role of yoga in medicine

1. D r.P.Sathiyaraj eswaran
Assi stant D i rector
SCR I,CCRS,CHENNAI
AVAILABLE EVIDENCE
TO SUBSTANTIATE ROLE
OF PRANAYAMAM IN
COMBATING HEART
DISEASES
SYMPOSIUM FIFTH YOGADAY 20062019

2.  The word Prāṇāyāma is
comprised of two components:
‘prāṇa’ and
‘yāma’. Prāṇa means ‘vital
energy’ or ‘life force.yāma is
defined as ‘extension’ or
‘expansion’.
 Thus, the
word Prāṇāyāma means
‘extension or expansion of the
dimension of prāṇa.
 In the Prāṇāyāma practices,
there are 3 important aspects of
breathing
 (1) Pūrakam (inhalation),
(2) Recakam (exhalation),
(3) kumbhakam (internal breath
retention),
 ஏறுதல் பூரகம் ஈரரட்டு
வாமத்தால்
 ஆறுதல் கும்பகம்
அறுபத்து நாள்தில்
 ஊறுதல் ரரசகம்
முப்பத்திரண்டத்தில்
PRANAYAMAM
SYMPOSIUM FIFTH YOGADAY 20062019

3.  The sympathetic nervous system prepares the body for
intense physical activity and is often referred to as the fight-
or-flight response. The parasympathetic nervous system
has almost the exact opposite effect and relaxes the body
and inhibits or slows many high energy functions.
சும்மா இருத்தரே சுகம்
SYMPOSIUM FIFTH YOGADAY 20062019

4. ஏற்றி இறக்கி இரு
காலும் பூரிக்கும்
காற்றற அடக்கும்
கணக்கறிவாளர்
இல்றே
காற்றற பிடிக்கும்
கணக்கறிவாளர்க்கு
கூற்றற உறதக்கும்
குறி அதுவாரம
The Apgar score, a
tool used to assess
well-being at 1 and
5 minutes after
birth, incorporates
five elements:
respiratory effort,
heart rate, reflex
irritability, muscle
tone, and color.
IMPORTANCE OF OXYGEN INFLOW AND
CARDIAC
SYMPOSIUM FIFTH YOGADAY 20062019

5.  கறே நாலு ரபாகிறறத எட்டில்
ரசரு
 கபடமற்ற ரதகமடா கண்டு பாரர
 The physiological effects of breath
retention among underwater divers
have been explored.
 The most common physiological
response of the body to voluntary
breath retention is to utilize the
oxygen available optimally.
 Such response include bradycardia,
reduction in stroke volume, cardia
coutput, and peripheral
vasoconstriction.
 The initial phase of breath retention
alters the physiology maximally,
whereas the hemodynamic changes
stabilize in the later part of extended
breath holding
 அண்டமுடி மீ தி ேங்கிரவ
விமதிறை
 கண்டு தரிசித்தல் கதி
 Yogic practices for 3 months
resulted in an improvement in
cardiorespiratory performance and
psychologic profile. The plasma
melatonin also showed an increase
after three months of yogic
practices.
 The systolic blood pressure,
diastolic blood pressure, mean
arterial pressure, and orthostatic
tolerance did not show any
significant correlation with plasma
melatonin. However, the maximum
night time melatonin levels in yoga
group showed a significant
correlation (r = 0.71, p < 0.05) with
well-being score
வாயு வங்கி
SYMPOSIUM FIFTH YOGADAY 20062019

6.  Cardiovascular functions are
controlled by neural factors as
well as others such as
temperature, hormones, etc.,
Of these, neural factors
primarily concern the
autonomic nervous system
(ANS), which plays a major
role in maintaining and
regulating cardiac functions,
e.g., systolic blood pressure
(SBP), diastolic blood pressure
(DBP) and heart rate (HR).
Imbalances in these lead to
cardiovascular disorders such
as hypertension, ischemia,
infarction, etc.,
மனமது ரசம்றமைானால்
SYMPOSIUM FIFTH YOGADAY 20062019

