International Journal of Yoga
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    Table of Contents - Current issue
September-December 2022
Volume 15 | Issue 3
Page Nos. 173-261

Online since Monday, January 16, 2023

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Promoting personalized medicine through Yoga-based lifestyle p. 173
Nandi Krishnamurthy Manjunath
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Yoga module development and validation: A systematic review with methodological guidelines p. 175
Naresh Katla, Atmika Ramsahaye, Arun Thulasi, Judu Ilavarasu, Aarti Jagannathan, Hemant Bhargav, Shivarama Varambally, Nanjudaiah Gangadhar
In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles have been validated or standardized as a program. The aim of this article is to review the different methodologies used for yoga module development and to assess their quality. Three databases (PubMed, Web of Science, and Scopus) were searched using the following keywords and Boolean operators: (validation OR development OR design) AND (yoga OR mind-body) AND (module OR protocol OR program). Three thousand six hundred and seventy-one articles were enlisted, and based on the inclusion and exclusion criteria, 37 articles were narrowed down for review. Since no checklist exists to assess the quality of yoga modules, the authors designed a 23-item checklist to categorize each having low, medium, or high quality. As per the yoga module quality checklist, only 21.6% of the studies had high quality, while 75.3% of the articles had medium quality and 8.11% had low quality. A commonly used development method was literature review, while for validation, experts' scoring of the Likert scale was the preferred means. The feasibility of the module was carried out only by half of the studies. Few diseases such as cardiovascular disease, diabetes mellitus, obesity, Parkinson's disease, and obesity had more than one yoga module developed. The findings of this systematic review have shed some light on the growing need for standardized methods of yoga module development. The 23-item checklist can guide researchers in the homogeneous development strategies when designing yoga interventions in the future.
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Functional connectivity of prefrontal cortex in various meditation techniques – A mini-review p. 187
Mrithunjay Rathore, Meghnath Verma, Mohit Nirwan, Soumitra Trivedi, Vikram Pai
Meditation is a practice of concentration and relaxation. In philosophical terms, it is a process of gaining self-consciousness. Although there is diversity in meditation (Mindfulness, compassion, transcendental, and focused attention meditation), interventions show that meditation practices improve prefrontal cortex (PFC) functions like cognition, self-awareness, attention, and memory and reduce psychological symptoms. These results are thought to be due to meditation increasing functional connections of different brain regions. We reviewed to show the functional connectivity of the prefrontal cortex in various meditation practices. We were viewed various neuroimaging interventions of functional connectivity associated with the prefrontal cortex and different brain areas during meditation techniques on healthy meditators compared with non-meditators. fMRI findings show that meditation practices are associated with increased neural function and processing, default mode network, gray matter volume, and functional coupling in the brain area related to different parts of PFC. PFC's functional connectivity is associated with increased attention, working memory, cognitive control, executive control, emotion regulation, counteracting adverse effects, self-perception, and self-compassion. Furthermore, PFC's functional connectivity decreases anxiety, depression, perceived stress, negative emotion, and hyperarousal symptoms. In this review, we outlined the published effect of meditation on the function and structure of the different parts of the prefrontal cortex. We suggest a positive theoretical correlation between meditation and the functional connectivity of the prefrontal cortex. Altered prefrontal connectivity is seen in some neurological and psychosocial disorders. Therefore meditation can also play an influential role in treating these disorders.
