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Yoga & Respiratory
Disorders
Yogacharya
Dr. ANANDA BALAYOGI BHAVANANI
MBBS, ADY, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT, DSc (Yoga)
Director
Centre for Yoga Therapy, Education and Research (CYTER),
Sri Balaji Vidyapeeth, Puducherry. www. sbvu.ac.in/cyter
SRI BALAJI VIDYAPEETH
(Deemed University Accredited with “A” Grade by NAAC)
Ranked 88 in NIRF 2020
Centre for Yoga Therapy, Education
and Research (CYTER)
Salutogenesis, our focus!
Salutogenesis, our Focus
 Moving from pathogenesis, the focus on disease
towards salutogenesis, the focus on health!
 CYTER is striding forward on an innovative path of
promoting holistic health for one and all.
Pathogenesis
Salutogenesis
Yoga places great importance on a proper and healthy
lifestyle whose main components are:
 ACHAR – healthy physical activities & exercise
 VICHAR – right thoughts and right attitude towards
life that are vital for wellbeing.
 AHAR – healthy, nourishing diet with adequate intake
of fresh water; balanced intake of fresh food, green
salads, sprouts, unrefined cereals & fresh fruits. Satwic
diet, prepared & served with love & affection.
 VIHAR – proper recreational activities to relax body
and mind are essential for good health.
 VYAVAHAR – healthy relationships for social health
All aspects of human psycho-
physiological functioning improved
When the breath is steady,
emotions become more balanced
When the body is stilled, the mind
starts to calm down
Conscious focus on the present
moment-the NOW
Integration breath pattern with
coordinated smooth body
movements
 The holistic science of Yoga is the best lifestyle ever
designed and is effective in managing non-
communicable lifestyle disorders (Bhavanani, 2013).
 Modern research has focused on psycho-physiological
beneficial effects of Yoga which is more than a mere
physical exercise (Jeter et al, 2015).
 Scientific basis of using Yoga as adjunct therapy in
COPD is well established with significant improvements
in lung function, quality of life indices and bronchial
provocation responses coupled with decreased regular
& rescue medicines (Nagarathna 1985; Vempati , 2009).
 Behera reported perceptible improvement in dyspnoea
&lung function in patients of bronchitis after 4 weeks
Yoga therapy with postures & breathing techniques
(Behera, 1998).
Proposed relationships among dyspnea, benefits of yoga,
and outcomes of participation in a yoga program.
Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V. Yoga Therapy Decreases Dyspnea-Related Distress and Improves Functional
Performance in People with Chronic Obstructive Pulmonary Disease: A Pilot Study. J Altern Complement Med 2009; 15: 225–234.
Mechanisms and
Correlates of Dyspnea
Proposed Benefits of
Yoga Training Proposed Outcomes
of Yoga Training
Hyperinflation
Hyperventilation
Hypoxemia
Hypercapnea
 Work of breathing
Respiratory muscle
weakness
Deconditioning
Depression
Anxiety
Fatigue
 Respiratory rate
 Airway resistance
 Respiratory muscle
strength
 Autonomic arousal
 Heart rate  HRV
 Depression
 Anxiety
 Panic Attacks
 Confidence in control
of breathing process
 Muscle strength
 Balance
 Coordination
 Flexibility
 Dyspnea
 Dyspnea – related
distress
 Depression
 Anxiety
HR
 QoL
 Physical
performance
 Yogic cleaning techniques such as dhauti kriya (upper
GI cleaning with warm saline or muslin cloth) and
neti kriya (warm saline nasal wash) remove excessive
mucous secretions, decrease inflammation & reduce
bronchial hypersensitivity thereby increasing
provocation threshold while kapalabhati through
forceful exhalations improves the capacity to exhale
against resistance (Satyaprabha, 2001).
 A nonspecific broncho-protective or broncho-
relaxing effect has been also postulated (Singh, 1987)
while
 Improved exercise tolerance reported following Yoga
therapy in patients of chronic severe airways
obstruction (Tandon, 1978).
 It has been reported that well-performed slow
yogic breathing maintains better blood
oxygenation without increasing minute
ventilation,
 reduces sympathetic activation during
altitude-induced hypoxia (Bernardi et al, 2001) and
 decreased chemoreflex sensitivity to hypoxia
and hypercapnia (Spicuzza et al, 2000).
 Asthmatic patients showed a statistically significant
improvement in Transfer factor of the lung for
carbon monoxide (TLCO), forced vital capacity (FVC),
forced expiratory volume in 1st sec (FEV1), peak
expiratory flow rate (PEFR), maximum voluntary
ventilation (MVV) and slow vital capacity (SVC) after
2 months Yoga practice. (Singh et al, 2012)
 Quality of life also increased significantly.
 It was concluded that pranayama and Yoga postures
may be used to increase respiratory stamina, relax
the chest muscles, expand the lungs, raise energy
levels, and calm the body. (Singh et al, 2012)
 A study to assess beneficial effects of Yoga in
exercise-induced broncho-constriction in children
aged 7-16y reported that all exercise-response-
positive asthmatics became exercise response-
negative asthmatics after 3 months of bi-weekly
Yoga training (Tahan et al, 2014).
 It was recommended that Yoga training can
supplement drug therapy to achieve better control
of asthma in children.