7.  Slow breathing/slow
deep breathing
 In a study on slow
Prāṇāyāma such as
Nāḍi śuddhi, practiced
for 20 minutes daily for
a duration of 3 months
had shown to modulate
ventricular
performance by
increasing
parasympathetic
activity and decreasing
sympathetic activity.
 Breath awareness
10 minutes of breath
awareness showed a
significant decrease in
SBP in patients with
hypertension.
SLOW BE AWARE
SYMPOSIUM FIFTH YOGADAY 20062019

8.  Stress either physical or mental, leads to
cardiovascular morbidity.
 Newly admitted medical students are lik ely to be
exposed to various stresses lik e change of
environment, demanding medical education and
different teaching protocol in a medical college.
Pranayama is known since ancient times to
relieve stress and stabilize autonomic f unction of
the body.
 Therefore it was decided to study effect of
Pranayama on stress and cardiovascular
autonomic f unction.
 The subjects were f irst M.B.B.S students and the
sample size was 59 consisting of 27 males and 32
f emales.
 The group of students thus selected was briefed
about the study.
 Af ter the orientation session, inf ormed written
consent was tak en, stress questionnaire was put
and the autonomic f unction tests were done.
 This was f ollowed by practice of Pranayama f or 2
months, 1 hour/day f or 5 days/week and again
stress questionnaire was put and the autonomic
f unction tests were performed on the study group.
The above tests were done bef ore and af ter the
practice of Pranayama. The results obtained were
analyzed using SPSS software. The stress level
has reduced af ter 2 months of practicing various
pranayama as evident by decrease in total stress
score which is highly significant.
STRESS AND HEART
SYMPOSIUM FIFTH YOGADAY 20062019

9.  Right nostril yogic breathing
 It involves both inhalation and
exhalation through right nostril.
A previous study reported that
the air flow through right
nostril is activatory in nature.
 The practice of RNYB is shown
to produce increase in oxygen
consumption (which could be
due to increased sympathetic
discharge to the adrenal
medulla)and SBPand HRalong
with significant decrease in
digit pulse volume. Hence it is
reported to have a sympathetic
stimulating effect.
 Left nostril yogic breathing
 It involves both inhalation and
exhalation through left nostril.
A previous study reported that
the air flow through left nostril
(candra nāḍi/iḍā svara) is
relaxatory in nature.
 Previous studies on LNYB had
shown to produce significant
reduction in RR, HR, SBP and
DBP in healthy subjects
SOORYAKALAI CHANDRAKALAI
PRANAYAMAM
SYMPOSIUM FIFTH YOGADAY 20062019

10.  Eleven normal healthy volunteers
were randomized
into Pranayamam group (n=6) and a
non-Pranayamam control group
(n=5); the Pranayamam volunteers
were trained in pranayama, the
technique being Anuloma-Viloma
pranayama with Kumbhak. All the
11 volunteers were made to sit in
similar environment for two
sessions of 20 min each for seven
days,whilethe pranayama volunteers
performed slow breathing under
supervision, the control group
relaxed without conscious control
on breathing. Pulse, GSR, blood
pressure (BP) and pulmonary
function tests (PFT) were measured
before and after the 7-day
programme in all the volunteers.
 While no significant changes
were observed in BP and
PFT, an overall reduction in
pulse rate was observed in
all the eleven volunteers;
this reduction might have
resulted from the relaxation
and the environment.
Statistically significant
changes were observed in
the Pranayamam group
volunteers in the
GSR(Galvanic Skin
Response) values during
standing phases indicating
that regular practice
of Pranayamam causes a
reduction in the sympathetic
tone within a period as short
as 7 days.
PRANAYAMA AMONG HEALTHY VOLUNTEERS
SYMPOSIUM FIFTH YOGADAY 20062019

