International Journal of Yoga
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    Table of Contents - Current issue
Coverpage
September-December 2021
Volume 14 | Issue 3
Page Nos. 173-260

Online since Monday, November 22, 2021

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EDITORIAL  

Kaivalya: The ultimate freedom p. 173
TM Srinivasan
DOI:10.4103/ijoy.ijoy_123_21  
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REVIEW ARTICLE Top

War-related mental health issues and need for yoga intervention studies: A scoping review p. 175
Akshay Anand, Abdul Ghani, Kanupriya Sharma, Gurkeerat Kaur, Radhika Khosla, Chandra Devi, Vivek Podder, Madhava S Sivapuram, Kalyan Maity, Harmandeep Kaur
DOI:10.4103/ijoy.ijoy_60_21  
Conflicts and humanitarian crises lead to serious mental health disorders, including depression, anxiety, stress, and cognitive decline. Exposure to these circumstances in early life can lead to the development of disorders such as mild cognitive impairment, dementia, and Alzheimer's disease (AD), for which no treatments are available. In this review, various research papers have been compiled to develop an understanding about mental health of population affected due to wars and conflicts and how stress and depression can accelerate the development of dementia and AD. Due to failure of drugs in the treatment of dementia and AD, yoga and mindfulness-based approach has been proposed for future investigations. Although studies have shown that yoga and mindfulness can be helpful in the management of stress, anxiety, depression, and posttraumatic stress disorder in the war-afflicted areas, limited mechanistic studies in yoga and mindfulness remain the chief cause precluding its clinical application in such warzones. The molecular studies in the field of yoga can be undertaken by targeting these warzones. This review provides a scientific evaluation of mind–body techniques as a justification for mental health rehabilitation in the war-afflicted zones in face of failed clinical trials for various drugs. This may help reduce the risk of developing dementia and AD in this susceptible population.
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ORIGINAL ARTICLES Top

The cardiovascular variability during transient 6° head down tilt and slow breathing in yoga experienced healthy individuals p. 188
Boligarla Anasuya, Kishore Kumar Deepak, Ashok Kumar Jaryal
DOI:10.4103/ijoy.ijoy_79_21  
Objective: The intervention of yoga has been shown to improve autonomic conditioning in humans and better adaptability to orthostatic challenges. Similarly, slow breathing at 0.1 Hz akin to pranayama also increases baroreflex sensitivity (BRS). Hence, we intended to investigate whether yoga practitioners have different autonomic responses at rest, during slow deep breathing as well as during 6° head down tilt (HDT) compared to naive group individuals. Aim: The aim of the study was to evaluate the acute effects of slow breathing on cardiovascular variability during HDT in yoga practitioners compared to yoga-naïve individuals. Settings and Design: This was a comparative study with repeated measures design conducted in Autonomic Function Test lab of the Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. Materials and Methods: Time domain and frequency domain parameters of heart rate variability, blood pressure variability (BPV), and BRS were evaluated during 6° HDT and slow breathing at 0.1 Hz on forty yoga-naïve individuals and forty yoga practitioners with an average age of 31.08 ± 7.31 years and 29.93 ± 7.57 years, respectively. All of the participants were healthy. Statistical Analysis Used: General Linear Mixed Model ANOVA was applied with yoga experience as a between-group factor in repeated measures. Independent sample t-test was applied for between group comparison of respiratory rate, demographic, and anthropometric data. P <0.05 is considered statistically significant. Results: Between-group comparison during HDT with spontaneous breathing has shown a significantly lower heart rate (P = 0.004) with higher RR interval (RRI) (P = 0.002) and pNN50% (P = 0.019) in yoga practitioners. The sequence BRS (P < 0.0001) and α low frequency (LF) of spectral BRS (P = 0.035) were also significantly higher in the yoga group compared to the naïve group. Similarly, during HDT with slow breathing, the heart rate was lower (P = 0.01); with higher RRI (P = 0.009); pNN50% (P = 0.048). Standard deviation of successive RR interval difference of systolic BPV was lower (P = 0.024) with higher sequence BRS (P = 0.001) and α LF of spectral BRS (P = 0.002) in yoga group than naïve group. Conclusion: The yoga experienced individuals exhibit higher resting parasympathetic activity, lower systolic BPV, and higher BRS than naïve to yoga individuals. It is inferred from the findings that yoga practitioners were better adapted to transient cephalad fluid shift that happens during 6° HDT. Furthermore, acute slow breathing during 6° HDT reduced the systolic blood pressure in all the participants suggesting the beneficial role of slow breathing during exposure to extreme conditions such as microgravity which might help in the prevention of adverse effects of cephalad fluid shift during long-term weightlessness and maintain the astronaut health. Future mechanistic studies with active yoga intervention are necessary to understand the adaptive mechanisms involving central and vascular modulations contributing to either attenuation or accentuation of the cardiovagal baroreflex during HDT and slow breathing in healthy individuals.
