Rhythmic breathing: immunological, biochemical, and physiological effects on health

Abstract

Yoga and breathing techniques have become increasingly popular in recent decades. Sudarshan Kriya (SK) is a type of rhythmic and controlled breathing that involves cyclic breathing in which long breaths are followed by medium and short breaths. Scientific research has been conducted to study the effects of SK on different physiological parameters. Various studies have shown that the technique is simple and cost effective and can be used as a complementary therapy, together with ongoing conventional treatments, to help people suffering from extreme levels of stress, anxiety, and other physical problems. Studies have demonstrated that SK can play an important role in promoting a healthy lifestyle by improving immunity, antioxidant status, hormonal status, and brain functioning. Through available scientific evidence and research, the current article aims to review the complementary role of rhythmic breathing (ie, SK) as a practical and effective tool to alleviate stress, improve health, and increase wellness.

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18 ADVANCES, WINTER 2015, VOL. 29, NO. 1 Sharma—Rhythmic Breathing and Health
Promila Sharma, PhD, is an assistant professor in the
Department of Biotechnology at Graphic Era University
(GEU) in Dehradun, Uttarakhand, India; Ashish
apliyal, PhD, is a professor in the Department of
Biotechnology at GEU; Tribhuwan Chandra, PhD, is an
assistant professor in the Department of Zoology at
Government Post Graduate College in Gopeshwar,
Uttarakhand, India; Saumya Singh, MS, is a junior research
fellow in the Department of Biotechnology at GEU; Himani
Baduni, MS, is a junior research fellow in the Department
of Biotechnology at GEU; and Syed Mohsin Waheed, PhD,
is an associate professor in the Department of Biotechnology
at GEU.
Corresponding author: Promila Sharma, PhD
E-mail address: promilasharma.bt@geu.ac.in
Rhythmic Breathing: Immunological,
Biochemical, and Physiological Eects on Health
Promila Sharma, PhD; Ashish apliyal, PhD; Tribhuwan Chandra, PhD; Saumya Singh, MS;
Himani Baduni, MS; Syed Mohsin Waheed, PhD
ABSTRACT
Yoga and breathing techniques have become increasingly
popular in recent decades. Sudarshan Kriya (SK) is a type
of rhythmic and controlled breathing that involves cyclic
breathing in which long breaths are followed by medium
and short breaths. Scientic research has been conducted
to study the eects of SK on dierent physiological
parameters. Various studies have shown that the technique
is simple and cost eective and can be used as a
complementary therapy, together with ongoing
conventional treatments, to help people suering from
extreme levels of stress, anxiety, and other physical
problems. Studies have demonstrated that SK can play an
important role in promoting a healthy lifestyle by
improving immunity, antioxidant status, hormonal status,
and brain functioning. rough available scientic
evidence and research, the current article aims to review
the complementary role of rhythmic breathing (ie, SK) as
a practical and eective tool to alleviate stress, improve
health, and increase wellness. (Adv Mind Body Med.
2015;29(1):18-25.)
REVIEW ARTICLE
During the last few decades, researchers have shown
an increased interest in the search for complementary
therapies to maintain health through changes in diet
and lifestyle. Yoga is one such process that aects not only
physical health but also mental state. Yoga includes various
asanas, or control of posture, and pranayamas, or breathing
exercises. Yoga is estimated to be a 5000-year-old discipline
originating in India.1
One of the most widely used breathing programs
derived from yoga is Sudarshan Kriya (SK).2 It is a set of
breathing techniques taught by the Art of Living Foundation.
Sudarshan is a Sanskrit word; Su stands for “proper” and
darshan means “vision.” Kriya is a yogic practice that is
meant to purify the body; thus, SK is a simple breathing
technique that harmonizes the body and mind.2 In addition
to breathing techniques, it emphasizes the importance of
prayers, asanas (yoga postures), and meditation.
SK has 4 components. e practitioner’s eyes are kept
closed through all the components. e rst and second
components are done in vajrasana (ie, sitting with the legs
folded and the spine erect). e rst component is a 3-stage
pranayama, with Ujjayi breath and specic arm positions.
Ujjayi is a slow and deep breathing technique, done at the

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ADVANCES, WINTER 2015, VOL. 29. NO. 1 19
Sharma—Rhythmic Breathing and Health
rate of 2 to 4 breaths per minute with a specic ratio of
inhalation, exhalation, and breath holds. e second
breathing component is Bhastrika, done with vigorous and
faster breathing at the rate of approximately 20 to 30
respiratory cycles per minute. Up-and-down arm movements
are used to increase the force of inhalations and exhalations.
