International Journal of Yoga
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   2022| January-April  | Volume 15 | Issue 1  
    Online since March 21, 2022

 
 
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REVIEW ARTICLES
The effects of yoga on cardiovascular risk factors among patients with type 2 diabetes mellitus: Systematic review and meta-analysis
Anuradha , Niharika Singh Rojaria, Jaspreet Kaur, Minaxi Saini
January-April 2022, 15(1):3-11
DOI:10.4103/ijoy.ijoy_151_21  
Type 2 diabetes mellitus (T2DM) is a fastest evolving metabolic disorder and India houses second highest number of patients with diabetes after China. Cardiovascular diseases are the major cause of mortality among patients with T2DM. Yoga is an ancient Indian practice that proves to be effective for patients with diabetes. The present systematic review and meta-analysis has been conducted to see the benefits of yoga on blood pressure, lipid profile, and anthropometric measures among patients with T2DM. The articles were extracted from three databases - PubMed, The Cochrane library, and Google scholar. Only English language articles, with PEDro score≥6, were included in the current study. The duplicates were removed using Mendeley. Fourteen randomized controlled trials (RCTs) and three 3 non-RCTs were included in the analysis. The meta-analysis was done using Review Manager 5.3. The results reveal that yoga is effect in improving blood pressure (P<0.01), lipid profile (P<0.01) except HDL (P=0.06), and anthropometric measures (P<0.01) except waist-hip ratio (P=0.79). Heterogeneity was also high for most of the variables. It may be concluded from the results that the yoga is effective in improving of blood pressure, lipid profile, and anthropometric measures. However, high heterogeneity sought the need of more high quality RCTs to affirm these findings.
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EDITORIAL
Stretch for health
TM Srinivasan
January-April 2022, 15(1):1-2
DOI:10.4103/ijoy.ijoy_30_22  
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REVIEW ARTICLES
Role of Yoga as an Adjunct in the Management of Migraine Headache-Current Status and Future Indications
D Nayar, M Mahapatro, P Nayar
January-April 2022, 15(1):12-18
DOI:10.4103/ijoy.ijoy_173_21  
Migraine headache is a painful, disabling condition afflicting 7% of the population. The long-term effort of coping with a chronic headache disorder predisposes the individual to other psychiatric illnesses, ischemic cerebrovascular disease as well as medicine overuse headache. The use of nonpharmacological methods to reduce the stress and pain associated with headache can improve the overall quality of life and reduce the burden of the disease. To examine the utility of yoga as an adjunct to pharmacological treatment of migraine headache. The review article is based on the secondary literature collected through the Google Scholar database between the years 2010 and 2020. Several themes were identified regarding the burden of migraine/headache and the need for the integration of yoga into the existing healthcare system. Despite the limitations and the need for greater scientific rigor, there have been consistent reports of the beneficial effects of yoga in the reduction of stress, anxiety, depression, and an enhanced quality of life, as well as better pain management in chronic diseases. Studies on the role of yoga in the treatment of migraine have been few in number. They have consistently shown that yoga can be a valuable adjunct to the existing pharmacological interventions in the management of migraine headache. In recent years, the Indian government has made enormous strides in establishing yoga outreach programs throughout the country. The need of the hour is to integrate evidence-based yoga with the wellness centers and noncommunicable diseases treatment plan. It can help to reduce the burden on the existing health care resources.
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ORIGINAL ARTICLES
Effect of yoga lifestyle in patients with heart failure: A randomized control trial
Ashish Kumar Jain, C Manchanda Subhash, S Vivek Bhola, Madan Kushal, Mehta Ashwini, S Sawhney Jitendrapal
January-April 2022, 15(1):40-44
DOI:10.4103/ijoy.ijoy_183_21  
Background: In spite of significant advances in the management of heart failure (HF), morbidity and mortality remain high. Therefore, there is a need for additional strategies. We did a randomized clinical trial to study effect of yoga in patients with HF in terms of quality of life (QOL), left ventricle ejection fraction (LVEF), C-reactive protein (CRP), and NTproBNP. Materials and Methods: 60 patients with stable HF New York Heart Association Class II with LVEF 30%–40% were randomized into control group (CG) and yoga group (YG). CG received the guideline-based therapy and YG in addition practiced the yoga, one hour daily for 3 months. All patients were assessed for QOL, CRP, NTProBNP, and LVEF at baseline and after 3 months. Results: A significant difference was observed in all four parameters in the YG as compared to the CG (P < 0.01) after 12 weeks. QOL as assessed by Minnesota living with heart failure questionnaire score improved significantly in YG as compared to CG (10 V/s 14, P < 0.001). There was a significant improvement within YG in terms of LVEF (33.4–36.8, P = 0.001), and the percentage change in LVEF was significant between the groups (10% V/s 5%, P = 0.001). NTproBNP also significantly reduced by 69.8% from 755 to 220 Pmol/l in YG as compared to 39.3% in CG (679-406 Pmol/l). CRP decreased by 49.3% (5.36-2.73 mg/L) in YG and 35.8% (5.39-3.45 mg/L) in CG. Conclusion: The result of this pilot study suggests that addition of yoga to guideline-based therapy for HF patients significantly improves QOL, LVEF, and NTProBNP and reduces CRP level. Larger studies are needed to confirm these findings.
