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IMRJ-Yoga & Medicine Effects of yoga -pranayama practices on metabolic parameters and anthropometry in type 2 diabetes

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  • Sri Siddhartha Institute of Medical Sciences and Research centre

Abstract

India being the diabetic capital of the world, there is a rise in the incidence of type 2 diabetes with the increase in age, physical inactivity and sedentary lifestyle. So, the present study was undertaken to assess the strength of association of these factors and the effects of yoga-pranayama in type 2 diabetes. We selected 44 uncomplicated type 2 diabetic patients in the age group of 40-55 years with diabetes duration of 1-10 years. They were divided into test group and control groups with 22 patients in each group. The test group (T1 and T2) were taught yoga and pranayama for 3 continuous months, 1 hour every day in the morning by yoga expert. The results showed significant decrease in metabolic parameters, with p < 0.001 in FBS of both the T1 and T2 sub groups [T1-182.87 + 45.55 to 135.77 + 38.88, T 2 – 160.64 + 41.22 to 130.82 + 36.11], PPBS with p< 0.001 [ T1-270.64 + 76.6 to 196.90 + 64.67, T 2 – 230.62 + 71.32 to 183.46 + 52.20], Hb A 1c with p < 0.001 in both the T1 and T2 sub groups, [T1-9.77 + 0.5 % to 7.68 + 0.4% and T 2 – 8.46 + 0.3% to 7.23 + 0.3%]. There was significant decrease with p < 0.001 in triglycerides of both the T1 and T2 sub groups, [T1-170 + 70.55 to 132.2 + 60.6, T 2 – 164 + 80.66 to 1143.1 + 28.89]. There was significant decrease with p < 0.001 in LDL of both the T1 and T2 sub groups [T1-108 + 36.24to 98 + 33.2, T 2 – 101.28 + 32.34 to 86.21 + 27.2]. However, no significant change in HDL levels in test groups (T1 and T2). It also showed significant decrease in weight, BMI and waist-hip ratio in test group. Addition to above benefits there was significant decrease in the requirement of insulin per day in the T2, from 36.42 + 4.2 units to 31.48 + 3.2 units. There were no significant changes in the control group. Thereby concluding that, there are significant benefits of yoga-pranayama practices on metabolic parameters and anthropometric measurements in uncomplicated type 2 diabetes.
International Multidisciplinary Research Journal 2011, 1(10): 01-04
ISSN: 2231-6302
Available Online: http://irjs.info/
IMRJ-Yoga & Medicine
Effects of yoga - pranayama practices on metabolic parameters and anthropometry
in type 2 diabetes
Dr. Balaji P.A. MD, PG [Diab]PGDMLE (NLSIU)1, Dr. Smitha R. Varne BNYS, MD, CFN, (MSc)2, *Dr. Syed Sadat Ali MD,DHHM1
1Assistant Professor, Department of Physiology, DR. B R Ambedkar Medical College, KG Halli, Bangalore -45, India
2Yoga Therapist and Nutrition Consultant, Healing Touch Yoga Centre, #13/1, Saunders Road, Near Coles Park , Frazer Town,
Bangalore-5, India
Abstract
India being the diabetic capital of the world, there is a rise in the incidence of type 2 diabetes with the increase in age,
physical inactivity and sedentary lifestyle. So, the present study was undertaken to assess the strength of association of
these factors and the effects of yoga-pranayama in type 2 diabetes. We selected 44 uncomplicated type 2 diabetic patients
in the age group of 40-55 years with diabetes duration of 1-10 years. They were divided into test group and control groups
with 22 patients in each group. The test group (T1 and T2) were taught yoga and pranayama for 3 continuous months, 1
hour every day in the morning by yoga expert. The results showed significant decrease in metabolic parameters, with p <
0.001 in FBS of both the T1 and T2 sub groups [T1- 182.87 + 45.55 to 135.77 + 38.88, T 2 – 160.64 + 41.22 to 130.82 +
36.11], PPBS with p< 0.001 [ T1- 270.64 + 76.6 to 196.90 + 64.67, T 2 – 230.62 + 71.32 to 183.46 + 52.20], Hb A 1c with p
< 0.001 in both the T1 and T2 sub groups, [T1- 9.77 + 0.5 % to 7.68 + 0.4% and T 2 – 8.46 + 0.3% to 7.23 + 0.3%]. There
was significant decrease with p < 0.001 in triglycerides of both the T1 and T2 sub groups, [T1- 170 + 70.55 to 132.2 + 60.6, T
2 – 164 + 80.66 to 1143.1 + 28.89]. There was significant decrease with p < 0.001 in LDL of both the T1 and T2 sub groups
[T1- 108 + 36.24to 98 + 33.2, T 2 – 101.28 + 32.34 to 86.21 + 27.2]. However, no significant change in HDL levels in test
groups (T1 and T2). It also showed significant decrease in weight, BMI and waist- hip ratio in test group. Addition to above
benefits there was significant decrease in the requirement of insulin per day in the T2, from 36.42 + 4.2 units to 31.48 + 3.2
units. There were no significant changes in the control group. Thereby concluding that, there are significant benefits of yoga-
pranayama practices on metabolic parameters and anthropometric measurements in uncomplicated type 2 diabetes.
