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Available Online at www.ijpba.info
International Journal of Pharmaceutical  BiologicalArchives 2019; 10(4):264-267
ISSN 2581 – 4303
RESEARCH ARTICLE
Assessment of Effects of Traditional Exercise on Galvanic Skin Response, Pulse
Rate, and Blood Pressure in Prehypertensive Patients Attending Out-patient
Department Clinic of Janaki Medical College, Nepal
Rajesh Chandra Das1
*, Bibeka Nanda Jha2
1
Department of Medicine, Janaki Medical College, Janakpur, Nepal, South Asia, 2
Department of Dermatology,
Janaki Medical College, Janakpur, Nepal, South Asia
Received: 15 June 2019; Revised: 15 July 2019; Accepted: 09 October 2019
ABSTRACT
Psychological stress, in this era of urbanization, has become a part and parcel of our lives, has led to a
serious problem affecting different life situations and carries a wide range of health-related disorders, and
has to observe the effects of traditional exercise pranayama on galvanic skin response (GSR), pulse rate,
and blood pressure (BP). This was an open-labeled, prospective, uncontrolled, single-centered, single-arm,
comparative, and clinical intervention study conducted in the Department of Medicine, Janaki Medical
College, for 2 months period January–February 2018 on 15 prehypertensive subjects. Of which 10 were
male and 5 were females, all in the age group of 22–35 years with a body mass index of 19.63–30.11 with
an average of 24.80. No significant change was seen when baseline GSR reading was compared with 15th
-
day reading, but on 30th
 day significant change observed. When the baseline value of pulse was compared
with that of the 15th
 and 30th
 days, a good positive change was seen in resting pulse. Similarly, BP recording
also showed a good positive effect when baseline value was compared with that 15th
 and 30th
 days. The
study concludes that practicing Pranayama on a regular basis increases the parasympathetic tone and blunts
the sympathetic tone of the body. This has shown good beneficial effects on pulse, BP, and GSR.
Keywords: Galvanic skin response, pranayama, sympathetic tone
INTRODUCTION
Cardiovasculardiseasesareoneoftheleadingcauses
of mortality and morbidity around the globe.[1]
High blood pressure (BP) is a major risk factor and
is associated with several types of cardiovascular
disease.[2]
A significant proportion, i.e., 57% of all
stroke deaths and 24% of all coronary heart disease
deaths in India can be attributed to hypertension.[3]
Studies have shown that nearly two-fifths of the
Indianadultpopulationarehypertensive.[4]
Although
no direct cause has been identified for primary/
essential hypertension, the contributing factors are
sedentary lifestyle, smoking, stress, visceral obesity,
*Corresponding Author:
Dr. Rajesh Chandra Das,
E-mail: rajesh93@gmail.com
potassium deficiency, obesity, salt sensitivity,
alcohol intake, and Vitamin D deficiency. Out of the
above, the most important risk factors are obesity
and psychological stress.[5]
Psychological stress,
in this era of urbanization, has become a part and
parcel of our lives. Chronic stress has become a
serious problem affecting different life situations
and carries a wide range of health-related disorders
such as cardiovascular disease, cerebrovascular
disease, diabetes, and immunological disorders.[6]
There are no direct ways to quantify stress, but its
surrogate markers can be identified and measured.
One such parameter is the galvanic skin response
(GSR), which can be measured with the help of
a POLYRITE Machine.[7]
The GSR is a highly
sensitive parameter to measure the sympathetic
outflow. Changes in GSR following exercise
can be used to assess the stress patterns in an
IJPBA/Oct-Dec-2019/Vol 10/Issue 4 265
Das and Jha: Assessment of effects of traditional exercise on galvanic skin response
individual.[8]
Several researchers have reported
that a non-pharmacological measure, Pranayama,
is effective in stress-related conditions. Pranayama
is an age-old science that has been practiced for
thousands of years. It consists of ancient theories,
observations, and principles about the mind and
body connection. Pranayama is a Sanskrit word
meaning “extension of the prana or breath” or,
more accurately, “extension of the life force.” Many
yoga teachers advise that Pranayama and exercise
should be a part of our daily routine.[9]
It helps by
regulating the autonomic functions of the body and
thereby controls the BP.[10]
As the prehypertensive
population is increasing day by day, efforts need to
be taken to control hypertension at an early stage
before starting the drugs. Keeping this in mind, we
conducted a study in antihypertensive drug naïve
prehypertensive patients with the objectives to
observetheeffectsoftraditionalexercisePranayama
on GSR, pulse rate, and BP.