Aer Bhastrika, the sitting posture is changed from
vajrasana to sukhasana (ie, sitting with the legs crossed). e
third component is Om chanting in which “Om” is chanted
3 times with prolonged expiration. e fourth and central
component is the healing breath technique. It involves
3 rounds of an exercise that uses cyclical breathing with slow,
medium, and fast rates in succession. In each round, slow
breaths are approximately 20 respiratory cycles per minute;
medium breaths are approximately 40 to 50 respiratory
cycles per minute; and fast breathing is approximately 60 to
80 cycles per minute. is breathing pattern is rotated during
SK in the above-described specic order.3,4
SK has many physical and emotional benets. ese
breathing techniques have the potential to relieve anxiety,
depression, posttraumatic stress disorder (PTSD), chronic
pain, and many stress-related medical illnesses. In addition,
it may be useful in treatment of behavioral disorders because
they generally are linked to stress.5
EFFECTS ON IMMUNE FUNCTION
Gene Upregulation
SK has remarkable eects at the molecular level on
circulating immune cells. Sharma et al6 carried out a study in
which blood samples were collected from 42 SK practitioners,
20 males and 22 females aged 22 to 64 years, and from 42 age-
and gender-matched controls, 20 males and 22 females, who
were not practicing any kind of stress-management technique.
Neither the controls nor the practitioners included in the
study were suering from any ailment. e SK practitioners
had been practicing SK daily for at least 1 year. e eect of SK
on expression of antiapoptotic genes and prosurvival genes at
the transcriptional level was studied. Reverse transcription
polymerase chain reactionanalysis was carried out using
glyceraldehydes 3-phosphate dehydrogenaseas an internal
control, and the results of the densitometry were expressed as
arbitrary units.
e cyclooxygenase 2 gene was signicantly (P
=
.035)
upregulated in SK practitioners (1.81
±
0.51) when compared
with controls (1.59
±
0.21), prolonging the life span of white
blood cells by inhibiting apoptosis and protecting more
eectively against cardiovascular disease. e results
indicated that a larger mean increase also occurred in the
upregulation of the antiapoptotic BCL2 gene in SK
practitioners (1.49
±
0.37) when compared with the increase
in controls (0.93
±
0.17), although the dierence was not
statistically signicant. Upregulation of BCL2 expression in
SK practitioners suggested a prolonged life span for
lymphocytes and, hence, better immune regulation.
Investigators also demonstrated that SK practices
signicantly upregulated heat shock protein 70 (HSP-70),
with the mean increase for controls at 0.37
±
0.079 versus
practitioners at 0.56
±
0.085 (P
=
.044).6 HSP-70 protects cells
against a variety of toxic conditions such as oxidative stress,
tumor necrosis factor α, heat shock, heavy metals, and
cellular damage aer ischemia.7 A signicantly higher
expression of HSP-70 proved to be cytoprotective for
lymphocytes, thereby improving the immune response of SK
practitioners.
Similarly, an aging-related gene, known as human
telomerase reverse transcriptase (hTERT), which encodes for
the catalytic component of the telomerase complex, was also
found to increase in the SK groups, with the mean increase for
controls at 0.95
±
0.21 versus SK practitioners at 1.33
±
0.28,
although the ndings were not statistically signicant. A
higher hTERT level further increases the life span of
lymphocytes by delaying replicative senescence. e
researchers concluded that a higher expression of hTERTgave
a better immune response for SK practitioners.6
Neutrophils and Platelets
It has been suggested that proinammatory cytokines
induced by stress may stimulate the proliferation of
hematopoietic cells, such as neutrophils and platelets.8
Subramanian et al9 conducted a study on a group of
engineering students from SRM Engineering College at SRM
University in Chennai, India, to investigate the eect of SK
on the changes in neutrophil and platelet counts related to
stress during exams. e study included 40 students aged
18 to 23 years, 19 in the control group (group 1) and 21 in the
intervention group (group 2), who did not have any medical
diseases, infections, or allergies. Students were not included
in the intervention group if they had ever taken major
psychotropic medications or were smokers or alcoholics.
Baseline data were measured a few days aer the
beginning of the second academic year for all participants in
both groups.
ere was approximately a 2-week period between
baseline and exam stress. Aer collecting the baseline and
exam stress blood samples students of the intervention group
were allowed to practice SK daily for 6 weeks. Blood was
collected aer 3 weeks and aer 6 weeks of exams from both
the groups. e 2 groups were further subdivided into
8 subgroups: (1) two baseline (no exam) groups (group 1a
and 2a), students who did not have any exam; (2) two exam
stress groups (group 1b and 2b), students who were tested
prior to an exam; (3) two 3-weeks-aer-exam stress groups
(group 1c and 2c), students who were tested 3 weeks aer the
exam; and (4) two 6-weeks-aer-exam stress groups (group
1d and 2d), students who were tested 6 weeks aer the exam.
