9 +283 +26.7 +15 +1.4 +0.384 +45 and above +1162 +69.9 +465 +28.0 +36 +2.1 +Total +1924 +70.7 +748 +27.4 +51 +1.9 +Mind instability +Below 45 +781 +73.1 +265 +24.8 +23 +2.1 +0.278 +45 and above +1179 +71.2 +444 +26.8 +33 +2.0 +Total +1960 +71.9 +709 +26.0 +56 +2.0 +Procrastination +Below 45 +802 +75.5 +233 +21.9 +27 +2.5 +0.489 +45 and above +1253 +75.5 +377 +22.7 +29 +1.7 +Total +2055 +75.5 +610 +22.5 +56 +2.1 +Over-exertion physical +Below 45 +807 +76.6 +216 +20.5 +31 +2.9 +0.361 +45 and above +1221 +73.5 +387 +23.3 +54 +3.3 +Total +2028 +74.7 +603 +22.2 +85 +3.1 +Oversleeping +Below 45 +689 +64.4 +340 +31.7 +41 +3.8 +0.886 +45 and above +1077 +64.4 +181 +32.5 +52 +3.1 +Total +1766 +64.4 +884 +32.1 +93 +3.5 +Occupational commitments +Below 45 +762 +72.0 +206 +19.5 +91 +8.6 +0.020* +45 and above +1144 +68.7 +393 +23.6 +129 +7.8 +Total +1906 +69.9 +599 +21.9 +220 +8.0 +Few places to do Yoga +Below 45 +736 +69.8 +236 +22.4 +83 +7.9 +0.152 +45 and above +1092 +66.5 +375 +22.8 +174 +10.7 +Total +1828 +40.5 +611 +22.6 +257 +9.6 +*Indicates p-value is less than 0.05 and a presence of significant association. +Corrected Proof +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +9 +population responded to these barriers as “rarely” +or “sometimes”. However, across age groups, it was +found “doubt about results” and “few places to +do yoga” were major barriers in younger popula- +tion, which prevent them from regular practice of +Yoga. Zone wise distribution showed that North zone +population considered “already having a disease con- +dition” as a significant potential barrier as compared +to other zones. +Earlier studies from India and elsewhere have +reported lack of time, modern (Western) lifestyle and +irregular schedules of people, among several other +reasons which prevented people from including Yoga +intheirdailyroutine.Laziness,oversleeping,overeat- +ing and a busy schedule were some of the other +barriers that prevented them from including Yoga to +be a part of daily life, which was also seen in this +study [13, 18–21]. Further, the Central Zone reported +had a very peculiar finding with Zero responders +considering several items to be a “strong barrier” +to yoga practice (Supplementary Table 2). This may +be due to fewer number of respondents from Central +zone. It is also interesting to note that although in the +North zone, where majority of respondents perceived +a number of benefits of doing Yoga, many respon- +dents perceived “Doubt about benefits of yoga” as +a barrier, which is higher than the national average +(Supplementary Table 2). +Several studies have alluded to Yoga positively +affecting physical and mental well-being both in the +healthy and in the ailing [11, 22–24]. Yoga has been +postulated to affect the body on a cellular and molec- +ular level and has shown to slow the process of aging +[25]. It is a technique that may be used not only to +improve physical health [26] but also for reducing +stress, discomfort and anxiety. It has even been shown +to alter levels of neurotrophic factors that help in +improving cognition, managing depression and other +psychiatric conditions such as Post Traumatic Stress +Disorder (PTSD) experienced by people exposed to +stressful life events [27]. Yoga-related research stud- +ieshavebeeninitiatedintheformofclinicaltrials[28, +29]. It has also been shown to enhance quality of life +in cancer survivors [20, 30] yet disease specific Yoga +protocols are not available for community or wellness +centers for adoption. Yoga therapy can be considered +an adjunct to treating certain medical conditions [19, +31–34] and managing psychological disorders. Abel +et al noted “that greater improvements in pulmonary +function are more likely to be seen in those that +engage in longer periods of pranayama” [35]. Percep- +tion of people about Yoga ranges from a technique of +physical activity or exercise to a spiritual practice. +Yoga as a spiritual practice is accepted as improving +various psychiatric conditions among patients [36]. +Therefore, it has been shown to be an effective or +a better exercise at improving a variety of health- +relatedoutcomemeasures[37].Work-related benefits +of yoga include stress reduction and injury prevention +[38]. +Yoga has become a very popular lifestyle modifica- +tiontechnique.Majorityofthepopulationbelievethat +it brings positive health-related benefits. Although +the awareness of yoga’s beneficial effects in man- +agement and prevention of various diseases is well +known, many people are yet to adopt Yoga based +lifestyle for disease prevention. This is an important +knowledge-practice gap that needs to be addressed +in public health strategies by undertaking subsequent +studies with larger sample size. +One of the limitations of the study was that the +number of participants was not constant. This is so +because all the respondents did not respond to all +questions, hence the variation in the number of par- +ticipants for each question. This explains the range +for the ‘N’. As this was a field study, the data was +not normally distributed, and hence nonparametric +tests were used to analyze the data. Another limitation +was that these scales measured only the self-declared +perceptions of participants which may be subjective. +Besides, the adherence of the participants to the yoga +protocol at home was based on self-declaration. Con- +sidering the limitations of the study design and data +analysis, randomized controlled trials are required +to capture and report objective observations about +benefits and barriers experienced by the participants +after the practice of Yoga for a fixed time period. +This can also be carried out at the time of Interna- +tional Day of Yoga i.e. June 21 which is celebrated +globally. +Among significant barriers to the practice of Yoga +is the paucity of evidence deposited in PubMed +indexed literature that hinders its translation into pre- +ventive medicine. Also, the minuscule number of +certified yoga teachers and local yoga role models +prevents inculcation of yoga as a way of life by the +masses. This can be related to the lack of popularity +of this discipline when compared to popular medical +specialties and/or sports which have several local role +models in various specialty and gaps thereof [39, 40]. +Developing community-level programs of yoga train- +ers and leaders, especially among the youth, would +provide a platform for improvement in the practice +of yoga which may address this gap. These centers +Corrected Proof +10 +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +may be established under the aegis of a set of higher +regulatory bodies and Institutes of excellence under +the Ministry of AYUSH and/or Ministry of Health +or both for proposing superior standards and pro- +tocols. This may lead to development of leadership +roles to generate good quality research data. Con- +sequently, the masses can be mobilized to practice +evidence-based Yoga protocols for prevention of non- +communicable diseases, besides inclusion of Asanas +into sports which is another good step in this direc- +tion. +An additional barrier in the practice of Yoga, +though not sampled in this study, could be the lack +of prescription of Yoga by the health care profession- +als [12, 41]. Consequently, health care professionals +could consider prescribing Yoga protocols to their +patients for the treatment of various ailments or +refer such cases to Yoga professionals. However, +this may be influenced by the practitioner’s personal +beliefs about Yoga. It may be difficult to achieve +this goal without installation of Integrative Medicine +in Medical Institutes. With emergence of Integra- +tive medicine, Yoga could be of much significance in +its protocols for treatment of various ailments [28]. +Though Yoga is widely perceived as a secular domain +of knowledge, its practice pervades and predates Hin- +duism. In this regard, its potential to be integrated as +a healthcare tool holds both promise and challenges +with respect to its affiliation [4]. Studies also show +that barriers to Yoga practice include the perception +that Yoga lacks physical and weight loss benefits and +do not exclude fear of injury, lack of ability and self- +efficacy to perform the practices, preference for other +physical activities, and scheduling difficulties [42]. +Indeed, there are a few studies which have reported +adverse effects of Yoga [43, 44]. This may have raised +doubts about the effects of Yoga practice, however, +practice of Yoga under supervision, just like phys- +iotherapy or other medical and surgical treatment +protocols, may help to easily overcome this barrier. +Various studies cite logistic and time management +concerns as important barriers to routine practice of +Yoga [45]. These authors recommend incorporation +ofYogainschoolsyllabi,atworkplaceandincommu- +nity halls which may be useful to improve people’s +participation in Yoga. The results of this study are +limited to the population which responded to the +questionnaire as most of participants have not filled +both the scales in the questionnaire. As only 3658 par- +ticipants responded to this study, a larger study could +sample perceptions regarding other barriers and ben- +efits, of which, some were missed in the current study. +Our results suggest that a study on hindrances to Yoga +among different age groups must be explored as such +research will help Yoga practitioners and lawmak- +ers across the world to overcome real and perceived +barriers. The regular practice of Yoga may help in pri- +mordial and primary prevention of lifestyle disorders +in a vast majority of the population. +5. Conclusion +Majorityofthestudiedpopulation(>90%)isfamil- +iar with the physical, psychological and spiritual +benefits of Yoga. There are various intrinsic (psycho- +logical) and extrinsic (physical and social) barriers +confronted by people who practice Yoga. Consider- +ing acceptability by majority in the country, increased +efforts could be made to overcome these barriers to +aid in primordial and primary prevention of lifestyle +diseases. +Acknowledgments +The authors acknowledge the Ministry of Health +and Family Welfare and the Ministry of AYUSH +Government of India, New Delhi for funding this +study through CCRYN. Authors are grateful to the +masters of the member institutions of Indian Yoga +association for their support by encouraging volun- +teers to teach Yoga. We are thankful to the 35 Senior +Research Fellows, 1200 Yoga Volunteers and the +central office staff of VYASA, Bengaluru for their +intensive, coordinated, interactive efforts to complete +the study within the stipulated time. +Author contributions +A.M., R.N., H.R.N. conceived the study, A.A. +conceptualized the manuscript, A.M., S.A.C., P.M., +M.S.S. wrote the introduction and results, A.A., +S.A.C. brought in ideas for discussion, M.S.S. pro- +vided the figures, S.P. and R.S.K. provided data +analysis. All authors reviewed the final manuscript. +Conflict of interests +The authors do not have any conflicts of interest to +declare. +Corrected Proof +A. Mishra et al. / Perceptions of benefits and barriers to Yoga practice across rural and urban India +11 +Supplementary material +The supplementary material is available in the +electronic version of this article: https://dx.doi.org/ +10.3233/WOR-203126. +References +[1] +Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin +RL. 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Edu. 2014;4(03):138. +Corrected Proof diff --git a/subfolder_0/Potential yoga modules for treatment of hematopoietic inhibition in HIV-1 infection.txt b/subfolder_0/Potential yoga modules for treatment of hematopoietic inhibition in HIV-1 infection.txt new file mode 100644 index 0000000000000000000000000000000000000000..9fac40dbad0fb14d08fd16b6216be44bc1a872ea --- /dev/null +++ b/subfolder_0/Potential yoga modules for treatment of hematopoietic inhibition in HIV-1 infection.txt @@ -0,0 +1,2759 @@ +Journal of Stem Cells + +ISSN: 1556-8539 +Volume 5, Number 3 + +© Nova Science Publishers, Inc. + + + + + +Potential Yoga Modules for Treatment of Hematopoietic +Inhibition in HIV-1 Infection + + + +Hemant Bhargav1∗, +Nagarathna Raghuram1, +Nagendra Hongasandra Rama Rao1, +Padmini Tekur, and +Prasad S Koka1,2* +1Department of Integrative Cell Biology, Division of +Yoga and Life Sciences, Swami Vivekanada Yoga +Anusandhana Samsthana (SVYASA) University, +19 Eknath Bhavan, Gavipuram Circle, Kempegowda +Nagar, Bangalore 560019, India +2Laboratory of Stem Cell Biology, Torrey Pines Institute +for Molecular Studies, 3550 General Atomics Court, +San Diego, California 92121, USA + + +∗ Corresponding Authors: Dr Hemant Bhargav, MBBS, MD +Email: urs.aatmiya@gmail.com Phone : +91 8762019348. +Dr Prasad Koka, PhD. Email: pkoka@tpims.org +Abstract + +This article is expected to contribute towards understanding +the therapeutic benefits of specific yoga modules on the +inhibition of replication and enhancement to normal levels +of hematopoiesis in HIV-1 infected subjects. More unique +could be the effects of yoga on the indirect effects of HIV-1 +induced hematopoietic inhibition of the CD34+ progenitor +stem cells, via the CD4+ T lymphocytes. Such indirect +effects may be caused by host cellular factors. Yoga +practices may also improve the self renewal capacity (a step +that precedes commitment of CD34+ progenitor cells to +terminal differentiation), via STAT5 gene regulation. This +may eliminate the need for constitutive STAT5 gene +expression through gene therapy. In this article recent +research and ancient Indian literature are reviewed to devise +yoga modules for the potential treatment of hematopoietic +inhibition in HIV-1 infection. The possible mechanisms +through which hematopoietic inhibition may occur in HIV- +1 infected patients are first described followed by the role +of stress in the progression of HIV where probable +involvement of psycho-neuro-immunological axis (PNI) is +highlighted. +Yoga +therapy +is +introduced +and +its +effectiveness in terms of evidence in relevant area is +reviewed. Further, the basic principles of Integrated +Approach of Yoga Therapy [IAYT] are described and +depending on the potential mechanisms through which yoga +therapy may act, both modern scientific research and +ancient “scriptural” evidence are provided at all the five +levels of existence (body, life force, emotional, intellectual +and bliss). This will enable to design comprehensive yoga +modules that may intervene in this indirect inhibition of +haematopoiesis +in +HIV-1 +infected +individuals +and +potentially restore normal levels of haematopoiesis. + +Keywords: HIV-1, Hematopoiesis, Self-renewal, Yoga, +Stress. + + +Introduction to Hematopoietic +Inhibition in HIV-1 Infected Subjects + +Hematopoetic abnormalities which include its +inhibition or lineage specific proliferation of CD34+ +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +130 + +progenitor cells often lead to hematological disorders +[1]. HIV infected patients often suffer from multiple +hematopoietic abnormalities which include anemia, +thrombocytopenia, lymphocytopenia, monocytopenia, +neutropenia, and myelodysplastic / hyperplastic +alterations of the bone marrow microenvironment [2]. +Evidence of alteration of fetal hematopoiesis +including leukopenia, anemia, and thrombocytopenia +has also been found in aborted fetuses from HIV-1 +seropositive women [3,4]. The factors which play a +role in HIV mediated hematopoietic inhibition could +include direct intracellular effects of virus infection, +interactions with viral proteins at the cell surface, and +perturbation of cytokine network due to abnormal +lineage specific expression of cellular genes. Such +genes can also include growth factor receptors, +receptor tyrosine kinases and factors involved in +embryonic development or immune mediated effects. + + +Indirect Effects of HIV in Hematopoietic +Inhibition + +It +has +been +observed +that +hematopoietic +progenitor cell colony growth and differentiation is +inhibited in long-term bone marrow cultures of HIV +positive patients [5-8]. In general, investigators have +failed to detect HIV infection in hematopoietic +progenitor cells isolated from infected individuals, +suggesting that HIV might have an indirect effect on +hematopoiesis [2]. Infection of CD34+ progenitor +cells in vitro has been reported by some investigators +[9, 10]. However, Shen et al, found that bone marrow +and peripheral blood derived CD34+ progenitor cells +are not susceptible to HIV-1 infection in vitro [11]. It +has further been reported that primitive hematopoietic +cells resist HIV-1 infection via p21Waf1/Cip1/Sdi [12]. +We have used the severe combined immunodeficient +mouse co-transplanted with human fetal thymus and +liver tissues (SCID-hu Thy/Liv) wherein this conjoint +hematopoietic organ that develops is a very useful +small chimeric animal model to investigate the +mechanisms +and +therapies +for +HIV +induced +hematopoietic inhibition [15]. This model system not +only mimics HIV infection but also recapitulates +functional human hematopoiesis in vivo, in the +absence of confounding factors found in humans. +Thus the effects of HIV that are seen in this model are +the direct result of virus mediated phenomena. Using +the SCID-hu model, we and others have found that +HIV-1 inhibits multilineage hematopoiesis in vivo +without direct infection of the CD34+ progenitor +cells, and presumably via indirect effects of the +infected microenvironment [13, 14]. We noted that +HIV-1 infection rapidly and severely decreases the ex +vivo recovery of human progenitor cells capable of +differentiation into both erythroid and myeloid +lineages. However, the total CD34+ cell population is +not depleted. Combination antiretroviral therapy +administered well after loss of multilineage progenitor +activity reverses this inhibitory effect, establishing a +causal role of viral replication [14]. Taken together, +the results suggest that pluripotent stem cells are not +killed by HIV-1; rather, a later stage important in both +myeloid and erythroid differentiation is affected. HIV +possibly +alters +the +stromal/progenitor +cell +microenvironment that supports hematopoiesis. +We used SCID-hu model to find that HIV-1 +mediates hematopoietic inhibition in vivo, as assessed +by multilineage colony forming activity (CFA) of the +CD34+ progenitor hematopoietic stem cells (HSC) +derived from the Thy/Liv implants, through a +decrease in their cytokine receptor (c-Mpl) expression +[16]. We further noted that these CD34+ cells that +experienced the indirect effects of HIV-1 infection in +the SCID-hu Thy/Liv implants in vivo can reacquire +c-Mpl expression, when engrafted into a fresh stromal +microenvironment in irradiated secondary recipient +SCID-hu +animal +implants. +Our +results +have +established a correlation between CFA and c-Mpl +expression, and that CFA segregates with c-Mpl +expression. + + +Effects of HIV-1 on Self Renewal of CD34+ +Cells + +Several transcription factors (Notch1, HOXB4, +STAT) are possibly involved in self-renewal of +hematopoietic precursors that precedes their terminal +differentiation [17, 18, 19]. However, STAT5 (signal +transducer and activator of transcription-5) proteins +are shown to be particularly relevant in self-renewal +of the hematopoietic progenitor cells. STAT5 protein +A and B isoforms are involved in thrombopoietin +(Tpo) receptor proto-oncogene, c-mpl, mediated +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +131 + +signaling +and +regulation +of +multilineage +hematopoiesis [20-23]. +In addition, possible mechanisms for HIV +induced +hematopoietic +inhibition +in +infected +individuals most likely include the involvement of +both c-mpl and STAT5A. This cytokine receptor (c +mpl) and transcription factor (STAT5A), respectively, +play +a +role +in +stem +cell +self-renewal +and +differentiation +into +multiple +lineages, +through +activation of signaling pathways [24, 41]. + + +Limitations and Shortcomings of Conventional +Pharmacological Agents + +Although great advances have been made in +antiretroviral (ART) treatment of HIV-1 infection, +there is still variability in treatment outcome [25], and +HIV disease course, that is, the length of time before +an acquired immune deficiency syndrome (AIDS) +diagnosis and mortality. Cytopenias are also induced +by continued drug treatment or HAART (highly +active anti-retroviral therapy) of HIV infected patients +[15, 26, 27] with thrombocytopenia more persistent +than the other cytopenias [28, 29]. Among these +cytopenias, +thrombocytopenia +in +particular +contributes to cardiac dysfunction [30, 31]. In HIV +infected individuals receiving HAART and those who +also require cardiovascular surgery, thrombocytopenia +can present a greater risk [30]. It has been observed +that hematopoietic growth factors such as granulocyte +macrophage-colony-stimulating factor (GM-CSF), +Epo, and stem cell factor (SCF) can reduce HIV or +zidovudine related cytopenias [32, 33]. Miles et al +reported in a review that hematopoietic growth +factors, along with reduction in dose of zidovudine +and ganciclovir, are used to reduce the impact of bone +marrow failure in AIDS patients. In spite of these +strategies, due to haematologic toxicity of zidovudine +approximately 30% of patients with AIDS become +transfusion-dependent [34]. Studies using the protease +inhibitor, ritonavir, indicate that this drug relieves +hematopoietic +inhibition +and +promotes +colony +formation through a reduction of FAS and ICE +(caspase-1) dependent apoptosis [35, 36]. However, +ritonavir treatment during HIV infection can give rise +to drug resistant virus mutants which can defeat the +purpose +of +increasing +hematopoiesis +by +the +appearance of other viral strains in vivo. Thus use of +such drugs may offset any balance to contain +apoptosis related cytopenias in HIV infection, +possibly by the evolution of viral strains that can be +more severe on hematopoietic inhibition. +Higher cost and significant side effects of +HAART further supports the need to find simple, low +cost, well-tolerated interventions that slowdown the +decline of CD4 cell count, decrease viral load and +have the potential to be effective in reversing the +hematopoietic inhibition. Such low cost interventions, +if effective, can additionally be useful to developing +nations, where the vast majority of the world’s HIV +infected population live. + + +Stress and Progression of HIV + +As discussed by Hand et al in a review [37], +psychoneuroimmunology theory proposes that the +reduction of perceived stress and increased immunity +are interrelated. It is interesting to note that the above +relation is not found for the reduction of the stressors +themselves. Studies suggest that neural, endocrine and +immune systems communicate with each other +through multidirectional pathways. Immune cells +have been found to have specific receptors for +catecholamines released during sympathetic nervous +system (SNS) activation and for corticosteroids +(primarily +cortisol) +released +by +the +limbic- +hypothalamic-pituitary-adrenal +axis +(LHPA) +respectively [38, 39]. Both these pathways of stress +response (SNS and LHPA), when activated, inhibit +immune functions like natural killer cell number and +activity, +percentage +of +circulating +B +and +T +lymphocytes, levels of various immunoglobulins, etc. +Most patients with AIDS have elevated basal +cortisol levels [40], and a chronic increase in the basal +endogenous cortisol levels may provoke an imbalance +in cytokine production, with decreased production of +type 1 and increased production of type 2 [41]. This +type 1 to type 2 shift as well as raised cortisol levels +may enhance viral replication and lead to HIV disease +progression [41]. Another study indicates that a +stressful exposure is associated with down regulation +of Th1 cytokines (IFN-gamma and IL-2) and a +selective up regulation of Th2 cytokines (IL-4, IL-5, +and IL-6) [42]. Nair et al have further demonstrated +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +132 + +that cortisol synergizes with gp120 (exterior envelope +glycoprotein on HIV-1 which sequentially binds to +CD4+ T lymphocytes) and induces apoptosis of +CD4+ T lymphocytes [43]. Also, through animal and +human studies, it has been reported that immune +reactivity to viral challenge is inhibited due to stress +[44]. +There is substantial evidence that depression and +stress are associated with more rapid CD4+ T cell +declines and HIV disease progression [45, 46]. A +study by Burack and colleagues found that in a cohort +of men with HIV, those who scored as depressed on +the Center for Epidemiologic Studies Depression +Scale (CES-D) had a 38% greater decline in CD4+ T +cells compared with men who were not depressed +[46]. In a large cohort study of women with HIV by +the HIV Epidemiology Research Study (HERS), +women with chronic depressive symptoms had more +rapid declines in CD4+ T cell counts, and were two +times more likely to die compared to women with +little or no depressive symptoms, after controlling for +other prognostic factors [47]. In a prospective study of +up to 7.5years, Leserman et al showed that +psychosocial factors such as stressful life events, +coping by means of denial, lower satisfaction with +social support is associated with accelerated HIV +disease progression to AIDS [48]. Further, Leserman +concluded in a couple of reviews that chronic +depression, stressful events, and trauma may decrease +CD4+ T lymphocytes, increase viral load, and may +lead to greater risk for clinical decline and mortality +in HIV patients [49, 50]. +Several psychosocial dimensions like stressors, +depression, anxiety and distress, coping, social +support, +disclosure, +emotional +expression +and +adherence may account for the variability in treatment +outcome with ART [51, 52]. Further, animal and +human +studies +have +demonstrated +that +stress +accelerates HIV-1 disease pathogenesis and impairs +the biological impact of ART [53, 54, 55]. +Theoretically, stress could adversely affect the +progression of HIV infection in a number of ways. +Antoni et al. [56] have proposed a working model +which provides a framework for the pathways that +may be involved, a simplified version of which is +presented in Figure 1. + + +Stress Management Therapies in HIV + +A randomized clinical trial by Antoni et al on +HIV infected gay men showed that cognitive +behavioral stress management as an adjuvant to ART +lead to significant decrease in viral load with +reduction in depressive symptoms over 15 month +period as compared to the control group taking ART +only [57]. Experimentally manipulated aerobic +exercise training intervention had been shown to +attenuate concurrent changes on some affective and +immunologic measures such as natural killer cell +decline in response to an acute stressor in HIV +patients [58]. Stress management therapies have also +been reported to decrease HIV-related symptoms and +increase CD4 cell number [59]. + + + +Figure 1. Stressors which result in maladaptive functioning can elicit a series of psychological, neuro-endocrinological and +immunological events which may result in faster progression in HIV Infection [56]. + + + + +Stressors + + + + +Maladaptive +Functioning + + +Psychological +Effects + +Neuro-endocrinological +Effects + +Immunological +Effects + + +Faster +Progression in +HIV +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +133 +Introduction to Yoga Therapy + +People living with HIV often use alternative or +complementary therapies to manage side-effects of +HIV or ART [60-64]. Surveys estimate that 47–74% +of HIV-infected individuals in the U.S. have used +some form of alternative-complementary therapy to +improve general health and well being [64]. +One such potentially safe, effective, low cost, and +popular intervention that has shown its efficacy in +HIV positive individuals in reducing psychological +distress [65], anxiety and depression [66], increasing +T cell count [66], natural killer cell activity [67] and +buffering CD4+ T lymphocyte declines [68], is the +practice of yoga, which incorporates spiritual +mantram repetition, meditation, mindfulness and other +mind-body techniques. +The term “yoga” originates from Samskrit root +“yuj” which means union. Madanmohan defines yoga +as a psycho-somatic-spiritual discipline to achieve +union and harmony between mind, body and soul and +to ultimately unite individual consciousness with the +Universal consciousness [69]. +As described in an ancient yogic scripture called +Patanjali Yoga Sutra (P.Y.S. 1.2) [70], yoga is a +holistic science, that chiefly deals with gaining +mastery over the mind through various mind-body +techniques such as āsanas (postures done with +awareness), Prāṇāyāma (voluntarily regulated nostril +breathing), and meditations along with kriyās +(purificatory practices) and yoga nidrā (guided +relaxation with imagery) [71]. Being holistic, it has +the potential to bring about a state of complete +physical, mental, social and spiritual well being in the +practitioners. +Yoga techniques not only bridge psychosocial +and somatic aspects of care but also address the +subject’s spiritual needs. Practitioners have to be +actively involved in the practice with a sense of self- +control and awareness. +Such awareness combined with relaxation and +attention of mental phenomena will alter the +perceptions and mental responses to both external and +internal stimuli, reduces hyper-reactive responses to +such stimuli and instills a greater sense of control over +situations, thereby causing reduction in the levels of +stress. +Clinical Efficacy of Yoga Therapy + +Yoga has been shown to have therapeutic benefits +for individuals with a wide range of health conditions, +including hypertension [72, 73] and diabetes [74, 75]. +The therapeutic benefit of yoga have also been +evidenced in numerous other health care concerns +such as asthma [76], cardio respiratory illnesses [77], +musculoskeletal disorders [78] and cancer [79], in +which mental stress is believed to play a role. Yoga +techniques were found to be effective in treating +obsessive-compulsive +disorder, +phobias, +major +depressive disorders, dyslexia, grief, insomnia and +other sleep disorders [80] and posttraumatic stress +disorder [81]. Hatha Yoga (a form of yoga which +chiefly focuses on dynamic body postures, cleansing +practices and breathing techniques) practices have +also been shown to reduce perceived stress, negative +affect and salivary cortisol levels [82]. +In lymphoma patients, yoga sessions conducted +weekly once for 7 weeks produced lower sleep +disturbances [83]. Reduced sleep disturbances may +also lead to enhanced immune functions. Kochupillai +et al measured natural killer cell counts in cancer +patients who had completed their standard therapy, to +study the effects of Sudarshan Kriya (SK) and +Prāṇāyāma (P), which are rhythmic breathing +processes. They found that natural killer (NK) cells +increased significantly (P <0.001) at 12 and 24 weeks +of the practice compared to baseline. And there was a +significant increase in NK cells at 24 weeks (P <0.05) +compared to controls [84]. In a randomized control +trial, 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 +radiotherapy treatment. Integrated yoga was used as +daily intervention with each session lasting 60 min. +Salivary cortisol levels were measured 3 days before +and after radiotherapy along with self-ratings of +anxiety, depression, and stress collected before and +after 6 weeks of radiotherapy. Results showed +significant decrease in anxiety, depression, perceived +stress, 6 am salivary cortisol and pooled mean cortisol +in the yoga group as compared to the control [85]. +Similarly, Integrated Yoga has also been found to +decrease psychological distress, fatigue, insomnia and +loss of appetite over time in early breast cancer +patients [86]. Another study demonstrated beneficial +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +134 + +effect of integrated yoga on post-chemotherapy- +induced nausea frequency and intensity [87]. Still +another study showed that following a yoga protocol +for eight week, there was lesser pain and fatigue and +higher levels of invigoration, acceptance, and +relaxation in metastatic breast cancer patients [88]. + + +Yoga Therapy for Hematopoietic Inhibition in +HIV: Potential Mechanisms + +Stress, a psychophysiological process, causes +various biological effects via the pathway of immune- +neuroendocrine axis which may lead to a greater +replication and faster progression of HIV in the +infected subjects [See Figure 1]. Such an increased +proviral burden depletes the CD4 counts and also +inhibits hematopoiesis [14]. Yoga has been proven to +reduce stress levels via decreasing sympathetic +activity and causing a state of parasympathetic +dominance. Also, by reducing cortisol levels in HIV +patients, yoga may prevent switching of cytokines +from type 1 to type 2 (as discussed under section +stress and progression of HIV) and thereby affect HIV +replication in a positive manner, which may decrease +viral loads in circulation and consequently improve +CD4 counts and restore more normal levels of +hematopoiesis. Although it may be logical to expect +that the proposed yoga modules may reduce HIV-1 +infection, it may also be likely that the yoga therapies +may bypass the route of interference with HIV-1 +replication and yet enhance hematopoiesis by other +unknown +mechanisms. +As +HIV-1 +induces +hematopoietic inhibition of the CD34+ progenitor +stem cells indirectly, via the CD4+ T lymphocytes, +yogic techniques may favourably alter the stromal / +progenitor +cell +microenvironment +of +CD34+ +progenitor stem cells to revive the hematopoietic +inhibition. Such favourable changes in stromal +microenvironment may also help CD34+ cells +reacquire normal levels of cytokine receptor (c-Mpl) +expression. Yoga may also have a role on the +maintenance of quiescence or self-renewal capacity +and lineage specificity of differentiation of CD34+ +cells, by potential regulation of the cellular +transcription factor and STAT5 gene expression, in +HIV-1 infected patients. Yoga practices may cause +stabilization of STAT5 gene expression to alleviate +the need for exogenous introduction (gene therapy +through autologous bone marrow transplantation) of a +mutant STAT5 (1*6) into the CD34+ cells using +lentiviral transduction. This will then maintain the +quiescence or self renewal capacity of the CD34+ +cells despite the indirect influence of HIV-1 infection +and thus may contribute to maintaining close to +normal levels of hematopoiesis as assessed by colony +forming activity of the CD34+ cells that are exposed +to the HIV-1 infected CD4+ T cells. +Among the cytopenias, thrombocytopenia in +particular is associated with cardiac dysfunction [90, +91, 92]. Whereas yoga lifestyle intervention has been +reported to improve cardiovascular functioning, +reduce cardiovascular risk factors, and retard coronary +artery disease [93-96]. +Further, the poor response of HIV for a lowering +of its replication and slower CD4 cell increase in +some HIV infected individuals after initiation of +HAART is associated with higher autonomic nervous +system activity as measured by a series of +physiological +parameters +like +palmar +skin +conductance and EKG inter-beat interval [89]. Hence +interventions that reduce autonomic nervous system +activity could have beneficial effects in HIV persons +who are on antiretroviral treatment. + + +Principles of Integrated Approach of Yoga +Therapy (IAYT) + +The Unique contribution of Yoga to therapeutic +sciences is the Panća Kośa (Five Body) model of +existence. Found in Taittarīya Upaniad, this +concept is unique in providing us a depth to the +understanding of human existence. The Upaniad +describes that every individual has five layers of +existence, which are Annamaya Kośa (Physical +Body), Prāṇamaya Kośa (Body of life force), +Manomaya Kośa (Mental body), Vijñanamaya Kośa +(Body of Intellect) and Ānandamaya Kośa (Body of +bliss) [97]. +Concept of IAYT says that man is in perfect +health in Vijñanamaya Kośa and Ānandamaya Kośa. +All diseases are manifestation of ‘ādhi’ (mental +conflicts) which develops as a response to demanding +situations in the mental sheath of existence +(manomaya kośa) resulting in wrong life style. The +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +135 + +four components of life style namely diet, lack of +exercise, bad habits (alcohol, smoking, uncontrolled +desires) and emotional stress are all traceable to the +mind. In the mind all these responses have one +common factor i.e. these are distressful emotions such +as depression, anxiety or anger. When one gets stuck +in any of these emotions due to repeatedly demanding +situations, he gets into a loop of habituated response. +Yoga looks at these problems as uncontrolled speeded +up repetition of thoughts in the mind. Hence the entire +concept of IAYT is based on reducing the speed of +the mind and deep rest to each and every cell of the +body to promote normalcy. IAYT techniques point to +the fact that gross techniques such as dynamic or slow +physical practices and breathing techniques are all +useful in reducing the speed of the mind. An ancient +yoga text [98] goes on to explain that ‘ādhi’ +percolates in to prāṇamaya kośa as excessively +speeded up flow of prāṇa (life force) that blocks the +prāṇa +channels. +This +further +manifests +as +uncontrolled speed at the annamaya kośa that can be +perceived as functional and structural abnormalities at +the cellular level. Thus, in HIV also it is to be +understood that the Psycho-Neuro-Immunological +(PNI) pathway working through HPA axis is +uncontrolled speed at the annamaya kośa. Correction +of these imbalances by the trick of slowing down is +the remedy. Relaxation at annamaya kośa, slowing +down the rate of breathing at prāṇamaya kośa and +calming down the mind at manomaya kośa to +establish in ānandamaya kośa, forms the basis of +IAYT [99]. +Though, +individual +āsanas, +Prāṇāyāma, +relaxation and meditative practices can selectively +affect sympathetic or parasympathetic nervous +system. The overall ability of IAYT to reduce +sympathetic activity and bring about a state of +parasympathetic dominance forms the rationale for its +use in stress management. Thus these principles may +provide the logical basis for designing the following +techniques of IAYT for containment of HIV infection +leading to its reduced replication and in turn rescue of +hematopoiesis in these subjects. + + + + +Evidence for Efficacy from IAYT + +Annamaya Kośa: Scriptural Evidence + +Several social behavioral norms are prescribed in +an ancient yogic text [70] as preparatory lifestyle +changes for a healthy living. These include yamās and +nīyamās. Yamā is a set of ‘don’ts’ and Nīyamā: a set +of ‘dos’. Yamā is abstention from harming others, +from falsehood, from theft, from incontinence, and +greed (P.Y.S.2.30). Nīyāma includes cleanliness, +contentment, austerity, self-study and resignation to +God. (P.Y.S. 2.32). The basis of yamā and nīyama is +to build congenial atmosphere - mandatory for +success in any work and they also are basic +prerequisites to perform any kind of yogic practices. +A healthy yogic diet, cleansing techniques +(kriyās), loosening exercises and yogāsanas are used +to operate at the Annamaya Kośa level and to remove +the physical symptoms of the ailments. Sāttvic diet +which is easy on the system is recommended in the +Gita [100] by Śri Kriśna in a verse -“The foods which +increase life, purity, strength, health, joy and +cheerfulness, which are savoury and oleaginous, +substantial and agreeable, are dear to Sāttvic (pure) +ones.” (B.G. 17.8). +Other yogic texts such as Hathyoga Pradipika +(H.Y.P.) [101], Gheranda Samhita (G.S.) [102] and +Hath Ratnāvali (H.R.) [103] describe beneficial +effects of various āsanas and kriyās as follows: +Steady and comfortable should be the posture (āsana) +(P.Y.S. 2.46), by loosening of effort and by +meditating on infinity, āsana is mastered (P.Y.S.2.47). +Śavāsana wards off fatigue and brings ćittaviśranti +(calms down the mind) (H.Y.P. 1.32). Śavāsana +pacifies the agitations of the mind (G.S.2.28). +Siddhāsana purifies all 72000 prāṇic channels (nādis) +(H.Y.P.1.35). Padmāsana destroys all the diseases of +Yogis (H.Y.P.1.44). +Kriyās : They are purificatory practices described +in hatha yoga to enhance inner healing potentials. For +e.g., Neti is a technique to purify and sensitise nasal +mucosa, it destroys disorders of kapha dośa +(imbalances of the phlegm) (G.H. 1.51). Basti is +another +purificatory +technique to +cleanse the +intestines which destroys all the accumulated +diseases, dropsy caused by all three dośas (basic +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +136 + +humors according to ayurvedic science) (H.Y.P. +2.28,29). + + +Annamaya Kośa (Āsanas and Yoga-Based +Lifestyle Modifications): Scientific Evidence + +Several studies suggest that stress reduction +interventions such as relaxation and exercise may +have beneficial effects on CD4 count and other +measures of immune status in HIV [104, 105, 106]. A +recent study by Gopal et al measured physiological +parameters like heart rate, respiratory rate, and blood +pressure, +psychological +variables +like +Global +Assessment of Recent Stress Scale and Spielbergers +State Anxiety score and biochemical markers like +serum cortisol levels, IL-4, and IFN-γ levels at +baseline and during the examination, as an indicator +of exam stress, in 60 first year medical undergraduate +students. The yoga group practiced integrated yoga +for 35 minutes daily in the presence of trained yoga +teacher for 12 weeks, control group followed daily +routine. At the end, they concluded that yoga resists +the exam-stress induced autonomic changes and +impairment of cellular immunity, as yoga group +showed significant improvement compared to the +control group in physiological, psychological as well +as biochemical parameters. The yoga group showed +less significant increase in serum cortisols and +decrease in IFN-γ as compared to the control group +during the exam [107]. Todd Cade et al [108] +randomly assigned sixty pre-hypertensive HIV- +infected adults with mild-moderate CVD risk factors +to 20 wks of supervised yoga practice or standard of +care treatment. Yoga group practiced āsanas and +breathing +techniques +2–3 +times/wk +for +~60 +min/session for a total duration of 20 weeks. They +found significant reduction in blood pressure in the +yoga group at the end of program as compared to +those on standard care. Each session included: +alignment of muscle locks (bandhās) and controlled +breathing +(ujjayī), +Sun +Salutations +(Surya +Namaskāra), Standing, Seated and Supine physical +postures (āsanas) and cooling down (restorative +breathing). Our randomized control trial on 70 +seropositive HIV patients randomly assigned to either +yoga +(36) +or +waitlist +control +(34) +groups, +demonstrated the efficacy of 3 month daily 1 hour +integrated yoga intervention in improving quality of +life and positive affect in HIV positive individuals +[109]. In a study on 7 yoga instructors, it was found +that alpha waves increased and serum cortisol +decreased during the yoga exercise [110]. Another +study reported the beneficial effects of two 1-hour +Iyengar Yoga classes each week for 5 consecutive +weeks on young adults with elevated symptoms of +depression. The yoga session specifically focussed on +yoga postures particularly back bends, standing poses, +and inversions, which are thought to alleviate +depression. Results showed significant decreases in +self-reported symptoms of depression and trait +anxiety [111]. A study by Schmidt et al reported +significant increase in urinary excretion of cortisol as +well as reduction in the excretion of various hormones +like adrenaline, nor adrenaline, dopamine and +aldosterone, they also found a decrease in serum +testosterone and luteinizing hormone levels in +participants after a comprehensive 3 month yoga- +based lifestyle program which included yoga, +meditation and vegetarian diet [112], suggesting the +modulatory effect of yoga on neuro-endocrinal axis. +Further, yadav et al found that a 9 day comprehensive +yoga-based lifestyle modification (YLMP) program +significantly reduced oxidative stress in 104 subjects. +They measured thiobarbituric acid reactive substances +(TBARS) in blood as an indicator of oxidative stress +at the beginning and at the end of YLMP and found +significant reduction in the levels [113]. The YLMP +consisted +of +āsanas, +Prāṇāyāmas, +meditation, +lectures and films on yoga, stress management and +individual counseling. + + +Prāṇamaya Kośa: Scriptural Evidence + +Prāṇa is the basic life principle. Prāṇāyāma is a +process for gaining control over prāṇa. Maharśi +Patanjali +defines +Prāṇāyāma +as +cessation +of +movement of inhalation and exhalation after having +attained mastery over āsana (P.Y.S.2.49). The five +manifestations of prāṇa and the corresponding most +comprehensive definition of Prāṇāyāma in the human +system are described in Praśnopaniśad [114]. +Suitable types of Prāṇāyāma and breathing help to +remove the random agitations in prāṇic flows in the +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +137 + +prāṇamaya kośa. Thus, the ailments are handled at +this prāṇamaya kośa level [98, 99]. +Other hathayoga texts describe usefulness of +specialised breathing techniques: Wherever there is +affliction due to disease, filling that region with +Prāṇa one should hold it there. (H.Y.P. 5.23) Lying +supine on even ground and extending the body one +should practice Prāṇāyāma for alleviation of every +kind of disease. (H.Y.P. 5.21) Bhastrikā removes +imbalances of all three dośas (basic humors according +to ayurvedic science); vāta, pitta and kapha. It also +improves body fire (H.Y.P.2.65) and those who do it +thrice daily, they shall never suffer from any disease +(G.S. 5.77). Nādishuddhi is useful in balancing vāta +(H.Y.P. 2.7, 2.10). Ujjayī Prāṇāyāma should form the +core, as it destroys all the diseases of the nādis, +dropsy, and diseases of the dhātus (sevenfold +structural components that support the body according +to ayurvedic science) and increases gastric fire +(H.Y.P. 2.52). + + +Prāṇamaya Kośa (Breathing Practices and +Prāṇic Healing): Scientific Evidence + +Yogic breathing is a unique method for balancing +the autonomic nervous system and influencing +psychological and stress-related disorders. Sudarshan +Kriyā Yoga (SKY), a sequence of specific breathing +techniques (ujjayī, bhastrikā [99] and sudarshan +kriyā) can alleviate anxiety, depression, everyday +stress, +post-traumatic +stress, +and +stress-related +medical illnesses [115]. Mechanisms contributing to a +state +of +calm +alertness +include +increased +parasympathetic drive, calming of stress response +systems, neuroendocrine release of hormones, and +thalamic +generators. +Relaxation +and +breathing +techniques utilize awareness of breathing rate, +rhythm, and volume. Most often breathing techniques +are used to minimize physiologic responses to stress, +possibly by increasing parasympathetic response +[116]. In a study, Telles et al checked the effect of +breathing +exclusively +through +one +nostril +on +autonomic functions. 48 male subjects were divided +randomly into three groups (viz. right nostril +breathing, left nostril breathing or alternate nostril +breathing). 27 respiratory cycles were repeated 4 +times daily for one month. At the end of one month it +was observed that right nostril breathing lead to +increase in metabolism as shown by the enhancement +of 37% in baseline oxygen consumption. This could +be due to increased sympathetic discharge to the +adrenal medulla. Whereas left nostril breathing caused +reduction in sympathetic nervous system activity +through significant increase in volar galvanic skin +resistance. Thus, breathing selectively through either +nostril can have a marked activating effect or a +relaxing effect on the sympathetic nervous system +[117]. Shannahoff-Khalsa claimed that ancient yogic +technique of unilateral forced nostril breathing +(UFNB) that employs forced breathing through only +one nostril while closing off the other is a non- +invasive technique that seems to selectively activate +the ipsilateral branch of the sympathetic nervous +system [118]. He further found that forced right +nostril breathing increases heart rate compared to left +forced nostril breathing whereas forced left nostril +breathing leads to rise in end diastolic volume and +stroke volume [119]. In a single blind control study, +Jain et al [120] compared the effect of Prāṇic healing, +a +non-touch +non +pharmacological +method +of +treatment, in chronic musculoskeletal pain with a +placebo session of random hand movements. Fifty +patients with chronic non-malignant continuous +musculoskeletal pain of more than 6 months duration +were assigned to two groups of 25 each. One group +received prāṇic healing for 25 min and another group +underwent a placebo session for 25 min. The results +showed highly significant reduction in pain and +sympathetic +activity +in prāṇic +healing +group +(student's t- test p <0.001) and non-significant change +in placebo group. They concluded that Prāṇic healing +when performed in the standardized method by a +trained healer is effective in reducing continuous +chronic pain of musculoskeletal origin, within 25 +minutes as compared to placebo random hand +movements which appears similar to the standard +method of prāṇic healing. + + +Manomaya Kośa: Scriptural Evidence + +According to Patanjali [70] , the culturing of +mind is accomplished by focusing of the mind +(Dhāraṇā) initially, followed by relaxed dwelling of +the mind in a single thought (Dhyāna) for longer and +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +138 + +longer +durations +leading +ultimately +to +superconsciousness (Samādhi) (P.Y.S. 3.1, 3.2, 3.3). +For various meditative techniques to be used we +can have following scriptural references: +Prāṇic Energisation Technique [121]: With +concentrated mind one should meditate upon the Vāyu +(life force) and should fill the lungs by inhaling. Then +a +complete +exhalation +should +effortlessly +be +performed according to one’s capacity (H.Y.P. 5.10) +do repeated exhalations and inhalations (H.Y.P 5.11). +Whenever any region is afflicted with disease one +should concentrate on the Vāyu stuck up in that region +(H.Y.P. 5.9). +Om Meditation [114]: The three mantrās (A U +M), when employed separately, leads to fruits that are +mortal and finite, but when they are strung together +they are not in any sense of the term ‘wrongly +employed’. But when they are ‘properly employed’ in +all their internal, external and midway functions, the +knower thereafter trembles not. +Cyclic Meditation [122]: ‘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’ [123, 124]. +Mind +Sound +Resonance +Technique +[125]: +(Nādānusandhāna)- ‘Senses cannot function without +cooperation of the mind and prāṇa, which in turn +cannot function without underlying life activities. Life +activities, and with them the mental, sensory and +motor activities are stopped by yoga. This is called +Layā. In this state, the yogis hear a centrally aroused +sound and lose themselves in that sound (nāda); and +this suspension of life activity in yoga is not a +vacuum. It is a higher state of consciousness +(samādhi). +After becoming indifferent to the world, a +controlled person should fix his mind on the (inner) +sound which he hears while his ears are closed at the +root, until he attains a state of perfect steadiness +(H.R.4.4-6, 4.8) [103]. In the state of Samādhi, when +kundalinī (mystic energy at the root of spine) is at +equilibrium and moves up from the middle path, by +making internal sound yogi is freed from diseases +[H.R. 2.114-115]. + + +Manomaya Kośa (Relaxation Techniques and +Meditations): Scientific Evidence + +Koar and William found a significant increase in +T-cells and a decrease in anxiety and depression in +HIV infected individuals following the practice of +meditation in their pilot study [66]. Mindfulness +meditation is the practice of bringing an open and +receptive awareness of the present moment to +experiences, avoiding thinking of the past or worrying +about the future. It is thought to reduce stress and +improve health outcomes in a variety of patient +populations. A randomized controlled trial in a +diverse community sample of HIV-1 infected adults +indicated that 8-week mindfulness meditation and +stress reduction program can buffer CD4+ T +lymphocyte declines [68]. A quasi-experimental study +tested the effect of a structured 8 week Mindfulness- +Based Stress Reduction (MBSR) program on HIV +infected individuals and reported significant increase +in natural killer cell activity and number in the MBSR +group compared to the comparison group [67]. In +another randomized controlled trial, Bormann et al +examined the effect of psycho-spiritual intervention +of mantram repetition, “a word or phrase with +spiritual associations repeated silently throughout the +day” on psychological distress, quality of life +enjoyment and satisfaction, and existential spiritual +well-being, in 93 HIV infected adults randomly +assigned to mantram (n = 46) or attention control +group (n = 47). Results showed significant +improvement in mantram group as compared to the +control in reducing trait anger and increasing spiritual +faith and connectedness. Mantram practice was +positively associated with quality of life and total +existential spiritual wellbeing and inversely associated +with HIV-related intrusive thoughts [65]. As +Madanmohan discussed in a review [126], a study by +Maini on 60 young medical students tested the effect +of Sahaj yoga meditation on lipid peroxidation and +found significant decrease in malonyl dialdehyde +levels and increase in RBC count, packed cell +volume, total leucocyte count, and mean corpuscular +fragility [127]. They concluded that Sahaj yoga +practice decreases lipid peroxidation levels in the +blood and levels of stress as well. Further, Tooley et +al demonstrated the ability of meditation to affect +plasma +melatonin +levels, +as +they +observed +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +139 + +significantly higher levels of plasma melatonin in +experienced meditators in the period immediately +following meditation. They suggested that facilitation +of +higher +physiological +melatonin +levels +at +appropriate times of day might be one avenue through +which the claimed health promoting effects of +meditation occur [128]. In another study, Harinath et +al noted significant improvement in cardiorespiratory +performance and increase in plasma melatonin levels +following a 3 month practice of hatha yoga and +Omkār meditation in healthy subjects [95]. Oswal et +al defined yogic prāṇic energization technique +(YPET) as an advanced yoga relaxation practice that +involves +breath +regulation, +chanting, +and +visualization, which according to yogic science +revitalizes the tissues by activating the subtle energies +(prāṇa) within the body [129]. They performed a +randomized control trial in 30 patients randomly +divided into yoga (n=15) and control groups (n=15) to +test the add-on effect of YPET on healing of fresh +fractures, and found significant improvement in pain +and tenderness reduction, fracture line density and +number of cortices united. They concluded that add- +on yoga-based YPET accelerates fracture healing +[129]. Cyclic Meditation (CM) is a yoga-based +relaxation technique based on a statement from Indian +vedic text [123], which suggests that combination of +"stimulating" and "calming" practices may be +especially helpful to reach a state of mental +equilibrium. In a study, the oxygen consumption, +breath rate and breath volume of 50 male volunteers +were assessed before, during, and after sessions of +CM and sessions of supine rest in the corpse posture +(Śavāsana, +SH). +The +results +showed +that +a +combination of yoga postures with supine rest (CM) +reduces the oxygen consumption more than resting +supine alone does [130]. Cyclic Meditation has also +been shown to reduce sympathetic activity and bring +about a state of parasympathetic dominance [131], to +reduce occupational stress [132] and to improve +quality of sleep [133]. + + +Vijñanamaya Kośa: Scriptural Evidence + +Questioning attitude and logical thinking is the +key to operate from vijñanamaya kośa. Upaniads +are the treasury of such knowledge which is the +redeemer of all miseries and obsessions. It is the lack +of inner jñana (knowledge) which is responsible for +many wrong habits, agitations, etc. The secret for +happiness, therefore, is conquering of the agitation of +mind through knowledge. Once the mind is calm +through the logic of knowledge, the understanding +becomes deeper and goes beyond the logic and one is +able to handle the stressors in a healthy way. +Different Upaniads describe different models +(prakriyās ) and techniques (upāsanās) to purify and +prepare the mind for this knowledge (Jñana). Which +can be achieved using Yogic counseling based on +ancient scriptures (Upaniads, Bhagavad Gita, +Brahmasutras), Lectures on Jñana Yoga, concept of +death according to Vedas etc., to bring about the +notional corrections [134]. + + +Vijñanamaya Kośa (Yogic Counseling, +Lectures and Notional Corrections): Scientific +Evidence + +A study tested the effect of yoga practices on +stress +induced +effects +in +first +year +medical +undergraduates. The results pointed to the beneficial +role of yoga in not only causing reduction in basal +anxiety level but also attenuating the increase in +anxiety score in stressful state such as exams. The +yoga group also reported improvement in sense of +well +being, +feeling +of +relaxation, +improved +concentration, self confidence, improved efficiency, +good +interpersonal +relationship, +increased +attentiveness, lowered irritability levels, and an +optimistic outlook in life as indicated by feedback +score [135]. Satyapriya et al randomized healthy +pregnant women to practicing yoga and deep +relaxation or standard prenatal exercises 1-hour daily, +to assess the effect of integrated yoga on perceived +stress and autonomic response. The results showed +reduction of perceived stress in the yoga group (by +31.57%) and rise of perceived stress in the control +group by 6.60% (P=0.001). Yoga also improved +adaptive autonomic responses to stress in healthy +pregnant women in the same study [136]. Suggesting +that yoga with its vast wisdom base in Indian vedic +literature, through notional corrections, can favorably +change the perception of individuals towards stressful +life events. +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +140 + +Ānandamaya Kośa (Laughter Yoga, Action in +Blissful Awareness): Scriptural Evidence + +The Happiness Analysis model: Search for +happiness is instinctive to sustain creation and to +avoid fear and death. It is essential to move towards +bliss and overcome misery. An ancient vedic text +describes that this analysis systematically leads the +student to that substratum from which prāṇa and +mind emerge - the Ānandamaya Kośa [97]. It leads to +the realization that happiness is within and ‘each one +of us’ in our causal state is ‘Ānanda’ (bliss) +embodied. As a result, life changes occur in person’s +outlook. Knowledge burns the strong attachments, +obsessions, likes and dislikes which are the basic +reasons for the agitations of mind. Happiness is an +inner state. It is an inner silence that is a state of +being. Sense objects only give temporary glimpse of +our own nature, Ānanda [134]. +Action in blissful awareness (Karma yoga), is a +technique where work is enjoyed with mindfulness +without caring for fruits. Routine activities are done +with relaxed but aware mind. One lives in the present +moment while performing his duties with an attitude +of universal well being. As Śri Kriśna tells in +Bhagavad Gita - ‘Whosoever, controlling the senses +by the mind, O Arjuna, engages his organs of action +in Karma yoga (action for universal well being +without attachment), he excels.’ (B.G. 3.7) [100]. + + +Ānandamaya Kośa (Laughter Yoga, Action in +Blissful Awareness): Scientific Evidence + +Laughter +is +basically +stimulation +and +physiological arousal and when combined with yoga +practice it leads to a hypo-metabolic state [137]. +Relaxation techniques also lead to reduction of +metabolic rate and sympathetic activity thereby +reducing stress. Laughter has shown different +physiological and psychological benefits [138]. A +pilot study demonstrated benefits at the biochemical +level, in terms of reduction in the serum levels of +cortisol, dopac, epinephrine, and growth hormone +after a 60 min session of mirthful laughter [139]. +Takashi et al tested the effect of Laughter by watching +a comic video, on gene expression in type-2 Diabetic +patients and observed an up-regulation of about 39 +genes at 1.5hr and 27 gene up-regulations were +sustained till 4hr after watching the video. Among the +up-regulated genes, 14 were related to natural killer +cell activity. They concluded that Laughter influences +the expression of many genes classified into immune +responses [140]. Masahiro et al investigated the effect +of Laughter on endocrinological stress marker +chromogranin-A (CgA) in 11 healthy males. Saliva +samples were collected before and after watching a +comic film. They found significant increase in CgA +levels, although subjective stress score on visual +analog scale was reduced [141]. Laughter Yoga +International commissioned a scientific research +project involving 200 IT professionals in Bangalore +(India), to determine the effect of laughter yoga on +stress at the work place. Participants were divided into +two groups, laughter yoga (LY) and control. LY +group received LY sessions every 2-3 days for 18 +days (Total of 7 sessions) while other group was wait +listed. Physiological (autonomic and respiratory +variables), +biochemical +(early +morning-salivary +cortisol) and psychological (Positive and Negative +Affect Scale, Perceived Stress Scale and Toronto +Alexythemia Scale) parameters were assessed. The +results showed significant reductions in systolic and +diastolic blood pressures, significant reductions in +early morning salivary cortisol levels in the LY group +as compared to control. There was also a reduction in +negative effect, perceived stress and alexithymia +[137]. + + +IAYT Module for Reversal of +Hematopoietic Inhibition in HIV-1 +Infected Patients + +Based on primary (Scriptural) and secondary +(Scientific) sources of references, the following +Yoga modules are devised + +The yoga sessions would be standardized to +optimize consistency between participants. Two basic +Yoga modules, one for intensive residential practice +at our health home (IP) [Table 1], Ārogyadhāma, for +first four weeks and second for regular practice at +home as out-patient (OP) [Table 2] for next 16weeks +with the help of CD’s, books, and printed material are +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +141 + +devised, a total of 20 week intervention. Each session +would begin with feedback from the participants +about their previous session. +These modules include preparatory breathing and +loosening practices, āsanas, Prāṇāyāma, different +types +of +meditations +i.e., +om +meditation, +nādānusandhāna meditation and cyclic meditation, +deep relaxation technique (DRT), advanced yoga +techniques like prāṇic energisation technique and +mind sound resonance technique, interactive lectures +on concepts of IAYT, jñana yoga, karma yoga, etc. + + +Table 1. The Schedule During Intensive Residential Intervention for Initial 4 weeks (Yoga Module 1) (IP) + +Time +Activity +Time +Activity +5.00 AM +Ablution +2:00 PM +Yogic Relaxation Technique [99] +(Yoga nidrā, Nādānusandhāna) +5:30 AM +Om Meditation [99, 123] +3:00 PM +Cyclic Meditation[122, 124] +6:00 AM +Special Yoga Technique1 +(see Table 3) [99] +(Āsanas/ Kriyās twice a week) +4:30 PM +Evening snacks (milk or juice) +7:00 AM +Karmayoga [100] +(work with mindfullness) +5:00 PM +Evening Walk (Tuning to nature) +8:00 AM +Bhagavad Gita chanting +and discourse on yoga philosophy +6:00 PM +Devotional Sessions, Chanting +8:45 AM +Breakfast (sāttvic yoga diet) +6:30 PM +Mind Sound Resonance Technique[125] +9:30 AM +Prāṇic Energisation Technique [121] +7:30 PM +Dinner +10:30 AM +Yogic Counselling/ Notional +Corrections +8:30 PM +Happy Assembly (Laughter Yoga, Yoga games) +11:00 AM +Prāṇāyāma (see Table 5)[99] +9:30 PM +Rest / Introspection +12:00 Noon +Special Yoga Techique2 +(see Table 4) [99] +10:00 PM +Lights Off +1:00 PM +Lunch (sāttvic yoga diet) + + + +Table 2. The Schedule During Home Practice Intervention for next 16 weeks (Yoga module 2) (OP) + +S.N. +NAME OF PRACTICE +TIME AND DURATION +SOURCE +1. +Om Meditation [99, 123] +From 5:30 AM to 6:00 AM (30min) +Om meditation CD +2. +Special Technique 1 [99] (see +Table 3) +From 6AM TO 7AM (1 hr) +As Taught During IP And As Per +The Printed Material Given +3. +Prāṇāyāma [99] (see Table 5) +7AM TO 7:45AM (45min) +As Taught During Ip And As Per +The Printed Material Given +4. +Prāṇic Energisation Technique +(PET) [121] +9 AM TO 10 AM +PET CD +4. +Karmayoga [100] +While doing daily routine activities +or job +As per the lectures taken during IP +5. +Cyclic Meditation [122, 124] +Afternoon 3:00 TO 4:00PM +Cyclic Meditation CD +6. +Special Technique 2 [99] (see +Table 4) +Evening 6:00PM TO 7:00PM +As Taught During IP And As Per +The Printed Material Given +7. +Mind Sound Resonance +Technique (MSRT) [125] +Either Evening 7:00PM TO 8:00PM +OR After Dinner Before Sleeping +Between 9:00PM TO 10:00PM +MSRT CD +Note: Yogic counselling given once in a fortnight for one hour. +Kriyās to be practiced once a week (as learnt during IP). +Diet as per yogic concepts of sāttvic diet at proper time. + +Hemant Bhargav, Nagarathna Raghuram, Nagendra Hongasandra Rama Rao et al. + +142 + +Table 3. Special Technique 1 [99] Duration of Special Technique 1: 1 hour + +Sl. No. +Name of practices +Number of rounds +Duration + +Starting prayer +2 mins +Loosening Practices +1 +Jogging +5 rounds +2 mins +2 +Forward and backward bending +5 rounds +2 mins +3 +Twisting +5 rounds +2 mins +4 +Side bending +5 rounds +2 mins +5 +Pavanmuktāsana stretch +5 rounds +2 mins +Surya namaskāra +5-10 rounds +15 mins +Breathing Practices +1 +Hands in and out Breathing +5 rounds +2 mins +2 +Ankle stretch breathing +5 rounds +2 mins +3 +Bhujangāsana Breathing +5 rounds +2 mins +4 +Straight Leg Raise Breathing +5 rounds +2 mins +5 +Both Leg Raising +5 rounds +2 mins +Āsanas +1 +Ardhakati Ćakrásana +1 round +2 mins +2 +Uśtrāsana +1 round +2 mins +3 +Paśćimottanāsana +1 round +2 mins +4 +Bhujangāsana +1 round +2 mins +5 +Śalabāsana +1 round +2 mins +6 +Setubandhāsana +1 round +2 mins +7 +Śavāsana/Deep Relaxation Technique (DRT) +5 mins +Closing prayer +2 mins + +Table 4. Special Technique 2 [99] Duration of Special Technique 2: 1 hour + +Sl. No. +Name of practices +Number of rounds +Duration + +Starting prayer +2 mins +Loosening Practices +1 +Jogging +5 rounds +2 mins +2 +Forward and backward bending +5 rounds +2 mins +3 +Twisting +5 rounds +2 mins +4 +Side bending +5 rounds +2 mins +Surya namaskāra +5-10 rounds +15 mins +Breathing Practices +1 +Hands in and out Breathing +5 rounds +2 mins +2 +Ankle stretch breathing +5 rounds +2 mins +3 +Bhujangāsana Breathing +5 rounds +2 mins +4 +Straight Leg Raise Breathing +5 rounds +2 mins +5 +Both Leg Raising +5 rounds +2 mins +Āsanas +1 +Ardha Ćakrásana/ Ćakrāsana +1 round +2 mins +2 +Paśćimottanāsana +1 round +2 mins +3 +Uśtrāsana +1 round +2 mins +4 +Dhanurāsana +1 round +2 mins +5 +Sarvāngāsana/Halāsana +1 round +2 mins +6 +Śirśāsana +1 round +2 mins +7 +Śavāsana/ Deep Relaxation Technique (DRT) +5 mins +Closing prayer +2 mins + + + +Potential Yoga Modules for Treatment of Hematopoietic Inhibition in HIV-1 Infection + +143 + +Table 5. Prāṇāyāma (Duration of Prāṇāyāma : 45min) + +PRĀĀYĀMA [99] +S. No. +Breathing Practices +ROUNDS +DURATION +Starting prayer +3 mins +1 +Kapālabhāti +60-80 rounds/min +5min +3 +Sectional breathing: +abdominal breathing in supine with AAA +chanting +thoracic breathing – UUU chanting +clavicular breathing in sitting –slow with MMM +chanting + +5 rounds + +5 rounds + +5 rounds + + + +5mins +3 +Nādishuddhi +27 rounds +10 min +4 +Bhastrikā +3 rounds +20 strokes each +6mins +5 +Bhrāmari + + +5min +6 +Ujjayī +(with Bandhās) + +5min +Closing prayer +2 min + +Other practices include healthy yogic diet based +on concepts of triguṇa (three basic attributes of +activity, inertia and balance in the individual +personality), devotional sessions and practice of +karma yoga in the daily routine with mindfulness as +selfless service and individual yoga counseling using +these concepts. + + +Conclusion + +Thus this article is a unique blend of cellular and +molecular biology in biomedical and life sciences and +ancient vedic prescriptions of Indian (South Asian) +treatments for disease. 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III) Glioblastoma +xenografts in immunocompetent rats: (A) Intensely +cellularized tumor; (B) perivascular concentration of +tumor cells; (C) Co-localization of DAPI and anti- +human nuclei fluorescence confirming xenografting. +Credit: Oswaldo Keith Okamoto + diff --git a/subfolder_0/Prevalence of prediabetes, and diabetes in Chandigarh and.txt b/subfolder_0/Prevalence of prediabetes, and diabetes in Chandigarh and.txt new file mode 100644 index 0000000000000000000000000000000000000000..7483e0c5f753c1ad72be3388f25b395c90a5fb25 --- /dev/null +++ b/subfolder_0/Prevalence of prediabetes, and diabetes in Chandigarh and.txt @@ -0,0 +1,635 @@ +Endocrinol Diab Metab. 2021;4:e00162. + + +  |  1 of 7 +https://doi.org/10.1002/edm2.162 +wileyonlinelibrary.com/journal/edm2 +1 | INTRODUCTION +Percentage of glycated haemoglobin (HbA1c) is used as an important +biochemical parameter to assess past three month's blood glucose +status.1 Factors affecting HbA1c level include blood sugar concentra- +tion, Red Blood Cell (RBC) duration to varying concentrations and quan- +tity of RBC. In 2009, American Diabetes Association (ADA) and, in 2011 +World Health Organization (WHO) recommended that HbA1c as a tool + +Received: 26 January 2020  |  Accepted: 17 May 2020 +DOI: 10.1002/edm2.162 +O R I G I N A L R E S E A R C H A R T I C L E +Prevalence of prediabetes, and diabetes in Chandigarh and +Panchkula region based on glycated haemoglobin and Indian +diabetes risk score +Saurabh Kumar1 + | Akshay Anand1 + | Raghuram Nagarathna2 | Navneet Kaur1,3 | +Madhava Sai Sivapuram4 + | Viraaj Pannu5 | Deepak Kumar Pal1 | Neeru Malik6 | +Amit Kumar Singh2 | Hongasandra Ramarao Nagendra2 +This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, +provided the original work is properly cited. +© 2020 The Authors. Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd. +1Neuroscience Research Lab, Department +of Neurology, Postgraduate Institute of +Medical Education and Research (PGIMER), +Chandigarh, India +2Swami Vivekananda Yoga Anusandhana +Samsthana (S-VYASA), Bengaluru, India +3Department of Physical Education, Panjab +University, Chandigarh, India +4Department of General Medicine, Dr. +Pinnamaneni Siddhartha Institute of Medical +Sciences and Research Foundation, Chinna- +Avutapalli, India +5Government Medical College and Hospital +Sector-32, Chandigarh, India +6Dev Samaj College of Education, +Chandigarh, India +Correspondence +Akshay Anand, Neuroscience Research Lab, +Department of Neurology, Postgraduate +Institute of Medical Education and Research +(PGIMER), Chandigarh, India. +Email: akshay1anand@rediffmail.com +Raghuram Nagarathna, Swami Vivekananda +Yoga Anusandhana Samsthana (S-VYASA), +Bengaluru, India. +Email: rnagaratna@gmail.com +Funding information +Ministry of AYUSH (through CCRYN), Grant/ +Award Number: 16-63/2016-17/CCRYN/ +RES/Y&D/MCT/ +Abstract +There is a rapid increase in the prevalence of diabetes in India. We wanted to review +the status of prediabetes and diabetes in the combined population of Chandigarh +and Panchkula region based on both Indian Diabetes Risk Score (IDRS) and Glycated +Haemoglobin (HbA1c). A total of 1215 subjects were recruited during the screen- +ing process, out of which 444 i subjects have been analysed for the current study +on the basis of high risk for IDRS (≥60) and their known diabetes status. This study +included 431 subjects having high risk for IDRS (≥60) and 13 known subjects with +diabetes (IDRS < 60) which were further analysed for biochemical and anthropomet- +ric parameters. The prevalence of diabetes was found to be 12.67% and prediabetes +11.69% in the combined population of Chandigarh and Panchkula. There was an in- +creased level of fasting blood glucose (183.12 ± 68.61), postprandial blood glucose +(262.57 ± 96.92), triglyceride (193.84 ± 119.88), very low-density lipoprotein (VLDL) +(34.87 ± 15.42) and High Density Lipoprotein(HDL) (4.61 ± 1.39) in the said diabe- +tes population. Mean HDL was found to be decreased in subjects having diabetes. +Glucose-induced lipid intolerance study revealed significant alteration in triglyceride, +HDL and VLDL. The study has revealed that high prevalence of diabetes in the sam- +pled population when compared with the national average of 8.8%. +K E Y W O R D S +blood glucose, diabetes, glycated haemoglobin, Indian diabetes risk score +2 of 7  |     +KUMAR et al. +for the screening, diagnosis and monitoring of diabetes.2 According to +ADA guidelines, the recommended values for the diagnosis of diabe- +tes includes HbA1c ≥ 6.5% (48 mmol/mol), fasting sugar ≥ 126 mg/dL +(7.0 mmol/L) and 2-hr postprandial level ≥ 200 mg/dL (11.1 mmol/L).2 +At cut-off value of 6.5% HbA1c demonstrated the sensitivity of 44% +and specificity of 99% in adult population (69.4  ±  11.1  years).3 For +prediabetes and healthy individuals, the recommended HbA1c value +is 5.7%-6.4% and <5.7%, respectively.4 A 6-year diabetes prediction +study showed that at 5.7% HbA1c cut-point, the sensitivity was 66% +whilst the specificity was 88%.5 Similarly, a study from National Health +and Nutrition Examination Survey (NHANES) demonstrated the sen- +sitivity of HbA1c to be 39%-45% and specificity to be 81%-91% for +5.7% HbA1c. Another study predicted the association of 5.7% HbA1c +with high risk for diabetes. Therefore, a value of 5.7%-6.4% is consid- +ered reasonable for identification of individuals within prediabetes.6 +HbA1c acts as a dependable method to detect chronic hyperglycaemia +and the risk of developing other diabetes complications in long term. +Studies suggest that the increased level of HbA1c acts as an indepen- +dent risk factor for complications like stroke and coronary heart dis- +ease in individuals with or without diabetes.7 In India, diabetes mellitus +(DM) is amongst the leading health problem which profoundly affects +the health budget due to the comorbidities associated with it.8 A total +of 415 million individuals have been reported to be affected with dia- +betes which is further expected to rise up to 642 million by the end of +2040.9 About 75% of the low/middle income countries will be affected. +This drastic increase in the number of affected individuals with dia- +betes poses a threat to the productivity and economy of a develop- +ing country. It was estimated that the annual expenditure on diabetes +costs about USD 760 billion which is 10% of the total annual global +health expenditure. India has estimated 72, 946, 000 diabetes cases +(with 8.8% prevalence in adults) is the second largest after China.10 +In India, the average cost per person on diabetes was USD 67.98 in +2012.11 According to a study published in Lancet, the number of indi- +viduals with diabetes was drastically increased in India from 1980 to +2016. In 1990, there were 26.0 million people suffering with diabetes +in India, which increased to 65.0 million in 2016.12 The prevalence of +diabetes in India varies across various states, ranging between 5% to +17% with highest prevalence in southern states and in urban areas.9 A +survey report (conducted between 2015-19) published by Ministry of +Health and Family Welfare reports the prevalence of diabetes to be +11.8% for these 4 years. This report has revealed the prevalence of +known diabetes cases to be 8%, whereas the prevalence of new cases +was 3.8%.13 The estimates of prevalence and identification of the in- +dividuals with high risk for diabetes are important for the planning. +The identification of these high-risk individuals are equally important, +and this can only be achieved if they are identified at transition state +or before that. Prediabetes can be considered as the transition state +between a healthy and a diabetes individual. Prediabetes, also called +intermediate hyperglycaemia, is a condition in which the serum blood +glucose levels are higher than the normal levels, but not enough to +cause diabetes. According to ADA, the cut-off level for prediabetes is +5.7%-6.4%. Prediabetes is linked with the abnormalities in the form of +insulin resistance and β-cell dysfunction which starts before glucose +changes are measurable. It is estimated that there will be >470 million +people with prediabetes in 2030. The conversion rate of prediabetes +to diabetes is around 5%-10%.14 +Furthermore, by identification of prediabetes in the population, the +threat of conversion from prediabetes into diabetes can be reduced.15 +The Indian Diabetes Risk Score (IDRS) is a method developed by +Mohan et al in 2005 to analyse the risk of prediabetes/diabetes at mass +level.16 IDRS considers four parameters: age, family history (father or +mother), physical activity and abdominal obesity (waist circumference). +Risk assessment by IDRS involves 3 categories: score < 30 (low risk), +30-50 (moderate risk) and ≥60 (high risk). We performed a cross-sec- +tional study in 2 regions of North West India population (Chandigarh +and Panchkula) based on IDRS in order to explore the prediabetes and +diabetes individuals in the community further validated on the basis of +HbA1c levels. Individuals with high risk (IDRS score ≥ 60) were selected +for the analysis. The specificity of IDRS score ≥ 60 was 60.1%, whereas +the sensitivity was 72.5%.17 +2 | METHODOLOGY +2.1 | Study design +This study was a part of Niyantrita Madhumeha Bharata (NMB) pro- +gramme, in which 29 Indian States and 7 Union Territories (UTs) +were screened. It was a multi-level cluster randomized controlled +trial. However, the data presented in this study are of two regions +of North West India i.e. Chandigarh (Union Territory), and Panchkula +(District). For sample size calculation, we referred to Diabetes +Community Lifestyle Improvement Program (D-CLIP) study pub- +lished in diabetes care.18 The details are published in our recent +publications.19,20 As a part of this national programme, house-to- +house screening was carried out by trained volunteers of Indian Yoga +Association (IYA). A two-page questionnaire was used which com- +prises of the personal information about name, age, family history of +diabetes, waist circumference, height and weight, besides collecting +the workout information. Based on this, IDRS score was calculated.17 +Initially, a total of 1215 subjects were recruited for the study, out of +which 444 subjects were assessed for the biochemical parameters +based on high risk for IDRS (IDRS ≥ 60) and their known diabetes +status. The Figure No - 1 shows the schematic of recruitment of an +individuals for the study. Kish formula for house-to-house screening +was not used (Figure 1). +2.1.1 | Inclusion and exclusion criteria used for +screening was as following +Inclusion criteria +• Both male and female participants with diabetes (self-reported, +which was cross verified) +• Subjects were from within the periphery of 10km distance from +rural and urban regions. +    |  3 of 7 +KUMAR et al. +• Those individuals who showed an IDRS score ≥ 60 (for further +recruitment) +• Patients/Subjects who gave their consents for the study. +Exclusion criteria +• Age below 18 years +• Patients with cardiac disease and tuberculosis. +• Those who had complex surgeries in past. +• Those who had major illness which may disable an individual hav- +ing diabetes. +• Individuals with neurological disorders. +2.2 | Assessments +2.2.1 | Biochemical +Participants were called for the special blood collection camp on +empty stomach with minimum eight  hours of fasting. The blood +sampling and subsequent biochemical analysis was carried out +by an National Accreditation Board for Testing and Calibration +Laboratories (NABL) accredited laboratory. Fasting blood glucose +(FBG), HbA1c, low-density lipoprotein (LDL), high-density lipopro- +tein (HDL), total cholesterol (TC), triglycerides (TG), cholesterol/ +HDL, LDL/HDL ratio and very low-density lipoprotein (VLDL) +were analysed for such fasting samples. An autoanalyser (model +2700/480) (Validation: Beckman Coulter) for the estimation of TC, +TG, LDL, HDL and VLDL was used. For HbA1c, we used HPLC-based +technique using the Variant II Turbo machine (Bio-Rad, Hercules). +Postprandial blood glucose (PPG) sample was taken after 2 hours +of breakfast and estimated using Mindray Autoanalyzer (BS-390 +model). The methods used for the assessment were certified by the +National Glycol Haemoglobin Standardization Program (NGHSP) as +detailed in our recent publication.19 +2.2.2 | Anthropometry +. +Height ( Stadiometer) and waist Circimference ( Standard mea- +suring tape) was measured in centimeters. weight. Weights ( digital +weighing machine) was measured in kgs. +2.3 | Ethical statement +Ethical clearance for the study was obtained from the Institutional +Ethical Committee of Indian Yoga Association, via letter number: +RES/IEC-IYA/001 dated 16th December 2016. Blood samples +of the participants were taken after the written informed con- +sent was signed by them. This study was primarily done by Swami +Vivekananda Yoga Anusandhana Samsthana (S-VYASA) under IYA. +FI G U R E 1 Schematic representation of recruitment of individuals +4 of 7  |     +KUMAR et al. +2.4 | Statistical analysis +The statistical analysis was done by using the IBM SPSS Statistics +Version 21. The data are presented as mean, standard deviation (SD) +and standard error (SE). Descriptive statistics was performed by +one-way ANOVA. The data were found to be statistically significant +at P < .05. +3 | RESULTS +Based on the house-to-house screening, 1215 individuals were re- +cruited and screened as per IDRS score as low-risk, moderate-risk +and high-risk individuals. Out of 1215, a total of 444 subjects were +found to be at high risk (≥60 or known diabetes status) which were +further assessed according to HbA1c levels. The final prevalence +of diabetes, prediabetes subjects were found to be 12.67% and +11.69%, respectively, as depicted in the Table 1. +Table No  2 summarizes the comparison between the three +groups: diabetes, prediabetes and healthy population amongst the +high-risk IDRS individuals (≥60). Out of 444 subject samples anal- +ysed, 307 were females and 137 were males. The estimated FBG +level was highest in diabetes group (183.12 ± 68.61) than the healthy +(93.01  ±  7.80) and prediabetes group (102.27  ±  13.26). Similarly, +the mean PPG levels in diabetes group were 262.57 ± 96.92, which +was higher than healthy (96.53  ±  17.14) and prediabetes group +(121.75 ± 36.32). We found TG levels were more (193.84 ± 119.88) in +diabetes group than the other two group used in the present study. +TA B LE 1 Prevalence of diabetes, and prediabetes in the combined population of Chandigarh and Panchkula +S No. +Population subsets +Number of +participants +Prevalence +(%) +1. +*Diabetes Population (High-risk IDRS/Known DM and HbA1c >6.5) +154 +12.67 +2. +Prediabetes Population (High-risk IDRS and HbA1c: 5.7 - 6.4) +142 +11.69 +3. +Healthy Population +High-risk IDRS and HbA1c ≤ 5.6 - (n = 148) +participants +919 +75.64 +Low- and moderate-risk IDRS - (n = 771) +participants +Total +1215 +100 +*There were total 13 individuals with IDRS score less than 60, but HbA1c ≥ 6.5. +TA B LE 2 Comparative analysis of various physiological and biochemical parameters in Healthy, Prediabetes and Diabetes individuals with +respect to HbA1c +Subgroups (HbA1c) +Total number +(n) +Healthy (≤ 5.6) +(Mean ± SD) (SE) +Prediabetes (5.7-6.4) +(Mean ± SD) (SE) +Diabetes (≥6.5) +(Mean ± SD) (SE) +*Significance +(P-Value) +(Female/Male) +444 (307/137) +148 (111/37) +142 (106/36) +154 (90/64) +- +Age (years) +45.77 ± 10.20 (1.07) +51.95 ± 10.78 (1.15) +53.79 ± 9.81 (1.02) +- +Weight (Kg) +444 +69.33 ± 14.10 (1.16) +72.58 ± 11.47 (0.96) +70.29 ± 12.76 (1.03) +- +BMI (Kg/m2) +444 +27.88 ± 5.94 (0.49) +29.30 ± 4.46 (0.37) +27.58 ± 4.80 (0.39) +.009 +IDRS +444 +71.15 ± 10.20 (0.84) +76.41 ± 9.99 (0.84) +75.19 ± 14.69 (1.18) +<.001 +Fasting Blood Glucose (FBG) +(mg/dL) +444 +93.01 ± 7.80 (0.64) +102.27 ± 13.26 (1.11) +183.12 ± 68.61 (5.53) +<.001 +Postprandial Glucose (PPG) +(mg/dL) +419 +96.53 ± 17.14 (1.49) +121.75 ± 36.32 (3.06) +262.57 ± 96.92 (8.05) +<.001 +Cholesterol (mg/dL) +444 +182.93 ± 36.88 (3.03) +190.99 ± 35.46 (2.98) +191.58 ± 43.06 (3.47) +.100 +Triglyceride (mg/dL) +444 +134.92 ± 71.39 (5.87) +140.13 ± 67.52 (5.67) +193.84 ± 119.88 (9.66) +<.001 +HDL (mg/dL) +444 +48.69 ± 13.04 (1.07) +47.46 ± 12.78 (1.07) +43.52 ± 9.91 (0.79) +.001 +LDL (mg/dL) +441 +109.01 ± 29.06 (2.40) +115.50 ± 29.78 (2.49) +109.64 ± 34.96 (2.83) +.156 +Cholesterol/HDL +444 +3.96 ± 1.13 (0.09) +4.22 ± 1.14 (0.09) +4.61 ± 1.39 (0.11) +<.001 +LDL/HDL +443 +2.38 ± 0.73 (0.06) +2.57 ± 0.86 (0.07) +2.60 ± 0.93 (0.07) +.045 +VLDL +435 +26.79 ± 13.36 (1.10) +27.51 ± 12.07 (1.02) +34.87 ± 15.42 (1.27) +<.001 +P values which are considered statistically significant and indicated in bold. +*Between group analysis (ANOVA); P < .05. +    |  5 of 7 +KUMAR et al. +VLDL was also found to be increased in individuals with diabetes +(34.87 ± 15.42). No much difference in mean TC was observed in +three groups. Mean TC for diabetes group was 191.58 ± 43.06, for +prediabetes it was 190.99 ± 35.46, and for group with HbA1c ≤ 5.6 +it was 182.93  ±  36.88. Amongst the high-risk IDRS individuals, +the mean IDRS was found to be 71.15 ± 10.20 for healthy group, +76.41 ± 9.99 for prediabetes and 75.19 ± 14.69 for diabetes. Good +cholesterol (HDL) was found to be reduced in diabetes group +(43.52 ± 9.91), in comparison with the prediabetes (47.46 ± 12.78) +and healthy group (48.69 ± 13.04). Apparently, the anthropometric +parameters, namely BMI (29.30 ± 4.46) and weight (72.58 ± 11.47), +were highest amongst the prediabetes subjects. We measured the +glucose-induced lipid intolerance by estimating different lipid pa- +rameters with respect to FBG and PPG, considering the reference +range of FBG as 70-110 mg/dL and a range of 80-140 mg/dL for +PPG.21 We found that for PPG and FBG, parameters like triglyceride +and VLDL showed significant increased (P < .05) in lipid intolerance, +whereas HDL showed significant decrease (Figure 2) (Table S1). +4 | DISCUSSION +In the present study, we have analysed the prevalence of predia- +betes, and diabetes subjects based on IDRS score and HbA1c lev- +els. Our study is based on IDRS assessment to diagnose diabetes +and prediabetes in the target population. There are very few IDRS- +based studies in the target population (Chandigarh and Panchkula). +In previously published study very low sample size (n  =  155) was +used.22 Therefore, we wanted to study the prevalence of diabetes +and prediabetes in larger sample size (n = 444). According to present +study, the prevalence of prediabetes and diabetes was 11.69% and +12.67%, respectively. Clinical parameters such as FBG and PPG are +considered as standard parameters for glycaemic index.23 Therefore, +considering these two parameters, we analysed the glucose-induced +lipid intolerance. We found significant alteration in case of triglycer- +ide (increased) and HDL (decreased) in the sampled population. HDL +biological activity is highly variable. It plays a crucial role in efflux +of cholesterol from the peripheral cells and further reverses the +FI G U R E 2 Glucose-induced lipid profile intolerance: (A & B) determined by postprandial glucose (PPG), considering its specific range (80- +140 mg/dL: Group 1; 141-220 mg/dL: Group 2; ≥221 mg/dL: Group 3). (C & D) determined by fasting blood glucose (FBG), with specific range +(70-110 mg/dL: Group 1; 111-160 mg/dL: Group 2; ≥161 mg/dL: Group 3) +6 of 7  |     +KUMAR et al. +cholesterol transfer from peripheral cells to the liver. HDL also neu- +tralizes the oxidized lipids thereby acting as an antioxidant. In case of +diabetes, HDL loses its antiatherogenic activity. In accordance with +the previous studies,7,24 we found that the mean HDL was reduced +in diabetes population.25,26 +Group comparison based on HbA1c between healthy, prediabe- +tes and diabetes group amongst high-risk IDRS population shows a +direct correlation of HbA1c with PPG, FBG, triglyceride, LDL and +VLDL and inverse correlation with HDL. Other such studies based +on Chandigarh residents suggest that the prevalence of diabetes +is more in this population (13.6%) as compared to other regions of +India.27,28 +We also found the mean age of prediabetes and diabetes was +more than the healthy individuals amongst the high-risk IDRS indi- +viduals. This is evident from previous studies explaining the early +onset of diabetes (40-60 years) in developing countries.28 Similarly, +the mean weight of individuals with diabetes was higher than the +healthy group of the high IDRS group. This suggests that with the +increase in age and weight, people are more prone to diabetes.28 +The higher risk of this population could be because of increasing age, +obesity and family history. One of the underlying reasons could be +physical inactivity (which is shown by high IDRS score), increased +BMI in our studied population. Physical inactivity decreases insu- +lin sensitivity which may cause diabetes.28 From the study, it is ev- +ident that sampled population analysed was overweight (BMI > 25) +and aged. The selected population is at higher risk for developing +diabetes, and this is reflected by two major previous studies.27,28 +Besides, this population is generally known for protective smoking +lifestyle which makes the results unique to this population.29 Since +IDRS and HbA1c both have been shown to diagnose patients with +diabetes, there is need to correlate the two parameters in a larger +cohort. IDRS is not used as per general guidelines even though it is +simple and effective tool. It is also less expensive to detect diabetes/ +prediabetes in large populations. However, further confirmation is +required with respect to the fasting and PPG estimation in order to +detect diabetes or prediabetes as per ADA guidelines. Also, IDRS is +considered as useful for prediction of risk of diabetes in real time as +it does not measure the long-term effect as in case of three month's +blood glucose status assessed by HbA1c. +5 | CONCLUSION +The study is unique for this population as it assesses the risk based +on simple and cost-effective tool, that is IDRS considering the HbA1c +level. However, Chandigarh and Panchkula represent a small part of +North West Indian population and hence there is a need to conduct +such studies at large scale. Also, the lifestyle, per capita income and +literacy rate in this region are high as compared to other regions +of India, and most of the population belongs to urban locality that +rarely smokes. Therefore, at this stage the transition from prediabe- +tes to diabetes can be controlled. Such study can, therefore, act as +an index of glycaemic control. Our findings can help the government +to implement IDRS-based HbA1c risk assessment, where the early +control is possible thereby halting the transition of prediabetes to +diabetes. +ACKNOWLEDGEMENTS +Authors would like to acknowledge the Ministry of Health and +Family Welfare and Ministry of AYUSH (through CCRYN), govern- +ment of India for funding the project (grant number: 16-63/2016- +17/CCRYN/RES/Y&D/MCT/ dated 15.12.2016) and Indian Yoga +Association (IYA) for overall project implementation. We would also +like to thank Divya Dwivedi, Diksha Puri and Debopriya Basu for +validating the data. +CONFLICT OF INTEREST +Authors declare no conflict of interest. +AUTHOR'S CONTRIBUTION +SK contributed to data collection, original writing and statistical +analysis; AA contributed to concept of manuscript; RN contributed +to proposal writing, study design, planning and monitoring; NK con- +tributed to data collection and segregation of the data; MSS contrib- +uted to manuscript writing and statistical analysis; VP contributed to +writing and editing; DKP contributed to data collection, NM contrib- +uted to data collection and monitoring; AKS contributed to planning, +monitoring, data management and quality assurance; HRN contrib- +uted to vision, concept, proposal, planning, monitoring, advice, prob- +lem solving and editing. +DATA AVAILABILITY STATEMENT +All the associated data is available within the article in the form of +table/figure/supplementary file. +ORCID +Saurabh Kumar  + https://orcid.org/0000-0003-2878-7426 +Akshay Anand  + https://orcid.org/0000-0001-9003-3532 +Madhava Sai Sivapuram  + https://orcid.org/0000-0003-2022-9630 +REFERENCES + 1. 