MATERIALS AND METHODS
Thiswasanopen-labeled,prospective,uncontrolled,
single-centered, single-arm, comparative, and
clinical intervention study conducted in the
Department of Medicine, Janaki Medical College
Teaching Hospital for 2 months period January–
February 2019 on 15 prehypertensive subjects. The
intervention was Pranayama and the parameters
measured were galvanic skin response (GSR), pulse
rate, and BP before and after the intervention. The
study commenced after obtaining approval from
the Institutional Ethics Committee and written
informed consent was taken from all the subjects.
Prehypertensive subjects of either sex aged
between 18 and 50 years who understood the study
procedures and those who were willing to cooperate
and give consent to the investigators were included
in the study. Subjects were randomly selected from
the teaching staff and postgraduate residents of
pharmacology department. JNC 7 classification
was used to label subjects as prehypertensive.[11]
Exclusion criteria
Subjects on antihypertensive, anxiolytics,
antidepressants, and psychotropic drug therapy,
those consuming more than 2 units of alcohol per
day (1 unit is equal to 30 ml of hard spirits/300 ml of
beer/250 mlofwine),thosewithanyothercomorbid
conditions, for example, diabetes, asthma, and
hypertension category beyond the prehypertension
stage as per the JNC 7, and those using any
other non-pharmacological measures for stress
reduction or BP control were excluded from the
study. Baseline readings for GSR, pulse, and
BP were taken on 16 channeled POLYRITE
Machine (Model PP-16, Manufacturer-Medicaid
System) in the department of pharmacology.
POLYRITE machine has the capacity to record
various parameters such as electrocardiogram,
electroencephalogram (EEG), electrooculogram,
electromyography, electronystagmogram, nerve
conductions, pulse front tilt, wave over-lap facility,
pulse analysis, and heart rate variability analysis
and identifies frequency component of EEG signal
delta, theta, alpha, and beta waves. Out of these, in
our study, we have recorded only the GSR, pulse
rate, and BP. All the subjects were trained under
proper expert guidance on the method of Anuloma
Pranayama. They performed breathing exercises
every alternate day for 30 min under observation,
in the department of pharmacology, and at home on
advice for a month. Anuloma pranayama was done
by the subjects sitting in padmasana position also
called as the lotus posture in which the individual
sits cross-legged and feet are placed on opposite
thighs, head, and neck relaxed, shoulders moved
backward and the ribcage lifts, the hands rested
on the knees in Jnanamudra, in a well-ventilated
room and it was ensured that they had no nasal
obstruction. In the first step subjects were asked
to close their right nostrils with the thumb and to
exhaletheairslowlythroughtheleftnostrilandthen
inhale back the air slowly through the same nostril.
Then, they were asked to close their left nostril
with the ring finger and were asked to exhale the
air slowly through the right nostril, and then inhale
back the air slowly through the same nostril. These
two steps were repeated in a cycle for 30 min in
morning every day for a month. Parameter such as
GSR, pulse, and BP was recorded on 15th
 day and
30th
 day of the cycle. Data obtained on the 15th
 and
30th
 days were compared with each other and with
the pre-test recordings. The data were represented
IJPBA/Oct-Dec-2019/Vol 10/Issue 4 266
Das and Jha: Assessment of effects of traditional exercise on galvanic skin response
as mean and standard deviation. The student’s t test
was used to determine the statistical significance at
P  0.05.
RESULTS
A total of 15 subjects who were borderline
hypertensive/prehypertensive, according to the
JNC 7 classification, were enrolled in the study.
Of which 10 were male and 5 were females, all
in the age group of 22–35 years with body mass
index of 19.63–30.11 with an average of 24.80. No
significant change was seen when baseline GSR
reading was compared with 15th
 day reading, but
on 30th
-day significant change observed. When the
baseline value of pulse was compared with that
of 15th
 and 30th
 days, a good positive change was
seen in resting pulse. Similarly, BP recording also
showed a good positive effect when baseline value
was compared with that 15th
 and 30th
 days.