In both the groups, control and intervention, neutrophil count
increased signicantly (P
<
.001) with exam stress when
compared with baseline values (group 1a
=
51.4
±
11.8%;
group 2a
=
52.6
±
5.7%; group 1b
=
64.9
±
12.2%;
group 2b
=
71.3
±
8.5%). A decrease in neutrophil count was
observed in 3 weeks (P
<
.01) and 6 weeks (P
<
.001) aer
exams in intervention group (group 2c
=
57.8
±
7.5%;

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20 ADVANCES, WINTER 2015, VOL. 29, NO. 1 Sharma—Rhythmic Breathing and Health
group 2d
=
51.5
±
5.6%) whereas the control group did not
show any decrease in neutrophil count aer 3 and 6 weeks
(group 1c
=
66.6
±
7.1%; group 1d
=
62.32
±
5.4%).
Platelet counts were also found to have increased
signicantly (P
<
.01), in both the control group (1b) and
intervention group (2b), with exam stress when compared
with baseline (group 1a
=
2.12
±
0.17 lakh/cumm; group
2a
=
2.06
±
0.51 lakh/cumm; group 1b
=
2.42
±
0.39 lakh/cumm;
group 2b
=
2.39
±
0.45 lakh/cumm). Aer 3 weeks (P
<
.05) and
6 weeks (P
<
.01) of exams, platelets decreased signicantly in
the intervention group (group 2c
=
1.96
±
0.42 lakh/cumm;
group 2d
=
1.94
±
0.46 lakh/cumm), but the control group did
not show any decrease (group 1c
=
2.44
±
0.52 lakh/cumm;
group 1d
=
2.33
±
0.14 lakh/cumm) (Table 1).
Peripheral Blood Mononuclear Cells
Another investigation by Qu et al10 demonstrated the
immediate eects of SK on gene expression proles in
peripheral blood mononuclear cells (PBMC) when compared
with a control regimen. e study included 10 participants,
all males aged 18 to 50 years with no chronic diseases and
good psychological health. Each man participated in 2
experimental regimens, practicing SK and 2 control
regimens, taking a nature walk, and listening to relaxing
music. e regimens occurred once per day on 4 consecutive
days, at the same time of the day: days 1 and 2 for the SK
regimens and days 3 and 4 for the control regimens. For both
regimens, the study indicated that rapid alterations in gene
expression occurred, which had benecial cellular eects,
but the number of dierentially expressed genes in response
to SK was 3 times higher than that inducedby the control
regimens. e SK intervention gave rise to 111 dierentially
expressed genes, whereas this number was 38 for the control
regimens; 14 genes were aected by both the SK and the
control regimens. It was shown that the AVIL gene, which
belongs to the family of actin regulatory proteins and which
is highly expressed in the small intestine and less expressed
in other organs, was signicantly expressed in PBMCs upon
performance of SK practices (P
<
.05). Similarly, the nuclear
factor erythroid 2 (NFE2) gene, which encodes a basic
leucine-zipper transcription factor and has an essential role
in megakaryocyte maturation and platelet production, was
also signicantly upregulated by SK (P
<
.05) but not by the
control regimen.10
EFFECT ON HORMONES, STRESS, AND ANXIETY
Depression
In the modern era, stress and anxiety have become part
of everyday life. A need exists for individuals to adopt a
lifestyle that relieves them of undesired stress and anxiety so
that they can lead a disease-free life. e cortisol hormone is
a measure of the stressresponse system.11 It was found that a
signicant reduction in cortisol levels occurred in a group of
depressed people aer 3 weeks of SK practice.11 Similarly, 4
weeks of practice of SK was found to elevate prolactin release
in patients suering from depression.2 Acute prolactin
release reduces fear and anxiety in animal models.12
Severe depression reduces the oxytocin hormone level
in addition to increasing cortisol.13 Oxytocin is known to
reduce stress created because of social separation and to help
in forming social bonds and aliation.14 It has been proposed
by Brown et al5 that SK practices elevate oxytocin levels,
possibly via vagal nerve stimulation and other somatosensory
stimuli related to its breathing practices.