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Haase CL, Tybjærg-Hansen A, Nordestgaard BG, et al. HDL choles- +terol and risk of type 2 diabetes: a Mendelian randomization study. +Diabetes. 2015;64(9):3328-3333. + 27. Anjana RM, Deepa M, Pradeepa R, et al. Prevalence of diabetes and +prediabetes in 15 states of India: results from the ICMR–INDIAB +population-based cross-sectional study. Lancet Diabetes Endocrinol. +2017;5(8):585-596. + 28. Ravikumar P, Bhansali A, Ravikiran M, et al. Prevalence and risk +factors of diabetes in a community-based study in North India: +the Chandigarh Urban Diabetes Study (CUDS). Diabetes Metab. +2011;37(3):216-221. + 29. Centre, H.a.T.M.Tobacco Control in India. 2004: New Delhi. +SUPPORTING INFORMATION +Additional supporting information may be found online in the +Supporting Information section. +How to cite this article: KumarS, Anand A, Nagarathna R, et al. +Prevalence of prediabetes, and diabetes in Chandigarh and +Panchkula region based on glycated haemoglobin and Indian +diabetes risk score. Endocrinol Diab Metab. 2021;4:e00162. +https://doi.org/10.1002/edm2.162 diff --git a/subfolder_0/RECORDING OF AUDITORY MIDDLE LATENCY EVOKED POTENTIALS DURING THE PRACTICE OF MEDITATION WITH THE SYLLABLE _OM_.txt b/subfolder_0/RECORDING OF AUDITORY MIDDLE LATENCY EVOKED POTENTIALS DURING THE PRACTICE OF MEDITATION WITH THE SYLLABLE _OM_.txt new file mode 100644 index 0000000000000000000000000000000000000000..6be30bcbb91a507f0e9b4e319dccd4c360090c99 --- /dev/null +++ b/subfolder_0/RECORDING OF AUDITORY MIDDLE LATENCY EVOKED POTENTIALS DURING THE PRACTICE OF MEDITATION WITH THE SYLLABLE _OM_.txt @@ -0,0 +1,6 @@ + + + + + + diff --git a/subfolder_0/RELATIONSHIP BETWEEN STATE MINDFULNESS AND WORKING MEMORY IN CHILDREN.txt b/subfolder_0/RELATIONSHIP BETWEEN STATE MINDFULNESS AND WORKING MEMORY IN CHILDREN.txt new file mode 100644 index 0000000000000000000000000000000000000000..4963e0fbbcb8a841933a72117f69a107e20792d0 --- /dev/null +++ b/subfolder_0/RELATIONSHIP BETWEEN STATE MINDFULNESS AND WORKING MEMORY IN CHILDREN.txt @@ -0,0 +1,298 @@ +Mindfulness an individual becomes increasingly aware and attentive in the moment has been one of the main +focuses of study within the positive psychology movement. The majority of this research has been conducted with +adults. The current study aimed to establish the relationship between state mindfulness and working memory in +children. Participants were 167 healthy school children (69 girls, 98 boys) who attended Personality Development +Camp. Participants age ranged from 12 to 16 years with a mean age of 13.97 years (SD=1.03). The Corsi-Blocks +task was used to measure of visuo-spatial Working memory. Further psychological states were measure using state +mindfulness attention awareness scale and state anxiety inventory. State mindfulness had a large inverse and +significant correlation with the State anxiety (r=−0.49, p<0.01) and a large positive and significant correlation with +the Corsi forward (Forward Corrected r=0.35, p<0.01 and forward block span r=0.31, p<0.01). Further state +mindfulness had significant positive correlation with Corsi backward (backward corrected r=0.26, p<0.01 and +backward block span r=0.26, p<0.01). Higher-order cognitive processes appear to have positive relationships +between mindfulness. +Keywords: state mindfulness, working memory, children +to examine the effects of mindfulness among children (Frank, +The concept of mindfulness and the practice employed to develop +Jennings, & Greenberg, 2013). Hence current study aimed to +mindfulness have in recent years come into view as one of the main +establish the relationship between state mindfulness and working +focus of study within the positive psychology movement. +memory in children. +Mindfulness is conceptualized as a state of attentiveness to present +events and experiences that is unmediated by discriminating +Method +cognition (Brown, Ryan, & Creswell, 2007). Study demonstrated +that mindfulness brings about various positive psychological effects, +Participants +emotional reactivity, self regulation and antidotes against common +Participants were 167 healthy school children (69 girls, 98 boys) +forms of psychological distress (Keng, Smoski & Robins, 2011, +who attended yoga based Personality Development Camp in +Hayes & Feldman, 2004). +summer holidays in the serene campus of SVYASA University, +Mindfulness is described as a state or trait in which an individual +Bangalore were randomly selected from a pool of 317 children. +becomes increasingly aware and attentive in the moment. Initial +Participants age ranged from 12 to 16 years with a mean age of 13.97 +researches on mindfulness-based programs were for adults, more +years (SD=1.03). All reported having a normal or corrected vision. +recent focus has been on the well-being of children and adolescents; +Children with any major disability or illness were excluded from the +as a result, mindfulness based actives in schools are becoming +study. Participants in this study had no formal training in yogic +prevalent and popular. Schools-based mindfulness intervention has +techniques. Signed informed consent was obtained from the parent +reported promising evidence of its acceptability, evidence of its +or guardian of the child at the time of registration after they had read +impact on depressive symptoms, efficacy in reducing stress and +the proposal of this simple non interventional study that involves +bolstering well-being (Kuyken et al., 2013). +non invasive data collection. All procedures were reviewed and +The human brain appears to have a synchronized system that +accepted by the institutional ethical committee of SVYASA +directs higher-order cognitive processes. Working memory is a +University. The children were explained in detail about the nature of +limited capacity system serving to keep “active” a limited amount of +the study and the voluntary nature of participation and were not +information for a brief period of time, and then to operate on it +provided with any incentives for their participation. +(Teixeira, Zachi, Roque, Taub, & Ventura, 2011), has also been +conceptualized as a component of higher-order cognitive processes +Instruments +(Engle, 2002). The Corsi block tapping task (CBTT) has been +Corsi-Blocks Task: The Corsi-Blocks task is a measure of visuo- +described as the single most important nonverbal task used in +spatial WM spatial (Kessels et al., 2000). A digital version of the task +diagnostics for the assessment of visuo-spatial working memory +was used. The Corsi Block task was programmed presented by the +(VSWM). +INQUISIT Millisecond software package (Inquisit 4, 2014) on a +Although much of mindfulness research is in its early stages and +Dell computer, 17-inch colour monitor. For each trial, nine +focus was more on psychological wellbeing. Mindfulness has been +randomly arranged blue squares are shown on the screen. Each trial +shown to be an effective means of reducing stress and improving +consists of a sequence of blocks that light up one block per second. +emotion balance in research with adults. The majority of this +Children were instructed to remember the sequence. Once a +research has been conducted with adults; research is only beginning +sequence had finished, participants reproduce the sequence, by +clicking those blocks in the same order for corsi forward recall, +while they have to reproduce reverse order for corsi backward. Two +trials of each sequence length were shown, and sequences gradually +Relationship between state mindfulness and working memory in children +Correspondence should be sent to Natesh B., Swami Vivekananda +Yoga Anusandhana Samsthana, Bangalore, Karnatka +Indian Journal of Positive Psychology +2014, 5(3), 310-312 +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 +Natesh B., Rajesh S.K. and H.R Nagendra +Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, Karnatka +increased in length from two to nine blocks. If participants correctly +Results +reproduced at least one of the trials of the same sequence length, then +All statistical analyses were performed using SPSS version 16.0 +the sequence length was increased by one. The task continued until +(SPSS Inc., Chicago, IL, USA). Data were inspected for normal +both trials of the same sequence-length were incorrect, or +distribution. Descriptive statistics for all three variables and +participants completed trials with the largest sequence. We recorded +demographic details are presented in Table-1. Correlations with +the number of the longest sequence remembered as Block Span and +State Mindfulness are reported in Table 2. State mindfulness scores +number of correct sequence as total correct (Teixeira, Zachi, Roque, +were correlated with state anxiety, Corsi forward and backward +Taub, & Ventura, 2011). +Task. State mindfulness had a large inverse and significant +State Trait Anxiety Inventory-Short Form: The state trait anxiety +correlation with the State anxiety (r=−0.49, p<0.01) and a large +inventory-short form (STAI-SF) consists of two questionnaires of 20 +positive and significant correlation with the Corsi forward (Forward +items each (Spielberger, 1983). The first questionnaire measures +Corrected r=0.35, p<0.01 and forward block span r=0.31, p<0.01). +state anxiety (how one feels at the moment); the second, trait anxiety +Further state mindfulness had significant positive correlation with +(how one generally feels). Standardized, short-form of STAI has +Corsi backward (backward corrected r=0.26, p<0.01 and backward +been used for this study (Marteau & Bekker, 1992). STAI-SF +block span r=0.26, p<0.01). Furthermore state anxiety scores were +consists of six items assessing the extent to which patients feel +inverse and significant correlation with the Corsi forward (forward +''calm,'' ''tense,'' ''upset,'' ''relaxed,'' ''content,'' and ''worried'' on a 4- +Corrected r=0.20, p<0.01 and forward block span r=0.20, p<0.01) +point scale ranging from ''not at all'' to ''very much.'' Items consist of +and Corsi backward (Backward Corrected r=0.21, p<0.01 and +equal numbers of anxiety-present and anxiety-absent. Three items +Backward Blockspan r=0.19, p<0.05). +are scored in reverse order to avoid a response bias. The items were +summed to produce a total score in which higher scores are related to +Table1: Descriptive statistics for all three variables and +greater anxiety. The six items STAI-SF demonstrated good reliability +Demographic details (N=167) +coefficient (r > 82). +Variable +Mean +SD +Range +State Mindful Attention Awareness Scale: The SMAAS is a valid tool +Age +13.98 +1.03 +12 - 16 +for measuring state mindfulness (Brown, & Ryan, 2003). The scale is +State Mindfulness +4.34 +1.16 +1.2 - 6 +designed to assess the short-term or current expression of a core +State Anxiety +12.57 +3.69 +6 - 21 +characteristic of mindfulness; this is a receptive state of mind and +Corsi Forward Correct +7.57 +1.63 +2 - 13 +sensitive awareness of observing the present moment. The SMAAS +Corsi Forward Block Span +5.29 +0.91 +3 - 8 +draws items drawn from the trait form of the MAAS (e.g., "I'm +Corsi Backward Correct +7.53 +1.84 +2 - 11 +finding it difficult to stay focused on what's happening in the +Corsi Backward Block Span +5.44 +1.00 +2 - 8 +present"). SMAAS has shown excellent psychometric properties +(Cronbach's alpha = 92). +Potential limitations of this research must also be considered. The +Discussion +sample included was healthy young children in a yoga camp +This study sets out to examine the relationship between state +environment which may be difficult to generalize for all children +mindfulness and working among school children. Participants in this +and adults. Further the causal direction of this relation is uncertain in +study had no formal training in mindfulness techniques. The +these studies due to cross-sectional design. Longitudinal and +significant positive relationship between state mindfulness and +experimental studies on mindfulness training may provide causal +working memory confirmed our primary hypothesis. Further state +relationships between mindfulness and working memory. Further +anxiety has shown significant negative relationship between +self-report measures may be compromised by response biases. +working memory. This study supports cultivating mindfulness as an +Additional higher-order cognitive measures such as attentional +effective and efficient technique for performance in a visual working +control and self-regulation measures could also be considered in this +memory (Vugt & Jha, 2011). Potential mechanisms by which state +line of research. Despite these limitations, the present study +mindfulness benefit performance in a visual working memory may +confirmed our primary hypothesis i.e. state mindfulness correlated +be positive emotional states through present movement awareness +positively with Working. To our knowledge, this is the first study to +and reduced mind wandering among participants who were prone to +understand the relationship between state mindfulness and working +distraction at testing (Mrazek et al., 2013). +memory in children. Mindfulness can be enhanced by training. +Table 2: Correlation Matrix for State Mindfulness, State Anxiety and Working Memory (N=167) + Variable +State +State +Corsi Forward +Corsi Forward +Corsi Forward +Corsi Backward +Mindfulness +Anxiety + Correct +Block Span +Total Score + Correct +State Anxiety +-.493** + +Corsi Forward Correct +.353** +-.204** +Corsi Forward Block Span +.305** +-.201** +.854** +Corsi Forward Total Score +.327** +-.186* +.952** +.950** +Corsi Backward Correct +.264** +-.207** +.471** +.454** +.452** +Corsi Backward Block Span +.259** +-.193* +.449** +.402** +.407** +.859** +Indian Journal of Positive Psychology 2014, 5(3), 310-312 +311 +Previous study suggests that cultivating mindfulness is an effective +and efficient technique for improving cognitive function, with wide- +reaching consequences (Mrazek et al., 2013). Our study suggests that +development of mindfulness in children may be a fruitful avenue for +future research. +References +Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on +psychological health: A review of empirical studies. Clinical Psychology Review, +31(6), 1041-1056. +Kessels, R. P., Zandvoort, M. J. van, Postma, A., Kappelle, L. J., & Haan, E. H. de. +(2000). The Corsi Block-Tapping Task: standardization and normative data. Applied +neuropsychology. 7, 252-258. +Kuyken, W., Weare, K., Ukoumunne, O. C., Vicary, R., Motton, N., Burnett, R., Cullen, +C., et al. (2013). Effectiveness of the Mindfulness in Schools Programme: non- +randomised controlled feasibility study. The British journal of psychiatry : the +Brown, K. W., & Ryan, R. M. (2003). The Benefits of Being Present : Mindfulness and Its +journal of mental science, 203(2), 126-31. +Role in Psychological Well-Being. Journal of Personality and Social Psychology, +Marteau, T. M., & Bekker, H. (1992). The development of a six-item short-form of the +84(4), 822- 848. +state scale of the Spielberger State-Trait Anxiety Inventory (STAI). The British +Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness : Theoretical +journal of clinical psychology / the British Psychological Society, 31( Pt 3), 301-306. +Foundations and Evidence for its Salutary Effects. Psychological Inquiry, 18(4), 211- +Mrazek, M. D., Franklin, M. S., Phillips, D. T., Baird, B., & Schooler, J. W. (2013). +237. +Mindfulness training improves working memory capacity and GRE performance +Engle, R. W. (2002). Working memory capacity as executive attention. Current +while reducing mind wandering. Psychological science, 24(5), 776-81. +Directions in Psychological Science, 11(1), 19-23. +Spielberger CD. (1983).Manual for the State-Trait Anxiety Inventory (Form Y). Palo +Frank, J. L., Jennings, P. A., & Greenberg, M. T. (2013). Mindfulness-based +Alto: Mind Garden. +interventions in school settings: An introduction to the special issue. Research in +Teixeira, R., Zachi, E., Roque, D. T., Taub, A., & Ventura, D. F. (2011). Memory span +Human Development, 10(3), 205-210. +measured by the spatial span tests of the Cambridge Neuropsychological Test +Hayes, A., & Feldman, G.(2004). Clarifying the Construct of Mindfulness in the Context +Automated Battery in a group of Brazilian children and adolescents. Dementia & +of Emotion Regulation and the Process of Change in Therapy. Clinical Psychology: +Neuropsychologia 5(2), 129-134. +Science and Practice, 11(3), 255-262. +Vugt, M. K. van, & Jha, A. P. (2011). Investigating the impact of mindfulness meditation +Hollis-Walker, L., & Colosimo, K. (2011). Mindfulness, self-compassion, and happiness +training on working memory: a mathematical modeling approach.Cognitive, +in non-meditators: A theoretical and empirical examination. Personality and +affective & behavioral neuroscience, 11(3), 344-353. +Individual Differences, 50(2), 222-227. +NATESH ET AL./ RELATIONSHIP BETWEEN STATE MINDFULNESS +312 diff --git a/subfolder_0/Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis.txt b/subfolder_0/Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis.txt new file mode 100644 index 0000000000000000000000000000000000000000..9b7867ff8ac846d2d2465e9f9c6a613023c514d5 --- /dev/null +++ b/subfolder_0/Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis.txt @@ -0,0 +1,681 @@ +Respirology (2004) 9, 96–101 +Blackwell Science, LtdOxford, UKRESRespirology1323-77992004 Blackwell Science Asia Pty LtdMarch 20049196101Original Article +Yoga for pulmonary tuberculosisNK Visweswaraiah and S Telles +Correspondence: Shirley Telles, Vivekananda Yoga +Research Foundation, # 9, Appajappa Agrahara, Chama- +rajpet, Bangalore 560 018, Karnataka, India. Email: +anvesana@vsnl.com +Received 4 November 2002; revised 18 June 2003; +accepted for publication 15 August 2003. +ORIGINAL ARTICLE +Randomized trial of yoga as a complementary therapy for +pulmonary tuberculosis +Naveen K. VISWESWARAIAH AND Shirley TELLES +Vivekananda Yoga Research Foundation, Bangalore, India +Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis +NK VISWESWARAIAH, TELLES S. Respirology 2004; 9: 96–101 +Objective: +The present prospective, randomized trial compared the efficacy of anti-tuberculosis +treatment (ATT) with two separate programs (yoga and breath awareness), on lung capacities and +bacteriological status in pulmonary tuberculosis patients. +Methodology: +A total of 1009 pulmonary tuberculosis patients were screened and 73 were alter- +nately allocated, to yoga (n = 36) or breath awareness (n = 37) groups, with 48 patients completing +the 2-month trial. Patients aged between 20 and 55 years, who were sputum-positive on three con- +secutive examinations, had no prior ATT, and no comorbidities or extrapulmonary tuberculosis were +included. In addition to ATT, one group practised yoga (n = 25) and the other practised breath aware- +ness (n = 23) for 6 h per week, each session being 60 min. The main outcome measures were: +symptom scores, bodyweight, FVC, FEV1, FEV1/FVC%, sputum microscopy, sputum culture, and +postero-anterior view of the CXR. +Results: +At the end of 2 months, the yoga group showed a significant reduction in symptom scores +(88.1%), and an increase in weight (10.9%), FVC (64.7%) and FEV1 (83.6%) (P = 0.001, in all compar- +isons, paired t-test). The breath awareness group also showed a significant (paired t-test) reduction +in symptom scores (16.3%, P = 0.02), and an increase in weight (2.1%, P = 0.003) and FEV1 (63.8%, P += 0.04). Significantly more patients in the yoga group showed sputum conversion based on micros- +copy on days 30 and 45 compared to the breath awareness group (P = 0.045 and P = 0.002, respec- +tively, c2 test). Ten of 13 in the yoga group had negative sputum culture after 60 days compared with +four of 19 in the breath awareness group (P = 0.005, c2 test). Improvement in the radiographic picture +occurred in 16/25 in the yoga group compared to 3/22 in the breath awareness group on day 60 +(P = 0.001, c2 test). +Conclusions: +The improved level of infection, radiographic picture, FVC, weight gain and reduced +symptoms in the yoga group suggest a complementary role for yoga in the management of pulmo- +nary tuberculosis. +Key words: pulmonary tuberculosis, randomized trial, yoga. +INTRODUCTION +Extensive parenchymal and pleural involvement in +pulmonary tuberculosis results in residual fibrotic +changes with reduced vital capacity and other lung +volumes.1 Yoga is an ancient Indian science, which +includes physical postures (asanas), regulated breath- +ing (pranayama), and meditation (dhyana).2 In nor- +mal volunteers the practice of a combination of yoga +techniques for 2.5 months was shown to increase +the maximal voluntary ventilation and FVC.3 After 9 +months of yoga breathing exercises and postures, 11 +patients with chronic severe airway obstruction +showed significant improvement in objective tests for +exercise tolerance.4 +The practice of yoga is also known to bring about +relaxation and reduce physiological signs of stress.5 +Previous studies have shown that stress can increase +vulnerability to infections.6 Hence, the present study +examined yoga as a stress-reducing practice, influ- +encing bacteriological status and level of infection +Yoga for pulmonary tuberculosis +97 +as indicated by sputum conversion and changes in +the radiographic picture in pulmonary tuberculosis +patients. +Poor adherence to therapy is the most important +cause of anti-tuberculosis treatment (ATT) failure, in +both developed7 and developing countries.8 It has +been shown that psychological factors such as the +effectiveness of the patient–provider interaction +influence compliance.9 In the present study, individ- +uals participating in yoga or breath awareness inter- +acted closely with the instructor. Hence, the effects of +these programs on patient compliance with ATT dur- +ing the first 4 months of 10 months’ domiciliary treat- +ment were evaluated. +We developed a prospective, randomized trial +to compare the efficacy of ATT with one of two +programs, yoga or breath awareness, on lung per- +formance, bacteriological status and treatment +compliance. +METHODS +Participants +One thousand and nine patients with pulmonary +tuberculosis who were admitted to the Government +Tuberculosis Sanatorium, Bangalore, India were +screened. The criteria for participation were: age +between 20 and 55 years, sputum-positivity on direct +microscopy,10 no history of prior ATT and no evidence +of comorbidities or extrapulmonary tuberculosis. +Most patients were excluded as they were already +being treated with ATT in varying combinations for +varying durations. These patients were excluded as +prior (often inadequate) treatment would have influ- +enced their response to the ATT, with possible drug- +resistance.11 After screening, 73 patients fulfilled the +criteria. +Study design +Seventy-three patients were randomly assigned to +two groups, yoga and breath awareness. The charac- +teristics of the yoga group were as follows: average age +32.2 ± 10.0 years; gender, 17 males; drug sensitivity, 13 +sensitive, six resistant, and six contaminated. The +characteristics of the breath awareness group were as +follows: average age 37.3 ± 9.6 years; gender, 13 males; +drug sensitivity, 13 sensitive, seven resistant, and +three contaminated. Forty-eight completed the trial. +Out of 73 patients, 25 were excluded for the following +reasons: (i) they left the sanatorium against medical +advice before the 2 months of their prescribed stay +was over, and (ii) they failed to stay continuously in +the sanatorium for 2 months. +The protocol was approved by the directorate of the +tuberculosis control program, Department of Health +and Family Welfare, Government of Karnataka, India +and by the superintendent of the Government Tuber- +culosis Sanatorium, Bangalore, Karnataka, India. +Written informed consent was obtained from all par- +ticipants. All assessments were made at commence- +ment and at the end of 2 months stay in the +sanatorium. Treatment compliance was the only +measurement that was made every month for the 4 +months after the patients were discharged from the +sanatorium, during which time patients were asked to +continue the intervention to which they had been +allocated. However, they were not supervised. +Outcome measures +The outcome measures were symptom scores, body- +weight, FVC, FEV1, FEV1/FVC%, sputum microscopy, +sputum culture, and CXR. The method and frequency +of the measures are detailed in Table 1. +Interventions +The ATT regimen used in the trial consisted of 2 +months of an intensive phase of treatment with +0.75 mg of streptomycin (intramuscular injection +administered daily), 300 mg of isoniazid (orally, +daily), and 150 mg of thioacetazone (orally, daily). +This was followed by a 10 month continuous phase of +300 mg isoniazid, and 150 mg thioacetazone (orally, +daily).12 +The yoga group practised 60 min of yoga tech- +niques. The 60 min consisted of simple breathing +exercises (30 min), specific yoga voluntarily regulated +breathing (pranayamas, 20 min), and relaxation in a +supine posture (10 min). During simple breathing +exercises the following points were noted: (i) inhala- +tion and exhalation were in the ratio of 1 : 2, (ii) +inhalation and exhalation were synchronized with +separate body movements (e.g. stretching the arms +wide during inhalation and bringing them together +during exhalation), and (iii) awareness of breathing. +This was followed by the specific yoga breathing prac- +tices (pranayamas). These practices are traditionally +believed to reduce body temperature and to be espe- +cially useful for diseases of the respiratory system.13 +During pranayamas, as for breathing exercises, the +same inhalation : exhalation ratio (1 : 2) was main- +tained with awareness of breathing, along with other +voluntary regulations of breathing.13 The session +ended with relaxation in shavasana (the corpse pos- +ture), practised for 10 min. +The non-yoga group performed breath awareness +(as a control treatment), so that they would also have +intervention and interaction with the instructor. It +was hoped that this would reduce any difference +between the groups due to the psychological benefits +that have been ascribed to additional care.14 During +the breath awareness session, there were no body +movements or changes in the inhalation : exhalation +ratio. Patients were asked to direct their awareness to +their breathing during the 60-min session, keeping +their eyes closed. Breath awareness was selected as it +is one of the aspects of yoga that does not include the +following: (i) body movements synchronized with +breathing (called ‘breathing exercises’), (ii) changing +the inhalation : exhalation ratio voluntarily, and (iii) +relaxation while supine (called shavasana). Breath +98 +NK Visweswaraiah and S Telles +awareness need not be given with instructions to +relax. +The patients had no knowledge or experience of +either of the interventions before they started practis- +ing them for the study. Both groups had equal inter- +action with the instructor. The instructor for both +types of sessions (yoga and breath awareness) +recorded the participation of the patients every day. +The patients who completed the trial were without +exception able to attend all the sessions (six sessions +per week, for 8 weeks). Hence there were 48 sessions +of each intervention, during the 2-month stay at the +sanatorium. +Randomization +Eligible patients were randomized by alternate allo- +cation on admission to the two groups (initially des- +ignated as group 1 and group 2), by a medical officer +authorized to admit the patients but who had no role +in the trial. The two groups were then designated as +the ‘yoga group’ and the ‘breath awareness group’ by +the superintendent of the sanatorium who was +blinded to the patient allocation, and whose other +involvement in the trial was as one of the three read- +ers of the coded CXR of the patients. +Masking +It is difficult to assess yoga practices in double blind +trials because the intervention requires active partic- +ipation of the subject and hence the identities of the +interventions become known after allocation.15 How- +ever, the assessments for symptoms, bodyweight, +sputum microscopy, sputum culture, and CXR were +made and scored by a blinded investigator. CXR +were read independently by three radiologists. Two +consistent readings were considered for analysis, +using the rating scale detailed in Table 1. This was +possible in all cases. The spirometry recordings were +made by the instructor administering the interven- +tions (yoga and breath awareness), under the super- +vision of a doctor who did not otherwise participate +in the trial. +Statistical methods +The t-test for unpaired data was used to compare the +baseline (i.e. day 1) values for the yoga and the breath +awareness groups with respect to: (i) symptom scores, +(ii) bodyweight, (iii) FEV1, (iv) FVC, and (v) FEV1/ +FVC%. The McNemar’s test for significance of change +was used to compare the number of patients with dif- +Table 1 +Assessments +Assessments +Method +Frequency +1. +Body weight +Using a spring balance +Weekly +2. +Symptom scores: +cough, expectoration, chest pain, fever, +Graded as follows: +absent = 0; mild = 1 (symptoms present but no +inconvenience); moderate = 2 (symptoms present, +inconvenient for the patient, not disrupting their +routine); severe = 3 (symptoms present, disrupting +their routine). +Daily +haemoptysis, weakness, anorexia and insomnia +3. +FEV1 (litres) and FVC (litres) +Best of three exhalations recorded with a ventilometer +(Clement Clarke, UK). +Weekly +4. +Sputum microscopy +Three over-night sputum samples produced on +demand on three consecutive days, stained using +Ziehl-Neelsen method.10 Grading (number of bacilli +per 200 fields (b.p.f.)): Grade 0 = no b.p.f.; Grade +1 = 1–10 b.p.f.; Grade 2 = >10 b.p.f.; Grade 3 = several +clumps of b.p.f. +5. +Sputum culture +One over-night sample produced on demand, cultured +using a standard method.10 Sputum culture was not +quantified, but noted as positive or negative. +Monthly +6. +Radiograph +A full plate postero-anterior CXR was taken and graded +as follows: Grade 0 = clear; Grade 1 = slight to +moderate opacities without cavitation, including +bilateral lesions not exceeding the volume of lung +superior to the second costochondral junction; +Grade 2 = slight to moderate opacities not exceeding +one third of the lung volume, including bilateral +lesions, with a cavity less than 4 cm wide; Grade +3 = lesions more extensive than Grade 2. +Two monthly +7. +Patient compliance +The number of patients who returned for drug +collection, was recorded for 4 months after their +sanatorium stay. +Monthly +Yoga for pulmonary tuberculosis +99 +ferent grades in the two groups at baseline with +respect to sputum microscopy, culture and CXR. +The t-test for paired data was used to compare the +day 1 and day 60 values for each group separately, +with respect to: (i) symptom scores, (ii) bodyweight, +(iii) FVC, (iv) FEV1, and (v) FEV1/FVC%. Separate c2 +analyses were carried out on data for sputum micros- +copy comparing day 1 with days 30, 45, and 60. For +sputum culture and radiography, day 1 was compared +to day 60 (c2 analysis). The c2 test was used to com- +pare the number of patients in the two groups who (i) +improved by changing from a higher to a lower grade, +(ii) showed no change, or (iii) worsened by changing +from a lower to a higher grade. +RESULTS +The trial profile is shown in Fig. 1. +The baseline and post-treatment group mean val- +ues ± SD for symptom scores, bodyweight, FVC, FEV1, +and FEV1/FVC% are given in Table 2. The number of +patients with different grades of sputum microscopy, +sputum culture (based on 13 subjects in the yoga +group and 19 subjects in the control group), and CXR +for both groups on days 1 and 60 are shown in Table 3. +The two study groups were similar at baseline with +respect to symptom scores, bodyweight, FEV1 and +FEV1/FVC% (P > 0.05, unpaired t-test). The difference +between the FVC values of the two groups at baseline +was close to being significant (P = 0.05, unpaired t- +test). At baseline the grades of sputum microscopy, +culture, and CXR were not significantly different +(P > 0.05, McNemar’s test for significance of change). +No patient had a negative or clear CXR at baseline. +The paired t-test was used to compare values on +day 60 with those on day 1 for each of the groups sep- +arately for the following: (i) symptom scores; (ii) +bodyweight; (iii) FVC; (iv) FEV1, and (v) FEV1/FVC%. +The yoga group showed a significant decrease in +symptom scores (P = 0.001, 88.1%), increase in body- +weight (P = 0.001, 10.9%), increase in FVC (P = 0.001, +64.7%), and FEV1 (P = 0.001, 83.6%). The breath +awareness group also showed a significant reduction +in symptom scores (P = 0.02, 16.3%), increase in +bodyweight (P = 0.003, 2.1%), and increase in FEV1 +(P = 0.04, 63.8%), but no change in FVC. +Comparing the number of patients in the two +groups who improved, who showed no change or who +worsened (c2 test), significantly more patients from +the yoga group showed sputum conversion based +on microscopy on days 30 and 45 compared to +the breath awareness group. On day 30, for the yoga +group, 19 improved, none worsened, and six showed +no change, and for the breath awareness group, +10 improved, none worsened, and 13 showed no +change (P = 0.045). On day 45, for the yoga group, +24 improved, none worsened, and one showed no +change, and for the breath awareness group, 12 +improved, two worsened, and nine showed no change +(P = 0.002). Ten of the 13 in the yoga group had nega- +tive sputum culture after 60 days compared with 4/19 +in the breath awareness group (P = 0.005, c2 test). +Improvement in the CXR occurred in 16/25 in the +Figure 1 +Trial profile. +Number lost to follow up +n = 11 +Number lost to follow up +n = 14 +Number analyzed +n = 25 +Number analyzed +n = 23 +Number excluded + +n = 936 +Registered patients +n = 1009 +Randomization +(alternate allocation) + +Number who received +Yoga +n = 36 +Number who received Breath +awareness (control treatment) +n = 37 +Table 2 +General measurements (values are group mean ± SD) +Measurements +Yoga group (n = 25) +Breath Awareness group (n = 23) +Day 1 +Day 60 +Day 1 +Day 60 +Symptom scores +11.8 ± 3.0 +1.4*** ± 2.3 +12.2 ± 4.0 +10.2* ± 4.4 +Weight (kg) +41.1 ± 8.6 +45.6*** ± 9.4 +36.9 ± 7.1 +37.7** ± 7.2 +FVC (litres) + 0.8† ± 0.5 +1.4*** ± 0.4 +0.6 ± 0.4 + 0.8 ± 0.4 +FEV1 (litres) +0.7 ± 0.4 +1.2*** ± 0.4 +0.6 ± 0.4 +0.8* ± 0.4 +FEV1/FVC% +84.6 ± 33.8 +88.4 ± 11.8 +93.4 ± 25.4 +97.2 ± 25.0 +*P < 0.05, **P < 0.01, ***P < 0.001, day 60 vs day 1, t-test for paired data; †p = 0.05, day 1 (yoga) vs day 1 (breath awareness— +control group), t-test for unpaired data. +100 +NK Visweswaraiah and S Telles +yoga group and in 3/22 in the breath awareness group +(P = 0.001). +With respect to patient compliance, there was no +significant difference between the numbers of partic- +ipants in the yoga group compared to the number +from the breath awareness group who returned for +drug collection every month until the fourth month +(14 vs 15, respectively). +DISCUSSION +Pulmonary tuberculosis patients who practised yoga +in addition to receiving ATT, showed a significant +decrease in symptom scores, a gain in weight, and an +increase in FVC and FEV1 after 60 days. The group +with breath awareness combined with ATT also +showed a significant decrease in symptom scores, a +gain in weight, and an increase in FEV1. However, in +all cases the magnitude of change was less than that +of the yoga group. FVC did not increase significantly +in the breath awareness group. +There were also significantly more patients in the +yoga group compared to the breath awareness group +who showed improvement in sputum microscopy at +30 and 45 days and in sputum culture and radiogra- +phy after 60 days. +It has already been shown that the lung capacity +increases following yoga practice in normal volun- +teers.3 This was attributed to increased development +of the respiratory musculature following the regular +practice of yoga.16 The FVC is also an indicator +of the extent of disease in pulmonary tuberculosis, +with subsequent changes indicating progression or +improvement.17 The increase in FVC in the yoga group +after 60 days suggests improvement, while the +absence of change in the breath awareness group +could suggest ‘no improvement’ or could be related to +the lower FVC values at baseline. +The sequelae of pulmonary tuberculosis can result +in a restrictive disorder, characterized by the follow- +ing spirometry changes: lower FEV1 and FVC com- +pared to normal, and a higher FEV1/FVC% than +normal.18 Hence, the significant increase in FEV1 in +both groups suggests that restriction may not have +developed. +The improvement in the symptom scores and +weight in both groups on day 60, demonstrated the +efficacy of the ATT. Since the magnitude of change +was greater in the yoga group, this suggests that the +practice of yoga facilitates the response to ATT. +The improvement in the yoga group with respect to +bacteriological status (sputum microscopy, culture) +and radiography suggests that yoga potentiates the +action of chemotherapy in converting an active infec- +tion to a passive one. Macrophage activation by +lymphokines produced by sensitized T cells is the +predominant defence mechanism in tuberculosis.19 A +replicated finding in the literature is the association +between times of psychological distress and reduc- +tion in the proliferation of lymphocytes cultured with +mitogens that activate T cells.20 Further support for +a relationship between psychosocial variables and +altered immune responses was provided by an inter- +vention (i.e. relaxation training), which decreased +distress and increased NK cell activity.21 No +immunological assessments were made in the +present study and there are no previous reports on +changes in immune status following yoga practice. +There was no difference between the number of +patients in the two groups (14/25 in the yoga group +and 15/23 in the breath awareness group), who +returned for monthly drug collection, suggesting no +difference in compliance between the groups. These +results were comparable to previously reported treat- +ment compliance with ATT alone, in India.22 The cited +study assessed compliance with a short course of che- +motherapy. The short course of chemotherapy had +two phases (as did the present study): an intensive +phase (also of 2 months) and a continuation phase +(which lasted 6 months). During the continuation +phase, 44% of patients did not comply. In the present +study, the percentage of patients who did not comply +during the continuation phase was 44% for the yoga +group (11/25) and 35% (8/23) for the breath aware- +ness group. +The present study suggests a complementary role +for yoga in the management of pulmonary tuberculo- +sis, with symptomatic relief, better weight gain, +increased lung capacity, and better sputum conver- +sion during the intensive phase of ATT. In the breath +awareness group as compared to the yoga group, the +lesser magnitude of change in symptom scores, +weight gain, and FEV1, and the difference in bacteri- +ological status, implies that yoga with the compo- +nents of body movements, breath regulation, +Table 3 +Number of patients showing different grades of sputum microscopy, culture and radiography in yoga and breath +awareness groups +Groups +Day of +test +Sputum microscopy +Sputum culture* +Radiography** +Sample +(n) +Grades +Sample +(n) +Result +Sample +(n) +Grades +0 +1 +2 +3 +Positive +Negative +0 +1 +2 +3 +Yoga +Day 1 +25 +0 +19 +6 +0 +13 +13 +0 +25 +0 +1 +9 +15 +Day 60 +25 +23 +1 +1 +0 +13 +3 +10 +25 +6 +3 +9 +7 +Breath +Day 1 +23 +0 +15 +7 +1 +19 +18 +1 +22 +0 +0 +14 +8 +awareness +Day 60 +23 +9 +11 +3 +0 +19 +14 +5 +22 +0 +1 +12 +9 +*P = 0.005, **P = 0.001, comparing numbers of patients with different results (sputum culture) or grades (radiography) in +the yoga and breath awareness (control) groups on days 1 and 60 (c2 analysis). +Yoga for pulmonary tuberculosis +101 +relaxation and breath awareness, was of greater use in +these patients, compared with awareness of breath +alone. However, in view of the sample size and the +trial being restricted to the intensive phase of ATT, +these findings must be considered preliminary. +ACKNOWLEDGEMENTS +Vivekananda Yoga Research Foundation, Bangalore, +India, supported this work. We are grateful to Dr H. R. +Nagendra and Dr R. Nagarathna for their help in +developing the yoga program and in revising the +manuscript, and also to the scientists involved in +investigations on sputum culture and microscopy +carried out at the National Tuberculosis Institute, +Bangalore, India. We acknowledge Dr G. Visweswara- +iah, Dr V.Visweswaraiah and Dr Sophia Vijay for +reading the radiographic films and Mr Ravi for his +dedication while conducting the yoga and breath +awareness sessions. +REFERENCES +1 American Thoracic Society. Diagnostic standards and +classification of tuberculosis. Am. Rev. Respir. Dis. 1990; +142: 725–35. +2 Nagendra HR. Yoga—Its Basis and Applications. Swamy +Vivekananda Yoga Prakashana, Bangalore, 2000. +3 Makwana K, Khirwadkar N, Gupta HC. Effect of short- +term yoga practice on ventilatory function tests. Indian +J. Physiol. Pharmacol. 1988; 32: 202–8. +4 Tandon MK. Adjunct treatment with yoga in chronic +severe airways obstruction. Thorax 1978; 33: 514–17. +5 Wallace RK. Physiological effects of transcendental med- +itation. Science 1970; 167: 1751–4. +6 Kiecolt-Glaser JK, Marucha PT, Malarkey WB, Mercado +AM, Glaser R. Slowing of wound healing by psychologi- +cal stress. Lancet 1995; 346: 1194–6. +7 Gaudette LA, Ellis E. Tuberculosis in Canada: a focal dis- +ease requiring distinct control strategies for different +risk groups. Tuber. Lung Dis. 1993; 74: 244–53. +8 Ramachandran P, Prabhakar R. Defaults, defaulter +action and retrieval of patients during studies on tuber- +culous meningitis in children. Tuber. Lung Dis. 1992; 73: +170–3. +9 Snider DE, Hutton MD. Improving Patient Compliance +in Tuberculosis Treatment Programs. Centers for Disease +Control, Atlanta, 1986. +10 National Tuberculosis Institute. National Tuberculosis +Institute Laboratory Technician Manual for District +Tuberculosis Program (DTP). National Tuberculosis +Institute, Bangalore, 1993. +11 Crudu V, Arnadottir T, Laticevschi D. Resistance to anti- +tuberculosis drugs and practices in drug susceptibility +testing in Moldova, 1995–1999. Int. J. Tuberc. Lung Dis. +2003; 7: 336–42. +12 National Tuberculosis Institute. Introduction to District +Tuberculosis Program, 4th edn. National Tuberculosis +Institute, Bangalore, 1994. +13 Vivekananda Kendra. Yoga: An Introduction Booklet. +Vivekananda Kendra Publication, Madras, 1997. +14 Delbanco T. The healing roles of doctor and patient. In: +Moyers B (ed.). Healing and the Mind. David Grubin Pro- +ductions, New York, 1993; pp. 7–23. +15 Singh V, Wisniewski A, Britton J, Tattersfield A. Effect of +yoga breathing exercises (pranayama) on airway reac- +tivity in subjects with asthma. Lancet 1990; 335: 1381– +3. +16 Bhole MV. Treatment of bronchial asthma by yogic +methods—a report. Yoga Mimamsa 1967; 9 (3): 33–41. +17 Garay SM. Pulmonary tuberculosis. In: Rom WN, Garay +SM (eds). Tuberculosis. Little, Brown Co., Boston, 1995; +373–412. +18 West JB. Respiratory Physiology, 5th edn. Williams & +Wilkins, Baltimore, 1990. +19 Restrepo LM, Barrera LF, Garcia LF. Natural killer cell +activity in patients with pulmonary tuberculosis and in +healthy controls. Tubercle 1990; 71: 95–102. +20 Biondi M, Pancheri P. Mind and immunity: a review of +methodology in human research. Adv. Psychosom. Med. +1987; 17: 234–51. +21 Kiecolt-Glaser JK, Glaser R. Psychological influences on +immunity: implications for AIDS. Am. Psychol. 1988; 27: +892–8. +22 Chaudhari K, Jagota P, Parimala N. Results of treatment +with a short course chemotherapy regimen used under +field conditions in district tuberculosis program. Indian +J. Tuber. 1993; 40: 83–9. diff --git a/subfolder_0/Role of Yoga for Psychological Distress in Orphaned Adolescents..txt b/subfolder_0/Role of Yoga for Psychological Distress in Orphaned Adolescents..txt new file mode 100644 index 0000000000000000000000000000000000000000..b153688123ed2f17c881a3e90f5b0b10d43084a0 --- /dev/null +++ b/subfolder_0/Role of Yoga for Psychological Distress in Orphaned Adolescents..txt @@ -0,0 +1,102 @@ +10 +© 2018 Annals of Medical and Health Sciences Research + + +Original Article +Original Article +Letter to the Editor +How to Cite this Article: Sharma SD, Subramanya P, Ganpat TS, Nagendra +HR. Role of Yoga for psychological distress in orphaned adolescents. Ann +Med Health Sci Res. 2018; 8:10. +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. +Letter to the Editor +The absence of family support influences the general health +behaviour of the adolescent and the factors that lead to the +development of disease at a given point in time are likely to +have their roots in a complex chain of environmental events +that may have begun a year earlier. [1] The death (orphan) or +disappearance (separated) of one (single orphan/separated) +or both parents (double orphan/ separated) often involves +psychological distress, risk-taking behaviours, caregiver abuse +and human rights violations. [2] An orphaned adolescent (OA) +who often experience caregiver changes and report higher +psychological distress, depression, suicidal tendency, alcohol +abuse and impaired academic performance are at increased risk +of maltreatment and sexual abuse compared to non-orphan. [3] +Therefore a better understanding about their experiences may +help inform policy as well as prevention and intervention efforts. +First of all, there is a need to consider alternative and potentially +empowering approaches to psychological distress in OA. Yoga- +related self-care or self-management strategies are widely +accessible, are empowering, and may address the mind–body +symptoms of stress related disorders. [4] Yoga is a feasible and +acceptable activity with self-reported benefits to child mental +and physical health. A study on effectiveness of three months +yoga for OA reported that yoga enhances their executive +function and may have potential implications on learning, +classroom behaviour and in handling the adverse circumstances +and stand as a preventive measure for mental health problems. +[5] Furthermore, an evidence-based yoga review suggests that +certain postures, breathing techniques, concentration and +meditation practices helps for effective rehabilitation in orphans. +[6] As per previous report that children with trauma-related +distress shows improvements in symptoms after participation +in an 8-week yoga program compared to controls, [7] it may +suggested that regular yoga practice by OA may serve as a useful +adjunctive component of trauma-focused treatment to build +skills in tolerating and modulating physiologic and affective +states that have become deregulated by trauma exposure. Based +Role of Yoga for Psychological Distress in Orphaned +Adolescents +Sharma SD1, Subramanya P2, Ganpat TS3*, Nagendra HR4 +1Deparment of Yoga and Management Studies, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, +Bangalore, India; 2Department of Yoga and Life Sciences, S-VYASA University, Bangalore, India; 3Department of Yoga and +Ayurveda, Sanchi University of Buddhist-Indic Studies, Bhopal 462003 (M.P) India; 4S-VYASA University, Bangalore, India +Corresponding author: +Tikhe Sham Ganpat, +Assistant Professor, Department of +Yoga and Ayurveda, Sanchi University +of Buddhist-Indic Studies, Bhopal +462003 (M.P) India +Tel: +919891129339; +E-mail: rudranath29@gmail.com +on previous research findings, suggested evidence-based yoga +program for OA may include [4-7] Suryanamaskara (salutations +to the sun), Jalaneti (nasal cleansing with water), Nadishodhana +Pranayama (alternate nostril breathing) and Om meditation. +Conflict of Interest +All authors disclose that there was no conflict of interest. +References +1. +Petersen PE. Socio-behavioral risk factors in dental caries -interna- +tional perspectives. Community Dent Oral Epidemiol 2005; 33: 274- +279. +2. +Embleton L, Nyandat J, Ayuku D, Sang E, Kamanda A, Ayaya S, et +al. Sexual behavior among orphaned adolescents in Western Kenya: +A comparison of institutional- and family-based care settings. J Ado- +lesc Health 2017 [In Print]. +3. +Morantz G, Cole D, Vreeman R, Ayaya S, Ayuku D, Braitstein P. +Child abuse and neglect among orphaned children and youth living in +extended families in sub-Saharan Africa: What have we learned from +qualitative inquiry? Vulnerable Child Youth Stud 2013; 8: 338-352. +4. +Jindani FA, Khalsa GF. A yoga intervention program for patients suf- +fering from symptoms of posttraumatic stress disorder: A qualitative +descriptive study. J Altern Complement Med 2015; 21: 401-408. +5. +Purohit SP, Pradhan B. Effect of yoga program on executive functions +of adolescents dwelling in an orphan home: A randomized controlled +study. J Tradit Complement Med 2017; 7: 99-105. +6. +Sharma SD, Pailoor S, Tikhe SG. Rehabilitation in orphan children: +Role of evidence-based yoga. Yoga Mimamsa 2015; 47: 3-5. +7. +Culver KA, Whetten K, Boyd DL, O’Donnell K. Yoga to reduce trau- +ma-related distress and emotional and behavioral difficulties among +children living in orphanages in Haiti: A pilot study. J Altern Comple- +ment Med 2015; 21: 539-545. diff --git a/subfolder_0/Role of integrated approach of yoga therapy in the management of osteoporosis..txt b/subfolder_0/Role of integrated approach of yoga therapy in the management of osteoporosis..txt new file mode 100644 index 0000000000000000000000000000000000000000..a9d84918583462765998d500a3570dd06af2e2ef --- /dev/null +++ b/subfolder_0/Role of integrated approach of yoga therapy in the management of osteoporosis..txt @@ -0,0 +1,156 @@ + ISSN-2249-5746 + International Journal Of Ayurvedic And Herbal Medicine 2:1 (2012) 149:152 + + +Journal Homepage http://interscience.org.uk/index.php/ijahm + +Role Of Integrated Approach Of Yoga Therapy In The Management Of Osteoporosis +Bali Yogitha, Ebnezar john, Raghuram, Nagarathna, R Rangaji + +1.surgeon and yoga therapist,Ebnezar Orthopedic Centre, Bangalore. +2. Consultant Orthopedic surgeon Ebnezar Orthopedic Centre, Parimala Specialty Hospital,Bangalore. +3. Dean, Division of Yoga and Life-Sciences Swami Vivekananda Yoga Research Foundation (SVYASA). +Bengaluru, India +4.Yoga therapist , Swami Vivekananda Yoga Research Foundation (SVYASA). +Correspondence Author:- Dr.yogitha bali surgeon and yoga therapist,Ebnezar Orthopedic Centre, +Bangalore. +Email:-baliyogitha@gmail.com + +Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural +deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. +Aims +To assess the effectiveness of integrated approach of yoga therapy in the management of osteoporosis. +Methods and Materials +Total of 17 subjects, randomized to yoga (n=8) and exercise (n=9) groups. Subjects were volunteers. Yoga +group was administered integrated approach of yoga therapy and light weight bearing exercises for the +exercise group. Assessments were made at the 1 and the 21st day using Short Form 36 (SF-36) and self +evaluation questionnaires (STAI) and a visual pain scale. The analysis was done using SPSS 10.0. + +Results and Conclusion +Exercise group has shown a significant difference in physical functioning component of SF-36. Yoga group +has shown a significant change in STAI Form 1 and 2, in SF-36 pain component and visual pain scale. +Exercise has shown significant change in physical functioning and pain components of SF-36 and visual pain +scale. The study hints that yoga can be a good tool to handle the anxiety levels which forms an important +part of management of this particular disease. + +INTRODUCTION +Osteoporosis is a disease characterized by low bone mass.1 This loss of bone mass is caused because of +several reasons including lifestyle and heredity. The exact disease burden is difficult to quantify, in +developing countries there is a lack of data compared to the developed countries.2 Currently 1.6 million hip +fractures occur worldwide each year; which could go up to 4.5 million and 6.3 million 2050.3, 4 Because +osteoporosis causes bone degeneration which leads to loss of height over time and also back pain, hence, +early on prevention is to be kept in mind as the treatment. This will also ensure that the older population will +have independence, because only 30% recovers full functionality after a hip fracture.5 This is yet another +condition which can be majorly attributed to the lifestyle mess; excessive consumption of alcohol or +smoking can increase the risk of osteoporotic hip fracture by folds (Kanis et al. 2005). Lifestyle change is +the current talk to curtail or prevent the younger population to join this trend. It can be through exercise or +Bali Yogitha International journal of ayurvedic & herbal medicine 2(1) feb. 2012(149‐152) + + +150 + +simple active daily life routine. Exercise not only has influence in the lifestyle but the bones themselves, +there are enough studies published to substantiate this, especially weight bearing exercises are advised for +controlling the disease and to build bone mass.6 + +Background +Osteoporosis is now considered as one of the major repercussions of bad life style, and there are many ways +to address this problems, like medical interventions, lifestyle change programs which include exercise and +proper dieting. As for preventing this disease, medical interventions are of little help. Aversion of this +disease remains in how much the individual is active in his life and maintaining good health. Exercise has +proved to be effective to maintain good amount of bone mass from early on. The individual has to pay +attention when the peak bone mass is achieved, he has to take measures to protecting it from faster +degeneration due to age. Over exercising has also been proved to have some negative effects especially to +females. With this in mind, yoga as a management technique can help maintain the bone mass in the long +run.7 + +Integrated Approach to Yoga Therapy (IAYT) +IAYT is a combination of physical postures (asanas), breathing practices (pranayama), meditation practices, +and other techniques to relax the mind and body, this makes it a holistic approach to health. The aim of this +study is to assess the role of an integrated approach to yoga therapy (IAYT) in the management of +osteoporosis. + +METHODOLOGY +Subjects: +18 patients (3 males and 15 females) age ranging between 45 – 75 with osteoporosis or osteopenia, selected +from Ebnezar orthopaedic centre, were randomly allocated to yoga (n=8) and exercise (n=9) groups. They +were selected by assessing their bone mineral density (BMD) to confirm either osteopenia or osteoporosis. +Design: +The yoga group performed simple joint mobilization movements and practiced physical postures (asanas) +and ending the session with yogic breathing practices (pranayama) and relaxation. +Exercise group performed the same joint mobilization practice and the main practice comprised light weight +bearing exercises combined with few active daily life practices like walking and climbing stairs and ended +the practice with short seated relaxation. Relaxation was similar to both groups. The practice was for one +hour a day. +Assessments: +The participants were assessed on the day 1 and 21, with Short Form 36,8 Self evaluation quesionnare by C. +D. Spielberger, R. L. Gorsuch and R. Lushene,9 and visual pain scale. The SF-36 contains 36 questions +aimed at the participants health under 8 major catagories – 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. Self +evaluation questionnaire or STAI, has 2 Forms, one looking at the participant’s state and the other at the +trait. It has a total of 40 questions, 20 under each Form. + +RESULTS +There were a total of eleven parameters. In the comparison between the groups, exercise group has a +significant difference in “physical functioning component of SF-36”, yoga 51.56±17.67 and exercise +71.67±19.36 (Mann-Whitney Test, p=0.036) than yoga. There were no other significant differences between +the groups. In the within groups analysis (Wilcoxon Signed Ranks Test), yoga had significant change in +STAI Form 1 (37.88±8.61, p=0.018), STAI Form 2 (37.13±9.91, p=0.042). There also was a significant +change in the Pain component of SF-36 (80.31±22.93, p=0.026) and visual pain scale (2.21±0.96, p=0.042). +Bali Yogitha International journal of ayurvedic & herbal medicine 2(1) feb. 2012(149‐152) + + +151 + +While in the exercise group, there is a significant difference in physical functioning component of SF-36 +(71.67±19.36, p=0.011), pain component of SF-36 (81.94±16.43, p=0.043) and visual pain scale (2.83±2.28, +p=0.043). + +DISCUSSION +The yoga group has shown significant changes in within groups comparison in SF-36 component pain, +STAI, and visual pain scale. Whereas in exercise group, the changes are significant in SF-36 components +namely – physical functioning, pain. There has also been a significant change in visual pain scale. Exercise +has shown a significant difference from yoga in physical functioning component of SF-36. +Any disease has an influence on the patients’ mindset, which can be commonly seen as anxiety or +depression, in the case of osteoporosis, since fall prevention is highly important,10 we can see patients can be +very cautious in their movements and hence their overall daily life is restricted. The results suggest that this +is an area that can be worked upon, yoga shows a significant reduction in the anxiety levels of the +participants. Pain is another associated limiting factor that can slow down a person over time, both yoga and +exercise have proved well in handling pain and thereby increasing their activity level. + +CONCLUSION +This was an exploratory study that needs further research by application on large sample size to determine +the effects of both the interventions, exercise has been proved effective in building bone mass in other +studies, where other factors like pain and anxiety were not concentrated upon, but as yoga has shown a +positive sign in handling anxiety and pain and hence needs to be applied for a longer term and for a larger +population. + +REFERENCES +1. World +Health +Organization. +Men, +Ageing +and +Health. +01WHO/NMH/ +NPH +01.2 +(www.who.int).Anthony D. Woolf, BSc, MBBS, FRCP* and Bruce Pfleger, PhD et al. Burden of +Osteoporosis and Fractures in Developing Countries Current Osteoporosis Reports 2005, 3:84–91. +2. Gullberg B, Johnell O, Kanis JA (1997)World-wide projections for hip fracture. Osteoporos Int. +7:407-413. +3. Cooper C, Campion G, Melton LJ, 3rd (1992) Hip fractures in the elderly: a world-wide projection. +Osteoporos Int. 2:285-289 +4. Sernbo I, Johnell O: Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int +1993, 3:148–153 +5. M. O’Brien. Exercise and osteoporosis. Irish Journal of Medical Science. 1863-4362. +6. Loren M. Fishman, Yoga for Osteoporosis, topics in geriatric rehabilitation,2009;25; 244–250 +7. McHorney CA, Ware JE, Jr., Lu JFR, Sherbourne CD. The MOS 36 Item Short Form Health Survey +(SF 36): 3. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. +Medical Care 1994; 32:40-66. +8. Quek KF, Low WY, Razack AH, Loh CS, Chua CB. Reliability and validity of the Spielberger +State-Trait Anxiety Inventory (STAI) among urological patients: a Malaysian study. 59(2):258-67. +9. Järvinen TLN, Sievänen H, Khanet KM, et al. : Shifting the focus in fracture prevention from +osteoporosis to falls. BMJ 2008, 336: 124– 126. diff --git a/subfolder_0/Safety and usefulness of Laghu shankha prakshalana (Yogic bowel cleansing) in patients with_unlocked.txt b/subfolder_0/Safety and usefulness of Laghu shankha prakshalana (Yogic bowel cleansing) in patients with_unlocked.txt new file mode 100644 index 0000000000000000000000000000000000000000..bbe19520129ecf37e2a5121bfc0770ed3562135c --- /dev/null +++ b/subfolder_0/Safety and usefulness of Laghu shankha prakshalana (Yogic bowel cleansing) in patients with_unlocked.txt @@ -0,0 +1,1101 @@ +Journal of Ayurveda & Integrative Medicine +1 +INTRODUCTION +Essential hypertension is a major health burden due to +its lethal complications such as cerebral, cardiac and renal +events.[1] According to WHO health statistics 2012, the +prevalence of hypertension in India was 23.1% in men and +22.6% in women. It was considered directly responsible for +7.5 million deaths in 2004, about 12.8 percent of the total +of all global deaths.[2] +Decline in the blood pressure is the best determinant +of cardiovascular risk reduction and most hypertensive +patients need two or more antihypertensive drugs for the +blood-pressure control. Despite the availability of effective +drugs, the progression of the disease and its complications +remain uncontrolled in most patients.[1] The reason appears +O R I G I N A L R E S E A R C H A R T I C L E +C L I N I C A L +Safety and usefulness of Laghu shankha +prakshalana (Yogic bowel cleansing) in patients +with essential hypertension: A self controlled +clinical study +Prakash Mashyal, Hemant Bhargav, Nagarathna Raghuram +Department of Yoga and Cardiology, Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), +Bengaluru, Karnataka, India +Background: Yoga and Ayurveda texts emphasize the role of cleansing the bowel as an important component of management +of hypertension (HTN). Observations during our clinical experience and pilot studies on Laghu shankha prakshalana kriya (LSP), +a yogic bowel cleansing technique, appeared to be safe and complimentary. Objective: To test the safety and effectiveness +of LSP in patients with essential hypertension. Materials and Methods: This self control study recruited 32 patients with +mild to moderate essential HTN admitted for a week long residential integrated yoga therapy program at the integrative +health home in Bengaluru. Patients had a daily routine of 6 hours of integrated approach of yoga therapy (IAYT) module +for HTN that included physical postures, relaxation sessions, pranayama and meditations. LSP, an additional practice, +that involved drinking of luke-warm water (with or without a herbal combination, triphala) followed by a set of specifi + c +yoga postures that activates defecation refl + ex, was administered on 2nd (LSP without triphala) and 5th day (LSP with +triphala). Assessments (sitting blood pressure and pulse rate) were done just before and after both the sessions of LSP. +Secondary outcome measures such as body mass index (BMI), symptom scores, medication scores, fatigue, state and +trait anxiety, general health and quality of life were assessed on 1st and 6th day of IAYT intervention. Results: There was +signifi + cant (P < 0.001, paired t test) reduction in blood pressure (systolic and diastolic) and pulse rate immediately after +both the sessions (LSP with and without triphala). There were no adverse effects reported during or after LSP. There was +no signifi + cant difference between the two techniques (P < 0.505, independent samples t test), although the percentage +change appeared to be higher after triphala LSP session. The number of visits to clear the bowel during the procedure was +signifi + cantly (P < 0.001, independent samples t test) higher after LSP with triphala than LSP without triphalā. After weeklong +IAYT, there were signifi + cant reductions in blood pressure (P < 0.001), BMI (P < 0.004), medication score (P < 0.001), +symptoms score (P < 0.001), fatigue (P < 0.001), state and trait anxiety (STAI, P < 0.001), scores of general ill +health (GHQ, P < 0.001), and increase in comfort level (P < 0.001) and quality of sleep (P < 0.001). Conclusion: LSP (a +part of IAYT) is a safe and useful procedure for patients with essential hypertension. LSP with triphala is more useful. +Key words: Bowel cleansing, hypertension, laghu shankha prakshalana kriya, triphala, yoga +A B S T R A C T +Address for correspondence: +Dr. Prakash Mashyal, No. 19, Eknath Bhavan, Gavipuram Circle, +Kempegowda Nagar, Bengaluru - 560 019, Karnataka, India. +E-mail: prakash.sm1986@gmail.com +Received: 07-Sep-2013 +Revised: 22-Oct-2013 +Accepted: 29-Dec-2013 +Access this article online +Quick Response Code: +Website: +www.jaim.in +DOI: +10.4103/0975-9476.131724 +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +2 +Journal of Ayurveda & Integrative Medicine +to be a lack of holistic approach in its management, as we +know that life style and psychological stresses play a major +role in the genesis of hypertension and heart disease.[3,4] +Sullivan et al., showed that depression and anxiety are +related to increased symptom severity and functional +impairment in patients with hypertension and heart +diseases.[5] Complementary therapies and healing practices +have been found to reduce stress, anxiety and depression. +Promising therapies amongst these include imagery and +hypnosis, meditation, yoga, tai chi, prayer, music, exercise, +diet and use of dietary supplements.[6] Yoga offers several +practices that help in mastery over the modifi + cations of the +mind (chitta vritti nirodha)[7] through the process of calmness +of mind (mana prashamana upaya)[8] to reach a state of +balanced functioning of the mind-body complex (samatvam +yoga uchyate).[9] Integrated approach of Yoga therapy (IAYT) +involves selecting physiologically acceptable and useful +practices that can be grouped under four domains (raja +yoga, karma yoga, bhakti yoga and jnana yoga). Raja yoga includes +physical postures (asanas), breathing practices (Pranayama), +cleansing techniques (kriyas) and meditation (dharana, +dhyana, samadhi); karma yoga refers to stress free activity +through action in relaxation; bhakti yoga is emotional mastery +through nurturing pure love; jnana yoga offers cognitive +correction through right knowledge.[3] Studies have found +that yoga interventions are effective in reducing body weight, +blood pressure, glucose level and high cholesterol.[10] Yogic +relaxation leads to a state of parasympathetic dominance +that promotes cardiac vagal modulation which could be +benefi + cial in conditions (hypertension) characterized by +increased sympathetic activity.[11] Meditations and yogic +relaxation techniques specifi + cally have been found to +be effective in reducing blood pressure in patients with +essential hypertension and preventing its complications.[12,13] +Yoga and Ayurveda, the Indian systems of medicine, lay +emphasis on clearing the bowel as an essential component +of therapy based on its disease model.[14,15] This model of +hypertension, a life style disease (adhija vyadhi),[8] proposes +that these diseases begin in the mind as persitent long +standing emotional responses to stressful demanding +situations of life (adhi = stress); these (uncontrolled +rewinding thoughts) manifest as disturbed breathing and +digestive functions (poor appetite and constipation) due +to prana (chi or vital energy) imbalance. As time lapses, +this habituated imbalance of prana percolates to the body +level (annamaya kosha) causing biochemical imbalances +that shows up as hypertension.[16] Hence, IAYT aims at +correcting the imbalances at all levels (the mind, prana and +body). Correction of imblances in breathing (pranayama) +and bowel disturbance (purgation) are considered primary +requisites. Shankhaprakhsālana is a yoga practice (kriya) +recommended for cleansing the bowel.[17] Laghu shankha +prakshālana (LSP) is a simplifi + ed version of this kriya that is +completed in a shorter time and offers lesser physical strain. +Ayurveda recommends a strictly monitored procedure for +purgation called virechana. Studies have observed reduction +in blood pressure (BP) after virechana in patients with +essential hypertension.[14,15] Mild laxatives, such as triphala, +whose safety is time tested and already established in +number of previous studies [18,19] may also be used instead +of virechana in the management of hypertension.[20-23] +Considering the amount of water consumed and physical +exertion involved, it is sometimes felt that LSP may not +be safe for persons with hypertension as water intake may +raise blood volume (and hence the cardiac output) and +strenuous exercise may further increase the heart rate. +Thus, both these factors may raise the blood pressure. +Therefore we conducted a pilot study to assess the safety +of LSP on 8 essential hypertension patients (5 males and +3 females) in the age range of 50 ± 8.1 years. The study was +conducted under the supervision of medical professionals +and blood pressure and pulse rate were measured before +and after the practice of LSP. The assessments were done +daily early morning, empty stomach, on respective patients. +We found a reduction in the blood pressure as well as +pulse rate after the practice of LSP.The present study +was designed based on this observation with an aim to +investigate the immediate effect of LSP on blood pressure +and pulse rate in patients with essential hypertension. As +triphala (combination of three fruits Phyllanthus emblica, +Terminalia bellerica and Terminalia chebula) is known to have a +mild laxative effect it was hypothesized that LSP done with +a decoction of triphala may have complementary effect in +hypertension.[24] Thus, this study had two objectives: (a) to +study the safety of LSP and (b) to compare the effect of +LSP with and without triphala. +MATERIALS AND METHODS +Patients +This study involved thirty two patients who were diagnosed +with mild to moderate hypertension as per American Heart +Association criteria. Patients were diagnosed to be suffering +from essential hypertension by the physician based on +initial history, physical, and laboratory evaluation after +ruling out all the causes of secondary hypertension. The +lab evaluations included kidney functions tests (blood urea +nitrogen, creatinine, and the urinalysis), USG abdomen, +complete blood count, serum potassium, sodium, fasting +glucose, total cholesterol, high-density cholesterol, and +electrocardiogram. Both male (n = 14) and female (n = 18) +patients in the age range of 30-70 years were included. +Patients were selected from those who had enrolled for a +holistic yoga therapy plan at a residential yoga health home. +A sample size of 32 was derived by computing (G power +software) the values for alpha (0.05), effect size (0.6) and +power (0.8). The effect size was calculated by considering +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +Journal of Ayurveda & Integrative Medicine +3 +the mean and standard deviation of blood pressure before +and after the yoga intervention in hypertension patients +who were treated in the same inpatient setting in our pilot +study. +The inclusion criteria were: (a) those diagnosed as primary/ +essential hypertension by excluding renal and other +causes of secondary hypertension by the physician at the +time of diagnosis (checked by going through the earlier +records), (b) those with mild to moderate hypertension +under control with antihypertensive medication, (c) those +with co-morbid conditions such as obesity or diabetes, +(d) no prior experience in yoga and (e) those who were +willing to participate in the study. Those with severe HTN, +complications in HTN or secondary hypertension were +excluded from the study. Also, patients with complications +of diabetes or other major associated diseases such as +coronary artery disease, psychiatric illnesses were excluded. +Those on Ayurveda medication for bowel clearance, those +with severe obesity (BMI >40), and those admitted to +health home for 'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +4 +Journal of Ayurveda & Integrative Medicine +strength of the tablet as given in the Current Index of +Medical Specialities (CIMS) was checked as one tablet +e.g. Amlodipine 5 mg was considered as one tablet; if the +patient was taking 2.5 mg/day, it was counted as 0.5, and if +it was 10 mg, it was recorded as 2 tablets. The dosage was +changed only when absolutely necessary by the attending +physician. +Level of fatigue +The participants were asked to mark the degree of fatigue +on an eleven point (1-10) numerical analogue scale of +10 centimeters with ‘0’ at the left extreme indicating ‘nil’ +fatigue and ‘10’ at the right extreme representing ‘worst +possible experience of fatigue’. +Level of comfort +The participants were asked to mark the degree of comfort +on an eleven point (0-10) numerical analogue scale of +10 centimeters with ‘0’ at the left extreme indicating ‘nil’ +comfort and ‘10’ at the right extreme representing ‘most +comfortable’. +General health questionnaire +Goldberg’s GHQ designed to identify psychiatric morbidity +in general practice, is a self-administered questionnaire. +It has 28 items with four domains to measure somatic +symptoms, anxiety and insomnia, social dysfunction and +severe depression. It provides information about the +recent mental status, thus distinguishing the presence of +possible psychiatric disturbance. GHQ has acceptable +psychometric properties and has good internal consistency +and reliability with Cronbach’s alpha of 0.85 and validity +of 0.76 (39). +STAI inventory (State trait anxiety inventory) +STAI is a commonly used psychological inventory based +on a 4-point Likert scale and consists of 40 questions on +a self-report basis. STAI measures two types of anxiety +i.e. state anxiety that refers to ‘how I feel now’ and trait +anxiety that refers ‘how I generally feel’. Higher scores are +positively correlated with higher levels of anxiety. STAI is +a highly reliable test with a Chronbach’s alpha of 0.6996 +and validity value of 0.8027. +Quality of sleep +A checklist containing the following questions was +prepared for the participants to mark their quality +of sleep on the previous night on the 2nd and 6th day +of their program. These were: (a) Time taken to fall +asleep: measured in minutes, (b) Total duration of sleep: +measured by an analogue scale, (c) Feeling of freshness +on waking up: measured by an analogue scale and (d) the +number of interruptions as reported by the patient on +the next day. +Intervention +Integrated Approach of yoga Therapy (IAYT) module +for Hypertension [Table 2] that has evolved over the past +20 years (by daily BP monitoring and also feedback from +the patients and the teaching therapists) during our clinical +experience at the center, was followed.[16] The daily routine +included about 6 hours of practices selected from all +four domains of yoga mentioned above. These included +specifi + c asanas for hypertension, pranayama, meditation and +relaxation sessions. Yogic life style and cognitive change +for stress management were discussed during individual +yogic counseling sessions and daily group lectures. Table 3 +shows the procedure for Laghu shankha prakshalana (LSP). +The intervention was delivered by trained yoga therapists +who had experience of administering LSP as well as IAYT +module for hypertension for more than two years. This was +done under the supervision of physicians [Tables 2 and 3]. +Statistical analysis +The data were analyzed using statistical package for the +Social Science (SPSS Version 10.0). Shapiro-Wilk’s test +was used for checking normality. Normally distributed +variables (BP, Pulse, Respiratory rate, Bhramari, BMI, +Comfort, STAI Anxiety level) were analyzed using +Paired sample t test. Data that were not normally +distributed (GHQ, Medication score, Symptom score, +fatigue and quality of sleep) were analyzed using Wilcoxon’s +signed ranks test. The numerical variables were analyzed +using Chi-square test. +RESULTS +Table 1 shows the demographic details of the patients. Thirty +two patients (14 males) with essential HTN were recruited +for the study. The mean age was 57.78 ± 10.28 years?. +The mean weight was 70.34 ± 13.68kg. Of these 17 had +associated diabetes. +Immediate Effect of LSP +There were no signifi + cant baseline differences between +the values recorded before the sessions. All variables were +normally distributed [Table 4]. +Blood Pressure +Paired samples t test showed significant reduction in +systolic (P < 0.001) and diastolic blood pressure (P < 0.001) +after both the sessions. The systolic blood pressure +decreased by 6.8% after normal water LSP (NWLSP) +session and 11.4% after LSP with triphala water (TWLSP); +diastolic blood pressure decreased by 6.62% after NWLSP +and 10.4% after TWLSP session. Statistically, there was no +signifi + cant difference between the post values of the two +sessions (P < 0.505, Independent sample t test). +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +Journal of Ayurveda & Integrative Medicine +5 +Pulse rate +There was signifi + cant reduction in pulse rate in both +groups (paired t test, P < 0.001), 7.4% after NWLSP +and 9.02% after TWLSP. But no signifi + cant difference +was found between the groups post-LSP. (P < 0.847, +Independent sample t test). +Respiratory rate +The respiratory rate reduced significantly in both +groups (paired t test P < 0.001), 6.14% after NWLSP and +11.03% after TWLSP. There was no signifi + cant difference +between the groups (Independent samples t test, P = 0.65). +Number of visits to toilet to empty the bowel during +the procedure +The mean value was 1.78 for NWLSP and 3.3 for TWLSP +with signifi + cant difference between the sessions (P < 0.001, +Chi-square test). +Effect of weeklong yoga therapy +There was signifi + cant reduction in systolic and diastolic +blood pressure (P < 0.001), BMI (P < 0.004), medications +score (P < 0.001), symptoms score (P < 0.001), +fatigue (P < 0.001), state and trait anxiety scores (STAI, +P < 0.001) and scores on ill health (GHQ, P < 0.001) with +increase in duration of Bhramari time (P < 0.001), comfort +level (P < 0.001) and quality of sleep (P < 0.001) [Table 5]. +DISCUSSION +This self as control study on 32 participants with essential +hypertension was aimed at looking at the safety of LSP. There +were no adverse effects; there was signifi + cant (P < 0.001) +Table 1: Demographic details of the subjects +Variables +Subgroups +Values ( N) +Age + Mean±SD +57.78±10.28 +Range +40-50 +5 +51-60 +15 +61-70 +11 +>70 +1 +Gender +Males +14 +Females +18 +Occupation +Employed +16 +Retired +03 +Housewives +13 +Weight +Mean±SD +70.34±13.68 +Hypertensive patients +Mild (140-160/80-90) +23 +Moderate (160/90-100) +9 +Sever (>160/100) +Nil +Baseline systolic BP +Mean±SD (mmHg) +131.56±15.54 +Baseline diastolic BP +Mean±SD (mmHg) +80.15±7.6786±9.47 +Associated conditions +Diabetes +17 +Overweight +25 +Obesity +7 +Hyperlipidemia +11 +Sleep Apnea +2 +Others +Nil +SD=Standard diviation, BP=Blood Pressure +Table 2: IAYT module for hypertension +GROUP +Practices +Duration +Sanskrit name + English translation +Shakti vikasaka sukshma +vyayama +Anguli & Manibanda shakti vikasaka +Loosening of fi + ngers & wrist +2 min +Kurpara sandhi & Amsa sandhi shakti vikasaka +Elbow & Shoulder strengthening +2 min +Padasancalana praṇayama +Leg movement breathing +2 min +Breathing exercises +Gulfa vistara svasa +Ankle stretch breathing +2 min +Vyaghra svasa +Tiger breathing +2 min +Shaasha svasa & Setubandhasana svasa +Rabbit & Bridge posture breathing +4 min +Asanas +Ardakati cakrasana & Vrukshaṣana +Side bending & Tree posture +4 min +Garudasana, vajrasana & ajataraparivrutasana +Eagle, Hero & Lumbar stretch posture +4 min +Bhujangasana, Shalabhasana & Parvatasana +Cobra, Locust & mountain posture +6 min +Vakrasana, Ustrasana & Gomukhasana +Spinal twist, camel & Cow face posture +6 min +Upavista konasana, Navasana & Bhunamanasan +Seated Angle, boat pose & salutation to earth +6 min +Yoga nidra +Deep relaxation technique +20 min + Total-special techniques +60 min’s +Pranayama +Nadishuddhi pranayama +Alternate nostril breathing +10 min +Vibhagiyapranayama +Divided breathing +10 min +Bhahya & antara kumbaka +Holding breath in and out +10 min +Sitalikara praṇayamas +Cooling breathings +10 min +Nadanusandhana +A, U, M-kara paahana ९ samya +A, U, M chanting of each letters 9 times +10 min +A-U-M kara pathana ९ samya +A-U-M chanting in a single breath, 9 times +10 min +Total-pranayama +60 mins +Ḍhyana +Avartana dhyana +Cyclic meditation +30 min +ॐ dhyana +Om meditation +30 min +Total-meditation +60 min’s +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +6 +Journal of Ayurveda & Integrative Medicine +reduction in blood pressure, pulse rate and respiratory rate +after both sessions of LSP (NWLSP and TWLSP) with +better clearance of the bowel after TWLSP. Signifi + cant +changes were also observed in the comprehensive battery +of tests after the weeklong program of residential IAYT. +Comparisons +Several well designed controlled studies have shown the +benefi + ts of different types of yoga based relaxation (with +or without biofeedback) and meditative techniques +in hypertensive patients on blood pressure and other +hemodynamic variables practiced for varying periods of +time. Biofeedback studies reduced systolic BP by 19.6% +and the diastolic BP by 10.6% at the end of 8 weeks of +meditation, which further reduced by 22.4% and 11.5% at +the end of 8 months respectively.