DISCUSSION
The three parameters which we measured in
our study were GSR, pulse, and BP. GSR is the
electrical resistance offered by the skin to the
passage of a feeble electric current between two
electrodes placed on the skin of the forearm. The
GSR of the skin depends on a number of factors,
the most important being the presence or absence
of sweat. Sweat contains water and electrolytes
and hence decreases the resistance to passage of
current, thereby decreasing the GSR. An increase
in the sympathetic tone increases sweating and
thereby decreases the GSR. A significant increase
in the GSR reading was observed on the 30th
 day
of the study while a slight increase was seen on
the 15th
 day. This indicates a significant decrease
in the sympathetic tone following daily practices
of Pranayama. Pranayama helps decrease the
sympathetic tone and simultaneously increases
the parasympathetic tone by a number of
mechanisms.[12,13]
It causes an increase in the
sensitivity of the baroreceptor reflex[14]
improves
the tissue oxygenation[13]
and favorably affects
the nervous system metabolism and autonomic
functions.[15]
In contrast, a significant decrease
was seen in the baseline reading of pulse and on
15th
 and 30th
 days, which indicates a significant
positive effect of Pranayama on pulse.A significant
drop in the systolic and diastolic BP was also noted
on 15th
 and 30th
 days of the study; this also shows
a positive effect of Pranayama on BP. Similar
findings were seen with other studies conducted
previously in hypertensive patients.[16,17]
CONCLUSION
The study concludes that practicing traditional
exercise Pranayama on a regular basis increases the
parasympathetic tone and blunts the sympathetic
tone of the body. This has shown good beneficial
effects on pulse, BP, and GSR. Hence, Pranayama
practice can be alternative to the available non-
pharmacological treatments used for hypertension.
However, our study was a short span study;
whatever observation made cannot as such imply
to the larger population. Further studies on a large
number of individuals and for a long duration are
required to confirm the findings on a large scale.
REFERENCES
1.	 Murray CJ, Lopez AD. Mortality by cause for eight
regions of the world: Global burden of disease study.
Lancet 1997;349:1269-76.
2.	 Deedwania P, Gupta R. Hypertension in South Asians.
In: Izzo JL, Black HR, editors. Primer on Hypertension.
Dallas, USA: American Heart Association; 2002.
3.	 Rodgers A, Lawes C, MacMahon S. Reducing the global
burden of blood pressure-related cardiovascular disease.
J Hypertens Suppl 2000;18:S3-6.
4.	 Mourya M, Mahajan AS, Singh NP, Jain AK. Effect
of slow- and fast-breathing exercises on autonomic
functions in patients with essential hypertension. J Altern
Complement Med 2009;15:711-7.
5.	 Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B,
Kongara S, et al. Prevalence and Risk factors of pre-
hypertension and Hypertension in an affluent North
Indian population. Indian J Med Res 2008;128:712-20.
6.	 Cacioppo J, Tassinary L, Berntson G. Handbook of
Psychophysiology. New York: Cambridge University
Press; 2000.
7.	 Boucsein W. ElectrodermalActivity. New York, London:
Plenum Press; 1994.
8.	 Handri S, Nomura S, Kurosawa Y, Yajima K, Ogawa N,
Fukumura Y. User Evaluation of Student’s Physiological
Response Towards E-Learning Courses Material by
IJPBA/Oct-Dec-2019/Vol 10/Issue 4 267
Das and Jha: Assessment of effects of traditional exercise on galvanic skin response
Using GSR Sensor. Yamagata, Japan: Proceedings of
9th
 IEEE/ACIS International Conference on Computer
and Information Science; 2010.
9.	 Sengupta P. Health impacts of yoga and pranayama:
A State-of-the-art review. Int J Prev Med 2012;3:444-58.
10.	 Jerath R, Edry JW, Barnes VA, Jerath V. Physiology of
long pranayamic breathing: Neural respiratory elements
may provide a mechanism that explains how slow deep
breathing shifts the autonomic nervous system. Med
Hypotheses 2006;67:566-71.
11.	 Chobanian AV, Bakris GL, Black HR, Cushman WC,
Green LA, Izzo JL Jr., et al. The seventh report of the
joint national committee on prevention, detection,
evaluation, and treatment of high blood pressure: The
JNC 7 report. JAMA 2003;289:2560-72.
12.	 Bhargava R, Gogate MG, Mascarenhas JF. Autonomic
responses to breath holding and its variations following
pranayama. Indian J Physiol Pharmacol 1988;32:257-64.
13.	 Pal GK, Velkumary S, Madanmohan. Effect of short-term
practice of breathing exercises on autonomic functions
in normal human volunteers. Indian J Med Res
2004;120:115-21.
14.	 Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M,
Rossi M, et al. Slow breathing improves arterial
baroreflex sensitivity and decreases blood pressure in
essential hypertension. Hypertension 2005;46:714-8.