META-ANALYSIS ON YOGA & COPD (2019)
 To determine the effectiveness and safety of yoga
interventions on disease symptoms, quality of life
and function in patients diagnosed with chronic
obstructive pulmonary disease (COPD).
 This meta-analysis found robust effects of yoga on
exercise capacity and pulmonary function in patients
with COPD. Yoga, specifically yoga breathing
techniques, can be an effective adjunct intervention
for patients with COPD. Yoga's safety needs to be
assessed in more depth in future studies.
Cramer H, Haller H, Klose P, Ward L, Chung VC, Lauche R. The risks & benefits of yoga for patients with chronic
obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 ; 33 : 1847-62.
Deep breathing is economical *
Normal Shallow Deep
Volume (ml) 500 200 1000
Rate/min 12 30 6
Ventilation (ml) 6000 6000 6000
Dead space (ml) 150 150 150
Dead space V (ml) 1800 4500 900
Alveolar V (ml) 4200 1500 5100
* Prof Madanmohan, Director Centre for Yoga Sciences, AVMC, Pondicherry
Deep breathing is economical *
Normal Shallow Deep
Volume (ml) 500 200 1000
Rate/min 12 30 6
Ventilation (ml) 6000 6000 6000
Dead space (ml) 150 150 150
Dead space V (ml) 1800 4500 900
Alveolar V (ml) 4200 1500 5100
* Prof Madanmohan, Director CYTER and Head Department of Physiology, MGMC & RI
Sarvanga Asana &
variations
Bala Asana
Meru Asana
Padhasta Asana
Chant Your Way To
Healthy Sinuses
 Chanting creates sound vibrations encouraging air
to move back & forth between sinus membranes
and nasal passages.
 This helps open the tiny ducts connecting the nose
to the sinuses, allowing the sinuses to drain
properly.
 Sinuses are effectively ventilated by humming.
 Previous research has shown that poor sinus
ventilation increases the risk for sinusitis.
 Daily humming or "Om" chanting may prevent
infections from actually taking hold, according to
Jon Lundberg and Eddie Weitzberg of the
Karolinska Institute, Sweden.
 They found that humming increased nitric oxide
levels fifteenfold, compared to quiet exhalations
without sound.
 The exhalations of people with healthy sinuses
tend to have high nitric oxide levels, indicating
that more air is able to flow between the sinuses
and the nose.
 Nada Pranayamas of Yoga such as Bhramari and
the Pranava are similar to the humming used in
the study.
 Vowel sounds are useful in sleep apnea!
Neti: The Yogic Nasal
Cleansing Technique
Types of Neti:
 Jala Neti -Nasal irrigation with lukewarm saline
 Sutra Neti -cleaning with a thread or catheter
 Dugdha Neti -Nasal irrigation with milk
 Ghrta Neti -Nasal irrigation with melted ghee
 Jala Kapalabhati
 Vyutkrama Kapalabhati
 Seetkrama Kapalabhati
Benefits of Neti Kriya
 Removes mucus and dust particles from the nasal
passages and the sinuses.
 All the five Jnanendriyas are purified, cleansed and
activated by Neti Kriya
 Excellent preventive against cold, cough, sinusitis
and infections of the respiratory tract.
 Neti also renders the nose resistant to irritants like
water, cotton, rubber, ghee, milk and thus helps in
hypersensitivity eg. Allergic Rhinitis.
 Helps to overcome addictions especially to
tobacco and alcohol.
Nasal irrigation
 Hypertonic nasal irrigation is a therapy that
flushes the nasal cavity with saline solution,
facilitating a wash of the structures within.
 Originally part of the Yogic tradition as Neti, this
technique is anecdotally regarded as safe and
effective.
 It has been suggested as adjunctive therapy for
sinusitis related symptoms.
 Potential efficacy is supported by the observation
that hypertonic saline improves mucociliary
clearance, ciliary beat frequency thins mucus, and
may decrease inflammation.
 David Shoseyov and colleagues have shown that
hypertonic saline improves both clinical scores and
plain Waters’ projection radiology scores in
children with chronic sinusitis.
 They have also commented that the treatment is
tolerable, inexpensive, and effective.
 Dr. Marple, professor of otolaryngology at the
University of Texas says that saline nasal irrigation
is a highly effective, minimally invasive
intervention for people suffering from nasal issues.
 He however adds, “But it’s just not as sexy to talk
about. People want to hear about surgery or
antibiotics.”
 David Rabago and colleagues at the University of
Wisconsin have shown that daily hypertonic saline
nasal irrigation improves sinus-related quality of
life, decreases symptoms, and decreases
medication use in patients with frequent sinusitis.
 They also recommended that primary care
physicians can feel comfortable recommending
this therapy.
Kunjal Kriya
 One of the Shat Karmas
 Immense value for mucous (Kapha) disorders
 Done in the morning on an empty stomach.
 One or two litres of lukewarm saline drunk rapidly
 Abdomen churned with Nauli Kriya or Agnisara
 Induce vomiting with fingers
 Mechanism: Close functional relationship between
upper GIT and airways with reflex action in nerves
supplying both esophagus and bronchi.
Breath-body harmonizing practices
 Tala and Ardhakati kriyas
 Nasarga Mukha Bhastrika
 with Jathis
 in Meru Asana
 in Ushtra Asana
 Vyagraha Pranayama
 Pawan Mukta Kriya
 Bhujangini Mudra
Surya Namaskar
 Ancient Yogic method of worshiping the sun
through a sequence of 12 postures that streamline
the functioning of all systems of the human body.