[25] This was the maximum +reduction noted in BP variables by any mind-body +intervention. Another effective mind-body technique, the +MBSR (Mindfulness Based Stress Reduction),[26] caused +reduction of systolic BP by 21.92% and diastolic BP by +16.70% after 8 weeks of the practice. Other meditations +such as Transcendental meditation,[27] yogic relaxation,[28] +Om meditation,[29] traditional Chinese physical and mental +exercises[30] etc., caused reduction in Systolic BP ranging +from 2 to 10% and the diastolic between 1.5 to 13%. +Looking at the effect of only the yoga postures on blood +pressure, there appears to be mixed responses observed +by different studies. Miles et al.,[31] showed a signifi + cant +increase in blood pressure, heart rate and cardiac output +immediately after a series of 23 hatha-based yoga postures +in healthy volunteers, whereas Mizuno et al.,[32] observed +signifi + cant reduction of systolic blood pressure (P < 0.05), +heart and respiratory rate (P < 0.05) after 4 months of +regular practice of a sequence of yoga postures in patients +with hypertension. This suggests that though acute +cardiovascular responses (increase in blood pressure, heart +rate and cardiac output) to yoga postures are similar to +those observed in isometric exercise,[31] when practiced +regularly for a longer duration yoga postures actually cause +reduction in blood pressure and heart rate.[32] This may be +due to the modulation of autonomic nervous system which +is induced by regular practice of yoga postures.[32] +There are very few studies that have looked at the immediate +effects on blood pressure after the practice of selected yoga +techniques. Telles et al.,[33] looked at the immediate effect +of alternate nostril yoga breathing (ANYB) in a three +armed randomized control study on 90 participants with +essential hypertension and showed signifi + cant decrease +in both systolic (4.24%, P < 0.001) and diastolic blood +pressures (1.56%, P < 0.05). The immediate effect +of sukha pranayama (at the rate of 6 breaths/min for +5 min) was studied by Bhavanani et al., in hypertensive +patients (attending a hospital yoga outpatient dept.) which +showed signifi + cant (P < 0.05) reduction in heart rate, +systolic pressure, pulse pressure, mean arterial pressure and +rate-pressure product, after just 5 min of the practice.[34] +The effect of 10 sessions of slow abdominal breathing (six +cycles/min) combined with frontal EMG biofeedback +was compared with abdominal breathing without EMG +feedback in postmenopausal women with pre-hypertension; +significant reduction in systolic blood pressure by +8.4% and diastolic by 3.9% was observed in those with +the biofeedback.[35] Palomba et al., showed reduction +in blood pressure and BP emotional reactivity after a +short (four sessions) Heart Rate-Biofeedback (HR-BF) +protocol in unmedicated outpatients with pre- or stage 1 +hypertension.[36] The present study on the immediate effect +of yogic LSP in patients with moderate to mild HTN has +shown reduction by 11.4% (systolic) and 6.68% (diastolic) +after TWLSP, and 10.4% (systolic) and 6.62% (diastolic) +after NWLSP. Thus, it seems that for immediate BP +reduction, LSP is not only safe but may be more effective +Table 3: Procedure of laghuśankhaprakṣālana +Procedure +Time (am) +Assessments +5.30-6.00 +General preparations +6.15-6.20 +Drinking Luke warm water (3-4 glasses) +6.20-6.25 +Practices : Tādasana (palm tree pose), +tiryakatadasana (swaying palm tree pose), +kati chakrasana (waist rotating pose), +tiryaka bhujangasana (twisting cobra pose), +udarukarshana (abdominal strech pose) +6.25-6-45 +Evacuation of bowel +6.50-7-05 +Deep Relaxation Technique in supine posture +7.05-7-30 +Assessments +7.30-7.50 +Table 4: Effect of NWLSP and TWLSP on blood pressure +Variables +NW LSP +% +change +P# +TW LSP +% +change +P# +Between sessions +−P$ +Pre +Post +Pre +Post +Blood pressure (mmHg) +Systolic +137.25±16.3 127.81±12.8 +6.88 +0.001 141.8±19.2 +125.5±13.9 +11.4 +0.001 +0.505 +Diastolic +86.43±9.47 +80.68±8.0 +6.62 +0.001 +87.5±10.15 +78.40±8.2 +10.4 +0.001 +0.266 +Pulse rate +83.5±9.83 +77.28±7.09 +7.44 +0.001 83.06±8.09 +75.56±7.6 +9.02 +0.001 +0.847 +Respiratory rate +18.71±3.29 +17.56±3.05 +6.14 +0.001 +18.3±2.6 +16.28±1.92 +11.03 +0.001 +0.649 +Number of visits to toilet to clear the bowel +1.78±0.87 +3.3±1.00 +−85.39 +0.001 +0.001 +#Paired sample t test, $Independent sample t test, NWLSP=Normal water laghushankhaprakshalana, TWLSP=Triphala water laghu shankha prakshalana +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +Journal of Ayurveda & Integrative Medicine +7 +than ANYB, Breath Awareness or abdominal breathing +with biofeedback. +Mechanisms +Improved autonomic stability with reduced stress appears +to be the mechanism by which yoga helps in reducing the +blood pressure in hypertensive patients. Studies point +to reduction in sympathetic arousal following yoga based +relaxation techniques.[37] Yoga offers mastery over the +emotional surges through controlled and need based +physiological responses to stressfully demanding situations +instead of uncontrolled overtones of HPA axis during +chronic stress.[38] Yoga changes the physiological responses +to stressors by improving autonomic stability with better +parasympathetic tone and reduction in sympathetic arousal +with improved performance.[39] +Yoga texts clearly mention that the aim of any yoga practice, +whether physical, breathing, mental or emotional, is to +reach a state of control (chittavrtti nirodha) over the responses +to situations (healthy stress response)[7] by the process of +slowing or silencing the mind.[8] Internal awareness of +the changes in the mind helps in conscious slowing down +and thus offers physiological rest. Sage Gaudapada in his +treatise, mandukya karika,[3] proposes a concept that one +can go on deepening the level of rest by using a series of +alternate stimulations (physical stretch or breath awareness +or chanting) followed by relaxation technique. Stronger the +stimulation (within safety limits), deeper is the rest that +follows. Studies using this concept have shown the expected +benefits of deep rest and autonomic stability.[40] All +kriyas (procedures) including LSP seem to offer this deep +stimulation by activating the basic autonomic refl + exes. Thus +we propose that the activated peristaltic refl + ex during LSP +provided the strong internal awareness that could lead to +deeper physiological rest during the relaxation session that +followed. Another factor that may have helped in reduction +of blood pressure after LSP can be - the dehydration caused +due to repeated loose motions. The percent reduction of +BP was higher after triphala water LSP than normal water +LSP and frequency of stools was signifi + cantly more in the +triphala group, this can be explained on the basis of mild +laxative effect of triphalawhich may help in reducing blood +volume further, thereby reducing the blood pressure. We +are not sure whether during normal water LSP (without +triphala) person loses the same amount of water that he has +consumed or he loses some extra water from the body as +well. Another possibility is enhanced biomechanical effects +of laxation as according to the Indian systems of health, +the apana vata in the GI tract infl + uences other vatas in the +body, including the vyana vayu. Blood pressure is a function +of the vyana vata. +Limitations and scope of the study +This is the fi + rst controlled study on LSP with a good sample +size that offers the evidence for the safety of the procedure +in hypertensive patients. +It may have helped to have an additional group (as baseline +control) with only IAYT practices without LSP to make +the study more robust. Durability of response - short +term and long term, outcomes with repeated procedures, +subgroup analysis of those with a tendency to constipation +may all help to bring forth the effects. Measuring serum +electrolytes and stool volume would have been helpful +to understand mechanisms. Blood pressure and pulse +variations in supine and standing conditions for autonomic +response, ankle brachial index and serum electrolytes +could have enhanced the study. It would be interesting to +assess the effects of LSP using more objective measures +such as heart rate variability, holter blood pressure and +heart rate monitoring during the entire practice in normal +volunteers and hypertensive patients. Glomerular fi + ltration +rate alterations, urinary frequency and volume could have +assisted in speculating extent of water absorption. There +are no repeated measures were done in this study to +know the carry over effect of LSP. Future studies should +consider this important evaluation and try to generate a +dose response curve. +Also, future studies could look into application of these +non-pharmacological interventions in pre hypertensive and +early hypertensive patients to assess whether these simple +Table 5: Weeklong IAYT therapy on secondary +outcome measures +Variables +Pre +Post +% change + P* +BMI (kg) +28.63±4.14 +27.73±4.40 +3.14 +0.004 +BHT (Sec) +16.18±5.30 +19.25±6.27 +−18.97 +0.001 +Symptom Score +4.12±2.69 +1.40±1.34 +66.01 +Medication score +33.98 +0.001 +Fatigue +4.53±1.60 +2±2.04 +55.84 +0.001 +Comfort +6.43±1.79 +8.59±1.04 +−33.59 +0.001 +GHQ +3.06±4.62 +0.5±1.21 +83.66 +0.001 +STAI +State anxiety +39.68±8.16 +26.06±5.82 +34.32 +0.001 +Trait anxiety +41.59±9.70 +30.71±6.46 +26.16 +0.001 +Sleep +Time taken to fall +asleep (min) +31.40±12.90 +22.81±7.06 +27.35 +0.001 +Duration of +Sleep (hrs.)/night +6.71±1.08 +6.87±0.87 +−2.38 +0.503 +Feeling of freshness +on waking +7.18±1.74 +8.75±0.87 +−21.86 +0.001 +No. of interruptions +2.21±1.15 +1.53±0.80 +30.76 +0.001 +Blood pressure +Systolic +131.56±15.54 120.06±13.32 +−8.74 +0.001 +Diastolic +80.15±7.67 +75.68±7.15 +−5.57 +0.007 +BMI=Body mass index, BHT=Bhramari time, GHQ=General health questionnaire, +STAI=State and trait anxiety inventory, IAYT=Integrated approach of yoga therapy +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +8 +Journal of Ayurveda & Integrative Medicine +and safe interventions could reduce the dependence on +modern anti-hypertensive drugs. +CONCLUSION +This study provides the fi + rst evidence that laghu shankha +prakshalana kriya can be used safely in patients with mild to +moderate essential hypertension. Addition of triphala to the +water of LSP provides better cleansing. Also a weeklong +practice of specifi + c set of integrated yoga program is useful +in improving the subjective and objective measures of +health in patients with essential hypertension. +REFERENCES +1. +Messerli FH, Williams B, Ritz E. Essential hypertension. +Lancet 2007;370:591-603. +2. +WHO: World health statistics, 2012. Available from: +http://www.who.int/gho/publications/world_health_ +statistics/2012. Last accessed on 06-09-2013. +3. +Nagendra HR, Nagarthna R. New Perspective In Stress +Management. 1st ed. Bangalore: Swami Vivekananda Yoga +Prakashana; 2000. p. 15-20. +4. +Bijlani RL. Understanding medical Physiology. 2nd ed. +New Delhi: Jaypee Brothers Medical Publishers; 1997. +p. 183-88. +5. +Sullivan MD, LaCroix AZ, Spertus JA, Hecht J. Five-year +prospective study of the effects of anxiety and depression +in patients with coronary artery disease. Am J Cardiol +2000;86:1135-8. +6. +Kreitzer MJ, Snyder M. 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Munshi R, Bhalerao S, Rathi P, Kuber VV, Nipanikar SU, +Kadbhane KP. An open-label, prospective clinical study to +evaluate the effi + cacy and safety of TLPL/AY/01/2008 in the +management of functional constipation. J Ayurveda Integr +Med 2011;2:144-52. +19. Baliga MS, Meera S, Mathai B, Rai MP, Pawar V, Palatty PL. +Scientifi + c validation of the ethnomedicinal properties of +the Ayurvedic drug Triphala: A review. Chin J Integr Med +2012;18:946-54. +20. Munshi R, Bhalerao S, Rathi P, Kuber V. An open-label, +prospective clinical study to evaluate the effi + cacy and +safety of triphalaguggulu in the management of functional +constipation. J Ayurveda Integr Med 2011;2:144-52. +21. Acharya Yadavji Trikamji. Susruta sutrasthana. 6th ed. +Varanasi: Chaukhamba Surabharathi Prakashan; 1992. p. 46. +22. 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Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, +Gaylord-King C, et al. Stress reduction in the secondary +prevention of cardiovascular disease: Randomized, controlled +trial of transcendental meditation and health education in +Blacks. Circ Cardiovasc Qual Outcomes 2012;5:750-8. +28. Patel C. Twelve month follow-up of Yoga and bio-feedback in +the management of hypertension. Lancet 1975;305:62-4. +29. Telles S, Nagarathna R, Nagendra HR. Autonomic changes +during “OM” meditation. Indian J Physiol Pharmacol +1995;39:418-20. +30. Zhang Y, Li N, Sun J. Effects of combined traditional Chinese +exercises on blood pressure and arterial function of adult +female hypertensive patients. Res Sports Med 2013;21: +98-109. +31. Miles SC, Chun-Chung C, Hsin-Fu L, Hunter SD, Dhindsa M, +Nualnim N. Arterial blood pressure and cardiovascular +responses to yoga practice. Altern Ther Health Med +2013;19:38-45. +32. Mizuno J, Monteiro H. An assessment of a sequence of yoga +exercises to patients with arterial hypertension. J Bodyw +Mov Ther 2013;17:35-41. +33. Telles S, Yadav A, Kumar N, Sharma S, Naveen K, +Balakrishna A. Blood pressure and purdue pegboard scores in +individuals with hypertension after alternate nostril breathing, +breath awareness, and no intervention. Med Sci Monit +2013;19:61-6. +34. Bhavanani AB, Sanjay ZM, Madanmohan. Immediate effect +of sukhaprānāyāma on cardiovascular variables in patients of +hypertension. Int J Yoga Therap 2011;21:73-6. +35. Wang SZ, Li S, Xu XY, Lin GP, Shao L, Zhao Y. Effect of +slow abdominal breathing combined with biofeedback on +blood pressure and heart rate variability in prehypertension. +J Altern Complement Med 2010;16:1039-45. +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Mashyal, et al.: Usefulness of yogic bowel cleansing in hypertension +Journal of Ayurveda & Integrative Medicine +9 +36. Palomba D, Ghisi M, Scozzari S, Sarlo M, Bonso E, +Dorigatti F. Biofeedback-assisted cardiovascular control in +hypertensive exposed to emotional stress: A pilot study. Appl +Psychophysiol Biofeedback 2011;36:185-92. +37. Vempati RP, Telles S. Yoga based guided relaxation reduces +sympathetic activity in subjects based on baseline levels. +Psychol Rep 2002;90:487-94. +38. Leonard BE. HPA and immune axes in stress: Involvement +of +the +serotonergic +system. +Neuroimmunomodulation +2006;13:268-76. +39. Telles S, Narendran S, Raghuraj P, Nagarathna R, +Nagendra HR. Comparison of changes in autonomic and +respiratory parameters of girls after yoga and games at a +community home. Percept Mot Skills 1997;84:251-7. +40. Subramanya P, Telles S. A review of the scientifi + c studies on +cyclic meditation. Int J Yoga 2009;2:46-8. +How to cite this article: Mashyal P, Bhargav H, Raghuram N. +Safety and usefulness of Laghu shankha prakshalana (Yogic bowel +cleansing) in patients with essential hypertension: A self controlled +clinical study. J Ayurveda Integr Med 0;0:0. +Source of Support: Nil, Confl + ict of Interest: None declared. +>'RZQORDGHG IUHH IURP KWWSZZZMDLPLQ RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO diff --git a/subfolder_0/Self-reported measures of mindfulness in meditators and non-meditators.txt b/subfolder_0/Self-reported measures of mindfulness in meditators and non-meditators.txt new file mode 100644 index 0000000000000000000000000000000000000000..70ea044be494e18fa4c9924d1d9863ee3544f405 --- /dev/null +++ b/subfolder_0/Self-reported measures of mindfulness in meditators and non-meditators.txt @@ -0,0 +1,487 @@ +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 +142 +Self‑reported measures of mindfulness in meditators and +non‑meditators: A cross‑sectional study +Suhas Ashok Vinchurkar, Deepeshwar Singh, Naveen Kalkuni Visweswaraiah +Department of Yoga and Life sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India +Address for correspondence: Dr. Naveen Kalkuni Visweswaraiah, +SVYASA # 19 Eknath Bhavan, Gavipuram Circle, KG Nagar, Bengaluru - 560 019, Karnataka, India. +E‑mail: anvesana@gmail.com +over an object and as one grows in his practice, he +leans towards the attentional disengagement or open +monitoring.[3] Meditation imbibes an initial phase of +mindfulness, making mindfulness a key determinant of +meditation practice. +During the last decade, scientific interest in meditation +and mindfulness practice has seen an explosive and +unprecedented surge. Several studies have been conducted +across the globe to report the development of mindfulness +and its effects on health and well‑being. One such study +conducted on a martial art technique − Aikido using a +Mindfulness Attention Awareness Scale (MAAS) concluded +that consistent practice of Aikido leads to development of +mindfulness.[4] Another study on insomnia in menopausal +women reported that postmenopausal women with +insomnia are less mindful than women without insomnia, +thereby concluding that mindfulness‑based interventions, +such as meditation, may be beneficial for postmenopausal +insomnia.[5] A study assessing the health risk behavior in +INTRODUCTION +Mindfulness refers to an awareness that emerges by +paying attention to purpose and to the present moment +and nonjudgmentally focusing on the unfolding of one’s +immediate experience.[1] More recently, mindfulness +has been proposed as a cognitive behavior, rather than +physiological, paradigm for meditation. Mindfulness aims +to develop enhanced awareness of the moment‑to‑moment +experience of perceptible mental processes[2] and forms an +important component of meditation practices. Initially, a +meditator engages in focused concentration or attention +Context: Mindfulness forms an important component of meditation practice and has been increasingly popular around the +world. There has been growing interest in studying the mindful component of various meditation techniques. One of the various +forms of mindfulness is the practice of a unique technique called cyclic mediation (CM). We aimed at ascertaining the level of +mindfulness in experienced practitioners of CM using a Mindfulness Attention Awareness Scale (MAAS). +Materials and Methods: 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 executed a cross sectional design. +One hundred and thirty‑three (n = 133) healthy male volunteers (66 meditators and 67 non‑meditators) with ages ranging from +25 to 35 years participated in the study. Meditators had a minimum 3 years experience of meditation. +Results: Data were analyzed using IBM SPSS 20. The data were checked for normality and an independent samples t‑test +was employed to compare the means of both the groups. MAAS scores were significantly higher in meditators as compared +with the non‑meditators (P < 0.001). We found a positive correlation (r = 0.620) between the years of meditation practice and +the levels of trait mindfulness. +Conclusions: CM can lead to development of higher levels of mindfulness and may have the ability to positively impact mental +states and attention, thereby offering the potential for prevention of clinical levels of psychopathology and improving overall +psychological well‑being in healthy individuals. +Key words: Attention; cyclic meditation; meditation; mindfulness; yoga +ABSTRACT +Access this article online +Website: +www.ijoy.org.in +Quick Response Code +DOI: +10.4103/0973-6131.133898 +Short Communication +Vinchurkar, et al.: Measures of mindfulness in meditators +143 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +adolescents concluded that mindfulness possibly shields +against decision‑making processes that place adolescents +at risk for smoking.[6] There are several others studies +looking at the effects of mindfulness on neurological +and psychiatric diseases and also assessing the levels of +mindfulness in normal and diseased individuals.[4‑8] Most +studies use MAAS as a tool for measuring mindfulness. +One of the studies reviewing the instruments of measuring +mindfulness concluded that the MAAS was used by most +studies (n = 27) and had positive overall quality ratings +for most of the psychometric properties reviewed.[9] +Given the fact that past studies have looked at the levels +of mindfulness in various practices, health and disease +conditions, we planned the current study to asses the levels +of mindfulness in a moving meditation practice. +One of the various forms of mindfulness is the practice of +a unique technique called cyclic mediation (CM). CM is +a moving meditation derived from an ancient Indian text, +Mandukya Upanishad.[10] It was fundamentally designed +for novice practitioners and combines the practice of +yoga postures with guided meditation. CM is known to +induce a quiet state of mind, which is compatible with the +description of meditation (dhyana or effortless expansion), +according to Patanjali.[11] Although this moving meditation +differs from the classic description of meditation, in which +the practitioners remain seated, keeping as still as possible, +the mental state in both practices (moving meditation +and seated practices) is supposed to be comparable.[12] +An essential part of the practice of CM is being aware of +sensations arising in the body,[10] which emphasize the +mindful component. +There have been several studies which have proven the +beneficial effects of CM. In one of the studies conducted on +middle managers, CM program decreased occupational stress +levels and baseline autonomic arousal in 26 asymptomatic, +male, middle managers.[13] Studies conducted to ascertain +the effects of CM practice reported a decreased oxygen +consumption indicating physiological relaxation as in +mindfulness.[14] Few studies looking at the immediate effects +of CM concluded that it improves attention, cognition, +enhances slow wave sleep, and reduces anxiety.[12,15‑17] +Mindful yoga practices (like CM) may generate the state +of mindfulness, which, when evoked recurrently through +repeated practice, may accrue into trait or dispositional +mindfulness.[18,19] Despite several studies on CM, none have +reported its mindful component. The current study aimed at +investigating the level of mindfulness in experienced cyclic +meditators. We also report the correlation between the years +of meditation experience and the level of mindfulness. +MATERIALS AND METHODS +One hundred and thirty‑three (n = 133) healthy male +volunteers (66 meditators and 67 non‑meditators) with ages +ranging from 25 to 35 years [group mean age ± standard +deviation (S.D.), 24.6 ± 4.5 for meditators and 24.1 ± 4.7 +for non‑meditators] participated in the study. Meditators +were selected from S‑VYASA Yoga University, South India +and corresponding non‑meditators  (controls) matched +for age, gender, and education were obtained from +similar institutes in Bangalore, India. Meditators had a +minimum 3 years experience of meditation (group mean +experience ± S.D., 5.12 ± 1.35 years). Non‑meditators had +no exposure to any yoga practices and were unaware of the +aims of the study. Subjects with cognitive deficits ruled out +by routine clinical examination were excluded from the +study. This study was approved by the institutional ethics +committee and a signed informed consent was obtained +from all the subjects following explanation of the study. +The questionnaire was administered in a classroom +setup (for approximately 30 min) and two of the project +coordinators were present to supervise the administration +and to assist the participants where necessary. The +questionnaire was administered to 155 participants. All +the participants filled out the questionnaire, but for whom +more than 10% of the items were missing or whose reports +were considered unreliable (i.e., consistently rated the +highest or the lowest scores on all items), were excluded +from the analyses (n = 06; 4%). The subjects participating +in this study had higher educational qualifications with +almost 90% of the participants being postgraduates. +Design +This was a cross‑sectional study, where subjects (meditators) +were recruited from S‑VYASA Yoga University and other +Universities (non‑meditators) by convenience sampling. +Assessments +We assessed mindfulness using the popular MAAS. +MAAS is a 15‑item self‑reported single‑factor scale that is +exclusively focused on attention/awareness component +of mindfulness construct. This instrument has been +independently used to assess individuals either with or +without meditation experience.[20] This scale has been +widely used for various studies and has reported positive +overall quality ratings for most of the psychometric +properties reviewed.[9] MAAS is a brief, easy to administer +scale, and has therefore been used in wide range of +studies related to assessing mindfulness trait. MAAS is +known to have good reliability ratings and a history of +clinical and research use that was developed to assess +the core attentional aspect of mindfulness, and the +capacity for moment‑to‑moment attention in particular.[1] +The MAAS consists of 15 items that measure the level of +mindfulness (example items are “I could be experiencing +some emotion and not be conscious of it until some time +later”, or “I find it difficult to stay focused on what’s +Vinchurkar, et al.: Measures of mindfulness in meditators +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +144 +While there are known differences between Buddhist +views of mindfulness and modern psychological +adaptations, there is broad agreement that a clearly +formulated mental training, usually referred to as +meditation, is required for developing and improving levels +of mindfulness.[21] The practice of CM involves physical +postures (asanas), breath work, physical and mental +awareness together leading to a state of meditation.[10] +Mindfulness develops as a result of consistent practice +or attempt of meditation practice. According to Patanjali, +development of meditation (dhayana) is a process and takes +a series of practices, which together are called Ashtanga +yoga − the eightfold path to reach the highest state of +consciousness. One reaches the state of mindfulness or +meditation or Antaranga yoga as a result of continued +and consistent practice of the first six limbs of yoga.[22] +Our results are very much in accordance with Patanajali’s +concept of the process of development of mindfulness and +meditation. Another school of yoga, Hatha yoga comprises +practices of postures, breath work, and cleansing practices, +all aimed at striking a balance between the body and the +mind. Consistent practice of these hatha yoga techniques +transforms the practitioner and establishes him in the +state of mindfulness and meditation.[23] The meditation +technique practiced in the current study comprises all +these components, which justifies the higher levels of +mindfulness in the meditation group. Also, higher levels +of trait mindfulness in CM practitioner can be accredited +to the years of CM practice, which would have lead to the +development of mindful trait in the meditators as signified +by the positive correlation between level of mindfulness +and the duration of meditation practice. +The findings of the present study are in line with earlier +studies on trait mindfulness in meditators. Highly +experienced Zen meditators showed similar trends where +levels of mindfulness were found to have strong positive +correlation to the years of meditation experience.[1] The +results of this study indicate that MAAS is sensitive +to individual differences in levels of mindfulness and +suggest that the higher scores among those consciously +practicing this skill are due to such training. An +8‑week Mindfulness‑Based Stress Reduction  (MBSR) +program showed increase in the trait mindfulness of +the participants, which mediate the effects of training +on clinical outcomes.[24,25] In a similar study, 8  weeks +of yoga training resulted in significant increases in trait +happening in the present”). The items are answered on +a six‑point scale (1 = Almost always; 6 = Almost never) +on which higher scores are an indication of higher trait +mindfulness. +The MAAS has been validated in various samples +of students  ( = 0.82) and adults from the general +community ( = 0.87).[1] +Data extraction +The questionnaire was scored by computing a mean of the +15 items in the questionnaire. The data were tabulated for +each subject to be subjected for analysis. +Data analysis +Data were analyzed using IBM SPSS 20. The data were +checked for normality and an independent samples t‑test +was employed to compare the means of both the groups. We +also calculated the partial correlation (r) between the years +of meditation experience against the levels of mindfulness. +For all the analysis, we present 95% confidence intervals +and considered P < 0.05 as significant. +RESULTS +MAAS scores were significantly higher in meditators +as compared to with the non‑meditators (independent +samples t‑test, t = 10.391, P < 0.001). The 95% confidence +interval for the difference in the levels of mindfulness trait +between meditators and non‑meditators was (1.05, 1.55). +We found a positive correlation  (r  =  0.620) between +the years of meditation practice and the levels of trait +mindfulness. +Group mean values ± S. D. are given in Table 1. +DISCUSSION +In the present study, we studied trait mindfulness and +its correlation with duration of meditation practice using +a MAAS. We found that meditators had higher levels of +trait mindfulness and were positively correlated with the +duration of meditation practice. +Table  1: Mean total scores of meditators and non‑meditators on the Mindfulness Attention Awareness Scale. Values +are mean±standard deviation +Characteristic +Meditators +(n=67) +Non‑meditators +(n=68) +Effect +size  (r) +Partial correlation with +meditation experience  (r) +Mean age +24.6±4.5 +24.1±4.7 +0.054 +0.045 +Years of education +15.13±1.57 +14.12±1.76 +0.290 +0.026 +Mindfulness Attention Awareness Scale +4.69±0.72*** +3.39±0.72 +0.670 +0.62 +***P<0.001, Independent samples t-test +Vinchurkar, et al.: Measures of mindfulness in meditators +145 +International Journal of Yoga • Vol. 7 • Jul-Dec-2014 +mindfulness of practitioners.[26] Another study with cancer +patients undergoing 8‑weeks of MBSR, showed improved +levels of mindfulness and lowered mood disturbances and +symptoms of stress.[27] A similar study like ours, comparing +two different meditation techniques concluded that +meditation improves the levels of mindfulness regardless +of the meditation technique.[28,29] +Studies explaining the underlying mechanisms of +development of mindfulness have been its stage of infancy. +There is very little research focusing on the mechanisms +of mindfulness. However, if mindfulness is considered +to be a component of self‑awareness and meditation, one +of the studies reports the role of frontal control systems +in neuroanatomical models of self‑awareness.[30] Several +neuroimaging and Electroencephalograpy  (EEG)/Event +Related Potentials  (ERP) studies  have shown changes +in activation of prefrontal cortex (PFC) and the anterior +cingulate cortex (ACC), as well as significant increases in +alpha and theta activity during meditation. This pattern +of activation is commonly associated with meditation and +relaxation.[31] There is substantial evidence of changes in +PFC during mindfulness meditation, which is known to +be associated with attention, concentration, and emotion +regulation. In another study, individuals with higher levels +of mindfulness demonstrated less emotional reactivity in +the midbrain (amygdala, dorsal ACC), which is likely due +to an enhanced ability to engage the PFC.[32] Functional +magnetic resonance imaging studies comparing experienced +mindfulness meditators and novice controls have suggested +increased neuronal activity in regions of the brain related +to self‑awareness  (e.g.,  dorsolateral and medial PFC), +particularly momentary self‑awareness/self‑reference.[33] +Majority of the studies on mindfulness meditation and +other mindfulness training programs have demonstrated +significant changes in the PFC. These findings show promise +for the individual’s ability to train the mind, changing +not only emotional experiences, but also brain structure +and functioning; moreover, the ability to do so appears to +improve over time as experience with meditation increases. +One of the limitations of our study is that the meditators +participating in this study lived in a yoga institute and +practiced other yoga techniques. Therefore, we are not sure +if the development of higher levels of mindfulness is due +to the meditation practice or an influence of other yoga +practices. Further studies should be conducted on subjects +practicing only CM and not adhering to any other yoga +practices. Another limitation could be the small sample +size. Given the huge number of yoga practitioners in today’s +date, studies with larger sample sizes are warranted. +CONCLUSION +Consistent practice of moving meditation practices like CM +can lead to development of higher levels of mindfulness. +This may positively impact mental states and attention, +which can in turn help psychological well‑being of +individuals. This furthers the scope for clinical trials with +CM as an intervention in the management of psychological +disorders. +ACKNOWLEDGMENT +The grant from Department of Science and Technology under the +Cognitive Science Initiative is greatly acknowledged [Project No. +SR/CSI/22/2009]. +REFERENCES +1. +Brown KW, Ryan RM. The benefits of being present: Mindfulness and its +role in psychological wellbeing. J Pers Soc Psychol 2003;84:822‑48. +2. +Awasthi B. Issues and perspectives in meditation research: In search for a +definition. Front Psychol 2013;3:613. +3. +Malinowski P. 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Soler J, Tejedor R, Feliu‑Soler A, Pascual JC, Cebolla A, Soriano J, et al. +Psychometric proprieties of Spanish version of Mindful Attention Awareness +Scale (MAAS). Actas Esp Psiquiatr 2012;40:19‑26. +21. Chiesa A, Malinowski P. Mindfulness based interventions: Are they all the +same? J Clin Psychol 2011;67:404‑24. +22. Taimini IK. The science of yoga. Madras: The Theosophical Publishing House; +1986. +23. Muktibodhananda Swami. Hatha Yoga Pradipika. 2nd ed. Munger: Yoga +Publication Trust ; 2004. +24. Carmody J, Reed G, Kristeller J, Merriam P. Mindfulness, spirituality, and +health‑related symptoms. J Psychosom Res 2008;64:393‑403. +25. Greeson JM, Webber DM, Smoski MJ, Brantley JG, Ekblad AG, Suarez EC, +et  al. Changes in spirituality partly explain health‑related quality of +life outcomes after Mindfulness‑Based Stress Reduction. J Behav Med +2011;34:508‑18. +26. Shelov DV, Suchday S, Friedberg JP. A pilot study measuring the impact of +yoga on the trait of mindfulness. Behav Cogn Psychother 2009;37:595‑8. +27. Garland SN, Tamagawa R, Todd SC, Speca M, Carlson LE. Increased +mindfulness is related to improved stress and mood following participation +in a mindfulness‑based stress reduction program in individuals with cancer. +Integr Cancer Ther 2013;12:31‑40. +28. Schoormans D, Nyklíček I. Mindfulness and psychologic well being: Are +they related to type of meditation technique practiced? J Altern Complement +Med 2011;17:629‑34. +29. Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T. Cultivating +mindfulness: Effects on well‑being. J Clin Psychol 2008;64:840‑62. +30. Hoerold D, Dockree PM, O’Keeffe FM, Bates H, Pertl M, Robertson IH. +Neuropsychology of self‑awareness in young adults. Exp Brain Res +2008;186:509‑15. +31. Cahn BR, Polich J. Meditation states and traits: EEG, ERP, and neuroimaging +studies. Psychol Bull 2006;132:180‑211. +32. +Creswell JD, May BM, Eisenberger NI, Lieberman MD. Neural correlates of +dispositional mindfulness during affect labeling. Psychosom Med 2007;69:560‑5. +33. Farb NA, Segal ZV, Mayberg H, Bean J, McKeon D, Fatima Z, et al. Attending +to the present: Mindfulness meditation reveals distinct neural modes of +self‑reference. Soc Cogn Affect Neurosci 2007;2:313‑22. +How to cite this article: Vinchurkar SA, Singh D, Visweswaraiah NK. +Self-reported measures of mindfulness in meditators and non- +meditators: A cross-sectional study. Int J Yoga 2014;7:142-6. +Source of Support: Department of Science and Technology- +Cognitive Science Initiative Grant [Project No. SR/CSI/22/2009], +Conflict of Interest: None declared +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/Sleep Disorder, Gastrointestinal Problems and Behaviour Problems Seen in Autism Spectrum Disorder Children.txt b/subfolder_0/Sleep Disorder, Gastrointestinal Problems and Behaviour Problems Seen in Autism Spectrum Disorder Children.txt new file mode 100644 index 0000000000000000000000000000000000000000..7151512fa427a9a4a639b6b28e9e2893c00caf13 --- /dev/null +++ b/subfolder_0/Sleep Disorder, Gastrointestinal Problems and Behaviour Problems Seen in Autism Spectrum Disorder Children.txt @@ -0,0 +1,403 @@ +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): VE01-VE03 +1 +DOI: 10.7860/JCDR/2016/24175.8922 +Review Article +Introduction +Way back in 1943, Leo Kanner a child psychiatrist observed a group +of 11 children and found that the behaviour of these children were +totally different from a typically growing child. He then published +an article of about twenty pages in a journal called “Nervous +Child” which is extinct now [1]. After Kanner’s publication in 1943, +Hans Asperger in Austria further studied and published an article +about autism in 1944 [2]. Due to number of deficiencies in these +children, the word Autism Spectrum Disorder (ASD) was framed. In +Greek the meaning of the word ‘auto’ is self. Autism is one of the +complex neurodevelopmental disorder, the characteristic of which +is manifested in the form of impairments in social communication +and interaction, peer communication, repetitive and restricted +behaviour, adhering to sameness, stereotyped pattern of behaviour +and in some cases hyperactiveness and attention deficit problems. +Autism is just one of the spectrum disorders under the umbrella +of pervasive developmental disorders, the others being Asperger’s +Syndrome, Rett’s Disorder, Pervasive Developmental Disorder Not +Otherwise Specified (PDD-NOS) and Childhood Disintegrative +Disorder. ASD children have normal life span like any other individual. +Autism is not a single disorder but it refers to behavioural phenotype. +Since, no aetiology can explain this disorder, aetiological based +intervention is also not available [3]. Onset of autism happens in +infantile childhood somewhere between 18 months to 30 months. +Cause of autism is not yet precisely known, but suspected causes +could be genetics, presence of toxins in the environment, maternal +related complications, pregnancy related problems, marriages +in blood relatives and certain vitamin deficiency etc., [4,5]. +Recent studies seem to be pointing at various physiological and +metabolic abnormalities in ASD other than psychiatric disorders +such as immune dysregulation or inflammation, oxidative stress, +mitochondrial dysfunction and exposure to environmental toxicants +[6]. +Prevalence of ASD population has increased by many folds in +recent years. In 2006, 1 child in every 110 children was suffering +from ASD (1:70 male and 1:315 female) [7]. Then according to +revised estimation in 2010 it was 14.7 per 1000 (1 in 68) children +considering the age of 8 years old [8]. According to the Centre for +Disease Control which monitors these numbers through Autism +and Developmental Disabilities Monitoring Network (ADDM) the +community report of 2016 in United States, the occurrence of ASD +was found to be same as in previous report, that is 1 in every 68 +children [9]. Cost involved in caring and maintaining ASD children is +huge on both, the families of these children and the community. It +is estimated that, the total cost per year from the time of the ASD +child’s birth until the age of 17 years is found to be between $11.5 +billion to $60.9 billion in United States [10]. In United Kingdom the +prevalence rate is estimated to be 1% of the total population after +using various methods of diagnosis [11]. +Prevalence in India: Earliest literature available in India about autism +dates back to 1944 by a Viennese paediatrician A. Ronald, working +in Darjeeling. In the same year as that of Kanner’s publication, +Ronald also presented an overview of the detection, causes, types +and treatment for what he termed as abnormal children. Later in +1959 the word autism was first used in Indian literature and by 1960 +few more publications appeared [12]. In India ASD population is +estimated to be 2.3 million considering the metropolitan and urban +population [12]. There seems to be a lack of awareness about +autism disorder in rural population and therefore, it is very difficult to +estimate this population. +Recent researches show that other than behaviour problems, ASD +children also suffer from physiological problems like sleep disorders, +gastrointestinal problems etc., which may aggravate the severity of +day time behaviour. +Sleep disorder: Sleep is one of the basic needs of human beings like +food that we take to sustain. Both food and sleep are physiological +needs of human body. Studies on sleep problems of ASD children +are very scarce. Initiating and maintaining sleep for longer period +among ASD children is very difficult [13]. If sleep is disrupted then, +it affects academic behaviour and other activities during day time. +Sleep disorder is a common concern for individuals with ASD +children. Evidence suggests that there seems to be significant sleep +Psychiatry Section +Sleep Disorder, Gastrointestinal Problems +and Behaviour Problems Seen in Autism +Spectrum Disorder Children and Yoga as +Therapy: A Descriptive Review +KUMAR Narasingharao1, Balaram Pradhan2, JanardhanA Navaneetham3 +Keywords: Neuro-developmental, Non-invasive, Parental, Physiological, Psychological +ABSTRACT +Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder with deficiencies in many developmental milestones +during the infantile childhood. Recent researches have shown that apart from behaviour problems, the ASD children also suffer from +physiological conditions such as disturbed sleep and gastrointestinal problems that could be the contributing factors to their daytime +behaviour problems. Lots of parents have expressed that, lack of sleep among the children have resulted in high levels of stress among +the family members particularly among the immediate caretakers which are in most cases the mother of the child. Early behaviour +intervention is a norm for ASD children which mainly affect the psychological level. Through this paper, an effort has been made to study +the contributions made by yoga in order to mitigate such problems. Yoga is a non-invasive and alternative therapy that brings change +in both physiological and psychological level of an individual. High levels of stress among the caretakers of these children could make +them susceptible to non-communicable diseases such as hypertension, diabetes, arthritis etc. Parental based yoga intervention can be +more effective for both children and parents and subsequently to the entire family. +Kumar Narasingharao et al., Autism and Yoga Therapy +www.jcdr.net +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): VE01-VE03 +2 +problems with ASD children [14]. Rate of disturbed sleep is very +high among ASD [15]. The sleep problems exacerbate symptoms of +autism [16]. Due to disturbed sleep or lack of sleep at night most of +the ASD children behave aggressively during daytime which makes +it difficult for the caretakers in general and mothers in particular to +manage them. Sleep disorders among ASD children can also result +in disturbed sleep among family members. Identification and proper +treatment of sleep disorders of both the child and the adult is an +important factor in treating the ASD children. This will help in better +management of daytime behaviour problems. The ASD children’s +sleep disorders include refusing to go to bed, insomnia, sleepiness +during day time, sleep apnoea etc., [17]. Difficulties pertaining to +sleep and patterns of disrupted sleep can have a negative effect on +academic, emotional, behavioural, physical and social functioning. +Early detection of sleep disorders among ASD children and use of +properly utilized strategies by qualified professionals may prove to +be helpful to these children [18]. Due to indifferent sleeping patterns +of the ASD children, the routine of the entire family gets disturbed +causing them to undergo a lot of stress particularly for the immediate +care taker which in most cases is the mother. +Gastrointestinal problems: The other medical condition which +require immediate attention is Gastrointestinal (GI) problems +[19]. Gl problems among subsets of autism individuals leads to +chronic constipation, diarrhoea, abdominal pain, bloody stools, +vomiting and flatulence etc., [20]. GI symptoms are associated with +inflammation in intestinal tract, irritation bowel syndrome, bloating +and other digestion related problems. Some ASD children always +insists to have particular type of food due to which imbalances in +the diet may happen [21]. GI problems and associated symptoms +are very common among autistic children but these conditions are +not completely understood [22]. Most of the children don’t chew the +food properly and swallow instead and this may lead to digestion +problems. Some children may not eat fruits, vegetables or some +food which should be a part of their daily balanced diet. GI problems +may be associated with compositional changes in intestinal bacteria +[23]. All these problems may lead to imbalanced food and nutrition +supply to body. In paediatric sittings, parents often raise concern +about possible GI symptoms in ASD, yet the specificity of these +concerns are not well studied. Gastro-Intestinal Dysfunction (GID) in +ASD children is not properly understood [24]. Factor associated with +GID could be atypical eating habits of ASD children when compared +to normal children. All these days it was considered as the parents’ +perception of GID in ASD children [25]. Due to communication +problems associated with the ASD children, it is very difficult to +understand this issue. Experts in this area need to understand +whole issue related to GID of ASD children instead of relying on +opinion of parents as parents themselves may not be experts in +determining the GID problems of their children. A subgroup of ASD +children suffer from symptoms like belching, constipation, bloating, +abdominal pain, reflux, vomiting, flatulence etc. Some of the ASD +children also suffer from urine and faecal incontinence problems +[26]. +Behaviour problems: More importance is being given to behaviour +interventions for ASD children and it is the only intervention available +right now in conventional methods. ASD children disconnect +themselves from external world and involve in self stimulatory +behaviours, self injuring like biting, head banging, unusual talk or +peculiar sounds, running around without purpose, lack of sitting +tolerance, lack of attention, learning disability etc. An individual with +ASD requires behaviour interventions throughout life since, it is a +pervasive developmental disorder. Behaviour intervention is needed +in multiple areas such as social behaviour, social communication +and interaction, psycho-social behaviour, motor movement, +sensory integration, intellectual disability, cognitive difficulties, life +skills problems, to control self-stimulation behaviours, defiance +behaviours, rigidity, repeated restricted behaviour problems +etc. ASD children also suffer from depression and anxiety and +require psychiatric treatment. In case of an individual with autism +who is adult or is in older age hospitalization may be required for +psychiatric treatments [27]. Psychiatric comorbidities have been +reported to be 72% among infantile childhood of autism children +[28]. To some extent behaviour interventions are found to be +successful which helps some children to do better in academic +and social communication etc. ASD children are unique and they +differ from each other in patterns of behaviour. Early diagnosis and +intervention play a major role in improving the health and behaviour +of ASD children. Other than high functioning autistic children with +good communication skills, most of the children are associated with +deficit expressive and receptive language skills. +Yoga as therapy: Availability and role of pharmacological +interventions are limited in ASD children. Integrated approach of +yoga helps children to improve imitation skills, social communication +and also helps in improving the overall quality of life [29]. Attempts +have been made to identify safe and effective complementary and +alternative therapy for the families of ASD children [30]. Yoga acts +as sensory integration which helps children to overcome excess +stimuli in their life [31]. Since, the children require individual attention +even for behavioural intervention, the cost of the intervention is too +high. ASD children suffer from attention deficit and yoga helps in +overcoming this problem [32]. Most of the parents cannot afford +intervention particularly in India due to poor financial background +of the majority of the families [33]. Such parents go in search of +low cost alternative medicine and therapies. As the prevalence of +ASD children increase so does the need for alternative therapies +for effective intervention to reduce the intensity of symptoms. +Integrated movement therapy involving yoga bring changes in +speech, language pathology and overall mental health [34]. There +has been increased interest in developing effective intervention for +ASD children. Yoga has been found to bring positive effects on +mental health of the ASD children [35]. Yoga is an ancient science +being practiced in India for thousands of years. The meaning of the +word yoga is oneness or to join two in to one that is to unite body and +mind [31]. Yoga also helps in improving sensory integration, motor +movements and increase in cognitive ability, social communication +and interaction etc. By practicing pavana mukthasana set of asana +(wind releasing exercises) GI symptoms which lead to digestion +related problems can be solved. Breathing practices and meditation +helps in psychological problems like concentration, increasing +attention span and memory power. By practicing dynamic exercises +and loosening exercises excessive energy can be controlled which +helps in reducing hyperactiveness of children. Yoga is a form of +alternative therapy for those having ASD. Yoga acts as a form of +sensory integration therapy which helps ASD children cope with the +overload of stimuli in their day to day life. Care takers particularly +mothers are prone to excessive stress in managing ASD children. +Keeping this in mind mothers should also be made part of any yoga +intervention of ASD children. Apart from assisting trainers in making +child perform yoga, they can learn yoga themselves which can help +them in reducing the stress level in dealing with autistic children. +Conclusion +Affordable and effective pharmacological interventions are yet to +be found for ASD based on aetiology of disorder. Since, effect on +behaviour intervention is limited, parents go in search of alternative +and complementary medicine or therapies to find relief for their +children. Yoga being accepted by people all over the world either +to find cure or to control different ailments, definitely it will be more +effective in case of ASD children also. Yoga affects both physiological +and psychological level which helps in overall development of ASD +children and thus, enhancing the quality of life of children as well as +family. Yoga can be used as best alternative therapy which has no +side effects. Yoga should be a routine and part of day to day activity +for ASD children. If yoga is practiced regularly, it can be used as a +preventive therapy to keep away many non-communicable diseases +www.jcdr.net +Kumar Narasingharao et al., Autism and Yoga Therapy +Journal of Clinical and Diagnostic Research. 2016 Nov, Vol-10(11): VE01-VE03 +3 + + +PARTICULARS OF CONTRIBUTORS: +1. +Research Scholar, Division of Yoga and Humanities, S-VYASA Yoga University, Bengaluru, Karnataka, India. +2. +Assistant Professor, Division of Yoga and Humanities, S-VYASA Yoga University, Bengaluru, Karnataka, India. +3. +Associate Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India. +NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: +Mr. Kumar Narasingharao, +S-VYASA Yoga University, Bengaluru-560018, Karnataka, India. +E-mail: nknrao2007@gmail.com +Financial OR OTHER COMPETING INTERESTS: None. +Date of Submission: Sep 15, 2016 +Date of Peer Review: Sep 30, 2016 + Date of Acceptance: Oct 10, 2016 +Date of Publishing: Nov 01, 2016 +like diabetes, hypertension, arthritis etc. among the caretakers. +Since, ASD children require individual attention and physical prompt +in doing any activity, parental based yoga interventions will prove to +be a successful program. With short duration of yoga intervention +we see improvements in physiological conditions but longer +intervention is required to see changes in psychological symptoms. +Yoga teaching should be mandatory or a part of special school +curriculum to make it more effective for ASD children. +References + kanner Leo. Autistic Disturbances Of Affective Contact. 1943. +[1] + H A. Asperger and his Syndrome. 1944. +[2] + Francis K. Autism interventions : a critical update. +[3] +Dev Med Child Neurol. +2005;47:493–99. + Balasubramanian B, Bhatt C V, Goyel NA. Genetic studies in children with +[4] +intellectual disability and autistic spectrum of disorders. Indian J Hum Genet. +2009;15(3):103-07. + Bener A, Khattab AO, Dabbagh MM Al. Is high prevalence of Vitamin D deficiency +[5] +evidence for autism disorder ?: In a highly endogamous population. J Pediatr +Neurosci. 2014;9:227–33. + Rossignol DA, Frye RE. A review of research trends in physiological abnormalities +[6] +in autism spectrum disorders : immune dysregulation, inflammation, oxidative +stress, mitochondrial dysfunction and environmental toxicant exposures. Mol +Psychiatry [Internet]. Nature Publishing Group; 2012;17(4):389–401. Available +from: http://dx.doi.org/10.1038/mp.2011.165 + Rutledge TF, Boyd MF, Starr TM. Prevalence of Autism Spectrum Disorders, +[7] +2006. CDC Community Rep Autism. 2009;58:1-20. + CDC 2014. Prevalence of Autism Spectrum Disorder among children aged 8 +[8] +years, 2010. 2014;63(2). + CDC 2016. Community report on Autism. +[9] +CDC Community Rep Autism. +2016;65:1-23. + Lavelle TA,Weinstein MC, Newhouse JP +, Munir K, Kuhlthau KA, Prosser LA. +[10] +Economic burden of childhood Autism Spectrum Disorders. Pediatrics. 133. + Baron-cohen S, Scott FJ, Allison C, Williams J, Bolton P +, Matthews FE, et al. +[11] +Prevalence of autism-spectrum conditions : UK school-based population study. +Br J Psychiatry. 2009;194:500–09. + BARUA, MERRY DTCD. Autism prevalence in India. +[12] +Book. 1997; + Allik H, Larsson J, +[13] +Smedje H. high-functioning autism. 2006;11:1–11. + Cohen, Simonne et al. The relationship between sleep and behavior in autism +[14] +spectrum disorder (ASD): a review. 2014; + Wiggs L, Stores G. Sleep patterns and sleep disorders in Children with Autistic +[15] +Spectrum Disorders. + Schreck KA, Mulick JA, Smith AF. +[16] +Sleep problems as possible predictors of +intensified symptoms of autism $. 2004;25:57–66. + Klukowski M, Wasilewska J, Lebensztejn D. +[17] +SLEEP AND GASTROINTESTINAL +DISTURBANCES. 2015; + Brown J, Herrick SE, Luskin B, Cardwell E, Brown H, Brown J, et al. Autism +[18] +Spectrum Disorder and Sleep-Related Disturbances: A General Overview. + Mouridsen SE, Rich B. Diseases of the gastrointestinal tract in individuals +[19] +diagnosed as children with atypical autism : A Danish register study based on +hospital diagnoses. 2012; + Hsiao EY. Gastrointestinal issues in autism spectrum disorder. +[20] +Harv Rev +Psychiatry. 2014;22(2):104–11. + Gorrindo P +. +[21] +gastrointestinal dysfunction in Autism. 2013;5(2):101–08. + Buie AT, Campbell DB, Hyman SL, Jirapinyo P +. Evaluation, Diagnosis, and +[22] +Treatment of dastrointestinal disorders in Individuals With ASDs : A consensus +report. Pediatrics. 2010;125(January). + Williams BL, et al. Application of novel PCR-based methods for detection, +[23] +quantitation, and phylogenetic characterization of Sutterella Species in intestinal +biopsy samples from Children with Autism and gastrointestinal disturbances. +MBio. 2012;3(1):1–11. + McElhanon BO, McCracken C, Karpen S, MD, Sharp WG. Gastrointestinal +[24] +symptoms in Autism Spectrum Disorder : A meta-analysis abstract. Pediatrics. + Gorrindo P +, Williams KC, Lee EB, Walker LS, McGrew SG, Levitt P +. Gastrointestinal +[25] +dysfunction in Autism: Parental report, clinical evaluation, & associated factors. +Autism Res. 2013;5(2):101–08. + Hanney NM, Jostad CM, LeBlanc LA, Carr JE, Castile AJ. Intensive behavioral +[26] +treatment of urinary incontinence of Children With Autism Spectrum Disorders: +An archival analysis of procedures and outcomes Ffom an outpatient clinic. +Focus Autism Other Dev Disabl [Internet]. 2012 [cited 2016 Oct 4];28(1):26–31. +Available from: http://foa.sagepub.com/cgi/doi/10.1177/1088357612457987 + Gabriels RL, Agnew JA, Beresford C, Morrow MA, Mesibov G, Wamboldt M. +[27] +Improving psychiatric hospital care for pediatric patients with autism spectrum +disorders and intellectual disabilities. Autism Res Treat [Internet]. 2012 [cited +2014 Aug 4];2012:685053. Available from: http://www.pubmedcentral.nih.gov/ +articlerender.fcgi?artid=3420632&tool=pmcentrez&rendertype=abstract + Lord C, Wagner A, Rogers S, Szatmari P +, Aman M, Charman T, et al. Challenges +[28] +in evaluating psychosocial interventions for Autistic Spectrum Disorders. J +Autism Dev Disord. 2005;35(6):695-708. + Radhakrishna S, Nagarathna R, Nagendra HR. Integrated approach to yoga +[29] +therapy and autism spectrum disorders. J Ayurveda Integr Med [Internet]. +2010[cited 2014 Aug 4];1(2):120–24. Available from: http://www.pubmedcentral. +nih.gov/articlerender.fcgi?artid=3151379&tool=pmcentrez&rendertype=abstract + Akins RS, Angkustsiri K, Hansen RL. Complementary and alternative medicine +[30] +in autism : An evidence-based approach to negotiating safe and efficacious +interventions with families. Neurotherapeutics. 2010;7(3):307-19. + Studnitzer A, Miller A. Yoga: Therapy for children on the autism spectrum. +[31] +Acad +Exch Q. 2014;18(2). + Hariprasad VR, Arasappa R, Varambally S, Srinath S, Gangadhar BN. Feasibility +[32] +and efficacy of yoga as an add on intervention in attention deficit hyperactivity +disorder : An exploratory study. Indian J Psychiatry. 2013;55(Suppl 3):S379-84. + Juneja M, Mukherjee SB, Sharma S, Jain R, Das B. Original Article Evaluation +[33] +of a parent-based behavioral intervention program for children with autism in a +low-resource setting. Jounal Pediatr Neuro Sci. 2012;7:24–26. + Kenny M. Integrated Movement Therapy TM : Yoga-Based Therapy as a viable +[34] +and effective intervention for Autism Spectrum and related disorders. Int J Yoga +Therap. 2002;12(12):71–79. + Keshavan MS, Rao NP +, Rao TSS, Yoga and mental health: Promising road +[35] +ahead, with caution. Indian J Psychiatry. 2013;55(Suppl 3):S329–31. diff --git a/subfolder_0/Stress management in medical students A yogic therapy approach.txt b/subfolder_0/Stress management in medical students A yogic therapy approach.txt new file mode 100644 index 0000000000000000000000000000000000000000..777523ba8a63a8b8c1c869c88cd4a4a29d006c28 --- /dev/null +++ b/subfolder_0/Stress management in medical students A yogic therapy approach.txt @@ -0,0 +1,338 @@ +© 2016 International Journal of Educational and Psychological Researches | Published by Wolters Kluwer - Medknow +65 +Stress management in medical students: + +A yogic therapy approach +Sir, +A student under optimal stress does bring out his or her best, +however, the extremes of stress can result in stress induced +disorders and deteriorating performance.[1] Medical school +training is intended to prepare graduates for a personally +rewarding and socially meaningful career. However, the +reports have shown that this is a time of great personal distress +for medical students, and they suffer significantly higher +levels of stress than the age‑matched general population.[2] +Consequently, this excessive levels of stress in medical student +leads to burnout, dropping out, psychiatric problems, and +impact on future performance.[3] However, it is also important +to note that some stress is necessary to drive medical students +to perform better, build character, and prepare them for the +demands of future medical practice. It is now well‑known that +stress is a normal response of a body to any demands while +stressors are the demands and pressure that lead to stress. +Further, stress results due to the discrepancy between excessive +pressure and different types of demand and individual +capacities to fulfill these demands.[4,5] Similarly, the perception +of stress is under the control of students’ personal system of +belief and attitude.[6] The stressors in student also can vary +with their personal attitude, belief, and cultural background. +The distorted perceptions overemphasize their limitations +and make the situation more stressful.[7] +Academic Issues and Curriculum Planning +in Medical Education +Medical education with study burden and a busy schedule +might adversely affect the students’ mental health and there +is a concern regarding the mental well‑being of the medical +students. Similarly, the medical students have high “baseline” +traits of depression, anxiety, and stress, and these are higher +if an examination is near. Smoking and female sex predicts +the higher levels of “baseline” depression, anxiety, or stress. +The study burden and a busy schedule of medical education +are the major reasons for high depression, anxiety, and stress +scale‑21 scores.[8] This stress may negatively affect the quality +of patient care, patient safety,[9] and professionalism.[10] +The most frequently occurring stressors among the students +are related to academic issues.[11] Therefore, the academic +and nonacademic stressors need to be considered in +curriculum planning, and a mechanism need be in place +to monitor and address the medical students’ stress. The +stressed students may benefit by improving the academic +support systems via senior students, academic staff, and +counselor driven continuous mentoring. The medical +student requires increased stress awareness, improved coping +skills, and focused support. Sometimes, the involvement of +the parents may be necessary. The medical students must +be equipped with the necessary skills to assess personal +distress, determine its effect on professional growth, +recognize when to seek help, and develop the strategies to +promote mental well‑being. Stressors and starting points +for health‑promoting interventions are closely related to +the medical curriculum and its organization. Therefore, +the curriculum itself in addition to a program aimed at +improving stress management should be the primary stands +at the center of activities for enhancing students’ health.[12] +Undergraduate Medical Education +A substantial proportion of medical undergraduate students +was found to be depressed, anxious, and stressed revealing a +neglected area of the students’ psychology.[13] Undergraduate +medical education comprises the strenuous course burden +and hectic schedule for 5–6 years. Due to the expanding +knowledge and evolving therapies, the medical students +need to acquire adequate professional knowledge, skill, and +attitudes in order to prepare themselves to deal with lifelong +professional challenges independently. This course burden +and hectic schedule adversely affect the medical student’s +physical and mental health. Therefore, the medical students +suffer from depression, anxiety, and stress.[14‑16] +Postgraduate Medical Education +The competition for getting postgraduate training and +job opportunities is an additional trigger for psychological +illness. Consequently, the poor academic performance, +increased rates of substance use, and suicide is becoming +common in medical students.[17‑19] Therefore, some sound +intervention strategies or stress management program +could be incorporated in medical education to help medical +students to better deal with their stress that may lead an +effective mental well‑being among the medical students.[20] +Stress Management in Medical Students +Prior research has revealed that the medical students +participating in stress management programs demonstrated +Letter to Editor +[Downloaded free from http://www.ijeprjournal.org on Thursday, February 4, 2021, IP: 136.232.192.146] +Letter to Editor +66 +International Journal of Educational and Psychological Researches / Vol 2 / Issue 1 / January-March 2016 +to improve the immunologic functioning, decreases in +depression and anxiety, increased spirituality and empathy, +enhanced knowledge of alternative therapies for future +referrals, improved knowledge of the effects of stress, +greater use of positive coping skills, and the ability to +resolve role conflicts.[21] +Yoga: An Effective Stress Management +Program +Yoga is effective in decreasing stress and improving +general well‑being in medical students.[22] In addition, +compared to the control group, the medical students +undergoing yoga reported various beneficial effects +such as better sense of well‑being, feeling of relaxation, +improved concentration, self‑confidence, improved +efficiency, good interpersonal relationship, increased +attentiveness, lowered irritability levels, and an optimistic +outlook in life were. Furthermore, these results point to +the beneficial role of yoga in not only causing a reduction +in basal anxiety level but also attenuating the increase in +anxiety score in a stressful state such as exams. Similarly, +the results of the exam indicated a statistically significant +reduction in a number of failures in the yoga group as +compared to the control group.[1] Medical students also +reported that improved pulmonary functions related to +vital capacity, tidal volume, expiratory reserve volume, +breath holding time, 40  mm endurance, and peak +expiratory flow rate following yoga training.[23] Even a +short yoga is effective in improving general and mental +well‑being in medical students.[24] Furthermore, an +increase in self‑regulation and self‑compassion after yoga +was reported by medical students.[25] The practice of yoga +even for a short period showed the ability to improve most +of the cardiovascular functions in medical students. The +regular practice of yoga for a longer period may further +improve these functions and possible result in improved +management of their daily stress.[26] Counseling certainly +helped to increase the levels of self‑confidence and the +ability of adjustment of the medical students. Moreover, +the relaxation technique, which is a part of yoga, have +time and again proved that they are adjunct to medicine +in a number of ways; thus they have to be imbibed as +a way of life for many to overcome the stress related +problems.[27] The effect of yoga and relaxation changes +in psychophysiological parameters such as anxiety level, +heart rate, blood pressure, and galvanic skin resistance in +response to the stress of examination in medical students +reported the significant improvement in choice reaction +time in yoga and relaxation group as compared to control +group.[28] Based on previous literary and experiential +review research in yoga, suggested the evidence‑based +yoga program for effective stress management in medical +student may include the following yoga practices:[1,22‑26,28‑36] +Shithilikarana Vyayama (loosening and stretching practices) +• Suryanamaskara (salutations to the sun) + +Asana (postures) +• Eka Pada Pranamasana (one‑legged prayer pose) +• Simhagarjanasana (roaring lion pose) +• Bhujangasana (cobra pose) +• Shashankasana (pose of the moon or hare pose) +• Sarvangasana (shoulder stand pose) +• Matsyasana (fish pose) +• Shavasana (corpse pose)/Yoga Nidra (psychic sleep) + +Pranayama (breathing practices) +• Nadi Shodhana Pranayama  (psychic network +purification) +• Ujjayi Pranayama (the psychic breath) +• Bhramari Pranayama (humming bee breath) + +Dharana and Dhyana (concentration and meditation +practices) +• OM Meditation (OM chanting) + +Kriya (cleansing practices) +• Jala Neti (nasal cleansing with water). +Conclusions and Recommendations +Yoga is an easy, safe, low cost, acceptable, and scientifically +validated preventive approach[28] for effective stress +management in a medical student. The aim of both +community medicine and yoga is a health promotion and +a disease prevention.[24] Therefore, there is a strong reason +to include yoga in teaching a curriculum of community +medicine. This will allow our future doctors to adopt and +maintain the positive health, and disseminate the same +to their patients and the community. +Acknowledgment +Authors acknowledge Swami Vivekananda Yoga +Anusandhana Samsthana University, Bengaluru for kind +support to carry out this work. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +Anant Shhurao Kukade, Rajesh, Tikhe Sham Ganpat1, +Hongasandra Ramarao Nagendra +  +Department of Yoga and Management Studies, Swami Vivekananda +Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, +1Department of Yoga,  WHO‑CC (Yoga) Morarji Desai National +Institute of Yoga, New Delhi, India +[Downloaded free from http://www.ijeprjournal.org on Thursday, February 4, 2021, IP: 136.232.192.146] +Letter to Editor +International Journal of Educational and Psychological Researches / Vol 2 / Issue 1 / January-March 2016 +67 +Address for Correspondence: +Dr. Tikhe Sham Ganpat, +WHO‑CC (Yoga) Morarji Desai National Institute of Yoga, No. 68, + +Ashoka Road, New Delhi ‑ 110 001, India. +E‑mail: rudranath29@gmail.com +References +1. +Malathi  A, Damodaran  A. 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Stress, anxiety, and depression among +medical students in a multiethnic setting. Neuropsychiatr Dis +Treat 2015;11:1713‑22. +9. +Shanafelt  TD, Bradley  KA, Wipf  JE, Back  AL. Burnout and +self‑reported patient care in an internal medicine residency +program. Ann Intern Med 2002;136:358‑67. +10. Mareiniss DP +. Decreasing GME training stress to foster residents’ +professionalism. Acad Med 2004;79:825‑31. +11. Babar MG, Hasan SS, Ooi YJ, Ahmed SI, Wong PS, Ahmad SF +, +et  al. Perceived sources of stress among Malaysian dental +students. Int J Med Educ 2015;6:56‑61. +12. Kötter T +, Pohontsch NJ, Voltmer E. Stressors and starting points for +health‑promoting interventions in medical school from the students’ +perspective: A qualitative study. Perspect Med Educ 2015;4:128‑35. +13. Iqbal  S, Gupta  S, Venkatarao  E. Stress, anxiety and +depression among medical undergraduate students and their +socio‑demographic correlates. Indian J Med Res 2015;141:354‑7. +14. 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Social +consequences of psychiatric disorders, I: Educational attainment. +Am J Psychiatry 1995;152:1026‑32. +20. Shi M, Wang X, Bian Y +, Wang L. The mediating role of resilience +in the relationship between stress and life satisfaction among +Chinese medical students: A cross‑sectional study. BMC Med +Educ 2015;15:16. +21. Shapiro SL, Shapiro DE, Schwartz GE. Stress management +in medical education: A review of the literature. Acad Med +2000;75:748‑59. +22. Simard  AA, Henry  M. Impact of a short yoga intervention +on medical students’ health: A pilot study. Med Teach +2009;31:950‑2. +23. Karthik PS, Chandrasekhar M, Ambareesha K, Nikhil C. Effect +of pranayama and suryanamaskar on pulmonary functions in +medical students. J Clin Diagn Res 2014;8:BC04‑6. +24. Bansal R, Gupta M, Agarwal B, Sharma S. Impact of short term +yoga intervention on mental well being of medical students posted +in community medicine: A pilot study. Indian J Community Med +2013;38:105‑8. +25. Bond  AR, Mason  HF, Lemaster  CM, Shaw  SE, Mullin  CS, +Holick EA, et al. Embodied health: The effects of a mind‑body +course for medical students. Med Educ Online 2013;18:1‑8. +26. Parshad  O, Richards  A, Asnani  M. Impact of yoga on +haemodynamic function in healthy medical students. West Indian +Med J 2011;60:148‑52. +27. Velayudhan  A, Gayatridevi  S, Bhattacharjee  RR. Efficacy of +behavioral intervention in reducing anxiety and depression among +medical students. Ind Psychiatry J 2010;19:41‑6. +28. Malathi A, Damodaran A, Shah N, Krishnamurthy G, Namjoshi P +, +Ghodke  S. Psychophysiological changes at the time of +examination in medical students before and after the practice of +yoga and relaxation. Indian J Psychiatry 1998;40:35‑40. +29. Gopal A, Mondal S, Gandhi A, Arora S, Bhattacharjee J. Effect of +integrated yoga practices on immune responses in examination +stress‑A preliminary study. Int J Yoga 2011;4:26‑32. +30. Balasubramanian B, Pansare MS. Effect of yoga on aerobic +and anaerobic power of muscles. Indian J Physiol Pharmacol +1991;35:281‑2. +31. Dhume RR, Dhume RA. A comparative study of the driving effects +of dextroamphetamine and yogic meditation on muscle control for +the performance of balance on balance board. Indian J Physiol +Pharmacol 1991;35:191‑4. +32. Iyengar B. Light on Yoga. New York: Schocken Books; 1966. +33. Nagendra  HR, Nagaratna  R. New Perspective in Stress +Management. Bangalore: Vivekananda Kendra Prakashana; +2007. p. 14‑79. +34. Saraswati  S. Asana Pranayama Mudra Bandha. Bihar: Yoga +Publication Trust; 2005. p. 525‑39. +35. Brahmachari D. Yogasana Vijnana – The Science of Yoga. 1st ed. +Mumbai, India: Asia Publishing House; 1970. +36. Kuvalayananda  S. Asana. Lonavla, India: Kaivalyadhama, +S.M.Y +.M. Samiti; 1998. +How to cite this article: Kukade AS, Rajesh, Ganpat TS, Nagendra HR. +Stress management in medical students: A yogic therapy approach. Int J +Educ Psychol Res 2016;2:65-7. +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.ijeprjournal.org +DOI: +10.4103/2395-2296.174793 +[Downloaded free from http://www.ijeprjournal.org on Thursday, February 4, 2021, IP: 136.232.192.146] diff --git a/subfolder_0/Study of physical fitness and technical skills on college soccer players playing positions.txt b/subfolder_0/Study of physical fitness and technical skills on college soccer players playing positions.txt new file mode 100644 index 0000000000000000000000000000000000000000..0f3529e1a1820f7878f9b8d1d7aba573e94ed733 --- /dev/null +++ b/subfolder_0/Study of physical fitness and technical skills on college soccer players playing positions.txt @@ -0,0 +1,505 @@ +International Journal of Yoga, Physiotherapy and Physical Education +22 +International Journal of Yoga, Physiotherapy and Physical Education +ISSN: 2456-5067 +Impact Factor: RJIF 5.24 +www.sportsjournal.in +Volume 3; Issue 2; March 2018; Page No. 22-26 +Study of physical fitness and technical skills on college soccer players playing positions +Poornabodha V Kadagadakai, Balaram Pradhan +Division of Yoga and Humanities, SVYASA University, Bengaluru, Karnataka, India +Abstract +The aim of this study was to evaluate performance factors of college soccer players as per their playing position. A total of 82 +college soccer players were selected and classified into goalkeeper (n=8), defender (n=20), midfielder (n=19) and forward (n=35) +positions. All subjects were assessed tests on Handgrip, Sit-up, Harvard step-up, height and weight, sit and reach. The dribble, +lofted-pass, shooting, short pass, and juggling tests were for soccer skills. Harvard test score was significantly differing but not in +soccer’s skills test score based on player position. +Further, it was found significantly greater in midfielders as compare to forward players (P<0.05). Hence, we suggest that, all the +players must have proper physical fitness and specific skills need to improve based on player’s position to attain better +performance. + +Keywords: soccer, playing position, soccer skills, physical fitness components +Introduction +Soccer is the game which involves various skills, strategies, +tactics and physical elements which are required for better +performance. To enhance these conditions, specialized +training shall be given to the players. Finding the gap in the +opponent’s defense and quick judgment for movement are the +qualities of forward player. The midfielder requires more +agility, short and long passing abilities. A defending player +shall be able to jump high and be effective at heading and +tackling skill [1]. Endurance is one of the most important +factors of football players. Midfielders cover maximum +distance while acting as a connection between attack and +defense [2]. The somato type components and physical abilities +of soccer players were found equal by playing position [3, 4]. In +contrast, the size and physical ability were differing according +to player’s position [5]. This may be due to the different +training program were adopted by the previous researcher, +need future study to clarifying this limitation. +The previous findings report that, anaerobic exercise capacity +higher in the midfielders [6]. But in another study, forwards +had significantly higher anaerobic exercise capacity [7, 8]. Also, +earlier reports states that, there was no significant difference +in the performance on the physical test between the various +playing positions except for squat jump among youth soccer +players. The central defenders and forwards showed higher +values in squat jump and counter movement jump (CMJ) than +full back and mid fielders. The full back and midfielders +performed well in sprint and Yo-Yo IE2 test but difference +were no significant. Agility mean values were reasonably +similar in all positional roles [9]. Deepak Shendkar, Shimal H +Hamad [10] showed that, there was significant difference +between cardiovascular endurance, Explosive strength and +speed among the play position of soccer players. The study +revealed that there was no significant difference in flexibility +and agility between the positions of the soccer players. +Overall soccer skills influence by the anaerobic capacity based +on the above finding. This controversial issue has greater +implications on soccer performance. Dribbling, shooting, +passing and juggling had similar score based on playing +position [11]. Another study shows that, defender had stronger +long distance kick power (Lee et al. (2013) [12]. The recent +study found that, dribbling skill was significantly differ +compare to other players (Joo & Seo, 2016) [7]. +These variations recommend that, the influencing element +shall not be only the degree of difference in physical training +based on position. Earlier findings have no significant +difference in bodily trained ability by position. The soccer +players usually follow regular workout schedule to a certain +extent without proper practice of specific exercises for +particular positions. In this regard, additional investigation +shall be useful to develop considerable bodily skills in soccer +player’s classification by their playing positions. + +Methods +Subjects +The study was incorporated for 82 college football players; +eight goalkeepers, twenty defenders, nineteen midfielders, and +thirty five forwards selected for the study. Table 1 shows the +physical characteristics of subjects. + +International Journal of Yoga, Physiotherapy and Physical Education +23 +Table 1: The physical fitness components and related tests + +Sl. No +Variable +Training +Test +Criterion Measures +1 +Muscular strength +Push-ups /Sand Training +Hand Grip Dynamometer +Kilograms +2 +Muscular Endurance +Pull ups / Squat thrust +Sit ups (Bent knees) +Counts +3 +Cardiovascular Endurance +Circuit training +Harvard step test +Fitness Index (Te*100/Hb*2) +4 +Body Composition + +BMI +Formula +5 +Flexibility +Rhythmic exercise +Sit and reach +Centimeters + +Handgrip Strength Test +The subject was asked to hold the dynamometer in one hand. +Then, he was instructed to squeeze the dynamometer with all +out efforts. Body movements are not allowed. Tester shall +record the score. This test measures the hand grip strength of +forearm. + +Sits up Test +The participant asked to lie down on the mat with the bent +knees at right angles. The feet shall be hold by the partner. +The fingers interlocked behind the neck. After the ‘start’ +command, the subject raises his upper body from the trunk +region towards knee and then returns back on the floor. +Successful counts shall be recorded. + +Harvard step test +This test is a type of cardiac stress test for finding +cardiovascular endurance. The platform or a stool is kept in +front of the subject at a height of about 50 cm or 20 inches. On +the command ‘start’, the subject steps up and down on a +platform with the rhythm for which metronome instrument +was used. The subject will continue the exercise for five +minutes. Immediately after exercise, the subject was asked to +lie-down on back. After one minute rest, start counting the +pulse from one to one and half minute, two to two and half +minute and three to three and half minute. Physical efficiency +Index = duration of exercise in sec. x 100/2 x sum of pulse +during recovery. + +Body Composition +The height in meter and weight in kilogram was recorded in +the record sheet. The body mass index (BMI) was calculated +as per the weight of a person in kilogram divided by height in +meter squared. + +Sit and Reach Flexibility Test +The subject was asked to sit on the floor with bare feet and +instructed to put the feet flat against the closed end of the box +through the open end of the box with the knees fully extended. +The subject then extends his both arms ahead as far as +possible along with the measuring scale which was fixed on +the top of the box. The distance covered is measured and +recorded. +Bobby Charlton soccer skill tests were used for the present +soccer skill analysis as shown in Table-2. + +Table 2: Football skills and Bobby Charlton’s soccer sports tests. + +Sl. No +Variable +Test +Criterion Measures +1 +Dribbling +Ball control at pace +Seconds +2 +Lofted Pass +Accuracy pass +Scores +3 +Shooting +Shooting accuracy +Scores +4 +Short Passing +Passing over short distance +Scores +5 +Juggling +Ball control in air +Seconds + +Dribbling +The subject was asked to dribble the ball around each cone in +a zigzag manner. After clearing the final cone, the player has +to run along with the ball towards end line as shown in fig. 1. +The subject scores 200 points for finishing the test in 30 +seconds. 10 additional points shall be scored for every second +under and 10 points shall be deducted for every second over +30. + + + +Fig 1: Dribbling test +International Journal of Yoga, Physiotherapy and Physical Education +24 +Lofted pass +This test is designed to develop accuracy. Every subject has 4 +attempts. The subject was asked to push the ball towards +designated marker as shown in the fig. 2. If the ball passes at +the center without bouncing, 100 points shall be given. The +subject is allowed to attempt with weaker foot and double +points shall be given if the attempt is successful. Total 4 +attempt scores shall be recorded. + + + +Fig 2: Lofted pass test + +Shooting +This test is useful for measuring accuracy in shooting. As +shown in fig. 3, the subject was asked to push the ball towards +goal post. Every subject will be given 4 attempts and score +shall be recorded within 15 seconds. + + + +Fig 3: Shooting test + +Passing +This test promotes the subject to use his feet for passing a +short distance. As shown in fig. 4, the subject starts passing +the ball to the designated distance and takes next attempt with +alternate leg. Each successful pass shall be given 50 points. If +the subject able to pass all 4 attempts successfully, he shall be +given 50 bonus points. + + + + +Fig 4: Passing (short) test + + + +Fig 5: Juggling or ball control test + +Juggling +This test measures the skill of controlling the ball off the air. +The subject was asked to hold the ball in air as long as +possible. If the ball was hold in air for 5 seconds, 50 points +shall be given. 