Keywords: Yoga, Pranayama, Diabetes, Glycosylated hemoglobin
Abbreviations Used: FBS: fasting blood sugar, PPBS: post prandial blood sugar, HbA1C: glycosylated hemoglobin, LDL:
low density lipoprotein, HDL: high density lipoprotein, TG: triglycerides, TC: total cholesterol, SD: standard deviation, ANOVA:
analysis of variance, BMI: body mass index, OHA: oral hypoglycemic agents
INTRODUCTION
Diabetes is a complex metabolic syndrome with absolute or
relative deficiency or inefficiency of insulin. [1] In type 2 diabetes,
most patients are obese when they develop diabetes and the obesity
is becoming a major health hazard worldwide. The incidence of type
2 diabetes is also increasing with the increase in age, physical
inactivity and sedentary lifestyle. Its strong familial predisposition
makes the situation even worse with the result that children and
adolescents now present with juvenile diabetes. [2, 3, 4]
For many physically inactive people who are overweight, any
kind of physical activity appears difficult, and this often prevents
people who are obese from initiating and adhering to a specific form
of physical activity. [5] The ancient Indian science of yoga is a way of
life which includes changes in mental attitude, diet, and the practice
of specific techniques such as yoga postures (asanas), breathing
practices (pranayamas), and meditation. [6] Among different yoga
techniques, breathing practices (pranayamas) can be performed
while seated, and are less challenging for people who are physically
inactive.[7] Yoga has proven its efficacy in the improvement of
oxidative stress as well as in improving the glycemic status of
diabetics through neuroendocrinal mechanisms.[8] This study was
under taken to see the effects of 3 months of yoga-pranayama
practices on metabolic parameters like FBS, PPBS, Hb A1c, lipid
profile and anthropometric measurements like weight, BMI, Waist-hip
ratio in uncomplicated type 2 diabetes patients. Also we tested any
effect on modification of daily dosage of insulin.
METHODS
The study was conducted from January to March 2011 in
Department of Physiology, Dr. B R Ambedkar Medical College,
Received: July 19, 2011; Revised September 18, 2011; Accepted September 18,
2011.
*Corresponding Author
Dr. Syed Sadat Ali
Assistant Professor, Dept of Physiology, Dr. B R Ambedkar Medical College,
Kadugondana Halli, Bangalore – 45, India
Tel: +91 9964318714 (Mob)
Email: drsadatali@gmail.com
Dr. Balaji P.A et al.
2
Kadugondana Halli, Bangalore and Healing touch Yoga Centre,
Bangalore. Ethical clearance was obtained from institutional ethics
committee, Dr. B R Ambedkar Medical College, Kadugondana Halli,
Bangalore. After taking consent, 44 type 2 diabetic patients were
selected in the age group of 40-55 years with diabetes duration 1-10
years. Patients with features of micro and macro vascular
complications of diabetes were excluded. They were divided into test
group (who underwent yoga practice) and control group (who did not
undergo any yoga practice). The test group consisting of 22 patients
was further divided into 2 sub group T1 and T2. T1 group consisting
of 16 patients were on oral drugs only whereas T2 group consisting 6
patients were on oral drugs and insulin. The test groups were taught
yoga and pranayama for 3 continuous months, 1 hour every day in
the morning between 7.00 am and 8.00 am by yoga expert. The
control group involved 22 patients and were on treatment did not
undergo any yoga practice. Both the test and control groups were
asked to continue same medications throughout the study period.
Blood samples for FBS, PPBS, Hb A1c, lipid profile and
anthropometric measurements like weight, BMI, Waist-hip ratio were
estimated before the starting and at the end of the study period. The
data obtained was analyzed using appropriate statistical methods
like SD, ANOVA, t-test for paired data etc.
Name and duration of various pranayamas & yogaasanas
included in yogic practice
Pranayama
1. Bhastrika- pranayama, 3-5 mins per day
2. Kapal- bhati, 5-7mins per day
3. Anulom-viloma, 5-10 mins per day
4. Bhramari, 5 times a day
5. Udgit-Om Uccharan, 5 times a day
Yoga-asanas
1. Surya namakar, 3-7 turns of each, the pose being maintained
for ten seconds adding each turn, every fortnight
2. Tadasana, ¼ minute to one minute for adding ¼ minute per
week.