 Includes a breath sequence & chanting
 Helps improve all aspects of physical fitness
including cardio-respiratory efficiency.
 When done with the Surya Namaskar Mantras it
has the added benefits of ventilating the sinuses.
 Helps develop breath-body movement
coordination - corrects psychosomatic disorders by
reuniting the body and mind through the breath.
Postures done from Standing
Meru Asana
Ardha Kati Chakrasana
Postures done
from Sitting
Ushtra Asana
Ardha
Matsyendrasana
Chatus Pada Asana and Vyagrah Pranayama
Postures done from lying Down
Bhujanga Asana
Matsya Asana
Bala Asana
Pawan Mukta Asanas
Vibhaga Pranayama
Adham Pranayama
Low Chest Breathing
Madhyam Pranayama
Mid Chest Breathing
Adhyam Pranayama
Upper Chest Breathing
Mahat Yoga Pranayama
Integrated Complete Breath
Pranayamas
 Bhastrika Pranayama
 Bellows breathing
 Surya Bhedana
 Breathe in right and
out left nostril
 Pranava Pranayama
 Chanting Akara,
Ukara, Makara and
Omkara
 Anu Nasika Pranayama
 Blasting out through the
nostrils in a specific
pattern
 Kukkriya Pranayama
 Dog pant breathing
 Bhramari Pranayama
 Bee sound breathing
HATHENAS
Asanas, Kriyas and Mudras
to mindfully utilize all parts of the lungs
by consciously forcing air
into all of the
bronco-pulmonary segments.
“Yatho mana, tatha prana”
Where the mind goes, there the energy flows!
Adhama (low lung areas)
Madhyama (mid lung areas)
Adhyama
(high lung areas)
Mahat Yoga
(unified lung areas)
HATHENAS
Vibhaga
Pranayama
 Adham Pranayama
 abdominal and lower limb disorders
 Madhyam Pranayama
 chest and upper limb disorders
 Adhyam Pranayama
 head and neck disorders
 Mahat Yoga Pranayama
 affects the whole body
Focusing consciousness into broncho-pulmonary segments
Pranava Pranayama
 Using foundation of Vibhaga
 Chanting Akara, Ukara, Makara and
Omkara Nada
 2 to 3 times longer exhalations
 Appropriate hand gestures (Mudras)
Adham Pranayama
“A”
Breathing Part of Body Part of Brain
Lower Chest Lower Reptilian complex
Madhyam Pranayama
“U”
Breathing Part of Body Part of Brain
Mid Chest Mid Mammalian complex
Adhyam Pranayama
“M”
Breathing Part of Body Part of Brain
Upper Chest Upper Neo-cortex
Pranava AUM Pranayama
“AUM”
Breathing Part of Body Part of Brain
Whole Chest Whole Body Whole Brain
Relaxation
Makara Asana
Shpanda Nishpanda Kriya
Kaya
Kriya
Nada Yoga techniques
 Nasarga mukha bhastrika
 Hakara kriya
 Kukkriya pranayama
 Simha nada
 Bhramari pranayama
 Brahma mudra
 Pranava pranayama and dhyana
An Integrated Approach
 The need of the modern age is an integrated
approach towards therapy utilizing Yoga in
coordination & collaboration with other systems of
medicine such as Allopathy, Ayurveda, Siddha and
Naturopathy
 Physiotherapy, osteopathy and chiropractic practices
may be used with the Yoga if needed
 Advise on diet and life style is very important
 Adoption of right attitudes through Yogic counseling
Recent research on Yoga and
COPD from CYTER
Comparison of delta changes in lung function in adjuvant
yoga therapy group and control (medication alone) group
before and after the four weeks study period.
***p<0.001 by Student’s unpaired ‘t’ test for inter group comparison.
-0.5
-0.4
-0.3
-0.2
-0.1
0
0.1
0.2
0.3
0.4
0.5
0.6
FEV1 FVC FEV1/FVC
***
***
*p<0.05, **p<0.01 & ***p<0.001 by Student’s unpaired ‘t’ test for inter group comparison.
-35.00
-30.00
-25.00
-20.00
-15.00
-10.00
-5.00
0.00
5.00
10.00
15.00
SS AS IS QS
Comparison of delta in symptoms, activities, impact & total
SGRQ scores in adjuvant yoga therapy and control (medication
alone) groups before & after 4 weeks study period.
***
***
**
*
SS – symptoms score, AS – activity score, IS – impacts score, QS – quality score (total)
RCT ON EFFECTIVENESS OF ADJUVANT YOGA
THERAPY IN DIABETIC LUNG
 72 DM patients with lung function less than 70% randomized
to either Yoga /Control group. Both groups received standard
medical care in the form of individualized drug therapy.
 Patients in Yoga group underwent 3 supervised Yoga therapy
sessions per week for 4 months. Hathenas were main focus.
 Significant reduction in weight & BMI in Yoga group
 Reduction in fasting & postprandial blood sugar levels with a
long-term benefit of reduction in HbA1c
 Improvement in pulmonary functions (FEV1 & FVC)
 Reductions in blood urea & serum creatinine levels indicating
that Yoga may delay onset and progression of nephropathy.