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The cardiovascular variability during transient 6° head down tilt and slow breathing in yoga experienced healthy individuals p. 188
Boligarla Anasuya, Kishore Kumar Deepak, Ashok Kumar Jaryal
DOI:10.4103/ijoy.ijoy_79_21  
Objective: The intervention of yoga has been shown to improve autonomic conditioning in humans and better adaptability to orthostatic challenges. Similarly, slow breathing at 0.1 Hz akin to pranayama also increases baroreflex sensitivity (BRS). Hence, we intended to investigate whether yoga practitioners have different autonomic responses at rest, during slow deep breathing as well as during 6° head down tilt (HDT) compared to naive group individuals. Aim: The aim of the study was to evaluate the acute effects of slow breathing on cardiovascular variability during HDT in yoga practitioners compared to yoga-naïve individuals. Settings and Design: This was a comparative study with repeated measures design conducted in Autonomic Function Test lab of the Department of Physiology, All India Institute of Medical Sciences, New Delhi, India. Materials and Methods: Time domain and frequency domain parameters of heart rate variability, blood pressure variability (BPV), and BRS were evaluated during 6° HDT and slow breathing at 0.1 Hz on forty yoga-naïve individuals and forty yoga practitioners with an average age of 31.08 ± 7.31 years and 29.93 ± 7.57 years, respectively. All of the participants were healthy. Statistical Analysis Used: General Linear Mixed Model ANOVA was applied with yoga experience as a between-group factor in repeated measures. Independent sample t-test was applied for between group comparison of respiratory rate, demographic, and anthropometric data. P <0.05 is considered statistically significant. Results: Between-group comparison during HDT with spontaneous breathing has shown a significantly lower heart rate (P = 0.004) with higher RR interval (RRI) (P = 0.002) and pNN50% (P = 0.019) in yoga practitioners. The sequence BRS (P < 0.0001) and α low frequency (LF) of spectral BRS (P = 0.035) were also significantly higher in the yoga group compared to the naïve group. Similarly, during HDT with slow breathing, the heart rate was lower (P = 0.01); with higher RRI (P = 0.009); pNN50% (P = 0.048). Standard deviation of successive RR interval difference of systolic BPV was lower (P = 0.024) with higher sequence BRS (P = 0.001) and α LF of spectral BRS (P = 0.002) in yoga group than naïve group. Conclusion: The yoga experienced individuals exhibit higher resting parasympathetic activity, lower systolic BPV, and higher BRS than naïve to yoga individuals. It is inferred from the findings that yoga practitioners were better adapted to transient cephalad fluid shift that happens during 6° HDT. Furthermore, acute slow breathing during 6° HDT reduced the systolic blood pressure in all the participants suggesting the beneficial role of slow breathing during exposure to extreme conditions such as microgravity which might help in the prevention of adverse effects of cephalad fluid shift during long-term weightlessness and maintain the astronaut health. Future mechanistic studies with active yoga intervention are necessary to understand the adaptive mechanisms involving central and vascular modulations contributing to either attenuation or accentuation of the cardiovagal baroreflex during HDT and slow breathing in healthy individuals.
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Correlation of heart rate variability with carotid intima media thickness after 6 month of yoga intervention in prediabetics p. 198
Neha Saboo, Sudhanshu Kacker, Jeevraj Rathore
DOI:10.4103/ijoy.ijoy_74_21  
Introduction: Atherosclerotic carotid intimamedia thickness (CIMT) may be associated with alterations in the autonomic functions. The aim of this study was to investigate the effect of 6-month yoga intervention on heart rate variability (HRV) and CIMT in elderly subjects and the correlation between HRV and CIMT. Methodology: This was a randomized controlled study, in which a total of 250 subjects were enrolled. Randomization and allocation in yoga and control groups were performed using computer-generated random numbers. The CIMT was determined by B-mode ultrasonography, and cardiac autonomic function was determined through frequency domain parameter of HRV measures at baseline and after 6 months of yoga intervention. Results: Participants had a mean age of 45.4 ± 6.4 years, and a mean CIMT in control (0.70 ± 0.05) and study group (0.69 ± 0.073), and low frequency/high frequency (LF/HF) ratio in control (2.20 ± 1.05) and study group (0.57 ± 0.54). Yoga group had evidence of increased vagal activity in the frequency domain (HF and LF/HF ratio, P < 0.001) with respect to control group. Moreover, a study group showed lower intimamedia thickness (IMT) than control subjects (P < 0.01). In the whole population, LF/HF ratio positively and significantly correlated (r = 0.665, P < 0.01) to IMT. Conclusion: This study demonstrated that, after yoga intervention, LF/HF ratio is positively correlated with CIMT, a putative index of atherosclerosis, confirming cardiac autonomic neuropathy as a part of the pathophysiological pathway for atherosclerosis. It confirms that the regular yoga represents a valuable strategy to counter impairments of cardiac autonomic activity and artery structural changes.