3. Trikona-asana, ¼ minute to one minute for each side, adding
¼ minute per week
4. Pashimottanasana, ¼ minute to one minute adding ¼ minute
per week
5. Bhujangasana, 3-7 turns of each, the pose being maintained
for ten seconds adding one turn each, every fortnight
6. Vajrasana, ¼ min to 1 min adding ¼ min per week
7. Shalabasana, ¼ min to 1 min adding ¼ min per week
8. Shavasana, 2- 5 minutes, adding 1 minute per week
RESULTS
Table 1: Metabolic parameters in Type 2 diabetes patients of test group and control group
Test group Control group
Parameters T1 (Only on OHA’s)
T2 (On OHA’s + Insulin)
Before
A
fter 3 months Before
A
fter 3 months
Before
A
fter 3 months
FBS 182.87 ± 45.55 135.77± 38.88* 160.64 ± 41.22
130.82 ± 36.11*
174.52 ± 34.91 169.40 ± 38.32
PPBS 270.64 ± 76.6 196.90 ± 64.67 230.62 ± 71.32
183.46 ± 52.20*
262.27 ± 51.53 260.43 ± 50.22
HBA1c 9.75 ± 0.59 7.68 ± 0.4* 8.46 ± 0.3
7.23 ± 0.3*
10.46 ± 0.2 9.67 ± 0.3%
TC 178.90 ± 42.2 162.18 ± 32.34 162.32 ± 32.33
154 ± 31.78
187.4 ± 44.46 182.86 ± 42.66
Triglycerides 170 ± 70.55 132.2 ± 60.6* 164 ± 80.66
143.1 ± 28.89*
176 ± 72.62 172 ± 71.66
LDL 108 ±36.24 98 ± 33.2* 101.28 ± 32.34
86.21 ± 27.2*
111.28 ± 36.64 110.21
± 35.26
HDL 38.2 ± 4.86 38.3 ± 5.2 39.51 ± 3.88
39.59 ± 4.02
36.2 ± 4.25 36.4 ± 4.33
Requirement of
Insulin/day 36.42 ± 4.2
31.48 ± 3.2*
*P<0.001, TC= Total cholesterol, OHA’s = Oral Hypoglycemic agents
Table 2: Anthropometric measurements in test and control group
Test group Control group
T1 T2
Parameters Before
A
fter 3 months Before
A
fter 3 months
Before
A
fter 3 months
Weight 66.20 ± 4.45 61.60 ± 4.46* 64.20 ± 4.45
61.62 ± 4.42*
68.83 ± 4.27 63.92 ± 4.89
BMI 27.86 ± 1.54 24.98 ± 1.52* 26.86 ± 1.46
24.84 ± 1.48*
25.84 ± 1.76 26.02± 2.43
Waist hip ratio 0.91 ± 0.09 0.83 ± 0.07* 0.89 ± 0.08
0.81 ± 0.06*
0.90 ± 0.09 0.91 ± 0.09
*P<0.001
Table 1 shows that there is significant decrease in FBS, PPBS
and HbA1c of both the T1 and T2 sub groups with p < 0.001.
Similar significant change in triglycerides and LDL of both the T1 and
T2 sub groups with p < 0.001 was seen. There was no significant
change in HDL levels both in test groups T1 and T2. There was no
significant change in all the parameters of the control group. The
requirement of insulin in the test group 2(T2) was significantly
reduced after the yoga for 3months.
Table 2 indicates a significant decrease in the weight, BMI and
waist- hip ratio in both T1 and T2 with p < 0.001. Such a significant
change in the control group was not found.