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Effective stress management through meditation: An electroencephalograph-based study
Ronnie V Daniel, Greeshma Sharma, Sushil Chandra
January-April 2022, 15(1):45-51
DOI:10.4103/ijoy.ijoy_171_21  
Introduction: Stress among college students is a common health problem that is directly correlated with poor cognitive health. For instance, cognitive mechanisms required for sustenance can be affected due to stress caused by daily mundane events, not necessarily by chronic events. Thus, it becomes essential to manage stress effectively especially for college students. Meditation is one of the useful techniques that facilitates cognitive flexibility and has consequences at the molecular and endocrinal level to treat stress. Objectives: The present study attempts to understand the effect of meditation on the brain waves when participants face stressful events. Methods: A randomized controlled pre-post experimental design was used. Total 18 subjects were randomly assigned to control group and experimental group. Subsequently, Electroencephalograph (EEG) data were recorded during the determination test (DT) before and after the meditation. The Control group underwent relaxation music while the experimental group practiced Sudarshan Kriya Yoga (SKY) (a type of meditation). Non-linear EEG signal processing algorithm was applied to capture dynamics and complexity in brain waves. Results: Results indicated that the efficacy of meditation was reflected with the improved information processing in the brain. Improved performance and reduced errors were reported in DT Scores in the experimental group. Increased complexity of beta band was observed for non-linear features, signifying efficient utilization of cognitive resources while performing the task. Conclusion: Findings implicated the usefulness of the meditation process for effective stress management.
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Effect of tratak (yogic ocular exercises) on intraocular pressure in glaucoma: An RCT
Sankalp , Tanuj Dada, Raj Kumar Yadav, Hanjabam Barun Sharma, Ritesh Kumar Netam, Kanwal Preet Kochhar
January-April 2022, 15(1):59-69
DOI:10.4103/ijoy.ijoy_160_21  
Introduction: In healthy subjects, the intraocular pressure (IOP) is maintained by a dynamic equilibrium between continuous production of aqueous humor by ciliary bodies and continuous outflow through the two drainage pathways: trabecular meshwork and uveoscleral outflow. Here, we hypothesized that yogic ocular exercises, including extraocular muscles exercise, and modified Tratak Kriya (mTK), might reduce the IOP as well as stress and improve quality of life (QoL) in patients with glaucoma. Methodology: A parallel two-arm randomized controlled trial (RCT) was conducted in glaucoma patients (Control group and Intervention group). Control group patients were on standard medical treatment and intervention group patients practiced a Yoga-based lifestyle intervention (YBLI) for 4 weeks as add-on therapy with their standard medical treatment. All Participants were assessed at baseline day 1, day 14 (D14), and day 28 (D28). A minimum of 30 patients were recruited in each group. Results: We did not observe any statistically significant different mean IOP of right (IOP-r) or, left eyes at any time point as well as cortisol level and QoL between the two groups. However, with in intervention group, there was a reduction in IOP-r at D14 (15.54 ± 2.81 mmHg) and D28 (15.24 ± 3.1 mmHg), P = 0.006 and 0.001, respectively, compared to their baseline IOP (16.26 ± 2.98). Conclusion: Based on the present RCT, yoga-based ocular exercises practiced here cannot be recommended for management of raised IOP in glaucoma patients. Further larger studies are warranted with yoga-based interventions in patients with glaucoma. Clinical Trial Registration Number CTRI/2016/03/006703
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Immediate effects of OM chanting on heart rate variability measures compared between experienced and inexperienced yoga practitioners