 Adjuvant Yoga therapy offers many benefits to patients of DM
while controls deteriorated despite medical Rx.
 Which patients tend to respond to integrative medicine
interventions? (Kligler et al, 2012).
 Responders demonstrated an attitude of "change as
challenge;" a view of themselves as "independent" and
"leaders;" an ability to accept one's illness while still
maintaining a feeling of control over one's choices; a
connection to the deeper context or meaning of
complementary and alternative medicine (CAM) interventions,
as opposed to just "previous experience" of CAM; and a sense
of determination, commitment, and "willingness to fight" for
what one needs from the health care system.
 Non-responders were more often uncertain and anxious in
their relationship to their asthma, tending to fall back on
denial, and lacking a connection to the deeper context or
philosophy of CAM interventions.
 All of these mechanisms can help bring about
both objective and subjective improvements in
the condition of patients with respiratory
disorders.
 Yoga as a therapy is also cost effective, relatively
simple and carries minimal risk
 Should be advocated as an adjunct,
complementary therapy in our search for an
integrated system of medicine capable of
producing health and well being for all.
In Conclusion..
 However all this optimism needs to be tempered with
the negative findings from a recent systematic review
and meta-analysis that reviewed 14 RCTs with 824
patients (Cramer et al, 2014).
 They concluded that there was no evidence for effects
of Yoga compared with sham Yoga or breathing
exercises and that no effect was robust against all
potential sources of bias.
 They ended by saying, "Yoga cannot be considered a
routine intervention for asthmatic patients at this
point. It can be considered an ancillary intervention or
an alternative to breathing exercises for asthma
patients interested in complementary interventions."
Some final words…….
 The ancient art and science of Yoga has infinite
possibilities of solutions for the health related issues
faced by modern humankind.
 We however want it to be a miracle pill, that we take
only once - immediate solution to all problems!
 Yoga is a w-holistic science and must be learnt and
practiced with a holistic view.
 The dedicated practice of Yoga as a way of life is no
doubt a panacea for psychosomatic, stress related
disorders helping us to regain our birthright of
natural health and universal happiness.
 The integration of Yoga and modern medicine can
help create a healthier and happier world.
Gratitude
is the
highest
attitude.
SRI BALAJI VIDYAPEETH
(Deemed University Accredited with
“A” Grade by NAAC and Ranked 88 in NIRF 2020 )
www.sbvu.ac.in/cyter
References:
 Artchoudane S, Ranganadin P, Bhavanani AB, Ramanathan M, Trakroo M. Effect of Adjuvant Yoga Therapy on Pulmonary
Function and Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease: A Randomized Control Trial. J
Basic Clin Appl Health Sci. 2018; 2(3):117-22.
 Balaji R, Ramanathan M, Bhavanani AB, Ranganadin P, Balachandran K. Effectiveness of adjuvant yoga therapy in
diabetic lung: A randomized control trial. Int J Yoga 2019;12:96-102.
 Behera D. Yoga therapy in chronic bronchitis. J Assoc Physicians India 1998; 46: 207-8.
 Bernardi L, Passino C, Wilmerding Vetal. Breathing patterns and cardiovascular autonomic modulation during hypoxia
induced by simulated altitude. J Hypertens 2001; 19 : 947-58
 Bhavanani AB. Yoga Chikitsa: The application of Yoga as a therapy. Pondicherry, India: Dhivyananda Creations, 2013.
 Cramer H, Haller H, Klose P, Ward L, Chung VC, Lauche R. The risks & benefits of yoga for patients with chronic
obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 ; 33 : 1847-62.
 Cramer H, Posadzki P, Dobos G, Langhorst J. Yoga for asthma: a systematic review and meta-analysis. Ann Allergy
Asthma Immunol 2014;112(6):503-510.
 Jeter PE, Slutsky J, Singh N, Khalsa SB. Yoga as a therapeutic intervention: A bibliometric analysis of published research
studies from 1967 to 2013. J Altern Complement Med. 2015;21:586–92.
 Kligler B, McKee MD, Sackett E, Levenson H, Kenney J, Karasz A. An integrative medicine approach to asthma: who
responds? J Altern Complement Med 2012; 18 (10): 939-45.
 Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. BMJ 1985; 291: 1077-79.
 Satyaprabha TN, Murthy H, Murthy BTC. Efficacy of naturopathy and Yoga in bronchial asthma - a self controlled matched
scientific study. IJPP 2001; 45: 80-6.
 Singh S, Soni R, Singh KP, Tandon OP. Effect of Yoga practices on pulmonary function tests including transfer factor of
lung for carbon monoxide (TLCO) in asthma patients. Indian J Physiol Pharmacol 2012; 56 (1):63-8.
 Singh V. Effect of respiratory exercises on asthma. The Pink City lung exerciser. Journal of Asthma 1987; 24: 355-359.
 Sodhi C, Singh S, Bery A. Assessment of the quality of life in patients with bronchial asthma, before and after Yoga: a
randomised trial. Iran J Allergy Asthma Immunol 2014;13 (1) :55-60.
 Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and chemoreflex response to hypoxia and hypercapnia.
Lancet 2000 ; 356: 1495-96.
 Tahan F, Eke Gungor H, Bicici E. Is Yoga training beneficial for exercise-induced bronchoconstriction? Altern Ther Health
Med 2014;20 (2):18-23.