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Yoga module for somatoform pain disorders: Development, content validation, and feasibility testing p. 206
Monika Jha, Sowjanya Dumbala, Kankan Gulati, Hemant Bhargav, Rashmi Arasappa, Shivarama Varambally, BN Gangadhar, Geetha Desai
DOI:10.4103/ijoy.IJOY_125_20  
Background: Yoga practices have been found to be useful in chronic pain conditions but studies focussing specifically on somatoform pain disorders (SPDs) are limited. Aims: Current study aims to develop and test the feasibility of a yoga program for patients with SPDs. Materials and Methodology: Athorough search of traditional and contemporary literature was performed with the objective of formulating a yoga program for reducing chronic non-specific pain and associated psychological distress. Content validity of the program was then determined by taking the opinion of 18 yoga experts (who had >5 years of experience in treating mental health disorders) using content validation ratio (CVR) through Lawshe's formula. The feasibility of the module was tested on 10 subjects diagnosed with SPDs as per the International Classification of Diseases (ICD) -10 criteria using standard scales. Results: In the finalized module, 70.83% (34 out of 48 items) of the practices were retained along with the modifications as suggested by the experts. Two practices were not found to be feasible (Trikonasana and Shalabhasana) and hence were removed from the final module. A significant reduction in pain severity was observed in the subjects after practising the yoga module for 2 weeks. The content validity index for the whole module (average of all CVRs) was 0.55. Conclusions: Ayoga module was developed for SPD. The content validity of the module was found to be good. The module was found safe and potentially useful for reducing pain severity in patients with SPD. Future studies should test the efficacy of the developed program through a randomized controlled clinical trial.
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A correlation study between tri-guna and emotional style: A theoretical approach toward developing a working model to integrate tri-guna with affective neuroscience and well-being p. 213
PN Ravindra, Prashanth Babu
DOI:10.4103/ijoy.ijoy_52_21  
Background: Science of well-being is getting focused across all walks of life from health care to organizational behavior. Indian psychological principles of Tri-Guna offer a universal theoretical framework to understand the behavioral aspects of emotions and well-being, whereas affective neurosciences have explored neural circuits underlying few universal emotional styles. Both Tri-Guna and emotional styles are dynamic and vulnerable for modifications with training. Hence, establishing a relation between Tri-Guna and emotional style offers a novel insight to explore neural basis of Tri-Guna and its application in health and behavioral sciences. Aims: To establish the correlation between Tri-Guna and emotional styles in healthy adult subjects. Materials and Methods: Healthy adults (n = 121, 18–21 years) of both genders were individually administered with questionnaires to assess Tri-Guna (Vedic personality inventory) and emotional style (emotional style questionnaire). The relationship between Tri Guna (Sattva, Rajas and Tamas) and Six dimensions of emotional styles (attention, self awareness, outlook, resilience, social intuition and sensitivity to context) were assessed using Pearson's correlation coefficient. Results: All the emotional styles showed a positive correlation with Sattva and negative with Rajas and Tamas, except resilience. Resilience showed a negative correlation with Sattva and positive with Rajas and Tamas. Further, between Rajas and Tamas, emotional styles showed a stronger correlation with Tamas. Conclusions: Sattva guna showed an association with emotional styles that favors to develop a positive emotional pattern. Having fairly understood neural circuitry of emotional styles, this first preliminary correlation data will provide a theoretical framework to explore neural circuitry involved in understanding emotional aspects of Tri-Guna.