Ganagarajan Inbaraj, Raghvendra M Rao, Amritanshu Ram, Sapna K Bayari, Spoorthi Belur, PV Prathyusha, TN Sathyaprabha, Kaviraja Udupa
January-April 2022, 15(1):52-58
DOI:10.4103/ijoy.ijoy_141_21  
Background: Chanting “OM” is a form of meditation that has numerous health benefits. However, the neurophysiological mechanisms underpinning its effect are surprisingly scarce. The present study aimed to investigate the effect of OM chanting on autonomic modulation, using heart rate variability (HRV), on experienced yoga practitioners and yoga naïve persons. Methods: This prospective study included 19 yoga practitioners (9 females and 10 males; group mean age ± standard deviation [SD]; 25.9 ± 3.2 years) and 17 yoga naïve persons (8 females and 9 males; group mean age ± SD; 24.8 ± 3.6 years) of both sexes and similar age range. Both the groups were assessed for HRV indices (time and frequency domain measures) before and after loud OM chanting for 5 min. Results: Baseline comparison using Mann–Whitney U test between groups showed yoga practitioners had significantly increased high frequency (HF) power (P < 0.029) than nonyoga practitioners, signifying a state of tranquility before the chanting of OM. After 5 min of loud chanting of OM, a comparison between groups assessed using Wilcoxon Signed Ranks test revealed: HF Power, a component of the parasympathetic nervous system, was further amplified with a significantly increase (P < 0.001) in the yoga practitioners group compared to nonyoga practitioners. Furthermore, this increase in HF power was positively correlated with the years of experience in yoga. Conclusion: The present study showed that a brief chanting of OM (5 min) might enhance parasympathetic nervous system activity, promote relaxation, and provide calmness. Further, this experience may be achieved effectively in individuals experienced in yoga than nonyoga practitioners.
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Multi-omics integration and interactomics reveals molecular networks and regulators of the beneficial effect of yoga and exercise
Manoj Khokhar, Sojit Tomo, Ashita Gadwal, Purvi Purohit
January-April 2022, 15(1):25-39
DOI:10.4103/ijoy.ijoy_146_21  
Background: Yoga is a multifaceted spiritual tool that helps in maintaining health, peace of mind, and positive thoughts. In the context of asana, yoga is similar to physical exercise. This study aims to construct a molecular network to find hub genes that play important roles in physical exercise and yoga. Methodology: We combined differentially expressed genes (DEGs) in yoga and exercise using computational bioinformatics from publicly available gene expression omnibus (GEO) datasets and identified the codifferentially expressed mRNAs with GEO2R. The co-DEGs were divided into four different groups and each group was subjected to protein–protein interaction (PPI) network, pathways analysis, and gene ontology. Results: Our study identified immunological modulation as a dominant target of differential expression in yoga and exercise. Yoga predominantly modulated genes affecting the Th1 and NK cells, whereas Cytokines, Macrophage activation, and oxidative stress were affected by exercise. We also observed that while yoga regulated genes for two main physiological functions of the body, namely Circadian Rhythm (BHLHE40) and immunity (LBP, T-box transcription factor 21, CEACAM1), exercise-regulated genes involved in apoptosis (BAG3, protein kinase C alpha), angiogenesis, and cellular adhesion (EPH receptor A1). Conclusion: The dissimilarity in the genetic expression patterns in Yoga and exercise highlights the discrete effect of each in biological systems. The integration and convergences of multi-omics signals can provide deeper and comprehensive insights into the various biological mechanisms through which yoga and exercise exert their beneficial effects and opens up potential newer research areas.