 Tandon M K. Adjunct treatment with Yoga in chronic severe airways obstruction. Thorax 1978; 33: 514-517
 Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive lifestyle modification programme based on Yoga in the
management of bronchial asthma: a randomized controlled trial. BMC Pulm Med 2009 ; 30; 9:37.

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Yoga and Respiratory Disorders by Dr Ananda

  • 1. Yoga & Respiratory Disorders Yogacharya Dr. ANANDA BALAYOGI BHAVANANI MBBS, ADY, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT, DSc (Yoga) Director Centre for Yoga Therapy, Education and Research (CYTER), Sri Balaji Vidyapeeth, Puducherry. www. sbvu.ac.in/cyter
  • 2.
  • 3. SRI BALAJI VIDYAPEETH (Deemed University Accredited with “A” Grade by NAAC) Ranked 88 in NIRF 2020 Centre for Yoga Therapy, Education and Research (CYTER) Salutogenesis, our focus!
  • 4. Salutogenesis, our Focus  Moving from pathogenesis, the focus on disease towards salutogenesis, the focus on health!  CYTER is striding forward on an innovative path of promoting holistic health for one and all. Pathogenesis Salutogenesis
  • 5.
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  • 7.
  • 8. Yoga places great importance on a proper and healthy lifestyle whose main components are:  ACHAR – healthy physical activities & exercise  VICHAR – right thoughts and right attitude towards life that are vital for wellbeing.  AHAR – healthy, nourishing diet with adequate intake of fresh water; balanced intake of fresh food, green salads, sprouts, unrefined cereals & fresh fruits. Satwic diet, prepared & served with love & affection.  VIHAR – proper recreational activities to relax body and mind are essential for good health.  VYAVAHAR – healthy relationships for social health
  • 9. All aspects of human psycho- physiological functioning improved When the breath is steady, emotions become more balanced When the body is stilled, the mind starts to calm down Conscious focus on the present moment-the NOW Integration breath pattern with coordinated smooth body movements
  • 10.
  • 11.  The holistic science of Yoga is the best lifestyle ever designed and is effective in managing non- communicable lifestyle disorders (Bhavanani, 2013).  Modern research has focused on psycho-physiological beneficial effects of Yoga which is more than a mere physical exercise (Jeter et al, 2015).  Scientific basis of using Yoga as adjunct therapy in COPD is well established with significant improvements in lung function, quality of life indices and bronchial provocation responses coupled with decreased regular & rescue medicines (Nagarathna 1985; Vempati , 2009).  Behera reported perceptible improvement in dyspnoea &lung function in patients of bronchitis after 4 weeks Yoga therapy with postures & breathing techniques (Behera, 1998).
  • 12. Proposed relationships among dyspnea, benefits of yoga, and outcomes of participation in a yoga program. Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V. Yoga Therapy Decreases Dyspnea-Related Distress and Improves Functional Performance in People with Chronic Obstructive Pulmonary Disease: A Pilot Study. J Altern Complement Med 2009; 15: 225–234. Mechanisms and Correlates of Dyspnea Proposed Benefits of Yoga Training Proposed Outcomes of Yoga Training Hyperinflation Hyperventilation Hypoxemia Hypercapnea  Work of breathing Respiratory muscle weakness Deconditioning Depression Anxiety Fatigue  Respiratory rate  Airway resistance  Respiratory muscle strength  Autonomic arousal  Heart rate  HRV  Depression  Anxiety  Panic Attacks  Confidence in control of breathing process  Muscle strength  Balance  Coordination  Flexibility  Dyspnea  Dyspnea – related distress  Depression  Anxiety HR  QoL  Physical performance
  • 13.  Yogic cleaning techniques such as dhauti kriya (upper GI cleaning with warm saline or muslin cloth) and neti kriya (warm saline nasal wash) remove excessive mucous secretions, decrease inflammation & reduce bronchial hypersensitivity thereby increasing provocation threshold while kapalabhati through forceful exhalations improves the capacity to exhale against resistance (Satyaprabha, 2001).  A nonspecific broncho-protective or broncho- relaxing effect has been also postulated (Singh, 1987) while  Improved exercise tolerance reported following Yoga therapy in patients of chronic severe airways obstruction (Tandon, 1978).
  • 14.  It has been reported that well-performed slow yogic breathing maintains better blood oxygenation without increasing minute ventilation,  reduces sympathetic activation during altitude-induced hypoxia (Bernardi et al, 2001) and  decreased chemoreflex sensitivity to hypoxia and hypercapnia (Spicuzza et al, 2000).
  • 15.  Asthmatic patients showed a statistically significant improvement in Transfer factor of the lung for carbon monoxide (TLCO), forced vital capacity (FVC), forced expiratory volume in 1st sec (FEV1), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV) and slow vital capacity (SVC) after 2 months Yoga practice. (Singh et al, 2012)  Quality of life also increased significantly.  It was concluded that pranayama and Yoga postures may be used to increase respiratory stamina, relax the chest muscles, expand the lungs, raise energy levels, and calm the body. (Singh et al, 2012)
  • 16.  A study to assess beneficial effects of Yoga in exercise-induced broncho-constriction in children aged 7-16y reported that all exercise-response- positive asthmatics became exercise response- negative asthmatics after 3 months of bi-weekly Yoga training (Tahan et al, 2014).  It was recommended that Yoga training can supplement drug therapy to achieve better control of asthma in children.