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Effectofcommunity-basedstructuredyogaprogramonhba1clevelamong type 2 diabetes mellitus patients: An interventional study p. 222
Puneet Misra, Gautam Sharma, Nikhil Tandon, Shashi Kant, Meenu Sangral, Sanjay K Rai, Kapil Yadav, Sreenivas Vishnubhatla, Suprakash Mandal, Priyanka Kardam, Nishakar Thakur
DOI:10.4103/ijoy.ijoy_150_21  
Context: In view of the rising burden of type 2 diabetes mellitus (DM) cases in India, there is an urgent need for an effective, low-cost, sustainable intervention controlling diabetes thus preventing complications. Aims: This study aimed to assess the effect of structured yoga programs on diabetes. Subjects and Methods: This was a community-based interventional study that was conducted in an urban resettlement colony of Delhi, India. Known diabetes patients with glycated hemoglobin (Hb1Ac) ≥6.5% were enrolled from 12 randomly selected blocks of the community with a sample size of 192 in each intervention and wait-listed control arm. The intervention was structured yoga of 50 min daily, 2 consecutive weeks in a nearby park and health center followed by twice a week home practice up to the 3rd month. The primary outcome measure was HbA1c% and secondary outcome measures were lipid profile and fasting blood glucose. Statistical Analysis Used: Aper-protocol analysis was done. Mean, standard deviation (SD), and 95% confidence interval were estimated. The level of significance was considered for 0.05. Results: There was a significant decrease of Hb1Ac (0.5%, SD = 1.5, P = 0.02), total cholesterol (11.7 mg/dl, SD = 40.5, P < 0.01), and low-density lipoprotein (3.2 mg/dl, SD = 37.4, P < 0.01) from baseline to end line in the intervention group. These changes in intervention group were also significantly different from the change in the wait-listed control group. The other variables did not change significantly. Conclusions: It revealed that structured yoga program improved glycemic outcome and lipid profile of individuals in a community-based setting. Yoga can be a feasible strategy to control hyperglycemia, lipid levels, and can help better control type 2 DM.
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Development and feasibility testing of a brief yoga module on well-being and cognition of postgraduate mental healthcare students in tertiary settings p. 229
Adil Hakkim, Aarti Jagannathan, Hemant Bhargav, Nishitha Jasti, Shivarama Varambally, Bangalore N Gangadhar
DOI:10.4103/ijoy.ijoy_87_21  
Background: Mental health-care students experience stress and burnout during their training period. Yoga has been found to be helpful in improving one's mental health and well-being. Aim: The aim of this study is to develop and test the feasibility of a brief yoga module for postgraduate mental health-care students. Methods: Amixed method design was used. Phase 1 involved development and validation of the yoga module using the qualitative exploratory method. Phase II tested the feasibility of the module on a sample of 28 first-year postgraduate students. These students participated in a 15-day (30 min/day) brief yoga module for improving their well-being and cognition (mirror neuron activation [MNA] and tower of London task as assessed on day 0, day 15 (2 weeks), and day 30 (4 weeks). Qualitative feedback of the student volunteers was also recorded. Results: Significant improvement in the well-being scores was observed in the students who adhered to the yoga practice after 2 weeks and 4 weeks. Functional near infra-red spectroscopy (fNIRS) data indicated that adherents showed significant activation of left somatosensory region of the brain and deactivation in the right primary somatosensory region during the static and active phase of the MNA task, respectively. Adherent group showed significant improvement in reaction time during “Zero-Moves” tasks of Tower of London. The qualitative thematic analysis showed that the module helped improve the well-being and mental health of the students. Conclusion: The yoga program was found to have high need and medium to high feasibility. A systemic integration of student well-being-oriented interventions including yoga in the curriculum of postgraduate mental health-care courses is advocated.
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PERSPECTIVE Top

Mind-body wellness: A complement to dental education and professional development p. 239
Christina DiBona Pastan
DOI:10.4103/ijoy.ijoy_7_21  
We strive in dental education to train our students to leave dental school with a skill set that enables them to be competent in diagnosis, treatment planning, and in their technical skills to treat their patients. We do not however train our students in practices to maintain their physical and mental well-being, cope with the demands of the dental school curriculum, and provide a toolbox of skills to manage the stresses of dentistry that will be with them for as long as they practice. The COVID-19 pandemic has added a new layer of stress on dental students and although the topic of wellness has been addressed in various ways in dental school environments, integrating a wellness component that supports our student's vulnerabilities while also teaching skills to build resilience to adversity is a needed and missing component in the dental curriculum. Elective stress management wellness courses have been implemented in dental schools and although this is a promising start, the demands of the dental school curriculum make it a difficult environment to become relaxed, grounded, and focused. Based on 6 years of experience in creating and implementing an integrated wellness program at an academic dental institution, this article aims to outline the benefits and applications for teaching mind-body practices in the dental school curriculum as preventative approaches to maintaining overall student wellness, for developing effective strategies to manage academic and clinical challenges and how it sets the foundation for the health, well-being, and professional mindset of future dentists.