6-10 seconds, 100 points shall be given. +Further, for each 10 seconds, 20 additional points shall be +given and total scores shall be recorded. + +Statistical analysis +Data were analyzed using a one-way analysis of variance to +evaluate significant differences in the measures of physical +fitness and soccer skills among the playing positions of soccer +players. The post hoc Tukey test was administered to evaluate +pair wise differences. The P<0.05 norm was used to designate +statistical significance. + +Results +Fitness +Physical fitness abilities of each position (Table 3), cardio- +vascular endurance measured by the Harvard step up test +showed significant differences (P<0.05) in terms of +midfielders as compare to forward players (P<0.05) as shown +in Table-3. The results reveal similar outcome in other +component of physical fitness in play position of college +soccer (football) players. + + + +International Journal of Yoga, Physiotherapy and Physical Education +25 +Table 3: Comparison of the physical fitness components and football skills among player’s position by using SPSS software analysis. + + +Defenders +Forward +Goal Keepers +Mid Fielders +F test +P value + +20 +35 +8 +19 + + +Hand grip Strength +59.45±12.20 +60.91±11.75 +58.50±14.08 +60.11±13.51 +0.111 +0.953 +Muscular endurance (sit up) +24.65±10.09 +24.37±8.44 +18.38±3.29 +24.32±7.46 +1.275 +0.289 +Cardio-vascular endurance +119.11±24.73 +110.00±18.09 +117.75±14.23 +127.44±24.20 +2.906 +0.04* +BMI +21.22±2.62 +20.96±2.19 +21.31±1.89 +21.30±2.06 +0.133 +0.94 +Flexibility +3.90±2.81 +5.06±3.13 +6.88±4.32 +6.47±5.92 +1.822 +0.15 +Dribbling +39.20±4.20 +38.06±4.28 +40.25±3.49 +38.58±3.55 +0.795 +0.5 +Lofted Passing +144.50±45.13 +155.14±62.75 +146.25±37.39 +149.47±50.16 +0.187 +0.905 +Shooting +108.50±44.28 +102.29±36.55 +102.50±31.51 +95.79±34.85 +0.367 +0.777 +Passing +75.00±57.35 +80.00±50.29 +75.00±59.76 +78.95±34.62 +0.054 +0.983 +Juggling pre +109.50±30.17 +99.14±29.44 +106.25±24.46 +100.00±41.77 +0.674 +0.513 + +Skills +There were no significant differences in terms of dribbling, +lofted pass, shooting, short passing and juggling in different +playing position. Particularly, goal keepers showed better +dribbling skill than other positional players which was not +anticipated. Forward players showed lower shooting skill and +grater lofted passing skill as compare to defenders. Defenders +and goal keepers showed higher juggling skill as compared to +other positional players. + +Discussion +In the present study, 82 college soccer players of different +positions were evaluated in terms of their physical fitness +ability and technical personality. There was no significant +variation in aerobic exercise. Other studies reported that, +midfielders have greater aerobic abilities than others [13, 14, 15, +16]. The present outcome varies from earlier [17] in which +defenders run faster than others in the Yo-Yo test. As per the +above mentioned results, irrespective of playing position, each +player need to have better physical fitness to perform well. To +fulfill these criteria, different kinds of fitness program need to +introduce to improve their physical fitness in terms of aerobic +and anaerobic power. But, the drawback of the study is less +number of goal keepers, similar fitness and skills with other +positional players. +In the present case, midfielders showed significantly higher +cardiovascular endurance as compared to the forward players +[1]. Whereas, different studies showed different kind of playing +position in their exercises test e.g. peak power exercise test. A +study showed that, peak power of forwards highest followed +by defender and mid fielders. Other studies found that, center +defender have greater than mid fielder [18]. In this respect, +different playing position player need to have specific kind of +fitness. For example, Goal keepers and defender must be able +to execute explosive power. Midfielders trained to improve +aerobic power and agility. Forwarders shall improve anaerobic +capacity. + +Soccer skills +No significant differences in terms of dribbling, lofted pass, +shooting, short passing and juggling in different playing +position. Whereas, similar results were observed in terms of +passing, shooting [7]. But, the results of dribbling differ as +compare to other playing position which is quite opposite of +our findings though the number of goal keepers were almost +similar [7]. +Every positional player requires unlike specific fitness and +skillful qualities because, every position plays an important +role in the game. To get success in the match, suitable players +have to be placed by the proper players. Implementation of +systematic conditioning and fitness programs will be more +effective relatively than regular inadequate fitness and +techniques. The practice of stills, strategies and tactics shall be +more useful if it is executed in the game effectively. + +Conclusion +This study found certain differences in physical fitness +abilities and skills by playing position in college soccer +players. First, there were no significant differences in physical +fitness +components +like +muscular +strength, +muscular +endurance, BMI and flexibility. Second, cardio-vascular +endurance was significantly greater in midfielders as compare +to forward players (P<0.05). Third, greater dribbling skill than +other position such as defenders, midfielders, and forwards +which was not anticipated. Forth, forward players showed +lower shooting skill and grater lofted passing skill as compare +to defenders. Hence, a variety of conditioning, training +programs shall be useful for college soccer players to enhance +their physical fitness, technical and tactical skills to become +successful in the game. + +References +1. Kim YK. A fitness profiles of the professional soccer +players by each position. Korean Journal of Sports +Medecine. 2000; 18:217-226. +2. Rienzi E, Drust B, Reilly T, Carter JE, Martin A. +Investigation of anthropometric and work-rate profiles of +elite South American international soccer players. Journal +of Sports Medicine, Physiology and Fitness. 2000; +40:162-169. +3. Noh JW, Kim MY, Lee LK, Park BS, Yang SM, Jeon HJ, +et al. Somatotype and body composition analysis of +Korean youth soccer players according to playing +position for sports physiotherapy research. Journal of +Physical Therapy Science. 2015; 27:1013-1017. +4. Ruas CV, Minozzo F, Pinto MD, Brown LE, Pinto RS. +Lower-extremity strength ratios of professional soccer +players according to field position. Journal of Strength +and Conditioning Research. 2015; 29:1220-1226. +5. Gil SM, Hong CB, Kim KJ. Comparison of physique and +physical fitness following to high school soccer players’ +position. J Liv. Sci. Res. 2008; 34:235-245. +International Journal of Yoga, Physiotherapy and Physical Education +26 +6. Son JS, Jeong JU, Kim JH, Lim JS, Kim H. The analysis +of the anaerobic capacity in different soccer players’ +positions. Journal of Natural Science. 2003; 19:131-140. +7. Chang Hwa Joo, Dong-Il Seo. Analysis of physical fitness +and technical skills of youth soccer players according to +playing position. Journal of Exercise Rehabilitation. +2016; 12(6):548-552. +8. Gil SM, Gil J, Ruiz F, Irazusta A, Irazusta J. +Physiological and anthropometric characteristics of young +soccer players according to their playing position: +relevance for the selection process. Journal of Strength +and Conditioning Research. 2007; 21:438-445. +9. Ramos A, Vale P, Salagado B, Correia P, Oliveria E, +Seabra A, et al. Physical test performance of elite +Portuguese junior soccer players according to positional +play. International Research in Science and Soccer, 2014; +7-11. +10. Deepak Shendkar, Shimal H. Hamad. Comparative study +of soccer player’s physical fitness playing at different +positions of play from Pune city, 2017. +11. Malina RM, Cumming SP, Kontos AP, Eisenmann JC, +Ribeiro B, Aroso J, et al. Maturity-associated variation in +sport-specific skills of youth soccer players aged 13-15 +years. Journal of Sports Science, 2005; 23:515-522. +12. Lee WJ, Lee SJ, Lee JJ. A study on the analysis of +stamina, anaerobic power and performance of varying +positions among high school soccer players. Journal of +Coach Development, 2013; 15:132-140. +13. Bangsbo J, Nørregaard L, Thorsø F. Activity profile of +competition soccer. Canadian Journal of Sport Science. +1991; 16:110-116. +14. Davis JA, Brewer J, Atkin D. Pre-season physiological +characteristics of English first and second division soccer +players. Journal of Sports Science, 1992; 10:541-547. +15. Ekblom B. Applied physiology of soccer. Journal of +Sports Medicine. 1986; 3:50-60. +16. Wisløff U, Helgerud J, Hoff J. Strength and endurance of +elite soccer players. Medicine and Science in Sports and +Exercise. 1998; 30:462-467. +17. Krustrup P, Mohr M, Amstrup T, Rysgaard T, Johansen J, +Steensberg A, et al. The yo-yo intermittent recovery test: +physiological response, reliability, and validity. Medicine +and Science in Sports and Exercise. 2003; 35:697-705. +18. Al-Hazzaa HM, Chukwuemeka AC. Echocardiographic +dimensions and maximal oxygen uptake in elite soccer +players. Saudi Medical Journal. 2001; 22:320-325. diff --git a/subfolder_0/THE EFFECT OF YOGA PRACTICE ON PROPRIOCEPTION IN CONGENITALLY BLIND STUDENTS.txt b/subfolder_0/THE EFFECT OF YOGA PRACTICE ON PROPRIOCEPTION IN CONGENITALLY BLIND STUDENTS.txt new file mode 100644 index 0000000000000000000000000000000000000000..2bb55c07ce25c121927cc0be0f7dcacd03c4f3cc --- /dev/null +++ b/subfolder_0/THE EFFECT OF YOGA PRACTICE ON PROPRIOCEPTION IN CONGENITALLY BLIND STUDENTS.txt @@ -0,0 +1,24 @@ +THE EFFECT OF YOGA PRACTICE ON PROPRIOCEPTION IN +CONGENITALLY BLIND STUDENTS + +Soubhagyalaxmi Mohanty, Balaram Pradhan, R Nagathna + +ABSTRACT + +Mobility of the visually impaired (VI) requires greater proprioception. Yoga practice has been +shown to improve proprioception in normal sighted children and may therefore be expected to do +so in VI students. To study the effect of yoga practice on proprioception in VI students. In a wait- +listed two-armed-matched case–control study, 54 (28 yoga, 26 control) VI students of both genders +aged 10–19 years from two blind schools were assessed for proprioceptive function on a +kinesthesiometer on the 1st and 30th days. The yoga group practiced a specific yoga module for +1½ hr daily, which included a complete spectrum of yoga activities. The control group had no +intervention. Baseline data matched between groups on all variables. There was a significant +decrease in error score of proprioceptive sense measurement at 20° and 120° positions of the right +elbow within the yoga group, whereas significant difference between the groups at 120° position +of the right elbow. Overall, the yoga group showed improvements at all six positions measured, +and similarly, their percentage improvements were greater than controls in all six positions. Sign +tests yielded p = (1/64) < 0.016 against null hypotheses, indicating that yoga generally improves +proprioception in blind children, significantly outperforming no-intervention. In contrast, only 3 +of the 12 t-tests reached significance. The yoga module used may help improve proprioceptive +function in VI children. Further studies are necessary to refine details of this result. + diff --git a/subfolder_0/The Effect of Add-on Yogic Prana Energization Technique.txt b/subfolder_0/The Effect of Add-on Yogic Prana Energization Technique.txt new file mode 100644 index 0000000000000000000000000000000000000000..cfd94bbc0435a64f55c10883b4aa4f9231d33f3e --- /dev/null +++ b/subfolder_0/The Effect of Add-on Yogic Prana Energization Technique.txt @@ -0,0 +1,712 @@ +Original Articles +The Effect of Add-on Yogic Prana Energization Technique +(YPET) on Healing of Fresh Fractures: +A Randomized Control Study +Pragati Oswal, MSc, +1 Raghuram Nagarathna, MD, +1 John Ebnezar, MBBS, DNB, +2 +and Hongasandra Ramarao Nagendra, ME, PhD3 +Abstract +Objectives: The objective was to study the effect of the add-on yogic prana energization technique (YPET) on +healing of fresh fractures. +Materials and methods: Thirty (30) patients (22 men and 8 women) between 18 and 55 years with simple extra- +articular fractures of long and short bones were selected from the outpatient department of Ebnezar Orthopaedic +Centre and Parimala Speciality Hospital, Bengaluru. They were randomized into yoga (n ¼ 15) and control +(n ¼ 15) groups. Compound, complicated, pathologic fractures, old fractures, and those associated with dislo- +cations were excluded. Both groups received the conventional plaster of paris immobilization of the fracture site +as the primary treatment. The yoga group, in addition, practiced YPET twice a day (30 minutes/session) for +2 weeks using taped audio instructions after learning under supervision for 1 week. YPET is an advanced yoga +relaxation practice that involves breath regulation, chanting, and visualization, which according to yogic science +revitalizes the tissues by activating the subtle energies ( prana) within the body. Both the groups were assessed on +the 1st and 21st day by the Numerical Pain Rating Scale for pain (NRS), tenderness (0–4), swelling (0–4), fracture +line density (1–4), and the bridging of cortices (1–4). +Results: Two (2) groups were matched on all variables. The Wilcoxon test showed significant improvement in +both groups on all variables. Pain reduction (NRS) was better ( p ¼ 0.001 Mann–Whitney test) in the YPET group +(94.5%) than in the control group (58.6%); Tenderness reduced ( p ¼ 0.001) better in the YPET group (94.4 %) than +in the control group (69.12%); Swelling reduced by 93% in the YPET group and by 69.4% in controls (between- +groups p ¼ 0.093, i.e., nonsignificant); increase in fracture line density was better ( p ¼ 0.001) in the YPET group +(48%) than in the control group (18.25%). The number of cortices united was significantly better ( p ¼ 0.001) in the +YPET group (81.4%) than in controls (39.7 %). +Conclusions: Add-on yoga-based YPET accelerates fracture healing. +Introduction +B +one fractures represent a global medical challenge for +health care administrations, orthopedic care providers, +and patients alike, as millions of people across the world are +afflicted with these injuries annually.1 In fact, of the estimated +6.2 million fractures occurring annually in the United States, +between 5% and 10% exhibit either delayed healing or non- +union.1 Even those fractures that heal ideally without compli- +cations can take months to heal. During this time of treatment +and recovery, there is a significant burden in terms of socio- +economic costs, personal costs, and patient’s quality of life.2 +It is estimated that on an average day, any large hospital +in India treats 75 fresh fractures cases, out of which at least +5–8 require operative intervention.2 About 500–700 cases of +nonunions and infected nonunions are treated per year.2 +Each metropolitan city has a number of such hospitals; thus, +India has to deal with an enormous burden of fresh fractures +and complicated trauma.2 Due to significant repercussions of +untimely fracture healing, substantial research has sought to +elucidate the effectiveness of adjunctive therapies for accel- +erating fresh fracture healing.1 +Several adjunctive therapies have been tried in cases of +delayed fracture healing, of which very few have been +1Division of Yoga and Life-Sciences, Swami Vivekananda Yoga Research Foundation (SVYASA), Bengaluru, India. +2Ebnezar Orthopaedic Centre, Parimala Speciality Hospital, Bengaluru, India. +3Swami Vivekananda Yoga Research Foundation (SVYASA), Bengaluru, India. +THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE +Volume 17, Number 3, 2011, pp. 1–6 +ª Mary Ann Liebert, Inc. +DOI: 10.1089/acm.2010.0001 +1 +ACM-2010-0001-Oswal_1P +Type: research-article +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 1 +studied scientifically. Biophysical stimulations of the im- +mobilized fracture site using pulsed electromagnetic fields +(PEMFs),3 low-intensity pulsed ultrasound stimulation (LI- +PUS),4 and extracorporeal shock wave therapy (ESWT)5 have +been found effective. Delima and Tanna3 found an 82.5% suc- +cess rate with PEMFs for recalcitrant nonunion of long bones. +In a study by Dijkman et al.4 on low-intensity pulsed ultra- +sound for nonunions, healing rates averaged 87% (range +65.6%–100%) among eight trials wherein the mean time to +healing was 146.5 days (range 56–219 days). In their review on +ESWT, Petrisor et al.5 found a 72% union rate overall for non- +unions or delayed unions, and a 46% relative risk reduction in +nonunions when it is used for acute high-energy fractures. +Yoga, an ancient science that provides a holistic approach, +has been investigated by researchers for its application in +therapy over the last 5 decades with several publications on +its efficacy in management of chronic pain6 and wound +healing.7 A randomized control trial in an intensive resi- +dential weeklong integrated yoga program6 showed a re- +duction in chronic low-back pain in the yoga group by +48.76% compared to 8.09% in the control group. Yoga was +found to be effective for patients undergoing surgery for +early operable breast cancer7 as there was a rapid healing of +the surgical wounds, as evidenced by shorter intervals for +suture removal (95% confidence interval [CI] ¼ 0.23–4.6) and +a decrease in the duration of hospital stay (95% CI ¼ 0.44–2.1) +following surgery in the yoga group as compared to controls. +Yoga-based yogic prana energization technique (YPET) is +an advanced yoga relaxation practice that involves breath +regulation, chanting, and visualization. According to the +traditional yoga texts,8 all these practices are meant to revi- +talize the tissues and restore their healthy functioning. Prana, +the term used by yoga masters of India, seems to be syn- +onymous to qi referred to by the Chinese masters of qigong +therapy. Zin and Jinding9 +AU1 c +demonstrated that the amount and +density of callus formation was significantly higher in +emitted +AU2 c +qi group compared to the control group in experi- +mentally induced fractures in rabbits.9 There are no studies +that have explored the role of add-on yoga to conventional +management in acute traumatic conditions such as fracture. +Materials and Methods +Subjects +Thirty (30) subjects of both sexes ages 18–55 years who sat- +isfied the selection criteria were allotted to experimental YPET +and control groups, using a random-number table generated +on www.randomizer.com. Concealed envelopes were used for +allocation to avoid selection bias. The inclusion criteria were (1) +simple fractures, (2) fractures of the long and short bones (ex- +cluding femur) requiring conservative (nonsurgical) treatment, +(3) extra-articular fractures, (4) age 18–55 years, and (5) literate +AU3 c +patients. The exclusion criteria were (1) compound fractures, +(2) intra-articular fractures, (3) cancellous bone fractures, (4) +fractures with multisystem injuries, (5) old fractures, (6) frac- +tures with vascular and neurological complications, (7) path- +ological fractures, and (8) fracture dislocations. +Source of subjects +All patients were selected from the outpatient department +of Ebnezar Orthopaedic Centre and Parimala Speciality +Hospital, Bengaluru. +Ethical clearance +The study was approved by the institutional review board +(IRB) that consisted of unaffiliated, impartial members as per +the criteria for an IRB as specified by the Indian Council of +Medical Research, and the ethical clearance for the project +was obtained from the ethical committee of Swami Viveka- +nanda Yoga Anusandhana Samsthana. Signed informed +consent was obtained from all of the patients. +Design +This was a prospective, randomized control two-group +study to assess the efficacy of add-on YPET on healing of +simple fractures. Thirty (30) subjects who satisfied the se- +lection criteria and signed informed consent were random- +ized into yoga and control groups. Both groups were treated +by the same orthopedic surgeon by the conventional im- +mobilization procedure using plaster of paris cast with ad- +vice on the necessary precautions such as general exercise, +care of the immobilization material, etc. All were prescribed +nonsteroidal anti-inflammatory agents twice a day for 3–5 +days and were advised to report to the center if there were +any unusual swelling or complications. +The yoga group was asked to come to the center for 30 +minutes daily for 7 days for training in YPET. Following this, +they were advised to practice YPET twice a day for 3 weeks +by using prerecorded instructions on an audio CD. The +compliance was monitored with the help of a booklet pro- +vided to the subjects in which they checked off the box im- +mediately after their practice of YPET twice a day. Phone +calls by the therapist to the patient once in 3 days ensured the +regularity. This was further checked when they came for a +follow-up check at the end of the second and the third week +for follow-up. +Blinding and masking +The coded data sheets of all measures were withheld for +assessments at the end of the study to prevent assessment +bias. The radiologist and the statistician were blind to the +group. +Intervention +YPET 1 +This technique involves six steps that progressively dee- +pen the internal awareness and helps in developing volun- +tary mastery over the subtle energy ( prana) system of the +body. According to the science of ashtanga yoga of patanjali, +pranayama (voluntary slowing of breath rate) is one of the +eight techniques that help in achieving mastery over the +mind–body complex (Swasa praswasayoh gatir vichedah pra- +nayamah). Through this, one develops the ability to perceive +and master the subtle energy system ( pranamaya kosha) that +is responsible for all the physiologic activities (that makes us +live) of the material body (annamaya kosha). Yoga therapy +works on the principle that the mind (chitta) can manipulate +the body functions through changing the quantity of prana +that flows to an organ. This is possible only by developing an +introspective ability to first channelize the mind through +intense focusing on a single thought that is fixed on the zone +to be healed (desa bandha chittasya dharanam). The next step is +2 +OSWAL ET AL. +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 2 +to let go the effort and maintain the flow of the same thought +( pratyaya ekatanata) and then move on to samadhi (i.e., be- +come the object by dropping the observer, the ‘‘I’’) (tadeva +artha matra nirbhasam swarupa shunyamiva samadhi). This is +said to bring about the necessary mastery and intended +healing. This concept was used in designing YPET wherein +the patient directs their prana in the form of healing white +light to the fracture site and gets lost into samadhi. +T1 c +Table 1 +gives the steps of instructions for the practice of YPET. +Assessments +Clinical parameters +Pain. +Pain was measured using a Numerical Pain Rating +Scale13 (NRS). NRS, the most widely used tool for assessing +pain, requires patients to rate their pain from 0 to 10, with 10 +being the most severe. +Tenderness. +Tenderness was assessed clinically and +marked according to the standard tenderness grades:14 0— +nil, 1—just a suspect, 2—winces, 3—winces and withdraws, +4—doesn’t allow to touch. +Swelling. +Swelling was assessed clinically according to +these grades: 0—none, 1— mild, 2— moderate, 3—severe. +Radiologic parameters +Fracture line density. +Following Sinha and Goel’s15 ex- +ample, radiologic evaluation was carried out by the assess- +ment of a standard x-ray film, assigning a score based on the +following criteria: 1— fracture line clearly visible, 2—hazy, +3—dense, 4—bony dense. +Cortices.2 +The radiologist looked for the number of +broken cortices (1–4) visible on the first and the 21st day. +Data Analysis +The data were analyzed using SPSS 10.00. The data were +tested for normalcy using Kolmogorov and Smirnov test. As +the data were not normally distributed, Wilcoxon signed- +ranks test and Mann–Whitney test were used for within- and +between-groups comparison, respectively. +Results +b T2 +Table 2 shows the demographic and baseline details of +subjects in the 2 groups. There were 22 men and 8 women. +One (1) case was dropped as he would not practice YPET +regularly. The mean age of the control group was 34.73  8.39 +years and for the YPET group was 34.35  13.88 years. The +baseline characteristics of the 2 groups were matched +( p > 0.05 Mann–Whitney test) on all five outcome measures. +b T3 +Table 3 shows the results after the intervention. +NRS was reduced from 9  1.30 to 3.73  1.48 (58.55%) in +controls and 9.07  1.32 to 0.5  0.75 (94.48%) in YPET groups, +with a faster reduction in the YPET group ( p < 0.001). +Tenderness was reduced from 3.66  0.48 to 1.13  0.35 +(69.12%) in controls and from 3.78  0.57 to 0.21  0.42 +Table 1. Steps for Yogic Prana Energization Technique +Step 1—Prayer: Become a child and pray to all-pervading mother prana +Step 2—Relaxation to perceive the prana + Phase I: Relax the lower limbs part by part up to the navel. Inhale deeply and chant AAAA. Repeat 5 times. Feel the +vibrations and guide them to the affected area. + Phase II: Now relax the torso from navel up to the neck. Inhale deeply and chant UUU. Repeat 5 times. Feel the vibrations +and guide them to the affected part. + Phase III: Now relax the head and all sense organs in the face. Inhale deeply and chant MMM. Repeat 5 times. Feel the +vibrations and guide them to the affected part. +Step 3—Visualization and directing the prana through breathing + Now visualize and fix the mind on a mass of soothing, white, glowing, pleasant, beautiful divine light entering your +body from all around. + Visualize the whole body cooperating in the process of healing; project the healing white light to the affected area as you +breathe in; feel all toxins going out as you breathe out to restore health of the fractured area. Enjoy the site completely +surrounded by the white light and absorbing the white light each time you breathe in. + Continue to stay on in the same mood. As your level of relaxation and pleasant feeling increases, you may start +experiencing the spontaneous healing prana as you project it on to the fracture site. +Step 4—Effortless flow of imagery + Don’t lose focus now. Concentrate on the white light entering the affected area with each breath and throwing the pain +out of the body with the out breath. + Enjoy the softness and the soothing effect of prana on the tissues around the fracture site. + Now let go all effort and retain the single thought ‘‘focused soothing white prana light focused effortlessly on the fracture +site.’’ +Step 5—Union + Merge in the white light, become one with the white light, enjoy the oneness; and let go. Relax ………relax………and +relax. +Step 6—Prayer of gratitude + Breathe normally. Thank the universal prana energy. Thank the prana within for its healing grace. Thank your personal +deity. Let go and slowly open the eyes. Try to recollect and retain this mood of softness and the subtle energy pervading +like a light all over the body several times in the day. +YOGIC PRANA ENERGIZATION IN HEALING FRACTURES +3 +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 3 +(94.44%) in YPET groups, with a more significant reduction +in the YPET group ( p < 0.001). +Swelling reduced from 1.73  0.70 to 0.53  0.63 in controls +(69.36%) and from 2.00  0.67 to 0.14  0.53 (93%) in the +YPET group. There was no significant difference between +groups ( p ¼ 0.093). +Fracture line density increased from grade 1 (clearly visi- +ble) to 1.73  0.45 (18.25%) in the control group and from 1 to +2.92  0.26 (48%) in YPET groups, with better healing in the +YPET group ( p < 0.001). +Number of cortices broken in the control group reduced +from 3.53  0.63 to 2.13  0.92 (39.88%, p ¼ 0.001); in the +YPET +group +it +reduced +from +3.5  0.65 +to +0.64  0.84 +(81.4%, p < 0.001), with significant difference between groups +( p ¼ 0.001). +Discussion +This two-armed prospective randomized control study on +30 patients explored the effect of the YPET as an add-on to +conventional nonsurgical immobilization of simple fresh +fractures. The experimental group practiced YPET 30 min- +utes, twice daily for 3 weeks. The results showed signifi- +cantly better healing ( p ¼ 0.001 Mann–Whitney U test) in the +YPET group than in the control group. +Pain +The pain reduced in both of the groups, with better re- +duction in the YPET group (94.5%) than in the control group +(58.6%), pointing to better pain reduction after YPET. As this +is the first study on YPET and there are no earlier studies +using similar interventions in fracture management, an at- +tempt is made to compare the current results with other +published add-on therapies such as ESWT. In a two-armed +randomized control study6 on 59 patients, the add-on ESWT +intervention showed lesser pain scores and weight-bearing +status than the control group ( p < 0.01) at all time points. +Tenderness +Both YPET and control groups improved with better +reduction in tenderness in the YPET group ( p < 0.001 Mann– +Whitney U test) by 3 weeks. In a randomized placebo- +controlled trial,13 patients with tibial nonunions were included +for assessment of pain and tenderness. An electrical stimula- +tion device was used for 24 weeks; no treatment other than the +device and a cast was given. No difference in union rates, pain, +or tenderness was found between the active and dummy de- +vice groups. +Table 2. Demographic Data +YPET (N ¼ 14) +Control (N ¼ 15) +Age +34.35  13.88 +34.73  8.39 +Range +17–53 +21–46 +Men +10 +11 +Women +4 +4 +Occupation +Skilled professionals +5 +5 +Semiskilled/student +6 +7 +Housewives +2 +2 +Others +1 +1 +Bones fractured +Tibia +2 +1 +Fibula +1 +0 +Metatarsal bones +5 +6 +Clavicle +1 +0 +Radius +4 +4 +Ulna +1 +2 +Metacarpals +1 +2 +No. of cortices broken +2 +1 +1 +3 +5 +5 +4 +9 +9 +YPET, yogic prana energization technique. +Table 3. Results After 3 Weeks of Intervention in Yogic Prana Energization Technique +and Control Groups +Within groups +Yoga +Control +Between +groups +Variable +Pre +(mean  SD) +Post +(mean  SD) +% +Change +p-value +Wilcoxon +Pre +(mean  SD) +Post +(mean  SD) +% +Change +p-value +Wilcoxon +Mann– +Whitney +Pain +9.07  1.32 +0.5  0.75 +94.48% +p ¼ 0.001 +9  1.30 +3.73  1.48 +58.55% +p ¼ 0.001 +p < 0.001 +CI (LB–UB) +(8.3–9.83) +(0.06–0.93) +(8.27–9.72) +(2.91–4.55) +Tenderness +3.78  0.57 +0.21  0.42 +94.44% +p ¼ 0.001 +3.66  0.48 +1.13  0.35 +69.12% +p < 0.001 +p < 0.001 +CI (LB–UB) +(3.45–4.11) +(0.03–0.46) +(3.39–3.93) +(0.93–1.32) +Swelling +2  0.67 +0.14  0.53 +93% +p ¼ 0.001 +1.73  0.70 +0.53  0.63 +69.36% +p ¼ 0.001 +p ¼ 0.093 +CI (LB–UB) +(1.6–2.39) +(0.16–0.45) +(1.34–2.12) +(0.17–0.88) +Fracture line +1 Constant +2.92  0.26 +48% +Quality +p < 0.001 +1 Constant +1.73  0.45 +18.25% +quality +p < 0.001 +p < 0.001 +CI (LB–UB) +(2.77–3.08) +(1.47–1.98) +Cortices +broken +3.5  0.65 +0.64  0.84 +81.4% +p < 0.001 +3.53  0.63 +2.13  0.92 +39.88% +p ¼ 0.001 +p < 0.001 +(3.12–3.87) +(0.16–1.13) +(3.17–3.88) +(1.63–2.64) +SD, standard deviation; CI (LB–UB), confidence interval (lower bound–upper bound). +4 +OSWAL ET AL. +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 4 +Swelling +Both YPET and control groups improved ( p < 0.001) with +nonsignificant difference between groups. This was probably +because the swelling had disappeared completely in most of +the cases in both groups by 3 weeks. There are no similar +studies that had included assessment of swelling as an out- +come variable. +Fracture line density and breaks in cortices +Both YPET and the control groups showed increase in +density +and +reduction +in +number +of +broken +cortices +( p < 0.001), with significant difference between groups indi- +cating a better radiological healing after YPET. +Data are available on the efficacy of LIPUS therapy in +decreasing the healing time. In a study of 67 closed or grade +1 open diaphyseal fractures of the tibia, treated by closed +reduction and cast immobilization, the time taken for +bridging of all four cortices was significantly less for the 33 +fractures treated with LIPUS than for the 34 treated with +placebo (114  7.5 days LIPUS versus 182  15.8 days pla- +cebo, p ¼ 0.0002).14 +One (1) published study on qigong therapy by Zin and +Jinding9 demonstrated that the amount and density of callus +formation was significantly higher in the experimental +(emitted qi) group compared to the control group in experi- +mentally induced fractures in rabbits.9 It may be hypothe- +sized, based on the available literature, that there are three +mechanisms to explain the processes involved in rapid +healing observed in this study: (1) YPET may have similar +effects to qigong therapy, where the concept of projecting the +qi energy to the fracture site by an external healer is practiced +widely in China. (2) Research indicates that the techniques +included in the YPET program, such as progressive relaxa- +tion, guided visualization (white light projected to the af- +fected area), suggestion, and meditation, could affect the +hypothalamic–pituitary–adrenal (HPA) axis,15 sympathova- +gal balance, and probably oxytocin release.16 All of these +could affect wound17 and bone healing,16,18 pain percep- +tion,19 and stress.17 Guided imagery has also been associated +with reduced stress, reduced cortisol, and enhanced wound +healing.17 There are various studies on the effect of medita- +tion on the HPA axis.15 It has been suggested that oxytocin +(OT) can become conditioned to psychologic state or imag- +ery, and therefore it may also mediate the benefits attributed +to therapies such as hypnosis or meditation.16 Stripolli et al. +report that OT, a primitive neurohypophyseal hormone, +hitherto thought solely to modulate lactation and social +bonding, is a direct regulator of bone mass.18 The techniques +included in YPET probably enhance parasympathetic tone +and may release OT which could enhance bone healing. (3) +Hypnotic suggestion has been shown to induce forearm +vasodilation and blood flow while decreasing vascular re- +sistance.20 Hypnosis is a form of focused attention. It may be +hypothesized that the suggestion of white light projected to +the affected area in YPET has a similar effect and culminates +in enhanced blood flow at the fracture site. +Several confounding variables such as site of the fracture, +type of fracture, time lapsed before seeking help, diet, ac- +tivity level, and the basic nutritional status may all have +influenced the rate of healing. Many more randomized +control studies controlling for all variables may be necessary +before recommending this practice routinely in clinical +practice. +Limitations +Small sample size, short duration of study, lack of an ac- +tive control intervention, and assessments done using a +simple roentgenographic image repeated at two points could +be considered limitations of this study. +Strength and suggestions +Randomized design with well-matched groups with sim- +ple fractures recruited from one orthopedic center with the +same surgeon’s protocol of management for both groups. +b AU4 +Results showing significant difference between groups even +with a small sample size is another useful contribution. +Future studies on cases of nonunion in different ethnic +groups are recommended. +Conclusions +In a randomized controlled study of simple fractures, +patients given add-on YPET showed significant improve- +ments in ratings of pain, tenderness, fracture line density, +and bridging of cortices compared with those given standard +treatment alone. +Acknowledgments +We thank the hospital administration of Ebnezar Ortho- +pedic Centre, Parimala Speciality Hospital, Bengaluru for +funding the study. We are grateful to the biostatistician +Dr. R. Kulkarni for his help. +Disclosure Statement +No competing financial interests exist. +References +1. Mundi R, Petis S, Kaloty R, et al. Low-intensity pulsed ul- +trasound: Fracture healing. Indian J Orthop 2009;43:132–140. +2. Arora A, Agarwal A, Gikas P, Mehra A. Musculoskeletal +training for orthopaedists and nonorthopaedists: Experi- +ences in India. Clin Orthop Rel Res 2008;466:2350–2359. +3. Delima DF, Tanna DD. Role of pulsed electromagnetic fields +in recalcitrant non-unions. J Postgrad Med 1989;35:43. +4. Dijkman BG, Sprague S, Bhandari M. Low-intensity pulsed +ultrasound: Nonunions. Indian J Orthop 2009;43:141–148. +5. Petrisor BA, Lisson S, Sprague S. Extracorporeal shockwave +therapy: A systematic review of its use in fracture manage- +ment. Indian J Orthop 2009;43:161–167. +6. Tekur P, Singphow C, Nagendra HR, Nagrathna R. Effect of +short-term intensive yoga program on pain, functional dis- +ability and spinal flexibility in chronic low back pain: A +randomized control study. J Altern Complement Med +2008;14:637–644. +7. Rao RM, Nagendra HR, Raghuram N, et al. Influence of +yoga on postoperative outcomes and wound healing in early +operable breast cancer patients undergoing surgery. Int J +Yoga 2008;1:33–41. +8. Rodriguez T, Ram K. Pure yoga: A translation from the +Sanskrit into English of the tantric work, The Gher- +andasamhita, with a guiding commentary by Yogi Prana- +vananda. Delhi: Motilal Banarasidass, 2003. +YOGIC PRANA ENERGIZATION IN HEALING FRACTURES +5 +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 5 +9. Zin J, Jinding J. Healing of experimentally induced fractures +in rabbits aster +AU5 c +(Qigong–a controlled study). In: Proceedings +of the First World Conference for Academic Exchange of +Medical Qigong. Beijing, 1988:13. +AU6 c +10. Krebs EE, Carey TS, Weinberger M. Accuracy of the Pain +Numeric Rating Scale as a screening test in primary care. +J Gen Intern Med 2007;22:1453–1458. +11. Ebnezar J. Textbook of Orthopaedics. 3rd ed. New Delhi: +Jaypee, 2006. +12. Sinha S, Goel SC. Effect of amino acids lysine and arginine +on fracture healing in rabbits: A radiological and histomor- +phological analysis. Indian J Orthop 2009;43:328–334. +13. Simonis RB, Parnell EJ, Ray PS, Peacock JL. Electrical treat- +ment of tibial non-union: A prospective, randomised, +double-blind trial. Injury 2003;34:357–362. +14. Emami A, Larsson A, Petrn-Mallmin M, Larsson S. Serum +bone markers after intramedullary fixed tibial fractures. Clin +Orthop Rel Res 1999;368:220–229. +15. Kenneth G, Robert H, Sanford I, et al. Psychosocial stress +and cardiovascular disease part 2: Effectiveness of the +Transcendental Meditation Program in treatment and pre- +vention. Behav Med 2002;28:106–123. +16. Uvna +¨s-Moberg K. Oxytocin may mediate the benefits of +positive +social +interaction +and +emotions. +Psychoneur- +oendocrinology 1998;23:819–835. +17. Holden-Lund C. Effects of relaxation with guided imagery +on surgical stress and wound healing. Res Nurs Health +1988;11:235–244. +18. Tamma R, Colaianni G, Zhu LL, et al. Oxytocin is an ana- +bolic bone hormone. Proc Natl Acad Sci U S A 2009;106: +7149–7154. +19. Lang EV, Joyce JS, Spiegel D, et al. Self-hypnotic relaxation +during interventional radiological procedures: Effects on +pain perception and intravenous drug use. Int J Clin Exp +Hypn 1996;44:106–119. +20. Casiglia E, Rossi A, Tikhonoff V, et al. Local and systemic +vasodilation following hypnotic suggestion of warm tub +bathing. Int J Psychophysiol 2006;62:60–65. +Address correspondence to: +Raghuram Nagarathna, MD +Division of Yoga and Life-Sciences +b AU7 +Swami Vivekananda Yoga Research Foundation +No. 19, Eknath Bhawan, Gavipuram Circle +Kempegowda Nagar +Bengaluru 560019 +India +E-mail: rnagaratna@svyasa.org +6 +OSWAL ET AL. +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 6 +AUTHOR QUERY FOR ACM-2010-0001-OSWAL_1P +AU1: Cite refs. 10, 11, 12 in order in text. +AU2: Check word ‘‘emitted’’; meaning unclear here. +AU3: Is ‘‘literate’’ correct here? +AU4: Please complete this sentence. +AU5: In ref. 9, verify ‘‘aster’’. +AU6: Add publisher in ref. 9. +AU7: Added Division name here, as in affiliation line, OK? +ACM-2010-0001-Oswal_1P.3d +01/27/11 +10:39am +Page 7 diff --git a/subfolder_0/The Effect of Anapanasati Meditation on Depression A Randomized Control Trial..txt b/subfolder_0/The Effect of Anapanasati Meditation on Depression A Randomized Control Trial..txt new file mode 100644 index 0000000000000000000000000000000000000000..333e68ccce9fb851f60c8882f0a7392c564fc24b --- /dev/null +++ b/subfolder_0/The Effect of Anapanasati Meditation on Depression A Randomized Control Trial..txt @@ -0,0 +1,488 @@ + +102 +Journal of Ayurvedic and Herbal Medicine 2018; 4(3): 102-105 + +Clinical Study +ISSN: 2454-5023 +J. Ayu. Herb. Med. +2018; 4(3): 102-105 +© 2018, All rights reserved +www.ayurvedjournal.com +Received: 17-07-2018 +Accepted: 20-09-2018 + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +*Corresponding author: +P Venkata Giri Kumar +Division of Yoga and Physical +Sciences, +S-VYASA +Yoga +University, Vivekananda Road, +Kalluballu Post, Jigani, Anekal, +Bengaluru – 560105, Karanataka, +India +Email: girikumar.pv@gmail.com +The Effect of Anapanasati Meditation on Depression: A +Randomized Control Trial +B Sivaramappa1, Sudheer Deshpande2, P Venkata Giri Kumar3, H.R. Nagendra4 +1 Research Scholar, Division of Yoga and Physical Sciences, S-VYASA Yoga University, Bengaluru, Karnataka, India +2 Joint Director, VYASA, Eknath Bhavan, Bangalore, Karnataka, India +3 Research Scholar, S-VYASA Yoga University, Bengaluru, Karnataka, India +4 Chancellor, S-VYASA Yoga University, Bengaluru, Karnataka, India + +ABSTRACT +Aim: To study the effect of Anpanasati Meditation on individuals with moderate depression. Methods: A total of 115 +participants who were willing to participate in the study were recruited for the study. Anapanasati meditation was used +as an intervention. The participants were divided into two groups experiment and control groups. Experiment group +had 59 persons performing Anapanasati meditation and Control group had 56 persons not performing any type of +meditation. The experiment group practiced one hour of Anapanasati meditation daily under the supervision of experts +for six months and continued their daily routine and control group was not given any intervention, but they continued +their daily routine. Beck Depression Inventory II is used to assess the depression level. Results: The BDI score before +and after Anapanasati meditation was analysed for both experiment and control groups using Paired Samples T test. +The experiment group has shown significant reduction in the BDI (P < 0.05) score after the intervention whereas in the +control group the reduction in BDI score was not significant. Conclusion: This study has shown that after six months of +intervention, the subjects with moderate depression who practiced Anapanasati meditation had a significant decrease +in their Depression score and the control group has not shown significant change in the depression score. +Keywords: Anapanasati meditation, Beck Depression Inventory, Mindfulness. +INTRODUCTION +Meditation is well known to India and it is one of eight limbs (Yama, Niyama, Asana, Pranayama, +Pratyahara, Dharana, Dhyana and Samadhi) in Patanjali Yoga. There are number of definitions for +meditation and as per western definition meditation is termed as a set of self-regulatory practices, the +focus of which is to train the attention and awareness such that the mental processes will be under +control and the concentration will be developed [1]. Felipe in his systematic review has given a similar +definition for meditation and has termed meditation as a set of psychosomatic practices which involve +training and regulating attention towards the interoceptive foci such as breadth or other parts of the +body and exteroceptive foci such as statue, flame or images [2]. +In the recent past there has been increasing research interest in understanding the therapeutic benefits of +meditation for psychological disorders such as anxiety, depression and as per the recent studies +meditation has shown significant positive results in psychological disorders [3]–[5]. In another study authors +have reported that self-rated mental health has improved with meditation though there were no +significant changes in primary cognitive functions or physiological measures [6]. In similar lines the +preliminary results of automatic self-transcending meditation on late life depression are positive and +encouraging [7]. Although the therapeutic benefits of meditation are quite impressive with research +results, the studies on the effect of meditation on brain have shown considerable discrepancies in their +results may be due to lack of standardized designs for studying the meditation effects [8]. The studies were +done using Electroencephalogram (EEG), evoked potential, event related potential, neuroimaging +techniques such as Positron Emission Tomography (PET), functional Magnetic Resonance Imaging (fMRI). +Considering the clinical utility of meditation practice there is a need for in depth studies to understand the +effects of meditation on the brain. +There are various meditation techniques such as Yoga, Tai Chi, Qigong, Jewish Hassidic and Kabalistic +dillug and Tzeruf, Islamic Sufism’s zikr but the Mindfulness and Transcendental meditation techniques +have gained significant research interest [1]. The earlier studies have considered different meditation +techniques but there were no studies done with Anapanasati meditation, a form of Mindfulness +meditation. In Pali ‘Ana’ means inhaling, ‘Apana’ means exhaling and ‘Sati’ means being with. Anpanasati +meditation is the name of the meditation practice adopted by Goutam Buddha and it is nothing but mere + +103 + +observation of one’s own breath ie., inhaling and exhaling [9]. In this +study we aimed at studying the effect of Anapanasati meditation on +the individuals with moderate depression when assessed with Beck +Depression Inventory II. +METHODS +Subjects +The subjects were selected from Pyramid Valley International +Bangalore and Pyramid Spiritual Science Academy, Koramangala, +Bangalore. A total of 115 subjects who were willing to participate in the +study were selected for the study. The age group ranged between 20 +and 65 years. +Inclusion Criteria +The individuals with mild to moderate depression were included in the +study. Both males and females within the age group of 20 to 65 years +were included in the study. +Exclusion Criteria +Individuals who have been diagnosed with diabetes, cancer, +hypertension were excluded from the study. +Ethical Clearance +Signed informed consent was obtained from all the subjects. The +institutional ethical committee of the parent institution (S-VYASA) had +cleared the project proposal. +Design +This is a prospective random control design. The participants were +divided into two groups experiment and control. The subjects selected +for study were randomly allotted into two groups by using random +number generator program. A total of 59 participants were included in +experiment group and 56 participants were included in control group. +The invigilators coded and saved the answered questionnaires after the +study. A person not involved in group formation evaluated the coded +answer sheets. A person who was not involved in this study decoded +the answer sheets only after noting the scores before and after data +was completed. +Beck Depression Inventory II [10], [11] is used as the scale for measuring +the effect of intervention. BDI is a 21-point questionnaire on a 4-point +scale with each question taking points from 0 to 3 such that total score +lies between 0-63. A score of 0-9 is considered as no or low depression, +10-18 as mild depression, 19-29 as moderate depression and 30-63 as +severe depression. The subjects were to read each statement and +select one statement in each group that best describe the way they +have been feeling during the past few weeks, including that day. Earlier +studies have shown that BDI has significant correlation with Hamilton +depression rating scale and other scales [12]. The consent form was +distributed to all the participants who were willing to participate in the +study. After reading the instructions the participants willingly +consented to participate in the study duly signing the consent forms. +Intervention +The Experiment Group was practicing Anapanasati Meditation, one +hour daily along with their routine duties and the Control Group did +not practice meditation but they were asked to continue their daily +routine. The Meditation classes were conducted six days a week for six +months under the supervision of experts. It was ensured that there +was no interaction between the groups during the entire period of six +months. The tests were administered on the first and last day of the +study. The subjects were accommodated at a quiet environment free +from distractions to fill up the questionnaires. The subjects were asked +to fill up the questionnaires with experts present for any clarification +and without consulting other subject while filling up the questionnaire. +Statistical Analysis +The data were analysed using SPSS Statistics Version 10. The data was +presented as mean ± standard deviation. The data was assessed for +normality using Kolmogorov-Smirnov test and BDI score was found to +be normal in both experimental and control groups. P value <0.05 is +considered statistically significant for all comparisons and the data +were reported to two significant figures. The statistical tests used were +Paired Samples T test for pre-post comparison within the groups. The +Cohen’s d effect size for assessing the effect of intervention was +computed as the ratio of the difference between means of experiment +and control groups to the pooled standard deviation. +RESULTS +The BDI score before and after the Anapanasati intervention was +analysed for both experiment and control groups using Paired Samples +T test as shown in Table 1. The experiment group has shown significant +reduction in the BDI (P < 0.05) score after the intervention whereas in +the control group the reduction in BDI score was not significant. +The pre and post BDI scores across age groups of Experiment and +Control groups were tabulated in Table 2. The pre and post BDI scores +of Experiment and Control groups across low, mild, moderate and +severe categories were tabulated in Table 3. +The Cohen’s d effect size was computed and it has taken a value of +1.38. + +Table 1: Paired Samples T Test +Group +N +BDI Score Pre + +BDI Score Post +P Value +CI +Experiment +59 +26.09 ± 8.98 +4.09 ± 6.08 +0.00* +[18.41, 24.1] +Control +56 +18.84 ± 13.47 +8.84 ± 13.84 +1.00 +[-1.78, 1,78] + +Data is represented as mean ± standard deviation +BDI: Beck Depression Inventory II +N: Number of Participants +Pre: Pre data taken before intervention +Post: Post data taken after intervention +*P Value significance at 0.05 level +CI : 95% Confidence Interval of the difference between pre and post BDI scores + + + + +J Ayu Herb Med ǀ Vol 4 Issue 3 ǀ July- September 2018 +104 +Table 2: BDI Score vs Age in Experiment and Control Groups +Age Group +Experiment Group +Control Group + +BDI Pre +BDI Post +BDI Pre +BDI Post +20-29 +19.5 ± 6.36 +6.37 ± 2.10 +17.86 ± 12.20 +16.93 ± 11.59 +30-39 +21.17 ± 5.67 +10.82 ± 7.71 +16.33 ± 17.61 +16.22 ± 18.16 +40-49 +25.96 ± 1.86 +6.95 ± 2.92 +18.33 ± 15.82 +18.30 ± 15.64 +50 and above +26.1 ± 4.05 +10.87 ± 4.57 +18.67 ± 13.63 +22.33 ± 18.35 + +Data is represented as mean ± standard deviation +BDI: Beck Depression Inventory II +BDI Pre: BDI Score before intervention +BDI Post: BDI Score after intervention + +Table 3: Pre and Post BDI Score across low/mild/moderate/severe categories +BDI Score +Experiment Group +Control Group + +BDI Pre (N1) +BDI Post (N2) +BDI Pre (N3) +BDI Post (N4) +0-9 +9 (1) +2.25 ± 2.63 (52) +3.19 ± 3.31 (16) +2.94 ± 3.26 (16) +10-18 +14.86 ± 1.83 (14) +14.0 ± 2.55 (5) +14.60 ± 2.17 (15) 14.87 ± 2.48 (15) +19-29 +23.92 ± 3.29 (24) 22 (1) +23.55 ± 3.1 (11) +21.70 ± 1.77 (10) +30-63 +35.20 ± 4.54 (20) 32 (1) +37.57 ± 4.85 (14) +37.87 ± 5.83 (15) + +Data is represented as mean ± standard deviation +N1: Number of participants before intervention in Experimental Group in each of the four categories +N2: Number of participants after intervention in Experimental Group in each of the four categories +N3: Number of participants before intervention in Control Group in each of the four categories +N4: Number of participants after intervention in Contro Group in each of the four categories +BDI Pre: BDI Score before intervention +BDI Post: BDI Score after intervention + +DISCUSSION +In this study the effect of Anapanasati meditation on the individuals +with mild to moderate depression was investigated and BDI score was +used for assessing the depression level. BDI score has been used in +many studies on depression and is well established scale for assessing +depression [13]–[15]. The BDI scores have significantly reduced in the +participants who have participated in Anapanasati meditation whereas +in control group there was there was no significant change in the BDI +score. +In Anapanasati, as the name indicates, there is only observation of +inhaling and exhaling and there is no interference of the breathing in +and out. It is just observation of breathing in and out and nothing else. +This is in a way ‘Sukha Prānāyāma’. Anapanasati translates as the +mindfulness (Sati) of inhalation (Ana) and exhalation (Apana) as a +result of an engaged observation of it. The Buddhist practice of +Anapanasati envisages the breathing exercises are almost similar to +those exercises taught in the Upanishads. In the Upanashids, we call +‘Prānāyāma’ where there is some forceful interference in inhaling and +exhaling. +The mindfulness meditation technique has gained significant research +interest and has shown positive results on depression [4]. The +Anapanasati +meditation +technique +comes +under +mindfulness +meditation technique as Sati in the name implies mindfulness or being +with the self and in our study we have seen that the depression levels +have reduced with Anapanasati meditation. The difference is that +earlier studies have used Hospital anxiety and depression scale- +subscale depression, 20 item Centre for Epidemiologic Studies- +depression scale, 17 item Hamilton depression scale whereas we have +used Beck’s depression inventory II for our study. In the experiment +group subjects were divided into four groups based on age (Table 2). +The average pre BDI scores of all age groups were moderate lying +between 19 to 29 with a gradual increase with the age. We have +observed that Anapanasati was effective in all the age groups as post +BDI score has changed from moderate to low after six months of +intervention. A similar analysis was done for control group but the +change in the BDI score was not that significant. At the end of six- +month intervention BDI score has shown significant change from mild, +moderate and severe depression levels to low depression level with +large effect size (Table 3) when compared to control group. Earlier +studies explain the therapeutic benefits of the mindfulness meditation +but this is the first time the effect of Anapanasati meditation was +studied on depression and the results were encouraging. +According to Delphi poll on future trends of psychotherapy, +mindfulness theories along with cognitive-behavioural, integrative and +multi-cultural theories are predicted to be increasingly used in the +next decade [16]. This emphasizes the importance of studying the +mindfulness meditation techniques in the line of psychotherapy and +we considered Anapanasati meditation, a mindfulness meditation +technique, to investigate its effect on depression. The initial study on +the effect of Anapanasati meditation on Electron Photonic Imaging +(EPI) parameters has shown that the stress parameter activation +coefficient (AC) and health parameter integral area (IA) have reduced +significantly [17]. In another study Lee et.al has shown that the +Anapanasati (Focussed Attention Meditation) is associated to attention +task performance [18]. As the results with Anapanasati meditation were +encouraging we aimed at investigating its effect on depression and the +BDI score in our study has reduced from moderate to low in meditators +compared to non-meditators. The results are of the initial study are +promising. +The current study has some limitations which need to be addressed in +future studies. Firstly the socio-economic status of the participants was +not recorded as part of the study and hence the results cannot be +generalized to a wider population. It is quite evident from the results +that Anapanasati meditation has reduced the BDI scores when +compared to control group but comparing them at the same or similar +socio-economic status would have brought in the strength to the study. +Secondly we have not measured general anthropometric and clinical +parameters such as height, weight, blood pressure, pulse rate etc. and +hence study lacks the strength in assessing the therapeutic benefits of +the intervention. + + +J Ayu Herb Med ǀ Vol 4 Issue 3 ǀ July- September 2018 +105 +CONCLUSION +In conclusion, the participants of Anapanasati meditation have shown +significant reduction in the depression score measured with Beck +Depression Inventory II. There was no such significant change in the +BDI score of control group. Anapanasati meditation is a form of +mindfulness meditation and Psycotherapy trends indicate that +mindfulness is increasingly used in the next decade which signifies the +importance of Anapanasati meditation. +Acknowledgements +I am thankful to all who willingly participated in this study and I +sincerely acknowledge their whole-hearted participation. I thank all +those who helped me to make this study and arrive at the results. +Funding +This research did not receive any specific grant from funding agencies +in the public, commercial or not-for-profit sectors. +REFERENCES +1. +R. Walsh and S. L. Shapiro, “The meeting of meditative disciplines +and western psychology: A mutually enriching dialogue,” Am. +Psychol., vol. 61, no. 3, pp. 227–239, 2006. +2. +B. Medsker, E. Forno, H. Simhan, C. Juan, and R. Sciences, “HHS +Public Access,” vol. 70, no. 12, pp. 773–779, 2016. +3. +A. Sharma, M. S. Barrett, A. J. Cucchiara, N. S. Gooneratne, and M. E. +Thase, “A Breathing-Based Meditation Intervention for Patients With +Major Depressive Disorder Following Inadequate Response to +Antidepressants,” J. Clin. Psychiatry, vol. 78, no. 01, pp. e59–e63, +2017. +4. +J. M. Greeson et al., “Decreased Symptoms of Depression After +Mindfulness-Based Stress Reduction: Potential Moderating Effects of +Religiosity, Spirituality, Trait Mindfulness, Sex, and Age,” J. Altern. +Complement. Med., vol. 21, no. 3, pp. 166–174, 2015. +5. +G. Groesbeck, D. Bach, P. Stapleton, K. Blickheuser, D. Church, and R. +Sims, “The Interrelated Physiological and Psychological Effects of +EcoMeditation,” vol. 23, pp. 1–6, 2018. +6. +B. S. Oken, H. Wahbeh, E. Goodrich, D. Klee, T. Memmott, and R. Fu, +“function or physiological measures,” vol. 8, no. 3, pp. 627–638, +2018. +7. +A. Vasudev et al., “A training programme involving automatic self- +transcending meditation in late-life depression: preliminary analysis +of an ongoing randomised controlled trial,” Br. J. Psychiatry Open, +vol. 2, no. 2, pp. 195–198, 2016. +8. +B. R. Cahn and J. Polich, “Meditation states and traits: EEG, ERP, and +neuroimaging studies,” Psychol. Bull., vol. 132, no. 2, pp. 180–211, +2006. +9. +Anapanasati Sutta : Mindfulness of Breathing (MN 118), translated +by Thanissaro Bhikku, Access to Insight (BCBS Edition), 30 November +2013, +http://www.accesstoinsight.org/tipitaka/mn/mn.118.than.html. . +10. B. AT, W. CH, M. MM, M. JJ, and E. JJ, “An inventory for measuring +depression,” Arch. Gen. Psychiatry, vol. 4, no. 6, pp. 561–571, Jun. +1961. +11. Beck, A T, Steer, R A, Brown, G K, Manual of the Beck Depression +Inventory II. San Antonio, Tx, Psychological Corporation, 1996. +12. M. Davoudi, A. Omidi, M. Sehat, and Z. Sepehrmanesh, “The Effects +of Acceptance and Commitment Therapy on Man Smokers’ +Comorbid Depression and Anxiety Symptoms and Smoking Cessation: +A Randomized Controlled Trial.,” Addict. Heal., vol. 9, no. 3, pp. 129– +138, 2017. +13. Y. Okamoto, Y. Miyake, I. Nagasawa, and M. Yoshihara, “Cohort +survey of college students’ eating attitudes: interventions for +depressive symptoms and stress coping were key factors for +preventing bulimia in a subthreshold group.,” Biopsychosoc. Med., +vol. 12, no. 1, p. 8, 2018. +14. M. Wrzosek, M. Wojnar, A. Sawicka, M. Tałałaj, and G. Nowicka, +“Insomnia and depressive symptoms in relation to unhealthy eating +behaviors in bariatric surgery candidates,” BMC Psychiatry, vol. 18, +no. 1, pp. 1–10, 2018. +15. R. M. R. Tulloh et al., “A pilot randomised controlled trial +investigating +a +mindfulness-based +stress +reduction +(MBSR) +intervention in individuals with pulmonary arterial hypertension +(PAH): the PATHWAYS study.,” Pilot Feasibility Stud., vol. 4, p. 78, +2018. +16. J. C. Norcross, R. A. Pfund, and J. O. Prochaska, “Psychotherapy in +2022: A delphi poll on its future,” Prof. Psychol. Res. Pract., vol. 44, +no. 5, pp. 363–370, 2013. +17. G. Deo, K. Itagi R, S. Thaiyar M, and K. K. Kuldeep, “Effect of +anapanasati meditation technique through electrophotonic imaging +parameters: A pilot study,” Int. J. Yoga, vol. 8, no. 2, pp. 117–121, +2015. +18. T. M. C. Lee et al., “Distinct neural activity associated with focused- +attention meditation and loving-kindness meditation,” PLoS One, vol. +7, no. 8, 2012. + + + + +HOW TO CITE THIS ARTICLE +Sivaramappa B, Deshpande S, Kumar PVK, Nagendra HR. The Effect of +Anapanasati Meditation on Depression: A Randomized Control Trial. J Ayu +Herb Med 2018;4(3):102-105. + diff --git a/subfolder_0/The Effect of Integrated Yoga on Labor Outcome A Randomized Controlled Study.txt b/subfolder_0/The Effect of Integrated Yoga on Labor Outcome A Randomized Controlled Study.txt new file mode 100644 index 0000000000000000000000000000000000000000..9ba7c408ca8c305eb1fe7aa1bbbf3d12d2e27764 --- /dev/null +++ b/subfolder_0/The Effect of Integrated Yoga on Labor Outcome A Randomized Controlled Study.txt @@ -0,0 +1,1489 @@ +Official Publication of the International Confederation of Midwives +www.springerpub.com/ijc +International +Journal + Childbirth +of +With the Compliments of Springer Publishing Company, LLC +INTERNATIONAL JOURNAL OF CHILDBIRTH Volume 3, Issue 3, 2013 +© 2013 Springer Publishing Company, LLC www.springerpub.com +http://dx.doi.org/10.1891/2156-5287.3.3.165 +165 +The Effect of Integrated Yoga on Labor ­ +Outcome: +A Randomized Controlled Study +Satyapriya Maharana, Raghuram Nagarathna, Venkatram Padmalatha, +Hongasandra Ramarao Nagendra, and Alex Hankey +BACKGROUND:  Antenatal yoga has been found to be useful and reported to have many beneficial +effects. The objective of this study was to investigate the effect of yoga on labor outcome. +METHODS:  This randomized two-armed active control study recruited 96 women with normal +­ +pregnancy. The experimental group practiced integrated yoga and the control group practiced standard +antenatal exercises (1 hr/day), from 18 to 20 weeks of gestation until term. +RESULTS:  The first stage of labor was 4.71 6 0.59 and 6.19 6 0.79 hr in yoga and control groups, +respectively (p , .001, independent samples t test); the second stage was 23.41 6 7.68 min in yoga +and 55.19 6 10.87 min in control group (p , .001); the third stage took 9.07 6 2.35 min in yoga +and 12.96 6 2.86 min in control group (p , .001). Fewer number of women in yoga group required +­ +epidural analgesia (p , .001). The cesarean sections (7/51 in yoga and 18/45 in control; p 5 .004) and +complications of pregnancy (intrauterine growth restriction [IUGR], pregnancy-induced hyperten- +sion [PIH], and preterm labor) were fewer (p 5 .010) in yoga than in control group. Birth weight +of babies (p , .001) was higher and Apgar scores (p , .001) were better in yoga as compared to the +control group. +CONCLUSION:  Yoga during pregnancy decreases the duration of all stages of labor, complications of +pregnancy, need for epidural analgesia, and cesarean sections; it also improves birth weight and Apgar +scores of the infant. +KEYWORDS:  yoga; duration of labor; analgesia; birth weight +al., 2006). The changes in women’s role in the society +and its associated lifestyle modifications appear to +be the cause of increasing sensitivity that results in +exaggerated stress responses and heightened anxiety +(Melender, 2002). Labor poses psychological challenge +for women because of conflicting emotions of fear and +apprehension coupled with excitement and happiness. +Tension, anxiety, and fear may reinforce the perception +of pain and affect labor and birth experience (Walden- +strom, Borg, Olsson, Skold,  & Wall, 1996). Several +attempts have been made to reduce pain, anxiety, and +stress in pregnant women by using physical exercises +and relaxation therapies (Smith, ­ +Collins, Cyna, & +Crowther, 2006). +INTRODUCTION +Rates of cesarean section vary in different populations: +According to World Health Organization (WHO) +reports, Asian countries tended to have higher rates +of cesarean sections 25.7% (Lumbiganon et al., 2010), +32.9% in the United States (Hamilton, Martin, & +Ventura, 2010), 33.7% in Latin America (Villar, Car- +rolli, & Zavaleta, 2007; Villar et al., 2006) and 46.2% +in China (Souza et al., 2010). These reports identify +cesarean without indications as a significant risk fac- +tor for maternal mortality and morbidity, strongly +recommending its disuse but suggesting no alterna- +tive for the mother (Hamilton et al., 2010; Villar et +Copyright © Springer Publishing Company, LLC +166 The Effect of Integrated Yoga on Labor Outcome  Maharana et al. +relaxation exercise with group psychoeducation reduces +fear of delivery and cesarean section (Saisto, Toivanen, +Salmela-Aro, & Halmesmäki, 2006). +Reducing the duration of labor is an ­ +important and +useful measure of healthy progression of labor, which +would reduce the analgesic requirement, maternal dis- +tress, and decrease feto-maternal mortality. A randomized +controlled trial (RCT) by Chuntharapat, Petpichetchian, +and Hatthakit (2008) reported the effect of antenatal yoga +(1 hr/day, once a week from 26th to 37th week) in reduc- +ing the duration of labor ­ +(Chuntharapat, et al., 2008). +Based on this report and a promising previous study of +antenatal yoga as a preparation for childbirth (Narendran +et al., 2005), we planned this randomized controlled study +with the hypothesis that specific module of integrated +yoga that includes physical postures, pranayama, medita- +tion, and yogic education practiced during pregnancy can +show improvement in labor outcome. +MATERIAL AND METHODS +Subjects +Sample Size +A sample size of 47/group was required for the inferences +to be made at alpha 0.05 and a power of 0.8. The previ- +ous study (Chuntharapat et al., 2008) reported an effect +size of 0.59 on labor duration between the two cohorts, +which was used to extrapolate the optimum sample size +for this study using the G*Power software. There were +105 recruited into this study and there were 9 dropouts +subsequently. Data available for the final analyses were for +51 and 45 in yoga and control groups, respectively. +Source of Subjects +Subjects were recruited from antenatal clinics of four hos- +pitals in South Bengaluru, India. All these four hospitals +followed the same antenatal and labor protocols under +the guidance of a senior obstetrician (LV +, ­ +coauthor of this +article). The obstetric units of these hospitals conducted +about 1,200–1,500 deliveries per year. One hundred and +five pregnant women who ­ +registered in these hospitals +between 2008 and 2010 were selected for the study. +Inclusion Criteria +The inclusion criteria were as follows: (a) normal preg- +nancies between 18 and 20 weeks and (b) either primi- +gravida or secundigravida with a live child through a +normal previous delivery. +Despite yoga’s increasing popularity as a discipline, +it is still little appreciated that in ancient India, yoga was +practiced as much as a system of medicine as a system +of personal development. However, contemporary India +has been rediscovering its medical applications (Naga- +rathna, 2009), and recent decades have seen several quality +­ +studies of yoga applications to medicine and related fields +(­ +Banerjee et al., 2007; Cade et al., 2010; Chandwani et al., +2010; Chattha, Nagarathna, Padmalatha, & Nagendra, +2008; ­ +Chattha, Raghuram, Venkatram,  & ­ +Hongasandra, +2008; Cohen et al., 2011; Nagarathna & Nagendra, 1985; +­ +Nagendra & ­ +Nagarathna, 1986; Rao et al., 2009), including +limited studies of pregnancy and childbirth (­ +Narendran, +Nagarathna, Narendran, Gunasheela, & Nagendra, 2005; +Rakhshani, Maharana, Raghuram, Nagendra, & Venka- +tram, 2010; Satyapriya, Nagendra, Nagarathna, & Pad- +malatha, 2009). Many stress-related conditions have been +found to benefit from specially designed yoga programs. +These include, inter alia, asthma (­ +Nagarathna & Nagen- +dra, 1985; ­ +Nagendra & Nagarathna, 1986), hypertension +and heart disease (Cade et al., 2010; Cohen et al., 2011), +climacteric syndrome (Chattha, ­ +Nagarathna, et al., 2008; +Chattha, Raghuram, et al., 2008), and breast cancer +(Banerjee et al., 2007; ­ +Chandwani et al., 2010; Rao et al., +2009). Our earlier studies in healthy volunteers using +the integrated program of yoga that included physical +postures (asanas), breathing practices (pranayama), and +meditation have shown better physical fitness, handgrip +strength, flexibility, and dexterity (Manjunath & Telles, +1999; Raghuraj & Telles, 1997). Pranayama and medita- +tion reduced stress and metabolic rate (Chaya, Kurpad, +Nagendra, & Nagarathna, 2006) with increased autonomic +stability and alertful rest (Telles, Nagarathna, & Nagendra, +1995). It has also been shown that yoga ­ +practices can +reduce anxiety ­ +levels (Gupta, Khera, ­ +Vempati, Sharma, & +Bijlani, 2006), perceived stress, and cortisol levels (West, +Otte, Geher, Johnson, & Mohr, 2004). +Evidence is growing that antenatal yoga programs +may improve stress indicators in pregnancy (Satyapriya +et al., 2009), quality of life, interpersonal relationships +(Rakhshani, Maharana, Raghuram, Nagendra, & Venka- +tram, 2010), mode of delivery, and birth weight (Naren- +dran et al., 2005). The programs depend partly on effects +in common with current antenatal programs: physical +exercise, breathing, and relaxation programs produce +well-substantiated benefits. Exercise reduces duration of +first and second stages of labor (­ +Beckmann & Beckmann, +1990); regular “leisure physical ­ +activity” during pregnancy +reduces percentage of low birth weight babies (Leiferman +& Evenson, 2003); ­ +breathing techniques and massage +reduce perception of pain (Yildirim & Sahin, 2004); and +Copyright © Springer Publishing Company, LLC + The Effect of Integrated Yoga on Labor Outcome  Maharana et al.  167 +was conducted in semilithotomy position with the head +end raised to 30°–45° from horizontal, in the presence +of an obstetrician. Labor outcome measures were noted +during and immediately after delivery. +The attendance for the supervised training classes +was 95%. The compliance in home practice was also +90%. There were no dropouts because of lack in compli- +ance, although the study had planned to exclude partici- +pants with lower than 60% regularity. Both groups were +given prerecorded audio CD for home practice that had +instructions for 1 hr of the practice for the complete +module taught to them. +Yoga, being an active intervention, cannot be stud- +ied using a double-blinded study design. Attempts were +made to mask personal identifiers wherever possible. +The statistician, who did the randomization and the final +analysis, and the staff making the outcome assessments +of the women were blinded to the grouping of subjects. +The medical professionals involved in clinical care of the +subject as well as the therapist administering the inter- +ventions were not blinded. The two groups had different +class venues and times to avoid participant contact. +Intervention +The yoga group practiced modules of yoga techniques +specific to second and third trimesters of pregnancy +(Table 1). The control group practiced standard ante- +natal exercises (Table 1). Initially, each group received +essential additional pregnancy information covering all +concepts and techniques required for successful holistic +health management (Table 1). +The antenatal classes for both groups were aimed +at educating the women (a) about the physical and psy- +chological changes expected during pregnancy; (b) to +incorporate the necessary changes in lifestyle including +diet, exercise, and occupation; (c) avoid excess weight +gain and stress to ensure better general health and physi- +cal stamina; (d) improve emotional stability for a positive +quality of life; and (e) prepare them for labor. The specific +yoga module used for the ­ +experimental group  called +“integrated approach of yoga during ­ +pregnancy” is based +on the knowledge culled out from yoga scriptures (Patan- +jali Yoga Sutras and Mandukya Karika). This module that +incorporated the concepts and techniques for a holistic +health management at physical, mental, emotional, and +intellectual levels was also used in our earlier study on +yoga in pregnancy by (Narendran et al., 2005). +Control group practiced the standard antenatal +practices, which included simple stretching exercises +Exclusion Criteria +The exclusion criteria were as follows: (a) associated +medical problems (diabetes, hypertension, psychiatric +illness, etc.), (b) multiple pregnancies, (c) in vitro fertil- +ization (IVF) pregnancy, (d) maternal physical abnor- +malities, (e) fetal abnormality, and (f) previous exposure +to yoga or vigorous physical exercises. +The study was cleared by the institutional ethi- +cal committee of the university (Swami Vivekananda +Yoga Anusandhana Samsthana [SVYASA]) and ­ +written +­ +permission was obtained from individual sites of +recruitment. Signed informed consent was sought from +all 105 participants before randomization into the yoga +intervention group and antenatal exercise controls. +Design +This was a prospective randomized active control study. +Women consenting to participate, who satisfied the study +criteria as assessed by the obstetrician, were allotted to two +groups, by the researcher who was not involved in ­ +assessment +or administering the intervention. A ­ +computer-generated +random number table (www.­ +Randomizer.org) was used. +Paper slips with the group names were inserted in 105 seri- +ally numbered envelopes, sealed, and kept confidentially +by the researcher. Each envelope was opened only after +writing the name of the next recruited participant against +her serial number. Certified instructors taught both groups +in batches of 1–10 women per group. After initial training +of 2 hr daily for 1 month, 1 hr of home practice using a +prerecorded audio CD was advised for the rest of the term +in both groups. Two-hour refresher classes were provided +during routine antenatal obstetric visits (once in 4 weeks +until the 28th week, once a fortnight until the 36th week, +and weekly thereafter until delivery). Compliance was doc- +umented by signed ­ +attendance at initial training and moni- +toring by phone and activity diaries thereafter. Assessments +were done at the time of recruitment ­ +(18th–20th week), +at the time of each follow-up visit, and at the 36th week. +­ +Postassessments of clinical variables were done on the 36th +week, but the final outcome variables were recorded on the +next day after completion of labor. +All deliveries were conducted in hospitals. Safe +labor ward facilities, a neonatologist/pediatrician, and +24-hr senior nurses were available in all these centers for +conducting the delivery. Certified staff nurses trained +specially in midwifery by the consultant obstetricians +were looking after one to two women in labor. Feto- +maternal surveillance by cardiotocograph was done by +the nursing staff with supervision of doctors. The labor +Copyright © Springer Publishing Company, LLC +168 The Effect of Integrated Yoga on Labor Outcome  Maharana et al. +TABLE 1  Yoga and Exercise Intervention Group Practice Details (60 Minutes Daily) +Yoga group +SECOND +TRIMESTER +THIRD +TRIMESTER +Control group +SECOND +TRIMESTER +THIRD +TRIMESTER +A. Lectures +B. Breathing exercises +1.  +Hasta a +¯ya +¯ma s +s +´  +vasanam +(Hands in and out breathing) +2.  +Hasta vista +¯ra s +´  +vasanam +(Hands stretch breathing) +3.  +Gulpha vista +¯ra s +´  +vasanam +(Ankle stretch breathing) +4. Vya +¯ghra s +´  +vasanam (Tiger breathing) +5.  +Setu bandha s +´  +vasanam +(Bridge posture breathing) +C. Asana postures +Standing asanas +  1. Tadasana (tree pose) +  2.  +Ardhakati-chakrasana +(lateral arc pose) +  3. Trikonasana (triangle pose) +Sitting asanas +  4. Vajrasana (ankle pose) +  5. Vakrasana (spine twist pose) +  6. Siddhasana(sage pose) +  7. BaddhaKonasana (bound ankle pose) +  8. UpavistaKonasana (spread legs pose) +  9. Squatting (Garland pose) +Supine asanas +10.  +Viparita karani (half-shoulder stand) +11.  +Ardha-pavanamuktasana +(folded leg lumbar stretch) +D. Pranayama & Meditation +1. Sectional breathing +2. Naadisuddhi +3. Sheetali +4. Bharamari +5. Nadanusandhana +6. Om meditation +E. Deep relaxation technique +15 min +10 min +Yes +Yes +Yes +Yes +Yes +15 min + +Yes +Yes +Yes +Yes +Yes +No +No +No +No +Yes +Yes +10 min +Yes +Yes +Yes +Yes +Yes + +10 min +10 min +5 min +Yes +Yes +Yes +No +No +10 min + +Yes +Yes +Yes +Yes +No +Yes +Yes +Yes +Yes +No +Yes +20 min +Yes +Yes +Yes +Yes +Yes + +15 min +A. Lectures +B. Loosening exercises +1. Twisting +2.  +Forward and backward +bend +3. Side bending +4. Calf-raise +5. Hamstring stretch +6.  +Lateral pull-up +and pull-down +7. Calf extension +8. Hip abduction +C. Antenatal exercises +Standing exercises +  1. Thigh stretch +  2. Push-up and down +  3. Pull-downs +  4. Low-back lift +Sitting exercises +  5. Inner thigh stretch +  6. Calf stretch +  7. Dips +  8. Squatting +  9. Hip abduction +10. Shoulder-chest stretch +11.  +Neck and upper back +stretch +12. Seated rowing +13. Oblique curls +14. Kickbacks +15. Pelvic floor exercise +Supine exercise +16. Pelvic tilt +D. Slow walking +E. Supine rest (10 min) +15 min +10 min +Yes +Yes +Yes +Yes +Yes +Yes +Yes +No +15 min + +Yes +Yes +Yes +Yes + +Yes +Yes +Yes +No +Yes +Yes +Yes + +Yes +Yes +Yes +Yes + +Yes +10 min +10 min +10 min +5 min +Yes +No +Yes +Yes +Yes +No +No +Yes +10 min + +Yes +Yes +No +No + +Yes +Yes +No +Yes +Yes +Yes +Yes + +Yes +Yes +Yes +Yes + +Yes +20 min +15 min +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 (Geogory, Larry, Michelle, & Catherine, 2003). +Compliance: Attendance at initial training was +recorded; thereafter, monitoring was by phone and +activity diaries. +Assessments +Because duration of labor is an important measure of +healthy progression of labor, we considered this as the +primary outcome measure; related variables, mode of +delivery, and requirement of analgesia were also included +under primary outcome measures. ­ +Complications of +pregnancy, gestational age at delivery, birth weight, and +Apgar scores were secondary measures. +A. Clinical assessments at recruitment and each follow- +up visit recorded the blood pressure, body weight, +symphysis-fundal height, and fetal heartbeat. +­ +Random venous blood glucose and hemoglobin ­ +levels +were checked on entry and at 32 weeks of gestation. +Ultrasound scans assessed the fetus’s ­ +normality at +18–20 weeks and fetal growth at 32–34 weeks. +B. Primary outcome measures—labor outcome noted +during and immediately after the delivery. + +1.  +Labor duration: The three stages of labor were +defined as follows (Albers, Schiff, & ­ +Gorwoda, +1996): Stage 1: from time of 3 cm ­ +cervical +­ +dilatation (or admission time) up to full ­ +dilatation; +Copyright © Springer Publishing Company, LLC + The Effect of Integrated Yoga on Labor Outcome  Maharana et al.  169 +Stage 2: up to completion of baby’s ­ +delivery; +Stage 3: completion of placental delivery. + +2.  +The number of subjects who required epidural +analgesia. + +3.  +Mode of delivery: normal, instrumental (forceps +or vacuum), or cesarean section. +C. Secondary outcome measures + +1.  +Pregnancy complications included the fol- +lowing: (a) pregnancy-induced ­ +hypertension +(PIH), defined as resting systolic blood pres- +sure (SBP) .140 mmHg and/or diastolic +blood pressure (DBP) .90 mmHg recorded in +­ +sitting position on two occasions 24 hr apart; +(b) ­ +gestational diabetes defined as fasting blood +glucose .90 mg/dl or 2-hr postprandial blood +glucose .140 mg/dl; and (c) intrauterine growth +restriction (IUGR), defined as fetal growth less +than the 10th percentile on ultrasound scanning. + +2. Gestational age at delivery. + +3. Birth weight. + +4.  +First and fifth minute Apgar scores after the birth +of the baby. +Data Analysis +SPSS 10.0 was employed for data analysis (SPSS Inc., +1999). Unpaired t test was used for comparison of +means of the two groups. Effect sizes and odds ratio +were also calculated. +RESULTS +Figure 1 shows the trial profile. Out of 200 women +who were screened, 150 women satisfied the selection +FIGURE 1  +Antenatal RCT profile. +Number screened +200 +Satisfied the selection criteria +150 +Registered and randomized +105 +Intervention—16 weeks +Reasons for dropout +Moved out—2 +Dropouts +2 +Dropouts +7 +Reasons for dropout +Moved out of city—4 +Shifted to yoga—3 +Yoga +Final analysis—51 +Control +Final analysis—45 +Yoga group +53 +Control group +52 +Copyright © Springer Publishing Company, LLC +170 The Effect of Integrated Yoga on Labor Outcome  Maharana et al. +TABLE 2  +Participant Characteristics +VARIABLES +YOGA (N 5 51) +CONTROL (N 5 45) +MEAN 6 SD +MEAN 6 SD +Age in years +26.41 6 3.01 +24.96 6 2.58 +Height (inches) +63.67 6 1.81 +62.84 6 1.98 +Gravida* +Primi +45 (88%) +39 (87%) +Secundi +6 (12%) +6 (13%) +Occupation* +Working +33 (65%) +22 (49%) +Housewives +18 (35%) +23 (51%) +Weight (kilograms) +Prea +63.69 6 9.67 +61.56 6 8.56 +Postb +71.82 6 9.90 +69.91 6 8.84 +BMI +Prea +24.97 6 3.52 +25.05 6 3.80 +Postb +28.54 6 3.60 +28.55 6 3.86 +BP (mmHg) (systolic) +Prea +114.71 6 14.74 +115.076 8.13 +Postb +117.25 6 9.61 +118.00 6 8.15 +BP (diastolic) +Prea +73.12 6 5.43 +72.40 6 6.56 +Postb +75.06 6 5.33 +75.84 6 6.24 +Note. Nonsignificant (p . .05) difference between groups in all variables. BMI 5 body mass index; BP 5 blood pressure. +a20th week. b36th week. +*Chi-squared test; other variables—independent samples t test. +­ +criteria. Of these, 105 who agreed to participate in the +study were randomized into yoga and control groups +and 96 women (51 yoga and 45 control) completed the +study. +The reasons for dropout were as follows: (a) shift- +ing from control to yoga group because of the growing +awareness about yoga through the media; (b) shifting +from Bengaluru to parent’s town: although this aspect +was discussed at the time of recruitment, the women had +to oblige to the invitation by the parent’s family, which +is a sociocultural norm in South India; and (c) irregular +attendance: those who practiced at home but could not +appear for regular monitoring of the parameters were +also considered as dropouts. +Table 2 shows the maternal characteristics. The +baseline values of the two groups were matched on +all variables (p . .05; independent samples t test and +­ +Chi-squared test). +Primary Outcome Measures +Table 3 shows the duration of all three stages of labor. +The duration of all three stages of labor was significantly +TABLE 3  +Results of Parturition Data in Both Groups +VARIABLES +YOGA +CONTROL +EFFECT +SIZE +% CHANGES +BETWEEN +GROUPS +SIG. p  +a +MEAN 6 SD +95% CI +MEAN 6 SD +95% CI +LOWER +UPPER +LOWER +UPPER +LD Stage 1 (min) +283.63*** 6 35.11 +272.96 +294.31 +371.11 6 47.17 +352.44 +389.77 +2.10 +23.57 +.001 +LD Stage 2 (min) +23.41*** 6 7.68 +21.07 +25.75 +55.19 6 10.87 +50.88 +59.49 +3.37 +57.60 +.001 +LD Stage 3 (min) +9.07*** 6 2.35 +8.35 +9.78 +12.96 6 2.86 +11.83 +14.10 +1.48 +30.00 +.001 +AS (1 min) +7.82 6 0.56 +7.67 +7.98 +7.69 6 0.51 +7.53 +7.84 +0.24 +1.69 +.221 +AS (5 min) +9.02*** 6 0.55 +8.87 +9.17 +8.64 6 0.48 +8.50 +8.79 +0.73 +4.39 +.001 +BW +3.22*** 6 0.33 +3.13 +3.32 +2.87 6 0.37 +2.75 +2.98 +0.99 +12.19 +.001 +GAD +38.80 6 1.56 +38.36 +39.24 +38.69 6 1.50 +38.24 +39.14 +0.07 +0.28 +.714 +Note. Yoga group showed significantly lesser duration of labor in all three stages with higher birth weight and fifth minute Apgar score of the infants. +CI 5 confidence interval; LD 5 labor duration; AS 5 Apgar score; BW 5 birth weight; GAD 5 gestational age at delivery. +aIndependent sample t test. +Copyright © Springer Publishing Company, LLC + The Effect of Integrated Yoga on Labor Outcome  Maharana et al.  171 +lower in the yoga group as compared to the ­ +control +group at p , .001 (independent t test). The first stage of +labor was 371.11 6 47.17 min in the control group and +283.63 6 35.11 min in the yoga group, with a ­ +difference +of 23.57%. The second stage was 55.19 6 10.87 min in +control group and 23.41 6 7.68 min in the yoga group, +with a difference of 57.60%. The duration of the third +stage was 12.96 6 2.86 and 9.07 6 2.35 min in the +­ +control and yoga groups, respectively, with a differ- +ence of 30.00%. Table 4 shows the number of normal +­ +deliveries in different time intervals in all three stages +of labor. There were 41 out of 44 vaginal deliveries and +3  out of 27 in yoga and control groups respectively +completed “the first stage” within 360 min; Stage 2 was +completed within 30 min by 42/44 in the yoga group +whereas only 2/27 in the control group completed +within 30 min. +Mode of Delivery +The number of normal vaginal deliveries (Table 5) was +higher and the cesarean sections was fewer (p 5 .004) in +the yoga group (14%) than in the control group (40%) +with an odds ratio of 0.23 between vaginal delivery +versus cesarean section and a confidence interval of +0.64–0.08. +The reasons for cesareans in the two groups were +as follows (Table 5): (a) maternal–medical conditions: +yoga 14% (1/7) and control 17% (3/18); (b) malpre- +sentation: yoga 29% (2/7) and control 11% (2/18); (c) +fetal distress: yoga 14% (1/7) and control 17% (3/18); +(d) fetal condition: yoga 0% (0/0) and control 6% +(1/18); (e) failed induction: yoga 14% (1/7) and con- +trol 6% (1/18); and (f) failure to progress: yoga 29% +(2/7) and ­ +control 44% (8/18). There was nonsignificant +TABLE 4  +Duration of Labor in Three Stages: Frequency Distribution +STAGE 1a +STAGE 2b +STAGE 3c +DURATION +FREQUENCY +DURATION +FREQUENCY +DURATION +FREQUENCY +Minutes +Yoga +Control +Minutes +Yoga +Control +Minutes +Yoga +Control +,300 +15 +  1 +15–19 +  2 +  0 +3–6 +  8 +  1 +300–310 +26 +  2 +20–29 +30 +  1 +7 +  1 +  0 +311–360 +  3 +16 +30–39 +10 +  1 +8 +  4 +  0 +361–420 +  0 +  7 +40–49 +  1 +  3 +9–10 +29 +  9 +.420 +  0 +  1 +50–60 +  1 +22 +11–15 +  2 +17 +Note. There were 41/44 in the yoga group and 3/27 in the control group who completed the first stage within 310 minutes; 42/44 in the yoga group and 2/27 in the +control group completed the second stage within 30 min; and 42/44 and 10/27 completed the third stage within 10 min in the yoga and control groups, respectively. +a3 cm—full dil.atation. bCompletion of baby’s delivery. cCompletion of placental delivery. +TABLE 5  +Difference Between Groups in Mode of Delivery and Complications +VARIABLES +YOGA (n 5 51) +CONTROL +(n 5 45) +DIFFERENCE BETWEEN GROUPS +95% CI +SIG. p* +ODDS +RATIO +n +% +n +% +UPPER +LOWER +Mode of delivery +Vaginal +  delivery +44 +86 +27 +60 +0.64 +0.08 +.004 +0.23 +Cesarean +  section +  7 +14 +18 +40 +Preg Compl +Nil +48 +94 +33 +73 +0.65 +0.04 +.010 +0.17 +Present +  3 +  6 +12 +27 +Epidural analgesia +11 +22 +24 +53 +0.58 +0.09 +.001 +0.24 +Note. Yoga group shows significantly fewer numbers of cesarean sections, fewer complications, and fewer numbers requiring epidural analgesia. +CI 5 ­ +confidence interval; Preg Compl 5 complications of pregnancy. +*Chi-squared test. +Copyright © Springer Publishing Company, LLC +172 The Effect of Integrated Yoga on Labor Outcome  Maharana et al. +­ +difference between yoga and control groups except in +“failure to progress.” +Among those who had vaginal deliveries, the fol- +lowing subgroups were noted: (a) induced labor: yoga +5% (2/44) and control 11% (3/27); (b) spontaneous +delivery: yoga 95% (42/44); and control 89% (24/27)— +the number of women who had spontaneous labor was +significantly higher in yoga than the control group with +an odds ratio of 0.37. +Analgesia Requirement +The number of women who required epidural anal- +gesia during labor was fewer (p , .001) in the yoga +group (11/51) than the control group (24/45) with +an odds ratio of 0.24 and a confidence interval of +0.11–0.59. +Secondary Outcome Measures +1. Complications of pregnancy. The total number of +pregnancy complications was fewer in the yoga +group compared to the control group (p 5 .010) +with an odds ratio of 0.17. +The subgroup analysis (Table 5) for +­ +different complications showed the following: +(a) IUGR: yoga 0% (0/0) and control 7% (3/45); +(b) PIH: yoga 6% (3/51) and control 11% (5/45); +(c) gestational diabetes: yoga 0% (0/0) and control +4% (2/45); and (d) preterm delivery: yoga 0% (0/0) +and control 4% (2/45). +2. There was no significant difference between groups +in the gestational age at delivery (Table 3). +3. Fetal parameters (Table 3): birth weight was higher +for the yoga group than controls with a mean differ- +ence of 0.35 kg (p , .001). +Apgar scores: first minute Apgar scores showed +no significant difference between groups (p 5 .221). +Fifth minute scores were significantly higher in the +yoga group than the control group (p , .001). +DISCUSSION +In this RCT, labor duration was diminished by more +than 2 hr and cesarean rates by 25% for subjects in the +yoga group practicing the specialized antenatal yoga +program from 18th week of gestation; lesser number +of women required analgesia during labor, pregnancy +complications were lower, and the birth weight and +Apgar scores were higher in yoga group. +Duration of Labor +The remarkable difference in the duration of the second +stage with a median value of 20 min in the yoga group +and 60 min in the control group is noteworthy. This is +the first study that has shown such an impressive reduc- +tion in the duration of labor by yoga, a nonpharmaco- +logical and self-corrective technique. We propose that +this may be caused by the following factors: +a. Improvement in coordinated performance of +abdomino-pelvic musculature resulting in well-­ +controlled and better expulsive forces. Yoga +­ +practices in normal adults showed improved motor +performance with better strength (Raghuraj & +Telles, 1997), flexibility (Manjunath & Telles, 1999), +dexterity (Raghuraj & Telles, 1997), and motor +speed (Dash & Telles, 1999). +b. Women in the yoga group practiced a yoga +­ +posture called Baddha konasana (resembling +squatting position) twice daily after 36 weeks +of gestation and delivered in semirecumbent +­ +position. They were asked to repeat this yogic +posture during each contraction in labor. The reg- +ular practice of this posture may have resulted in +­ +better alignment and application of the ­ +presenting +part to the axis of the pelvis and the cervix. This +could have contributed to healthy progress of +labor resulting in ­ +reduction in the duration of +the first and second stages, and also the need for +induction in the yoga group. The only earlier +RCT ­ +(Chuntharapat et al., 2008) that ­ +compared +usual nursing care with add-on yoga in normal +pregnacy (1 hr/day, once a week from the 28th +week until delivery) documented shorter dura- +tion of labor in both the first stage and the total +labor duration (p , .001), with nonsignificant +­ +difference in the duration of the second stage of +labor between the two groups. +There are a few studies that have shown the +­ +beneficial effect of squatting position during labor. +In a controlled trial that compared the outcome of +labor in women squatting in an obstetric aid (the +Copyright © Springer Publishing Company, LLC + The Effect of Integrated Yoga on Labor Outcome  Maharana et al.  173 +“birth cushion” that allows the parturient to sink +into a supported squatting posture) with those +in the conventional semirecumbent position, the +­ +squatting group had significantly fewer forcep +deliveries (9% vs. 16%) and significantly shorter +second stages (median length of pushing is 31 min +vs. 45 min) than the semirecumbent group. In our +study, the second stage was reduced to 20 min as +compared to the control group (60 min). Another +study on pelvic floor exercises did not show signifi- +cant reduction in duration of the second stage of +labor (Gardosi, ­ +Hutson, & B-Lynch, 1989; Salvesen +& Mørkved, 2004). +c. Reduced psychological stress resulting in more +coordinated uterine contractions in the yoga +group may explain the shorter duration of labor +and reduced fetal distress in spite of the same +augmentation regime used in both groups. We +have demonstrated that yoga can reduce stress +levels and improve autonomic stability in normal +pregnancy as observed by improved parasympa- +thetic tone during guided relaxation (Satyapriya +et al., 2009). There are also studies (Chaya et al., +2006; Gupta et al., 2006; ­ +Manjunath & Telles, 1999; +Telles et al., 1995; West et al., 2004) that have +shown the stress-reducing effect of yoga practices +in normal volunteers. Hao, Li, and Yao (1997) +showed that psychological suggestions of encour- +agement during conversations by the attending +nurse continuously during labor had shorter time +of both the first and second stages of labor than +the control group. One of the popular techniques +using antepartum Lamaze-training psychoprophy- +laxis showed no apparent effects on the length of +labor, frequency of fetal distress, or mean Apgar +scores although it reduced the analgesic require- +ment (Scott & Rose, 1976). It appears that yoga +may provide better mind management tech- +niques than other conventional psychotherapeutic +interventions. +The duration of the third stage of labor +reduced significantly and this could be caused +by the effect of yoga on neuroendocrinal path- +ways probably influencing oxytocin release. +There are studies that have shown the beneficial +effects of yoga on hypothalamic-pituitary-adrenal +(HPA) axis resulting in better cortisol rhythmic- +ity. Decrease in serum cortisol during yoga prac- +tices has also been documented in patients with +early breast cancer (Rao et al., 2009), which cor- +related with alpha wave ­ +activation (Kamei et al., +2000). +Analgesia Requirement +The number of women who required epidural analge- +sia was significantly lesser in yoga group than the con- +trol group. This can be attributed to more coordinated +uterine activity and lesser duration of labor. It has +also been shown that stress of pregnancy has negative +effects on pain perception and analgesia requirement +during pregnancy (Iwasaki & Namiki, 1997; Takahashi, +1991). Yoga, practiced all throughout pregnancy, may +have improved the stress adaptation mechanisms that +may have contributed to this benefit. There are many +studies that have shown that nonpharmacological +interventions can reduce analgesic requirement dur- +ing labor. Acupuncture (Chung, Hung, Kuo, & Huang, +2003; Jenkins & Pritchard, 1993; Nesheim & Kinge, +2006; Smith et al., 2006) during the active first stage of +labor was found to be beneficial for the management of +pain during labor with reduced use of epidural analge- +sia (Nesheim & Kinge, 2006). Analgesic requirements +during the duration of the first and second stages of +labor were reduced in hypnotherapy group compared +to control group (­ +Jenkins & Pritchard, 1993). Breath- +ing technique and massage were effective in reducing +the perception of pain, leading to a more satisfactory +birth experience (Yildirim & Sahin, 2004). Prenatal +mothers’ knowledge, attitudes, and practice of Lamaze +training has been shown to influence her attitudes +toward labor, the requirement of narcotics and con- +duction of anesthesia during labor, and also improve +her postnatal health (Scott & Rose, 1976; Shih, Lee, +Chen, & Tung, 2005). +Mode of Delivery +The number of normal deliveries was much higher +in yoga than in control group, with significant reduc- +tion in the need for cesarean sections that was fewer +(p 5 .004) in the yoga group (15%) than the control +group (40%). Looking at the reasons for cesarean sec- +tions, although the numbers in each category were +small, the most notable difference between the two +groups was as ­ +follows: 44% (8/18) of cesareans in the +Copyright © Springer Publishing Company, LLC +174 The Effect of Integrated Yoga on Labor Outcome  Maharana et al. +control group were because of failure to progress com- +pared to 29% (2/7) in the yoga group. Reduction in fetal +distress and good progress of labor in the yoga group +could explain this. A positive and prepared attitude of +the mother to accept labor as a physiological phenom- +enon could have contributed to these results similar to +the observations in the Lamaze therapy study (Scott & +Rose, 1976). In the study by Saisto et al. (2006), group +psychoeducation and relaxation exercises were well- +received and rated as very helpful in reducing delivery +fear, which helped in withdrawing their requests for +elective cesarean section. The integrated yoga module +used in this study that included breathing and medi- +tation practices seems to  have contributed to these +results through reduction in stress levels (Satyapriya et +al., 2009). +Complications of Pregnancy, Birth Weight, and +Apgar Scores +An earlier study with good sample size (169 in yoga and +166 in control) showed positive effects on birth weight, +mode of delivery, and pregnancy complications after +integrated yoga practices in normal pregnancy (Naren- +dran et al., 2005). However, that study could not remove +the subject selection bias because the groups were not +randomized. This RCT offers supporting evidence to +those earlier observations of improved birth weight, +Apgar scores (fifth minute), and reduced prevalence of +PIH and IUGR after yoga. Better Apgar score of babies +may be attributed to (a) improved birth weight and (b) +decreased labor duration, the first correlating with gen- +eral health and the second with decreased exposure to +delivery stress. +Thus, reduced psychological stress with healthier +pregnancy could have contributed to all the benefits +observed in this study. It appears that the mind manage- +ment techniques of yoga, which are meant to improve +the quality of life (Oken et al., 2006), greatly contrib- +ute to the harmonizing effect on the psycho-neuro- +humoral-immunological pathways, thereby resulting in +healthier pregnancy outcomes. +Generalizability +Studies in different cultures and different parts of India +and abroad would throw more light on the generaliz- +ability of yoga techniques. +Suggestions for Future Research +Further studies may evaluate the effect of yoga on +neuromuscular dynamics and psychosocial stresses in +pregnancy and its effect on the molecular biology of +pregnancy and fetal programming. +Strength of the Study +Strengths of the study were (a) its prospective random- +ized control design with a good sample size in which +controls actively practiced a matched intervention for +the same duration of time and (b) specially designed +integrated yoga modules for different trimesters. +Limitations of the Study +The unplanned move to a different town in the third +trimester and requests to shift from antenatal exercise +group to yoga group because of the wide spread popu- +larity of yoga through the media contributed to these +drop outs from the RCT. 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The effect of breathing +and skin stimulation techniques on labour pain percep- +tion of Turkish women. Pain Research and Manage- +ment, 9(4), 183–187. +Acknowledgments. We thank the staff of Maiya Multispeci- +ality Hospital and Swami Vivekananda Yoga Anusandhana +Samsthana who helped us throughout the study. We are +thankful to Dr. Kulkarni R. for his help in statistical analysis +of the data. Our thanks are because of Mr. Pradhan B. for his +help in scoring and preparing the manuscript. +Copyright © Springer Publishing Company, LLC + The Effect of Integrated Yoga on Labor Outcome  Maharana et al.  177 +Raghuram Nagarathna, MBBS, MD, FRCP (Edin), dean, +­ +Division of Yoga and Life Sciences, SVYASA, ­ +Bengaluru, India. +Padmalatha Venkataram, MBBS, FRCOG, MRCPI, consultant +obstetrician and gynecologist, Maiya Multispecialty Hospital +and Wockhardt Hospitals, Bengaluru. India. +Hongasandra Ramarao Nagendra, ME, PhD (Mech. Eng.), +vice chancellor, SVYASA, Bengaluru, India. +Alex Hankey, MA (Cantab.), PhD (MIT), distinguished +­ +professor, SVYASA, Bangalore, India. +Correspondence regarding this article should be directed to +Raghuram Nagarathna, Division of Yoga and Life Sciences, Swami +Vivekananda Yoga Research Foundation (Yoga ­ +University), # 19, +Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bengaluru, 560 +019, India. E-mail: rnagarathna@gmail.com +Satyapriya Maharana, MSc, Student of PhD, Division of +Yoga & Life Sciences, Swami Vivekananda Yoga Research +Foundation (SVYASA), Bengaluru, India. +Copyright © Springer Publishing Company, LLC diff --git a/subfolder_0/The Effect of Trataka, a Yogic Visual Concentration Practice on critical flicker fusion.txt b/subfolder_0/The Effect of Trataka, a Yogic Visual Concentration Practice on critical flicker fusion.txt new file mode 100644 index 0000000000000000000000000000000000000000..98f5b6aa0b2be33e6f771e8c0cb2484e14b00645 --- /dev/null +++ b/subfolder_0/The Effect of Trataka, a Yogic Visual Concentration Practice on critical flicker fusion.txt @@ -0,0 +1,218 @@ +The Effect of Trataka, a Yogic Visual Concentration +Practice, on Critical Flicker Fusion +Taruna Mallick, MSc, and Ravi Kulkarni, PhD +Abstract +Objectives: The study objective was to study the change in the critical flicker fusion (CFF) after a yogic visual +concentration practice (trataka). +Design: Thirty (30) subjects participated in a study where they were evaluated for the CFF immediately before +and after the practice. The subjects also participated in a comparable control session. +Subjects: The subjects were 30 volunteers in the age range 25–40. Fifteen (15) of the volunteers were male. The +mean age was 31.33  4.67. +Results: The CFF showed a statistically significant increase from 37.35  2.84 to 38.66  2.91 after the yoga +practice of trataka. The control session did not produce a statistically significant change in the CFF. +Conclusions: An increase in the CFF is seen immediately after the yogic concentration practice called trataka. +Introduction +A +long with physical postures and breathing practices, +an important role is played in the hatha yoga tradition by +certain cleansing practices called the kriyas. These are de- +scribed explicitly in a text1 (circa 10th century ad) that is +considered one of the sources of the hatha yoga tradition. Four +(4) of these six cleansing practices deal with the cleansing of +the nasal and digestive tracts, one is a practice roughly akin to +hyperventilation, and the last is a practice called trataka, the +subject of this work. (This Sanskrit word means ‘‘to gaze +steadily.’’ The first ‘‘a’’ is pronounced as in ‘‘art,’’ the other two +are pronounced ‘‘uh.’’) In the version of the practice studied in +this article, the subject sits very still in a dark room and fixates +the vision on the flame of a candle, which is at eye level about +4 feet away. The practice is described in greater detail below. +The critical flicker fusion (CFF) is defined as the frequency +at which a flickering stimulus is perceived to be continuous. +It is known to be affected by many factors: the luminosity of +the source, the wavelength, wave form, and the light–dark +ratio of the stimulating light, the light-adapted state, and the +area of the retina illuminated.2 It has found use as a medical +diagnostic tool and has been studied as a means of under- +standing the mechanism of vision.3,4 An increase in the CFF +after yoga practices over several days that included postures +and breathing routines has been reported before.5–7 The ob- +jective of the present work was to compare the CFF before +and immediately after the practice of trataka. +Materials and Methods +In this experiment, the subjects were novices to the practice +of trataka and were first introduced to the practice in five +sessions on separate days before the assessments. The practice +itself consisted of two distinct parts. In the first part, the +subjects were taught eye exercises. These consisted of eyeball +movements in the horizontal, vertical, and diagonal directions +and were followed by circular movements of the eyeballs. +These were done with eyes open, in a well-lit room. The sub- +jects were instructed to pay attention to the objects perceived +in the changing field of vision, rather than moving the eyeballs +mechanically. This was followed by the practice of palming to +relax the visual system. Palming consists of putting slightly +cupped palms over the eyes, so that the eyes perceive com- +plete darkness. Subsequently, there were three rounds of fix- +ating the gaze on the candle flame in a darkened room. In +each round, the subjects were told to hold their gaze on the +flame for at least 2–3 minutes, suppressing the urge to blink as +far as possible. These three rounds were interspersed by the +practice of palming for 2–3 minutes to relax the eyes. The +entire practice as described above took roughly 30 minutes. +After the subjects had learned the technique in the pre- +liminary group sessions, each subject did the practice indi- +vidually +for +the +CFF +assessment. +Each +subject +also +participated in an individual control session where they did +the eye exercises and palming and then sat blindfolded in the +dark for 10 minutes, before being assessed for the CFF. This +Swami Vivekananda Yoga University, Bangalore, India. +THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE +Volume 16, Number 12, 2010, pp. 1265–1267 +ª Mary Ann Liebert, Inc. +DOI: 10.1089/acm.2010.0012 +1265 +was done to account for the possibility that the ambient +darkness and the relaxation induced by palming could +influence the CFF. The design of the experiment thus was +‘‘self-as-control.’’ Each participant did trataka and the control +session on consecutive days, at the same time of the day (late +evening for everyone). The subjects were randomly allocated +to two groups, to randomize the order in which the trataka +and control sessions were done. +Thirty (30) subjects (15 were male) volunteered to partic- +ipate in the study. The mean age was 31.33  4.67 years and +the ages ranged from 25 to 40. All subjects had normal vision +and none were color blind. None of the subjects had any +previous training in the practice of trataka. +The CFF was measured using a standard electronic ap- +paratus. The apparatus consisted of a red light-emitting di- +ode, 6 mm in diameter, with a luminous intensity of 50 mcd, +a flicker rate adjustable between 12 and 95 Hz with equal on +and off times. A white background with an illumination of +150 lux surrounded the stimulus. The CFF was assessed four +times for each subject in each condition (trataka and control), +twice with frequency increasing and twice with decreasing +frequency to determine the critical point, and the mean of +these was taken to be the CFF for that subject. +Results +Table 1 shows the means and standard deviations of the +CFF immediately before and after the trataka and control +sessions. +All data were normally distributed. The trataka group +showed a statistically significant increase in the CFF from +37.35 to 38.66 ( p < 0.001, paired-samples t test). The control +group showed a statistically nonsignificant decrease in the +CFF from 37.33 to 36.88 ( p ¼ 0.06, paired-samples t test). The +two sessions showed no significant difference in the mean +CFF before intervention ( p ¼ 0.953, paired-samples t test), +while the difference in the CFF after intervention is signifi- +cantly different ( p < 0.001, paired-samples t test). +Discussion +It is well known that it is impossible to keep the vision +absolutely fixed on an object. In fact, if this happens, the +visual perception itself fades away.8 The eye always per- +forms tiny movements called saccades to counter this hap- +pening. Saccades of the type called microsaccades are +believed to play an important role in visual perception. Mi- +crosaccades typically carry the retinal image across several +dozen to several hundred photoreceptor widths and are +about 25 ms in duration. Recent research indicates that mi- +crosaccades lead to neural activity in the visual pathway.9 +Moreover, the induced neural activity occurs at all levels of +the visual system, from the ganglion cells in the retina to the +cortex. Flicker rates above the perceptual threshold are +known to generate cortical and subcortical responses,10 in- +dicating that the fusion does not occur in the retinal cells, but +later in the visual pathway. The practice of fixating the vision +in the trataka practice would therefore seem to indicate +changes at a cortical level in the processes that mediate fu- +sion. Subjects also uniformly report a feeling of calm alert- +ness after the practice of trataka, which is consistent with the +fact that the CFF increases, since it has been observed that the +CFF decreases under stress and fatigue.11 +The CFF and cognitive performance are known to be re- +duced in patients with sleep disorders.12 It would be inter- +esting to see whether regular practice of trataka can result in +improvement in cognitive functions and subjective alertness +in such subjects. A recent study on visual experience indi- +cates that the CFF threshold can be increased by prolonged +exposure to stimuli.13 While this article studied the imme- +diate effects of trataka, it would be interesting to see whether +regular sustained practice of trataka can lead to an elevated +CFF threshold. +Conclusions +The CFF rate has been shown to increase significantly as +the result of a yogic practice (trataka) that involves fixating +the vision on a candle flame. +Disclosure Statement +No competing financial interests exist. +References +1. Swami Muktibodhananda. Hatha Yoga Pradipika (Light on +Hatha Yoga). Munger, India: Yoga Publications Trust, 1993. +2. Turner P. Critical flicker frequency and centrally acting +drugs. Br J Ophthalmol 1968;52:245–250. +3. Kircheis G, Wettstein M, Timmermann L, et al. Flicker +frequency for quantification of low grade hepatic encepha- +lopathy. Hepatology 2003;35:357–366. +4. Werner H, Thuma BD. Critical flicker frequency in children +with brain injury. Am J Psychol 1942;55:394–399. +5. Telles S, Nagarathna R, Nagendra HR. Improvement in vi- +sual perception following yoga training. J Indian Psychol +1995;13:30–32. +6. Vani PR, Nagarathna R, Nagendra HR, Telles S. Pro- +gressive increase in critical flicker fusion frequency fol- +lowing yoga training. Indian J Physiol Pharmacol 1997;41: +71–74. +7. Manjunath NK, Telles S. Improvement in visual perceptual +sensitivity in children following yoga training. J Indian +Psychol 1999;17:41–45. +8. Riggs LA, Ratcliffe F. The effects of counteracting the normal +movements of the eye. J Opt Soc Am 1952;42:872–873. +9. Martinez-Conde S, Macknik SL, Hubel DH. The role of +fixational eye movements in visual perception. Nature Rev +Neurosci 2004;5:229–240. +10. Martinez-Conde S, Macknik SL, Hubel DH. The function of +bursts of spikes during visual fixation in the awake primate +lateral geniculate nucleus and primary visual cortex. Proc +Natl Acad Sci USA 2002;99:13920–13925. +Table 1. Values of the Critical Flicker Fusion (Hz) +Trataka +Control +Pre +37.35  2.84 +37.33  2.67 +Post +38.66  2.91 +36.88  2.84 +Values are mean  standard deviation. +1266 +MALLICK AND KULKARNI +11. Simonson E, Enzer N. Measurement of fusion frequency of +flicker as a test for fatigue of the central nervous system. J +Indus Hyg Tox 1941;23:83–89. +12. Schneider C, Fulda S, Schulz H. Daytime variation in per- +formance and tiredness/sleepiness ratings in patients with +insomnia, narcolepsy, sleep apnea and normal controls. J +Sleep Res 2004;13:373–383. +13. Seitz AR, Nanez JF, Holloway SR, Watanabe T. Visual +experience can substantially alter critical flicker fusion +thresholds. Hum Psychopharmacol Clin Exp 2005;20:55–60. +Address correspondence to: +Ravi Kulkarni, PhD +Swami Vivekananda Yoga University +Prashanti Kuteeram +19, Eknath Bhavan +Gavipuram Circle +Bangalore 560 019 +India +E-mail: ravi.kulk@gmail.com +EFFECT OF TRATAKA ON CRITICAL FLICKER FUSION +1267 diff --git a/subfolder_0/The effect of active and silent music interventions on patients with type 2 diabetes measured with electron photonic imaging technique.txt b/subfolder_0/The effect of active and silent music interventions on patients with type 2 diabetes measured with electron photonic imaging technique.txt new file mode 100644 index 0000000000000000000000000000000000000000..5b11d3e42288f62a13e31995dba86c246a8e26cd --- /dev/null +++ b/subfolder_0/The effect of active and silent music interventions on patients with type 2 diabetes measured with electron photonic imaging technique.txt @@ -0,0 +1,419 @@ + +www.iaset.us editor@iaset.us +International Journal Humanities +and Social Sciences (IJHSS) +ISSN(P): 2319-393X; ISSN(E): 2319-3948 +Vol. 3, Issue 5, Sep 2014, 7-14 +© IASET + + + +THE EFFECT OF ACTIVE AND SILENT MUSIC INTERVENTIONS ON PATIENTS WITH +TYPE 2 DIABETES MEASURED WITH ELECTRON PHOTONIC IMAGING TECHNIQUE +T. INDIRA RAO & HONGSANDRA RAMARAO NAGENDRA +Department of Yoga and Humanities, SVYASA, Bangalore, Karnataka, India + +ABSTRACT +Background +Patients with type 2 Diabetes Mellitus (DM2) may have autonomic imbalance. Studies have found that music +influences the autonomous nervous system. The effect of Indian music on the autonomous imbalance of the patients with +DM2 has not been investigated so far. The present study aims at comparing the difference of the effect of active and silent +music interventions on the activation coefficient (shows the autonomous balance) of DM2 patients using Gas Discharge +Visualization (GDV), a technique of imaging photonic light. +Methods and Materials +The study design is a single group repeated measures pre-post design with two kinds of music (active and silent) +intervention. Written consent was obtained from the participants of Arogyadhama, the holistic health home of SVYASA, +a Yoga University, Bangalore, South Karnataka. The time duration for both the interventions was 45min.each. +29 participants (mean age ± SD, 56.83 ± 7.85) men (mean age ± SD, 57.75 ± 8.24) and women (mean age ± SD, +54.78 ± 6.89) were analyzed using SPSS. +Results +Both the interventions showed significant effect on GDV parameters. But, there was a significant difference +(p = 0.007) in the effect between the two types of intervention. It appears that silent music intervention (SMI) lead to +boredom compared to active music intervention (AMI). +Conclusions + +A single session of AMI achieved the significant change in the parameters towards improvement in the health +condition which may be helpful in achieving autonomous balance of the DM2 patients. +KEYWORDS: Autonomous Imbalance, GDV, Music Intervention, Type 2 Diabetes Mellitus +INTRODUCTION +Background +There are 62.4 million people living with diabetes in India and the growing prevalence of DM2 is a major concern +for the individual as well as the government (International Diabetes Federation, (IDF, 2013). Lack of self efficacy to +change life style and manage stress contributes to poor control of DM (Alipour et al 2012). +Stress and Diabetes +The autonomic imbalance that results from inadequate stress coping skills leads to several complications +8 T. Indira Rao & Hongsandra Ramarao Nagendra + +Impact Factor (JCC): 2.3519 Index Copernicus Value (ICV): 3.0 +(McEwen, 2007) in diabetics. This imbalance leads not only to an array of distressful symptoms such as persistent +tachycardia/ bradycardia, digestive disturbances, bladder problems but also contributes too many lethal complications like +nephropathy, neuropathy and/ or retinopathy that result from long term narrowing of the blood vessels (Kodl and Seaquist, +2008). +Stress Management in DM +Several stress management techniques have been tried with varying results both in diabetes and other life style +diseases. Among these, exercise therapy has been found to be effective as it brings about autonomic balance by increasing +parasympathetic tone and decreasing sympathetic activity (Routledge et al., 2010). Heat and massage therapy decreased +serum cortisol in healthy adults pointing to reduction in stress levels (Lee, Y.-H., Park, B. N. R., & Kim, S. H. (2011). +Meditation reduced sympathetic activity and increased parasympathetic activity in healthy male subjects (Telles et al., +2013).Yoga with combined physical postures, breathing techniques and meditation when used as an adjuvant therapy, +reduced the autonomic dysfunction in patients with refractory epilepsy (Satyaprabha et al., 2008). +Music Therapy for Stress +The beneficial effects of Music as an art therapy to manage stress has been recognized since nineteen seventies +(American Association for Music Therapy, 1970). Relaxing music reduces not only subjective anxiety, but also the +potentially harmful stress reactions (Wendy, Nikky, & Richard, 2001). Subjective anxiety reduced in normal healthy men +and women after listening to relaxing music (Knight & Richard, 2001). State anxiety reduced in the students after exposure +to a stressor (Labbe, Schmidt, Babin, Pharr, 2007). Both joyful and relaxing music together and independently with +different combinations reduced hyperglycemia (Cioca, 2012). +GDV as a Measure of Stress +Measurement of stress has been a major challenge to physiologists. Over the past two decades several +psychological tools have been used starting from those that document the stressful life events to those that document the +perception of stress by the individual. Heart rate variability, derived from Electrocardiogram records, is one of the accepted +objective methods of measuring the responses of the autonomic nervous system to stress (Thayer 2012). A technique called +gas discharge visualizer (GDV) that can detect abnormalities in the physiology and the effects of stress on autonomic +balance, by tracking the changes in photon emission from the body surface has been investigated over several years by +Korotkov et al. GDV is a technique of imaging the photonic light caused by the ionization of gas molecules around any +object produced by the excited electronic emission from the object created under a low electrical current of high frequency +(1024 hertz) and high voltage ( 10 KV) (Korotkov, 2004). +Studies on GDV +Studies have shown that GDV is sensitive to both the physiological changes and also changes in environment. +Korotkov et al observed by a series of experiments on musical performances using remote sensors of GDV. Differences +were observed in area, intensity and entropy of the environment during the performance compared to the time of interval. +(Korotkov, 2009). Significant changes in area and intensity were observed after music therapy in patients with different +ailments as compared to normal volunteers (Gibson, 2004). + +The Effect of Active and Silent Music Interventions on Patients with 9 +Type 2 Diabetes Measured with Electron Photonic Imaging Technique + +www.iaset.us editor@iaset.uss +GDV to Measure Autonomic Balance +The images captured by using some filters have been used to assess the physiological changes during stress. +Cioca et al compared different variables from the GDV output with that of HRV and demonstrated good correlations +between some of the outputs (Activation Coefficient) from GDV with that of autonomic balance (LF/HF ratio) of HRV +(Cioca, 2004). Korotkov et al have used GDV measurements to assess autonomic balance (activation coefficient) before +and after Osteopathy based relaxation treatment for stress management (Korotkov et al., 2012). +Need For Present Study +There are studies that have shown the benefits of music therapy in reducing stress in normal healthy men and +women (Knight & Richard, 2001), students after the exposure of a stressor (Labbe, Schmidt, Babin, Pharr, 2007) and +elderly demented patients (Sakamoto, Ando, & Tsutou, 2013). There are no studies that have looked at the effect of music +therapy in diabetics as measured by GDV. Hence the present pilot study was designed to assess changes in autonomic +balance after music therapy in patients with DM2 using this new technology of GDV measurement. +Aim +To find out the effect of music on the patients with type2 diabetes. +Objectives +To find out the effect of active and silent music interventions on the coefficients of activation, integral area and +front projection form and entropy, which are some of the parameters of GDV. Activation coefficient shows the autonomic +balance, integral area shows the adaptability of the system to the internal and external influences. Zero distance between +the ideal image and the image drawn shows the perfect image. Form coefficient gives an account of the conservation and +depletion of energy in the system. The internal disorderliness or chaos can be measured with entropy. +MATERIALS AND METHODS +The study design is a single group repeated measures pre-post design with two kinds of music intervention. One is +AMI and the other is SMI conducted at Arogyadhama, the holistic health home of SVYASA, a Yoga University, +Bangalore, South Karnataka, India. +Inclusion Criteria +Patients with type2 diabetes willing to participate in the study of both genders in the age range of 35 to 70 years +who came from different parts of India for treatment between May and July 2013 were recruited. +Exclusion Criteria +Participants with fingers having obvious visible lesions such as cuts or cracks, moles or tattoos, less number of +fingers than the normal, hearing and speech impaired, severe back-ache and skin irritation were excluded from the study. +The project was approved by Dr. R. Nagaratna (Chief Medical officer) of Arogyadhama (health home). +The written consent was obtained from the participants before conducting the experiment and the demographic data forms +were filled by them. + +10 T. Indira Rao & Hongsandra Ramarao Nagendra + +Impact Factor (JCC): 2.3519 Index Copernicus Value (ICV): 3.0 +Methods -Procedure +The experiment was conducted on the first day (AMI) and second day (SMI) of the arrival of the participants, +on both the days from 5.45 to 6.30p.m. The interference of yoga was negligible. The participant was given the time of 5 +min to sit and settle down mentally. The participant was asked to keep his each finger of both the hands, one by one on the +glass plate of GDV and the images were captured by inbuilt CCD camera. +Intervention +Five participants were taken in each batch of AMI and SMI. A wash out period of a day was given between the +two exposures. The AMI session had singing devotional songs in lead and follow manner. (Choir singing enhances positive +emotions (Kreutz et al., 2004). Group singing enhanced mood and coping with pain (Dianna T. Kenny and Gavin Faunce, +2004). Group singing improved the mental health and well being. (Clift et al., 2010). The participants also sang the songs +of their own choice. Listening to preferred music decreased agitated behavior in older people with dementia (Christina and +Marie, 2005). The individual singing of the participants was followed by 10 minutes listening to recorded flute music of +Hariprasad Chourasia without rhythm in raag Darbari Kanada. Darbari Kanada (Hindustani) is used for devotional singing +and it is of shanta (calming) rasa.( Ravikumar, 2002, p, 122, 130) +The SMI session consisted of writing the experiences of music, likes and dislikes of music and the songs they +know (check list was provided) followed by listening to 10 minutes drone sound (shruti). +Data Extraction +GDV Pro instrument was used to capture the data. Images without filter show the psycho-physiological state and +with filter, the physical state. +Gas Discharge Visualization (GDV) is a technique of imaging the photonic light caused by the ionization of gas +molecules around the object due to the excited electronic emission from the object created by low current with high +frequency (1024 hertz) and high voltage ( 10 KV) (Korotkov, 2004). This imaging is captured with filter (a thin sheet of +plastic) and without filter to measure the stress level. The information with filter shows the physical functional state of a +person i.e. parasympathetic system, filtering the sweat and other secretions and without filter provides the sympathetic +nervous system i.e. the psychosomatic state. The activation coefficient is a quantitative assessment. It gives the person’s +stress level, based on sympathetic/parasympathetic balance evaluation (Korotkov et al., 2012). The dysfunction of the body +can be found with the abnormality in the flow of energy which can be identified by obstructed flow of electrons to the +tissues of the affected part. The parameters that are taken for this study are integral area (deviation of the image from the +ideal image) activation coefficient (balance of sympathetic and parasympathetic systems), entropy (disorderliness) and +form coefficient (harmonious working of the inner systems together) (Korotkov, 2002). +Data Assessment +The images with and without filter were considered for the assessment of activation coefficient and for other +parameters the images without filter were considered. The images without filter give the information about the +psycho-physiological state of a person. + + +The Effect of Active and Silent Music Interventions on Patients with 11 +Type 2 Diabetes Measured with Electron Photonic Imaging Technique + +www.iaset.us editor@iaset.uss +Data Analysis +Excel and SPSS 19 were used for analysis. Shapiro-Wilk’s Test was done for checking the assumption of +normality. Paired sample t test was done for the pre and post differences and for the difference between the sessions post +data was compared. Wilcoxon non- parametric test was done for not normally distributed variables. GDV diagram data +gave the details of the activation coefficient, integral area, integral entropy and GDV energy diagram gave the details of +form coefficient. This data was used for the tests. +RESULTS +42 patients wanted to participate in the study. 6 patients were excluded for reasons like hearing and speech +impairment, severe back-ache, skin irritation and 4 participants did not turn up for the post data. The data of 3 participants +was not taken into consideration as there were mistakes in data taking. The data of 29 participants was analyzed. +Except the right (right side of the body) integral area and left (left side of the body) integral entropy, other variables were +normally distributed. AMI has brought a significant change in the integral entropy of the right side and front projection +form coefficient and SMI has brought a significant change in the integral area of right side and front projection form +coefficient of the participants. (Table 1). But both the interventions differed in their influence on the activation coefficient +parameter. (Table 2). +Table 1: Pre Post Values of the Effect of Active and Silent Music Interventions +Variable +Active +Music +Session +Pre- Post +Silent +Music +Session +Pre-Post +Sig: +between +Sessions +Mean ± SD +p +Effect +size +Mean ± SD +p Value +Effect +Size +p +IA L +Pre +0.104 ± 0.07 +0.130 +0.29 +0.119 ± 0.08 +0.713 +0.06 +0.576 +Post +0.136 ± 0.09 +0.125 ± 0.09 +IA R +Pre +0.094 ± 0.08 +0.411 +0.24 +0.094 ± 0.08 +0.008** +0.54 +0.316 +Post +0.117 ± 0.09 +0.140 ± 0.10 +IE L +Pre +1.489 ± 0.21 + 0.130 +0.35 +1.969 ± 0.16 +0.92 +0.008 +0.102 +Post +1.940 ± 0.15 +1.881 ± 0.16 +IE R +Pre +1.992 ± 0.15 +0.011* +0.05 +1.932 ± 0.14 +0.474 +0.131 +0.548 +Post +1.881 ± 0.16 +1.905 ± 0.17 +ACC +Pre +2.334 ± 0.70 +0.565 +0.15 +2.056 ± 0.72 +0.523 +0.12 +0.007** +Post +2.411 ± 0.78 +1.950 ± 0.75 +FPFC +Pre +18.406 ± +3.66 +0.032* +0.41 +19.688 ± +4.77 +0.028* +0.43 +0.073 +Post +19.611 ± +4.57 +18.664 ± +5.15 +IA- integral area, IE- integral entropy, L-left, R-right, ACC-activation coefficient, FPFCOE- Front projection +form coefficient +AM- active music, SM-silent music +*p<0.05, **p<0.01 +Table 2: The Difference between the Active and Silent +Music Interventions for Activation Coefficient (ACC) +Interventions +ACC Mean ± SD +P value +0.007** +Active music +2.4411 ± 0.78 +Silent music +1.950 ± 0.75 + **p<0.01 +12 T. Indira Rao & Hongsandra Ramarao Nagendra + +Impact Factor (JCC): 2.3519 Index Copernicus Value (ICV): 3.0 +DISCUSSIONS +Integral area coefficient shows how much the GDV gram (the image area) of the examined participant deviates +from the ideal model. ‘0’ indicates that the area of the test image and the ideal model are the same. -0.6 to 1.0 corresponds +to a good health state. (Korotkov, 2002, p.275). Good tolerance of the pilots was observed with lower values of right +integral area compared with left integral area (Korotkov, 2011, p. 55). In the present study, the significant increase in the +right integral area with silent music activity may denote low tolerance (0.094 ± 0.08 to 0.140 ± 0.10, p value= 0.008), +left integral area being (0.119 ± 0.08 to 0.125 ± 0.08). With active music intervention also the integral area increased but +the left right balance is maintained, left (0.104 ± 0.07 to 0.136 ± 0.09) and right (0.094 ± 0.08 to 0.117 ± 0.09). +A stationary state of the system is characterized by the minimal dispersion of entropy. The deviation from the +stationary condition requires additional energy consumption which leads to the growth of entropy. The entropy from 1.5 to +2.0 shows the normal healthy state. More entropy is related with more expenditure of energy (Korotkov, p 80, 2011). +With active music intervention the right entropy decreased significantly (1.992 ± 0.15 to 1.881 ± 0.16, p value= 0.011) +showing the conservation of energy. Korotkov reports Prigogine’s conception that in the process of growth and +development of the organism a decrease occurs in the speed of entropy production (Korotkov, 2002, p.219).The left right +imbalances are larger in diabetic patients (Sharma, 2014). Active music influenced the left right imbalances towards +healthy condition of the patients. +For analyzing the psycho-physiological state of a person, the parameter activation coefficient is an important +measure. A calm even tempered and healthy person has an anxiety index in the range of 2-4 (Korotkov, 2002, p 36). +Though the change is not significant, the activation coefficient of the silent music decreased below normal +(2.056 ± 0.72 to 1.950 ± 0.75). “Activation coefficient 0-2: absolutely calm and totally relaxed person. It could be for +several reasons: deep meditation, the effect of psychedelics; deep sleep in the peaceful phase; at the same time it may be +the case of chronic depression or severe diseases.” (Korotkov, 2002 , p 42). When 2-4 is the normal range, 3 may be taken +as the ideal. Towards 3 shows healthy state. Going below 2 may be because of boredom or depression in case of patients +with DM2 as stated by Korotkov, because studies also found that depression is a co-morbidity of type2 diabetes. +With active music the change is towards 3 (2.334 ± 0.78 to 2.411 ± 0.75) which shows a shift towards the healthy +condition. +Both active and silent music activities showed significant changes in the front projection form coefficient. +The front projection form coefficient shows the degree of irregularity of the GDV image's external contour +(Korotkov, p 274, 2011). The range is 15-25. Here also the ideal may be taken as 20. Less than15 shows exhaustion of the +system and greater than 25 shows excessive work of the regulatory systems (Korotkov, 2011). Active music lead towards +20, may be taken as preservation of energy (18.406 ± 3.66 to 19.611 ± 4.57, p value=0.032) where as silent music +decreased the form coefficient showing towards depletion of energy (19.688 ± 4.77 to 18.664 ± 5.15, p value= 0.028). +CONCLUSIONS +Participation in the active music session preserved energy level and decreased right side entropy and helped to +maintain left right balance in integral area. A single session of active music achieved the significant change in the +parameters towards improvement in the health condition which may be helpful in achieving autonomous balance of DM2 +patients. +The Effect of Active and Silent Music Interventions on Patients with 13 +Type 2 Diabetes Measured with Electron Photonic Imaging Technique + +www.iaset.us editor@iaset.uss +IMPLICATIONS +Music as a therapy may be used to improve the balance of autonomic nervous system. +ACKNOWLEDGEMENTS +A part of this study was used for the Poster Presentation in the Conference held at SVYASA. The authors are +grateful to Dr. R. Nagaratna for her immense help in conducting the experiment in Arogyadhama (the health home of +SVYASA). The authors also acknowledge the support from Dr. Judu and Kuldeep Kumar Kushwah. +REFERENCES +1. Alipour A, Zare H, Poursharifi H, Sheiban Kh Ai, and M Afkhami Ardekani M.A. (2012). 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F., Ahs, F., Fredrikson, M., Sollers, J. J., & Wager, T. D. (2012). A meta-analysis of heart rate +variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. +Neuroscience and biobehavioral reviews, 36(2), 747–56. doi:10.1016/j.neubiorev.2011.11.009 + + diff --git a/subfolder_0/The role of yogasanas and pranayama techniques in correcting the functional disorders of voice production.txt b/subfolder_0/The role of yogasanas and pranayama techniques in correcting the functional disorders of voice production.txt new file mode 100644 index 0000000000000000000000000000000000000000..0ddcc03e33632453a22af35734a84f960f3418f8 --- /dev/null +++ b/subfolder_0/The role of yogasanas and pranayama techniques in correcting the functional disorders of voice production.txt @@ -0,0 +1,328 @@ + +Impact Factor(JCC): 1.3648 - This article can be downloaded from www.impactjournals.us + +IMPACT: International Journal of Research in +Humanities, Arts and Literature (IMPACT: IJRHAL) +ISSN(E): 2321-8878; ISSN(P): 2347-4564 +Vol. 2, Issue 7, Jul 2014, 159-166 +© Impact Journals + +THE ROLE OF YOGASANAS AND PRANAYAMA TECHNIQUES IN CORRECTING THE +FUNCTIONAL DISORDERS OF VOICE PRODUCTION +T. INDIRA RAO1 & HONGSANDRA RAMARAO NAGENDRA2 +1Department of Yoga and Humanities, SVYASA, Bangalore, Karnataka, India +2Department of Yoga and Life Sciences, SVYASA, Bangalore, Karnataka, India + +ABSTRACT + +The three types of vocal disorders are organic, functional and neurological. The organic disorders can be corrected +with surgery. Faulty use of voice, yelling, screaming and loud talking may cause functional disorders. Precautions are to be +taken to avoid functional disorders. People like singers, orators and teachers who use their voice hours together are +supposed to know the fundamental and optimum frequency of their phonation which can be measured with stroboscope. +Otherwise forceful use of voice either in high pitch or low pitch other than optimum level leads to the damage of the vocal +cords. Studies in the West have scientifically investigated the methods of correcting these functional disorders. +Indian traditional practices of yoga and pranayama on voice culture are yet to be investigated. There are asanas which +stimulate the vocal muscles and strengthen them. Pranayama helps in soothening the vocal muscles and relaxing them. +The influence of the traditional practices of yogasanas and pranayama can be studied scientifically. +KEYWORDS: Functional Disorders, Optimum Frequency, Pranayama, Stroboscope, Voice Culture, Yogasanas +INTRODUCTION +Voice is a powerful medium of expression. Unlike the other musical instruments, it has features like warmth, +modulations, elasticity, adjustable resonators and articulation. The main anatomical structures required for the production +of voice are the actuators (lungs), vibrators (voice box) and the resonators (throat, mouth, lips, teeth, and nose) which work +together. The energy that is produced by the actuator is converted into compressions and rarefactions by the vibrator and +the resonators enrich the tonal quality. The problems in voice production are due to organic (physical abnormality), +functional (faulty use of vocal mechanism) and neurological (impairment in the coordination of vocal muscles) +vocal disorders (Yoga for Voice culture, n.d.). +Vocal Disorders +Organic Disorders +Organic causes such as nodules (growth on the vocal cords) due to excessive use of vocal cords, polyps +(growth on the vocal cords) due to inability of the vocal cords coming together, laryngitis due to inflammation of the +mucous +membrane +of +the +larynx +and +hemorrhaging +(bleeding) +can +be +corrected +with +surgery +(Yoga for Voice Culture, n.d.). +Functional Disorders + +In spite of the absence of anatomical factors, if the voice has any of the problems like hoarseness, harshness, +tightness, loss of voice, vocal fatigue or any defect of speech (dysphonia), it is understood that it may have developed + +160 T. Indira Rao & Hongsandra Ramarao Nagendra + + +Index Copernicus Value: 3.0 - Articles can be sent to editor@impactjournals.us + +functional disorder. The functional disorders are named as 1 throatiness, 2 unsteadiness, 3 breathiness, 4 break in voice +registers, 5 voice fatigue, 6 thin or feeble voice, 7 white tone, 8 nasality, 9 huskiness, 10 hoarseness, 11 register weakness +and 12 uneven voice (Durga, 2007). +Reasons for Functional Disorders + +The reasons for functional disorders are forceful singing, yelling, screaming and loud talking without paying +attention to the fundamental and optimum frequency of phonation that can be measured with stroboscope. +Aphonia is another vocal disorder observed in conditions like schizophrenia and depression. Yet another reason of the +inflammation of the vocal cords is the result of allergies, bacterial or fungal infections or vocal overuse +(Yoga for Voice culture, n.d.). +Merits and Demerits of the Voice of the Singers + +Moreover, there are merits and demerits of voice. Sharangadeva in his Sangeetaratnakara gives the blemishes of +voice as 1 dry 2. broken 3 hollow 4. hoarse 5. lack of sweetness 6. difficulty in the production 7. frail and 8. grunting. +According to him an ideal voice is one which is 1. pleasing 2. sweet 3. creamy and full 4. uniform in all the three registers +5. soothing 6. rich 7. tender 8. strong 9. audible from a distance 10. inspire pathos in the minds of the listeners 11. being +heard at a distance 12. not dry 13. flowing 14. capable of creating interest among the listeners and 15. faultless. +Bharatmuni in his Natyashastra mentions the six qualities of an ideal voice which are shravaka –can be heard from a long +distance-, ghana- loud and pleasing-, snigdha-loud but not harsh-, madhura –pleasant-, avadhanavana- neither too loud nor +too soft- and tristanashobi-pleasant in producing all the notes of the three octaves. +Other Factors + +Along with the anatomical and physiological aspects, language, culture and civilization also have their influence +on the quality of voice production. Different systems of music have different concepts of an ideal voice. In the Western +system of music, nasality is admired. In the East, the Chinese and Japanese look for nasality as perfection (Durga, 2007). + +Whatever may be the type of voice, it has to be cultivated and in the process of cultivation certain muscles of the +body play a very important role. The working of all these muscles is responsible for the production of sound. +The range of voice also can be improved by voice training. +LITERATURE SURVEY + +The scientific research has proved that the quality of voice can be improved by following certain norms in using +the voice and certain strategies in maintaining the routine. + +It was found that the teachers were able to improve their voices if they significantly reduced vocal abuses in daily +life and practised specific strategies to maintain classroom order and reduce the use of voice in teaching (Chan, 1994). +The four, 1-hour class sessions on vocal hygiene, including anatomy and physiology of the phonatory mechanism, vocally +abusive behaviors, voice disorders commonly seen in singers, and measures to prevent voice disorders reported minimal +changes in vocal hygiene behaviors and perceptual voice characteristics (Lawrence et al., 2000). Voice functional exercises +are useful alternative or adjunct to vocal hygiene programs in the treatment of voice problems in teachers +(Roy et al., 2001). The teaching profession causes the risk of occupational dysphonia. The training of how to use the voice +The Role of Yogasanas and Pranayama Techniques in Correcting the Functional Disorders of Voice Production 161 + + +Impact Factor(JCC): 1.3648 - This article can be downloaded from www.impactjournals.us + +to the students of postgraduate certificate of education (PGCE) course at the University of Ulster, Northern Ireland proved +to be beneficial (Duffy and Hazlett, 2004). A course inclusive of two lectures, a short group voice therapy, +home-controlled voice exercises, and hygiene is a feasible and cost-effective primary prevention of voice disorders in a +homogeneous and well-motivated population of teachers (Bovo et al., 2007). +Preventative voice training for teachers is likely to be effective (Pasa et al., 2007). The vocal health educational +actions had a positive effect on the quality of life and voice of teachers both from the psycho-emotional and functional +aspects of the voice (Pizolato et al., 2013). Vocal fatigue from the daily use of the voice could be treated as a chronic +wound. With vocal loading exercises the voice can be recovered (Hunter and Titze, 2009). +NEED AND SCOPE OF THE STUDY + +The literature review throws light on the practices which the West offers for voice disorders. In India Yoga is +being practised for a number of ailments either as an alternative or adjunct therapy. Yoga also offers special techniques for +voice improvement. Studies have not yet focused on the benefits of practising yoga and pranayama in a traditional way for +improving the voice quality and correcting the vocal problems. +Hence this is an attempt to conceptualize the yogasanas and pranayama practices in a traditional way that help in +correcting the functional disorders of voice production. Singers need to practice yoga and pranayama to keep their voice +intact. +AIM + +The aim of this study is to find out the breathing exercises, asanas and pranayama practices from the existed +literature of yoga that influence the vocal mechanism. +OBJECTIVES +• +To find out from the existing yoga literature the asanas that correct the defects of voice production. +• +To find out from the existing yoga literature the pranayama practices, helpful for strengthening the voice. +HYPOTHESIS + +Breathing exercises, yogasanas and pranayama practices (mentioned in the yoga texts) are helpful in correcting +the voice disorders. Those may play a great role in culturing the voice of the singers in particular by correcting the +functional disorders. The practice of the breathing exercises, asanas and pranayama may increase the range and pitch of the +voice. +PRACTICES FOR CORRECTING THE FUNCTIONAL DISORDERS OF THE VOICE + +The aim of voice training is to remove the blemishes and the functional defects of the voice and make it as +powerful as possible. The first step for vocal hygiene is proper breathing and coordinating sound production with +breathing. The objectives of breathing techniques are to produce a powerful voice and to increase its range. Breath control +is the primary requirement of singing. There are a series of breathing practices to increase the breath power. + +162 T. Indira Rao & Hongsandra Ramarao Nagendra + + +Index Copernicus Value: 3.0 - Articles can be sent to editor@impactjournals.us + +REVIEW OF LITERATURE +Breathing Exercises + +Smooth flow of air in the lungs is the primary source of energy for voice production. In fact, voice is produced by +the vibrations of the vocal cords. These vibrations are influenced by the respiratory muscles. The intensity of the voice +depends upon the flow of the breath caused by these respiratory muscles. For singing, voluntary control over breathing is +required. Singing requires not only more air but controlled exhalation which can be obtained through diaphragmatic +breathing. In normal breathing, the rate of respiration is approximately fourteen to sixteen minutes per minute but in the +process of singing the rate of respiration is lowered to six times per minute (Durga, pp. 31-38). + +To increase the breath holding time, the breathing practices help to increase the capacity of the lungs. + +Breathing practices like hands stretch breathing dog breathing and tiger stretch increase the capacity of the lungs +and tongue massaging, tongue in and out, tongue rotation, lip stretch, laughter, jaw twisting and tongue twisting increase +the capacity of the resonators (Yoga for Voice Culture, n.d.). +Yogasanas (Physical Postures) + +The traditional practices of yogasanas help in unlocking the pent-up energy in the body. They harness the body +and mind connections and relax the stressed muscles. They help in improving the function of the muscles +(Voice Improvement Techniques, 2011). They help in smooth functioning of the lungs and diaphragm, which are tightened +up by the emotional tensions (Saraswati, p. 11). Swami Satyananda Saraswati gives an account of the asanas that work on +different organs related to voice production. Simhasana (lion posture) relieves the tension from chest and diaphragm. +It helps to reduce the stuttering. It is an excellent asana for the eyes, nose, ears, mouth and the throat. It develops a strong +and beautiful voice. Ushtrasana (camel pose) stretches the front of the neck toning the organs in that region. It helps in +curing asthma. Dhanurasana (bow pose) improves respiration. Ardha Chandrasana (half moon posture) releases the +feelings of congestion by giving a good stretch to the neck, shoulders, back and chest. Padahastasana +(hand under foot pose) helps in nasal and throat diseases. +Sarvangasana (shoulder stand pose) revitalizes the ears, eyes and tonsils (Saraswati, pp. 115- 261). +It exerts pressure against the throat and clears throat congestion. The throat muscles get stimulated and the circulation of +blood gets improved. (Natural Therapy Pages, n.d. para, 4)There is a set of asanas which stimulate the muscles of the vocal +cords and remove the phlegm and the toxins from the body. They are Matyasana (fish pose), Bhujangasana (serpent pose), +Dhanurasana, Ushtrasana, Ardha chandrasana and Simhasana (Voice Improvement Techniques, 2011). The special asanas +for culturing the voice are Prasarita Paschimottanasana (expanded back-stretching pose), Vakrasana (spinal twist pose), +Ardhamatsyendrasana (half spinal twist pose), Matyasana and Prasarita Halasana (expanded plough posture) +(Yoga for Voice Culture, n.d. pp. 36 - 45). +Chanting + +Chanting provides a number of benefits. Due to the vibrations produced by chanting, the prana (vital force) blocks +are cleared, peace can be achieved and metabolism can be changed. The stamina and strength of the voice can be +improved. The vibrations and modulations improve the voice quality (Yoga for voice improvement, n.d. para 6, 7.). +Vedic chanting increases the pitch and develops the voice (Yoga for voice culture, n.d., p. 26). ‘Om’ chanting strengthens +The Role of Yogasanas and Pranayama Techniques in Correcting the Functional Disorders of Voice Production 163 + + +Impact Factor(JCC): 1.3648 - This article can be downloaded from www.impactjournals.us + +the lung capacity, removes the stress and strengthens the mind (Gokhale, p.108, as cited in Banerjie, 2013). It improves the +base of the voice and increases the stamina of the voice (Voice Improvement Techniques, 2011). +Prnayama (Controlling the Inhalation and Exhalation with Breath Holding) + +Pranayama brings balance in breathing and releases the trapped energy (Saraswati, p. 272, 273). +It clears the congestion in the voice box. It helps in pitch control and range of the voice. The vital capacity of the lungs is +increased when the breath is held after inhalation and exhalation. More air rushes in. There are different practices of +pranayama. Anuloma viloma (alternate nostril breathing) brings balance in breathing (Saraswati, p. 388). The very useful +pranayama practice for singers in particular is ujjai (closed lips and contracting throat) (Yoga for Voice Improvement, +2010) and bhramari (producing humming female bee sound) and bhramara (producing humming male bee sound) +(Yoga for voice Culture, n.d. p. 26). + +Ujjai pranayama is a tranquilizing pranayama. It also has a heating effect on the body. In this pranayama it is to be +imagined that the breath is being drawn in and out through the throat. There is a snoring sound which is audible to the +practitioner only (Saraswati, p. 402,403). + +Bhramari and bhramara pranayama increases the range and pitch of the voice due to the vibrations inside the +throat +and +also +throughout +the +body +(Yoga +for +voice +Culture, +n.d. +p. +26). +Nadanusandhana +(fixing one’s attention on the inner sound) pranayama increases the pitch and volume of the singers and orators +(Yoga for Voice Culture, pp. 30-33). + +Kapalabhati (passive inhalation and active exhalation) cleans the full respiratory system. It gives good resonation, +synchronization of voice production and improves the depth of voice. It activates mooladhara (root) and +swadhishtana (sacral) chakras and thereby increases of energy (Banerjie, 2013). +Bandhas + +Bandhas +(locks) +are +four +in +number. +Mooladhara +(perineum/cervix +retraction +lock), +uddiyana +(abdominal retraction lock) jalandhara (throat lock) and mahabandha (three together). Bandhas activate the psychic knots +(Saraswati, p. 471). Jalandhara bandha gives pressure on the throat alleviating throat disorders. It improves the quality of +the voice (Muktibodhananda, p. 353) +Diaphragmatic Breathing + +The singers have to sing from the diaphragm and not from the throat. Singing requires more air in the chest. +The exhalation also needs to be controlled. In diaphragmatic breathing, the diaphragm is made to descend to a larger +extent. The abdomen is compressed increasing the abdominal pressure. This pressure against the diaphragm controls the +exhalation. The capacity of the chest increases and the singer gets more quantity of air (Durga, p. 37). +Integrated Approach of Yoga Therapy + +In addition to the above practices integrated approach of yoga therapy (a package of asanas, pranayama, kriyas +(cleansing techniques) diet control, counseling, devotional sessions) helps in maintaining good physical as well as mental +health and stamina (Nagaratna and Nagendra, 2008) which is the basic requirement for the singers as they need hours of +practice and performance. +164 T. Indira Rao & Hongsandra Ramarao Nagendra + + +Index Copernicus Value: 3.0 - Articles can be sent to editor@impactjournals.us + +MEASUREMENTS + +Scientific experiments for measuring the vocal tones can be carried out by Oscilloscope, Spectogram and +Kymograph. These experiments provide the changes in the vibrations of the resonators which enrich the tonal quality. +The harmonic and inharmonic overtones of the voice frequency can be measured with Fourier analysis and +Vercelli analysis respectively (Durga, p. 84). +CONCLUSIONS + +There are many asanas and pranayama practices documented in the yogic literature. The efficacy of those asanas +and pranayama practices can be investigated empirically, scientifically and statistically. +ACKNOWLEDGEMENTS + +The authors express their gratitude to Ms. G. Padmashree, Dr. K. Subrahmanyam and Dr. T. M. Srinivasan for +their guidance. +REFERENCES +1. Banerjie, M. (2013). New Approach and Possibilities of Voice Culture in Hindustani Classical Music. Retrieved +from http://shodhganga.inflibnet.ac.in/bitstream/10603/7570/11/11_chapter%207.pdf +2. Bovo, R., Galceran, M., Petruccelli, J., & Hatzopoulos, S. (2007). Vocal problems among teachers: evaluation of +a preventive voice program. Journal of Voice, 21(6), 705-722. +3. Broaddus-Lawrence, P. L., Treole, K., McCabe, R. B., Allen, R. L., & Toppin, L. (2000). The effects of +preventive vocal hygiene education on the vocal hygiene habits and perceptual vocal characteristics of training +singers. Journal of Voice, 14(1), 58-71. +4. Chan, R. W. K. (1994). Does the voice improve with vocal hygiene education? A study of some instrumental +voice measures in a group of kindergarten teachers. Journal of Voice, 8(3), 279-291. +5. Duffy, O. M., & Hazlett, D. E. (2004). The impact of preventive voice care programs for training teachers: +A longitudinal study. Journal of Voice, 18(1), 63-70. +6. Durga, S. A. K. (2007). Voice culture, the art of voice cultivation. Delhi: B.R. Rhythms. +7. Hunter, E. J., & Titze, I. R. (2009). Quantifying vocal fatigue recovery: Dynamic vocal recovery trajectories after +a vocal loading exercise. The Annals of otology, rhinology, and laryngology, 118(6), 449. +8. Mozzarella, R. (2003). ‘How to speak with power’. Paper presented at the 14th International conference on +frontiers in yoga research and applications. Bangalore: Swami Vivekanada Yoga Prakashana. +9. Muktibodhananda, S. (2009). Hatha Yoga Pradeepika. (3rd edn.). Munger: Yoga Publications Trust. +10. Nagaratna, R. & Nagendra, H. R. (1986). Self management of excessive tension. Bangalore: Swami Vivekanada +Yoga Prakashana. +11. Nagaratna, R., & Nagendra H. R. (2008). Yoga for positive health. Bangalore: Swami Vivekanada +Yoga Prakashana. +The Role of Yogasanas and Pranayama Techniques in Correcting the Functional Disorders of Voice Production 165 + + +Impact Factor(JCC): 1.3648 - This article can be downloaded from www.impactjournals.us + +12. Pasa, G., Oates, J., & Dacakis, G. (2007). The relative effectiveness of vocal hygiene training and vocal function +exercises in preventing voice disorders in primary school teachers. Logopedics Phonatrics Vocology, +32(3), 128-140. +13. Pizolato, R., Rehder, M., Meneghem, M., Ambrosano, G., Mialhe, F., & Pereira, A. (2013). Impact on quality of +life in teachers after educational actions for prevention of voice disorders:a longitudinal study, Health and Quality +of Life Outcomes. 11(28), http://www.hqlo.com/content/11/1/28, doi:10.1186/1477-7525-11-28. +14. Roy, N., Gray, S. D., Simon, M., Dove, H., Corbin-Lewis, K., & Stemple, J. C. (2001). An Evaluation of the +Effects of Two Treatment Approaches for Teachers With Voice Disorders: A Prospective Randomized Clinical +Trial. Journal of Speech, Language, and Hearing Research, 44(2), 286-296. +15. Saraswati. S. S. (2009). Asana Pranayama Mudra Bandha. (4th edn.). Munger: Yoga Publications Trust. +16. Shringey, R. K. & Sharma P. (2007). Sangitaratnakara of Sharangadeva. Text and English translation, +vol. I &II. 2007. New Delhi: Munshiram Manoharlal Publishers Private Ltd. +17. Voice Improvement Techniques, (2011). Retrieved from +http://www.yogawiz.com/askquestion/427/voice-improvement-techniques-what-can-i-do-to-make.html +18. Yoga for Voice Culture. (n.d.) Retrieved from +http://indianmedicine.nic.in/writereaddata/linkimages/7196039746-yoga%20for%20voice%20culture4.pdf. +19. Yoga for Voice Improvement. (n.d.) In Natural Therapy Pages. Retrieved from +http://www.naturaltherapypages.co.nz/article/Yoga_for_Voice_Improvement. diff --git a/subfolder_0/Understanding Jyotisha astrology I Theoretical aspects as a holistic spiritual science.txt b/subfolder_0/Understanding Jyotisha astrology I Theoretical aspects as a holistic spiritual science.txt new file mode 100644 index 0000000000000000000000000000000000000000..175974a2439375596981003c51128fe2d8ea90bc --- /dev/null +++ b/subfolder_0/Understanding Jyotisha astrology I Theoretical aspects as a holistic spiritual science.txt @@ -0,0 +1,740 @@ + +~ 19 ~ +International Journal of Jyotish Research: 2019; 4(2): 19-24 + + + + + + + + + + + + + +ISSN: 2456-4427 +Impact Factor: RJIF: 5.11 +Jyotish 2019; 4(2): 19-24 +© 2019 Jyotish +www.jyotishajournal.com +Received: 15-05-2019 +Accepted: 20-06-2019 + +Prabhakar Vegaraju +M.Sc., S-VYASA, Department of +Molecular Biology Laboratory, +Alex Hankey, S-VYASA, +Prashanti Kutiram, Jigani, +Bengaluru District, Karnataka, +India + +Alex Hankey +Ph.D., Department of Molecular +Biology Laboratory, Alex +Hankey, S-VYASA, Prashanti +Kutiram, Jigani, Bengaluru +District, Karnataka, India + +Ramesh Mavathur +Ph.D., Department of Molecular +Biology Laboratory, Alex +Hankey, S-VYASA, Prashanti +Kutiram, Jigani, Bengaluru +District, Karnataka, India + + + + + + + + + + + + + + + + + + + + + + + + + + + + +Corresponding Author: +Alex Hankey +Ph.D., Department of Molecular +Biology Laboratory, Alex +Hankey, S-VYASA, Prashanti +Kutiram, Jigani, Bengaluru +District, Karnataka, India + + + + + + + + + + + + +Understanding Jyotisha astrology I: Theoretical aspects as a +holistic spiritual science + +Prabhakar Vegaraju, Alex Hankey and Ramesh Mavathur + +Abstract +Jyotisha expounds deep understanding of Vedic sciences of the soul. It is considered the supreme +spiritual science, and is known in the Vedic literature as the ‘Science of the Sciences’, it illuminates the +soul’s progress on the path of Sanatana Dharma. This paper shows how the structure of Jyotisha +illustrates the Chaturvidha Purushardha, the four-fold aims or goals of life, Dharma – Artha – Kama – +Moksha. It enables expert Jyotishis to evaluate a soul’s subtle energies, merits and demerits, and so assist +a native on the path to Moksha. The paper thus emphasizes how the structure of the Jyotisha Kundali +offers deep insights into the nature and theory of Dharma. The Kundali indicates at each point in time the +nature of active Prarabda Karma dominating a person’s life. Correctly used, Jyotisha implements the +principle, “Heyam Dukham Anagatam”, Avert the Danger Yet to Come. Of fundamental importance in +life are the influences of the Chaya Grahas, Rahu and Ketu, which carry forward Vasanas from previous +Janmas. Jyotisha thus presents a perspective of supreme wisdom which, when wisely used, can solve +problems, help the native avoid suffering, and advance the soul to spiritual fulfilment. + +Keywords: Jyotisha, soul, dharma, Artha, Kama, moksha + +Introduction +India’s ancient Vedic Sciences are often considered the height of mankind’s intellectual +achievements [1]. Supreme among them is Adishankara Shankaracharya’s system of Advaita +Vedanta [2], based on his celebrated commentaries on Bhagavad Gita [3], Brahma Sutras [4-6] +and Upanishads [7]. Some hail it as the supreme philosophical achievement of mankind [8-10]. +Based on the four Vedas and their subordinate Upavedas, the six limbs of the Veda, the +Vedangas, and their six subordinate limbs, or Upangas, the Vedic Sciences are similarly hailed +as a supreme system of knowledge [11], originating in the cognitions of the Vedic Rishis, or +seers. +Of these Vedic Sciences, one stands out [12] in that it is known as the ‘Science of Sciences’ [13]. +The sixth Vedanga, Jyotisha, presents a detailed account of both the life, and the journey, of +each soul. Its structure implicitly sets out the context for souls’ development, while the +predictions it makes of life events show how such development materialises in a given +lifetime. This paper is concerned with the first, ‘life of the soul’, aspect, while its sequel, will +more concern Jyotisha’s prediction of events in each life’s journey. +Jyotisha implicitly explains how the unbounded, infinite creative intelligence of nature is able +to direct and coordinate all events on our planet Earth [14]. As a spiritual science it is supreme, +because it elucidates the progress of the soul on its path from generation by the Divine Being, +Ishwara, to supreme fulfilment in the state of Moksha, spiritual liberation. This path, laid out +in the ancient system of Sanatana Dharma [15], is central to the Vedic sciences of the soul +given in the Vedic literature. +Sanatana Dharma describes the path of the soul as a transformation from dualistic states of +suffering to non-dualistic states of bliss and fulfilment [16]. As it progresses, the soul gains +increasing abilities that accumulate over many lifetimes. To expound the soul’s progress +through successive incarnations, the Vedic literature uses terms that are nigh untranslatable +into European languages, the Chaturvidha Purushardha: Dharma – Artha – Kama – Moksha +[15]. Each concept presents deep insights into the relationship between the soul and its creator. +Overall, the Purushardhas epitomize the nectar-like essence of Vedic philosophy. +This foundation paper presents Jyotisha astrology as a Holistic Spiritual Science. It treats the +interrelated structure of these four concepts, explaining the theory behind them, + +~ 20 ~ +International Journal of Jyotish Research +http://www.jyotishajournal.com +and showing how Jyotisha helps understand them. In the +process, it shows how Jyotisha helps people achieve them, +and how it can guide humanity into states of higher evolution. +In Sanatana Dharma, all souls are regarded as aspects of the +Divine, created before the beginning of time, and rising +through successive states of greater mental, emotional and +intellectual ability during the course of their experience of life +or lifetimes on earth [15, 16]. Incarnation is an opportunity for +the education of the soul, thereby adding to its Chit, the +accumulated sum of all its experiences. Eventually, through +development of both perception and comprehension of the +nature of life, the soul can clearly grasp the validity of truths +presented in texts like Bhagavad Gita, such as where Lord +Krishna declares, “He who sees all beings in Me, and Me in +all beings, he is not lost to Me, nor I to him” [17]. Intrinsic to +Jyotisha is its capability to assist souls in their progress on +paths to spiritual fulfilment. +Jyotisha intrinsically shows how Nature’s Infinite Intelligence +is reflected in ongoing processes in our finite world. The +Vedic literature embodies this in the saying “Anoraniyan +Mahatomahiyan” [18], from the smaller than the smallest to the +larger than the largest (is the Infinite Creative Intelligence +found). A similar statement was given in ancient western +tradition, “As above, So below” [19] (Sanskrit, “Yata pinde, +tata Brahmande” [20]), implying that what occurs here on earth +precisely reflects what happens in the heavens above. Indeed, +that precise encapsulates Jyotisha astrology, which holds that +every event on earth correlates with, and is predictable from, +positions and motions of the Navagrahas [21]. +The primary concern of Jyotisha is thus the Soul [22]. It works +on subtle levels using phenomena unknown on gross levels of +manifestation. In modern western studies, the only example +where ‘Remote Viewing’ [23] is considered possible, is +parapsychology. Even there it is regarded as rare, an +extraordinary ability, highly desired for misuse by immoral +people [24]. +To estimate a soul’s level, Jyotisha evaluates its subtle +energies and tendencies, its merits and demerits. Through +such soul properties Jyotisha predicts major events in a +person’s life, and says what steps may be taken to avoid them, +if possible – something it can also evaluate. +Traditionally in the Vedic civilization, Jyotisha was at the +heart of family life. Every newborn baby was taken to the +family Guru soon after birth, to be given blessings [25] and to +clarify the child’s Dharma, or path in life. She or he would +expound +the +path, +if +necessary +using +the +baby’s +Janmakundali, birth chart. Otherwise, he would simply use +his ability of Jyotishmati Pragya, the Siddhi enabling a person +to see events at great distances, or in the past or future. Either +way, the Guru would ‘see’ the Dharma of the newborn’s soul, +and the various karmas that would fructify in its life [26]. He +would inform the parents how to guide their child in the best +possible ways to maximize its achievements, Kama, on all +levels, material and spiritual, thus increasing progress on its +path of return to the Divine. Jyotishmati Pragya [27], the +Siddhi embodying the ability to see events at great distances, +or in the past or future, takes long Sadhana for most people to +master. For Jyotishis, Jyotisha practice helps it develop. + +The Kundali +The Vedic civilisation was dedicated to furthering Dharma +[28], the continuous progress seen in the world [29], originating +in the Infinite Creative Intelligence of nature, and the +creativity, that He/She has bestowed on created souls. The +structure of the Kundali [30], or astrological chart, in Jyotisha +gives deep insight into the nature and theory of Dharma. The +Kundali’s twelve Bhavas (houses) are divided in 4 triplets, +one each for Dharma, Artha, Kama, and Moksha [31]. The +Dharma triplet [32] presents spiritual nature and tendencies. +The Artha triplet [33] presents prescribed activities and +achievements that bring progress in life, e.g. wealth; the +Kama triplet [34] yields insights into aspirations and desires to +fulfil; while the Moksha triplet [35], presents feasibility of +attaining spiritual liberation, Moksha, in this life. +The Kundali thus presents deep structures in life like +fundamental tendencies, repeated patterns, etc. Also indicated +are dangers and vulnerability, diseases, accidents, and +problems like debt [36]. Most importantly, it presents probable +timings of specific events [37]. + +Karma: +source +of +the +Kundali’s +properties +and +predictions +The concept of Karma in the Vedic sciences is central to the +overall system of Sanatana Dharma. It plays a foundational +role, as the fundamental reason why a soul takes birth, or +continues its present incarnation. It explains a person’s +tendencies of personality, abilities, profession, and how their +life unfolds with the passing of time. As a soul’s lifetimes +unfold, he or she gains higher levels of various abilities +including spiritual potentiality. These are put to use in future +lives, making the soul’s lifetimes increasingly rich with the +passage of time. +Karma shows up in a person’s Janmakundali through the +influence of successive Grahas in the system of Vimshottari +Dasa-Bhuktis (major periods and minor periods) [38]. Together +with Graha Gochara (transits) [39], these lead to detailed +predictions of current events in a person’s life. Competent +Jyotishis are therefore always aware of the dates of +forthcoming transitions of Grahas from Rashi to Rashi, and +Nakshatra to Nakshatra etc. [39, 40] Such information enables +the Jyotishi to fulfil the danger-averting principle of Heyam +Dukham Anagatam [41]. +The Vedic Sciences divide Karma into three parts [42, 43]. First, +Prarabda Karma, representing the fruit of past actions, +Karma active in this lifetime [42]; second, Sanchita Karma, +that which we accumulate in this life, which will fructify in +future, and be experienced then [43]; and third, Agami Karma, +the store of Karma from previous lives that will fructify in +future lifetimes but not in this one [42-44]. According to the +tradition of Vedic wisdom, these last two kinds of Karma, +Sanchita Karma and Agami Karma, can be annulled by +actions in the present life, “The seeds (beeja) of future actions +can be roasted” [45]. That is a major purpose of advanced +stages of Yoga practised by high-level aspirants on the path to +Moksha. +In light of the above, we can now proceed to an exposition of +the Chaturvidha Purushardhas. + +Dharma +Dharma is primary, sustaining the other three components of +Chaturvidha Purushardha. The auspicious Trikona Bhavas, +Houses 1, 5 and 9, of a Kundali present the overall picture of +Dharma at the epoch time. Prathama Bhava, Lagna Bhava, +concerns the holistic state at that time [46]. Panchama Bhäva, +presents influences from the past on the process; Navama +Bhäva, how the spiritual world may help unfold it. +Regarding Lagna Bhava, Brihat Parashara Hora Shastra +(BPHS) states (BPHS 12.2) + +deh< êp< c }an< c v[¡ cEv blablm!, +suo< Ê>o< SvÉav l¶ÉavaiÚrI]yet!. 2. + +~ 21 ~ +International Journal of Jyotish Research +http://www.jyotishajournal.com +Meaning: Physique, complexion of the body, appearance, +vigour, weakness, intellect, happiness, grief and innate +nature are all to be divined from the Lagna Bhäva. + +Regarding Panchama Bhava, concerning influence of past +karmas [47], BPHS says (BPHS 12.6) + +yÙmÙaE twa iv*a< buÏeíEv àbNxkm!, +puÇraJyapæa. 6. + +Meaning: The learned deduce from Bhäva 5 amulets, sacred +spells, learning, knowledge, sons, royalty (or authority), fall +of position etc. + +Regarding Bhava 9, named for Dharma [48] itself, BPHS says +(BPHS 12.10) + +ÉaGy< Zyal< c xm< c æat&pTNyaidka. 9. + +Meaning: Bhava 8 (Randhra Bhava) indicates longevity, +battle, enemies, forts, wealth of the dead, things that have +happened, and things yet to happen, i.e. births, past and +future. + +Regarding Bhava 12, BPHS states (BPHS 12.13) + +Vyy< c vEirv&ÄaNtir>)mNTyaidk< twa, +Vyya½E; ih }atVyimin svRÇ xImta. 13. + +Meaning: Bhava 12 (Vyaya Bhava) indicates expenses, +history of enemies, one’s own death etc. Prosperity, or +Annihilation of a Bhava + +In terms of Karma, Moksha means annulment of Agami and +Sancita Karmas, by e.g. devotion to God, yoga meditation etc. +When action is in accordance with Natural Law, Sancita +Karma is no more created. Allowing God’s Will to direct all +one’s actions leads to Moksha. In Bhagavad Gita, actions in +accordance with Natural Law are implicitly illustrated by +Arjuna having Lord Krishna as his charioteer [59]. The horses +are said to symbolise the organs of action [60], so having Lord +Krishna holding the reins implies that all Arjuna’s actions are +directed by the Will of God. +BPHS Chapters 16, 20, 24 further elaborate on Bhävas 4, 8 +and 12 respectively. + +Discussion/further considerations +A fundamental idea in Jyotisha is that all Bhavas are equally +important in judging the strength of a Kundali. Any one of +them can have a key influence on its strength or weakness, +and play a major role in possible outcomes. Of course, the +strength of the Lagna does have implications for the whole +Kundali. Its strength can help guarantee positive outcomes for +the process being considered, while weakness will have the +opposite effect. The Dusthana Bhavas are all in the Artha – +Moksha pair of triplets. If one Dusthana is strong, the whole +triplet is dragged down. Rahu has inauspicious results similar +to Dusthanas, except that it will drag down a whole triplet, +e.g. towards values of materialism Its partner, Ketu, on the +other hand, will tend to advance a soul on the path to Moksha, +for which it is Karaka. Generally, each Graha’s results are +signified by the Bhava it occupies and the Bhavas of the +Graha in whose Nakshatra it is posited at the epoch time, +subject to other influences. +A very significant aspect of the Kundali is that it can be +understood to reflect the overall, unified nature of existence +asserted in Advaita Vedanta. The ancient Risis realized that +each Purushardha in itself presents a goal of life that the soul +must realize in order to attain final fulfilment. They can be +summarized as follows. + +The Dharma Bhavas, 1, 5 and 9, concern the soul’s path +and overall purpose. + +The Artha Bhavas, 2, 6 and 10, concern capabilities +needed to fulfil that Dharma. + +The Kama Bhavas, 3, 7 and 11 represent rewards that +bring the soul satisfaction, motivating it to progress +further on its journey. + +The Moksha Bhavas, 4, 8 and 12 indicate how the soul +achieves enlightenment. + +This sequence of four Purushardhas is repeated 3 three times +in the cycle of 12 Bhavas: + +The first Set of four, Bhavas 1 to 4, concerns the Knower +him / herself. + +The second Set of four, Bhavas 5 to 8, concerns the +Process of Knowing. + +The third Set of four, Bhavas 9 to 12, concerns the +Known, including the Ultimate. + +Thus, the three Sets of Four together, i.e. the Whole Kundali, +Bhavas 1 to 12, present the Wholeness of Knower, Process of +Knowing and Known, the overall, Unified Structure of +Reality according to Advaita Vedanta. + +Conclusion +In these various ways, Jyotisha presents a perspective of +supreme wisdom that can be wisely used to avoid problems +and suffering, Heyam Dukham Anagatam, and help the soul +advance to spiritual fulfilment. Its title in the Vedic literature +of being, ‘The Science of Sciences’ 13, is fully justified. No +other science lays out all aspects of the paths of Sanatana +Dharma so clearly, with the central concepts so well +delineated. + +Conflict of Interest +None of the authors has a conflict of interest to declare. + +~ 23 ~ +International Journal of Jyotish Research +http://www.jyotishajournal.com +References +1. Cartwright DE. Schopenhauer – A Biography, Chapter 7. +Cambridge University Press, Cambridge, 2010. +2. Mahadevan TM, Radhakrishnan S, Radhakrishnan S. The +philosophy of Advaita. Bharatiya Kala Prakashan, 2006. +3. Sankaracarya. (Kar A. Rya C. Shastri A.M. Trans.) The +Bhagavad +Gita, +with +the +commentary +of +Sri +Sankaracharya. Scholar’s Choice, Stratford, Ontario, +2015. +4. Brahmasutra Sankarabhashya with Anandagiri Tika Part +1 – Anandasram, 1890. +5. Brahmasutra Sankarabhashya with Anandagiri Tika Part +2 – Anandasram, 1891. +6. Badarayana. 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Ranjan, New Delhi. 1984; I(12.5):16. +57. Parashara M. (Santhanam R. Trans.) Brihat Parashara +Hora Shastra. Ranjan, New Delhi. 1984; I(12.9):20. +58. Parashara M. (Santhanam R. Trans.) Brihat Parashara +Hora Shastra. Ranjan, New Delhi. 