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Cerebrovascular dynamics associated with yoga breathing and breath awareness
Ankur Kumar, Niranjan Kala, Shirley Telles
January-April 2022, 15(1):19-24
DOI:10.4103/ijoy.ijoy_179_21  
Aims: Breath frequency can alter cerebral blood flow. The study aimed to determine bilateral middle cerebral arterial hemodynamics in high-frequency yoga breathing (HFYB) and slow frequency alternate nostril yoga breathing (ANYB) using transcranial Doppler sonography. Methods: Healthy male volunteers were assessed in two separate trials before, during, and after HFYB (2.0 Hz for 1 min, n = 16) and ANYB (12 breaths per minute for 5 min, n = 22). HFYB and ANYB were separately compared to breath awareness (BAW) and to control sessions. Statistical Analysis: The data were analyzed using repeated-measures ANOVA with Bonferroni adjusted post hoc tests. Results: During HFYB there was a decrease in end-diastolic velocity (EDV) and mean flow velocity (MFV) (P < 0.01 for left and P < 0.05 for right middle cerebral arteries; MCA) with an increase in pulsatility index (PI) for the right MCA (P < 0.05). During ANYB, there was a bilateral decrease in peak systolic velocity (P < 0.05 for left and P < 0.01 for right MCA), EDV (P < 0.01) and MFV (P < 0.01 for left and P < 0.001 for right MCA) and an increase in PI (P < 0.01). During BAW of the two sessions there was a decrease in lateralized flow and end-diastolic velocities (P < 0.05) and an increase in PI (P < 0.05). Conclusions: Changes in peak flow velocities and pulsatility indices during and after HFYB, ANYB, and BAW suggest decreased cerebrovascular blood flow and increased flow resistance based on different mechanisms.
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PERSPECTIVE
East meets west in therapeutic approaches to the management of chronic pain
Eleni G Hapidou, Ting Qi (Amy) Huang
January-April 2022, 15(1):70-75
DOI:10.4103/ijoy.ijoy_104_21  
Yoga as a holistic principle, not only practice of asanas or poses, integrates all aspects of the self, with biological, mental, intellectual, and spiritual elements. Yoga encompasses the biopsychosocial medical perspective, which regards pain as a dynamic interaction between physiological, psychological, and social factors. The purpose of this perspective article is to compare and contrast psychological practices such as mindfulness meditation, relaxation response (RR), and cognitive behavioral therapy (CBT) with Yoga in their management of chronic pain. The use of these practices is explored through history, literature, and research studies. Results from scientific studies on Yoga show changes in health-related pain outcomes for patients with chronic pain. The key aspects of Yoga, notably relaxation, positive thinking, and mindfulness, are discussed in relation to mindfulness meditation, RR, and CBT.
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CASE REPORT
Integrative medicine enhances motor and sensory recovery in guillain–Barre syndrome – A case study
Akhila Soman, Umesh Chikkanna, Kishore Kumar Ramakrishna, Hemant Bhargav, Shivakumar Venkataram, Nishitha Lakshmi Jasti, Shubham Sharma, Velayutham Selva Ganapathy, Shivarama Varambally
January-April 2022, 15(1):80-84
DOI:10.4103/ijoy.ijoy_186_21  
Guillain–Barre syndrome (GBS) is a heterogenous group of immune-mediated conditions affecting peripheral nerves. About 40% of patients treated with standard dosage of plasma exchange or intravenous immunoglobulins do not improve in the first 4 weeks following treatment. Add-on treatment from traditional medical approaches such as Yoga therapy and Ayurveda are increasingly being sought for rehabilitation of patients with chronic neurological disorders. The current case study reports the clinical utility of adjunct Yoga and Ayurveda treatment in the treatment of residual symptoms of GBS.
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SHORT COMMUNICATION
Perceptions about the Benefits and negative outcomes of yoga practice by yoga-naïve persons: A cross-sectional survey
Sachin Kumar Sharma, Savita Agnihotri, Niranjan Kala, Shirley Telles
January-April 2022, 15(1):76-79
DOI:10.4103/ijoy.ijoy_188_21  
Background and Objective: Understanding the way nonexercisers view the benefits and barriers to physical exercise helps promote physical exercise. This study reports perceived benefits and negative outcomes of yoga perceived by yoga-naïve persons. Methods: The 2550 yoga-naïve respondents of both sexes (m:f = 2162:388; group mean age ± SD 23.5 ± 12.6 years) participated in a convenience sampling in-person survey conducted to determine the perceived benefits and negative outcomes of yoga. Results: Among 2550 respondents, 97.4% believed yoga practice had benefits. The three most common perceived benefits of yoga were improvement in (i) physical health (39.8%), (ii) cognitive functions (32.8%), and (iii) mental health (20.4%). Among the respondents, 1.4% believed that yoga had negative outcomes. The three most common perceived negative outcomes were (i) apprehension that wrong methods may be harmful (0.24%), (ii) apprehension that excessive practice may harm (0.24%), and (iii) laziness (0.12%). Conclusion: The most common perceived benefit of yoga practice was “improvement in physical health,” with “apprehension that wrong or excessive practice could be harmful” as the most common perceived negative outcomes of yoga.
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