  • 17. META-ANALYSIS ON YOGA & COPD (2019)  To determine the effectiveness and safety of yoga interventions on disease symptoms, quality of life and function in patients diagnosed with chronic obstructive pulmonary disease (COPD).  This meta-analysis found robust effects of yoga on exercise capacity and pulmonary function in patients with COPD. Yoga, specifically yoga breathing techniques, can be an effective adjunct intervention for patients with COPD. Yoga's safety needs to be assessed in more depth in future studies. Cramer H, Haller H, Klose P, Ward L, Chung VC, Lauche R. The risks & benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 ; 33 : 1847-62.
  • 18. Deep breathing is economical * Normal Shallow Deep Volume (ml) 500 200 1000 Rate/min 12 30 6 Ventilation (ml) 6000 6000 6000 Dead space (ml) 150 150 150 Dead space V (ml) 1800 4500 900 Alveolar V (ml) 4200 1500 5100 * Prof Madanmohan, Director Centre for Yoga Sciences, AVMC, Pondicherry
  • 19.
  • 20. Deep breathing is economical * Normal Shallow Deep Volume (ml) 500 200 1000 Rate/min 12 30 6 Ventilation (ml) 6000 6000 6000 Dead space (ml) 150 150 150 Dead space V (ml) 1800 4500 900 Alveolar V (ml) 4200 1500 5100 * Prof Madanmohan, Director CYTER and Head Department of Physiology, MGMC & RI
  • 21.
  • 24. Chant Your Way To Healthy Sinuses  Chanting creates sound vibrations encouraging air to move back & forth between sinus membranes and nasal passages.  This helps open the tiny ducts connecting the nose to the sinuses, allowing the sinuses to drain properly.  Sinuses are effectively ventilated by humming.  Previous research has shown that poor sinus ventilation increases the risk for sinusitis.
  • 25.  Daily humming or "Om" chanting may prevent infections from actually taking hold, according to Jon Lundberg and Eddie Weitzberg of the Karolinska Institute, Sweden.  They found that humming increased nitric oxide levels fifteenfold, compared to quiet exhalations without sound.  The exhalations of people with healthy sinuses tend to have high nitric oxide levels, indicating that more air is able to flow between the sinuses and the nose.  Nada Pranayamas of Yoga such as Bhramari and the Pranava are similar to the humming used in the study.  Vowel sounds are useful in sleep apnea!
  • 26. Neti: The Yogic Nasal Cleansing Technique Types of Neti:  Jala Neti -Nasal irrigation with lukewarm saline  Sutra Neti -cleaning with a thread or catheter  Dugdha Neti -Nasal irrigation with milk  Ghrta Neti -Nasal irrigation with melted ghee  Jala Kapalabhati  Vyutkrama Kapalabhati  Seetkrama Kapalabhati
  • 27. Benefits of Neti Kriya  Removes mucus and dust particles from the nasal passages and the sinuses.  All the five Jnanendriyas are purified, cleansed and activated by Neti Kriya  Excellent preventive against cold, cough, sinusitis and infections of the respiratory tract.  Neti also renders the nose resistant to irritants like water, cotton, rubber, ghee, milk and thus helps in hypersensitivity eg. Allergic Rhinitis.  Helps to overcome addictions especially to tobacco and alcohol.
  • 28. Nasal irrigation  Hypertonic nasal irrigation is a therapy that flushes the nasal cavity with saline solution, facilitating a wash of the structures within.  Originally part of the Yogic tradition as Neti, this technique is anecdotally regarded as safe and effective.  It has been suggested as adjunctive therapy for sinusitis related symptoms.  Potential efficacy is supported by the observation that hypertonic saline improves mucociliary clearance, ciliary beat frequency thins mucus, and may decrease inflammation.
  • 29.  David Shoseyov and colleagues have shown that hypertonic saline improves both clinical scores and plain Waters’ projection radiology scores in children with chronic sinusitis.  They have also commented that the treatment is tolerable, inexpensive, and effective.  Dr. Marple, professor of otolaryngology at the University of Texas says that saline nasal irrigation is a highly effective, minimally invasive intervention for people suffering from nasal issues.  He however adds, “But it’s just not as sexy to talk about. People want to hear about surgery or antibiotics.”
  • 30.  David Rabago and colleagues at the University of Wisconsin have shown that daily hypertonic saline nasal irrigation improves sinus-related quality of life, decreases symptoms, and decreases medication use in patients with frequent sinusitis.  They also recommended that primary care physicians can feel comfortable recommending this therapy.
  • 31. Kunjal Kriya  One of the Shat Karmas  Immense value for mucous (Kapha) disorders  Done in the morning on an empty stomach.  One or two litres of lukewarm saline drunk rapidly  Abdomen churned with Nauli Kriya or Agnisara  Induce vomiting with fingers  Mechanism: Close functional relationship between upper GIT and airways with reflex action in nerves supplying both esophagus and bronchi.
  • 32.