11.  In study there were ninety
participants with essential
hypertension. Their ages ranged
from 20 to 59 years (group average
age ±S.D., 49.7±9.5 years; sixty
males). Participants were
randomized as three groups, with
thirty participants in each group.
One group practiced alternate
nostril yoga breathing for 10
minutes, the second group
practiced breath awareness for the
same duration and the third group
was given a control intervention
(i.e., reading a magazine with
neutral content). Assessments were
taken before and after the
interventions for participants of
the three groups. Assessments
included the blood pressure and
 Following alternate nostril
breathing (ANYB) there was a
significant decrease in systolic
and diastolic blood pressure
(p<0.001 and p<0.05), and an
improvement in Purdue
pegboard task scores for both
hands (p<0.05), and for the
right hand (p<.001). Breath
awareness (the control session)
also showed a significant
decrease in systolic blood
pressure (p<0.05). The right
hand scores improved in the
group reading a magazine
(p<0.05).
ALTERNATIVE NOSTRIL BREATHING
SYMPOSIUM FIFTH YOGADAY 20062019

12. Sukha
Prāṇāyāma consists of
a conscious, slow and
deep breathing with
equal duration of
inhalation and
exhalation at the rate
of 6 breaths/minute
which was shown to
reduce the HR and BP
in hypertensive
patients within 5
minutes of practice.
 Twenty-three hypertensive
patients attending the Yoga
OPD at JIPMER were
recruited for the study and
instructed to perform
sukha pranayama for 5
minutes at the rate of 6
breaths/min. This
pranayama involves
conscious, slow and deep
breathing with equal
duration for inhalation and
exhalation. Heart rate (HR)
and BP were recorded
before and immediately
after the intervention
SUKHA PRANAYAMAM
SYMPOSIUM FIFTH YOGADAY 20062019

13.  It involves inhalation
through both nostrils and
producing humming sound
of a bee while exhaling.
 Five minutes of slow
paced Bhrāmarī
Prāṇāyāma have been
reported to influence
parasympathetic
dominance on
cardiovascular system due
to its effects in reducing
SBP, DBP, mean arterial
BP and HR
BHRĀMARĪ PRĀṆĀYĀMA
SYMPOSIUM FIFTH YOGADAY 20062019

14.  It involves forceful exhalation followed by passive inhalation.[6]
A previous study reported a decrease in cardiac vagal tone
during Kapālabhāti due to changes in respiratory pattern and
decreased sensitivity of arterial baroreflex; and decrease in
respiratory rate (RR) and increased in SBP and low frequency BP
oscillations after Kapālabhāti which suggested a differentiated
pattern of vegetative activation and inhibition associated
with Kapālabhāti exercise. In a case study, a case of spontaneous
pneumo-thorax caused by Kapālabhāti Prāṇāyāma was reported
SYMPOSIUM FIFTH YOGADAY 20062019
Kapālabhāti

15.  The mechanism of how Prāṇāyamic breathing interacts with the
nervous system affecting metabolic and autonomic functions was
hypothesized by Jerath et al.
 It is their hypothesis that the voluntary slow deep breathing
functionally resets the ANS through stretch induced inhibitory
signals and hyperpolarization currents propagated through both
neural and non-neural tissue which synchronizes neural elements
in the heart, lungs, limbic system and cortex.
 During inspiration, stretching of lung tissue produces inhibitory
signals by action of slowly adapting stretch receptors (SARs) and
hyperpolarization current by action of fibroblasts. Both inhibitory
impulses and hyperpolarization current are known to synchronize
neural elements leading to the modulation of the nervous system
and decreased metabolic activity indicative of the
parasympathetic state
PRANAYAMAM SCIENCE BEHIND
SYMPOSIUM FIFTH YOGADAY 20062019

16.  Prāṇāyāma is one of the most important parts of the ancient
traditional Yoga practices. Different types of prāṇāyāma
techniques were shown to produce different effects, in which
slow type of yogic breathing techniques were reported to
improve cardiovascular and autonomic variables which might
be useful for the prevention and the management of
cardiovascular disorders.
SYMPOSIUM FIFTH YOGADAY 20062019
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