DISCUSSION
In the present study there was significant decrease in FBS,
PPBS values in both the sub groups T 1 and T2 who underwent the
3 months yoga and pranayama practice. Similar findings were found
by Malhotra [9], Savita s [10], Upadhyay VK [11]. The exact
mechanisms of actions of yoga-asanas and pranayama in
decreasing the blood sugar are still unknown. The possible
mechanisms are a) direct rejuvenation/ regeneration of cells of
pancreas due to abdominal stretching during yoga exercise, which
may increase utilization and metabolism of glucose in peripheral
tissues, liver and adipose tissues through enzymatic process.[12, 13,
14] b) More active practices followed by relaxing ones lead to deeper
International Multidisciplinary Research Journal 2011, 1(10): 01-04
3
relaxation than relaxing practices alone, documented by research
from swami Vivekananda yoga research foundation near Bangalore
city and possibility of neuroplasticity bringing about changes in the
hypo-pituitary-pancreatic axis.[15] c) Muscular relaxation,
development and improved blood supply to muscles might enhance
insulin receptor expression on muscles causing increased glucose
uptake by muscles and thus reducing blood sugar.[16]
There was significant decrease in the total cholesterol,
triglycerides and LDL levels. Similar observations were found by
Malhotra [9], Savita S [10], Vanish K Upadhyay [11] and Sahay [17]
and Bijlani [18] reported a significant reduction in free fatty acids,
LDL, VLDL and an increase in HDL. The improvement in the lipid
profile after yoga could be due to increased hepatic lipase and
lipoprotein lipase at cellular level, which affects the metabolism of
lipoprotein and thus increase uptake of triglycerides by adipose
tissues [19, 20]. There was no significant change in HDL levels in the
present study. Similarly in a study conducted in Haridwar, India by
Shirley T [21] to see the effects of Short term health impact of a yoga
and diet change program on obesity found that there was decrease
in the HDL levels which is not a favourable outcome. They reasoned
that the decrease in HDL levels may more likely be due to a change
in diet (with a decrease in saturated and monounsaturated fat and
animal-source protein) rather than related to the practice of
yoga. There was significant decrease in weight, BMI and waist-hip
ratio. Similar findings were observed by Sahay [17] and Shirley T
[21]. Also there was decrease in the HbA1c %. Similar findings was
observed by Sahay.[17] Another important observation was that the
insulin dose requirement per day in T2 significantly decreased.
Similarly Sahay [17] and Savita S[10] reported a decrease in the
drug requirements by some of the patients. Jain [22] also found that
there was significant reduction in hyperglycemia with decrease in
oral hypoglycemic drugs for maintenance of normoglycemia in
response to yoga therapy. All the above beneficial effects suggest
improvement in the insulin sensitivity following yogic exercises.
Addition to all above effects, following yoga-asanas and
pranayamas, many patients reported a feeling of well being, more
relaxed and satisfied, and a sense of relief from anxiety. They were
more alert and active which could be due to release of opioids and
altered adrenocortical activity. Yoga-asanas with its change in
posture and controlled breathing in pranayama influences mental
status of an individual allaying apprehension, stress and brings about
feelings of well being and hormonal balance. Concordant findings
were observed by Shirley T [21] and Udupa KN. [23]
Limitations
1. The numbers of patients involved were less.
2. Effect of diet modifications were not considered and assessed.
3. The parameters were taken only twice – Once, at the time of
start and other at the end of 3 months, therefore the trend of
reduction cannot be commented upon.
CONCLUSIONS
There are significant benefits of yoga- pranayama practices on
metabolic parameters and anthropometric measurements in
uncomplicated type 2 diabetic patients. Effects on HDL levels
remained unexplainable. However, further research on effects of
long term yoga-pranayama practices in diabetic patients need to be
studied.
ACKNOWLEDGMENTS
Dr. Stanley John, Principal, DR. B R Ambedkar Medical
College, KG Halli, Bangalore -45, India.
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... There are additional studies showing beneficial effects of Yoga on FBS [48], PPBS [49][50][51], HbA1c [50,51], total cholesterol, LDL [50,51]. The analysis of the yoga protocols used in above said studies reveal the incorporation of some common and important postures in DYP, which seem to be important in managing the disease. ...
... There are additional studies showing beneficial effects of Yoga on FBS [48], PPBS [49][50][51], HbA1c [50,51], total cholesterol, LDL [50,51]. The analysis of the yoga protocols used in above said studies reveal the incorporation of some common and important postures in DYP, which seem to be important in managing the disease. ...
... There are additional studies showing beneficial effects of Yoga on FBS [48], PPBS [49][50][51], HbA1c [50,51], total cholesterol, LDL [50,51]. The analysis of the yoga protocols used in above said studies reveal the incorporation of some common and important postures in DYP, which seem to be important in managing the disease. ...
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Research findings on biochemical responsivity to meditation are reviewed. Although there are some contradictory and inconclusive outcomes, there is nevertheless sufficient evidence of interest to warrant further investigation of this area. However, in the meantime, there is no compelling basis to conclude that meditation practice is associated with special state or trait effects at the biochemical level.
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Changes in blood glucose and glucose tolerance by oral glucose tolerance test (OGTT) after 40 days of yoga therapy in 149 non-insulin-dependent diabetics (NIDDM) were investigated. The response to yoga in these subjects was categorized according to a severity scale index (SSI) based on area index total (AIT) under OGTT curve. One hundred and four patients showed a fair to good response to the yoga therapy. There was a significant reduction in hyperglycemia and AIT with decrease in oral hypoglycemia and AIT with decrease in oral hypoglycemic drugs required for maintenance of normoglycemia. It is concluded that yoga, a simple and economical therapy, may be considered a beneficial adjuvant for NIDDM patients.
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