15.	 Kaushik RM, Kaushik R, Mahajan SK, Rajesh V. Effects
of mental relaxation and slow breathing in essential
hypertension. Complement Ther Med 2006;14:120-6.
16.	 Pinheiro CH, Medeiros RA, Pinheiro DG, Marinho
Mde J. Spontaneous respiratory modulation improves
cardiovascular control in essential hypertension. Arq
Bras Cardiol 2007;88:651-9.
17.	 Pramanik T, Sharma HO, Mishra S, Mishra A,
Prajapati R, Singh S, et al. Immediate effect of slow pace
bhastrika pranayama on blood pressure and heart rate.
J Altern Complement Med 2009;15:293-5.

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Effects of traditional exercise on prehypertensive patients

  • 1. © 2019, IJPBA. All Rights Reserved 264 Available Online at www.ijpba.info International Journal of Pharmaceutical BiologicalArchives 2019; 10(4):264-267 ISSN 2581 – 4303 RESEARCH ARTICLE Assessment of Effects of Traditional Exercise on Galvanic Skin Response, Pulse Rate, and Blood Pressure in Prehypertensive Patients Attending Out-patient Department Clinic of Janaki Medical College, Nepal Rajesh Chandra Das1 *, Bibeka Nanda Jha2 1 Department of Medicine, Janaki Medical College, Janakpur, Nepal, South Asia, 2 Department of Dermatology, Janaki Medical College, Janakpur, Nepal, South Asia Received: 15 June 2019; Revised: 15 July 2019; Accepted: 09 October 2019 ABSTRACT Psychological stress, in this era of urbanization, has become a part and parcel of our lives, has led to a serious problem affecting different life situations and carries a wide range of health-related disorders, and has to observe the effects of traditional exercise pranayama on galvanic skin response (GSR), pulse rate, and blood pressure (BP). This was an open-labeled, prospective, uncontrolled, single-centered, single-arm, comparative, and clinical intervention study conducted in the Department of Medicine, Janaki Medical College, for 2 months period January–February 2018 on 15 prehypertensive subjects. Of which 10 were male and 5 were females, all in the age group of 22–35 years with a body mass index of 19.63–30.11 with an average of 24.80. No significant change was seen when baseline GSR reading was compared with 15th - day reading, but on 30th  day significant change observed. When the baseline value of pulse was compared with that of the 15th  and 30th  days, a good positive change was seen in resting pulse. Similarly, BP recording also showed a good positive effect when baseline value was compared with that 15th  and 30th  days. The study concludes that practicing Pranayama on a regular basis increases the parasympathetic tone and blunts the sympathetic tone of the body. This has shown good beneficial effects on pulse, BP, and GSR. Keywords: Galvanic skin response, pranayama, sympathetic tone INTRODUCTION Cardiovasculardiseasesareoneoftheleadingcauses of mortality and morbidity around the globe.[1] High blood pressure (BP) is a major risk factor and is associated with several types of cardiovascular disease.[2] A significant proportion, i.e., 57% of all stroke deaths and 24% of all coronary heart disease deaths in India can be attributed to hypertension.[3] Studies have shown that nearly two-fifths of the Indianadultpopulationarehypertensive.[4] Although no direct cause has been identified for primary/ essential hypertension, the contributing factors are sedentary lifestyle, smoking, stress, visceral obesity, *Corresponding Author: Dr. Rajesh Chandra Das, E-mail: rajesh93@gmail.com potassium deficiency, obesity, salt sensitivity, alcohol intake, and Vitamin D deficiency. Out of the above, the most important risk factors are obesity and psychological stress.[5] Psychological stress, in this era of urbanization, has become a part and parcel of our lives. Chronic stress has become a serious problem affecting different life situations and carries a wide range of health-related disorders such as cardiovascular disease, cerebrovascular disease, diabetes, and immunological disorders.[6] There are no direct ways to quantify stress, but its surrogate markers can be identified and measured. One such parameter is the galvanic skin response (GSR), which can be measured with the help of a POLYRITE Machine.[7] The GSR is a highly sensitive parameter to measure the sympathetic outflow. Changes in GSR following exercise can be used to assess the stress patterns in an