e antidepressant eects of SK have also been shown in
patients with alcohol dependence.15 Following 1 week of
detoxication management, 60 consenting patients were
randomly assigned equally to receive SK therapy or not
(controls). Morning plasma levels of cortisol and
adrenocorticotropic hormone (ACTH) were measured at the
beginning and end of 2 weeks of SK practice. It was found
that a signicant reduction in stress hormone levels (cortisol
and ACTH) occurred in the intervention group, aer 2
weeks of SK practice (P
=
.005); the reduction for the control
Table 1. Neutrophil and Platelet Measurement of Control and Intervention Groups, Baseline rough 6 Weeks Postexam
Parameters Control Group Intervention Group
Before SK Practice Aer SK Practice
Group 1a
(baseline
reading
when no
exam)
Group 1b
(during
exam
stress)
Group 1c
(3 wk aer
exam)
Group 1d
(6 wk aer
exam)
Group 2a
(baseline
reading
when no
exam)
Group 2b
(during
exam
stress)
Group 2c
(3 wk
aer
exam)
Group 2d
(6 wk aer
exam)
Neutrophil (%) 51.4
±
11.8 64.9
±
12.2 66.6
±
7.1 62.32
±
5.4 52.6
±
5.7 71.3
±
8.5 57.8
±
7.5 51.5
±
5.6
Platelet Count
(lakh/cumm)
2.12
±
0.17 2.42
±
0.39 2.44
±
0.52 2.33
±
0.14 2.06
±
0.51 2.39
±
0.45 1.96
±
0.42 1.94
±
0.46
Abbreviation: SK, Sudarshan Kriya.
Note: Neutrophil count has been shown in percentage and values are mean
±
SD for neutrophil as well as platelet count.

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ADVANCES, WINTER 2015, VOL. 29. NO. 1 21
Sharma—Rhythmic Breathing and Health
group was lower. In both of these studies, researchers came
to conclusions suggesting that SK practices help in relieving
the stress of life.
Hypertension
Agte et al16 further supported results on the benets of
SK practice by studying some physiological and biochemical
parameters in mildly hypertensive patients. Fiy-two
patients aged 30 to 60 years were included in the study,
practicing SK for 2 months. On the 52 participants, 29 were
mildly hypertensive patients, 16 men and 13 women, and
23 were apparently healthy adults, 10 men and 13 women.
e study examined the eects of SK practice for 2 months
as a complementary therapy for both groups. In the
hypertensive group, the mean value of diastolic blood
pressure (DBP) before SK practice was 85.2
±
9.7 mm Hg in
women and 88.2
±
7.8 mm Hg in men, but a signicant
decrease in DBP was found for both women, to 81.7
±
5.8
mm Hg, and men, to 83.4
±
6.6 mm Hg, aer 2 months of SK
practice (P
=
.01). In the control group, DBP before SK
practice was 76.6
±
7.1 mm Hg in women and 79
±
2.6 mm Hg
in men, but the change in the DBPs of the control group from
the beginning to the end of the study was not statistically
signicant.
In the hypertensive group, the mean value of plasma
malondialdehyde adducts (MDA), an oxidative stress
marker, before SK practice was 6.7
±
2.4 nM/L in women
and 6.9
±
2.1 nM/L in men, but as a result of the practice,
MDA values were signicantlyreduced for the hypertensive
group, to 5.2
±
0.8 nM/L for women and to 5.6
±
0.9 nM/L for
men (P
=
.01). In the control group, the mean value of MDA
before SK practice was 6.2
±
3.1 nM/L for women and
7.2
±
4.1 nM/L for men. Aer SK practice, the MDA value
was signicantly reduced for the men, to 6.5
±
4.3 nM/L
(P
=
.01), but not for the women.
Similarly, the mean value for serum urea in the hypertensive
group before SK practice was 27.6
±
5.3 mg/dL for women and
32.9
±
13.7 mg/dL for men, but these levels were signicantly
reduced for both the women, to 23.3
±
4.8 mg/dL, and for the
men, to 26.6
±
4.5 mg/dL (P
=
.01). In the control group,
the serum urea level before SK practice was 24.5
±
4.8 mg/
dL for women and 32.9
±
8.5 mg/dL for men, and the changes
were not signicant for the control group at the end of the
study.16
Cholesterol, Triglycerides, and VLDL
In 2012, Subramanian et al,9 in a study discussed
previously under immune functions, provided further
evidence for the eect of SK in reducing exam stress in
students by measuring the levels of total cholesterol (TC),
triglycerides (TGL), and very-low density lipoproteins
(VLDL), which are altered during exam stress. At baseline, the
mean values of TC, TGL, and VLDL were 143
±
17.3 mg/dL,
75.4
±
22.5 mg/dL, and 15.0
±
4.2 mg/dL, respectively, for the
control group and 147.1
±
16.1 mg/dL, 72
±
7.1 mg/dL, and
14.1
±
1.2 mg/dL, respectively, for the intervention group.