1984; I(12.13):24. +59. Yogi MM. (Ed.). Maharishi Mahesh Yogi on the +Bhagavad-Gita: A Translation and Commentary, Penguin +Group, USA. 1990; 1-6(1):v.24. +60. Yogi MM. (Ed.). Maharishi Mahesh Yogi on the +Bhagavad-Gita: A Translation and Commentary, Penguin +Group USA, 1990, 1-6. + diff --git a/subfolder_0/Upper extremity strength and motor speed in children with visual impairment following a 16-week yoga training program.txt b/subfolder_0/Upper extremity strength and motor speed in children with visual impairment following a 16-week yoga training program.txt new file mode 100644 index 0000000000000000000000000000000000000000..97a367fbfb7c4b2f0eaafc298cd36acb25b303bf --- /dev/null +++ b/subfolder_0/Upper extremity strength and motor speed in children with visual impairment following a 16-week yoga training program.txt @@ -0,0 +1,793 @@ +Isokinetics and Exercise Science 24 (2016) 107–114 +107 +DOI 10.3233/IES-150607 +IOS Press +Upper extremity strength and motor speed in +children with visual impairment following a +16-week yoga training program +Soubhagyalaxmi Mohanty∗, Balaram Pradhan and Alex Hankey +SVYASA Yoga University, Bangalore, India +Received 1 October 2015 +Accepted 1 December 2015 +Abstract. +BACKGROUND: Yoga’s benefits on various aspects of health for sighted children is substantially supported by the literature. +This study aimed to extend those fidings to children with visual impairment. +OBJECTIVE: The aim of the study was to measure changes in upper extremity strength and motor speed in children with visual +impairment following 16-weeks of yoga training. +METHODS: This was a two arm pre post, single blind, waitlist-controlled study. Eighty-three (yoga [n = 41], control [n = +42]) participants (aged 9–16 years) enrolled, 6 dropped out from the trial. Demographic characteristics were not significantly +different between the two groups. The following variables: upper extremity muscle strength; elbow flexion and elbow extension, +pinch strength and motor speed were evaluated bilaterally using a handheld dynamometer, pinch dynamometer and finger tapping +board respectively at baseline and after the 16-week intervention. SPSS-20 was used for statistical analysis. +RESULTS: Significant improvements in all variables (P < 0.05) were observed in the yoga group for both limbs but no +significant changes were observed in the control group. +CONCLUSION: The study suggests that yoga may be considered an effective option to improve muscle strength and motor +function in children with visual impairment. +Keywords: Muscles strength, motor speed, visual impairment, children, yoga +1. Introduction +Physical activity plays a vital role in maintaining +muscle strength, an imperative predictor of function, +mobility, independence and activities of daily living +(ADL). Individuals with visual impairment (VI) spend +a relatively low percentage of the day physically ac- +tive, usually of insufficient duration and intensity to +improve overall health status [1]. Various aspects of fit- +ness are significantly lower in children with VI com- +∗Corresponding author: Soubhagyalaxmi Mohanty, Eknath Bha- +van, 19 Gavipuram Circle, K.G. Nagar, Bangalore 56 00 19, +India. +M: +80 9483852383; +Fax: +80 2660 8645; +E-mail: +mohantyslaxmi@gmail.com. +pared to their age-matched sighted peers [2–7] which is +associated with their loss of independence. To perform +their ADL the VI are usually dependent on caregivers +or assistants [8] thus incurring additional expenditure. +The upper extremities are essential for the per- +formance of many important tasks and also most +ADL; dressing, writing, combing, and most house- +work. Their strength, endurance and coordination are +essential components of motor speed [9], an impor- +tant measure of both cognitive and physical func- +tion [10]. The upper extremities are commonly used +for tasks such as reaching and grabbing, which may +involve multiple coordinated steps of precise motor +control [11]. Enhancing upper extremity strength can +therefore play an important role in improving daily +ISSN 0959-3020/16/$35.00 c +⃝2016 – IOS Press and the authors. All rights reserved +108 +S. Mohanty et al. / Upper extremity strength and motor speed in children with visual impairment +activity. Various studies have demonstrated deficien- +cies in upper extremity strength in individuals with +VI [12,13], but only limited effort has been given +to develop rehabilitative interventions aimed at their +specific needs. Strategies to improve upper extremity +functions would play vital roles in keeping those with +VI active and independent throughout their lives. +Yoga, a traditional Indian approach to right liv- +ing, promotes human health holistically which has in- +creasingly been gaining popularity in western coun- +tries [14]. It may generally be described as a practice +which integrates four elements: postures, breath con- +trol, meditation, and relaxation. It may be regarded as +a muscle strengthening and conditioning exercise pro- +gram [15], better than exercise at improving a variety +of health-related measures [16]. A growing number of +studies provide good evidence that yoga can lead to +improvement in musculoskeletal strength [17–20] and +finger tapping speed, a common assessment of motor +function [21–23]. Yoga’s positive effects on autonomic +arousal [24], balance [25], and proprioception [26] in +individuals with VI are well-documented, but on mus- +cle strength and motor speed have not been reported +on similar populations. To fill these gaps, we assessed +upper extremity strength and motor speed in children +with VI following a specific yoga intervention for 16- +weeks, designed to meet the requirements of our par- +ticipants, in consultation with a panel of five indepen- +dent yoga experts. +2. Methods +2.1. Participants +Eighty three children with VI aged 9–16 years were +enrolled by convenience sampling from the Ramana +Maharishi Academy for the Blind (residential school) +in Bangalore, South India. They were divided into two +groups: yoga (n = 41), and control (n = 42). All were +in good general health, independent in walking, able to +communicate and follow testing procedures. They had +right hand dominance, assessed using the Edinburgh +handedness inventory [27]. +Approval for the research was obtained from the +SVYASA’s Institutional Ethics Committee in accor- +dance with the Declaration of Helsinki, and reviewed +by Institutional Review Board. Written informed con- +sent was obtained from the school administration, par- +ents or guardians and each participant after explaining +the experimental procedure in detail. +2.2. Inclusion criteria +Participants, who had (a) Congenital blindness (b) +Visual acuity less than 20/200, field of vision limited +to 20◦(legally blind) [28] (c) aged 9 to 16 years (d) +able to understand both English and the regional Indian +language (Kannada) (e) no prior exposure to yoga, and +(f) agreed to provide written informed consent, were +included in the study. +2.3. Exclusion criteria +Children with (a) left hand dominance (b) multiple +impairments, (c) any injury restricting practice of yoga, +(d) and deformity in the upper extremities, (d) and +deficit in other sensory systems, (e) additional physical +disabilities were excluded from the study. +2.4. Design +This was a nonrandomised, single-blind, waitlist +control trial, with the two groups matched on age, +gender, height, weight and degree of blindness. Both +groups were assessed at baseline and after 16 weeks. +The yoga group participated in one hour of yoga prac- +tice, five days per week, while the control group spent +the same amount of time in ostensibly comparable ac- +tivities, learning dance, preparing hardboard, or play- +ing games. +2.5. Intervention +The yoga program was conducted by an experienced +yoga trainer with more than four years of yoga teach- +ing experience to children with VI with the help of two +other certified yoga instructors. For better learning, the +yoga group (n = 41) was divided into four subgroups +of 10 or 11 students each. Classes were conducted sep- +arately for each group in different sessions of 60 min +duration. The program lasted 16 weeks and the prac- +tices are listed in Table 1. All participants were pro- +vided with paper cut-out models of some yoga postures +to give them an idea about the same through touch and +feel method. Audio cassettes with detailed instructions +of all practices were also given. Individual care was +taken to ensure that they could understand, feel and +perform each practice accurately. +Control group participants were requested to main- +tain their routine activities and not to begin yoga or any +mind-body program during the course of the study. At +the end of the training period, they received the yoga +program. +S. Mohanty et al. / Upper extremity strength and motor speed in children with visual impairment +109 +Table 1 +List of yoga practices +Type of practice +Duration +Name of the practices +Breathing Practices +5 mins +Hands in and out breathing +Ankle stretch breathing +Sasankasana breathing +Tiger breathing +Loosening Practices +10 mins +Jogging and Jumping +Forward & backward bending +Twisting +Surya Namaskar (Sun salutation)(12 rounds) +Yogasanas +20 mins +Standing-Asanas +Ardhakati Cakrasana (Half waist sliding pose) +Ardha Cakrasana (Half wheel bend pose) +Padahastasana (Hand to foot pose) +Trikonasana (Triangle pose) +Parivritta Trikonasana (Twisted triangle pose) +Sitting-Asanas +Vajrasana (Thunderbolt pose) +Paschimottanasana (Back stretching pose) +Ustrasana (Camel pose) +Vakrasana (Half spinal twist) +Prone-Asanas +Bhujangasana (Cobra pose) +Salabhasana (Locust pose) +Dhanurasana (Bow pose) +Makarasana (Crocodile pose) +Supine-Asanas +Sarvangasana (Shoulder stand pose) +Halasana (Plough pose) +Matsyasana (Fish pose) +Pranayama +15 mins +Kapalabhati (Frontal brain cleansing) +Vibhagiya pranayama (Sectional breathing) +Nadisuddhi pranayama (Alternate nostril breathing) +Bhramari pranayama (Humming bee breathing) +Relaxation/Dharana +15 mins +Instant, Quick, and Deep Relaxation Techniques/ +& Dhyana +Nada-anusandhana +A+U+M Chanting (each 9 rounds) +Total +60 mins +2.6. Assessments +2.6.1. Anthropometric measures +The participants were instructed to stand in up- +right position in light clothes with bare feet. Height +was measured to the nearest centimetre using a non- +stretchable measuring tape (Gilick Anthropometric +tape60” Model J00305, Lafayette Instrument, USA). +The weight and Body Mass Index (BMI) were taken +using In Body R20 composition analyzer (Gymcom- +pany). The physical and functional assessment of the +upper limb with inspection, palpation and active move- +ment to check the integrity of the musculoskeletal and +neuro-functional system was carried out before com- +mencement of the test. +2.6.2. Upper extremity muscle strength +Elbow muscle strength +The maximum isometric muscle strengths (peak +force, in kg) of the Elbow Flexion (EF) and El- +bow Extension (EE) were measured bilaterally us- +ing the Lafayette Manual Muscle Test System (Model +01165, Lafayette Instrument Company, Indiana, USA) +with standardized measurement procedures [29] and +dynamometer placements [30]. Participants were in- +structed to pull or push against the device as firmly as +they could in each direction, as the investigator coun- +teracted that force for 5 seconds per trial. The instru- +ment was calibrated before each participant was tested. +Three consecutive trials were conducted, with a 10 sec- +onds rest between trials. Maximum peak force of the +three trials was recorded for analysis. +2.6.3. Pinch strength (PS) +PS was assessed bilaterally, using Jamar hydraulic +hand and pinch dynamometers (Lafayette Instruments, +Model No. J00111, Indiana, USA). During the evalu- +ation, participants were seated in a chair without arm- +rests, feet resting fully on the ground and hips against +the back of the chair. The arm remained parallel to the +body, shoulder adducted, elbow flexed at 90◦and fore- +arm in neutral position, wrist between 0◦and 30◦of +110 +S. Mohanty et al. / Upper extremity strength and motor speed in children with visual impairment +Dropped out +n=2 +Control group +n=42 (32 boys) +Dropped out +n=4 +Completed the study +n=39 +Intervention +16 weeks +Completed the study +n=38 +Yoga group +n=41 (26 boys) +Satisfied the criteria and selected +n=83 +After medical check up +7 excluded +n=3 late blind +n=2 neurological problems +n=2 other impairments +Accepted to participate +n=90 +Screened for eligibility +n=100 +10 excluded +n=2 parents did not agree +n=5 deny to sign consent form +n=3 did not show interest +Fig. 1. Trial profile of the study. +extension and 0◦to 15◦of ulnar deviation. This po- +sition has demonstrated the highest reliability coeffi- +cients [31]. Three consecutive measurements of each +hand (total 6 trials) were performed for PS, alternating +between the dominant and non-dominant sides, with +minimum intervals of 30 sec between them to avoid +muscle fatigue. Maximum values obtained from the +three trials were recorded for statistical analysis. Pre +and post measurements were made by the same exam- +iner. +2.6.4. Finger Tapping Test (FTT) +The FTT is a neuropsychological test that assesses +motor speed and motor control [32]. It was measured +using an apparatus consisting of an 18 inch fiber-resin +board with two rectangular metal plates on either end, +11 inches apart (Lafayette Instruments, Model No. +32012, Indiana, USA). The apparatus has a metal sty- +lus connected to it, and contacts between the stylus +and the two metal plates are registered on an impulse +counter. +The instrument was fixed to an adjustable-height flat +table positioned at the midline and waist level. Partici- +pants were instructed to use their right hand to hold the +stylus as a pen is held and tap on the steel plate using +index finger (not the whole hand or wrist) which was +on the right side of the board, and to use their left hand +for the board on the left side. After being familiarized +with the conditions with one practice trial, they were +instructed to tap as rapidly as possible for 10 sec for +five consecutive trials in each hand alternatively [32]. +Average scores of the 5 trials were used in the analysis, +for each hand. +Participants were given an opportunity to become +comfortable with the tasks before commencing the fi- +nal test. They were provided the trail sessions for each +test until they became familiar to the process. Ver- +bal instruction and tactile modelling were used to help +them. For accurate testing, it was important for the par- +ticipants to understand the protocol fully. +2.7. Statistical analysis +SPSS 20.0 software (IBM Corporation, USA) was +used to analyze the data. Continuous variables were re- +ported as mean ± standard deviation (SD) and categor- +ical variables were reported as number and percentage. +Paired samples t-test was used for within-group com- +S. Mohanty et al. / Upper extremity strength and motor speed in children with visual impairment +111 +Table 2 +Demographic characteristics +Variables +Yoga (n = 39) +Control (n = 38) +P-value +Gender +Male +24 (61.5)* +30 (78.9)* +P = 0.095 +Female +15 (38.5)* +8 (21.1)* +Degree of blindness +Total +31 (79.5)* +29 (76.3)* +P = 0.737 +Light perception +8 (20.5)* +9 (23.7)* +Age (years) +12.21 ± 1.90** +13.08 ± 2.13** +P = 0.061 +Height (cm) +144.51 ± 12.38** +149.50 ± 14.22** +P = 0.105 +Weight (kg) +34.51 ± 12.43** +40.03 ± 14.67** +P = 0.079 +Body mass index (kg/m2) +16.67 ± 3.49** +17.33 ± 4.17** +P = 0.450 +*n (%), chi square test and **Mean ± SD, independent t’ test. +Table 3 +Comparative changes in outcome variables for yoga and control groups +Variables +Group +Pre +Post +Post-Pre +% Change +EF_RH +Yoga +6.08 ± 0.77 +6.43 ± 0.53*** +0.35a +5.76 +Control +6.26 ± 0.76 +6.08 ± 0.51 +−0.18 +−2.88 +EE_RH +Yoga +4.94 ± 0.94 +5.95 ± 0.77*** +1.01a +20.45 +Control +5.41 ± 1.13 +5.62 ± 0.88 +0.21 +3.88 +EF_LH +Yoga +6.00 ± 0.68 +6.36 ± 0.54*** +0.36b +6.00 +Control +6.07 ± 0.83 +6.13 ± 0.59 +0.06 +0.99 +EE_LH +Yoga +4.64 ± 0.95 +5.75 ± 0.80*** +1.11a +23.92 +Control +5.31 ± 1.31 +5.59 ± 0.89 +0.28 +5.27 +PS_RH +Yoga +2.62 ± 1.00 +3.64 ± 1.01*** +1.02a +38.93 +Control +3.17 ± 1.09 +3.11 ± 1.16 +−0.06 +−1.89 +PS_LH +Yoga +2.44 ± 1.10 +3.00 ± 1.03*** +0.56b +22.95 +Control +2.92 ± 1.12 +3.01 ± 1.13 +0.09 +3.08 +FTT_RH +Yoga +56.35 ± 9.63 +61.93 ± 6.55*** +5.58b +9.90 +Control +60.57 ± 9.06 +61.02 ± 6.64 +0.45 +0.74 +FTT_LH +Yoga +52.32 ± 9.22 +56.76 ± 5.73*** +4.44c +8.49 +Control +54.84 ± 9.25 +55.65 ± 6.71 +0.81 +1.48 +Legend: LH = Left Hand; RH = Right Hand; EF = Elbow Flextion; EE = Elbow Extention; PS = +Pinch Strength; FTT = Finger Tapping Test. ∗∗∗P < 0.001 within pre and post comparisons (paired +t test) aP < 0.05, bP < 0.01, cP < 0.001, change in mean difference comparison between groups +(ANOVA, group time interaction). +parison. Repeated measures ANOVA (time x group) +were used to determine significant differences relative +to the intervention. The significance level was fixed at +P < 0.05 for all studied variables. +3. Results +Of the eighty three participants enrolled, 77 partici- +pants completed the trial (Fig. 1). Demographic char- +acteristics of the two groups are presented in Table 2. +Baseline characteristics were similar in both yoga and +control group. There was no significant difference be- +tween the two groups (P > 0.05). +Results of paired t-test assessing within group pre to +post intervention changes are given in Table 3. EF; left +hand (P < 0.001), right hand (P = 0.001) and EE; +left hand (P < 0.001), right hand (P < 0.001), PS; +left hand (P < 0.001), right hand (P < 0.001) and +FTT; left hand (P < 0.001), right hand (P < 0.001) +significantly increased in the yoga group. In contrast, +the control group did not demonstrate any significant +within group changes or trends. +Repeated measures ANOVA (time x group) interac- +tion found that there was significant differences in pre- +to-post intervention for all variables EF; left hand (P = +0.002), right hand (P < 0.001) and EE; left hand (P < +0.001), right hand (P < 0.001), PS; left hand (P = +0.002), right hand (P < 0.001) and Finger tapping; left +hand (P = 0.004), right hand (P = 0.035). +4. Discussion +The yoga group showed greater improvement in +muscle strength and motor speed compared to the con- +trol group, confirming the research hypothesis. Details +are as follows. +The upper extremity strength was evaluated bilater- +ally through PS and elbow strength in two different +112 +S. Mohanty et al. / Upper extremity strength and motor speed in children with visual impairment +positions; flexion and extension. No other study has +been published using these variables to compare upper +extremity strength in children with VI. Limited inter- +ventional studies on children with VI have shown that +some practices; goal ball [33,34], motor training pro- +gram [35], rope jumping [36], and indoor rowing ex- +ercise [37] have shown positive improvement in up- +per extremity strength. In support of these, our re- +sults demonstrate significant improvements in PS for +both hands in children who practiced yoga compared +to controls, who continued normal daily activities. As +an alternative to hand grip strength (HGS) for assess- +ing muscle strength [38], PS may provide a compari- +son with these studies. Our results are in accordance +with previous studies that found yoga significantly im- +proved HGS in normal children [20,39]. This is in con- +trast to a previous yoga study [40] which did not find +significant improvement in HGS in children aged 8– +13 years following a three month yoga program. This +disparity can be attributed to many factors, including +differences between intervention and population char- +acteristics. +The current study found that yoga increased mus- +cle strength bilaterally for both EF and EE in chil- +dren with VI, while the control group did not show +any improvement. Few studies exist concerning the use +of physical activity as training protocols for individu- +als with VI, though those differ on the basis of inter- +vention used and variables assessed, with the present +study. A study on goal ball players with varying de- +grees of VI reported that upper limb EF and EE is su- +perior in them after 6 hours per week training com- +pared with non-goal ball players [33]. In contrast simi- +lar goal ball training did not yield improvements in the +shoulder-stretch test [34]. +The mechanisms by which yoga provides benefi- +cial effects on muscular strength still need to be de- +termined. Suryanamaskar, combination of 12 different +postures stimulates skeletal muscles during isometric +contraction, which may have helped to achieve optimal +intensity to increase muscular strength [20]. In addi- +tion, yoga practice helps maintain proper posture and +spinal alignment, which also exerts beneficial effects +on muscular strength. Moreover, yoga practices im- +prove flexibility, which can improve efficiency of mus- +cles. +The FTT is a common assessment of motor speed. +The yoga group increased finger taping speed in both +hands, while no improvement was observed in the con- +trol group, which tends to rule out the possibility that +the increase was due to a practice effect. Previously +yoga practice has been observed to result in improved +tapping speed in healthy volunteers [22], male partici- +pants [23] and in those using computers for more than +5 hours per day [21]. Motor speed depends on muscle +strength, endurance and co-ordination [9]. Despite pos- +sible limitations in interpreting our findings, the yoga +group’s improvement suggests that yoga practice may +improve muscle tone, enhancing muscle function gen- +erally and reducing muscle fatigue. +Although some participants found difficulty with +certain yoga postures at the beginning of the interven- +tion, class attendance was consistently high. No ad- +verse events were reported. Therefore, our results sug- +gest that yoga may offer an effective, safe alternative +training modality for health enhancements in children +with VI. +The study has a few notable strengths: participants +were very willing to volunteer for the study; they +remained highly motivated throughout, missing no +classes. Also, to the best of our knowledge, this is the +first time upper extremity strength and motor speed +have been evaluated before and after a yoga interven- +tion for children in the VI population. +The study’s limitations include lack of randomiza- +tion, which may have led to selection bias and con- +founding factors between groups decreasing compara- +bility. Generalization of its outcomes may be limited as +the study group were residential students enrolled in a +special educational institution for children who are VI. +5. Conclusion +Results of this study revealed that a 16 week yoga +program can produce beneficial changes in upper ex- +tremity muscular strength and motor speed for children +with VI. High attendance rates and encouraging results +mean that yoga programs could be implemented in all +schools for visually challenged children to improve +their fitness levels. Further investigation with longer +follow-up (e.g., 6 months) for different age groups, in- +cluding adults young and old with VI should be con- +sidered. Such programs would offer insights into long- +term benefits of yoga practice. +Acknowledgments +We express our thanks to Mr P.V.R. Murty for assis- +tance implementing the yoga intervention; Dr Amara- +vathi for help with technical aspects of assessment in- +S. Mohanty et al. / Upper extremity strength and motor speed in children with visual impairment +113 +struments; Dr Rajashree and Mr Satyaprakash for help- +ful suggestions about the manuscript; Mrs V. Sasipriya, +and Mrs Savyadayananda for assistance in data collec- +tion; and the participants and their parents for their co- +operation and enthusiasm for the project. +Conflict of interest +The authors declared no conflicts of interest. +Funding +No financial support was received for this research. +Bellini A. +References +[1] +Holbrook EA, Caputo JL, Perry TL, Fuller DK, Morgan DW. +Physical Activity, Body Composition, and Perceived Quality +of Life of Adults with Visual Impairments. J Vis Impair Blind. +2009;103(1):17–29. +[2] +Houwen S, Hartman E, Visscher C. Physical activity and mo- +tor skills in children with and without visual impairments. +Med Sci Sports Exerc. 2009;41(1):103–9. +[3] +Augestad LB, Jiang L. Physical activity, physical fitness, +and body composition among children and young adults +with visual impairments: A systemetic review. Br J Vis +Impair.2015;33(3):167–82. +[4] +Wagner MO, Haibach PS, Lieberman LJ. 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Ashtanga +based yoga therapy increases the sensory contribution to pos- +tural stability in visually impaired persons at risk for falls as +measured by the Will balance board: A pilot randomised con- +trolled trial. PLoS One. 2015;10(6):e0129646. +[26] +Mohanty S, Pradhan B, Nagarathna R. The effect of yoga +practice on proprioception in congenitally blind students. Br +J Vis Impair. 2014;32(2):124–35. +[27] +Oldfield RC. The assessment and analysis of handedness: the +Edinburgh inventory. Neuropsychologia. 1971;9(1):97–113. +[28] +World Health Organization. International statistical classifica- +tion of diseases and related health problems: 10th revision, +Current version, Version for 2006 (Chapter VII, H54). Re- +trieved from http://www.who.int/classifiations/icd/en/ icdon- +lineversions/ en/ index.html. +[29] +Hislop HJ, Montgomery J. Daniels & Worthingham’s Mus- +cles Testing Techniques of Manual Examination. 8th ed. 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Training motor skills +of children with low vision. Percept Mot Skills. 2007;104(3 +Pt 2):1328–36. +[36] +Chena CC, Lin SY. The impact of rope jumping exercise on +physical fitness of visually impaired students. Res Dev Dis- +abil. 2011;32(1):25–9. +[37] +Ka-Young S, Eun-Hi C, Jong-Youb L, Ah-Ra C, Young-Ho L. +Effects of Indoor Rowing Exercise on the Body Composition +and the Scoliosis of Visually Impaired People: A Preliminary +Study. Ann Rehabil Med. 2015;39(4):592–8. +[38] +El-Katab S, Omichi Y, Srivareerat M, Davenport A. Pinch +grip strength as an alternative assessment to hand grip strength +for assessing muscle strength in patients with chronic kidney +disease treated by haemodialysis: a prospective audit. J Hum +Nutr Diet. 2015;Aug(7): [Epub ahead of print]. +[39] +Reddy TP. Effect of yoga training on handgrip, respiratory +pressures and pulmonary function. Br J Sports Med. 2010; +44(1). +[40] +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). diff --git a/subfolder_0/Validation of yoga module for children with intellectual disabilities.txt b/subfolder_0/Validation of yoga module for children with intellectual disabilities.txt new file mode 100644 index 0000000000000000000000000000000000000000..69f43f196f5fe81a5e40c655acd68ebc988d0a85 --- /dev/null +++ b/subfolder_0/Validation of yoga module for children with intellectual disabilities.txt @@ -0,0 +1,248 @@ +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +1/9 +Ind Psychiatry J. 2017 Jul-Dec; 26(2): 151–154. +doi: 10.4103/ipj.ipj_80_17: 10.4103/ipj.ipj_80_17 +PMCID: PMC6058432 +PMID: 30089962 +Validation of yoga module for children with intellectual disabilities +Vishvanath Pise, Balaram Pradhan, and Manmath M. Gharote +Swami Vinvekanada Yoga Anusandhan Samsthan University (SVYASA), Eknath Bhavan, Bengaluru, Karnataka, +India +Lonavla Yoga Institute, Pune, Maharashtra, India +Address for correspondence: Dr. Balaram Pradhan, S-VYASA, Eknath Bhavan, Gavipuram Circle, Kempegowda +Nagar, Bengaluru, Karnataka, India. E-mail: balaramp13@gmail.com +Copyright : © 2018 Industrial Psychiatry Journal +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: +Children with developmental disabilities generally experience more pain than the normal children due to +chronic systemic conditions associated with their disability. Description of pain is generally difficult in +children and more so in children with intellectual disabilities (IDs). Yoga has been regarded as a kind of +physical activity as well as a pain management strategy. Previous studies have reported the beneficial role +of yoga in enhancing physical and psychomotor abilities of IDs; however, a validated yoga module (YM) +for IDs is unavailable. The present study is aimed at developing a validated YM for children with IDs. +Materials and Methods: +The content validity of YM for children with IDs was assessed by a panel of 22 experienced yoga experts. +The YM for children with IDs was developed in the form of tailor-made yoga practices that were +supported by classical texts and research evidence. A total of 32 practices were included in the YM, and +each practice was discussed and rated as (i) not essential, (ii) useful but not essential, and (iii) essential. +The content validitity ratiowas calculated using Lawshe's formula. +Results: +Data analysis showed that out of 32 YM practices, 31 indicated significant content validity (cutoff value: +0.42, as calculated by applying Lawshe's formula for the CVR). +Conclusions: +The present study suggests that the YM for children with IDs is valid with good content validity. However, +future randomized controlled trials must determine the feasibility and efficacy of the developed YM for +children with IDs. +1 +1 +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +2/9 +Keywords: Children, intellectual disability, validation, yoga module +Children with developmental disabilities generally experience more pain than the normal children due to +chronic systemic conditions associated with their disability.[1,2] Description of pain is generally difficult +in children and more so in children with intellectual disabilities (IDs). IDs can be caused by a wide variety +of underlying diseases and may be associated with congenital anomalies such as cardiac defects, small- +bowel obstructions, or limb abnormalities as well as with comorbidities such as scoliosis, gastro- +esophageal reflux disease, spasticity, and epilepsy.[3] Children often confuse pain with fear and anxiety +due to their cognitive impairment. Especially children with IDs have an added challenge of not being able +to express their pain or verbalize it.[4] It is unfortunate that children with IDs often cannot communicate +pain to caregivers. Although these children are at a high risk of experiencing pain, researchers nevertheless +often have to exclude them from trials on pain management because of ethical considerations.[3] A +previous study has reported highly significant improvement in the intelligent quotient and social adaptation +parameters in the yoga group as compared to the control group, leading to enhancement of physical and +psychomotor abilities of IDs;[5] however, a validated yoga module (YM) for IDs is unavailable. The +present study is aimed at developing a validated YM for children with IDs. +MATERIALS AND METHODS +The content validity of YM for children with IDs was assessed by a panel of 22 experienced yoga experts. +The YM for children with IDs was developed in the form of tailor-made yoga practices that were +supported by classical texts and research evidence. A total of 32 practices were included in the YM, and +each practice was discussed and rated as (i) not essential, (ii) useful but not essential, and (iii) essential. +The content validity ratio (CVR) was calculated using Lawshe's formula. The steps followed to execute the +above-mentioned methods are as follows: +Step 1 (compilation of literary research on ID): An exhaustive literary search from the Vedas, +textbooks, and research papers/theses available in yoga was done for IDs and it was combined with +modern scientific view on IDs. +Step 2 (sorting of literary research on ID): The compiled literature has been put together in a tabular +form to get the common and unique features described in each text. Then, studies done on different +practices and published in journals as a scientific background were extracted. This gave a scientific +backup to the literary search. +Step 3 (preparing treatment protocol based on literary research on ID): A minute-wise treatment +protocol is developed in the form of tailor-made practice which is supported by classical texts and +research evidence. +Step 4 (validation by experts): This complete module was presented for validation in front of yoga +experts with clinical experience (≥5 years). These experts were requested to participate for +evaluating the content validity for the proposed instrument on a 3-point scale rated as follows: (i) not +essential, (ii) useful but not essential, and (iii) essential. +An expert panel including 22 health educationists, mental health specialists, and physical +educationalists with ≥5 years of yoga therapy experience examined the content validity. In this study, +experts with yoga therapy and clinical experience (≥5 years) were considered as yoga experts. The +experts selected for the present study (both males and females) were all Indians, with age ranging +from 36 to 63 years and following different yoga traditions such as Kaivalyadhama Yoga, Sivananda +Yoga, Satyananda Yoga, and Vivekananda Yoga including physical educational institutes and +universities. The expert panel was asked to comment on the necessity and relevance of the items in +order to calculate the CVR and the content validity index (CVI), respectively. The necessity of an +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +3/9 +item was assessed using a 3-point rating scale: (i) not essential, (ii) useful but not essential, and (iii) +essential. In this way, ratings were made blinded. Following the experts' assessments, the CVR for +total scale was computed. According to Lawshe's formula, if more than half of the panelists indicate +that an item is essential, then that item has the least content validity.[6] Here, the CVR for the scale +≥0.42 was considered satisfactory. The CVI was estimated by experts' ratings of items' relevancy, +simplicity, and clarity on a 4-point Likert scale. +Pilot study +To find the feasibility of the YM, 13 intellectually disabled children (6 males and 7 females) aged 12.53 ± +1.45 years were enrolled for this study. The participants were classified as mild-to-moderate ID on the +basis of IQ score. However, the selected participants' IQ range was between 50 and 70, i.e., with mild ID. +All the children were from School for Intellectually Disabled Individuals situated in Pune, Maharashtra. +The inclusion criteria were as follows: (a) mild-to-moderate ID, (b) age between 11 and 15 years, and (c) +normal health status. Exclusion criteria were as follows: (a) Major mental or physical disability, (b) severe +ID, (c) children who are unable to do yoga practice, and (d) a history of psychiatric episodes. The study +was approved by the Institutional Review Board and the Ethical Committee of the S-VYASA University. +Signed informed consent was obtained from the parents. Further, permission from school authorities was +also obtained to conduct this study. The objective of this study was to observe the effect of YM on health- +related physical fitness in intellectually disabled children. The participants were intervened with the +validated YM [Tables 1 and 2] for 6 weeks (1 h/day, 5 days a week) at the hall present in the school +campus. Further, none of the selected participants had a history of yoga practice as yoga training was not +part of the school curriculum. The selected participants were not having background yoga practices. All +the participants were assessed for flexibility (sit and reach test), abdominal muscle strength (sit-ups), and +balance (standing stork test) at the baseline and after completion of 6 weeks of yoga training. All the 13 +participants completed the intervention. No adverse effects were observed during the study period. +Statistical analysis +The cutoff value of 0.42 was calculated by applying Lawshe's formula for CVR.[6] According to Lawshe's +formula, we have CVR = (Ne−N/2)/N/2, where CVR = content validity ratio, Ne = total number of +essentials for each practice, and N = total number of panelists. The miecrosoft office 2010 software was +used for further analysis. +RESULTS +The CVR was calculated for all the 32 practices of designed YM for children with IDs. Among them, 31 +practices with CVR ≥0.42 were included in the validated YM. The practice with CVR <0.42, i.e., Ardha +Halasana was excluded as it was either a complementary pose for an important posture to align the body +and mind level or just it was an extra practice as Halasana already exists in the selection module. Due to +these reasons, the experts have not considered this as essential for children with IDs. Apart from this one +practice, all the other 31 practices were considered to be essential for children with IDs; this made the final +CVR ratio satisfy the minimum value as per Lawshe's CVR ratio. Thus, the data analysis showed that out +of 32 YM practices, 31 indicated significant content validity [Tables 1–3]. This result was based on the +frequency, length, intensity of the program, teacher qualification, and setting which were rated and made +blinded for their validity. +Results on pilot study +Thirteen intellectually disabled children were intervened with a validated YM, which consisted of 31 +practices with CVR ≥0.42. Assessments were done at baseline and after 1 month of intervention. All the +participants completed the intervention; no adverse effects were noticed during the study. Data were +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +4/9 +analyzed using paired sample t-test, which showed significant change in flexibility (t = 6.35, df = 12, P < +0.001); strength of abdominal muscles (t = 6.49, df = 12, P < 0.001); and static balance (t = 3.35, df = 12, +P < 0.05) after yoga training intervention. The results are presented in Table 4. +DISCUSSION +In the present study, an attempt has been made to develop an YM for children with IDs by choosing +specific yoga practices from the traditional literature and scientific studies on yoga to target specific +symptoms of children with IDs. This YM was validated by experts in yoga and was modified according to +their suggestions. Similarly, an effort was made to retain only those practices which were rated by all +experts as useful. The yoga practices were ordered as suggested by the experts. All the experts opined that +these practices should be easy for children with IDs. It was also decided to include some loosening +exercises as majority suggested so. The matching of yoga practices with symptoms of children with IDs +was performed after reviewing traditional literature.[7,8,9] The present study was closely associated with +previous studies on validation of YMs.[10,11,12,13,14,15,16,17] +Further, to find the efficacy of the developed YM, 13 intellectually disabled children were intervened by a +validated YM (31 practices) and they were assessed pre-and post-intervention for flexibility, strength of +abdominal muscles, and static balance. All the three outcome measures showed statistically significant (P +< 0.001) positive impact of the validated YM on intellectually disabled children. All the 13 children +completed the intervention; no adverse effects were noticed during the study. In fact, the validated YM can +be used in intellectually disabled children for improvement in health-related physical fitness and motor +function. However, randomized controlled trials with larger samples are needed to validate its efficacy as a +primary intervention. +In summary, an YM for children with IDs was designed based on traditional texts and was validated with +the help of experts. The module remains to be tested in formal clinical trials. +CONCLUSIONS +Based on the findings from the present study, the YM for IDs suggests good content validity for IDs. The +pilot study showed that the validated YM was found to be beneficial for improvement in flexibility, +strength of abdominal muscles, and static balance in children with IDs. +Financial support and sponsorship +Nil. +Conflicts of interest +There are no conflicts of interest. +REFERENCES +1. 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Hariprasad VR, Varambally S, Varambally PT, Thirthalli J, Basavaraddi IV, Gangadhar BN, et al. +Designing, validation and feasibility of a yoga-based intervention for elderly. Indian J Psychiatry. +2013;55:S344–9. [PMCID: PMC3768210] [PubMed: 24049197] +17. Ram A, Raghuram N, Rao RM, Bhargav H, Koka PS, Tripathi S, et al. Development and validation of +a need-based integrated yoga program for cancer patients: A retrospective study. J Stem Cells. +2012;7:269–82. [PubMed: 24196801] +Figures and Tables +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +6/9 +Table 1 +Selected yoga module practices (postures) by yoga experts with their content validity ratio +Open in a separate window +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +7/9 +Table 2 +Selected yoga module practices (pranayama and meditation) by yoga experts with their content +validity ratio +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +8/9 +Table 3 +Selected yoga module practices (loosening exercises) by yoga experts with their content validity +ratio +1/27/2021 +Validation of yoga module for children with intellectual disabilities +https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6058432/?report=printable +9/9 +Table 4 +Descriptive statistics and t-test results for within.group comparison in flexibility, strength of +abdominal muscles, and static balance +Articles from Industrial Psychiatry Journal are provided here courtesy of Wolters Kluwer -- Medknow +Publications diff --git a/subfolder_0/YOGA BREATHING THROUGH A PARTICULAR NOSTRIL INCREASES SPATIAL MEMORY.txt b/subfolder_0/YOGA BREATHING THROUGH A PARTICULAR NOSTRIL INCREASES SPATIAL MEMORY.txt new file mode 100644 index 0000000000000000000000000000000000000000..98367356ec50dc30cf1a44d74443c175075883cd --- /dev/null +++ b/subfolder_0/YOGA BREATHING THROUGH A PARTICULAR NOSTRIL INCREASES SPATIAL MEMORY.txt @@ -0,0 +1,31 @@ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/YOGA-BASED INTERVENTION FOR CAREGIVERS.txt b/subfolder_0/YOGA-BASED INTERVENTION FOR CAREGIVERS.txt new file mode 100644 index 0000000000000000000000000000000000000000..710be9d24c27b84274f5058a585edde97b5d8fb7 --- /dev/null +++ b/subfolder_0/YOGA-BASED INTERVENTION FOR CAREGIVERS.txt @@ -0,0 +1,27 @@ +YOGA-BASED INTERVENTION FOR CAREGIVERS OF OUTPATIENTS +WITH PSYCHOSIS: A RANDOMIZED CONTROLLED PILOT STUDY +Shivarama Varamballyemailemail, Sumathi Vidyendaran, Mangala Sajjanar, Jagadisha +Thirthalli, Ameer Hamza, H.R. Nagendra, B.N. Gangadhar +ABSTRACT +Purpose of the study +The use of yoga as an intervention for caregivers of patients with psychosis has been poorly +studied. The current study aimed to test the efficacy of a brief yoga program as an intervention in +caregivers of outpatients with functional psychotic disorders using a randomized controlled +research design. +Materials and methods +Caregivers who agreed to participate in the study (n = 29) were randomized into yoga (n = 15) or +wait-list group (n = 14). They were assessed at baseline and at the end of 3 months. Patients who +were randomized into the yoga group were offered supervised yoga training thrice a week for 4 +weeks, after which they were instructed to practice at home for the next 2 months. Due to the small +sample size and some variables not being normally distributed, non-parametric statistical analysis +was used. +Results +Results showed significantly reduced burden scores and improved quality of life scores in the yoga +group as compared to the wait-list group at the end of 3 months. There were no significant changes +in anxiety and depression scores in caregivers, or psychopathology scores in patients. +Conclusion +In caregivers of outpatients with functional psychosis, 4 weeks of training followed by 3 months +of home practice of a yoga module offered significant advantage over waitlist. Yoga can be offered +as an intervention for caregivers of patients with severe mental disorders. Methods of providing +yoga intervention closer to the community or use of flexible modules at hospitals needs further +study. diff --git a/subfolder_0/Yoga therapy as an add-on treatment in the management of patients with schizophrenia-a randomized controlled trial..txt b/subfolder_0/Yoga therapy as an add-on treatment in the management of patients with schizophrenia-a randomized controlled trial..txt new file mode 100644 index 0000000000000000000000000000000000000000..9ffc71f41293a42b5400e6d2d26c6a60a6e527a5 --- /dev/null +++ b/subfolder_0/Yoga therapy as an add-on treatment in the management of patients with schizophrenia-a randomized controlled trial..txt @@ -0,0 +1,931 @@ +Yoga therapy as an add-on treatment in the +management of patients with schizophrenia – +a randomized controlled trial +Introduction +Schizophrenia is one of the leading causes of +disability among young adults (1). It creates a huge +economic burden for society (2). Current treatment +modalities have certain limitations: About 30% of +patients with schizophrenia are refractory (3); +negative symptoms like anhedonia, apathy and +amotivation can be worsened by medication and +coexisting depression (4) and there are no effective +remedies for primary negative symptoms (5, 6); a +majority of the patients has relapsing and remitting +course even while on medication (7). Furthermore, +while the traditional antipsychotics have limita- +tions like extra pyramidal symptoms (EPS) and +tardive dyskinesia, the newer antipsychotics result +in obesity, diabetes, and hyperlipidemia. Hence, +there is search for alternative methods of treatment +in schizophrenia. +Yoga has significant effects in positive mental +health (8, 9). It has been shown to be useful in +treating +psychiatric +disorders +including +major +depressive disorder (10), dysthymia and alcohol- +dependence syndrome (11). Its efficacy has not +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. +Objective: Treatment of schizophrenia has remained unsatisfactory +despite the availability of antipsychotics. This study examined the +efficacy of yoga therapy (YT) as an add-on treatment to the ongoing +antipsychotic treatment. +Method: Sixty-one moderately ill schizophrenia patients were +randomly assigned to YT (n ¼ 31) and physical exercise therapy (PT; +n ¼ 30) for 4 months. They were assessed at baseline and 4 months +after the start of intervention, by a rater who was blind to their group +status. +Results: Forty-one subjects (YT ¼ 21; PT ¼ 20) were available at the +end of 4 months for assessment. Subjects in the YT group had +significantly less psychopathology than those in the PT group at the +end of 4 months. They also had significantly greater social and +occupational functioning and quality of life. +Conclusion: Both non-pharmacological interventions contribute to +reduction in symptoms, with YT having better efficacy. +G. Duraiswamy1, J. Thirthalli1, +H. R. Nagendra2, B. N. Gangadhar1 +1Department of Psychiatry, National Institute of Mental +Health and NeuroSciences (NIMHANS), Bangalore +560029, India and 2Swami Vivekananda Yoga +Anusandhana Samsthana (Deemed University), +Banaglore 560019, India +Key words: yoga; physical exercise; schizophrenia +Jagadisha Thirthalli, Associate Professor, Department of +Psychiatry, National Institute of Mental Health And +Neuro Sciences (NIMHANS), PO Box No. 2900, Hosur +Road, Bangalore 560029, India. +E-mail: jagatth@yahoo.com +Accepted for publication April 11, 2007 +Significant outcomes +• Yoga therapy, as an add-on treatment along with antipsychotics is beneficial in psychopathology and +other outcome measures in schizophrenia. +Limitations +• Single-blind nature of the study: only the rater was blind to the group-status. +• Intent-to-treat analysis could not be performed. +• Extrapyramidal symptoms were the only side-effects systematically assessed. +Acta Psychiatr Scand 2007: 116: 226–232 +All rights reserved +DOI: 10.1111/j.1600-0447.2007.01032.x +Copyright  2007 The Authors +Journal Compilation  2007 Blackwell Munksgaard +ACTA PSYCHIATRICA +SCANDINAVICA +226 +been examined in schizophrenia. Several features +of yoga make it an attractive option in schizo- +phrenia: It has been shown to improve cognitive +functions in normal individuals (12–15); it is also +useful in reducing stress (9). Since schizophrenia is +associated with cognitive deficits, and relapse of +schizophrenia is associated with stress (16, 17), +yoga may be particularly helpful in this condition. +Furthermore, yoga has positive effects on the +blood glucose, cholesterol and total lipids (18, +19). This aspect makes it an interesting add-on +treatment, as a majority of schizophrenia patients +treated with antipsychotic medication suffer from +dyslipidemia and obesity (20). +Aims of the study +The primary objective of this study was to examine +the effect of 4 months of yoga therapy (YT) as an +add-on treatment on the psychopathology of +schizophrenia patients. The secondary objectives +were to examine its effects on the quality of life and +social functioning. To control for changes due to +non-specific factors, the effect of yoga was com- +pared to that of physical training (PT). Subjects +with schizophrenia were randomized to receive YT +or PT as add-on treatments to their antipsychotic +drugs, and their clinical outcome was evaluated +after 4 months. +Material and methods +Subjects +The subjects for this study were schizophrenia +patients attending the out-patient and in-patient +services of National Institute of Mental Health and +Neuro Sciences, Bangalore, India. They belonged +to the age group of 18–55 years. Patients with +severe physical ailments like recent and decompen- +sated myocardial infarction, fracture, seizure dis- +orders, mental retardation or comorbid substance +dependence (except nicotine dependence) were +excluded. +Only +patients +with +Clinical +Global +Impression Severity Scale (21) score of 4 or more +and who were cooperative for YT were included. +Written informed consent was obtained from all +the participants. At least one family member +accompanied each subject; the family members +helped the subjects to understand and consent +for the study. The diagnosis was confirmed by +using Structured Clinical Interview for DSM-IV +[SCID-IV (22)]. All patients were on antipsychotic +medication for several months, and there was no +change in their medication dose for at least 4 weeks +before their entry into the study and through the +study period. Sixty-one patients were recruited into +the study between March 2003 and August 2004. +Assessments +Psychopathology was assessed using Positive And +Negative +Syndrome +Scale +for +Schizophrenia, +PANSS (23). An MD trainee (GD) with a 2-year +experience in clinical psychiatry administered the +PANSS. He was trained in administering PANSS +using eight training videos. The subjects were also +rated on the following: (a) social and occupational +functioning was assessed using Social and Occu- +pational Functioning Scale [SOFS (24)]; (b) side- +effects were assessed using the Simpson Angus +Scale for Extrapyramidal Symptoms (25) and +Abnormal Involuntary Movement Scale [AIMS +(26)]; (c) quality of life was assessed using WHO +Quality of Life BREF Version, WHOQOL-BREF +(27). All assessments were done twice – before +randomization and after 4 months. After the +baseline assessments were done, subjects were +randomly assigned, using a computer-generated +random number table, to receive either YT (n ¼ +31) or PT (n ¼ 30) for the next 4 months. The two +groups were similar in demographic and illness +characteristics and in the psychopathology ratings +at baseline (Table 1). +Training +A therapist trained to teach both YT and PT +taught the subjects in their allocated treatment +groups. He taught yoga and exercise in separate +Table 1. Demographic profile, illness parameters and psychopathology scores of +subjects in Y.T. and P.T. groups +Variables +YT group +PT group +t-value +P-value +Age, years +32.53 € 7.9 +31.30 € 7.9 +0.38 +0.70 +Sex ratio*, M : F +19:12 +23:7 +1.68 +0.27 +Unmarried : married* +24:7 +19:11 +1.45 +0.27 +Duration of illness (months) +99.1 € 96.1 +81.1 € 81.4 +0.82 +0.41 +CGI illness severity score +4.8 € 0.8 +5.2 € 0.9 +)1.55 +0.12 +Antipsychotic dosage +469.7 € 195.7 +476 € 205 +)0.12 +0.90 +PANSS scores +Positive score +17.03 € 6.5 +20.17 € 6.8 +)1.8 +0.07 +Negative score +21.31 € 5.7 +22.83 € 6.3 +)0.78 +0.43 +Depression subscore +10.54 € 3.3 +10.33 € 3.9 +0.23 +0.82 +Anergia subscore +9.61 € 2.6 +10.33 € 3.3 +0.93 +0.36 +SOFS score +13.1 € 10.5 +14.5 € 6.6 +0.51 +0.68 +Total AIMS score +4.2 € 7.9 +2.2 € 3.2 +1.2 +0.22 +Total Simpson Angus score +2.0 € 1.8 +1.7 € 2.3 +0.50 +0.61 +Quality of life +Psychological QOL +49.3 € 19.8 +48.4 € 19.1 +)0.71 +0.47 +Physical QOL +52.9 € 21.5 +56.5 € 14.8 +0.86 +0.93 +Social QOL +49.7 € 22.1 +56.6 € 22.1 +)1.2 +0.21 +Environmental QOL +52.0 € 19.9 +55.7 € 15.9 +0.73 +0.47 +All values except * are mean € standard deviation; v2-value; Chlorpromazine +equivalents in mg/day. +Yoga therapy for the management of patients with schizophrenia +227 +groups. The yogasanas were from the integrated +yoga treatment developed by Swami Vivekananda +Yoga Anusandhana Samsthana (SVYASA) (28). It +was a 1-h programme consisting of (a) Sithilikar- +ana Vyayama; (b) asanas including surya namaskar; +(c) breathing practice; and (d) relaxation tech- +niques. The ratio of Vyayama:asana:breathing +practice was 1:1:1. Meditation was not a part of +the yoga module. The exercises were adapted from +the National Fitness Corps – Handbook for +Middle High and Higher Secondary Schools (29). +This 1-h module of PT consisted of brisk walking, +jogging and exercises in standing and sitting +postures and relaxation (see Appendix). The sub- +jects in both groups underwent training for 15 days +(1 h a day; 5 days a week for 3 weeks). Both +training sessions were held in the same therapy hall +at different time points of the day. Of the 61 +recruited, 16 (26%) did not complete the training. +The reasons for non-completion included disinter- +est and long distance from the hospital for out- +patients. The subjects who completed the training +period continued to practice their respective ther- +apies for the next 3 months in the same sequence +and for the same duration as in the training +sessions. The therapist reviewed the adherence and +the correctness of yoga or physical exercises once a +month; the subjects were also reminded through +telephone and letters about practicing the exercises. +Follow up +All but four subjects who completed 3 weeks of +training were available for follow-up assessment +after 4 months. The final sample of 41 patients (21 +in YT and 20 in PT) and the remaining 20 from the +original sample were comparable on demographic +and clinical variables. Comparable proportions +(33% each) of patients allocated initially to each +of the two groups were available for the final +sample (Table 2). +Statistical analysis +Statistical Package for Social Sciences version +10.0.1 (SPSS Inc., 1999) was used for the analysis. +The group-differences were analysed using inde- +pendent sample t-test. Paired t-test was used to +analyse the pre–post changes. The ratings at the +end of 4 months were compared between the +groups by using analysis of covariance (ancova). +Age, sex, marital status, duration of illness, dose of +antipsychotics (in CPZ-equivalents), the type of +antipsychotic (typical or atypical) and the corres- +ponding baseline scores were used as covariates. +a was fixed at 5% (P < 0.05). +Results +The PANSS total and subscores significantly +dropped from pre- to post-assessment in both the +groups. Likewise, significant reduction in SOFS +total score occurred in both the groups. On the +other hand, QOL scores changed significantly only +in the YT group (Table 3 and Fig. 1). ancova +results indicated that the scores differed signifi- +cantly between groups at the end of 4 months after +controlling for the corresponding baseline scores, +age, sex, marital status, duration of illness, dose of +antipsychotics and the type of antipsychotic. The +subjects in the YT group scored significantly lower +in different symptom dimensions (except positive +syndrome score) and PANSS total score. They also +scored significantly better on SOFS and QOL +scores. There were no serious adverse events such +as delirium, confusion, suicidality or any serious +physical complications in either group during the +four-month period. +Discussion +At the end of 4 months schizophrenia patients in +the YT group showed better ratings than those in +PT on different symptom dimensions of schizo- +phrenia. They were also better in their social and +occupational functions and quality of life. These +were statistically significant after controlling for +the effects of baseline ratings, age, sex, marital +status, as also duration of psychosis besides the +type and the dosage of antipsychotics. Not only +were the differences statistically significant, they +were substantial too. For instance, the effect-size +for the difference in mean total PANSS score at the +Table 2. Comparison of demographic profile, illness parameters and psychopa- +thology scores between completed and dropped out patients +Variables +Completed +(n ¼ 41) +Dropout +(n ¼ 20) +t/v2-value P-value +Yoga : exercise +21:20 +10:10 +0.01 +0.93 +Age, years +30.41 € 7.9 +34.3 € 6.6 +)1.8 +0.06 +Sex ratio*, M : F +28:13 +14:6 +0.01 +1.00 +Unmarried : married* +31:10 +12:8 +1.5 +0.24 +Duration of illness (months) +77.7 € 82.1 +119.6 € 99.1 +)1.7 +0.08 +Antipsychotic dosage +479.0 € 183.4 +460 € 231 +0.34 +0.72 +CGI illness severity score +5.02 € 0.8 +5.05 € 0.6 +)0.11 +0.91 +Positive score +18.9 € 7.2 +18.0 € 5.2 +0.48 +0.62 +Negative score +22.5 € 6.5 +20.8 € 4.9 +1.1 +0.27 +Anergia score +9.95 € 3.1 +10.0 € 3.0 +)0.05 +0.95 +Depression score +10.7 € 3.7 +9.95 € 3.4 +0.74 +0.46 +SOFS scores +14.6 € 10.7 +12.5 € 8.5 +0.83 +0.41 +Total AIMS score +2.7 € 3.8 +2.3 € 2.2 +0.28 +0.77 +Total Simpson Angus Scale score +14.6 € 10.7 +12.5 € 5.8 +0.83 +0.41 +The difference was not significant (P < 0.05) All values except * are mean € SD; +v2-value; Chlorpromazine equivalents in mg/day. +Duraiswamy et al. +228 +end of 4 months was 0.74 and that for SOFS score +was 0.48, suggesting that the differences were +moderate-to-large. +It appears that the addition of YT offers benefits +across several dimensions in schizophrenia. How- +ever, no significant difference was seen between the +groups in the positive syndrome score on PANSS. +This could be because the positive symptoms were +already very low (mean total positive syndrome +score ¼ 18.6) achieved perhaps by the use of +antipsychotics. At this low level of positive symp- +toms, further improvement from YT could not be +demonstrated. +This is the first study to find the clinical effects +specifically of addition of YT in schizophrenia in a +randomized controlled design. The rater was blind +to the group status of the patients at both stages of +the assessment. The rating on the second occasion +was done without referring to the previous scores. +These steps minimized the scope for any rater- or +expectation-bias. In 74% of the subjects medica- +tions and their dosages were unchanged for at least +8 weeks before entering the study, and in all +subjects there was no change for at least 4 weeks. +Medication was changed during the study period in +only two patients (one from each group) as they +had exacerbation of symptoms. Thus the results +are not attributable to changes in antipsychotic +medications. The trainer was qualified to train +both forms of treatments. Furthermore, the exer- +cises taught in the PT group were very simple. +Having a separate physical therapist for the PT +group would not have influenced the quality of +training, but would have introduced a confounding +factor in the form of therapist variable. Use of the +same trainer to train both the groups for an equal +duration of time and for equal number of days +avoided this confound. +Some other methodological issues should be +considered while interpreting the results. It was a +Table 3. Analysis of covariance of scores at the end +of 4 months +Variable +YT group* +PT group* +F-value +P-value +Baseline +4 month +Baseline +4 month +PANSS +Positive +18.19 € 7.1 +12.19 € 5.9 +19.10 € 7.2 +14.60 € 5.9 +1.40 +0.24 +Negative +21.90 € 6.2 +14.19 € 5.1 +24.05 € 6.9 +19.75 € 7.3 +10.1 +<0.01 +Depression score +10.54 € 3.3 +5.71 € 2.3 +10.93 € 3.3 +8.60 € 4.04 +8.5 +<0.01 +Anergia score +9.6 € 2.6 +6.9 € 2.6 +10.33 € 3.3 +9.30 € 3.6 +4.7 +0.03 +Total +76.14 € 16.9 +51.05 € 16.4 +83.85 € 20.2 +66.00 € 23.2 +5.0 +0.03 +SOFS score +14.62 € 11.4 +7.05 € 8.0 +14.85 € 10.2 +11.40 € 9.9 +7.98 +<0.01 +QOL +Physical +53.57 € 24.0 +65.82 € 12.8 +54.10 € 14.4 +56.60 € 18.1 +4.4 +0.04 +Psychological +51.79 € 20.2 +66.87 € 17.5 +44.79 € 17.4 +49.17 € 19.0 +11.4 +<0.01 +Social +53.17 € 24.1 +68.45 € 20.4 +55.83 € 21.5 +47.70 € 23.0 +7.8 +<0.01 +Environmental +55.65 € 20.7 +66.22 € 15.2 +53.13 € 14.8 +48.13 € 18.6 +12.8 +<0.01 +AIMS +3.2 € 4.3 +1.3 € 2.1 +2.3 € 3.3 +1.5 € 2.4 +0.54 +0.46 +Simpson Angus Scale +2.0 € 1.9 +1.1 € 1.2 +1.7 € 2.4 +1.6 € 1.8 +3.02 +0.09 +*Mean € SD; d.f., 1,32. +SOFS +4 +7 +10 +13 +16 +BL +4M +Physical QOL +44 +51 +58 +65 +72 +BL +4M +Psychological QOL +44 +51 +58 +65 +72 +BL +4M +Social QOL +44 +51 +58 +65 +72 +BL +4M +Environmental QOL +44 +51 +58 +65 +72 +BL +4M +Positive Syndrome +10 +14 +18 +22 +26 +BL +4M +Negative Syndrome +10 +14 +18 +22 +26 +BL +4M +PANSS-Depression +4 +6 +8 +10 +12 +BL +4M +Anergia +4 +6 +8 +10 +12 +BL +4M +PANSS-Total +40 +55 +70 +85 +100 +BL +4M +PANSS Scores +SOFS and QOL Scores +YT +PT +Fig. 1. Charts showing the changes in psychopathology, social and occupational functioning and quality of life in both groups over +time. BL, baseline; 4M, 4 months. +Yoga therapy for the management of patients with schizophrenia +229 +single-blind study. In the YT group, the knowledge +that the subjects were receiving yoga might have +had a positive effect. This effect can only be +removed by a double-blind study. However, this is +not practical, as subjects in India are quite aware of +yoga techniques and cannot be blinded. An intent- +to-treat analysis of all randomized subjects would +have been in order. However, this could not be +done because the subjects who dropped out of the +study did so even before they received the treat- +ment and could not be contacted for follow-up +assessments. There were no serious adverse effects +of either YT or PT during the study period. +A comprehensive assessment of side-effects using +scales developed for drug-trials [e.g. UKU Scale +(30)] was not made. PANSS scores formed the +main measure in this study. Establishing inter-rater +reliability with a senior psychiatrist would have +enhanced the quality of the data. Furthermore, +although the therapist confirmed the adherence to +the respective treatments, it is possible that the +level of adherence could have varied in the subjects. +A quantitative assessment of this by way of a +written log could have thrown useful light on this. +At this stage, it is difficult to comment on the +possible mechanism by which YT helps in schizo- +phrenia. There is evidence that yoga helps in +positive mental health (9). Yoga also reduces +stress (10). Stress is associated with the worsening +of schizophrenia symptoms (31, 32) and, reduction +in stress is one putative mechanism of the beneficial +effect of YT in schizophrenia. Future studies may +include measures of stress also to examine this issue. +This is particularly important, as there is a good +body of literature that suggests that regular phys- +ical exercise also mitigates the effects of stress (33). +In conclusion, this study showed YT is beneficial +in schizophrenia as an add-on treatment. This +benefit is seen across several dimensions of the +schizophrenia outcome. It remains to be estab- +lished whether the benefits extend to cognitive +symptoms and are enduring. +References +1. Murray CJL, Lopez AD. The global burden of disease: a +comprehensive assessment of mortality and disability from +diseases, injuries, and risk factors in 1990 and Projected to +2020. Harvard University Press, Cambridge, MA, 1996. +2. Wyatt RJ, Henter I, Leary MC, Taylor E. 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Sudarshan Kriya yogic breathing +in the treatment of stress, anxiety, and depression. Part II– +clinical applications and guidelines. J Altern Complement +Med 2005;11:11–7. +10. Janakiramaiah N, Gangadhar BN, Naga Venkatesha M. +Antidepressant efficacy of sudarshan kriya yoga (SKY) in +melancholia: a randomized comparison with ECT and +imipramine. J Affect Disord 2000;57:255–259. +11. Nespor K. Treatment needs of alcohol dependent women. +Int J Psychosom 1990;37:50–52. +12. Uma K, Nagendra HR, Nagarathna R, Vaidehi S, Seethal- +akshmi R. The integrated approach of yoga; a therapeutic +tool for mentally retarded children: a one year controlled +study. J Ment Defic Res 1989;33:415–421. +13. Vani PR, Nagarathna R, Nagendra HR. Progressive increase +in critical flicker fusion frequency following yoga training. +Indian J Physiol Pharmacol 1997;41:71–74. +14. Naveen KV, Telles S. Yoga and psychosis: risks and +therapeutic potential. J Indian Psychol 2003;21:1. +15. Manjunath NK, Telles S. Improved performance in the +Tower of London tests following yoga. Indian J Physiol +Pharmacol 2001;45:351–354. +16. Ayuso-Gutierrez JL, Del rio vega JM. Factors influencing +relapse in the long-term course of schizophrenia. Schizophr +Res 1997;28:199–206. +17. Norman RM, Malla AK, Mclean TS et al. An evaluation of +a stress management program for individuals with schi- +zophrenia. Schizophr Res 2002;58:293–303. +18. Bijlani RL, Vempati RP, Yadav RK 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;11:267– +274. +19. Innes KE, Bourguignon C, Taylor AG. Risk indices associ- +ated with the insulin resistance syndrome, cardiovascular +disease, and possible protection with yoga: a systematic +review. J Am Board Fam Pract 2005;18:491–519. +20. Paton C, Esop R, Young C, Taylor D. Obesity, dyslipidae- +mias and smoking in an inpatient population treated with +antipsychotic drugs. Acta Psychiatr Scand 2004;110:299– +305. +21. Guy W. Clinical Global Impressions Scale (CGI). ECDEU +assessment manual for pharmacology. Rockville, MD: US +Department of Health, Education, and Welfare, 1976: 217– +221. +22. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured +Clinical Interview for DSM-IV Axis I Disorders (SCID). +Washington, DC: American Psychiatric Press, 1997. +23. Kay SR, Fiszbein A, Opler LA. The positive and negative +syndrome scale (PANSS) for schizophrenia. Schizophr Bull +1987; 13: 261–276. +24. Saraswat N, Rao K, Subbakrishna DK, Gangadhar BN. The +Social Occupational Functioning Scale (SOFS): a brief +Duraiswamy et al. +230 +measure of functional status in persons with schizophrenia. +Schizophr Res 2005; 31: 301–309. +25. Simpson GM, Angus JWS. A rating scale for extrapyramidal +side effects. Acta Psychiatr Scand 1970; 212: 11–19. +26. Guy W. Abnormal Involuntary Movements Scale (AIMS) +ECDEU Assessment Manual for Pharmacology. Rock- +ville, MD: US Department of Health, Education, and +Welfare, 1976: 534–537. +27. Skevington SM, Lotfy M and O’Connell KA. The World +Health Organization’s Whoqol-Bref quality of life assess- +ment: psychometric properties and results of the interna- +tional field trial. A report from the WHOQOL group. Qual +Life Res 2004;13:299–310. +28. Nagarathna R, Nagendra HR. Integrated approach of yoga +therapy for positive health, 2nd edn. Bangalore: Swami +Vivekananda Yoga Prakashana, 2004. +29. Ministry of Education. The National Fitness Corps – +Handbook for middle, high and higher secondary schools. +New Delhi: Government of India, 1965. +30. Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. +The UKU side effect rating scale. A new comprehensive +rating scale for psychotropic drugs and a cross-sectional +study of side effects in neuroleptic-treated patients. Acta +Psychiatr Scand Suppl 1987;334:1–100. +31. Howes OD, Mcdonald C, Cannon M, Arseneault L, Boydell +J, Murray RM. Pathways to schizophrenia: the impact of +environmental +factors. +Int +J +Neuropsychopharmacol +2004;7(Suppl. 1):S7–S13. +32. Yeap S, Thakore JH. Stress axis dysfunction in schizo- +phrenia. Eur Psychiatry 2005;20(Suppl. 3):S307–S312. +33. Dishman RK, Berthoud HR, Booth FW et al. Neurobiology +of exercise. Obesity 2006;14:345–356. +Appendix +Yoga therapy and physical exercise modules +Appendix A The integrated yoga therapy module (28); duration: 1 h +I. Shithileekarana vyayama (loosening exercises) +(1) Jogging-2 min +(2) Mukha dhouti (Cleansing Through A Single Blast Breath) 30 sec +(3) Twisting – 1 min +(4) Hand stretch breathing – 2 min +(5) Forward & backward bending – 1 min +(6) Tiger Breathing: nine rounds 1 min +(7) Cycling– 1 min +(8) Sashankasana (moon posture) breathing – 1 min +(9) Dandasana (staff posture)- 30 sec +II Asanas: +II A. Suryanamaskar (sun salutation) (12 rounds) – 6 min +II B. Instant relaxation technique (IRT) 1 min +Shavasana (corpse posture) – this involves progressively tensing all the muscles of the body in 15 s, relaxing all of them instantaneously and staying relaxed for 45 s +II C. Sitting posture asanas: +II C.1. Vakrasana (twist posture) – 30 s +II C.2. Prasarita pada paschimatanasana (stretching of back with stretched legs) – 1 min +II C.3. Ustrasana (camel posture) – 1 min +II D. Prone posture asanas: +II D.1. Bhujangasana (cobra posture) - 1 min +II D.2. Shalabhasana (locust posture) - 1 min +II D.3. Dhanurasana (bow posture) - 1 min +II E. Supine posture asanas: +II E.1. Sarvangasana (shoulder stand) – 3 min +II E.2. Matsyasana (fish posture) – 1 min +III Breathing exercises: +III A. Kapalabhati (cleansing breath exercise): 60–80 rounds – 2 min +III B. Sectional (abdominal, thoracic, clavicular and full yogic) breathing: each 5 rounds – 4 min +III C. Nadi-shuddi pranayama (balancing breath): nine rounds – 2 min +III D. Nadanusandhana (feeling of inner sound while chanting A, U, M) each 9 rounds – 10 min +IV Quick relaxation technique (QRT) – 3 min. This involves adopting Shavasana and three phases of observing abdominal movements, synchronizing them with deep +breathing and feeling of energy and collapsing all the muscles +Appendix B +Physical exercises: adopted from the national fitness corps. Handbook for middle high and higher secondary schools (29); duration: 1 h* +I Brisk walking – 10 min +II Jogging – 5 min +III Exercise in standing posture – 20 min +III A. Position: attention +(1) Raising the arms forward to the shoulder level palms facing each other, fingers together +(2) Bending arms, bringing fists in the armpits with elbows pushed backward +(3) Returning to position one +(4) Returning to position of attention +Yoga therapy for the management of patients with schizophrenia +231 +III B. Position: attention +(1) Raising the arms forward to the shoulder level fingers together +(2) Flinging arms sideward to the shoulder level, palms facing the ground heel raise +(3) Returning to position one +(4) Returning to position of attention +III C. Position: attention +(1) Stepping the left leg forward and raising the arms forward, palms are kept facing each other and fingers are kept together +(2) Flinging arms sideward at the shoulder level, palms facing the ground and lounging left leg forward +(3) Returning to position one +(4) Returning to position of attention +III D. Position: attention +(1) Raising arms forward to the shoulder level palms facing each other with the fingers together +(2) Raising the arms upward, palms facing each other and with fingers together heels are raised +(3) Returning to position one +(4) Returning to position of attention +III E. Position: attention +(1) Raising arms sideward, shoulder level, palms facing the ground, fingers together +(2) Squatting on toes, flinging arms upwards, palms facing each other +(3) Returning to position one +(4) Returning to position of attention +III F. Position: attention +(1) Jumping feet astride, raising arms sideward, palms facing the ground +(2) Flinging arms upward above head with a clap and jumping feet together +(3) Returning to position one +(4) Returning to position of attention +III G. Position: attention +(1) Hands forward upward rise to shoulder level, palms facing each other, heels raise +(2) Half squat, chest firm (hands bent at elbows) palm downward, middle fingers1/2¢¢ distance from each other +(3) Hands sideward raise, knees straight +III H. Position: attention +(1) Hands forward raised, half-knee bent (no gap between knees) +(2) Back to position +(3) Hands sideward raised, half-knee bent +(4) Back to position. +IV. Sitting posture exercises – 20 min +IV A. Position: cross-legged sitting, hands slanting +(1) Hands rise over had slowly without bending at elbows, palms touching each other, fingers extended upward +(2) Elbows bend, palms touching head +(3) Same as 1 +(4) Back to position +IV B. Position: cross-legged sitting, hands slanting +(1) Hands sideward, upward, elbows bend, palms touch the head +(2) Trunk bend, head downward +(3) Same as 1 +(4) Back to position +IV C. Position: cross-legged sitting, hands slanting +Chest firm (i.e. elbow bent palms downward and in front of the chest) +(1) Elbows backward press (chest expanding action) +(2) Hands forward sideward back-ward press +IV D. Position: cross-legged sitting, hands sideward slanting. 1–3: hands upward, downward swing, clap over head +*The therapist would give 2 min time in between the different exercises with a non-specific instruction, just relax now. +Duraiswamy et al. +232 diff --git a/subfolder_0/Yoga Based relaxation technique facilitates sustained attention in patients with low back pain_a pilot study.txt b/subfolder_0/Yoga Based relaxation technique facilitates sustained attention in patients with low back pain_a pilot study.txt new file mode 100644 index 0000000000000000000000000000000000000000..fad3721b51ff15ac96b94f6e07d40d9e6b8efe2d --- /dev/null +++ b/subfolder_0/Yoga Based relaxation technique facilitates sustained attention in patients with low back pain_a pilot study.txt @@ -0,0 +1,850 @@ +ADVANCES, SUMMER 2020, VOL. 34, NO. 3 11 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +Yoga-Based Relaxation Technique Facilitates +Sustained Attention in Patients with Low Back +Pain: A Pilot Study +Dwivedi Krishna, PhD; Singh Deepeshwar, PhD; Bharati Devi, PhD +ABSTRACT +Context • The experience of pain strongly influences +sustained attention, which is important for neurocognitive +performance. Yoga-based relaxation techniques may be +effective in improving sustained attention by attenuating +pain in patients with low back pain. Hence, we aimed to +investigate the effect of a yoga-based relaxation technique +on sustained attention and self-reported pain disability in +patients with low back pain. +Methods • A total of 22 men aged 30 to 50 years with low +back pain were recruited for the study. They were randomly +assigned to either the yoga (n = 11) or control (n = 11) +groups. The yoga group practiced a yoga-based relaxation +technique (YBRT) 1 hour a day for 4 weeks and the +control group maintained their usual physical activity +regimen. Assessments included the Sustained Attention to + + +Response Task (SART) and the Oswestry Low Back Pain +Disability Questionnaire (OLBPDQ) measured before and +after the 4-week intervention. +Results • The study showed a significant reduction in all +self-reported OLBPDQ domains and improvement in +sustained attention in a before and after comparison + +4 weeks following the yoga intervention. Pearson’s +correlation also showed a positive correlation between +sustained attention and pain reduction following the yoga +intervention. +Conclusion • The findings indicate that yoga practice +reduces pain and simultaneously improves information +processing speed with impulse control during the +performance of a sustained attention task. (Adv Mind +Body Med. 2020;34(3):11-17.) +PILOT STUDY +Dwivedi Krishna, PhD; Singh Deepeshwar, PhD, Associate +Professor; Bharati Devi, +PhD, Assistant Professor; +Department of Yoga and Life Sciences, Swami Vivekananda +Yoga Anusandhana Samsthana, Bangalore, India +Corresponding author: Singh Deepeshwar, PhD +E-mail address: deepeshwar.singh@outlook.com +Introduction +Cognitive abilities are dependent on mental processes +that involve the regulation of information processing, mental +flexibility and perceptual behavior. In general, the mental +processes associated with complex cognitive activities +require sustained attention.1 The occurrence of infrequent +and unpredictable signals over a prolonged period2 requires +uninterrupted, focused attention, known as sustained +attention (SA). Poor attentional abilities have been associated +with physical disabilities and a lack of mental awareness. A +few studies have reported that attention can be strongly +modulated by the experience of pain.3,4 Results from +neuroimaging studies of attention found that the regions of +the brain involved in attention modulation due to pain +include the anterior cingulate cortex (ACC), the amygdala, +and the primary and secondary somatosensory cortices.5,6 +Although inconclusive, this suggests that attention and pain +processing draw on the same brain sources.7 However, it is +clear that pain can modulate cognitive and executive +functions, which require sustained and selective attention.2 +Furthermore, attention and task execution were vulnerable +to a reduction in psychomotor speed and an increase in error +scores in patients with chronic pain.8 The limited physical +movement caused by low back pain (LBP) can cause +psychological distress that may induce pain, anxiety and +cognitive impairment.9 Oosterman, et al examined executive +functions and attention control in patients with chronic low +back pain (CLBP) and found a delayed response in sustained +attention and mental flexibility, likely reflecting a reduction +in psychomotor performance.10 A few other studies have +reported that difficult tasks may alter pain perception more +efficiently than easier tasks, possibly due to the displacement +of attention from pain to the complex task.11 On the other +12 ADVANCES, SUMMER 2020, VOL. 34, NO. 3 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +Although yoga practice has shown positive effects on +back pain and attention separately in different populations, +to the best of our knowledge there is no study reporting the +effect of yoga-based relaxation techniques on pain and +sustained attention in patients with LBP. Hence, we aimed to +investigate a yoga-based relaxation technique (YBRT) on +self-reported pain assessment and sustained attention in +patients with LBP. +Methods and Materials +Study Participants +A total of 22 male patients with LBP aged 30 to 50 years +(average age, 36 ± 5.1 years) were recruited from a company +in North India via the company notice board. The inclusion +criteria were patients (1) diagnosed by a physician as having +LBP for longer than 3 months, (2) having no cognitive +impairment and no neurologic or psychological issues, and +(3) willing to participate in the study. Patients with any +surgery, other co-morbidities (such as hypertension, asthma, +diabetes, etc.), or without back pain were excluded from the +study. The flow chart of study patients from enrollment to +hand, some investigations suggest that pain attenuation may +also promote the performance of a neurocognitive task, +which has fixed the intensity of a stimulus. Despite many +studies on attention and pain, an intervention for reducing +low back pain and simultaneously improving sustained +attention has not yet been explored. +The present study is an attempt to explore the effect of a +yoga-based relaxation technique—cyclic meditation—on +psychomotor responses that require sustained attention in +patients with LBP. The technique of cyclic meditation + +involves coupling yoga postures with deep relaxation that +helps to reduce psychological stress and improve psychomotor +performance, +which +requires +selective +attention, +concentration, visual scanning abilities and repetitive motor +responses.12,13 Yoga intervention has demonstrated positive +effects on reducing LBP, improving back disability and +reducing neck pain,14–18 as well as improving cognition in +healthy participants.13,19,20 Other benefits of yoga practice +include increases in muscle strength, flexibility and balance; +reduced anxiety, depression and stress; and enhancement of +overall well-being and quality of life.21 +Figure 1. Trial flow chart +Screening +N = 30 (Male) +Recruitment +(n = 22) +We selected 22 patients because the +calculated sample size was 18. +Randomization +Yoga group +(n = 11) +Control group +(n = 11) +Pre-assessment: +1. SART (11) +2. OLBPDQ (11) +Pre-assessment: +1. SART (11) +2. OLBPDQ (11) +4 weeks of yoga practice +4 weeks of normal activity +Post-assessment: +1. SART (11) +2. OLBPDQ (11) +Post-assessment: +1. SART (11) +2. OLBPDQ (11) +Statistical Analysis +Abbreviations: SART, Sustained Attention to Response Task; OLBPDQ, Oswestry Low Back Pain Disability Questionnaire. +ADVANCES, SUMMER 2020, VOL. 34, NO. 3 13 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +day following the 4-week intervention. All patients in the +yoga group used a yoga-based relaxation technique. +Assessments +Each patient was assessed for (1) sustained attention and +(2) low back disability, as follows. +Sustained Attention to Response Task (SART), is a +computer-based task designed to measure a person’s ability to +withhold responses to infrequent and unpredictable stimuli +during a period of rapid and rhythmic response to frequent +stimuli.22 Before the intervention, all patients performed the +SART test, which was programmed by Inquisit 5 lab +(Millisecond Software, Seattle, Washington). A total of 225 +trials were presented; in each trial, a single digit (1 to 9) was +presented for 250 ms and then followed by a 900 ms mask + +(a 2.5-cm diameter ring with a diagonal cross in the center).23 +Patients were instructed to respond to the appearance of each +digit by pressing the spacebar button (“go” target) with the +index finger of their dominant hand, except when the digit was +3 (“no-go” target; presented in 25 of the 225 trials), when they +were to refrain from responding. Accuracy and speed were +equally important in this task. +Patients were presented with a single digit (1 to 9) of +varying sizes in the middle of the screen for a short duration. +Each digit was followed by a crossed circle to enhance the +processing demand for a numerical value and avoid the +patients using a cognitive strategy of simply searching +templates for some peripheral features. Digits and masks were +presented in a black bold font on a white computer screen. +Before the formal SART task, each patient performed + +8 practice trials, of which 2 were no-go digit “3s.” The practice +procedure could be restarted if the patient did not understand +the task after the first practice. At the end of the task, the +omission error ( failure to respond to the go digit [not “3”]), +commission error (failure to refrain from responding to the +no-go digit [“3”]), mean reaction time (RT) for correct go +trials and the trial-to-trial RT fluctuation (reflected by intra- +individual variability, defined as RT standard deviation/mean +RT) were calculated for each patient. +The Oswestry Low Back Pain Disability Questionnaire +(OLBPDQ) is used to assess pain-related disability in people +with LBP. It consists of 10 sections that assess disability with +regard to activities of daily living: pain intensity, personal +care, ability to lift weight, walking, sitting, standing, sleeping, +traveling, social life and sex life. For each section, the total +possible score is 5; a total OLBPDQ score of 0 to 4 = no +disability, 5 to 14 = mild disability, 15 to 24 = moderate +disability, 25 to 34 = severe disability and 35 to 50 = complete +disability. In the original version, Cronbach’s alpha for the +total scale was 0.87.24 The patients were categorized according +to these criteria as shown in Table 2. +Yoga Intervention +The yoga group performed a yoga-based relaxation +technique while the control group continued their regular +physical activity regimen. +study completion is provided in the CONSORT flow diagram +in Figure 1, and demographic data from all patients are +provided in Table 1. The institutional ethics committee +approved the research study, and informed consent was +obtained from all patients after the study protocol had been +explained to them. Further, this study was registered in the +Clinical Trials Registry of India (CTRI/2018/01/011243). +Study Design +This is a parallel-group randomized controlled trial in +which all patients were randomly assigned to either the yoga +(n = 11) or the control group (n = 11). The assessments were +made between 5:30 pm and 6:30 pm the day before and the +Table 1. Patient Demographic Information +Demographic +Yoga Group +Control Group +Age, Mean (SD) +36.45 (5.1) +35.54 (3.87) +Occupation, n (%) +White collar +5 (46) +6 (54) +Blue collar +6 (54) +5 (46) +Education +Undergraduate +7 (63) +5 (46) +Graduate +3 (27) +4 (36) +Post-graduate +1 (9) +2 (18) +Pain Duration, n (%) +<12 months +1 (9.09) +1 (9.09) +>12months +10 (90.90) +10 (90.90) +Medication use +9 (81.81) +7 (63.63) +Table 2. Pain Disability Scores of Participants With Low Back +Pain in Different Categories Pre- and Post- Intervention +Yoga Group (n = 11) +Control Group (n = 11) +Subject +Code +Pre- +Intervention +Post- +Intervention +Subject +Code +Pre- +Intervention +Post- +Intervention +Yx1 +Cx1 +Yx2 +Cx2 +Yx3 +Cx3 +Yx4 +Cx4 +Yx5 +Cx5 +Yx6 +Cx6 +Yx7 +Cx7 +Yx8 +Cx8 +Yx9 +Cx9 +Yx10 +Cx10 +Yx11 +Cx11 + +Pain Disability Scores: +0-4 No disability = +5-14 Mild disability = +15-24 Moderate disability = +25-34 Severe disability = +14 ADVANCES, SUMMER 2020, VOL. 34, NO. 3 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +report any sleep-related issues on the OLBPDQ assessment, +and thus these scores were not reported. In addition, +sustained attention was improved on the SART; the +information processing speed (in ms), omission errors and +commission errors were reduced significantly (P < .001; .05; +.01, respectively) after the 4-week yoga intervention, while +the control group showed a marginal nonsignificant change. +Between-group comparisons showed that there was a +significant difference in post-intervention yoga scores and +control groups for all outcome measures. The summarized +results of the within and between group comparisons with +mean values and SD are shown in Table 4. +Pearson’s correlation coefficient heat map (Figure 2) +showed a significant negative correlation between post- +intervention pain disability scores and reaction time (r = .69; +P < .001) and post -intervention commission errors (r = .47 +and P < .05). This suggests that as pain intensity increases, +reaction time is delayed, and errors increase. +Discussion +This is the first study to present the results of sustained +attention and self-reported pain-related changes in patients +with LBP following yoga-based relaxation practice. The results +infer that yoga is more beneficial for LBP than simple physical +activity. It was demonstrated that a 4-week yoga-based +relaxation program caused a significant reduction in self- +reported pain outcomes and concomitantly improved +sustained attention compared with the physical activity group. +However, no study previously demonstrated pain reduction +and simultaneous improvement in the attentional process +following yoga-based relaxation techniques in patients with +LBP. Therefore, this study is unique in assessing back pain- +related symptoms and simultaneously assessing sustained +attention, suggesting the effectiveness of a yoga intervention. +The +yoga-based +relaxation +technique +included cyclic meditation (CM) derived from a +yoga text called Mandukya Upanishad as developed +by Dr HR Nagendra25,26 plus a set of lumber stretches +that are beneficial for patients with LBP.27 The +principle of CM is stimulation followed by deep +relaxation, which helps the practitioner reach an +equipoise state of mind. Throughout the practice, +the patients kept their eyes closed and followed +instructions from a trained yoga instructor, which +consisted of 5 phases of cyclic meditation as shown +in Table 3. Class attendance was taken into +consideration before analysis. +Patientd in the control group continued their +regular physical activity regimen. Control group +patients were free to access all healthcare services +(except yoga) and a 10-minute walk in the evening +was suggested. Patients randomly assigned to the +active control group were not precluded from +enrolling in the Yoga program for the duration of +the trial, although their data was excluded from the +analysis. +Table 3. Yoga Intervention Routine +Posture Name +# of Rounds +Duration +1. +Mantra Chanting and feeling +- +1 min +2. +Instant Relaxation technique +1 round +1 min 30 sec +3. +Centering +1 round +2 min 30 sec +4. +Ardhakatichakrasana +1 round +4 min 40 sec +5. +Quick relaxation technique +1 round +4 min 20 sec +6. +Vajrasana +1 round +1 min +7. +Sashankasana +1 round +1 min 50 sec +8. +Ushtrasana +1 round +1 min 50 sec +9. +Shavasana and om chanting +3 rounds +1min 20 sec +10. +Folded legs lumber stretch +5 rounds +5 min +11. +Legs apart lumber stretch +5 rounds +5 min +12. +Legs crossed lumber stretch +5 rounds +5 min +13. +Pawanamuktasana +5 rounds +5 min +14. +Setubandhasana +5 rounds +5 min +15. +Deep relaxation technique +1 round +14 min +16. +Mantra chanting and feeling +- +1 minute +Data Extraction +The patients were asked to submit their demographic +information, and then were assessed for LBP. Of the patients, +12 reported severe low back pain and were taking + +non-steroidal anti-inflammatory drugs when they had +unbearable pain, and 10 reported moderate LBP. In addition, +each patient underwent a 243-second sustained attention +test. After baseline assessment, the yoga group practiced the +yoga protocol for 4 weeks while the active control group +continued their usual regimen of physical activity. +Data analysis +Outcome measures were checked for normalcy using +the Kolmogorov-Smirnov test in Statistical Package for the +Social Science (SPSS version 25.00 IBM Corp., Armonk, +New York, USA). The scores of each outcome measure were +assessed for within group (pre- and post-intervention) and +between group (yoga and control) comparison using repeated +measure of variance (RM-ANOVA). Post-hoc analysis was +performed with Bonferroni correction for 2 timepoints + +(pre- and post-intervention) for all outcome measures. The +relationship between pain disability and sustained attention +in SART was computed with Pearson’s correlation coefficient. +A P value of <.05 was considered statistically significant. +Results +Two-way RM-ANOVA was performed and the results +showed that there was a significant main effect and interaction +effect for all outcome measures, as shown in Table 4. The +post hoc analysis with Bonferroni correction was applied for +all scores, and the results showed a significant decrease in all +OLBPDQ domains (P < .001) in the yoga group and no +change in the control group (P > .05). The patients did not +ADVANCES, SUMMER 2020, VOL. 34, NO. 3 15 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +Table 4. Comparison of Change in Outcome Measures in Yoga and Control Groups +Within Group +Between +Group +(P value) +2-Way RepeatedANOVA +Yoga Group +Control Group +F time +(P value) +F interaction +(Time × Group +(P value) +Before +After +Cohen’s d +Before +After +Cohen’s d +OLBPDQ +Pain Intensity +1.36 ± 1.12 +0.18±0.60a +1.12 +0.9 ± 0.30 +1.00±0.00 +0.33 +.002 +16.90 +12.41b +Personal care +1.27 ± 1.10 +0.00±0.40a +1.24 +1.09 ± 0.30 +1.09±0.30 +0.00 +<.001 +14.63c +14.63c +Lifting +1.90 ± 1.14 +0.18±0.40a +2.06 +2.54 ± 1.21 +2.45±1.29 +0.07 +<.001 +15.43c +19.05c +Walking +1.64 ± 1.20 +0.18±0.40a +1.32 +1.36 ± 0.50 +1.36±0.50 +0.00 +<.001 +13.91c +13.90c +Sitting +1.64 ± 0.92 +0.36±0.67a +1.55 +1.90 ± 0.54 +1.81±0.40 +0.18 +<.001 +16.90c +22.50c +Standing +1.73 ± 0.90 +0.54±0.52a +1.52 +1.81 ± 0.40 +1.73±0.47 +0.18 +<.001 +12.41b +16.89c +Social Life +0.73 ± 0.65 +0.18±0.40a +0.97 +1.36 ± 0.67 +1.18±0.60 +0.28 +<.001 +3.33 +13.33c +Travelling +1.27 ± 0.47 +0.36±0.50a +1.87 +1.81 ± 0.40 +1.63±0.50 +0.39 +<.001 +6.81† +15.32c +Empowerment +1.82 ± 0.87 +0.18±0.40a +2.17 +1.00 ± 0.00 +1.00±0.00 +0.00 +<.001 +27.50c +27.50c +Total +25.54 ± 4.67 +4.18±3.40a +5.11 +27.45 ± 2.20 +26.54±2.98 +0.34 +<.001 +164.68c +195.27c +SART +Reaction time +486.17 ± 102.78 +375.66±89.29a +1.14 +531.24 ± 96.23 +570.59±140.50 +0.31 +.001 +14.24c +3.21 +Omission +8.30 ± 7.36 +4.00±4.39e +0.67 +9.27 ± 6.32 +11.73±8.46 +0.32 +<.05 +6.96d +2.80 +Commission +13.50 ± 6.29 +7.00±5.98f +1.05 +12.73 ± 5.79 +14.18±6.94 +0.22 +<.05 +6.37d +0.47 +aP < .001 +bP < .01 +cP < .001 +dP < .05 +eP < .05 +fP < .01 +Abbreviations: OLBPDQ, Oswestry Low Back Pain Disability Questionnaire; SART, Sustained Attention to Response Task. +Figure 2. Pearson’s correlation heatmap depicting the relationship between pain intensity and reaction time, commission and +omission error scores of sustained attention task in patients with low back pain. Negative correlations are shown in blue and +positive correlations in red. +aP <.001 +bP <.05 +cP <.01 +a +a +a +a +b +b +c +c +16 ADVANCES, SUMMER 2020, VOL. 34, NO. 3 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +disability assessment, the lack of separate measures of pain +intensity and the fact that only male participants with LBP +were included, thus limiting the findings. This was a pilot +study, so the sample size is small. Nonetheless, we reported +moderate to high effect sizes for each outcome. Further +investigations are needed with a large sample size with +advanced imaging techniques such as electroencephalogram, +near-infrared spectroscopy or functional magnetic resonance +imaging (fMRI) for exploring the neural mechanism of pain- +related changes in sustained attention following a yoga +intervention in both genders. +Conclusion +The results showed that a yoga-based relaxation +technique induced pain attenuation in patients with LBP and +simultaneously facilitated sustained attention and alertness. +Thus, yoga can be considered as an add-on intervention for +back pain-related symptoms and the attentional process. +References +1. Ko LW, Komarov O, Hairston WD, Jung TP, Lin CT. Sustained attention in real +classroom settings: An EEG study. Front Hum Neurosci. 