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Effect of 4-week heartfulness meditation on stress scores, sleep quality, and oxidative and inflammatory biochemical parameters in COVID-19 patients after completion of standard treatment – A randomized controlled trial p. 195
Senthil Kumar Subramanian, Vidya Desai Sripad, Amudharaj Dharmalingam, V Naga Guhan, Vinoth Kumar Kalidoss, Nichenametla Gautam, Arundhathi Shankaralingappa, Rajathi Rajendran, Syed Ghouse Mohiuddin
Context: COVID-19-affected patients showed increased stress, impaired sleep quality, altered complete blood count, and increased inflammatory and oxidative parameters. Yoga is an add-on nonpharmacological treatment that is established to normalize the abovementioned parameters. Heartfulness meditation is a form of Raja yoga. Aims: The present study aimed to study the effects of 4 weeks of heartfulness meditation on the abovementioned parameters in COVID-19 patients following treatment completion. Settings and Design: The present study was a randomized controlled trial carried out in the Department of Physiology, AIIMS, Mangalagiri, Andhra Pradesh. Subjects and Methods: Out of 50 COVID-19 treatment-completed patients recruited for the study, 25 were randomly assigned to the study group who received 4-week app-based heartfulness meditation. Other 25 patients were assigned to the control group who received app-based relaxation for 4 weeks. Perceived stress score, Pittsburgh Sleep Quality Index questionnaire, baseline cardiovascular parameters, complete blood count, serum cortisol, inflammatory parameters, oxidative stress parameters, and antioxidant parameters were assessed before and after 4 weeks of intervention in both the groups. The outcome assessor was blinded in the present study. Statistical Analysis Used: The mean difference between the two groups was tested using the Student's t-test or Mann–Whitney U-test based on data distribution. Effect of intervention was analyzed using paired Student's t-test for dependent samples test or Wilcoxon signed-rank test based on data distribution. Results: The groups were comparable before intervention for all the variables. After 4 weeks of intervention, we observed a significant decrease in stress, circulating cortisol, inflammatory markers, and oxidative stress biomarker in both the groups. Further, we observed improved sleep quality and antioxidant biomarkers in both the groups. These beneficial alterations following intervention were high in the study group compared to the control group. Conclusions: Our results suggest that app-based heartfulness meditation/relaxation can be used as a nonpharmacological adjuvant to hasten the recovery process in patients who have completed the COVID-19 treatment protocol. Beneficial effects in subjects practicing heartfulness meditation were more than that observed in subjects practicing relaxation.
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Heartfulness meditation alters electroencephalogram oscillations: An electroencephalogram study p. 205
Dwivedi Krishna, Krishna Prasanna, Basavaraj Angadi, Bikesh Kumar Singh, Shrivastava Anurag, Singh Deepeshwar
Background: Heartfulness meditation (HM) has been shown to have positive impacts on cognition and well-being, which makes it important to look into the neurophysiological mechanisms underlying the phenomenon. Aim: A cross-sectional study was conducted on HM meditators and nonmeditators to assess frontal electrical activities of the brain and self-reported anxiety and mindfulness. Settings and Design: The present study employed a cross-sectional design. Methods: Sixty-one participants were recruited, 28 heartfulness meditators (average age male: 31.54 ± 4.2 years and female: 30.04 ± 7.1 years) and 33 nonmeditators (average age male: 25 ± 8.5 years and female: 23.45 ± 6.5 years). An electroencephalogram (EEG) was employed to assess brain activity during baseline (5 min), meditation (10 min), transmission (10 min) and post (5 min). Self-reported mindfulness and anxiety were also collected in the present study. The EEG power spectral density (PSD) and coherence were processed using MATLAB. The statistical analysis was performed using an independent sample t-test for trait mindfulness and anxiety, repeated measures analysis of variance (ANOVA) for state mindfulness and anxiety, and Two-way multivariate ANOVA for EEG spectral frequency and coherence. Results: The results showed higher state and trait mindfulness, P < 0.05 and P < 0.01, respectively, and lower state and trait anxiety, P < 0.05 and P < 0.05, respectively. The PSD outcomes showed higher theta (P < 0.001) and alpha (P < 0.01); lower beta (P < 0.001) and delta (P < 0.05) power in HM meditators compared to nonmeditators. Similarly, higher coherence was found in the theta (P < 0.01), alpha (P < 0.05), and beta (P < 0.01) bands in HM meditators. Conclusions: These findings suggest that HM practice may result in wakeful relaxation and internalized attention that can influence cognition and behavior.
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The role of integrated approach to yoga therapy-based yoga module in improving cardiovascular functions and lipid profile in hypertensive patients: A randomized controlled trial p. 215
Shivaprasad Shetty, NS Nandeesh, Prashanth Shetty
Background: Hypertension is a growing public health problem and its optimal management is imperative. Integration of lifestyle modification and yoga with antihypertensive drugs leads to its successful management. Yoga has been shown to modulate blood pressure (BP) and lipid metabolism in individuals with hypertension. The current study is a preliminary effort to ascertain the underlying mechanisms behind it. Materials and Methods: Hundred patients were screened, among which 65 who met the inclusion criteria were recruited. After baseline assessments, they were randomly allocated (1:1) to an intervention group (IG) who practiced integrated approach to yoga therapy (IAYT)-based yoga module for 6 days a week, for 3 months and a control group (CG) who received no intervention. BP, heart rate variability, and lipid profile were assessed before and after the intervention. Data acquired from 60 cases were analyzed by post-hoc analysis for multiple comparisons between the mean values. Results: At the end of 3 months, within-group comparison showed significant changes (P < 0.05) in IG in all variables except triglycerides, high-density lipoprotein (HDL), and very low-density lipoprotein (LDL) while similar changes were not present in the control group. Significant differences were seen between the groups in the TC (P = 0.005), HDL (P = 0.047), non-HDL (P = 0.013), LDL (P < 0.001), LDL/HDL Ratio (P = 0.031), CHOL/HDL Ratio (P = 0.043), DBP (P < 0.001), SBP (P < 0.001), and all indices of HRV (P < 0.001). Conclusion: These findings suggest that IAYT-based yoga module was effective in improving cardiovascular performance and lipid metabolism, thereby mitigating coronary artery disease risk.