  • 33. Breath-body harmonizing practices  Tala and Ardhakati kriyas  Nasarga Mukha Bhastrika  with Jathis  in Meru Asana  in Ushtra Asana  Vyagraha Pranayama  Pawan Mukta Kriya  Bhujangini Mudra
  • 34. Surya Namaskar  Ancient Yogic method of worshiping the sun through a sequence of 12 postures that streamline the functioning of all systems of the human body.  Includes a breath sequence & chanting  Helps improve all aspects of physical fitness including cardio-respiratory efficiency.  When done with the Surya Namaskar Mantras it has the added benefits of ventilating the sinuses.  Helps develop breath-body movement coordination - corrects psychosomatic disorders by reuniting the body and mind through the breath.
  • 35.
  • 36. Postures done from Standing Meru Asana Ardha Kati Chakrasana
  • 37. Postures done from Sitting Ushtra Asana Ardha Matsyendrasana Chatus Pada Asana and Vyagrah Pranayama
  • 38. Postures done from lying Down Bhujanga Asana Matsya Asana Bala Asana Pawan Mukta Asanas
  • 39. Vibhaga Pranayama Adham Pranayama Low Chest Breathing Madhyam Pranayama Mid Chest Breathing Adhyam Pranayama Upper Chest Breathing Mahat Yoga Pranayama Integrated Complete Breath
  • 40. Pranayamas  Bhastrika Pranayama  Bellows breathing  Surya Bhedana  Breathe in right and out left nostril  Pranava Pranayama  Chanting Akara, Ukara, Makara and Omkara  Anu Nasika Pranayama  Blasting out through the nostrils in a specific pattern  Kukkriya Pranayama  Dog pant breathing  Bhramari Pranayama  Bee sound breathing
  • 41. HATHENAS Asanas, Kriyas and Mudras to mindfully utilize all parts of the lungs by consciously forcing air into all of the bronco-pulmonary segments. “Yatho mana, tatha prana” Where the mind goes, there the energy flows!
  • 42.
  • 43.
  • 44. Adhama (low lung areas) Madhyama (mid lung areas) Adhyama (high lung areas) Mahat Yoga (unified lung areas) HATHENAS
  • 45.
  • 46.
  • 47.
  • 48.
  • 49. Vibhaga Pranayama  Adham Pranayama  abdominal and lower limb disorders  Madhyam Pranayama  chest and upper limb disorders  Adhyam Pranayama  head and neck disorders  Mahat Yoga Pranayama  affects the whole body Focusing consciousness into broncho-pulmonary segments
  • 50. Pranava Pranayama  Using foundation of Vibhaga  Chanting Akara, Ukara, Makara and Omkara Nada  2 to 3 times longer exhalations  Appropriate hand gestures (Mudras)
  • 51. Adham Pranayama “A” Breathing Part of Body Part of Brain Lower Chest Lower Reptilian complex
  • 52. Madhyam Pranayama “U” Breathing Part of Body Part of Brain Mid Chest Mid Mammalian complex
  • 53. Adhyam Pranayama “M” Breathing Part of Body Part of Brain Upper Chest Upper Neo-cortex
  • 54. Pranava AUM Pranayama “AUM” Breathing Part of Body Part of Brain Whole Chest Whole Body Whole Brain
  • 56. Nada Yoga techniques  Nasarga mukha bhastrika  Hakara kriya  Kukkriya pranayama  Simha nada  Bhramari pranayama  Brahma mudra  Pranava pranayama and dhyana
  • 57. An Integrated Approach  The need of the modern age is an integrated approach towards therapy utilizing Yoga in coordination & collaboration with other systems of medicine such as Allopathy, Ayurveda, Siddha and Naturopathy  Physiotherapy, osteopathy and chiropractic practices may be used with the Yoga if needed  Advise on diet and life style is very important  Adoption of right attitudes through Yogic counseling
  • 58. Recent research on Yoga and COPD from CYTER
  • 59. Comparison of delta changes in lung function in adjuvant yoga therapy group and control (medication alone) group before and after the four weeks study period. ***p<0.001 by Student’s unpaired ‘t’ test for inter group comparison. -0.5 -0.4 -0.3 -0.2 -0.1 0 0.1 0.2 0.3 0.4 0.5 0.6 FEV1 FVC FEV1/FVC *** ***
  • 60. *p<0.05, **p<0.01 & ***p<0.001 by Student’s unpaired ‘t’ test for inter group comparison. -35.00 -30.00 -25.00 -20.00 -15.00 -10.00 -5.00 0.00 5.00 10.00 15.00 SS AS IS QS Comparison of delta in symptoms, activities, impact & total SGRQ scores in adjuvant yoga therapy and control (medication alone) groups before & after 4 weeks study period. *** *** ** * SS – symptoms score, AS – activity score, IS – impacts score, QS – quality score (total)
  • 61. RCT ON EFFECTIVENESS OF ADJUVANT YOGA THERAPY IN DIABETIC LUNG  72 DM patients with lung function less than 70% randomized to either Yoga /Control group. Both groups received standard medical care in the form of individualized drug therapy.  Patients in Yoga group underwent 3 supervised Yoga therapy sessions per week for 4 months. Hathenas were main focus.  Significant reduction in weight & BMI in Yoga group  Reduction in fasting & postprandial blood sugar levels with a long-term benefit of reduction in HbA1c  Improvement in pulmonary functions (FEV1 & FVC)  Reductions in blood urea & serum creatinine levels indicating that Yoga may delay onset and progression of nephropathy.  Adjuvant Yoga therapy offers many benefits to patients of DM while controls deteriorated despite medical Rx.