2017;11:388. doi:10.3389/ +fnhum.2017.00388 +2. Sarter M, Givens B, Bruno JP. The cognitive neuroscience of sustained attention: +where top-down meets bottom-up. 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Chronic pain and distraction: An experimental investigation into the +role of sustained and shifting attention in the processing of chronic persistent +pain. Behav Res Ther. 1995;33(4):391-405. doi:10.1016/0005-7967(94)00057-Q +9. Kewman DG, Vaishampayan N, Zald D, Han B. Cognitive impairment in +musculoskeletal pain patients. Int J Psychiatry Med. 1991;21(3):253-262. +doi:10.2190/FRYK-TMGA-AULW-BM5G +10. Oosterman JM, Derksen LC, Van Wijck AJM, Kessels RPC, Veldhuijzen DS. +Executive and attentional functions in chronic pain: Does performance decrease +with +increasing +task +load? +Pain +Res +Manag. +2012;17(3):159-165. +doi:10.1155/2012/962786 +11. Vuong QC, Owen A, Akin-Akinyosoye K, Araujo-Soares V. An incremental dual- +task paradigm to investigate pain attenuation by task difficulty, affective content +and threat value. PLoS One. 2018;13(11):e0207023. doi:10.1371/journal. +pone.0207023 +12. Dahal PP, Pradhan B. Effect of 1-month cyclic meditation on perceived stress, +general health status, and cardiovascular parameters in school teachers. Adv Mind +Body Med. 2018;32(2):4-9. +13. Sarang SP, Telles S. Immediate effect of two yoga-based relaxation techniques on +performance in a letter-cancellation task. Percept Mot Skills. 2007;105(2):379-385. +14. Brämberg EB, Bergström G, Jensen I, Hagberg J, Kwak L. Effects of yoga, strength +training and advice on back pain: a randomized controlled trial. BMC +Musculoskelet Disord. 2017;18(1):132. doi:10.1186/s12891-017-1497-1 +15. Tekur P, Nagarathna R, Chametcha S, Hankey A, Nagendra HR. A comprehensive +yoga programs improves pain, anxiety and depression in chronic low back pain +patients more than exercise: An RCT. Complement Ther Med. 2012;20(3):107-118. +doi:10.1016/j.ctim.2011.12.009 +16. Wieland LSS, Skoetz N, Pilkington K, Vempati R, D’ +Adamo CRR, Berman BMM. +Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst +Rev. 2017;1(1):CD010671. doi:10.1002/14651858.CD010671.pub2 +17. Williams K, Abildso C, Steinberg L, et al. Evaluation of the effectiveness and +efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976). +2009;34(19):2066-2076. doi:10.1097/BRS.0b013e3181b315cc +The yoga-based relaxation technique combining yoga +postures and supine rest may effectively improve functional +mobility and spinal flexibility.28,29 On the other hand, it also +enhances mental awareness and focuses on physical +movements and breath, which may increase psychomotor +performance,30,31 namely, cyclic meditation (CM including +sustained attention, as reported in this study. During the +yoga practice, the attention process may switch from sensory +pain to the interoceptive awareness of the breath, resulting in +lower physical discomfort and increased psychological +benefits. Yoga is believed to enhance muscle flexibility and +strength by reducing muscle tension.32 The correct practice of +yoga, including stretching and positioning with extreme +spinal flexion and extension decreases body weight and disc +degeneration.33 The moderate movements in the weight- +bearing practice of yoga may strengthen the muscles +supporting the spinal column, promote balance, and improve +postural stability and quality of life. Further, mindful yoga +practices increase proprioceptive and interoceptive +capabilities that may draw direct patients’ attention from the +pain sensation to bodily awareness.34,35 These changes with +yoga practice may displace awareness of physical pain and +enhance engagement in ongoing cognitive activities. +Therefore, yoga may help the development of mental +capabilities that reduce pain and improve mental alertness. +With respect to sustained attention in LBP, this study +showed marked improvement in processing speed and error +detection following a 4-week yoga intervention. This suggests +that pain processing disrupts attentional performance in +both healthy people and patients with LBP. The possible +reason may be that both processes (pain and attention) share +similar regions of the brain, including the anterior cingulate +and insular cortices.36 However, previous studies have shown +that both painful stimulation and attention-demanding tasks +activate adjacent areas of the anterior cingulate and insular +cortices.37,38 +Yoga practice has been shown to increase insular gray +matter associated with pain tolerance and cognitive +improvement.39,40 In the yoga group, SART performance +changed rapidly over time; the number of commission errors +went down and correct response reaction time went up. One +possibility is that yoga practice predominantly controls +impulsive responses and improves response strategy, which +is imperative for sustained attention in LBP.41,42 Further, it +may also minimize the disruptive effect of pain by reducing +neural recruitment and reallocating more resources to the +task in order to maintain the performance level during tasks +demanding sustained attention.8 Little research has been +done on yoga practice for sustained attention and pain +reduction in LBP. This study may show that yoga facilitates +sustained attention by reducing pain in patients with LBP, +allowing them to focus on everyday life performance. +Study Limitations +Despite encouraging results, this study has several +limitations including a self-reported subjective scale for pain +ADVANCES, SUMMER 2020, VOL. 34, NO. 3 17 +Krishna—Yoga-Based Relaxation for Patients with Low Back Pain +18. Hartfiel N, Burton C, Rycroft-Malone J, et al. Yoga for reducing perceived stress +and back pain at work. Occup Med (Chic Ill). 2012;62(8):606-612. doi:10.1093/ +occmed/kqs168 +19. Nagendra H, Kumar V, Mukherjee S. Cognitive behavior evaluation based on +physiological parameters among young healthy subjects with yoga as intervention. +Comput Math Methods Med. 2015;2015:1-13. doi:10.1155/2015/821061 +20. Boeshansz M. The effects of curriculum based yoga on children with attention. +JAMA J Am Med Assoc Cogn Atten. 2009;8(1):31-42. +21. Tew GA, Howsam J, Hardy M, Bissell L. Adapted yoga to improve physical +function and health-related quality of life in physically-inactive older adults: a +randomised controlled pilot trial. BMC Geriatr. 2017;17(1):131. doi:10.1186/ +s12877-017-0520-6 +22. Robertson IH, Manly T, Andrade J, Baddeley BT, Yiend J. “Oops!”: Performance +correlates of everyday attentional failures in traumatic brain injured and normal +subjects. Neuropsychologia. 1997. doi:10.1016/S0028-3932(97)00015-8 +23. Fan J, Gan J, Liu W, et al. Resting-state default mode network related functional +connectivity is associated with sustained attention deficits in schizophrenia and +obsessive-compulsive disorder. Front Behav Neurosci. 2018;12:319. doi:10.3389/ +fnbeh.2018.00319 +24. Pereira MG, Roios E, Pereira M. Functional disability in patients with low back +pain: the mediator role of suffering and beliefs about pain control in patients +receiving physical and chiropractic treatment. Brazilian J Phys Ther. +2017;21(6):465-472. doi:10.1016/j.bjpt.2017.06.016 +25. Telles S, Subramanya P. A review of the scientific studies on cyclic meditation. Int +J Yoga. 2009;2(2):46. doi:10.4103/0973-6131.60043 +26. Tattwavidananda A. Mandukya Upanishad With Gaudapada’s Karika and +Shankara’s Commentary. 11th edition. Advaita Ashrama;West Bengal, India. +January 1, 2006. +27. França FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular +stretching and segmental stabilization on functional disability and pain in +patients with chronic low back pain: A randomized, controlled trial. J Manipulative +Physiol Ther. 2012;35(4):279-285. doi:10.1016/j.jmpt.2012.04.012 +28. Deepeshwar S, Tanwar M, Kavuri V, Budhi RB. Effect of yoga based lifestyle +intervention on patients with knee osteoarthritis: A randomized controlled trial. +Front Psychiatry. 2018;9:180. doi:10.3389/fpsyt.2018.00180 +29. Tekur P, Chametcha S, Hongasandra RN, Raghuram N. Effect of yoga on quality +of life of CLBP patients: A randomized control study. Int J Yoga. 2010;3(1):10-17. +doi:10.4103/0973-6131.66773 +30. Pradhan B, Nagendra H. Immediate effect of two yoga-based relaxation +techniques on attention in children. Int J Yoga. 2010;3(2):67-69. doi:10.4103/0973- +6131.72632 +31. Subramanya P, Telles S. Performance on psychomotor tasks following two yoga- +based relaxation techniques. Percept Mot Skills. 2009;109(2):563-576. +32. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase +quality of life. Int J Yoga. 2011;4(2):49-54. +33. Jeng CM, Cheng TC, Kung CH, Hsu HC. Yoga and disc degenerative disease in +cervical and lumbar spine: An MR imaging-based case control study. Eur Spine J. +2011;20(3):408-413. doi:10.1007/s00586-010-1547-y +34. Mohanty S, Pradhan B, Nagathna R. The effect of yoga practice on proprioception +in congenitally blind students. Br J Vis Impair. 2014;32(2):124-135. +doi:10.1177/0264619614522132 +35. Gibson J. Mindfulness, interoception, and the body: A contemporary perspective. +Front Psychol. 2019;10:2012. doi:10.3389/fpsyg.2019.02012 +36. Bantick SJ, Wise RG, Ploghaus A, Clare S, Smith SM, Tracey I. Imaging how +attention modulates pain in humans using functional MRI. Brain. 2002;125(2):310- +319. doi:10.1093/brain/awf022 +37. Hsieh J-C, Belfrage M, Stone-Elander S, Hansson P, Ingvar M. Central +representation of chronic ongoing neuropathic pain studied by positron emission +tomography. Pain. 1995;63(2):225-236. doi:10.1016/0304-3959(95)00048-W +38. Starr CJ, Sawaki L, Wittenberg GF, et al. Roles of the insular cortex in the +modulation of pain: Insights from brain lesions. J Neurosci. 2009;29(9):2684-2694. +doi:10.1523/JNEUROSCI.5173-08.2009 +39. Villemure C, Čeko M, Cotton VA, Bushnell MC. Insular cortex mediates +increased pain tolerance in yoga practitioners. Cereb Cortex. 2014;24(10):2732- +2740. doi:10.1093/cercor/bht124 +40. Jang JH, Kim JH, Yun JY, Choi SH, An SC, Kang DH. Differences in functional +connectivity of the insula between brain wave vibration in meditators and non- +meditators. Mindfulness (N Y). 2018;9(6):1857-1866. doi:10.1007/s12671-018- +0928-x +41. Cohen SCL, Harvey DJ, Shields RH, et al. Effects of yoga on attention, impulsivity, +and hyperactivity in preschool-aged children with attention-deficit hyperactivity +disorder symptoms. J Dev Behav Pediatr. 2018;39(3):1. doi:10.1097/ +DBP.0000000000000552 +42. Helton WS. Impulsive responding and the sustained attention to response task. J +Clin Exp Neuropsychol. 2009;31(1):39-47. doi:10.1080/13803390801978856 diff --git a/subfolder_0/Yoga as an Ancient Science of Healing It Impact on Mental Health of Women.txt b/subfolder_0/Yoga as an Ancient Science of Healing It Impact on Mental Health of Women.txt new file mode 100644 index 0000000000000000000000000000000000000000..5054386acf8de5fafeca25be522060d17186f449 --- /dev/null +++ b/subfolder_0/Yoga as an Ancient Science of Healing It Impact on Mental Health of Women.txt @@ -0,0 +1,499 @@ + +Int. J. Ayur. Pharma Research, 2014; 2(3): 1-4 + ISSN: 2322 - 0910 + + +Available online at : http://ijapr.in +Page 1 +International Journal of Ayurveda and Pharma Research + Review Article +YOGA AS AN ANCIENT SCIENCE OF HEALING: ITS IMPACT ON MENTAL HEALTH OF WOMEN +Naorem Jiteswori Devi1, Kambhampati Subrahmanyam2* +1Ph.D. Scholar, Division of Yoga and Humanities, S-VYASA, Bangalore, Karnataka, India. +*2Dean, Division of Yoga and Humanities, S-VYASA, Bangalore, Karnataka, India. +Received on: 22/05/2014 + + Revised on: 01/06/2014 + Accepted on: 10/06/2014 +ABSTRACT +Since time immemorial Yoga had been practiced in India. It is considered to be a +means for physical, mental and spiritual growth of an entity. With increasing research +evidence, yoga has been emerging as a powerful tool to achieve good states of health, +both at physical and mental levels. Several studies have demonstrated the beneficial +effects of yoga on the mental health of women. Yoga improved quality of life and sleep, +provided peace of mind, and reduced depression, anxiety levels and psychological +symptoms of stress-related problems, illness and insomnia, menopausal symptoms and +all pains. It also helped breast cancer survivor to achieve psychological well-being. Yoga +can be a useful tool for both physical and mental well being for women. +KEYWORDS: Yoga, Mental Health of Women, Psychological disorders. +INTRODUCTION +Yoga has been practiced in India over +several centuries to promote positive health and +well-being. It is considered to be a tool for both +physical +and +mental +development +of +an +individual. It gives solace for the restless mind +and can give great relief to the sickly person. It +has become quite necessary even for all to keep +fit. Some use yoga for developing memory, +intelligence +and +creativity. +With +growing +scientific evidence, yoga has been emerging as an +important health behavior-modifying practice to +achieve sound states of health, both at physical +and +mental +levels. +Several +studies +have +demonstrated the beneficial effects of yoga on +health behavior in many lifestyle-related somatic +problems +such +as +hypertension, +bronchial +asthma, diabetes including some psychiatric +conditions +such +as +anxiety +neurosis +and +depressive illness etc.[1] +According to yogic science, psychological +problems arise due to the imbalance speed in the +mind. Yoga is the science to control the mind. The +disturbance in the mind is the real cause of the +problem. Many studies concluded that yoga +improved balance of mind. A study showed that +mindfulness meditation improved psychological +well being and reduced psychological symptoms +of stress related problems, illness and anxiety[2]. +Gupta +et +al.[3] +concluded +that +lifestyle +modification +based +on +yoga +and +stress +management led to remarkable reduction in +anxiety score within a period of ten days. Yogic +breathing relieves post traumatic stress disorder +and depression[4]. +YOGA AS A HEALING TOOL FOR MENTAL +HEALTH OF WOMEN +Yoga has been used as a tool for stress +management that can assist in alleviating +depression and anxiety disorders, insomnia and +other psychological ailments. Many studies have +been done on the effect of yoga on mental health +of women in different dimensions. Yoga reduced +tension-anxiety, +depression, +anger-hostility, +fatigue, confusion; anxiety, depression, and +hostility significantly in healthy women. [5] A pilot +study was done on effect of Kripalu-based yoga on +women with current full or subthreshold +Posttraumatic stress disorder (PTSD) symptoms. +Yoga +practice +showed +reduction +in +reexperiencing and hyperarousal symptoms. It +Kambhampati Subrahmanyam et al. Yoga as an Ancient Science of Healing: Its Impact on Mental Health of Women + +Available online at : http://ijapr.in +Page 2 +was concluded that yoga may be an effective +adjunctive treatment for PTSD. [6] +There is evidence to suggest that yoga +effectively reduces distress and improves certain +stress-related +psychological +and +physical +outcomes in distressed women.[7] Michalsen et +al.[8] showed improvements in perceived stress, +State and Trait Anxiety and well-being, vigor, +fatigue and depression and reported pain relief +from headache or back-pain in distressed women. +Long-term practice of yoga provides clear and +significant +health +benefits +in +women. +Participation in a single 90-minute yoga class can +significantly reduce perceived stress. Doing Hatha +yoga regularly can reduce perceived stress even +more significantly.[9] +Yoga intervention can lead to significant +reduction in perceived level of anxiety in women +who suffer from anxiety disorder.[10] The Yoga +practice not only reduced anxiety and depressive +mood but also increased high-on-energy, positive +well-being and total well-being among married +women. [11] +Dixon et al. [12] studied effect of Hatha +yoga on mental health of low-income women who +are survivors of domestic violence and found that +there is better reduction in the symptoms of +depression. Yoga served as a self-care technique +for the reduction of stress and ruminative aspects +of depression and it also served as a relational +technique, facilitating connectedness and shared +experiences in a safe environment. [13] +Some of the studies were done on +efficacy of yoga on breast cancer patients. Yoga +practice improved their mood and reduced +anxiety.[14] It increased their peace of mind and +hope; and provided healthy connection to other +yoga participants.[15] Yoga improved their overall +quality of life.[16,17] A gentle type of yoga could be +beneficial on emotional outcomes and fatigue in +breast cancer patients.[18] Yoga could be an +important tool in the healing process in the areas +of mental, physical and social life for breast +cancer survivors.[19] +Field et al.[20] studied the effects of yoga +on prenatal and postpartum depression and +found reduction of depression, anxiety, and anger +scores and improved their relationship scores. +Women +who +practiced +yoga +during +late +pregnancy achieved greater optimism, power, +and well-being.[21] Antenatal yoga can be +beneficial for reducing women's anxieties toward +childbirth and preventing increases in depressive +symptoms. [22] +Yoga can be effective in reducing +insomnia[23], +menopausal +symptoms +and +improving the quality of life.[23,24] Integrated +approach of Yoga therapy improved hot flushes +and night sweats related to menopause. Even the +short-term practice of Yoga can decrease both +psychological and physiological risk factors for +cardiovascular on menopausal women. [25] +Yoga training improved quality of life in +women with mild-to-moderate asthma and +resulted in decreased parasympathetic and +increased sympathetic modulation.[26] Johnson et +al.[27] studied on effect of yoga on women military +veterans and found decreased depression and +increased energy. A study was done on the effect +of yoga on older women and the result showed +the +long-term +or +frequent +yoga +practice +increasingly protects older women from low +levels of psychological well-being and increased +protective effect against low levels of subjective +well being and vitality. [28] +According to objectification theorists, +sexual +objectification +of +the +female +body +contributes to mental health problems which +disproportionately +affect +girls +and +women +including eating disorders and depression. The +college-age women who practiced yoga found +reducing levels of perceived self-objectification +and increased internal bodily awareness. [29] +Jenning et al. examined efficacy of yoga +as a complementary therapy for smoking +cessation and found that it even made them +abstain from smoking and reduced anxiety. There +are improvements in perceived health well-being +when compared with controls.[30] The frequent +yoga practice might ameliorate the negative +impact of abuse history on self-concept and +coping skills. It suggested that women who +incorporated yoga into other areas of life could +get the greatest psychological benefits.[31] + + + +Int. J. Ayur. Pharma Research, 2014; 2(3): 1-4 + ISSN: 2322 - 0910 + + +Available online at : http://ijapr.in +Page 3 +CONCLUSION +Many +studies +concluded +that +yoga +improved the mental health of women. It showed +that yoga improved quality of life, quality of sleep +and provided peace of mind and reduced +depression, anxiety scores and psychological +symptoms of stress related problems, illness and +insomnia, menopausal symptoms. It also helped +breast cancer survivor to achieve psychological +well being. Though there were certain limitations, +these studies have shown the benefit of yoga on +mental health of women. Yoga can be a useful tool +for both physical and mental well being. +REFERENCE +1. Deshpande S, Nagendra HR, Raghuram N. A +randomized control trial of the effect of yoga +on Gunas (personality) and Health in normal +healthy volunteers. Int. J. Yoga. 2008;1:2–10. +2. Carmody J, Baer RA. Relationships between +mindfulness +practice +and +levels +of +mindfulness, +medical +and +psychological +symptoms and well-being in a mindfulness- +based stress reduction program. J. Behav. +Med. 2008;31:23–33. +3. Gupta N, Khera S, Vempati RP, Sharma R, +Bijlani RL. Effect of yoga based lifestyle +intervention on state and trait anxiety. Indian +J. Physiol. Pharmacol. [Internet]. 2006 [cited +2013 Nov 26];50(1):41–7. Available from: +http://www.ncbi.nlm.nih.gov/pubmed/1685 +0902 +4. Descilo T, Vedamurtachar A, Gerbarg PL, +Nagaraja D, Gangadhar BN, Damodaran B, et +al. Effects of a yoga breath intervention alone +and in combination with an exposure therapy +for +post-traumatic +stress +disorder +and +depression in survivors of the 2004 South- +East Asia tsunami. Acta Psychiatr. Scand. +2010;121:289–300. +5. Yoshihara K, Hiramoto T, Oka T, Kubo C, Sudo +N. Effect of 12 weeks of yoga training on the +somatization, psychological symptoms, and +stress-related biomarkers of healthy women. +Biopsychosoc. +Med. +[Internet]. +2014;8:1. +Available +from: +http://www.pubmedcentral.nih.gov/articlere +nder.fcgi?artid=3892034&tool=pmcentrez&r +endertype=abstract +6. Mitchell KS, Dick AM, DiMartino DM, Smith +BN, Niles B, Koenen KC, et al. A pilot study of a +randomized controlled trial of yoga as an +intervention for PTSD symptoms in women. J. +Trauma. Stress [Internet]. 2014 Apr [cited +2014 May 28];27(2):121–8. Available from: +http://www.ncbi.nlm.nih.gov/pubmed/2466 +8767 +7. Lüdtke R, Musial F, Dobos G, Kessler C, +Michalsen A, Brunnhuber S, et al. Iyengar +Yoga for Distressed Women: A 3-Armed +Randomized Controlled Trial. Evidence-Based +Complement. Altern. Med. 2012. p. 1–9. +8. Michalsen A, Grossman P, Acil A, Langhorst J, +Lüdtke R, Esch T, et al. Rapid stress reduction +and anxiolysis among distressed women as a +consequence of a three-month intensive yoga +program. Med. Sci. Monit. 2005;11:CR555– +R561. +9. Huang F-J, Chien D-K, Chung U-L. Effects of +Hatha yoga on stress in middle-aged women. +J. Nurs. Res. [Internet]. 2013;21:59–66. +Available +from: +http://www.ncbi.nlm.nih.gov/pubmed/2340 +7338 +10. Javnbakht M, Hejazi Kenari R, Ghasemi M. +Effects of yoga on depression and anxiety of +women. +Complement. +Ther. +Clin. +Pract. +2009;15:102–4. +11. Narayana N, Gopal D. Effect of yoga on +women’s psychological well-being. J. Indian +Psychol. 2008;26:39–46. +12. Dixon-Peters C. The psychological effects of +Hatha yoga on low-income women who are +survivors of domestic violence. Diss. Abstr. +Int. Sect. B Sci. Eng. [Internet]. 2007;68:619. +13. Kinser PA, Bourguignon C, Taylor AG, Steeves +R. “A Feeling of Connectedness”: Perspectives +on a Gentle Yoga Intervention for Women +with Major Depression. Issues Ment. Health +Nurs. 2013;34:402–11. +14. Blank SE, Kittel J, Haberman MR. Active +Practice of Iyengar Yoga as an Intervention +for Breast Cancer Survivors. Int. J. Yoga +Therap. 2005;15:51–9. +15. Thomas R, Shaw RM. Yoga for women living +with breast cancer-related arm morbidity: +findings from an exploratory study. Int J Yoga +Ther. 2011;39–48. +16. Siedentopf F., Utz-Billing I., Gairing S., +Schoenegg W., Kentenich H., Kollak I. Yoga for +patients with early breast cancer and its +impact on quality of life - A randomized +Kambhampati Subrahmanyam et al. Yoga as an Ancient Science of Healing: Its Impact on Mental Health of Women + +Available online at : http://ijapr.in +Page 4 +controlled trial. Geburtshilfe Frauenheilkd. +2013;73:311–7. +17. Chandwani KD, Perkins G, Nagendra HR, +Raghuram N V, Spelman A, Nagarathna R, et +al. Randomized, controlled trial of yoga in +women +with +breast +cancer undergoing +radiotherapy. J. Clin. Oncol. [Internet]. 2014 +Apr 1 [cited 2014 May 28];32(10):1058–65. +Available +from: +http://www.ncbi.nlm.nih.gov/pubmed/2459 +0636 +18. Danhauer SC, Mihalko SL, Russell GB, +Campbell CR, Felder L, Daley K, et al. +Restorative yoga for women with breast +cancer: findings from a randomized pilot +study. Psychooncology. 2009;18:360–8. +19. Van Puymbroeck M, Burk BN, Shinew KJ, +Kuhlenschmidt MC, Schmid AA. Perceived +Health Benefits From Yoga Among Breast +Cancer Survivors. Am. J. Health Promot. +[Internet]. +2013;27. +Available +from: +http://www.ncbi.nlm.nih.gov/pubmed/2340 +2226 +20. Field T, Diego M, Delgado J, Medina L. Yoga +and +social +support +reduce +prenatal +depression, anxiety, and corti. Yoga Phys. +Ther. 2012;2:2–6. +21. Reis PJ. Prenatal yoga practice in late +pregnancy and patterning of change in +optimism, power, and well-being. ProQuest +Diss. Theses. 2011. +22. Newham JJ, Wittkowski A, Hurley J, Aplin JD, +Westwood M. EFFECTS OF ANTENATAL +YOGA +ON +MATERNAL +ANXIETY +AND +DEPRESSION: A RANDOMIZED CONTROLLED +TRIAL. Depress. Anxiety [Internet]. 2014 Apr +30 [cited 2014 May 28]; Available from: +http://www.ncbi.nlm.nih.gov/pubmed/2478 +8589 +23. Rodrigues D, Goto V, Kozasa EH, Afonso RF, +Tufik S, Hachul H, et al. Yoga decreases +insomnia +in +postmenopausal +women. +Menopause J. North Am. Menopause Soc. +2012. p. 186–93. +24. Elavsky S, McAuley E. Physical activity and +mental health outcomes during menopause: a +randomized controlled trial. Ann. Behav. Med. +2007;33:132–42. +25. Vaze N, Joshi S. Yoga and menopausal +transition. J. Midlife. Health. 2010;1:56–8. +26. Bidwell AJ, Yazel B, Davin D, Fairchild TJ, +Kanaley JA. Yoga training improves quality of +life in women with asthma. J Altern +Complement Med. 2012;18:749–55. +27. Johnson N, Weingart K, Groessl E, Baxi S. +P02.113. The benefits of yoga for women +veterans with chronic low back pain. BMC +Complement. Altern. Med. 2012. p. P169. +28. Moliver N, Mika E, Chartrand M, Haussmann +R, Khalsa S. Yoga experience as a predictor of +psychological wellness in women over 45 +years. Int. J. Yoga. 2013;6:11–9. +29. Woolley, Lauren M. The relationship of yoga, +self-objectification, disordered eating, and +depressed mood in college-aged women. Diss. +Abstr. Int. Sect. B Sci. Eng. 2009. +30. Jennings E, Morrow KM, Fava JL, Bock BC, +Tremont G, Williams DM, et al. Yoga as a +Complementary +Treatment +for +Smoking +Cessation in Women. J. Women’s Heal. 2012. +p. 240–8. +31. Carroll LE, Schein R, Mattison AM, Neace WP, +Dale LP, Bliss A, et al. Yoga Practice May +Buffer the Deleterious Effects of Abuse on +Women’s Self-Concept and Dysfunctional +Coping. J. Aggress. Maltreat. Trauma. 2011. p. +90–102. + +Cite this article as: +Naorem Jiteswori Devi, Kambhampati Subrahmanyam. +Yoga as an Ancient Science of Healing: Its Impact on +Mental Health of Women. Int. J. Ayur. Pharma Research. +2014;2(3):1-4. +Source of support: Nil, Conflict of interest: None +Declared + +*Address for correspondence +Dr. Kambhampati Subrahmanyam +Professor and Dean +S-VYASA +# 19, Eknath Bhavan, Gavipuram Circle, +Kempe Gowda Nagar, Bengaluru – 560 019, +India. +Phone: +919741011833 +Email: drks42@gmail.com diff --git a/subfolder_0/Yoga for bronchial asthma a controlled study.txt b/subfolder_0/Yoga for bronchial asthma a controlled study.txt new file mode 100644 index 0000000000000000000000000000000000000000..07b0f36ee3037365f34bb1d4907929924b2c3d75 --- /dev/null +++ b/subfolder_0/Yoga for bronchial asthma a controlled study.txt @@ -0,0 +1,477 @@ +BRITISH MEDICAL JOURNAL +VOLUME 291 +19 OCTOBER 1985 +1077 +CLINICAL RESEARCH +Yoga for bronchial asthma: a controlled study +R NAGARATHNA, +H R NAGENDRA +Abstract +Fifty three patients with asthma underwent training for two +weeks in an integrated set of yoga exercises, including breathing +exercises, +suryanamaskar, +yogasana +(physical +postures), +pranayama (breath slowing techniques), dhyana (meditation), +and a devotional session, and were told to practise these +exercises for 65 minutes daily. They were then compared with a +control group of 53 patients with asthma matched for age, sex, +and type and severity of asthma, who continued to take their +usual drugs. There was a significantly greater improvement in the +group who practised yoga in the weekly number of attacks of +asthma, scores for drug treatment, and peak flow rate. +This study shows the efficacy of yoga in the long term manage- +ment of bronchial asthma, but the physiological basis for this +beneficial effect needs to be examined in more detail. +and unknown factors. We carried out this long term study with +matched controls to ascertain whether yoga could have a lasting +influence on the course of the disease. +Patients and methods +Table I shows details ofthe 106 patients with established bronchial asthma +satisfying the clinical criteria of Crofton and Douglas' and Shivpuri9 who +were included in this study. The age range was 9-47 years with a mean of26 4 +years. There were 15 women in each group. Fifty three pairs of patients +matched for age and sex and type, severity, and duration of asthma were +selected from a bigger group who came to our outpatient clinic for yoga +TABLE I-Details ofpatients +Control group +Yoga group +Introduction +Yoga has been used to treat patients with asthma for over 50 years in +yoga centres in India. Goyeche et al and several other workers have +shown convincing evidence of the beneficial effects of yoga in +patients with bronchial asthma. 1-6 Most of these studies were short +term, performed without controls, or qualitative but based on +subjective judgments. Our earlier investigation clearly indicated +the short term (two to four weeks) benefits ofyoga, as established by +standard controlled studies of large numbers of patients who +underwent yogic training as outpatients. +Prospective long term +studies using standardised research procedures +are, however, +unavailable. +It is well known that the clinical course of a disease like chronic +bronchial asthma is highly variable, being subject to many known +Vivekananda Kendra Yoga Therapy and Research Centre, Malleswaram, +Bangalore 560 003 +R NAGARATHNA, MD, MRCP, consultant physician +H R NAGENDRA, ME, PHD, yoga secretary +Correspondence to: Dr Nagarathna. +No of patients* +Men +Women +Mean age (range)* +Mean severity score for asthma (range)* +No with seasonal asthma* +No with perennial asthma* +Mean weekly No of attacks (range) +Mean weekly drug treatment score (range' +Mean peak flow rate (1/min) (range) +53 +38 +15 +26n41 (9-47) +1 45 (0-3) +33 +20 +3 08 (0-7) +10-26 (0-49) +264-2 (60-580) +53 +38 +15 +26 36 (9-47) +1-45 (0-3) +33 +20 +3-01 (0-7) +6-22 (0-21) +290-1 (80-690) +* Groups matched for these variables. +therapy. One from each pair was randomly selected for training in yoga, and +the other served as a control. +Although all 106 patients were equally motivated to take up yoga, the 53 +randomly allocated patients willingly served as controls. They continued +taking their usual drugs during the study. +All techniques of measurement, the length of each interview, and the +people recording the data were the same for both groups. The yoga group +attended a training programme of two and a half hours daily from 1800 to +2030 after work for two weeks. They were introduced to an integrated +programme of the following selected yoga exercises. +Breathing exercises (five minutes)-five types of rhythmic, comfortable +breathing techniques associated with simple hand and body movements. +Sithilikarana, zyayama, and suryanamaskar (five minutes)-Yoga exercises +to loosen the joints. +Yogasanas-(a) +General +yogasanas +(20 +minutes). +Simple +physical +postures (in the standing, sitting, prone, and supine positions), performed +BRITISH MEDICAL JOURNAL +VOLUME 291 +with smooth, comfortable bending movements and specific slow breathing +procedures. The asana practices end with the subject maintaining the final +posture with the body relaxed. (b) Savasana (10 minutes). Deep relaxation to +relax the muscles regionally followed by conscious slowing of breathing and +calming of the mind. +Pranayama (10 minutes)-Four types of special breathing techniques +performed with comfortable, slow, deep breathing. +Meditation and devotional session (15 minutes)-Slow mental chanting of +the syllable "OM," leading to the slowing of mental activity. The devotional +session was meant to harness the emotions, resulting in a feeling of freedom. +Kriyas (weekly)-Traditional voluntary nose and stomach wash tech- +niques (neti and vaman dhouti) followed by Savasana. +Lectures and discussions-These +were based +on yoga philosphy and +therapy. +We instructed 53 patients to continue the 65 minutes of yoga daily during +the follow up period. For the purposes of analysis those patients who +stopped the practices or did not practise for more than 16 days each month +were eliminated from the study, although we continued to record their +progress. Twenty five patients dropped out of the study: seven after six +months of follow up, seven after 12 months, two after 18 months, four after +24 months, and five after 30 months. All patients reported for check ups at +intervals of six months. The frequency of visits and the relationship between +doctor and patient were the same for both groups. +At the initial interview patients were instructed to keep a diary. They were +told to record each attack of airway obstruction, its severity, and the dosage +of the drugs they consumed. They continued to take prescribed broncho- +dilators during the study. When they noticed an improvement or deteriora- +tion in their asthma they were permitted to change their dosage as required, +and they recorded this in their diaries. Any change in the brand of drug, +however, was decided by the doctor. At each of the follow up visits +information from patients' diaries and from clinical examinations was +recorded. The mean weekly number of attacks for each period of follow up +was calculated. Severity of attacks was graded: +1=mild, but did not disturb +sleep or daily routine; 2= moderate, disturbed sleep and daily routine and +was relieved by oral drugs; 3=severe, required injection or admission to +hospital. We obtained a score for drug treatment by calculating the mean +number of bronchodilator tablets and injections taken each week for each +period of follow up. None of the patients used inhalers. Peak expiratory flow +rate was obtained by recording the best of three attempts on a mini Wright +peak flow meter. +Results +Table II shows the results of the study. Comparison of the two groups +using Student's +t test showed a highly significant improvement in the +number of attacks per week and drug treatment scores in the patients who +practised yoga. Because of large fluctuations in the mean, the standard +TABLE II-Results ofStudents' paired t testfor mean differences between values before and after 54 months'follow upfor the +two groups of53 patients +Significance +Difference +Mean (SD) +Mean (SD) +between initial +Difference +Variables +Group +initial value +final value +and final values +between groups +Noofattacksofasthmaweek +Control +29 +(301) +2-1 +(27) +2578** +2825** +Yoga +3- 55 +(1298) +0-83 +(2-49 +4.827** +Severity score +Control +1-6 +(0-75) +1-05 +(0-85) +4 006**3 +N +Severity +score +Yoga +1 47 +(0-66) +0 75 +(0-8) +5.016** +369(NS) +Drugtreatment score +Control +6 22 +7 18) +7-9 +(9 9) +0-556(NS)t +3.152** +Yoga +10-26 +13-16) +2-08 +(4-09 +4-964** +Peakflowrate(l/min)t +Control +264-2 +(117 2) +290 8 +(12 2) +4 065**1 +1 817* +Yoga +290 1 +(93 1) +362-8 +(107-6) +7-336**J +p=003. +** p<0005. +t Peak flow rate measured in only 50 controls and 44 patients in yoga group. +TABLE itt-Median test with x' evaluation ofsignificance +ofdifference in variables betweenyoga and control groups +before and after 54 months' follow up +X2 value +Variable +lnitial +Final +No of attacks of asthma/week +0-06 +5.665* +Severity score +0 149 +1-89 +Drug treatment score +1 1020 +4 56* +Peak flow rate +0-0448 +3.87* +* p<00l. +TABLE iv-Numbers ofpatients who changed their drug treatment +Stopped +Reduced +No change +Increased +Control group +23 +9 +7 +141 y2=448* +Yoga group +30 +12 +3 +8X +* p<00l. +deviation was similar to the mean for many of the values in table II. A non- +parametric median test with a x2 evaluation was therefore used to determine +significance. Table III shows the results and confirms that there were highly +significant improvements in the yoga group compared with the controls. A +highly significant difference in peak flow rate was also shown by the non- +parametric test. +Table IV shows the numbers of patients who changed their drug +treatment in both groups; yoga had a significantly beneficial effect (p<0-01). +Table V shows the distribution ofthe initial and final mean values for drug +treatment score and peak flow rate in the yoga and control groups over the +months of follow up. In the yoga group the drug treatment score fell +considerably and the peak flow rate increased (to a greater extent than that in +the controls). +Discussion +As care was taken to match the two groups for age and sex and +type, severity, and duration of asthma, we +can attribute the +improvement seen in the variables measured in the 53 patients in the +TABLE V-Variations in mean scoresfor drug treatment and peak flow rate after each six month period offollow up +Periods of follow up +Group +Initial +6 months +12 months +18 months +24 months +30 months +36 months +54 months +Mean drug treatment score +| +Control +10 26 +2-875 +10-66 +0-666 +1 875 +14 5 +7-0 +9 0 +M +Yoga +6-22 +0 428 +5-444 +7-0 +1 166 +1 20 +2-0 +3-111 +Peak flow rate (llmin) +Control +264-2 +291 25 +174 5 +190 +222-5 +236 66 +308 75 +320 62 +P +Yoga +290-1 +371 66 +339 375 +236 +372 5 +370-0 +410-0 +348-75 +1078 +19 OCTOBER 1985 +BRITISH MEDICAL JOURNAL +VOLUME 291 +19 OCTOBER 1985 +1079 +yoga group to the regular practice of yoga. The considerable +reduction in their drug treatment score in contrast with a non- +significant increase +in intake of drugs in the control group +strengthens this view, as do the significant differences between the +groups in the number of attacks per week and peak flow rate. +McFadden clearly showed that the responsiveness of airways is +noticeably increased in patients with asthma, who develop broncho- +constriction in response to smaller quantities of physical, chemical, +and pharmacological stimuli than healthy subjects.'0 A complex +interplay of several factors-namely, an inherent responsiveness of +the smooth muscle to stimuli, an abnormality in autonomic nervous +control, and a breakdown in airway defences-may promote +bronchial hyper-reactivity. Thus reducing the responsiveness of the +tracheobronchial tree could benefit these patients considerably. +Abundant objective data now exist indicating that pyschological +factors can interact with the asthmatic diathesis to worsen or +improve the course of the disease. The mechanisms of these +interactions are complex and not well understood, but psychological +factors may affect about half of all patients. Modification of vagal +efferent activity seems to affect the calibre of airways. It has been +shown that suggestion can actually decrease or increase the effects of +pharmacological stimuli on the airways. The role of the psychic +factor in inducing or prolonging attacks in acute exacerbations may +vary from patient to patient and in individual patients from episode +to episode. +Goyeche et al claimed that the psychosomatic imbalance is +present in many, if not all patients with asthma.' Suppressed +emotion, anxiety, dependence, and extreme self consciousness may +all be accompanied by generalised and localised muscle tension, +including that of the voluntary respiratory musculature. This +increased muscle tension may be a precipitating or concomitant +factor that perpetuates and aggravates the asthmatic syndrome. +Yoga seems to stabilise and reduce the excitability of the nervous +system. Transcendental meditation (a traditional yogic meditation +technique) and Savasana have been clearly shown to be associated +with reduced metabolic rate." Crisan showed a significant reduction +in the level of anxiety after the practice of Pranayama, as evidenced +by increased skin resistance and a reduction in pulse rate, urinary +catecholamine concentration, urinary cholinesterase activity, and +anxiety scores.'2 Several workers have found an increase in alpha +synchrony in electroencephalograms taken during transcendental +meditation, which points to its stabilising effect on the nervous +system. Yoga clearly relaxes the muscles, and this deep physical and +mental relaxation associated with the physiological changes seen in +our patients after daily yoga seems to have a stabilising effect on +bronchial reactivity, thus making the vagal efferents less excitable. +In conclusion, the reduction in psychological hyper-reactivity +and emotional instability achieved by yoga can reduce efferent vagal +reactivity, which has been recognised as the mediator of the +psychosomatic factor in asthma. +References +1 Goyeche JRM, Abo Y, Ikemni Y. The yoga perspective. Part II. Yoga therapy in the treatment of +asthma. J Asthma 1982;19:189-201. +2 Bhole MV. Treatment of bronchial asthma by yogic methods--a report. +Yoga Mimamsa +1967;9:3)-41 +3 Bhole MV. Rationale oftreatment and rehabiliation ofasthmatics byyogic methods. Collected papers on +yoga. Lonavia, India: Kaivalyadhama, 1975: 106-14. +4 Erskin J, Schonnel M. Relaxation therapy in bronchial asthma. 7 Psychosom Res 1979;23:131-9. +5 Honsberger R, Wilson AF. Transcendental meditation in treating asthma. Respiratory Therapy +1973;3:79-8 1. +6 Murthy KRJ, Sahaj BK, Silaramaraju P, et al. Effect of pranayama (rechaka, puraka, and +kumbhaka) on bronchial asthma-an open study. LungIndia 1983;5:187-91. +7 Nagarathna +R, +Nagendra HR. +Studies +on +bronchial +asthma +1981-84. +Bangalore, +India: +Vivekananda Kendra Yoga Therapy and Research Centre. (Reports 1-4, 8-11.) +8 Crofton J, Douglas A. Respiratory diseases. 2nd ed. Oxford: Blackwell Scientific Publications, +1975:429. +9 Shivpuri DN. Studies on methods of clinical research in bronchial asthma and allied conditions. +Aspects ofAllergy and Applied Immunology 1974;7:15-35. +10 McFadden ER. Pathogenesis of asthma. 7 Allergy Clin Immunol 1984;73:413-22. +11 Patel CH. Twelve month follow up of yoga and biofeedback in the management of hypertension. +Lancet 1975;i:62-3. +12 Crisan HG. Pranayama in anxiety neurosis-a pilot study. Heidelberg: University of Heidelberg, +1984. (PhD dissertation.) +(Accepted 8August 1985) +Treatment of homozygous familial hypercholesterolaemia: an +informative sibship +RICHARD WEST, +PENELOPE GIBSON, +JUNE LLOYD +Abstract +In a family in which both parents had the heterozygous form of +familial hypercholesterolaemia four of the children had the +homozygous form. The three oldest homozygous children, two of +whom did not receive any treatment and in one of whom +treatment did not lower the plasma cholesterol concentration, +developed xanthomas in early childhood and died aged 3, 9, and +10 years. The fourth homozygous child was treated with diet and +drugs from the age of 1 and at the age of 15 had no xanthomas, no +clinical evidence ofheart disease, and a virtualiy normal coronary +Department of Child Health, St George's Hospital Medical School, London +SW17 +RICHARD WEST, MD, FRCP, senior lecturer +PENELOPE GIBSON, MRCP, lecturer +JUNE LLOYD, MD, FRCP, professor +Correspondence to: Dr West. +angiogram. His plasma cholesterol concentration was reduced +by about 30% but remained considerably raised. +It is concluded that treatment, if started before atherosclerosis +develops, can delay the onset of atheroma and coronary heart +disease even though normal plasma cholesterol concentrations +are not achieved. +Introduction +Familial hypercholesterolaemia is dominantly inherited, and hetero- +zygotes have an increased risk of coronary heart disease in adult life. +Homozygotes have extremely high plasma cholesterol concentra- +tions and die of coronary heart disease in childhood or early adult +life.' Treatment of homozygotes is difficult. Normal cholesterol +concentrations are unlikely to be achieved, and uncertainty exists +over whether coronary atherosclerosis can be prevented.2 3 +We report on a family containing four siblings homozygous for +the disease. The progress ofthe youngest contrasted with that of the +other affected siblings, suggesting that prevention ofatherosclerosis +is possible. diff --git a/subfolder_0/Yoga for musculoskeletal pain, discomfort, perceived stress, and quality of sleep in industry workers a randomized controlled trial.txt b/subfolder_0/Yoga for musculoskeletal pain, discomfort, perceived stress, and quality of sleep in industry workers a randomized controlled trial.txt new file mode 100644 index 0000000000000000000000000000000000000000..08fe19ca4d2f79624f35333157d610811efc1aed --- /dev/null +++ b/subfolder_0/Yoga for musculoskeletal pain, discomfort, perceived stress, and quality of sleep in industry workers a randomized controlled trial.txt @@ -0,0 +1,12 @@ +1 +2 +3 +4 +5 +6 +7 +8 +9 +10 +11 +12 diff --git a/subfolder_0/Yoga practice is beneficial for maintaining healthy lifestyle and endurance under restrictions and stress imposed by lockdown during COVID-19 pandemic.txt b/subfolder_0/Yoga practice is beneficial for maintaining healthy lifestyle and endurance under restrictions and stress imposed by lockdown during COVID-19 pandemic.txt new file mode 100644 index 0000000000000000000000000000000000000000..356e65095a1cb65cdb31c0a09fee1aaaed260bbf --- /dev/null +++ b/subfolder_0/Yoga practice is beneficial for maintaining healthy lifestyle and endurance under restrictions and stress imposed by lockdown during COVID-19 pandemic.txt @@ -0,0 +1,2751 @@ +ORIGINAL RESEARCH +published: 22 June 2021 +doi: 10.3389/fpsyt.2021.613762 +Frontiers in Psychiatry | www.frontiersin.org +1 +June 2021 | Volume 12 | Article 613762 +Edited by: +Rochelle Eime, +Victoria University, Australia +Reviewed by: +Lucia Sideli, +Libera Università Maria SS. +Assunta, Italy +Ramajayam Govindaraj, +National Institute of Mental Health and +Neurosciences, India +*Correspondence: +Raghuram Nagarathna +rnagaratna@gmail.com +Akshay Anand +akshay1anand@rediffmail.com +Specialty section: +This article was submitted to +Public Mental Health, +a section of the journal +Frontiers in Psychiatry +Received: 07 October 2020 +Accepted: 11 May 2021 +Published: 22 June 2021 +Citation: +Nagarathna R, Anand A, Rain M, +Srivastava V, Sivapuram MS, +Kulkarni R, Ilavarasu J, Sharma MNK, +Singh A and Nagendra HR (2021) +Yoga Practice Is Beneficial for +Maintaining Healthy Lifestyle and +Endurance Under Restrictions and +Stress Imposed by Lockdown During +COVID-19 Pandemic. +Front. Psychiatry 12:613762. +doi: 10.3389/fpsyt.2021.613762 +Yoga Practice Is Beneficial for +Maintaining Healthy Lifestyle and +Endurance Under Restrictions and +Stress Imposed by Lockdown During +COVID-19 Pandemic +Raghuram Nagarathna 1*, Akshay Anand 2,3,4*, Manjari Rain 2, Vinod Srivastava 5, +Madhava Sai Sivapuram 6, Ravi Kulkarni 7, Judu Ilavarasu 7, Manjunath N. K. Sharma 1, +Amit Singh 1 and Hongasandra Ramarao Nagendra 1 +1 Divison of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India, 2 Department of Neurology, +Post Graduate Institute of Medical Education and Research, Chandigarh, India, 3 Centre for Mind Body Medicine, Post +Graduate Institute of Medical Education and Research, Chandigarh, India, 4 Centre of Phenomenology and Cognitive +Sciences, Panjab University, Chandigarh, India, 5 College of Health and Behavioral Sciences, Fort Hays State University, +Hays, KS, United States, 6 Department of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and +Research Foundation, Chinna-Avutapalli, India, 7 Division of Yoga and Physical Sciences, Swami Vivekananda Yoga +Anusandhana Samsthana, Bengaluru, India +Uncertainty about Coronavirus disease 2019 (COVID-19) and resulting lockdown caused +widespread panic, stress, and anxiety. Yoga is a known practice that reduces stress and +anxiety and may enhance immunity. This study aimed to (1) investigate that including +Yoga in daily routine is beneficial for physical and mental health, and (2) to evaluate +lifestyle of Yoga practitioners that may be instrumental in coping with stress associated +with lockdown. This is a pan-India cross-sectional survey study, which was conducted +during the lockdown. A self-rated scale, COVID Health Assessment Scale (CHAS), was +designed by 11 experts in 3 Delphi rounds (Content valid ratio = 0.85) to evaluate the +physical health, mental health, lifestyle, and coping skills of the individuals. The survey +was made available digitally using Google forms and collected 23,760 CHAS responses. +There were 23,290 valid responses (98%). After the study’s inclusion and exclusion +criteria of yogic practices, the respondents were categorized into the Yoga (n = 9,840) +and Non-Yoga (n = 3,377) groups, who actively practiced Yoga during the lockdown in +India. The statistical analyses were performed running logistic and multinomial regression +and calculating odds ratio estimation using R software version 4.0.0. The non-Yoga +group was more likely to use substances and unhealthy food and less likely to have +good quality sleep. Yoga practitioners reported good physical ability and endurance. +Yoga group also showed less anxiety, stress, fear, and having better coping strategies +than the non-Yoga group. The Yoga group displayed striking and superior ability to cope +with stress and anxiety associated with lockdown and COVID-19. In the Yoga group, +participants performing meditation reportedly had relatively better mental health. Yoga +may lead to risk reduction of COVID-19 by decreasing stress and improving immunity if +specific yoga protocols are implemented through a global public health initiative. +Keywords: COVID-19, Yoga, global health, stress, coping straregies +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +INTRODUCTION +WHO +declared +Coronavirus +disease +2019 +(COVID-19), +originating from Wuhan, China, caused by Severe Acute +Respiratory Syndrome Coronavirus-2 (SARS CoV-2), as a +pandemic on March 11, 2020. To prevent spread and provide +sufficient time for hospitals’ readiness, the Governments +worldwide had to impose “Lockdown” in their respective +countries. +Under +lockdown, +people +were +restricted +from +remaining +outdoors +with +certain +exceptions +resulting +from emergencies. +India imposed the world’s most extensive lockdown on March +23, 2020 (1). Many people were either stranded in their homes +or containment zones, disrupting small businesses’ earnings, +working of domestic maids, daily wagers, and laborers. In +addition, the uncertainty of the disease’s contagious nature +among the public and healthcare workers led to fear, panic, +anxiety, and stress. Stress also intensified among those with +chronic illnesses, as susceptibility and severity of COVID-19 +were associated with co-morbidities (2–4). Furthermore, global +infodemic and fake news exasperated anxiety and stress among +the general public (5, 6). +Previous studies have evidenced increased post-traumatic +stress disorder (PTSD) after epidemic or natural calamities such +as SARS, earthquake, or a tornado, including COVID-19 (7–10). +Wang et al. conducted a comprehensive self-administered online +survey in China to understand the prevalence of psychological +stress in the COVID-19 pandemic. They reported increased +panic, stress, anxiety, and depression similar to previous studies +conducted during the 2003 SARS epidemic (7, 8, 11). A similar +online survey by Liu et al. reported that 20% of people showed +anxiety, 27% reported depression, 7.7% had psychological +distress, and 10% suffered from phobias (12). Furthermore, there +were changes in people’s behavioral patterns due to lockdown, +especially concerning their eating habits. Increased consumption +of junk food, soft drinks, and alcohol resulted in obesity. +Lockdown disrupted the daily routines, sleep hours, outdoor +activities, and increased screen time and smoking, predisposing +people to risks of COVID-19 (13, 14). Two small studies from +India have shown similar trends (15, 16). +In the current study on the COVID-19 pandemic, it has been +reported that the impact on psychological stress might be more +pronounced due to persistent global media feeds and internet +access. The present COVID Health Assessment Scale (CHAS) +survey was designed to evaluate the physical and mental health +and coping skills of participants who practiced yoga and those +who did not. Several studies have shown that Yoga brings a +positive change in physical and mental health by regulating the +hypothalamic–pituitary–adrenal system, sympathetic nervous +system, reducing the cortisol, and improving immunity indicated +by an increase in CD4, heart rate, fasting blood glucose, +cholesterol, and low-density lipoprotein levels (17–20). Thus, it +appears that Yoga practitioners have healthy lifestyle among the +Abbreviations: +CHAS, +COVID +Health +Assessment +Scale; +COVID-19, +Coronavirus disease 2019; OR, Odds ratio; PTSD, Post-traumatic stress disorders; +S-VYASA, Swami Vivekananda Yoga AnusandhanaSamsthana. +general population. This study investigated that including Yoga +in daily routine is beneficial for physical and mental health. Also, +Yoga practitioners have a healthier lifestyle, which improves their +ability to cope with the restrictions and stress under lockdown. +MATERIALS AND METHODS +The current study received ethical approval from Swami +Vivekananda +Yoga +Anusandhana +Samsthana +(S-VYASA) +University, Karnataka, India. CHAS, a unique self-assessment +scale, was designed for the survey in 10 different languages, +English, +Hindi, +Assamese, +Bengali, +Kannada, +Malayalam, +Marathi, Odia, Tamil, and Telugu. A committee consisting +of 11 experts was constituted who undertook three rounds of +discussions as per Delphi protocol and agreed to the CHAS +questionnaire that assessed the positive and negative aspects +of physical and mental health, lifestyle, and associated coping +methods during the lockdown period (Table 1). Among 11 +experts, 6 had PhD in Yoga with more than 15 years of +experience in yoga research, 3 were post-graduate in yoga with +experience of more than 10 years in yoga, one is a professor of +statistics, a mathematician with masters in psychology and PhD +in yoga, and one is a psychologist with PhD in yoga. Content +valid ratio (CVR) was 0.85 for CHAS as per Delphi method +(21–23). CHAS also collected the demographic (questions 1–10) +and lifestyle (questions 39–64) details of the participants. +Questions +11–15 +accessed +COVID-19 +exposure +of +participants; these included self-reported symptoms, travel +history, details of interaction with COVID-19–positive patient, +and quarantine history. Physical health was accessed by rating +physical strength and endurance (question 16) and disease +history (question 17). In question 16, two extreme options were +considered as a single option during analysis. +Twelve questions (questions 18–29) were included in CHAS +to assess the mental health during the lockdown. The questions +were designed to evaluate fear and anxiety during the lockdown +and evaluate the individual’s general personality or character. +Standard neuropsychological questionnaires were not used to +evaluate stress and anxiety. +The coping ability of participants was accessed by a direct +question with four options, i.e., “Poor,” “Average,” “Very good,” +and “Excellent” (question 30). During analysis, “Poor” and +“Average” were merged into a single attribute, i.e., “Poor.” +Similarly, “Very Good” and “Excellent” were merged to constitute +“Good.” Questions 31–38 enquired about different activities of +participants during lockdown; these questions indicate coping +strategy of participants during lockdown. Questions 39–42 in +lifestyle domain also provide information on coping strategy. +Data Collection and Study Participants +The survey items for CHAS were prepared on Google forms +and circulated in public through social media. Snowball method +was used to acquire the data nationwide. 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 within this short period. No inclusion and +Frontiers in Psychiatry | www.frontiersin.org +2 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 1 | CHAS questionnaire. +Parameters +Question +number +Questions +Valid responses +Demographics +1 +Gender +Female, male, other +2 +Age +<20 years, 20–30 years, 31–40 years, 41–50 years, 51–60 years, +61–70 years, 71–80 years, above 80 years +3 +Weight (kg) +Open-ended question +4 +Height (cm) +Open-ended question +5 +State +Not in India, Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, +Chhattisgarh, Goa, Gujarat, Haryana, Himachal Pradesh, Jharkhand, +Karnataka, Kerala, Madhya Pradesh, Maharashtra, Manipur, +Meghalaya, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, Sikkim, +Tamil Nadu, Telangana, Tripura, Uttar Pradesh, Uttarakhand, West +Bengal, Andaman and Nicobar, Chandigarh, Delhi NCT, Dadra and +Daman, Jammu and Kashmir, Ladakh, Lakshadweep, Puducherry +6 +Country +India, China, USA, Italy, UK, Spain, France, Other +7 +Occupation +Agriculture, business, employed, homemaker, retired, student, +professional, other +8 +Education +Less than graduation, graduate, post-graduate +9 +During lock down staying with: +Family, friends, colleagues, alone, away from home +10 +During lock down are you: +Working from home, working from office, not working +COVID-19 +exposure +11 +Are you experiencing any of the +following? +No symptoms, cough, fever, breathing difficulty, other +12 +Have you traveled anywhere +internationally since January 2020? +Yes, no +13 +Which of the following apply to you? +Other, recent COVID-19 interacted, was quarantined, in quarantine, +health worker, hospitalized +14 +Number of days passed since you +interacted or lived with someone who has +been tested positive for COVID-19 +Open-ended question +15 +Number of days passed since you are in +quarantine. Please ignore if you were not +quarantined +Open-ended question +Physical health +16 +How do you rate your physical strength +and endurance? +Very good, good, average, bad, very bad +17 +History of chronic health problems +Healthy, BP +, lung disease, heart disease, cancer, arthritis, diabetes, +others +Mental health +18 +Do you feel you are low in energy and +downhearted during this lock-down +period? +Not at all, somewhat, very much +19 +How anxious are you about the +implications of COVID-19 in your life? +Not at all, somewhat, very much +20 +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, somewhat, very much +21 +How much do the following issues worry +you during this lock-down period? (Fear +of death) +Not at all, somewhat, very much +22 +How much do the following issues worry +you during this lock-down period? (Fear +of a possible financial burden) +Not at all, somewhat, very much +23 +How much do the following issues worry +you during this lock-down period? (Fear +of unknown related to COVID-19) +Not at all, somewhat, very much +24 +How much do the following issues worry +you during this lock-down period? (Fear +of spreading infection to near and dear +ones) +Not at all, somewhat, very much +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +3 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 1 | Continued +Parameters +Question +number +Questions +Valid responses +25 +How do you rate your personality? (Are +you generally goal driven; perfectionist +and persistent) +Disagree, maybe, agree +26 +How do you rate your personality? (Are +you caring and ready to help others all +the time) +Disagree, maybe, agree +27 +How do you rate your personality? (Do +you always feel insecure; stressed and +have mood swings) +Disagree, maybe, agree +28 +How do you rate your personality? (Are +you always open to new ideas and +suggestions and willing to try them) +Disagree, maybe, agree +29 +How do you rate your personality? (Do +you always enjoy sharing your thoughts +and ideas with others) +Disagree, maybe, agree +Coping strategy +30 +How do you rate your coping abilities +during this lock-down period? +Poor, average, very good, excellent +31 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Watching TV/playing +computer games) +Yes, no +32 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Reading/writing) +Yes, no +33 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Cooking) +Yes, no +34 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Exercise) +Yes, no +35 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Yogasana) +Yes, no +36 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Meditation) +Yes, no +37 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Faith-based practices +including prayer etc.) +Yes, no +38 +How do you prefer spending time (apart +from your regular, work-related +engagements) during this national +lock-down period? (Social media and +Internet) +Yes, no +Lifestyle +39 +As a coping strategy do you use? +(Tobacco) +Never, occasionally, regularly +40 +As a coping strategy do you use? (Drink +Alcohol) +Never, occasionally, regularly +41 +As a coping strategy do you use? (or use +any other substance) +Never, occasionally, regularly +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +4 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 1 | Continued +Parameters +Question +number +Questions +Valid responses +42 +Has the lock-down increased your +dependency on use of tobacco, alcohol, +or any other substances? +Yes, no, not applicable +43 +In general, how do you describe your +eating habits as? (I am disciplined with +respect to time and place of eating) +Yes, no +44 +In general, how do you describe your +eating habits as? (I am a strict +vegetarian/vegan) +Yes, no +45 +In general, how do you describe your +eating habits as? (I like eating junk food) +Yes, no +46 +In general, how do you describe your +eating habits as? (I like spicy and hot +food) +Yes, no +47 +In general, how do you describe your +eating habits as? (I like sweet and sour +food) +Yes, no +48 +In general, how do you describe your +eating habits as? (I like cold and +refrigerated food) +Yes, no +49 +In general, how do you describe your +eating habits as? (I tend to frequently +snack) +Yes, no +50 +How would you describe your overnight +sleep DURING this lock-down period? +Very good, good, OK, bad, very bad +51 +How would you describe your overnight +sleep BEFORE this lock-down period? +Very good, good, OK, bad, very bad +52 +What activity were you engaged with +BEFORE this lock-down period? +Did yoga, went fitness, went walking, did household, other +53 +What activity are you engaged with +DURING this lock-down period? +Doing yoga, going fitness, going walk, doing household, other +54 +How much time do you spend for a +structured physical activity as mentioned +above during this lock-down period? +Never, <30 min, 30 min−1 h, >1 h +55 +Duration of practices per week during this +lock-down period? (Asana) +Don’t practice, <2 h, 2–4 h, 4–6 h, >6 h +56 +Duration of practices per week during this +lock-down period? (Pranayama) +Don’t practice, <2 h, 2–4 h, 4–6 h, >6 h +57 +Duration of practices per week during this +lock-down period? (Meditation) +Don’t practice, <2 h, 2–4 h, 4–6 h, >6 h +58 +Duration of practices per week during this +lock-down period? (Religious practices) +Don’t practice, <2 h, 2–4 h, 4–6 h, >6 h +59 +How motivated are/were you to start +Yoga during this lock-down period? +Not at all, somewhat, very much so +60 +In general, how do you rate the +happiness/peace you derive from the +following? (Yoga and/ or religious +practices) +Not at all, somewhat, very much +61 +In general, how do you rate the +happiness/peace you derive from the +following? (Money) +Not at all, somewhat, very much +62 +In general, how do you rate the +happiness/peace you derive from the +following? (Sensory pleasures) +Not at all, somewhat, very much +63 +In general, how do you rate the +happiness/peace you derive from the +following? (Name and fame) +Not at all, somewhat, very much +64 +In general, how do you rate the +happiness/peace you derive from the +following? (Service to society) +Not at all, somewhat, very much +Frontiers in Psychiatry | www.frontiersin.org +5 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +exclusion criteria were defined during the circulation of CHAS. +Hence, the received responses showed diversity in age, gender, +occupation, education, and other demographics (Table 2). +This study was sponsored and conducted by S-VYASA. The +participation was voluntary, and the response sheets were +downloaded daily. +The CHAS data were collected between May 9, 2020 and +May 31, 2020, and 23,760 responses were received. Incomplete +and unreliable responses, respondents from outside of India +and respondents aged <18 years were excluded (n = 470). The +remaining 23,290 responses were evaluated to assign participants +in Yoga and non-Yoga groups. Inclusion criteria were age +should be ≥18 years and all respondents should be residing in +India. Yoga and non-Yoga group was defined according to the +responses of question numbers 52, 53, 55, 56, and 57 of the CHAS +questionnaire (Table 1). +Criteria for Defining Yoga Group +The Yoga group was defined as individuals who performed Yoga +both before (question 52) and during (question 53) the lockdown, +which included practicing one or more among Asanas (question +55) (Yoga postures), Pranayama (Yogic breathing exercises) +(question 56), and meditation (question 57) for a few hours to +more than 6 h per week during the lockdown. Participants, who +replied “Did Yoga” for questions 52 and 53, but marked “Don’t +practice” for questions 55–57 were excluded from the Yoga +group. According to these criteria, 9,840 participants qualified for +the Yoga group. +Furthermore, the Yoga group was divided into four sub- +groups, i.e., Yoga practitioners who practiced Asana, Pranayama, +and meditation (all three together; n = 6,156), practitioners who +practiced only Asana (n = 149), only Pranayama (n = 89), and +only meditation (n = 1,485). The combination of two practices +among Asana, Pranayama, and meditation was not considered +as a sub-group. +Criteria for Defining Non-Yoga Group +The non-Yoga group included respondents who did not +perform Yoga before (question 52) or during (question 53) the +lockdown and replied “Don’t Practice” for the questions on +Asana (question 55), Pranayama (question 56), and meditation +(question 57). Following the aforementioned inclusion criteria, +3,377 participants were accepted in the non-Yoga group. +Statistical Analysis +R Statistical software, version 4.0.0, was used for data cleaning, +extraction, and analyses. The arsenal package in R was used to +determine cross-tabulations and χ2 test; logistic and multinomial +regression was used. Age, gender, occupation, education, and +working status during lockdown were used as covariates. +The dependent variables were the study groups. We used +multiple predictors in each of the regression models. Sequential +contrast was used for ordinal variables. The predictors were +selected based on the domains presented in the survey. The +domains were demographic details, physical health, mental +health, coping strategy, and lifestyle. +RESULTS +Demographic Characterization +Table 2 summarizes the demographics of the non-Yoga group +(25.6%), Yoga group (74.4%), and total participants. Participation +of males in the survey was proportionally higher in both non- +Yoga (67.5%) and Yoga (55.3%) groups. The young population in +the age group of 20–30 years was higher in the non-Yoga (50.5%) +group than in the Yoga group (22.8%). The participation from the +age group > 50 years was higher in the Yoga group (26.8%) than +in the non-Yoga group (6.0%). Our data also revealed that the +percentage of employed and professional participants was higher +in both groups, with 44.1% in non-Yoga and 40.4% in Yoga. The +non-Yoga group had 37.0% participation from young students. +Most of the participants had a good educational background +as they were either graduates or post-graduates. We noted that +85.0% of the participants stayed with their family during the +lockdown, apparently lending help to cope with stress. On further +analysis, we found that the non-working participants were fewer +in the non-Yoga group (36.5 vs. 43.9%). Furthermore, the +proportion of participants going to the office during lockdown +was more in the non-Yoga group (25.7 vs. 15.2%). +COVID-19 Exposure +Participants with no symptoms are less likely to be in the +non-Yoga group than participants with cough, fever, breathing +difficulty, and other symptoms (Table 2). The symptoms of +COVID-19 were self-reported. Approximately 98.1% of non- +Yoga and 97.8% of the Yoga group did not undertake any +international travel since January 2020. Further, the non-Yoga +group is more likely to have exposure to COVID-19 than the +Yoga group. +Lifestyle +Although the proportion of participants using substances was +lower in both groups, the non-Yoga group was more likely to +depend on alcohol, tobacco, and other substances (Table 3). The +non-Yoga group was less likely to have a good quality of sleep +before and during the lockdown than the Yoga group, odds ratio +(OR) < 1 (Table 3). +Participants of the non-Yoga group were less likely to have +food in a disciplined manner [unadjusted OR = 0.58 (0.49– +0.69), adjusted OR = 0.60 (0.51–0.52)] and were less likely to +be vegetarian [unadjusted OR = 0.27 (0.23–0.31), adjusted OR += 0.31 (0.27–0.36)] (Table 3). The non-Yoga group was more +likely to consume junk food [unadjusted OR = 1.69 (1.44– +1.98), adjusted OR = 1.39 (1.18–1.64)] and spicy and hot food +[unadjusted OR = 1.91 (1.65–2.21), adjusted OR = 1.77 (1.53– +2.05)]. Interestingly, about 55.3% of the non-Yoga participants +were motivated to start Yoga during the lockdown (Table 3). +Physical Health +The Yoga group reported very good physical strength and +endurance, with only 7.5% of participants reporting an average +or below average physical strength and endurance (Table 4). The +non-Yoga practitioners were less likely to have good physical +strength and endurance (OR < 1), suggesting physical endurance +attributes might be superior in Yoga practitioners. Disease risk +Frontiers in Psychiatry | www.frontiersin.org +6 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 2 | Demographic characteristics and COVID-19 exposure in non-Yoga and Yoga groups. +Demographics +Non-Yoga (N = +3,377), No. (%) +Yoga (N = 9,840), +No. (%) +Total N = 13,217, +No. (%) +P-value +Gender +<0.001 +Female +1,097 (32.5) +4,397 (44.7) +5,494 (41.6) +Male +2,280 (67.5) +5,443 (55.3) +7,723 (58.4) +Age +<0.001 +<20 years +372 (11.0) +332 (3.4) +704 (5.3) +20–30 years +1,704 (50.5) +2,240 (22.8) +3,944 (29.8) +31–40 years +761 (22.5) +2,375 (24.1) +3,136 (23.7) +41–50 years +341 (10.1) +2,243 (22.8) +2,584 (19.6) +51–60 years +136 (4.0) +1,519 (15.4) +1,655 (12.5) +61–70 years +49 (1.5) +880 (8.9) +929 (7.0) +71–80 years +12 (0.4) +209 (2.1) +221 (1.7) +Above 80 years +2 (0.1) +42 (0.4) +44 (0.3) +Occupation +<0.001 +Agriculture +104 (3.1) +245 (2.5) +349 (2.6) +Business +99 (2.9) +708 (7.2) +807 (6.1) +Employed +1,209 (35.8) +2,809 (28.5) +4,018 (30.4) +Homemaker +123 (3.6) +1,504 (15.3) +1,627 (12.3) +Retired +56 (1.7) +744 (7.6) +800 (6.1) +Student +1,248 (37.0) +1,358 (13.8) +2,606 (19.7) +Professional +280 (8.3) +1,171 (11.9) +1,451 (11.0) +Other +258 (7.6) +1,301 (13.2) +1,559 (11.8) +Education +<0.001 +Less than graduation +992 (29.4) +2,459 (25.0) +3,451 (26.1) +Graduate +1,398 (41.4) +3,748 (38.1) +5,146 (38.9) +Post graduate +987 (29.2) +3,633 (36.9) +4,620 (35.0) +Lockdown stay status +<0.001 +Family +2,799 (82.9) +8,429 (85.7) +11,228 (85.0) +Friends +64 (1.9) +113 (1.1) +177 (1.3) +Colleagues +193 (5.7) +332 (3.4) +525 (4.0) +Alone +169 (5.0) +588 (6.0) +757 (5.7) +Missing data +152 (4.5) +378 (3.8) +530 (4.0) +Working status during lockdown +<0.001 +Working from home +1,276 (37.8) +4,027 (40.9) +5,303 (40.1) +Working from office +867 (25.7) +1,494 (15.2) +2,361 (17.9) +Not working +1,234 (36.5) +4,319 (43.9) +5,553 (42.0) +COVID-19 symptoms +<0.001 +No symptoms +2,943 (87.1) +9,037 (91.8) +11,980 (90.7) +Cough +68 (2.0) +78 (0.8) +146 (1.1) +Fever +5 (0.1) +2 (0.0) +7 (0.0) +Breathing difficulty +8 (0.2) +20 (0.2) +28 (0.2) +Other +353 (10.5) +703 (7.1) +1,056 (8.0) +International travel since January 2020 +0.383 +Yes +65 (1.9) +214 (2.2) +279 (2.1) +No +3,312 (98.1) +9,626 (97.8) +12,938 (97.9) +Exposure to COVID-19 +<0.001 +No exposure +3,106 (92.0) +9,381 (95.3) +12,487 (94.5) +Recent COVID-19 interaction +19 (0.6) +40 (0.4) +59 (0.4) +Were in quarantine +90 (2.7) +166 (1.7) +256 (1.9) +Still in quarantine +54 (1.6) +99 (1.0) +153 (1.2) +Healthcare worker +104 (3.1) +143 (1.5) +247 (1.9) +Hospitalized +4 (0.1) +11 (0.1) +15 (0.1) +Frontiers in Psychiatry | www.frontiersin.org +7 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 3 | Lifestyle in non-Yoga and Yoga groups. +Lifestyle +Non-Yoga (N += 3,377) Reference +Yoga (N = 9,840) +Substance abuse +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Tobacco +Never +2,961 (87.7) +9,586 (97.4) +Occasionally +288 (8.5) +191 (1.9) +0.001 +0.58 (0.42–0.80) +0.64 (0.47–0.87) +Regularly +128 (3.8) +63 (0.6) +0.067 +0.57 (0.31–1.03) +0.59 (0.32–1.05) +Alcohol +Never +2,703 (80.0) +9,499 (96.5) +Occasionally +636 (18.8) +317 (3.2) +<0.001 +0.56 (0.44–0.72) +0.59 (0.46–0.75) +Regularly +38 (1.1) +24 (0.2) +0.010 +3.08 (1.29–7.14) +3.33 (1.38–7.80) +Other substances +Never +3,261 (96.6) +9,688 (98.5) +Occasionally +74 (2.2) +113 (1.1) +0.090 +1.53 (0.94–2.51) +1.41 (0.87–2.30) +Regularly +42 (1.2) +39 (0.4) +0.229 +0.58 (0.24–1.39) +0.51 (0.21–1.23) +Increased substance +dependence +Yes +63 (1.9) +55 (0.6) +No +1,229 (36.4) +1,917 (19.5) +<0.001 +0.32 (0.18–0.58) +0.30 (0.17–0.55) +Not applicable +2,085 (61.7) +7,868 (80.0) +<0.001 +0.27 (0.15–0.48) +0.26 (0.14–0.47) +Eating habits +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Disciplined to time +Yes +2,414 (71.5) +8,915 (90.6) +No +963 (28.5) +925 (9.4) +<0.001 +0.60 (0.51–0.52) +0.58 (0.49–0.69) +Vegetarian/vegan +Yes +1,373 (40.7) +8,713 (88.5) +No +2,004 (59.3) +1,127 (11.5) +<0.001 +0.31 (0.27–0.36) +0.27 (0.23–0.31) +Junk food +Yes +1,505 (44.6) +1,166 (11.8) +No +1,872 (55.4) +8,674 (88.2) +<0.001 +1.39 (1.18–1.64) +1.69 (1.44–1.98) +Spicy and hot food +Yes +2,322 (68.8) +2,992 (30.4) +No +1,055 (31.2) +6,848 (69.6) +<0.001 +1.77 (1.53–2.05) +1.91 (1.65–2.21) +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +8 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 3 | Continued +Lifestyle +Non-Yoga (N += 3,377) Reference +Yoga (N = 9,840) +Sweet and sour food +Yes +2,225 (65.9) +5,234 (53.2) +No +1,152 (34.1) +4,606 (46.8) +0.115 +1.12 (0.97–1.30) +1.15 (1.00–1.33) +Cold and refrigerated food +Yes +1,123 (33.3) +1,019 (10.4) +No +2,254 (66.7) +8,821 (89.6) +0.993 +(0.84–1.19) +1.09 (0.92–1.30) +Frequent snacks +Yes +1,758 (52.1) +2,729 (27.7) +No +1,619 (47.9) +7,111 (72.3) +0.235 +0.92 (0.79–1.06) +0.98 (0.85–1.12) +Sleep +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +During lockdown period +Good +2,171 (64.3) +8,558 (87.0) +Ok +856 (25.3) +1,107 (11.2) +<0.001 +0.67 (0.55–0.81) +0.67 (0.55–0.81) +Bad +350 (10.4) +175 (1.8) +0.011 +0.64 (0.45–0.9) +0.60 (0.43–0.85) +Before lockdown period +Good +2,427 (71.9) +8,744 (88.9) +Ok +776 (23.0) +992 (10.1) +0.035 +0.81 (0.66–0.99) +0.81 (0.67–0.98) +Bad +174 (5.2) +104 (1.1) +0.387 +0.81 (0.51–1.29) +0.76 (0.48–1.21) +Happiness/peace +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +By doing Yoga/religious +practices +Not at all +1,358 (40.2) +184 (1.9) +Somewhat +1,391 (41.2) +1,795 (18.2) +<0.001 +5.88 (4.63–7.52) +6.05 (4.78–7.70) +Very much +628 (18.6) +7,861 (79.9) +<0.001 +2.42 (2.07–2.82) +2.54 (2.18–2.95) +By earning money +Not at all +688 (20.4) +3,344 (34.0) +Somewhat +1,760 (52.1) +5,456 (55.4) +<0.001 +0.68 (0.57–0.82) +0.70 (0.59–0.84) +Very much +929 (27.5) +1,040 (10.6) +<0.001 +0.56 (0.46–0.68) +0.54 (0.45–0.66) +By sensory pleasure +Not at all +764 (22.6) +3,727 (37.9) +Somewhat +1,895 (56.1) +4,330 (44.0) +<0.001 +0.71 (0.59–0.85) +0.72 (0.60–0.86) +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +9 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 3 | Continued +Lifestyle +Non-Yoga (N += 3,377) Reference +Yoga (N = 9,840) +Very much +718 (21.3) +1,783 (18.1) +0.698 +0.96 (0.79–1.17) +0.98 (0.81–1.19) +By name and fame +Not at all +1,084 (32.1) +5,705 (58.0) +Somewhat +1,540 (45.6) +3,033 (30.8) +0.020 +0.81 (0.68–0.97) +0.73 (0.62–0.87) +Very much +753 (22.3) +1,102 (11.2) +0.840 +0.98 (0.79–1.21) +0.96 (0.78–1.19) +By social service +Not at all +361 (10.7) +401 (4.1) +Somewhat +1,460 (43.2) +3,157 (32.1) +0.292 +1.17 (0.88–1.55) +1.22 (0.93–1.61) +Very much +1,556 (46.1) +6,282 (63.8) +0.970 +(0.86–1.16) +0.92 (0.80–1.07) +Motivation to start/practice more Yoga +during lockdown +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Not at all +1,508 (44.7) +395 (4.0) +Somewhat +1,665 (49.3) +2,405 (24.4) +<0.001 +4.54 (3.79–5.46) +4.22 (3.54–5.03) +Very much +204 (6.0) +7,040 (71.5) +<0.001 +11.39 (9.50–13.72) +11.33 (9.47–13.62) +Any religious practices other than Yoga +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Never +2,002 (59.3) +3,155 (32.1) +<4 h +1,331 (39.4) +5,658 (57.5) +<0.001 +1.79 (1.56–2.06) +1.82 (1.59–2.09) +>4 h +44 (1.3) +1,027 (10.4) +<0.001 +3.09 (2.04–4.80) +3.13 (2.08–4.80) +Sequential contrast was used for ordinal variables and reference level is mentioned in the table for nominal variables. +Frontiers in Psychiatry | www.frontiersin.org +10 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 4 | Physical health in non-Yoga and Yoga groups. +Physical health +parameters +Non-Yoga (N = +3,377), No. (%) +(Reference) +Yoga (N = 9,840), +No. (%) +Non-Yoga vs. Yoga, +unadjusted odds +ratio (95% CI) +Non-Yoga vs. Yoga, +adjusted odds ratio +(95% CI) +Adjusted p-value +Physical strength and endurance +Good +2,688 (79.6) +9,106 (92.5) +Average +630 (18.7) +697 (7.1) +0.31 (0.28–0.35) +0.32 (0.28–0.37) +<0.001 +Bad +59 (1.7) +37 (0.4) +0.51 (0.32–0.79) +0.59 (0.35–0.98) +0.045 +Disease history +High risk +391 (11.6) +1,739 (17.7) +0.53 (0.46–0.60) +1.08 (0.94) +0.286 +No risk +2,986 (88.4) +8,101 (82.3) +Sequential contrast was used for ordinal variables and reference level is mentioned in the table for nominal variables. +for co-morbidities, including heart diseases, lung disease, blood +pressure, and others, was lower in both the groups (Table 4). +Mental Health +The non-Yoga group reported higher anxiety and fear than +the Yoga group when asked about “down-hearted” feeling, low +energy (30.9%), anxiety due to COVID-19 (63.9%), fear of getting +infected, related suffering (53.4%), fear of death (28.7%), fear of +financial difficulties (63.0%), fear of the unknown (57.0%), and +fear of spreading infection (65.9%) (Figure 1A). +Furthermore, the non-Yoga group was less goal-driven and +oriented toward perfection in their activities (15.9%), less helpful +and caring (5.2%), more insecure (50.2%), not open to new ideas +(6.6%), and do not enjoy sharing their thoughts (9.7%) than the +Yoga group (Figure 1B). +Strategies for Coping With COVID-19 and +Lockdown-Related Stress +Most of the Yoga group members reported good coping ability +(82.8%), while most of the non-Yoga (58.8%) group reported +poor coping ability thereby highlighting a significant difference +in two groups (Figure 1C). +Figure 1D shows that the non-Yoga group could cope using +the Internet, watching TV, reading/writing, cooking, religious +activity, and exercise (>50%). In contrast, the Yoga group +was engaged in yoga Asanas, meditation, and religious/spiritual +activities besides using the Internet, reading/writing, cooking, +and exercise (>50%). +Meditation Is Highly Effective to Bring +Mental Stability and Strength +We also examined whether practicing a combination of Asanas, +Pranayama, and meditation has a different influence on outcome +variables than practicing one of these three yogic practices, +individually. Table 5 summarizes the different parameters of +physical health, mental health, and coping strategies of four sub- +groups. Meditation was frequently performed by the age group +of 41–50 years (26.3%), while Asana (49.7%) and Pranayama +(39.3%) were favored by young people between the ages of 20 and +30 years. The consolidated Yoga practice was preferred mainly by +participants of 31–40 years (24.5%). +Physical health, predicted by strength and endurance, revealed +that the Asana group might have lower physical health, whereas +co-morbidities were higher in the meditation group (19.3%). +Good mental ability was revealed by lower anxiety and stress in +the meditation group, followed by the combined group, Asana +and Pranayama, sequentially. In addition, the ability to cope +with the stress of COVID-19 was highest and comparable in +the meditation group (85.3%) and the combined yoga group +(83.2%). The preference of watching TV during lockdown was +least in the meditation group (30.2%); their preferences included +reading/writing (90.0%) and meditation (96.5%). The combined +group preferred a range of activities, including reading/writing +(92.2%), cooking (75.7%), exercise (93.2%), Yogasana (96.9%), +meditation (97.1%), and religious activity (86.2%). TV watching +was preferred by the Pranayama group (66.3%) followed by the +Asana group (62.4%), and the Internet was preferred by the +Asana group (87.9%) followed by the Pranayama group (76.4%). +The aforementioned