During exam stress (1b), the mean values of TC, TGL, and
VLDL for the control group were 169.1
±
16.6 mg/dL,
106.1
±
22.5 mg/dL, and 21.1
±
5.9 mg/dL, respectively, whereas
for the intervention group (2b), the mean values were
168.3
±
14.4 mg/dL, 101.3
±
13.3 mg/dL, and 22.6
±
4.7 mg/dL,
respectively. e levels of TC, TGL, and VLDL were found to
have increased signicantly during exam stress when
compared with baseline, P
<
.01, P
<
.001, and P
<
.001,
respectively.
Signicant decreases in levels of TC (P
<
.05), TGL
(P
<
.001), and VLDL (P
<
.01) were found for the intervention
group from baseline to the group’s second measurement (2d),
6 weeks aer exams.. At the second measurement, mean values
obtained for TC, TGL, and VLDL were 146.7
±
23.6 mg/dL,
71.0
±
11.4 mg/dL, and 14.3
±
4.2 mg/dL, respectively, for the
intervention group, whereas no signicant change occurred in
levels of TC (168.2
±
18.2 mg/dL), TGL (102.4
±
15.1 mg/dL),
and VLDL (21.2
±
2.8 mg/dL) in the control group at the
corresponding time (1d). us, researchers in the study
concluded that practice of SK might be benecial on lipid
prole during exam stress in engineering students (Table 2).
Table 2. Total Cholesterol, Triglyceride, and Very-low Density Lipoproteins Measurement of Control and Intervention
Groups, Baseline rough 6 Weeks Postexam
Parameters Control Group Intervention Group
Before SK Practice Aer SK Practice
Group 1a
(baseline
reading
when no
exam)
Group 2b
(during exam
stress)
Group 1d
(6 wk aer
exam)
Group 2a
(baseline
reading
when no
exam)
Group 2b
(during exam
stress)
Group 2d
(6 wk aer exam)
Cholesterol (mg/dL) 143
±
17.3 169.1
±
16.6 168.2
±
18.2 147.1
±
16.1 168.3
±
14.4 146.7
±
23.6
TGL (mg/dL) 75.4
±
22.5 106.1
±
22.5 102.4
±
15.1 72
±
7.1 101.3
±
13.3 71.0
±
11.4
VLDL (mg/dL) 15.0
±
4.2 21.1
±
5.9 21.2
±
2.8 14.1
±
1.2 22.6
±
4.7 14.3
±
4.2
Abbreviations: SK, Sudarshan Kriya; TGL, triglycerides; VLDL, very-low density lipoproteins.

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22 ADVANCES, WINTER 2015, VOL. 29, NO. 1 Sharma—Rhythmic Breathing and Health
Posttraumatic Stress Disorder
Carter et al17 demonstrated that SK was useful in treating
the PTSD of Australian Vietnam veterans. e study was
conducted with 25 male Vietnam veterans with an average
age of 58 years, 14 in the intervention group and 11 in the
control group, who had service-related PTSD. e eects of
SK on symptoms of PTSD were measured by determining
changes in scores for participants on the Clinician
Administered PTSD Scale (CAPS). e investigators found a
signicant reduction in CAPS scores in SK practitioners aer
6 weeks of SK practice, whereas the control group had no
decline in CAPS scores within the same period. At that point,
the control group also started practicing SK, and a signicant
improvement was observed in their CAPS scores. e
average, mean baseline values for CAPS scores for the
intervention group and the control group were 56.3
±
12.3
and 56.6
±
18.7, respectively. e intervention group showed
signicant decreases in CAPS scores aer 6 weeks when
compared with baseline values, to a mean value of
42.1
±
18.2, P
<
.01, and further signicant decreases aer
6 months, when compared with 6 weeks postintervention, to
a mean value of 26.2
±
14.8, P
<
.01. e control group also
showed a signicant decline in CAPS scores aer SK practice
to a mean value of 30.7
±
25.9 at 6 weeks postintervention,
but at 6 months postintervention, the change in CAPS score
from 6 weeks postintervention was not signicant. e
overall change in the CAPS score was signicant for the
control group aer SK practice (P
=
.02). e researchers
concluded that the results suggest that SK can be a valuable
tool to treat patients suering from PTSD.17
EFFECTS ON ANTIOXIDANT STATUS
Reactive oxygen species (ROS) include hydroxyl radicals,
superoxide anion, hydrogen peroxide, and nitric oxide, which
are produced during normal cellular function. ey are highly
reactive and, therefore, lead to lipid peroxidation and oxidation
of DNA and proteins.18 Under normal conditions, antioxidant
systems of the cell minimize the damaging eects of ROS.
When generation of ROS is increased to an extent that the
antioxidant system of the body is not able to counteract the
ROS, the result is oxidative stress.