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Men with and without alcohol dependence: A comparative study of Triguna, nonattachment, personality and subjective well-being p. 222
Chandana Nedungottil, Jyotsna Agrawal, Mahendra Prakash Sharma, Pratima Murthy
Context: Indian models of personality are seldom explored in relation to alcohol dependence. Triguna is an Indian model of personality originating from the Sankhya philosophy, whereby three gunas, Sattva, Rajas and Tamas describe personality features. Additionally, the trait of Non attachment which is a concept discussed extensively in Bhagavad Gita is also studied along with Triguna. Aims: The current study discusses these concepts and attempts to explore their relationship with personality and subjective well-being, among men with and without alcohol dependence. Subjects and Methods: A cross-sectional survey method was adopted, with a sample of 84 men from the community without alcohol dependence, screened through alcohol use disorders identification test and 30 men diagnosed with alcohol dependence. Informed consent was obtained from all the participants. Statistical Analysis Used: The data were analyzed using descriptive statistics, independent sample t-test, and Mann–Whitney U-test. Results: Men without alcohol dependence scored significantly higher on variables such as Sattva, extraversion and conscientiousness, positive affect, and life satisfaction, than men in the clinical group. Men who were diagnosed with alcohol dependence, scored significantly higher on Tamas, neuroticism, and negative affect. Conclusions: This novel understanding of the personality structure of patients with alcohol dependence from the Triguna perspective may be helpful in the development of indigenous psychological interventions for alcohol dependence.
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Yoga as an Escape from Depreciating Mental Health due to COVID 19: A Qualitative study analyzing the factors associated with mental status based on the experiences of geriatric population's participation in an Online program during COVID 19 lockdown in India p. 230
Varun Malhotra, Ananyan Sampath, Danish Javed, Rajay Bharshankar, Shweta Mishra, Vijender Singh, Dibyanshu Singh, Avani Kulkarni, Namita Gautam, Rimjhim Rastogi
Introduction: The COVID-19 pandemic has left an array of direct physical consequences unevenly on the elderly apart from leaving a wide range of indirect consequences of mental health problems on them. This study aims to understand the effect of a Yoga-Meditation based mobile phone application intervention to reduce the duress by mental health issues via a qualitative analysis. Methods: A phenomenological qualitative succession of an explanatory sequential design of a prior quantitative study followed by a Yoga-Meditation mobile phone based intervention, where 30 participants who had mild or moderate Depression, Anxiety or Stress as assessed by DASS-21 were chosen by random sampling and were asked to take part in an interview. The interview was transcribed, coded, patterns identified and themes were created to understand the perceptions. Results: Three major schools of thought were identified and explored to understand the general perception of Mental health, COVID-19 and the intervention: a) Knowledge Axis patterns of COVID-19, which included their prior knowledge about the disease, its consequences and their cues to action based on those beliefs, b) Mental Health and Strategies to Positivity, involves all their actions to promote, restore or propagate a positive mental attitude from religious activities to physical activities and c) Application related thoughts, involved their perceptions of the app, the barriers to use and suggestions to improve. Conclusion: This study gave deeper insight into the schools of thought which will be important in designing future interventions and yoga-meditation based programs in the future, essentially for geriatric populations as it serves as a feasible simple measure for the same.