  • 2. IJPBA/Oct-Dec-2019/Vol 10/Issue 4 265 Das and Jha: Assessment of effects of traditional exercise on galvanic skin response individual.[8] Several researchers have reported that a non-pharmacological measure, Pranayama, is effective in stress-related conditions. Pranayama is an age-old science that has been practiced for thousands of years. It consists of ancient theories, observations, and principles about the mind and body connection. Pranayama is a Sanskrit word meaning “extension of the prana or breath” or, more accurately, “extension of the life force.” Many yoga teachers advise that Pranayama and exercise should be a part of our daily routine.[9] It helps by regulating the autonomic functions of the body and thereby controls the BP.[10] As the prehypertensive population is increasing day by day, efforts need to be taken to control hypertension at an early stage before starting the drugs. Keeping this in mind, we conducted a study in antihypertensive drug naïve prehypertensive patients with the objectives to observetheeffectsoftraditionalexercisePranayama on GSR, pulse rate, and BP. MATERIALS AND METHODS Thiswasanopen-labeled,prospective,uncontrolled, single-centered, single-arm, comparative, and clinical intervention study conducted in the Department of Medicine, Janaki Medical College Teaching Hospital for 2 months period January– February 2019 on 15 prehypertensive subjects. The intervention was Pranayama and the parameters measured were galvanic skin response (GSR), pulse rate, and BP before and after the intervention. The study commenced after obtaining approval from the Institutional Ethics Committee and written informed consent was taken from all the subjects. Prehypertensive subjects of either sex aged between 18 and 50 years who understood the study procedures and those who were willing to cooperate and give consent to the investigators were included in the study. Subjects were randomly selected from the teaching staff and postgraduate residents of pharmacology department. JNC 7 classification was used to label subjects as prehypertensive.[11] Exclusion criteria Subjects on antihypertensive, anxiolytics, antidepressants, and psychotropic drug therapy, those consuming more than 2 units of alcohol per day (1 unit is equal to 30 ml of hard spirits/300 ml of beer/250 mlofwine),thosewithanyothercomorbid conditions, for example, diabetes, asthma, and hypertension category beyond the prehypertension stage as per the JNC 7, and those using any other non-pharmacological measures for stress reduction or BP control were excluded from the study. Baseline readings for GSR, pulse, and BP were taken on 16 channeled POLYRITE Machine (Model PP-16, Manufacturer-Medicaid System) in the department of pharmacology. POLYRITE machine has the capacity to record various parameters such as electrocardiogram, electroencephalogram (EEG), electrooculogram, electromyography, electronystagmogram, nerve conductions, pulse front tilt, wave over-lap facility, pulse analysis, and heart rate variability analysis and identifies frequency component of EEG signal delta, theta, alpha, and beta waves. Out of these, in our study, we have recorded only the GSR, pulse rate, and BP. All the subjects were trained under proper expert guidance on the method of Anuloma Pranayama. They performed breathing exercises every alternate day for 30 min under observation, in the department of pharmacology, and at home on advice for a month. Anuloma pranayama was done by the subjects sitting in padmasana position also called as the lotus posture in which the individual sits cross-legged and feet are placed on opposite thighs, head, and neck relaxed, shoulders moved backward and the ribcage lifts, the hands rested on the knees in Jnanamudra, in a well-ventilated room and it was ensured that they had no nasal obstruction. In the first step subjects were asked to close their right nostrils with the thumb and to exhaletheairslowlythroughtheleftnostrilandthen inhale back the air slowly through the same nostril. Then, they were asked to close their left nostril with the ring finger and were asked to exhale the air slowly through the right nostril, and then inhale back the air slowly through the same nostril. These two steps were repeated in a cycle for 30 min in morning every day for a month. Parameter such as GSR, pulse, and BP was recorded on 15th  day and 30th  day of the cycle. Data obtained on the 15th  and 30th  days were compared with each other and with the pre-test recordings. The data were represented
  • 3. IJPBA/Oct-Dec-2019/Vol 10/Issue 4 266 Das and Jha: Assessment of effects of traditional exercise on galvanic skin response as mean and standard deviation. The student’s t test was used to determine the statistical significance at P 0.05. RESULTS A total of 15 subjects who were borderline hypertensive/prehypertensive, according to the JNC 7 classification, were enrolled in the study. Of which 10 were male and 5 were females, all in the age group of 22–35 years with body mass index of 19.63–30.11 with an average of 24.80. No significant change was seen when baseline GSR reading was compared with 15th  day reading, but on 30th -day significant change observed. When the baseline value of pulse was compared with that of 15th  and 30th  days, a good positive change was seen in resting pulse. Similarly, BP recording also showed a good positive effect when baseline value was compared with that 15th  and 30th  days. DISCUSSION The three parameters which we measured