Antioxidants are substances that delay or prevent the
oxidation of cellular oxidizable substrates. Antioxidant
molecules are present in the body in the form of glutathione,
and antioxidant enzymes, such as superoxide dismutase
(SOD), catalase, and glutathione peroxidase.19A study was
conducted by Agte et al20 in a free-living population in Pune,
India, to evaluate the eects of 2 months of SK practice on
health and behavior. For 37 volunteers, 16 men and 21
women aged 20 to 55 years, investigators found a signicant
increase in antioxidant capacity as measured by SOD aer 2
months of SK practice, P
<
.00001.
is nding was supported by Sharma et al6 who
investigated the levels of glutathione, glutathione peroxidase,
and SOD in the blood of 42 SK practitioners, 20 males and
22 females aged 22 to 64 years. e researchers compared
those results with the results for 42 age- and gender-matched,
normal healthy controls, 20 males and 22 females, who did
not perform any conventional physical exercise. Neither the
controls nor the practitioners included in the study were
suering from any ailment. e SK practitioners had been
practicing SK daily for at least 1 year. e glutathione levels
in SK practitioners were signicantly higher when compared
with those for controls (P
<
.05). e mean level of glutathione
was 76.7
±
4.06 nmol/mL for controls, whereas for SK
practitioners, it was 96.5
±
4.41 nmol/mL.
Glutathione peroxidase activity was also signicantly
higher for SK practitioners when compared with that for
controls. e mean level of glutathione peroxidase activity
was 5516
±
415 U/L for controls, whereas for SK practitioners,
it was 6923
±
382.3 U/L. Similarly, SOD activity for controls
was 173.6 ± 7.6 U/mL, whereas for SK practitioners, it was
214.7
±
12.2 U/mL. us, a better antioxidant status was
observed in SK practitioners.
EFFECTS ON CARDIAC FUNCTION
Cortisol Levels
Heart disease is caused by a number of factors. ese
reasons include obesity, poor diet, and lack of exercise. In
today’s fast-paced world, one of the key contributors to heart
disease is a high level of stress and anxiety. e increased
levels of cortisol, a stress hormone, in the body can increase
a person’s chance of developing heart disease quite
signicantly.21 In such cases, the regular practice of SK can
induce dramatic falls in cortisol levels in the body.
A study by Vedamurthachar et al22 showed short-term
eects for SK on lipid and hormone proles of type 2 diabetic
patients. e study was conducted on 50 patients, aged 22 to
69 years, who underwent an Art of Living workshop and
practiced SK for 6 days. All the patients were on prescribed
medications for diabetes. When average levels of hormones
before and aer 6 days of SK workshop were analyzed, it was
found that cortisol levels were signicantly decreased (P
<
.05).
e mean value of cortisol levels before undergoing the SK
workshop was 14.19
±
4.6 mcg/dL, and aer undergoing the
SK workshop, it was 12.34
±
3.0 mcg/dL. is decrease caused
the researchers to conclude that SK practitioners suer from
less stress and anxiety and are also more resilient to stress.
Plasma Cholesterol Levels
Heart patients also tend to have higher plasma cholesterol
levels. Vedamurthachar et al22 also tested the eects of SK on
cholesterol levels. e results showed that signicant drops
in levels of plasma cholesterol (P
<
.03) and signicant increases
in high-density lipoprotein (HDL), or benecial cholesterol,
levels (P
<
.03) aer the SK workshop. e mean value of TC
before undergoing SK workshop was 188
±
45.2 mg/dL, and
aer undergoing the SK workshop, it was 172.08
±
39.7 mg/dL.
e mean value of HDL levels before undergoing SK
workshop was 58.87
±
17.3 mg/dL, and aer undergoing the
SK workshop, it was 79.54
±
26.9 mg/dL. e researchers
concluded that SK is an eective tool in treating health

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ADVANCES, WINTER 2015, VOL. 29. NO. 1 23
Sharma—Rhythmic Breathing and Health
conditions, such as high blood pressure, high cholesterol,
and subsequently heart disease.
Stress, Anxiety, and Depression
SK can also help prevent high levels of stress and feelings of
anxiety and depression that may exacerbate cardiovascular
problems and other health complaints. Studies were conducted
on 64 diabetic patientsaged 35 to 72 years to observe the eect
of SK on cardiac autonomic functions.23 Patients were randomly
assigned to 2 groups: (1) one group (28 patients) received
standard therapy for diabetes—dietary advice, brisk walking for
45 minutes, and oral antidiabetic drugs; and (2) the other group
(36 patients) received standard therapy for diabetes and the SK
program. Before and aer the 6 months of the study, cardiac
autonomic functions were assessed by such measures as a deep-
breathing test, valsalva maneuver, sustained hand grip test, cold
pressure test, and lying-to-standing test.