  • 62.  Which patients tend to respond to integrative medicine interventions? (Kligler et al, 2012).  Responders demonstrated an attitude of "change as challenge;" a view of themselves as "independent" and "leaders;" an ability to accept one's illness while still maintaining a feeling of control over one's choices; a connection to the deeper context or meaning of complementary and alternative medicine (CAM) interventions, as opposed to just "previous experience" of CAM; and a sense of determination, commitment, and "willingness to fight" for what one needs from the health care system.  Non-responders were more often uncertain and anxious in their relationship to their asthma, tending to fall back on denial, and lacking a connection to the deeper context or philosophy of CAM interventions.
  • 63.  All of these mechanisms can help bring about both objective and subjective improvements in the condition of patients with respiratory disorders.  Yoga as a therapy is also cost effective, relatively simple and carries minimal risk  Should be advocated as an adjunct, complementary therapy in our search for an integrated system of medicine capable of producing health and well being for all. In Conclusion..
  • 64.  However all this optimism needs to be tempered with the negative findings from a recent systematic review and meta-analysis that reviewed 14 RCTs with 824 patients (Cramer et al, 2014).  They concluded that there was no evidence for effects of Yoga compared with sham Yoga or breathing exercises and that no effect was robust against all potential sources of bias.  They ended by saying, "Yoga cannot be considered a routine intervention for asthmatic patients at this point. It can be considered an ancillary intervention or an alternative to breathing exercises for asthma patients interested in complementary interventions."
  • 65. Some final words…….  The ancient art and science of Yoga has infinite possibilities of solutions for the health related issues faced by modern humankind.  We however want it to be a miracle pill, that we take only once - immediate solution to all problems!  Yoga is a w-holistic science and must be learnt and practiced with a holistic view.  The dedicated practice of Yoga as a way of life is no doubt a panacea for psychosomatic, stress related disorders helping us to regain our birthright of natural health and universal happiness.  The integration of Yoga and modern medicine can help create a healthier and happier world.
  • 66.
  • 68. SRI BALAJI VIDYAPEETH (Deemed University Accredited with “A” Grade by NAAC and Ranked 88 in NIRF 2020 ) www.sbvu.ac.in/cyter
  • 69. References:  Artchoudane S, Ranganadin P, Bhavanani AB, Ramanathan M, Trakroo M. Effect of Adjuvant Yoga Therapy on Pulmonary Function and Quality of Life Among Patients with Chronic Obstructive Pulmonary Disease: A Randomized Control Trial. J Basic Clin Appl Health Sci. 2018; 2(3):117-22.  Balaji R, Ramanathan M, Bhavanani AB, Ranganadin P, Balachandran K. Effectiveness of adjuvant yoga therapy in diabetic lung: A randomized control trial. Int J Yoga 2019;12:96-102.  Behera D. Yoga therapy in chronic bronchitis. J Assoc Physicians India 1998; 46: 207-8.  Bernardi L, Passino C, Wilmerding Vetal. Breathing patterns and cardiovascular autonomic modulation during hypoxia induced by simulated altitude. J Hypertens 2001; 19 : 947-58  Bhavanani AB. Yoga Chikitsa: The application of Yoga as a therapy. Pondicherry, India: Dhivyananda Creations, 2013.  Cramer H, Haller H, Klose P, Ward L, Chung VC, Lauche R. The risks & benefits of yoga for patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Clin Rehabil. 2019 ; 33 : 1847-62.  Cramer H, Posadzki P, Dobos G, Langhorst J. Yoga for asthma: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2014;112(6):503-510.  Jeter PE, Slutsky J, Singh N, Khalsa SB. Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967 to 2013. J Altern Complement Med. 2015;21:586–92.  Kligler B, McKee MD, Sackett E, Levenson H, Kenney J, Karasz A. An integrative medicine approach to asthma: who responds? J Altern Complement Med 2012; 18 (10): 939-45.  Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. BMJ 1985; 291: 1077-79.  Satyaprabha TN, Murthy H, Murthy BTC. Efficacy of naturopathy and Yoga in bronchial asthma - a self controlled matched scientific study. IJPP 2001; 45: 80-6.  Singh S, Soni R, Singh KP, Tandon OP. Effect of Yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Indian J Physiol Pharmacol 2012; 56 (1):63-8.  Singh V. Effect of respiratory exercises on asthma. The Pink City lung exerciser. Journal of Asthma 1987; 24: 355-359.  Sodhi C, Singh S, Bery A. Assessment of the quality of life in patients with bronchial asthma, before and after Yoga: a randomised trial. Iran J Allergy Asthma Immunol 2014;13 (1) :55-60.  Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and chemoreflex response to hypoxia and hypercapnia. Lancet 2000 ; 356: 1495-96.  Tahan F, Eke Gungor H, Bicici E. Is Yoga training beneficial for exercise-induced bronchoconstriction? Altern Ther Health Med 2014;20 (2):18-23.  Tandon M K. Adjunct treatment with Yoga in chronic severe airways obstruction. Thorax 1978; 33: 514-517  Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive lifestyle modification programme based on Yoga in the management of bronchial asthma: a randomized controlled trial. BMC Pulm Med 2009 ; 30; 9:37.