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Immediate effect of Pranava Pranayama on fetal and maternal cardiovascular parameters p. 240
Vasudevan Rajalakshmi Vasundhara, Meena Ramanathan, Seteesh Ghose, Ananda Balayogi Bhavanani
Introduction: Maternal stress responses play an important role in the etiology of fetal and maternal disorders other than biomedical risks. The surge of emergency evidence that yoga as adjuvant therapy can have significant beneficial effects in the prenatal period and in the fetus. Aim: The aim of this study was to evaluate the immediate effect of Pranava Pranayama on maternal and fetal cardiovascular parameters. Materials and Methods: Three-way cross-over study was done on 3 consecutive days in 60 pregnant women (3rd trimester) with 10 min of breath awareness, listening to OM, and performing Pranava Pranayama. Maternal heart rate (MHR) and systolic and diastolic pressures were measured before and after each session, and cardiovascular indices were derived with formulae. Fetal heart rate (FHR) was obtained from nonstress test tracing. Data were assessed using GraphPad InStat version 3.06. Student's t-test was used for intragroup comparisons while repeated measured ANOVA with Tukey–Kramer multiple comparison tests were done for intergroup comparison. Results: Significant changes (P < 0.001) were found in MHR and FHR immediately after all three interventions. Delta% changes showed the greatest fall in MHR (P = 0.03) after Pranava as compared to the other two while in FHR, both OM group and Pranava were significant (P < 0.001). Conclusion: There were significant changes found in MHR, FHR, and cardiovascular responses rate-pressure product and double product after a single session of intervention. Yogic breathing techniques Pranava may enhance cardiovascular hemodynamics of the maternal–fetal unit. Reduction in maternal and fetal cardiovascular parameters attributed to reduced sympathetic activity coupled with enhanced vagal parasympathetic tone. Such changes in cardiac autonomic status may enhance placental circulation and lead to healthier fetal development.
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Integrating yoga into undergraduate American medical education p. 246
Sridevi R Pitta, Alexandra Reischman, Robert Zalenski
Undergraduate medical education (UGME) is the time when doctors' attitudes toward patients and their profession are formed. It is also a period of tremendous stress for future physicians, including high levels of negative stress. Such stress can be maladaptive and may sow the seeds of burnout and long-term dissatisfaction. We believe that the introduction of yoga practice in the 1st year of medical school could ameliorate the negative stressors to which undergraduate medical students are exposed. Although there are some studies in the U.S. and internationally that support the use of Yoga in UGME, they do not provide sufficient data to make a compelling case for widespread implementation of yoga programs in undergraduate curricula. We, therefore, wish to advocate for conducting a trial of the integration of yoga in the undergraduate medical curriculum to combine yoga's ancient health wisdom into the context of modern scientific medicine. Large, prospective, multicenter, and multi-method pilot projects are needed to identify how a program of yoga practice and theory could counter the UGME environment that ultimately produces depression, anxiety, and non-effective coping strategies among medical students. A curriculum for yoga for undergraduate medical students deserves serious consideration and a prominent place among efforts to improve UGME.
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Yoga as an adjunct therapy for musculoskeletal pain and burnout in orthopedic surgery: A trainee's perspective p. 250
Jeffrey Mark Brown, Mariah L Wellman
Orthopedic surgeons face significant physical and psychosocial stressors during their training as surgical residents and throughout their career. Aside from occupational hazards intrinsic to the profession, two notable and treatable concerns are musculoskeletal pain and emotional burnout, which have a reported prevalence as high as 97% and 56%, respectively, among orthopedic residents. Management of musculoskeletal pain and burnout is essential for promoting surgeon well being, education, and longevity as well as avoiding medical errors and compromises to patient care. This perspective manuscript describes the occupational challenges faced by orthopedic surgeons and promotes a habitual practice of yoga as an adjunct therapy for managing musculoskeletal pain and emotional burnout, and furthermore, introduces the need to reconsider gendered perceptions surrounding orthopedics and the practice of yoga in a profession largely comprised of men.
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Smart Yoga instructor for guiding and correcting Yoga postures in real time p. 254
D Mohan Kishore, S Bindu, Nandi Krishnamurthy Manjunath
In recent days, Yoga is gaining more prominence and people all over the world have started to practice it. Performing Yoga with proper postures is beneficial. Hence, an instructor is required to monitor the correctness of Yoga postures. However, at times, it is difficult to have an instructor. This study aims to provide a system that will act as a personal Yoga instructor and practitioners can practice Yoga in their comfort zone. The device is interactive and provides audio guidance to perform different Yoga asanas. It makes the use of a camera to capture the picture of the person performing Yoga in a particular position. This captured pose is compared with the benchmark postures. A pretrained deep learning model is used for the classification of different Yoga postures using a standard dataset. Based on the comparison, the practitioner's posture will be corrected using a voice message to move the body parts in a certain direction. As the device performs all the operations in real-time, it has a quick response time of a few seconds. Currently, this work aids the practitioners in performing five Asanas, namely, Ardha Chandrasana/Half-moon pose, Tadasana/Mountain pose, Trikonasana/Triangular pose, Veerabhadrasana/Warrior pose, and Vrikshasana/Tree pose.
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