in our study were GSR, pulse, and BP. GSR is the electrical resistance offered by the skin to the passage of a feeble electric current between two electrodes placed on the skin of the forearm. The GSR of the skin depends on a number of factors, the most important being the presence or absence of sweat. Sweat contains water and electrolytes and hence decreases the resistance to passage of current, thereby decreasing the GSR. An increase in the sympathetic tone increases sweating and thereby decreases the GSR. A significant increase in the GSR reading was observed on the 30th  day of the study while a slight increase was seen on the 15th  day. This indicates a significant decrease in the sympathetic tone following daily practices of Pranayama. Pranayama helps decrease the sympathetic tone and simultaneously increases the parasympathetic tone by a number of mechanisms.[12,13] It causes an increase in the sensitivity of the baroreceptor reflex[14] improves the tissue oxygenation[13] and favorably affects the nervous system metabolism and autonomic functions.[15] In contrast, a significant decrease was seen in the baseline reading of pulse and on 15th  and 30th  days, which indicates a significant positive effect of Pranayama on pulse.A significant drop in the systolic and diastolic BP was also noted on 15th  and 30th  days of the study; this also shows a positive effect of Pranayama on BP. Similar findings were seen with other studies conducted previously in hypertensive patients.[16,17] CONCLUSION The study concludes that practicing traditional exercise Pranayama on a regular basis increases the parasympathetic tone and blunts the sympathetic tone of the body. This has shown good beneficial effects on pulse, BP, and GSR. Hence, Pranayama practice can be alternative to the available non- pharmacological treatments used for hypertension. However, our study was a short span study; whatever observation made cannot as such imply to the larger population. Further studies on a large number of individuals and for a long duration are required to confirm the findings on a large scale. REFERENCES 1. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global burden of disease study. Lancet 1997;349:1269-76. 2. Deedwania P, Gupta R. Hypertension in South Asians. In: Izzo JL, Black HR, editors. Primer on Hypertension. Dallas, USA: American Heart Association; 2002. 3. Rodgers A, Lawes C, MacMahon S. Reducing the global burden of blood pressure-related cardiovascular disease. J Hypertens Suppl 2000;18:S3-6. 4. Mourya M, Mahajan AS, Singh NP, Jain AK. Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Altern Complement Med 2009;15:711-7. 5. Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B, Kongara S, et al. Prevalence and Risk factors of pre- hypertension and Hypertension in an affluent North Indian population. Indian J Med Res 2008;128:712-20. 6. Cacioppo J, Tassinary L, Berntson G. Handbook of Psychophysiology. New York: Cambridge University Press; 2000. 7. Boucsein W. ElectrodermalActivity. New York, London: Plenum Press; 1994. 8. Handri S, Nomura S, Kurosawa Y, Yajima K, Ogawa N, Fukumura Y. User Evaluation of Student’s Physiological Response Towards E-Learning Courses Material by
  • 4. IJPBA/Oct-Dec-2019/Vol 10/Issue 4 267 Das and Jha: Assessment of effects of traditional exercise on galvanic skin response Using GSR Sensor. Yamagata, Japan: Proceedings of 9th  IEEE/ACIS International Conference on Computer and Information Science; 2010. 9. Sengupta P. Health impacts of yoga and pranayama: A State-of-the-art review. Int J Prev Med 2012;3:444-58. 10. Jerath R, Edry JW, Barnes VA, Jerath V. Physiology of long pranayamic breathing: Neural respiratory elements may provide a mechanism that explains how slow deep breathing shifts the autonomic nervous system. Med Hypotheses 2006;67:566-71. 11. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr., et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report. JAMA 2003;289:2560-72. 12. Bhargava R, Gogate MG, Mascarenhas JF. Autonomic responses to breath holding and its variations following pranayama. Indian J Physiol Pharmacol 1988;32:257-64. 13. Pal GK, Velkumary S, Madanmohan. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res 2004;120:115-21. 14. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M, et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension 2005;46:714-8. 15. Kaushik RM, Kaushik R, Mahajan SK, Rajesh V. Effects of mental relaxation and slow breathing in essential hypertension. Complement Ther Med 2006;14:120-6. 16. Pinheiro CH, Medeiros RA, Pinheiro DG, Marinho Mde J. Spontaneous respiratory modulation improves cardiovascular control in essential hypertension. Arq Bras Cardiol 2007;88:651-9. 17. Pramanik T, Sharma HO, Mishra S, Mishra A, Prajapati R, Singh S, et al. Immediate effect of slow pace bhastrika pranayama on blood pressure and heart rate. J Altern Complement Med 2009;15:293-5.