observations suggest that meditation might +be more effective in reducing stress and anxiety and improving +coping abilities in lockdown situations. +DISCUSSION +Despite limited public health intervention strategies, Yoga has +remained the mainstay for improving well-being, disease risk +reduction, and improving mental and physical health (17–20, +24, 25). We had earlier reported significant barriers in access +to Yoga resources even though the prevalence of Yoga in India +and elsewhere was significantly noteworthy (26, 27). Regardless, +several studies have reported over time better physical health, +mental health, and quality of life both among healthy individuals +and those with disease or disorder (17–20, 24, 25). Yoga has been +known to improve physical and mental health compared with +a physically active group or a physically inactive group, yet the +reliance on its anticipated benefits has never been assessed in any +nationwide study during a health crisis (28, 29). +Yoga represents a regulated lifestyle that involves Asanas, +Pranayamas, and meditation. It makes an individual self- +aware of his/her body, mind, thoughts, and soul. The Yogic +Frontiers in Psychiatry | www.frontiersin.org +11 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +FIGURE 1 | Mental health and coping strategy of non-Yoga and Yoga groups. (A) Anxiety and fear during lockdown, (B) general personality, (C) coping ability, and (D) +coping activities. In (A,B), odds ratio and CI (in brackets) for each parameter are mentioned on the right side of the bar. The small alphabets represent the pair of +tested variables when Yoga group is compared with non-Yoga group. The representation are (a) not at all vs. somewhat, (b) somewhat vs. very much, (c) disagree vs. +maybe, and (d) maybe vs. agree. Sequential contrast was used for ordinal variables. *p < 0.05, **p < 0.01, ***p < 0.001. +Frontiers in Psychiatry | www.frontiersin.org +12 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 5 | Physical health, mental health, and coping strategy among the different Yoga groups practicing all or a particular form of Yoga. +Combined Yoga +group (N = 6,156) +(Reference) +Only Asana (N = +149) +Only meditation (N += 1,485) +Only Pranayama (N += 89) +Physical health +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Physical strength and endurance +Good +5,729 (93.1) +124 (83.2) +1,388 (93.5) +85 (95.5) +Average +405 (6.6) +23 (15.4) +89 (6.0) +4 (4.5) +0.133 +0.581 +0.332 +2.28 (0.78–6.64) +0.85 (0.47–1.53) +0.76 (0.44–1.32) +2.79 (0.96–8.07) +0.90 (0.50–1.62) +0.73 (0.00–2.34E06) +Bad +22 (0.4) +2 (1.3) +8 (0.5) +0 (0.0) +0.074 +0.009 +<0.001 +1.92 (0.94–3.91) +1.69 (1.14–2.49) +0.00 (0.00–0.00) +1.91 (0.94–3.88) +2.03 (1.37–2.99) +0.05 (0.00–271.11) +Disease history +High risk +1,076 (17.5) +20 (13.4) +287 (19.3) +15 (16.9) +No risk +5,080 (82.5) +129 (86.6) +1,198 (80.7) +74 (83.1) +0.588 +0.892 +0.287 +0.87 (0.52–1.45) +0.99 (0.84–1.16) +0.72 (0.40–1.31) +1.71 (1.02–2.85) +0.86 (0.74–1.00) +1.10 (0.60–2.01) +Mental health +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Down-hearted and low energy +Not at all +5,485 (89.1) +109 (73.2) +1,385 (93.3) +72 (80.9) +Somewhat +620 (10.1) +36 (24.2) +91 (6.1) +16 (18.0) +0.580 +0.803 +0.500 +1.25 (0.56–2.78) +1.07 (0.64–1.78) +1.76 (0.34–9.09) +1.31 (0.59–2.91) +1.13 (0.67–1.90) +1.33 (0.31–5.69) +Very much +51 (0.8) +4 (2.7) +9 (0.6) +1 (1.1) +0.926 +0.189 +0.526 +1.03 (0.60–1.77) +1.27 (0.89–1.81) +0.71 (0.25–2.04) +1.26 (0.73–2.16) +0.90 (0.63–1.29) +0.53 (0.21–1.35) +Anxiety due to COVID-19 +Not at all +4,001 (65.0) +62 (41.6) +1,197 (80.6) +45 (50.6) +Somewhat +1,752 (28.5) +65 (43.6) +230 (15.5) +27 (30.3) +0.430 +0.003 +0.347 +1.19 (0.77–1.84) +0.71 (0.57–0.89) +0.78 (0.47–1.31) +1.26 (0.82–1.95) +0.70 (0.57–0.88) +0.84 (0.51–1.38) +Very much +403 (6.5) +22 (14.8) +58 (3.9) +17 (19.1) +0.218 +0.081 +<0.001 +1.24 (0.88–1.73) +1.17 (0.98–1.40) +2.48 (1.57–3.92) +1.36 (0.98–1.89) +1.15 (0.97–1.37) +2.79 (1.80–4.33) +Fear of getting infected +Not at all +4,260 (69.2) +67 (45.0) +1,254 (84.4) +51 (57.3) +Somewhat +1,649 (26.8) +67 (45.0) +210 (14.1) +33 (37.1) +0.153 +0.423 +0.415 +1.54 (0.85–2.77) +0.85 (0.56–1.27) +0.68 (0.27–1.73) +1.57 (0.87–2.82) +0.80 (0.54–1.20) +0.79 (0.33–1.90) +Very much +247 (4.0) +15 (10.1) +21 (1.4) +5 (5.6) +0.453 +0.566 +<0.001 +1.15 (0.79–1.68) +0.93 (0.72–1.20) +0.20 (0.12–0.36) +1.03 (0.71–1.50) +0.96 (0.74–1.23) +0.27 (0.16–0.47) +Fear of death +Not at all +5,393 (87.6) +120 (80.5) +1,411 (95.0) +61 (68.5) +Somewhat +614 (10.0) +23 (15.4) +62 (4.2) +18 (20.2) +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +13 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 5 | Continued +Combined Yoga +group (N = 6,156) +(Reference) +Only Asana (N = +149) +Only meditation (N += 1,485) +Only Pranayama (N += 89) +0.143 +0.546 +0.282 +0.58 (0.29–1.20) +0.85 (0.50–1.44) +1.48 (0.72–3.03) +0.56 (0.28–1.15) +0.86 (0.52–1.43) +1.98 (0.98–4.01) +Very much +149 (2.4) +6 (4.0) +12 (0.8) +10 (11.2) +0.061 +0.833 +<0.001 +0.61 (0.37–1.02) +1.04 (0.73–1.49) +4.38 (2.45–7.81) +0.62 (0.37–1.03) +1.13 (0.80–1.61) +3.17 (1.85–5.46) +Fear of finance +Not at all +3,931 (63.9) +59 (39.6) +1,182 (79.6) +46 (51.7) +Somewhat +1,777 (28.9) +62 (41.6) +261 (17.6) +32 (36.0) +0.068 +0.043 +0.952 +1.49 (0.97–2.28) +0.76 (0.58–0.99) +1.02 (0.53–1.95) +1.48 (0.98–2.24) +0.74 (0.57–0.96) +1.00 (0.54–1.87) +Very much +448 (7.3) +28 (18.8) +42 (2.8) +11 (12.4) +0.226 +0.007 +0.117 +1.21 (0.89–1.65) +0.78 (0.65–0.93) +0.69 (0.44–1.10) +1.26 (0.93–1.71) +0.81 (0.68–0.97) +0.80 (0.51–1.24) +Fear of unknown +Not at all +4,366 (70.9) +69 (46.3) +1,275 (85.9) +44 (49.4) +Somewhat +1,486 (24.1) +57 (38.3) +184 (12.4) +34 (38.2) +0.532 +0.326 +0.169 +1.19 (0.70–2.02) +0.83 (0.56–1.21) +1.70 (0.80–3.63) +1.41 (0.83–2.40) +0.80 (0.55–1.17) +2.00 (0.95–4.23) +Very much +304 (4.9) +23 (15.4) +26 (1.8) +11 (12.4) +0.015 +0.764 +0.121 +1.56 (1.09–2.23) +0.96 (0.75–1.23) +1.48 (0.90–2.41) +1.63 (1.14–2.31) +1.07 (0.84–1.36) +1.30 (0.80–2.10) +Fear of spread +Not at all +3,665 (59.5) +65 (43.6) +1,127 (75.9) +42 (47.2) +Somewhat +1,933 (31.4) +56 (37.6) +309 (20.8) +32 (36.0) +0.634 +0.300 +0.908 +0.89 (0.56–1.42) +0.87 (0.66–1.14) +1.04 (0.54–2.01) +0.75 (0.47–1.20) +0.83 (0.63–1.08) +0.99 (0.52–1.87) +Very much +558 (9.1) +28 (18.8) +49 (3.3) +15 (16.9) +0.545 +0.010 +0.347 +0.90 (0.65–1.26) +0.79 (0.66–0.94) +0.80 (0.51–1.27) +1.02 (0.73–1.42) +0.75 (0.63–0.90) +0.80 (0.51–1.24) +Goal driven, perfectionist, and persistent +Disagree +715 (11.6) +20 (13.4) +181 (12.2) +15 (16.9) +Maybe +1,963 (31.9) +59 (39.6) +422 (28.4) +31 (34.8) +0.541 +0.260 +0.738 +0.88 (0.59–1.31) +1.08 (0.94–1.25) +0.91 (0.54–1.55) +0.80 (0.55–1.19) +1.04 (0.91–1.20) +0.73 (0.45–1.17) +Agree +3,478 (56.5) +70 (47.0) +882 (59.4) +43 (48.3) +0.387 +0.124 +0.572 +0.87 (0.63–1.19) +1.10 (0.97–1.24) +1.13 (0.74–1.73) +0.88 (0.64–1.21) +1.03 (0.91–1.16) +0.92 (0.61–1.38) +Helping and caring +Disagree +199 (3.2) +6 (4.0) +41 (2.8) +6 (6.7) +Maybe +751 (12.2) +24 (16.1) +169 (11.4) +23 (25.8) +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +14 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 5 | Continued +Combined Yoga +group (N = 6,156) +(Reference) +Only Asana (N = +149) +Only meditation (N += 1,485) +Only Pranayama (N += 89) +0.840 +0.053 +0.760 +0.93 (0.46–1.87) +1.32 (1.00–1.75) +1.12 (0.53–2.38) +0.96 (0.49–1.88) +1.55 (1.17–2.05) +1.18 (0.56–2.51) +Agree +5,206 (84.6) +119 (79.9) +1,275 (85.9) +60 (67.4) +0.481 +0.863 +<0.001 +1.22 (0.71–2.10) +0.98 (0.79–1.22) +0.32 (0.18–0.56) +1.10 (0.66–1.84) +0.93 (0.75–1.15) +0.38 (0.22–0.66) +Insecurity +Disagree +4,651 (75.6) +73 (49.0) +1,261 (84.9) +59 (66.3) +Maybe +977 (15.9) +50 (33.6) +114 (7.7) +21 (23.6) +0.001 +<0.001 +0.326 +1.85 (1.29–2.67) +0.60 (0.51–0.70) +1.30 (0.77–2.22) +2.06 (1.45–2.94) +0.61 (0.52–0.72) +1.17 (0.69–1.99) +Agree +528 (8.6) +26 (17.4) +110 (7.4) +9 (10.1) +0.886 +<0.001 +0.184 +1.02 (0.74–1.41) +1.52 (1.25–1.84) +0.71 (0.43–1.18) +1.04 (0.76–1.43) +1.53 (1.27–1.85) +0.82 (0.50–1.34) +Open to new ideas +Disagree +319 (5.2) +8 (5.4) +91 (6.1) +6 (6.7) +Maybe +893 (14.5) +38 (25.5) +196 (13.2) +13 (14.6) +0.067 +0.879 +0.081 +1.87 (0.96–3.66) +0.98 (0.78–1.24) +2.05 (0.92–4.59) +2.07 (1.09–3.91) +0.90 (0.72–1.13) +1.86 (0.84–4.13) +Agree +4,944 (80.3) +103 (69.1) +1,198 (80.7) +70 (78.7) +0.237 +0.183 +0.147 +0.75 (0.47–1.21) +0.88 (0.73–1.06) +1.63 (0.84–3.17) +0.75 (0.47–1.18) +0.88 (0.73–1.06) +1.90 (0.99–3.65) +Enjoy sharing your thoughts +Disagree +361 (5.9) +17 (11.4) +96 (6.5) +15 (16.9) +Maybe +854 (13.9) +33 (22.1) +164 (11.0) +12 (13.5) +0.002 +0.158 +<0.001 +0.48 (0.30–0.76) +0.86 (0.69–1.06) +0.21 (0.12–0.35) +0.54 (0.35–0.85) +0.86 (0.70–1.07) +0.20 (0.12–0.34) +Agree +4,941 (80.3) +99 (66.4) +1,225 (82.5) +62 (69.7) +0.386 +0.632 +0.253 +0.83 (0.55–1.26) +1.05 (0.86–1.27) +1.45 (0.77–2.74) +0.71 (0.48–1.07) +1.12 (0.93–1.35) +1.23 (0.67–2.24) +Coping strategy +No. (%) +Adjusted p-value +Adjusted OR (95% CI) +Unadjusted OR (95% CI) +Coping ability +Poor +1,037 (16.8) +50 (33.6) +219 (14.7) +18 (20.2) +Good +5,119 (83.2) +99 (66.4) +1,266 (85.3) +71 (79.8) +0.163 +0.006 +0.472 +0.80 (0.59–1.10) +1.23 (1.06–1.42) +0.86 (0.58–1.29) +0.64 (0.48–0.86) +1.23 (1.07–1.42) +1.09 (0.74–1.61) +Do you prefer watching TV +Yes +2,698 (43.8) +93 (62.4) +449 (30.2) +59 (66.3) +No +3,458 (56.2) +56 (37.6) +1,036 (69.8) +30 (33.7) +0.037 +<0.001 +0.001 +0.64 (0.42–0.97) +1.38 (1.18–1.62) +0.43 (0.26–0.71) +0.68 (0.46–1.01) +1.38 (1.18–1.61) +0.41 (0.26–0.67) +(Continued) +Frontiers in Psychiatry | www.frontiersin.org +15 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +TABLE 5 | Continued +Combined Yoga +group (N = 6,156) +(Reference) +Only Asana (N = +149) +Only meditation (N += 1,485) +Only Pranayama (N += 89) +Do you prefer reading/writing +Yes +5,677 (92.2) +116 (77.9) +1,337 (90.0) +71 (79.8) +No +479 (7.8) +33 (22.1) +148 (10.0) +18 (20.2) +0.051 +<0.001 +0.959 +1.72 (1.00–2.95) +0.52 (0.39–0.70) +1.02 (0.52–2.01) +1.63 72 (1.00–2.95) +0.57 (0.43–0.76) +1.24 (0.66–2.30) +Do you prefer cooking +Yes +4,662 (75.7) +110 (73.8) +1,094 (73.7) +57 (64.0) +No +1,494 (24.3) +39 (26.2) +391 (26.3) +32 (36.0) +0.496 +0.061 +0.988 +0.84 (0.52–1.38) +0.84 (0.69–1.01) +1.00 (0.59–1.68) +0.73 (0.47–1.13) +0.80 (0.68–0.95) +1.15 (0.71–1.86) +Do you prefer exercise +Yes +5,739 (93.2) +134 (89.9) +919 (61.9) +74 (83.1) +No +417 (6.8) +15 (10.1) +566 (38.1) +15 (16.9) +0.008 +<0.001 +0.942 +0.40 (0.21–0.79) +3.96 (3.27–4.79) +1.03 (0.51–2.07) +0.41 (0.22–0.79) +4.18 (3.46–5.04) +0.92 (0.47–1.80) +Do you prefer Yoga Asana +Yes +5,965 (96.9) +135 (90.6) +744 (50.1) +74 (83.1) +No +191 (3.1) +14 (9.4) +741 (49.9) +15 (16.9) +0.242 +<0.001 +0.121 +0.64 (0.31–1.35) +24.31 (19.85–29.78) +1.84 (0.85–3.98) +0.79 (0.39–1.61) +24.78 (20.29–30.27) +1.92 (0.93–3.95) +Do you prefer meditation +Yes +5,984 (97.2) +50 (33.6) +1,433 (96.5) +51 (57.3) +No +172 (2.8) +99 (66.4) +52 (3.5) +38 (42.7) +<0.001 +<0.001 +<0.001 +58.60 (37.77–90.90) +0.23 (0.14–0.36) +19.01 (11.05–32.70) +62.43 (41.25–94.49) +0.21 (0.13–0.32) +19.15 (11.42–32.11) +Do you prefer religious activity +Yes +5,305 (86.2) +89 (59.7) +1,121 (75.5) +62 (69.7) +No +851 (13.8) +60 (40.3) +364 (24.5) +27 (30.3) +0.026 +0.009 +0.057 +1.66 (1.06–2.59) +1.28 (1.06–1.54) +1.69 (0.99–2.91) +1.74 (1.14–2.65) +1.25 (1.04–1.51) +1.39 (0.83–2.33) +Do you prefer Internet +Yes +4,247 (69.0) +131 (87.9) +806 (54.3) +68 (76.4) +No +1,909 (31.0) +18 (12.1) +679 (45.7) +21 (23.6) +0.039 +0.022 +0.994 +0.54 (0.31–0.97) +1.20 (1.03–1.41) +1.00 (0.56–1.78) +0.41 (0.24–0.71) +1.34 (1.15–1.56) +0.84 (0.49–1.45) +Sequential contrast was used for ordinal variables and reference level is mentioned in the table for nominal variables. +Frontiers in Psychiatry | www.frontiersin.org +16 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +teaching is based on the fundamentals of Yama (restraints) +and Niyama (observances) (30). Yama includes teachings of +non-violence, truthfulness, non-stealing, moderation, and non- +hoarding, whereas Niyama includes teachings of cleanliness, +contentment, self-discipline, self-study, and wellness. Yoga +practitioners routinely isolate themselves from the general +population to achieve higher spiritual goals (31). Thus, one +who follows the Yoga and Yogic lifestyle can easily maintain +cleanliness and social distancing without an agitated mind. +Therefore, Yoga practitioners can be hypothesized to quickly +adapt to lockdown rules without experiencing chronic anxiety +and stress. +The +present +study +extends +the +above +hypothesis +operationalized as an investigation carried out when the +world is gripped with fear and uncertainty due to an impending +pandemic. In this context, the present study has evaluated the +outcomes of physical and mental health, including lifestyle +and coping strategies of Yoga and non-Yoga groups, during +the lockdown imposed by COVID-19 pandemic. A CHAS +questionnaire was generated following the Delphi protocol and +was circulated among the Indian mass by snowball method as +Google Forms. Phone calls and special requests were sent to +different sections of the society including ∼200 universities, +Corporate +companies, +healthcare +institutions, +government +organizations, wellness centers, and their networks to acquire +data. The data were collected between May 9, 2020 and May 31, +2020; data were downloaded daily. +In the present survey, among the total respondents of 23,290, +42.2% (n = 9,840) were Yoga practitioners, which is much higher +than the previous report of 11.8% of a nationwide randomized +structured survey in 2017 (27). This may not indicate a true rise +in the number of yoga practitioners in the country as this was not +a randomly selected population. +The current study reports proportionately higher response +from males than females. Non-Yoga group has a higher +percentage of young participants than the Yoga group, which is a +limitation of the study. In both Yoga and non-Yoga groups, most +of the participants were employed or well-educated professionals. +Furthermore, the analysis of the data collected during this survey +revealed that both groups represented a similar proportion of +participants living with family; however, a small proportion of +participants were also reported to be living alone in both groups. +Thus, loneliness cannot be a leading attribute of anxiety, stress, +and fear in this study. Another feature of the participants who +responded to the survey was that a greater proportion of the +working and office going population was represented in the non- +Yoga. Working and attending office during the lockdown may be +considered as a reason for not practicing Yoga. +Emerging data have shown differences in the susceptibility +to COVID-19 symptoms based on age and co-morbidities (4). +Studies have shown the benefits of Yoga intervention in reducing +the risk and severity of diabetes and other co-morbidities +(24, 25). Such interventions may, therefore, be helpful for the +risk reduction of COVID-19. Our data show increased non- +Yoga group susceptibility to COVID-19 compared with those +belonging to the Yoga group; however, RT-PCR for COVID-19 +was not carried out to confirm this. Regardless, this calls for +new public health and cost-effective intervention strategies based +on a digital Yoga interface, compliant to Tele-Yoga regulations. +Recently, a breathing technique known as Liuzijue has been +reported to improve pulmonary function and quality of life +in discharged COVID-19 patients (32). However, it cannot +be neglected that the Yoga group is mainly constituted by +participants who are “not working” or “working from home,” +because of which they have a lower COVID-19 risk and are less +fearful about COVID-19. +Sleeping and eating habits in the Yoga group were more health +promotive. Furthermore, it also revealed that the dependence +on substances use, as resources to cope with anxiety and +stress, was lower in the Yoga group. Moreover, good physical +strength and endurance coupled with the absence of chronic +disease were also proportionately higher in the Yoga group, +suggesting better health outcomes corresponding to COVID- +19. Our study, however, did not estimate the non-Yoga exercise +groups consisting of sportsmen or other physical activities. +We +observed +that +the +non-Yoga +group +was +coping +with COVID-19 lockdown by relying on the Internet, TV, +reading/writing, cooking, and exercise, while the Yoga group +was more engaged in Asana, meditation, and religious/spiritual +activities besides using the Internet, reading/writing, cooking, +and exercise. The Yoga group maintained their routine +consistently, while the non-Yoga group could not sustain their +regular practices. +The comparisons between the two groups unanimously +showed that the non-Yoga group faced mental challenges. They +reported higher anxiety and fear associated with COVID-19, +including fear of getting infected with COVID-19, death, finance- +related stress, and spreading COVID-19 in addition to other +unknown causes. Instead, compared with the non-Yoga group, +the Yoga group was reportedly more goal-driven and methodical, +eliciting responses that showed a helping and caring attitude. The +latter group displayed more openness to new ideas and enjoyed +sharing their thoughts, being less insecure. Reports from China +also show similar psychological distress (8, 17, 33). +COVID-19–related stress creates panic and reduces quality +of life in patients as well as in healthcare workers (HCWs). +Hence, introducing Yoga in the healthcare system would be +beneficial for the patients, HCWs, and other service providers: +they may successfully cope with psychological stress (34–37). +Stress, anxiety, and depression among HCWs in COVID-19 +pandemic was reduced by practicing Sudarshan kriya (38). +Perceived stress in COVID-19 patients was also reduced by +multimedia psychoeducational intervention, which included +relaxation and mindfulness techniques (39). Not limited to +COVID-19, integrative medicine including modern medicine, +Yoga, mindfulness techniques, Ayurveda, and many more can +be helpful for managing health and quality of life, and have the +ability to reduce severity of disease. However, randomized trials +are required to develop integrative healthcare. +It has been shown that meditation can potentially decrease the +risk of acquiring cold and flu by improving physiological function +and quality of life (40). Yogic breathing techniques improve +respiratory and cardiac function, rendering it an effective tool +to combat COVID-19 (41). Yoga will help calm down the +Frontiers in Psychiatry | www.frontiersin.org +17 +June 2021 | Volume 12 | Article 613762 +Nagarathna et al. +Yogic Endurance During COVID-19 Pandemic +mind and enhance immunity (17–20). PTSD due to natural +disasters, epidemics, and wars has been shown to regress after +practicing Yoga (42). Its application in the current pandemic +using the digital module of Yoga and mindfulness may be helpful. +If administered to COVID-19 patients under supervision, it +may even reduce psychological stress (43). A few randomized +controlled trials are taken up in the present pandemic that +are investigating the efficacy of various breathing techniques +including Yogic breathing in COVID-19 (44–46). +It is pertinent to note that we had stratified the Yoga +group into a consolidated Yoga group, only Asana, only +Pranayama, and only meditation groups. Meditation seemed +to evoke beneficial outcomes than those practicing all, i.e., +Asana, Pranayamas, and meditation. However, a longitudinal +randomized trial is imperative to establish evidence. Our +observation that the younger population preferred Asanas +and Pranayama, while meditation was mainly preferred by +the elderly, can help deliver innovative yoga protocols that +make meditation more attractive to the young population and, +consequently, useful for mental hygiene if presented as integrated +yoga protocols (available at www.svyasa.edu.in). Our report +highlights that a large number of subjects practiced consolidated +Yoga (including Asanas, Pranayama, and meditation), proving +the acceptability of an integrated module for school and college +teachers. This could partly be due to the widespread popularity +of both the Common Yoga Protocol released by the Ministry +of AYUSH on the eve of International Day of Yoga, celebrated +on June 21, as well as the widely published efficacy of Diabetic +Yoga Protocol and COVID-19 Yoga Protocols released by the +S-VYASA University (47, 48). These protocols include Asana, +Pranayama, and meditation. +LIMITATIONS OF THE STUDY +The study is limited by the fact that the sampling does not +generate a study group that represents the general population as +it was collected through social media. Second, the duration and +regularity of Yoga practice before the lockdown was not assessed +in the Yoga group, which would have given details of practice +before lockdown. The same was assessed for lockdown period. +Third, a proportionately higher number of younger subjects +were found represented in the non-Yoga group; this might have +influenced the outcome in a few components of the scales like +the use of the Internet, physical strength, and others. Fourth, +the self-reported COVID-19 symptoms could not be verified +and RT-PCR for COVID-19 was not performed to establish +increased susceptibility of non-Yoga group because of the +lockdown restrictions. Fifth, a non-standard questionnaire was +used. Mental health was not evaluated by any neuropsychological +questionnaire such as the Perceived Stress Scale, but was based on +the responses of CHAS. +We also could not rule out the role of physical exercises +in +improving +mental +and +physical +health; +however, +outdoor +activities +were +restricted +due +to +the +lockdown. +Furthermore, +whether +the +restrictions +mentioned +earlier +provided the environment conducive for the practice of +Asanas, +Pranayamas, +and +meditation, +available +through +digital media, cannot be ascertained unless another validation +study is carried out. In addition, we did not explore means +to rule out repetitive form filling by the same individual +due to error or intention; however, there were no rewards +or +benefits +attached +to +completing +the +survey. +Because +the +survey +was +administered +online, +the +possibility +of +cognitive +bias +in +the +study +was +minimal; +however, +we +entirely +relied +on +the +answers +provided +online +without +verifying the IP address, consistent with similar reports +published elsewhere. +DATA AVAILABILITY STATEMENT +The raw data supporting the conclusions of this article will be +made available by the authors, upon eligible request. +ETHICS STATEMENT +The studies involving human participants were reviewed +and approved by Swami Vivekananda Yoga Anusandhana +Samsthana. Written informed consent for participation was not +required for this study in accordance with the national legislation +and the institutional requirements. +AUTHOR CONTRIBUTIONS +RN conceptualized the study, supervised data collection, +and involved in discussions during article preparation. AA +conceptualized the article. MR and MSS wrote and edited +the article and contributed in data presentation. MNKS +conceptualized the study. RK and JI performed the statistical +analyses. AS created the scale and administered it nationally. +HN envisioned the study, and inspired and guided the study +to its completion imparting quality assurance. RN, AA, and VS +critically reviewed and edited the article. All authors contributed +to the article and approved the submitted version. +ACKNOWLEDGMENTS +We acknowledge all the participants of the CHAS survey. This +study is part of a larger pan-India study. +REFERENCES +1. 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The effects of yoga compared to active and inactive controls on +physical function and health related quality of life in older adults- systematic +review and meta-analysis of randomised controlled trials. Int J Behav Nutr +Phys Act. (2019) 16:33. doi: 10.1186/s12966-019-0789-2 +30. Saraswati S, Saraswati SN. Four Chapters on Freedom: Commentary on the +Yoga Sutras of Patanjali. Munger: Yoga Publications Trust (2002). +31. Muktibodhananda S. Hatha Yoga Pradipika. 4th ed. Munger, Bihar: Yoga +Publications Trust (2012). p. 718. +32. Tang Y, Jiang J, Shen P, Li M, You H, Liu C, et al. Liuzijue is a promising +exercise option for rehabilitating discharged COVID-19 patients. Medicine. +(2021) 100:e24564. doi: 10.1097/MD.0000000000024564 +33. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide +survey of psychological distress among Chinese people in the COVID-19 +epidemic: implications and policy recommendations. Gen Psychiatr. (2020) +33:e100213. doi: 10.1136/gpsych-2020-100213 +34. 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Yoga and mindfulness as a tool for influencing affectivity, anxiety, mental +health, and stress among healthcare workers: results of a single-arm clinical +trial. J Clin Med. (2020) 9:1037. doi: 10.3390/jcm9041037 +38. Divya K, Bharathi S, Somya R, Darshan MH. Impact of a Yogic +breathing +technique +on +the +well-being +of +healthcare +professionals +during +the +COVID-19 +pandemic. +Glob +Adv +Health +Med. +(2021) +10:2164956120982956. doi: 10.1177/2164956120982956 +39. Shaygan M, Yazdani Z, Valibeygi A. The effect of online multimedia +psychoeducational +interventions +on +the +resilience +and +perceived +stress +of +hospitalized +patients +with +COVID-19: +a +pilot +cluster +randomized +parallel-controlled +trial. +BMC +Psychiatry. +(2021) +21:93. doi: 10.1186/s12888-021-03085-6 +40. Obasi CN, Brown R, Ewers T, Barlow S, Gassman M, Zgierska A, et al. +Advantage of meditation over exercise in reducing cold and flu illness is +related to improved function and quality of life. 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(2019) +13:2705–13. doi: 10.1016/j.dsx.2019.07.007 +Conflict of Interest: 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. +Copyright © 2021 Nagarathna, Anand, Rain, Srivastava, Sivapuram, Kulkarni, +Ilavarasu, Sharma, Singh 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 Psychiatry | www.frontiersin.org +20 +June 2021 | Volume 12 | Article 613762 diff --git a/subfolder_0/Yoga programme for type-2 diabetes prevention (YOGA-DP) among high-risk people in India a multicentre feasibility randomised controlled trial proto.txt b/subfolder_0/Yoga programme for type-2 diabetes prevention (YOGA-DP) among high-risk people in India a multicentre feasibility randomised controlled trial proto.txt new file mode 100644 index 0000000000000000000000000000000000000000..e8ab6351a1320b98642f72007eb56bec3393da04 --- /dev/null +++ b/subfolder_0/Yoga programme for type-2 diabetes prevention (YOGA-DP) among high-risk people in India a multicentre feasibility randomised controlled trial proto.txt @@ -0,0 +1,1172 @@ +1 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +Yoga programme for type-2 diabetes +prevention (YOGA-­ +DP) among +high risk people in India: a multicentre +feasibility randomised controlled +trial protocol +Kaushik Chattopadhyay  ‍ ‍ + ,1 Pallavi Mishra,2 Kavita Singh,2 Tess Harris  ‍ ‍ + ,3 +Mark Hamer  ‍ ‍ + ,4 Sheila Margaret Greenfield,5 Sarah Anne Lewis,1 +Nandi Krishnamurthy Manjunath,6 Rukamani Nair,7 Somnath Mukherjee,7 +David Ross Harper,8 Nikhil Tandon,9 Sanjay Kinra,10 Dorairaj Prabhakaran,2 On +behalf of YOGA-­ +DP Study Team +To cite: Chattopadhyay K, +Mishra P, Singh K, et al. Yoga +programme for type-2 diabetes +prevention (YOGA-­ +DP) among +high risk people in India: +a multicentre feasibility +randomised controlled +trial protocol. BMJ Open +2020;10:e036277. doi:10.1136/ +bmjopen-2019-036277 +► +►Prepublication history for +this paper is available online. +To view these files, please visit +the journal online (http://​ +dx.​ +doi.​ +org/​ +10.​ +1136/​ +bmjopen-​ +2019-​ +036277). +Received 08 December 2019 +Revised 01 May 2020 +Accepted 23 June 2020 +For numbered affiliations see +end of article. +Correspondence to +Dr Kaushik Chattopadhyay; +​ +kaushik.​ +chattopadhyay@​ +nottingham.​ +ac.​ +uk +Protocol +© Author(s) (or their +employer(s)) 2020. Re-­ +use +permitted under CC BY. +Published by BMJ. +ABSTRACT +Introduction  A huge population in India is at high risk of +type-2 diabetes (T2DM). Physical activity and a healthy diet +(healthy lifestyle) improve blood glucose levels in people +at high risk of T2DM. However, an unhealthy lifestyle is +common among Indians. Yoga covers physical activity and +a healthy diet and can help to prevent T2DM. The research +question to be addressed by the main randomised +controlled trial (RCT) is whether a Yoga programme for +T2DM prevention (YOGA-­ +DP) is effective in preventing +T2DM among high risk people in India as compared with +enhanced standard care. In this current study, we are +determining the feasibility of undertaking the main RCT. +Intervention  YOGA-­ +DP is a structured lifestyle education +and exercise programme. The exercise part is based on +Yoga and includes Shithilikarana Vyayama (loosening +exercises), Surya Namaskar (sun salutation exercises), +Asana (Yogic poses), Pranayama (breathing practices) and +Dhyana (meditation) and relaxation practices. +Methods and analysis  This is a multicentre, two-­ +arm, +parallel-­ +group, feasibility RCT with blinded outcome +assessment and integrated mixed-­ +methods process +evaluation. Eligible participants should be aged 18–74 +years, at high risk of T2DM (fasting plasma glucose +level 5.6–6.9 mmol/L) and safe to participate in physical +activities. At least 64 participants will be randomised +to intervention or control group with final follow-­ +up +at 6 months. Important parameters, needed to design +the main RCT, will be estimated, such as SD of the +outcome measure (fasting plasma glucose level at +6-­ +month follow-­ +up), recruitment, intervention adherence, +follow-­ +up, potential contamination and time needed to +conduct the study. Semistructured qualitative interviews +will be conducted with up to 20–30 participants, a +sample of those declining to participate, four YOGA-­ +DP +instructors and around eight study staff to explore their +perceptions and experiences of taking part in the study +and of the intervention, reasons behind non-­ +participation, +experiences of delivering the intervention and running the +study, respectively. +Ethics and dissemination  Ethics approval has been +obtained from the following Research Ethics Committees: +Faculty of Medicine and Health Sciences, University of +Nottingham (UK); Centre for Chronic Disease Control +(CCDC, India); Bapu Nature Cure Hospital and Yogashram +(BNCHY, India) and Swami Vivekananda Yoga Anusandhana +Samsthana (S-­ +VYASA, India). The results will be widely +disseminated among key stakeholders through various +avenues. +Trial registration number  CTRI/2019/05/018893. +INTRODUCTION +India has the world’s second-­ +largest type-2 +diabetes (T2DM) epidemic, a disorder with +significant health, social and economic +consequences.1 More than 77 million Indians +are in the high risk of T2DM category, with +higher blood sugar levels than normal, but +lower than the established threshold for +Strengths and limitations of this study +► +►We are determining the feasibility of undertaking the +main randomised controlled trial (RCT), and import- +ant parameters, needed to design the main RCT, will +be estimated. +► +►This is a multicentre, two-­ +arm, parallel-­ +group, fea- +sibility RCT with blinded outcome assessment and +integrated mixed-­ +methods process evaluation. +► +►The study is registered with the Clinical Trials +Registry-­ +India, a part of the WHO Registry Network. +► +►Being a feasibility RCT, it is not adequately powered +to detect a difference in outcomes between the two +study arms. +► +►However, appropriate regression methods will be +used to get initial estimates of effects with CIs to +guide the design of the main RCT. + on September 15, 2020 by guest. Protected by copyright. +http://bmjopen.bmj.com/ +BMJ Open: first published as 10.1136/bmjopen-2019-036277 on 6 September 2020. Downloaded from +2 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +T2DM itself.2 They are more likely to develop T2DM +and its complications than people with normal blood +glucose levels.3 Physical inactivity and an unhealthy diet +are important risk factors of T2DM.3 Screening of people +at high risk of T2DM, followed by an effective lifestyle +intervention (ie, physical activity and a healthy diet) is a +cost-­ +effective strategy.3 It improves blood glucose levels in +people at high risk of T2DM and has other health bene- +fits.4 5 However, physical activity levels are lower among +Indians.6 Similarly, consumption of an unhealthy diet is +high among Indians.7 8 +Yoga, an ancient Indian mind-­ +body discipline, covers +not only physical activity, but also a healthy diet.9 There +are many different styles of Yoga, focusing on the same +core issue, that is, a healthy lifestyle. No style is necessarily +better or more authentic than any other.10 The accept- +ability of Yoga is usually high among Indians because it +fits their health beliefs and culture.11 12 Generally, Yoga +uses a gentle approach, is easy to learn and safe, requires +a low to moderate level of guidance, is inexpensive to +maintain and can be practised indoors and outdoors.11 +It can be practised by older people or those with a wide +range of comorbidities—it can help with arthritis and +can prevent falls.10 11 Some of the Yogic practices are of +low-­ +intensity (<3.5 kcal/min) and some are of moderate-­ +intensity (3.5–7.0 kcal/min).10 13 For example, the Surya +Namaskar component of Yoga (sun salutation exercises) +burns about 3.8–6.7 kcal/min.14 15 Yoga is also consid- +ered as a muscle-­ +strengthening activity.10 Thus, it can +contribute to the aim of routine lifestyle advice to prevent +T2DM among high risk individuals. +The beneficial effects of Yoga practice on T2DM-­ +related risk profiles appear to occur via two major path- +ways. First, by reducing the activation and reactivity of the +sympathoadrenal system and the hypothalamic-­ +pituitary-­ +adrenal axis, and promoting feelings of well-­ +being, it may +alleviate the effects of stress and foster multiple positive +downstream effects on neuroendocrine status, metabolic +function and related systemic inflammatory responses. +Second, by directly stimulating the vagus nerve, it may +enhance parasympathetic activity and lead to positive +changes in cardiovagal function, mood, energy state and +in related neuroendocrine, metabolic and inflammatory +responses. Furthermore, Yoga may lead to weight loss, +which itself lowers the risk of T2DM.16 +Systematic reviews of clinical trials suggest beneficial +effects of Yoga on T2DM-­ +related outcomes in T2DM (as +adjuvant therapy) and in metabolic syndrome.17–20 One +such systematic review of 44 randomised controlled trials +(RCTs) analysed data from T2DM, metabolic syndrome +and healthy participants (n=3168).17 Relative to usual +care or no intervention, Yoga improved blood glucose +levels (mean difference=−0.45%; 95% CI −0.87 to −0.02). +No major safety issues were reported. However, most of +the included studies were short-­ +term (≤3 months) and +were often associated with considerable methodolog- +ical limitations, such as small sample sizes in treatment +groups, resulting in lack of statistical power for outcome +assessment, and poor concealment of treatment alloca- +tion in outcome assessment, leading to potential analysis +bias. +In addition, some of the relevant previous studies have +not described the intervention in detail, making it diffi- +cult to replicate successful interventions.17–20 Most studies +have not reported the intervention development process. +It is hard to know whether these interventions were care- +fully thought out (eg, their safety and acceptability) and +comprehensive in their development. Thus, it is difficult +to select (and replicate) one successful intervention over +another. A further selection barrier is their heterogeneous +contents, which needed to be summarised for utilisation +in T2DM prevention. Therefore, we addressed these +issues by systematically developing a Yoga programme for +T2DM prevention (YOGA-­ +DP) among high risk people in +India, which will be published elsewhere. Briefly, this iter- +ative process included five steps: (1) a systematic review +of the literature to generate a list of Yogic practices that +improves blood glucose levels among adults at high risk of +or with T2DM, (2) validation of identified Yogic practices +by Yoga experts, (3) development of the intervention, (4) +consultation with a range of relevant experts about the +intervention and (5) pretest the intervention among Yoga +practitioners and lay people in India. +Health interventions should be informed by and +compatible with the sociocultural expectations of people +and their health beliefs.21 Yoga is such an intervention in +India. The Indian government is committed to and has +prioritised the prevention and management of chronic +diseases like T2DM through traditional Indian therapies +like Yoga. The Ministry of AYUSH is dedicated exclusively +towards traditional Indian therapies.22 There is, therefore, +a need for a definitive, robustly designed study to assess +the utility of Yoga in T2DM prevention among high risk +people in India. The principal research question to be +addressed by the main RCT is whether YOGA-­ +DP is effec- +tive in preventing T2DM among high risk people in India +as compared with enhanced standard care. The primary +outcome of the main RCT will be the difference in mean +fasting plasma glucose level between the two treatment +arms. We intend to do long-­ +term (≥1 year) follow-­ +ups in +the main RCT. The chances of successful completion of +a costly T2DM prevention RCT will improve if the feasi- +bility of its key elements is checked before it starts.23 24 +Important parameters, needed to design the main RCT, +will be estimated.23 Thus, in this current study, we are +determining the feasibility of undertaking the main RCT. +METHODS AND ANALYSIS +Study design +This is a multicentre, two-­ +arm, parallel-­ +group, feasibility +RCT (see figure 1) with blinded outcome assessment and +integrated mixed-­ +methods process evaluation. +Study setting +The study is conducted at two Yoga centres in India— +one each in the northern part of India (Bapu Nature + on September 15, 2020 by guest. Protected by copyright. +http://bmjopen.bmj.com/ +BMJ Open: first published as 10.1136/bmjopen-2019-036277 on 6 September 2020. Downloaded from +3 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +Cure Hospital and Yogashram (BNCHY, New Delhi)) +and southern part of India (Swami Vivekananda Yoga +Anusandhana Samsthana (S-­ +VYASA, Bengaluru)). People +from a range of socioeconomic backgrounds access +the services provided by these two research-­ +active Yoga +centres. Three languages (English, Hindi and Kannada) +are used to conduct the study. +Sample size estimation +Randomised controlled trial +At least 64 participants (32/group) will be adequate to +precisely estimate the SD of the outcome measure (fasting +plasma glucose level at 6-­ +month follow-­ +up). This is calcu- +lated in relation to the desired level of confidence (95%) +for the SD, the chosen power (80%) and significance +level (5%, two-­ +tailed) of the analysis in the main RCT and +the expected loss to follow-­ +up (20% at 6 months) in the +current study.25 26 +Qualitative evaluation +► +►Participants: interviews will be conducted with +up to 20–30 participants. Until data saturation is +achieved, purposive sampling will be used to ensure +the representation of diversity within the RCT +population.27 +► +►Those who decline to participate in the study: a +sample of those who agree to be interviewed about +their reasons for non-­ +participation, around 10–15, +but will continue until saturation is reached.27 +► +►Four YOGA-­ +DP instructors and around eight study +staff (at the two sites). +Screening and recruitment strategies +A multipronged approach is used to identify potential +participants at both sites: +► +►Advertisement through posters and pamphlets +(placed/distributed at various locations including +these Yoga centres, communities, religious places, +parks and health clinics). +► +►Screening camps at various locations (including these +Yoga centres, communities and religious places) and +times. +► +►Door to door visits in various communities and at +various times. +After potential participants have been given the partic- +ipant information sheet, a description of the study and +any questions have been answered, people interested +in the study are requested to provide written informed +consent. Those providing written informed consent are +assessed against the study eligibility criteria. Their fasting +blood glucose level is determined by finger-­ +prick using +a glucometer. At these two sites, two glucometer brands +are used for this purpose: HemoCue Glucose 201+ System +and Accu-­ +Chek Active. Those potentially at high risk of +Figure 1  Randomised controlled trial design. YOGA-­ +DP +, Yoga programme for T2DM prevention. + on September 15, 2020 by guest. Protected by copyright. +http://bmjopen.bmj.com/ +BMJ Open: first published as 10.1136/bmjopen-2019-036277 on 6 September 2020. Downloaded from +4 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +T2DM (ie, fasting blood glucose level 5.6–6.9 mmol/L +(ie, 100–125 mg/dL))28 are invited to these Yoga centres +for a confirmatory venous blood test, using a standard- +ised method (see table 1) and after taking further written +informed consent. They are re-­ +assessed against the eligi- +bility criteria for the study. +Eligibility criteria +Inclusion criteria +Participants should be: +► +►Aged 18–74 years. +► +►At high risk of T2DM. +► +►Safe to participate in physical activities (assessed +using the Physical Activity Readiness Questionnaire +(PAR-­ +Q)/clinician).29 +► +►Willing and able to attend the intervention/control +sessions on their own. +► +►Able to provide written informed consent. +Exclusion criteria +► +►Pregnant women. +► +►Those with glycated haemoglobin ≥6.5% (ie, +≥48 mmol/mol; with T2DM).28 +Table 1  Data collection +Face-­ +to-­ +face assessments* +Assessment details +Screening and +recruitment +Baseline +Final at +6  +months +Eligibility assessment +   +√ +Socio-­ +demographics +   +√ +Medical and surgical history +   +√ +Family history of diabetes +   +   +√ +   +Current medications +   +   +√ +√ +Biochemical parameters† +   +   +   +   +   +Blood glucose +   +   +   +   +   +Fasting plasma glucose +Glucose oxidase-­ +peroxidase method +   +√ +√ +   +Glycated haemoglobin +High-­ +performance liquid chromatography method +   +√ +√ +   +Lipid profile +   +   +   +   +   +Total cholesterol +Cholesterol oxidase method +   +√ +√ +   +High-­ +density lipoprotein +Direct clearance method +   +√ +√ +   +Low-­ +density lipoprotein +Direct clearance method +   +√ +√ +   +Very low-­ +density lipoprotein +Calculated value +   +√ +√ +   +Triglyceride +Lipase/Glycerol-3-­ +phosphate oxidase-­ +phenol+aminophenazone +no correction method +   +√ +√ +Physiological parameters +   +   +   +   +   +Blood pressure +Omron HEM-7201 +   +√ +√ +   +Heart rate +Omron HEM-7201 +   +√ +√ +Anthropometric parameters +   +   +   +   +   +Waist circumference +Seca 201 (measuring tape) +   +√ +√ +   +Weight +Omron HN-286 (weighing scale) +   +√ +√ +   +Height +Seca 206 (stadiometer) +   +√ +√ +   +Body mass index +Calculated value +   +√ +√ +Diet +Time-­ +recall: past 1  +week +√ +√ +Physical activity +International Physical Activity Questionnaire—short; time-­ +recall: +past 1  +week33 +   +√ +√ +Tobacco usage +   +   +√ +√ +Alcohol consumption +   +   +√ +√ +Health-­ +related quality-­ +of-­ +life +EuroQol-­ +5D-­ +5L; time-­ +recall: at the time of questionnaire +completion34 +√ +√ +Depression, anxiety and stress +Depression, Anxiety and Stress Scale; time recall: past 1  +week35 +   +√ +√ +Yoga practice +Time-­ +recall: past 1  +week +   +√ +√ +Self-­ +efficacy (to assess confidence in +participant’s ability to practise Yoga) +0–100 rating scale; time-­ +recall: at the time of questionnaire +completion36 +   +√ +√ +*A standard operating procedure has been developed for this purpose. +†Blood samples are analysed at the International Organization for Standardization or Christian Medical College External Quality Assurance Scheme (Vellore, India) +accredited laboratories. + on September 15, 2020 by guest. Protected by copyright. +http://bmjopen.bmj.com/ +BMJ Open: first published as 10.1136/bmjopen-2019-036277 on 6 September 2020. Downloaded from +5 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +► +►Those with any serious or uncontrolled medical +condition (eg, cancer). +► +►Those who regularly practice Yoga, that is, ≥150 min/ +week. +► +►Those currently receiving (or with plans to +receive during the study period) any related +non-­ +pharmaceutical/pharmaceutical +research +intervention. +Randomisation +Eligible participants are randomised to intervention or +control group according to a computer-­ +generated rando- +misation schedule (1:1, block randomisation, stratified by +sex and site), done centrally by an independent statisti- +cian at the Centre for Chronic Disease Control (CCDC), +New Delhi, India. This is accessed by calling a telephone +line. The exception to this rule is individuals recruited +from the same household or if they are close relatives +or friends, who are randomised to the same group to +avoid contamination. After randomisation, key baseline +data are collected. Participants and intervention/control +providers cannot be ‘blinded’ to group allocation, but the +outcome assessors are ‘blind’. +Interventions +Intervention (YOGA-DP) +YOGA-­ +DP is a structured lifestyle education and exer- +cise programme, provided over a period of 24 weeks +(see table  2). The exercise part is based on Yoga and +includes Shithilikarana Vyayama (loosening exercises), +Surya Namaskar (sun salutation exercises), Asana (Yogic +poses), Pranayama (breathing practices) and Dhyana +(meditation) and relaxation practices. Online supple- +mentary table S1 shows the structure and content of the +Yoga sessions. The programme is delivered by YOGA-­ +DP +instructors—qualified and experienced Yoga teachers +with formal training provided on the intervention. +Female instructors are available for female participants. +Group Yoga sessions are run locally (such as at these Yoga +centres and community centres) at different time points +of the day (with evening and weekend sessions), and +participants can join as per their convenience. We are +reimbursing some of their local travel costs for attending +the sessions. A family member or someone close to the +participant is invited to join them in the sessions. Once +participants complete the programme, they are strongly +encouraged to maintain a healthy lifestyle in the long-­ +term, using the intervention booklet and a video. +Intervention fidelity will be ensured through regular +training of YOGA-­ +DP instructors, based on the manual +developed for them. Also, sessions will be regularly +observed and assessed with a checklist to ensure that +they are being delivered as per the manual. To improve +performance, structured and instructive feedback will be +provided. +Control (enhanced standard care) +Currently, no standard lifestyle intervention is available +in India for people at high risk of T2DM. Control group +participants will receive a leaflet on routine lifestyle +advice to prevent T2DM among high risk individuals. +Table 2  Structure of YOGA-­ +DP +Week +Group Yoga sessions delivered +by YOGA-­ +DP instructors +Self-­ +practice of Yoga at home using +YOGA-­ +DP booklet and a video +Extra features +1–4 +(month 1) +At least two sessions of 45  +min +per week. An attendance register +is kept. +– +At the first session, the instructor is giving +participants part one of our programme +booklet. This gives them information +about being at high risk of T2DM and +how to prevent T2DM (ie, by being more +physically active, keeping a healthy weight, +eating less fat (especially saturated fat) +and eating more fibre). +5–12 +(month 2–3) +At least two sessions of 75  +min +per week. An attendance register +is kept. +– +At the last session, the instructor is giving +participants part two of our programme +booklet and a video. These give them +information on Yoga practice to prevent +T2DM. Also, a Yoga diary and non-­ +slippery +Yoga mat are provided for self-­ +practice of +Yoga at home. +13–24 +(month 4–6) +At least one session of 75  +min +every 4  +weeks. An attendance +register is kept. +At least two sessions of 75  +min per +week. Participants are given the Yoga +diary to record their Yoga practice +(types and minutes). +The instructor is phoning participants +every week to offer support and help and +to troubleshoot any problems. +25+ +(month 7+) +– +At least two sessions of 75  +min per +week. Participants are given the Yoga +diary to record their Yoga practice +(types and minutes). +– +T2DM, type-2 diabetes; YOGA-­ +DP +, Yoga programme for T2DM prevention. + on September 15, 2020 by guest. Protected by copyright. +http://bmjopen.bmj.com/ +BMJ Open: first published as 10.1136/bmjopen-2019-036277 on 6 September 2020. Downloaded from +6 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +This is delivered by a different team member (ie, not by +the YOGA-­ +DP instructor) to avoid contamination. This +provision would ensure that control group participants +feel that there are benefits to participation (hence, lower +attrition). Contamination could occur in the control +group if they start practising Yoga during follow-­ +up. +However, the specific intervention (YOGA-­ +DP) is not +available externally, even if Yoga classes are. +Study parameters and data collection +Randomised controlled trial +► +►SD of the outcome measure (mentioned before), +which will be used to calculate the main RCT sample +size. +► +►Recruitment—number of people approached to +participate, written informed consent given, screened +for eligibility, found eligible and randomised. +► +►Intervention +adherence—number +of +sessions +attended out of the 27 sessions, number who self-­ +practice at home and frequency and duration of self-­ +practice at home. +► +►Follow-­ +up—number +of +randomised +participants +followed-­ +up at 6 months. +► +►Potential contamination—number of control group +participants participating in any Yoga class during +6-­ +month follow-­ +up (self-­ +reported). +► +►Time needed to conduct the study (eg, to recruit +participants). +► +►See table 1. +Qualitative evaluation +► +►Participants: interviews will be conducted with them to +explore their perceptions and experiences of taking +part in the study (intervention and control group +participants who complete or do not complete the +study) and of the intervention (intervention group +participants who complete or do not complete the +intervention). +► +►Those who decline to participate in the study: they +are requested to complete a questionnaire (including +reasons behind non-­ +participation), and a sample of +those who agree to be interviewed to further explore +these reasons. +► +►YOGA-­ +DP instructors and study staff (at the two sites): +interviews will be conducted with them to explore +their experiences of delivering the intervention and +running the study, respectively. +Predeveloped interview guides will be used by a quali- +tative researcher to conduct these semistructured inter- +views. The interviews will be conducted in interviewees’ +preferred language and with the help of an interpreter +if needed. With consent, these will be noted and digitally +recorded. +Data analyses +Randomised controlled trial +Baseline characteristics and important parameters such as +follow-­ +up will be summarised and compared between the +two study arms using numbers and percentages for cate- +gorical data and summary measures of mean or median +and spread for continuous data. Being a feasibility RCT, +it is not adequately powered to detect a difference in +outcomes between the two study arms. However, appro- +priate regression methods will be used to get initial esti- +mates of effects with CIs to guide the design of the main +RCT. All primary analyses will be based on the intention-­ +to-­ +treat principle and will be unadjusted. Subsequently, +the adjustment will be done for the baseline data and site. +No interim analysis is planned. +Qualitative evaluation +All the semistructured interviews will be transcribed +(verbatim), translated (if necessary), anonymised and +checked for accuracy. An interpretive analysis will be +conducted using thematic analysis, using NVivo soft- +ware. Transcripts will be read and re-­ +read by two qual- +itative researchers. These researchers will develop +the initial codes and will apply initially to a small +number of transcripts, enabling further iteration of the +thematic index. We will use illustrative non-­ +attributable +quotations.27 +Patient and public involvement +The research topic was identified and discussed with a +Public Engagement Coordinator and among a patient +and public involvement group. They acknowledged the +importance of this research topic and the issues identi- +fied during these discussions were taken into consider- +ation while designing the study. They are involved in the +discussions and are giving feedback on different aspects +of the study. +ETHICS AND DISSEMINATION +Ethics and other related issues +Ethics approval has been obtained from the following +Research Ethics Committees: Faculty of Medicine +and Health Sciences, University of Nottingham, UK +(14-1805); +CCDC, +India +(CCDC_IEC_09_2018); +BNCHY, India (BNCHY/IEC/2/2019) and S-­ +VYASA, +India (RES/IEC-­ +SVYASA/138/2018). Written informed +consent is obtained from all the participants. We have +also received approval from the Health Ministry’s +Screening Committee (HMSC, India). An independent +Trial Steering Committee is monitoring and providing +overall supervision for the study. +Serious adverse events +Like other physical activities, Yoga is known to be safe.10 +Information will be collected on serious adverse events +(including death) occurring in participants that may +be attributed to the interventions. Based on medical +and scientific judgement, an independent clinician +will determine the relationship of any event to the +interventions. + on September 15, 2020 by guest. Protected by copyright. +http://bmjopen.bmj.com/ +BMJ Open: first published as 10.1136/bmjopen-2019-036277 on 6 September 2020. Downloaded from +7 +Chattopadhyay K, et al. BMJ Open 2020;10:e036277. doi:10.1136/bmjopen-2019-036277 +Open access +Participant withdrawal +Participants will be withdrawn from the study either at +their request or at the discretion of the site investigator +for example, if diagnosed with diabetes (will receive +the standard treatment) or if no longer safe to partici- +pate in physical activities (determined by PAR-­ +Q/clini- +cian).29 They will be made aware that this will not affect +their future care. Also, they will be made aware (via the +participant information sheet and consent form) that +should they withdraw, the data collected to date will not +be erased and may still be used in the final analyses. +Dissemination +The results will be reported according to the relevant +extension of the Consolidated Standards of Reporting +Trials statement, that is, for randomised pilot and feasi- +bility trials.30 The results will be widely disseminated +among key stakeholders through various avenues, such as +through dissemination meetings and informal discussions +with them, presentations at national and international +conferences, publications in peer-­ +reviewed open-­ +access +journals and press offices and websites of host institutions. +DISCUSSION +We are now conducting a multicentre feasibility RCT in +India to determine the feasibility of undertaking the main +RCT. The study started in May 2019, and we are aiming to +finish the study by the end of October 2020. If the feasi- +bility is promising (such as recruitment, randomisation, +intervention adherence and follow-­ +up), then the param- +eters estimated will be used to design the main RCT. +Decisions over whether to modify the protocol will be +informed by the process evaluation, including the qual- +itative data. +If the intervention is found to be effective in the main +RCT, it will be a low-­ +cost, acceptable and local solu- +tion to prevent T2DM among high risk people in India +and to become healthier overall. The future clinical, +personal and economic burden of T2DM on patients, +their families, the health system and the economy will +be prevented. The benefits of preventing T2DM may +extend to the prevention of its complications. People +will be provided with more evidence-­ +based choices +for preventing T2DM. The programme will simulta- +neously empower them to manage their health. Apart +from India and neighbouring South Asian countries, +Yoga is popular or becoming popular in many other +countries.31 32 Given that T2DM prevention is a global +concern and costs are a concern everywhere, a low-­ +cost +Yoga-­ +based T2DM prevention option will be of interest +in other countries, particularly in other South Asian +countries and in countries with South Asian ethnic +minorities. +Author affiliations +1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, +UK +2Centre for Chronic Disease Control, Delhi, India +3Population Health Research Institute, St George’s University of London, London, UK +4Institute Sport Exercise and Health, Division of Surgery and Interventional Science, +University College London, London, UK +5Institute of Applied Health Research, University of Birmingham, Birmingham, UK +6Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India +7Bapu Nature Cure Hospital and Yogashram, Delhi, India +8Harper Public Health Consulting Limited, London, UK +9All India Institute of Medical Sciences, Delhi, India +10London School of Hygiene And Tropical Medicine, London, UK +Acknowledgements  The authors would like to extend thanks to all who have +participated in this study and the TSC members. +Contributors  KC conceptualised and designed the study with the help of TH, MH, +SMG, SAL, NKM, DRH, NT, SK and DP. KC wrote the first draft of the manuscript. +PM, KS, TH, MH, SMG, SAL, NKM, RN, SM, DRH, NT, SK and DP contributed +significantly to the revision of the manuscript. All authors read and approved the +final manuscript. +Funding  The study is funded by the UK’s DFID/MRC/NIHR/Wellcome Trust Joint +Global Health Trials (MR/R018278/1). The funding agencies have no role in +designing the study or in writing the manuscript. +Competing interests  None declared. +Patient and public involvement  Patients and/or the public were involved in the +design, or conduct, or reporting, or dissemination plans of this research. Refer to +the Methods section for further details. +Patient consent for publication  Not required. +Provenance and peer review  Not commissioned; externally peer reviewed. +Open access  This is an open access article distributed in accordance with the +Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits +others to copy, redistribute, remix, transform and build upon this work for any +purpose, provided the original work is properly cited, a link to the licence is given, +and indication of whether changes were made. See: https://​ +creativecommons.​ +org/​ +licenses/​ +by/​ +4.​ +0/. +ORCID iDs +Kaushik Chattopadhyay http://​ +orcid.​ +org/​ +0000-​ +0002-​ +3235-​ +8168 +Tess Harris http://​ +orcid.​ +org/​ +0000-​ +0002-​ +8671-​ +1553 +Mark Hamer http://​ +orcid.​ +org/​ +0000-​ +0002-​ +8726-​ +7992 +REFERENCES + 1 International Diabetes Federation (IDF). IDF diabetes atlas. 9th Ed. +Brussels: IDF +, 2019. + 2 Anjana RM, Pradeepa R, Deepa M, et al. 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Downloaded from diff --git a/subfolder_0/Yoga therapy for promoting emotional sensitivity in university students_unlocked.txt b/subfolder_0/Yoga therapy for promoting emotional sensitivity in university students_unlocked.txt new file mode 100644 index 0000000000000000000000000000000000000000..0a00a4665a406aeb41ebfa6cd1ccebfd71722b61 --- /dev/null +++ b/subfolder_0/Yoga therapy for promoting emotional sensitivity in university students_unlocked.txt @@ -0,0 +1,325 @@ +69 +Journal of Education and Health Promotion | Vol. 3 | April 2014 +Yoga therapy for promoting emotional sensitivity in +University students +Tikhe Sham Ganpat, Sasmita Dash1, Nagendra Hongasandra Ramarao +Swami Vivekananda Yoga Anusandhana Samsthana, 1(S‑VYASA) University, Bangalore, India +ABSTRACT +Background: Students need emotional intelligence (EI) for their better academic excellence. +There are three important psychological dimensions of EI: Emotional sensitivity (ES), emotional +maturity (EM) and emotional competency (EC), which motivate students to recognize truthfully, +interpret honestly and handle tactfully the dynamics of their behavioral pattern. Objective: The +study was designed to assess ES in the students undergoing yoga therapy program in the +form of yoga instructor’s course (YIC) module. Materials and Methods: One hundred and +eighty four YIC students with 25.77 ± 4.85 years of mean age participated in this study of +21 days duration (a single group pre‑post design). The ES data was collected before (pre) +and after (post) YIC module using Emotional Quotient test developed by Dr Dalip Singh +and Dr N K Chadha. Statistical Analysis: Means, standard deviations, Kolmogorov‑Smirnov +test, and Wilcoxon signed rank test were used for analyzing the data with the help of SPSS +16. Results: The data analysis showed 3.63% significant increase  (P  <  0.01) in ES. +Conclusion: The present study suggests that YIC module can result in improvement of +ES among university students, thus paving the way for their academic success. Additional +well‑designed studies are needed before a strong recommendation can be made. +Key words: Academic success, emotional sensitivity, yoga instructor’s course +maturity (EM) and emotional competency (EC) are the three +important psychological dimensions of EI, which motivate +student to recognize truthfully, interpret honestly and handle +tactfully the dynamics of their behavioral pattern.[4] Many +corporations and institutions have examined and to some extent +used EI as a measure of these concepts and domains, which some +speculate are better predictors of educational and occupational +performance.[5,6] In the psychological sense, ES means the +characteristic of being peculiarly sensitive and judges the +threshold for various types of stimulations, evoking sensations, +feelings and emotions. The students may seek to evolve the ES +characteristics in their personality: understanding threshold of +emotional arousal, empathy, improving inter‑personal relations +and communicability of emotions.[4] Recent study on yoga based +self management of excessive tension  (SMET) in managers +published in prestigious Industrial Psychiatry Journal suggest +that yoga is associated with improvement in EI combined with +ES, EM and EC, thus leading to mental health promotion in +managers indicating yoga as a powerful tool for their effective +stress management.[7] However, the changes in ES that +characterize the efficacy of yoga instructor’s course (YIC) +Original Article +Access this article online +Quick Response Code: +Website: +www.jehp.net +DOI: +10.4103/2277-9531.131933 +INTRODUCTION +T +oday’s students are more concerned with the technical +aspects of various professions and more emotionally immature +compared to previous generations of learners.[1,2] Emotional +intelligence (EI) in students most commonly involve +concepts of self‑awareness, empathy, emotional expression +and regulation.[3] Emotional sensitivity (ES), emotional +Copyright: © 2014 Ganpat TS. 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. +Address for correspondence: Dr. Tikhe Sham Ganpat, +Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University, +Bangalore, India. +E‑mail: rudranath29@gmail.com +This article may be cited as: Ganpat TS, Dash S, Ramarao NH. Yoga therapy for promoting emotional sensitivity in University students. J Edu Health +Promot 2014;3:45. +>'RZQORDGHG IUHH IURP KWWSZZZMHKSQHW RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Ganpat, et al.: Yoga for emotional sensitivity in university students +Journal of Education and Health Promotion | Vol. 3 | April 2014 +70 +module based on integrated approach of yoga therapy (IAYT) +for students have not been reported adequately. Hence, the +present study was designed to assess the efficacy of YIC module +on ES in university students. +Objective +The objective was to assess ES in university students +undergoing YIC module. +MATERIALS AND METHODS +Subjects +One hundred and eighty four YIC students with +25.77 ± 4.85 years of mean age participated in this study. +Inclusion criteria +Age between 18 and 37 years (males and females), physically +and mentally fit to undergo training of YIC module and +understand giving responses to psychological testing. +Exclusion criteria +Students with serious medical conditions, taking medication +and using any other wellness strategy, psychiatric drugs, +alcohol, or tobacco in any form. +Source +Subjects for the present study were selected from Swami +Vivekananda Yoga Anusandhana Samsthana  (S‑VYASA) +University, Bangalore undergoing YIC module. +Informed consent +An informed consent was obtained from all the participants. +The institutional review board approval +The study was approved by the IRB of S‑VYASA University, +Bangalore. +Design +A single group pre‑post study +Pre ⇒ +21 Days YIC module ⇒ Post. +Assessments +Emotional quotient (EQ) test (available online free of cost +at www.eqindia.com/EQ TEST +.PDF) developed by Dr Dalip +Singh and Dr. N K Chadha was used in this study.[4,7,8] The +test has 22 real‑life situations experienced by individuals in +their day‑to‑day life based on 5‑point scale rating and then +finally obtained scores that was converted into percentile +score. This test is useful to measure emotional dimensions +like EC, EM and ES. This test has been standardized for +professional managers, businessmen, bureaucrats, artists, and +graduate students and adolescent population. This EQ test +has a test‑retest and split‑half reliability of 0.94 and 0.89, +respectively and validity of 0.89. +Intervention +All the subjects participated in the YIC module Table 1 which +was based on IAYT to bring positive health.[9] The concept of +IAYT is based on ancient yoga texts.[10] It consists of Kriya +(yogic purificatory processes), Sukshma Vyayama (loosening +and stretching practices), Asanas (physical postures), +Pranayama (breathing techniques), Krida Yoga (yogic games), +Bhajan (devotional sessions), meditation and a healthy yogic +diet to bring about a total personality transformation at +physical, mental, emotional, social and spiritual levels.[11] +Data collection +The ES data was collected before and after the 21 days of +YIC module. +Data scoring +It was based on interpretation of ES scores in +percentile [Table 2]. +Data analysis +Data analysis was carried out using the version 16.0 of the +Statistical Package for Social Sciences (SPSS) software. The +Kolmogorov‑Smirnov test showed that the data was not +normally distributed. Wilcoxon signed rank test was used to +compare means of the data. +Table 1: Schedule of the yoga instructor’s course +module +Time +Activity +Time +Activity +05.00 AM +Ablution +03.00 PM +Lecture session +2 +05.30 AM +Prayer (Prathasmaran) +04.00 PM +Cyclic +Meditation +06.00 AM +Asana/special yoga +technique +05.00 PM +Tuning to +nature +07.15 AM +Friendship meet +(Maitri Milan)‑Gita +Sloka chanting and +discourse (Satsanga) +06.00 PM +Devotional +session (Bhajan) +08.00 AM +Breakfast +06.45 PM +Lecture session +3/Trataka +09.30 AM +Karma yoga +07.30 PM +Dinner +10.30 AM +Lecture Session 1 +08.30 PM +Happy +assembly (yoga +game session)/ +cultural +program +11.30 AM +Milk or Ayurvedic +tea (Malt) +09.15 PM +Group +discussion/self +practice +12.05 PM +Special yoga +techniques +10.00 PM +Lights off +01.00 PM +Lunch and rest +Table 2: Interpretation of emotional sensitivity scores +Score +Percentile +Interpretations +91‑100 +P‑90 +Extremely high ES +81‑90 +P‑75 +High ES +56‑80 +P‑50 +Moderate ES +31‑55 +P‑40 +Low ES +30 and below +P‑20 +Try the test some other day +ES = Emotional sensitivity +>'RZQORDGHG IUHH IURP KWWSZZZMHKSQHW RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO +Ganpat, et al.: Yoga for emotional sensitivity in university students +71 +Journal of Education and Health Promotion | Vol. 3 | April 2014 +RESULTS AND DISCUSSION +Yoga is thought to bring physical, psychological and spiritual +benefits to practitioners and has been associated with +reduced stress and pain.[11] An extensive and standardized +teacher‑training program support reliability and safety of YIC +module.[12] Goleman[13] claims that about 80% of a person’s +success in life depends on emotional competencies, emotional +maturity and ES as measured by Emotional quotient. In the +present study, the data analysis showed 3.63% significant +increase (P < 0.01) in ES between pre and post intervention +measurements  [Table  3]. One way to understand yoga’s +strong positive effect on EQ is that it first increases alertness +(exemplified by increases in sustained attention); next it +erases negative influences on personality  (exemplified by +decreases in T +amas or dull personality trait); and finally +this leads to increased sensitivity to others’ feelings and +emotions  (exemplified by increases in Sattva or balanced +personality trait).[8] Previous report on SMET program +in general and Cyclic Meditation in particular revealed +significant increase in EQ and thus strengthening the +importance of yoga for increased ES.[14,15] Similarly, yoga +based SMET program reported significant improvement +EQ and other health variables indicating positive impact of +yoga module on ES.[7] The present study is consistent with +these findings, suggesting that a systematic adoption of the +YIC module can result in better ES among students for their +academic success. +CONCLUSION +The result from the present study suggests that YIC module +was associated with improvement in ES, thus paving the +way for their academic success. Additional well‑designed +studies are needed before a strong recommendation can be +made. +ACKNOWLEDGEMENT +Authors acknowledge Swami Vivekananda Yoga Anusandhana +Samsthana (S‑VYASA) University for granting permission to carry +out this work. +REFERENCES +1. +Romanelli F, Ryan M. A survey and review of attitudes and beliefs +of generation X pharmacy students. Am J Pharm Educ 2003;67:1‑9. +2. +Ryan  M, Romanelli  F, Smith  K, Johnson  MM. Identifying and +teaching Generation X pharmacy students. Am J Pharm Educ +2003;67:1‑7. +3. +Romanelli  F, Cain  J, Smith  KM. Emotional intelligence as a +predictor of academic and/or professional success. Am J Pharm +Educ 2006;70:69. +4. +Singh D. Emotional Intelligence at Work: A professional Guide. +New Delhi, India: Sage Publications; 2003. +5. +Goleman  D. Working With Emotional Intelligence. New  York: +Bantom Books; 1998. +6. +Goleman D. What makes a leader? Harv Bus Rev 1998;11‑12:92‑102. +7. +Ganpat TS, Nagendra HR. Integrated yoga therapy for improving +mental health in managers. Ind Psychiatry J 2011;20:45‑8. +8. +Khemka SS, Ramarao NH, Hankey A. Effect of integral yoga on +psychological and health variables and their correlations. Int J Yoga +2011;4:93‑9. +9. +Deshpande S, Nagendra HR, Raghuram N. A randomized control +trial of the effect of yoga on verbal aggressiveness in normal healthy +volunteers. Int J Yoga 2008;1:76‑82. +10. Lokeswarananda S. Taittiriya U. The Ramakrishna Mission Institute +of Culture: Calcutta: Ramakrishna Mission 1996. p. 136‑80. +11. Kumar  S, Nagendra  HR, Manjunath  NK, Naveen  KV, Telles  S. +Meditation on OM: Relevance from ancient texts and contemporary +science. Int J Yoga 2010;3:2‑5. +12. Ganpat TS, Nagendra HR. Yoga therapy for developing emotional +intelligence in mid‑life managers. J Midlife Health 2011;2:28‑30. +13. Goleman D. Emotional Intelligence “Why it can more matter than +IQ” New York: Bantam Books; 1996. +14. Adhia H, Nagendra HR, Mahadevan B. Impact of yoga way of life +on organizational performance. Int J Yoga 2010;3:55‑66. +15. Subramanya P, Telles S. A review of the scientific studies on cyclic +meditation. Int J Yoga 2009;2:46‑8. +Table 3: Data analysis +Psychological +dimension +Mean±standard +deviation before yoga +instructor’s course (Pre) +after YIC (Post) +Percentage +increase +P +ES +84.65±12.84 87.72±10.84 +4.60 +<0.01* +*Significant at 0.01 levels (Wilcoxon Signed Ranks Test as the data +was not normally distributed) ES = Emotional sensitivity, YIC = Yoga +instructor’s course +Source of Support: Nil, Conflict of Interest: None declared +>'RZQORDGHG IUHH IURP KWWSZZZMHKSQHW RQ 0RQGD\ $XJXVW   ,3 @  __  &OLFN KHUH WR GRZQORDG IUHH $QGURLG DSSOLFDWLRQ IRU WKLV MRXUQDO diff --git a/subfolder_0/immediate effects of two relaxation techniques on healthy volunteers.txt b/subfolder_0/immediate effects of two relaxation techniques on healthy volunteers.txt new file mode 100644 index 0000000000000000000000000000000000000000..98bf907428b089ca0b77d6bdd5f79bd22cafd7c4 --- /dev/null +++ b/subfolder_0/immediate effects of two relaxation techniques on healthy volunteers.txt @@ -0,0 +1,19 @@ + + + + + + + + + + + + + + + + + + + diff --git a/subfolder_0/spectral analysis of indian musical notes.txt b/subfolder_0/spectral analysis of indian musical notes.txt new file mode 100644 index 0000000000000000000000000000000000000000..ad26790b2fe387483e36c7f2ae0953cd46d4156f --- /dev/null +++ b/subfolder_0/spectral analysis of indian musical notes.txt @@ -0,0 +1,333 @@ +Indian Journal of Traditional Knowledge +Vol. 4(2), April 2005, pp. 127-131 + + + + + + +Spectral analysis of Indian musical notes +J Chandrasekaran, Heisnam Jina Devi, N V C Swamy* and H R Nagendra +Swami Vivekananda Yoga Anusandhana Samsthana +19, Gavipuram Circle, Kempegowda Nagar, Bangalore 560 019, Karnataka +Received 31 May 2004, revised 23 July 2004 +Music forms an important part of Indian culture. It is believed that Indian music originated from the Samaveda. It is now +available in two forms, the Hindustani and the Carnatic. There is a lot of information concerning the technical aspects of +musical renditions, but hardly any information on the sound aspect. +In this paper, attempts made to study the spectral aspects of Indian musical notes, particularly the Carnatic music has +been discussed. Recordings were made of the seven notes of the classical music using three male and three female voices. +The analysis of the waveforms using the appropriate software yielded the energy, frequency and time spectra, helping in +identifying the formants of the signals which in turn define the signatures of the sound pattern. +Keywords: Musical Notes, Indian Music, Carnatic Music, Classical Music, Spectral Analysis. +IPC Int. Cl7: G10L13/00; G10L15/00. +The characteristics of the sound spectrum of the +Omkara Mantra along with its constituent sounds of A, +U and M have recently been reported1. The Omkara is +one of the holiest sounds of the Vedic heritage and is +an integral part of all Vedic rituals2. It has now become +widely known around the world and is regularly being +used as a part of meditation process. +Another important contribution of Indian heritage is +its classical music. During the last half-century, it has +also become quite well known around the globe. A +systematic study of the technicalities of the musical +form from the point of view of musical renditions has +been taken up. However, a study of the sound patterns +themselves from the point of view of their spectral +characteristics has not attracted the attention of the +scientific community. This report, a preliminary +attempt in this direction is expected to lead to detailed +investigations. +Indian classical music has a hoary tradition. Its +origins are shrouded in mystery. Traditionally, it is +believed to have originated from the Samaveda. Vedas +are four in number – the Rigveda, the Yajurveda, the +Samaveda and the Atharvaveda. Of these, the Rigveda +is the oldest consisting of hymns addressed to various +godheads, composed by sages, called Rishis about +whom very little is known historically. These hymns +form the Mantra or Samhita portion of the Rigveda. +The Samaveda Samhita consists essentially of the +same hymns as the Rigveda Samhita but makes use of +elaborate and ornate singing techniques based upon a +scale of seven notes. The other Vedic Samhitas +generally make use of three or five notes but the +Samaveda Samhita makes use of the full scale of +seven notes which later got reorganized into the +standard notes of the classical tradition, viz. sa +(shadja), +ri +(rshabha), +ga +(gandhara), +ma +(madhyama), pa (panchama) dha (dhaivata) and ni +(nishada)3-4. + +With the passage of time, Indian classical music +got split into two branches – the Hindustani and the +Carnatic. This appears to have occurred around seven +hundred years ago5. Even though the two systems +appear today to be almost independent of each other +both of them owe their origin to the seven notes or +Saptaswara of the Samaveda. + +There are a large number of text books available on +both systems. There are also scholarly tomes written +by musicologists about the technical intricacies +involved. But, there has been no systematic +investigation into the nature of the basic notes +themselves and their sound patterns as is available for +western classical music. Since the time of Lord +Rayleigh, there has been a lot of investigation into the +sound patterns of the English alphabets and the +western classical musical notes6. Corresponding +studies on Indian musical notes have not been +________________ +*Corresponding author +INDIAN J TRADITIONAL KNOWLEDGE, VOL. 4, No. 2, APRIL 2005 + + +128 +undertaken systematically. An attempt has been made +using more or less the same techniques as adopted +earlier1 to study on the spectral characteristics of the +seven musical notes. + +Methodology +The experimental procedure consists of the +following steps: (1) recording of the musical notes +with the use of a sensitive microphone (2) digitizing +the analog wave forms with the help of a computer +using a sampling rate of 44100 per second (3) +analyzing the digitized data to get information about +the energy – frequency and frequency – time spectra +and (4) identifying the predominant frequencies and +formants. The procedure for recording was essentially +the same as described earlier1. Here also, experts from +outside institutions vetted the quality of the signals. +The recording was done for a total of ten male and +female voices for both ascending and descending +scales. Two inclusion criteria were used – the +steadiness of the voice and the perfection of the notes. +Based on these criteria, four voices were eliminated. +The rest of the six voices, three male and three female +were then used for analysis only for the ascending +scale since the variation of these voices for the +ascending and the descending scales was hardly +noticeable. +The ascending musical scale was that used in +Carnatic music based on Raga Mayamalavagowla. +The number of musical notes available for study was +42, half for the male voices and the other half for the +female. + +Observations +The wave forms for the seven musical notes for the +six voices formed the raw data, which can be +processed to yield the following information: +(a) Short time window patterns of the waveforms +usually of 100 millis displaying the periodic +nature of the signals. +(b) Energy – frequency spectra for all notes and +voices displaying the energy distribution among +the various harmonics and sub harmonics. +(c) Frequency +– +time +spectra +for +all +cases +complementing the energy – frequency spectra. +(d) Predominant frequencies and their sub harmonics +for all cases. +The total number of figures arising out of the +analysis, works out to 111, with 6 wave forms, 21 +short time window patterns, 42 energy – frequency +spectra and 42 frequency – time spectra. All +conclusions drawn have been based on the analysis of +all these figures. Only a few representative ones are +given here. +The wave forms for a male voice are given in fig. 1 +and those for a female voice in fig. 2. The 100 +millisec window amplification of the signal for “sa” is +shown in fig. 3 for a male and a female voice. The +energy – frequency for the first four notes for a male +voice are given in fig. 4 - 7 and the same for a female +voice for the last three notes in fig. 8 -10. +The most important figures from the point of view +of the analysis are the frequency – time spectra. The +spectra corresponding to the fig. 4-10 are shown in +fig. 11and 12. As mentioned earlier, these are only +samples of the total information available. + +Discussion +The raw data for the analysis are the wave forms as +recorded directly with the help of the appropriate +Sound Forge software. Several trials were conducted +before selecting the reliable waveforms for further +analysis. +Musical notes are expected to be highly periodic as +compared to noise. The analysis of noise requires +stochastic +methods +which +follow +their +own +methodology. On the other hand, analysis of +periodical signals is a much simpler affair. Therefore, +it was felt necessary that the current waveforms +should be checked for periodicity. Short time +windows of the waveforms were selected and +amplified. It was seen that in all cases the amplified +signal displayed periodicity (Fig.3). Hence, it was felt +that no stochastic analysis was called for. +The energy – frequency spectra indicate the +distribution of the energy of the wave form among the +various frequencies of the periodic signal. The lowest +frequency is the fundamental frequency and the +higher ones are the sub harmonics. These frequencies +are also called “formants”. It is seen from all the +spectra that the energy expressed in terms of decibels +decreases with increasing frequencies. Since the +spectra (Fig. 4 - 10) use the logarithmic scale, it is +easy to estimate the frequency at which the energy +falls to 1% of its value at the fundamental frequency. +This helps us in identifying the effective formants. +The identification of the sound is based upon the +number of formants. The first formant is a +characteristic of the voice box of the reciter. The +higher formants constituting the sub harmonics +represent the characteristics of the musical note. The +CHANDRASEKARAN et al: SPECTRAL ANALYSIS OF INDIAN MUSICAL NOTES + + +129 + + + + + + + + + + + + + + + + + + + + +INDIAN J TRADITIONAL KNOWLEDGE, VOL. 4, No. 2, APRIL 2005 + + +130 + + + + + + + + + + +CHANDRASEKARAN et al: SPECTRAL ANALYSIS OF INDIAN MUSICAL NOTES + + +131 +first formant depends on whether the voice is that of a +male or a female. Male voices usually have a lower +pitch than female voices and hence a lower +fundamental frequency. Usually, the ratio of the two +pitches is 1:2. +The information contained in the fig. 4 - 10 is +presented in a complementary form in the figs. 11 and +12. These show the frequency – time spectra with the +energy level as a parameter. These are called +spectrograms and form in a sense the “signature” of +the sound. They do not add anything to the +conclusions but present a three dimensional display of +the information and contain in themselves the entire +information which can be extracted from the wave +forms. +The number of formants depends upon the +resonance produced in the voice box. Male singers are +capable of producing higher resonance than female +singers. This is a well recognized fact which has also +been demonstrated by earlier worker1. This is +indicated by the larger number of formants for the +male voices as compared to the female ones. For +instance, in the present case the number of formants +for all the male voices were 5(sa), 3(ri), 6(ga), 5(ma), +5(pa), 6(dha) and 2(ni). The corresponding values for +the female voices were 3, 2, 3,3,3,5 and 1. It should +be noted in this context that Indian music is +predominantly nasal especially for female voices, +unlike western music which is sung with the throat. +This is the reason for the lower number of formants +for the female voices as compared to the male voices. +This, of course, requires a deeper study. + +Conclusion +The +information +provided +above +helps +in +characterizing the sound pattern. It is a simple matter +for an experienced person to be able to identify from +this the musical note being produced and whether the +voice is that of a male or female. However, if a +specific voice needs to be identified more detailed +investigations are needed which form part of the +science of Speech Recognition. +The analysis in this paper has been confined itself +to the individual notes of the musical scale. However, +one specific feature of Indian music, which is not to +be found in western music, is the use of Gamaka or +the smooth transition from one note to another. + +Acknowledgement +The authors are grateful to Natesh Babu for his +kind help in the recordings and in the preparation of +the paper and to Pratibha Nagwar for her suggestions. +Authors also place on record their appreciation to Shri +Prakash, Shri Shripad, Dr Padmini, Ms Manjula and +Dr Srividya for having lent their voices. This work +forms a part of the dissertation submitted by the first +author to Swami Vivekananda Yoga Anusandhana +Samsthana, Bangalore, for his Master’s degree. + +References +1 +Jina Devi Heisnam, Swamy N V C & Nagendra H R, Spectral +analysis of the Vedic Mantra Omkara, Indian J Traditional +Knowledge, 3(2) (2004) 154. +2 +Jina Devi Heisnam, Concept of Mantras and their corresponding +qualities, M.Sc. Degree Dissertation in Hindu Studies, Submitted +to the Hindu University of America, Florida, January, 2003. +3 +Prajnanananda Swami, Music, its form, function and value, +(Munshiram Manoharlal, New Delhi), 1979. +4 +Chandrasekaran J, Indian Music – its origin and growth, Part I, +M.Sc. Degree Dissertation, Submitted to Swami Vivekananda +Yoga Anusandhana Samsthana, Bangalore, January 2004. +5 +Narasimhan Sakuntala, All you wanted to know about Indian +Music, (Veenapati Center for Arts, Bangalore), 1999. +6 +O’Shaughnessy Douglas, Speech Communication – Human and +Machine, 2nd Ed. Indian Reprint, (University Press, Hyderabad), +2001. + diff --git a/subfolder_0/yoga- chair breathing for acute episodes of bronchial asthma.txt b/subfolder_0/yoga- chair breathing for acute episodes of bronchial asthma.txt new file mode 100644 index 0000000000000000000000000000000000000000..f4944ed7be94a7960afee309e3c58ed4bdc5e4a8 --- /dev/null +++ b/subfolder_0/yoga- chair breathing for acute episodes of bronchial asthma.txt @@ -0,0 +1,11 @@ + + + + + + + + + + +