In the SK group, 24 patients underwent the tests for
sympathetic cardiac autonomic function (those capable of
participating), and 18 patients had abnormal results
preintervention. Six patients’ results improved aer practicing
SK for 6 months. is improvement in sympathetic function
was statistically signicant (P
=
.04). In the standard therapy
group, 17 patients underwent the tests, and the change in
sympathetic function in that group was not signicant (P
=
.75).
irty-three patients in the SK group and 24 patients in
the standard therapy group were able to perform the tests of
parasympathetic cardiac autonomic function. In the SK group,
of 9 participants who had abnormal results preintervention, 6
had improved results postintervention. e change in the
results for parasympathetic cardiac autonomic function for the
SK group was not signicant (P
=
.46). Similarly, the change in
parasympathetic cardiac autonomic function for the standard
therapy group was also not signicant (P
=
.70).
When both sympathetic and parasympathetic cardiac
autonomic functions were considered, a trend appeared that
showed a movement toward improvement in function
following the SK program (P
=
.06). e change in results for
the standard therapy group was not signicant (P
=
.99).23
EFFECTS ON THE BRAIN
Rhythmic breathing in SK acts at the level of the
autonomic nervous system by adjusting any imbalances in it
and, thereby, providing a therapeutic action for a broad range
of mental and physical disorders.24 An electroencephalography
(EEG) study was conducted by Bhatia et al25 to investigate the
eects of SK on brainwave patterns. e study comprised 2
groups of participants. Group 1 included 19 teachers who
were connected to Ved Vignan Maha Vidya Peeth, a school
in Bengaluru, India, started by the founder of AOL, and
regularly practiced SK. Group 2 included 15 healthy controls.
e mean age of participants in group 1 was 41.9
±
10.9, and
in group 2, it was 36
±
11.12; no statistically signicant
dierence in age existed between the 2 groups. No participants
had any history or concurrent use of medications acting on
the central nervous system.
EEG changes were recorded for SK practitioners and
compared with the EEG patterns of controls. Pattern of beta
waves were studied; they normally are found in the state of
calm alertness.26 A signicant increase in beta activity was
observed in the le frontal, parieto-occipital, and midline
regions of the brain for the SK practitioners in group 1 when
compared with the controls in group 2 (P
<
.05). ese results
led the researchers to the conclusion that SK practitioners
showed signicantly greater mental alertness (beta activity).25
EFFECTS ON CANCER
Natural Killer Cells
e impact of SK has also been evaluated for cancer
patients by Kochupillai et al.27 e investigators reported that SK
practice was helpful in signicantly increasing the number of
natural killer (NK) cells in cancer patients. e study included
27 patients, registered at the Institute Rotary Cancer Hospital at
the All India Institute of Medical Sciences in Delhi, India. ese
patients had already been treated for their cancers.
All participants in the intervention group learned SK in
an Art of Living workshop and were advised to practice SK
regularly at home and to come for weekly follow-up sessions.
at group, aged 22 to 65 years, was composed of 21
patients—9 with breast cancer, 5 with multiple myeloma, 3
with lymphoma, and 1 each with acute myeloid leukemia,
acute lymphoblastic leukemia, gastric carcinoma, and germ
cell tumor of the ovary. Sixteen of those participants were in
complete remission; the remaining patients had stable disease
or progressive disease. e controls were 6 patients, aged 35
to 50 years, with a complete remission status, 4 with breast
cancer and 1 each with multiple myeloma and lymphoma.
NK cells were studied in the patients, and the researchers
demonstrated that no changes occurred in the NK cell
population for the control group between day 0 and week 4.
However, when compared with baseline, a statistically
signicant increase in the NK cell population was found for
the intervention group at week 12 (P
=
.001) and week 24
(P
=
.0001). A signicant dierence was found at week 24
between the intervention group and the control group
(P
<
.05). is study on cancer patients had several limitations
because it was prospective and controlled, but not
randomized; the patients in the study had dierent types of
cancer; and the statuses of the cancers were not entirely
uniform. Nevertheless, the researchers concluded that the
study does suggest that SK is an easily available technique, is
cost eective, has no side eects, and, hence, may be used as
an adjunct in cancer management.27
Tobacco Addiction
Kochupillai et al27 also conducted a study to evaluate the
eects of SK on tobacco addiction. Tobacco dependence is a
well-known risk factor for many diseases, including cancer.28
e study was conducted on 82 tobacco users who attended
an Art of Living workshop to learn SK.27 Most participants
(62%) started tobacco use when they were between 15 and 25
years of age.