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Mindfulness-based interventions: Potentials for management of internet gaming disorder p. 244
Manoj Kumar Sharma, Hemant Bhargav, Ajay Kumar, Vishnu Digambhar, TL Alka Mani
DOI:10.4103/ijoy.ijoy_46_21  
Mindfulness-based interventions have been found to be efficacious among cases with substance addiction. Its role in Internet gaming disorder (IGD) has not been extensively studied. Prisma model approach was used to search for relevant articles from January 2009 to March 2021, to synthesize the role of empirical findings with mindfulness-based interventions to address various psychological domains in IGD. Eighteen relevant papers were included to understand the role of mindfulness-based interventions in IGD. Studies revealed the role of mindfulness-based interventions in the promotion of emotional regulation, metacognitive awareness, adaptive coping/cognition, reducing impulsivity, and craving for playing games. Studies also reveal neuro-biological basis for the effect of these interventions among users with IGD. Mindfulness-based interventions are potentially useful in IGD. It implicates the need to understand the empirical linkages within the root factors for a comprehensive understanding of the phenomenon of mindfulness-based treatment in IGD.
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Yogic principles of artha and dāna with reference to individual and corporate social responsibility p. 248
HR Dayananda Swamy, Karuna Nagarajan, Natesh Babu
DOI:10.4103/ijoy.ijoy_106_21  
A key element of all the Indian systems of philosophy is self-realization, leading to Mokṣa. Yoga, a branch of Indian philosophy, describes the techniques to attain the goal of Kaivalya or Mokṣa. The Puruṣārthas, which are the foundation of human pursuits, combine the spiritual value of Mokṣa with Artha and Kāma worldly requirements, governed by Dharma. Artha is the foundation for two purposes, according to Kauṭilya's Arthaśāstra: Dharma and Kāma. In the absence of affluence and security at society or at the individual level, following ethics and fulfilling desires become difficult. Hardships rear evil and disgust, while affluence rears virtues and love. The Vedic and philosophical traditions advocate wise use of wealth – onself-improvement, economic commotion, and charitable giving (Dāna). Ṛgveda mentions that whatever is given to others selflessly as Dāna returns many times over (Ṛgveda: 1–8). Yoga also specifies the disciplines of Aparigraha (non-hoarding) and Asteya (non-stealing), a balancing act of striking an equilibrium between our desires and virtues. Human beings have one universal duty or Dharma, which is a virtue. By virtue is meant the cultivation of compassion for our fellow beings; an individual social responsibility (ISR) which means to share and coexist with all living beings including insects, animals, etc., If ISR becomes a way of life, then corporate social responsibility will occur by its very nature. Nature follows the principle of “Idam-na-mama” – “this is not mine; it is for collective well-being.” The ocean, sun, stars, moon, wind, trees, etc., perform functions to give to other's welfare not for themselves.
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SHORT COMMUNICATION Top

Yoga for caregiving dyads experiencing chronic pain: Protocol development for merging yoga and self-management to develop skills intervention p. 256
Barbara Ann Gibson, Marieke Van Puymbroeck, Christine A Fruhauf, Arlene A Schmid, Jennifer D Portz
DOI:10.4103/ijoy.ijoy_93_21  
Context: Caregivers often provide unpaid care for family members and friends with physical disabilities, often to the detriment of their health and well-being. Caregivers often experience pain, and individuals with physical disabilities also are likely to experience pain. Merging yoga and self-management to Develop Skills Study (MY-Skills) is an intervention that merges self-management education with yoga for dyads experiencing chronic pain. Aim: This article presents the yoga protocol for the MY-Skills intervention. Methods: The yoga protocol was revised based on feedback from six caregiving dyads. The protocol focuses on reducing pain interference and supporting the caregiving dyad. Results: The final yoga protocol incorporated the following elements: Centering and mantra, prana vidya and pranayama, asanas, mudra, and guided savasana/dhyana. Conclusion: The MY-Skills yoga protocol was modified by a yoga therapist with feedback from study participants. Revisions focused on the caregiving dyad, with specific attention to reducing pain interference.
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