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24 ADVANCES, WINTER 2015, VOL. 29, NO. 1 Sharma—Rhythmic Breathing and Health
e participants were advised to practice SK daily at
home and to come for weekly follow-ups. e results were
analyzed on the basis of a questionnaire, designed to collect
information on the pattern and amount of participants’
tobacco consumption. Fiy-three of 82 individuals did not
use tobacco during the 6 days of the workshop. e remaining
individuals reported a reduction in tobacco use of 50% to
90%. Fiy-six percent observed withdrawal symptoms in the
form of restlessness; however, 95% felt that regular practice
of SK would help them to quit using tobacco. Individuals
were followed up at weekly-to-monthly intervals. By 6
months, complete cessation of tobacco use was reported by
17 of 34 participants available for follow-up, demonstrating a
success rate of 21% (17 of 82). Although a better follow-up
would be necessary to document the results accurately, the
researchers concluded that outcomes still suggested that SK
is an easy, eective, and nontoxic process to reduce tobacco
consumption.27
Pain and Anxiety
It has been reported that women suering from breast
cancer undergo a lot of pain and anxiety.29 is stressful
mental state further deteriorates their physical condition.
Women suering from breast cancer have higher cortisol
level when compared with healthy women.30
A study was carried out in AIIMS by Kumar et al31 to
examine the eect of SK practices on women suering from
advanced-stage breast cancer. A signicant drop inlevels of
blood cortisol was observed in women aer 3 months and 6
months of practice of SK when compared with controls who
underwent conventional cancer treatment but did not follow
any SK practice.
Participants, 147 women aged 35 to 60 years, were
screened and randomly assigned to 2 groups. Both groups
received regular conventional treatments. e World Health
Organization’s ladder of nonsteroidal, anti-inammatory
drugs, both rst- and second-generation, and the morphine
group of medicines, with and without surgical interventions
and counseling, were part of regular treatment. Group A
(n
=
78) received regular treatment together with an SK
intervention imparted in one 18-hour workshop, lasting 3
days, whereas group B (n
=
69) received onlyregular treatment.
Participants in group A regularly practiced SK on a daily basis.
e fasting levels of serum cortisol did not have
statistically signicant dierences at baseline for the
intervention and control groups, 421
±
70 nmg/L and
493
±
51 nmg/L, respectively. Serum cortisol was signicantly
reduced for the intervention group versus the control group:
(1) aer 3 months, 341.4
±
51.4 nmg/L versus 549.2
±
69.5 nmg/L,
respectively, and (2) aer 6 months, 376.2
±
74.9 nmg/L versus
517.8
±
69.7 nmg/L, respectively (P
≤
.002). SK practice was
also helpful in reducing pain for these women.
It was found that pain perception in the SK group was
reduced by 3 points in comparison with the control group,
on a 0 to 10 verbal scale of pain. us, the researchers
concluded that SK is an eective intervention for reducing
stress and pain among patients with advanced-stage breast
cancer.31
RISKS WITH SK
Although SK has many potential benets, an improper
or excessive practice of SK can cause dizziness, light
headedness, irritability, euphoric states, or psychosis in
vulnerable patients, particularly those with bipolar disorder,
dissociative disorders, or schizophrenic spectrum illnesses.
Bhastrika or breath-holding exercises are not suggested for
pregnant women or for patients with high blood pressure,
cerebral vascular disease, or migraines. SK is generally not
taught to patients with seizure disorders. e SK technique
should be done more gently by patients with respiratory
problems. erefore, trained teachers are required to teach
SK so that the risk of adverse events can be minimized by
appropriate screening of patients.32
CONCLUSION
Scientists are evolving ancient practices to help
individuals live a richer and healthier life. SK is a form of
yoga and pranayama that incorporates natural rhythms of
the breath to harmonize the body and mind. As reviewed in
the current article, a lot of research has occurred on the
therapeutic eects of SK. e benets of regular practice of
SK that research has found are interesting. Altogether, data
imply that SK facilitates physical, mental, and social well-
being. SK practitioners have reported better immunity and
general well-being. e current overview of the benets of
SK has suggested that it might be used as a complementary
therapy in clinical practice to improve health and allow
individuals to build an enhanced quality of life.
AUTHOR DISCLOSURE STATEMENT
One of the authors, Dr Promila Sharma, is a member of Art of Living. is review aims
to highlight the usefulness of the breathing technique SK as a complementary therapy
to already existing clinical practices for various pathophysiological conditions.
ACKNOWLEDGEMENTS
e study was inspired by Sri Sri Ravi Shankar, Founder of Art of Living Foundation.
e authors wish to thank Graphic Era University for its constant encouragement for
the authors’ research.
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