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EFFECTS OF INTEGRATED APPROACH OF YOGA (IAY) ON ESSENTIAL HYPERTENSION

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The present study was designed to find out the effects of Integrated Approach of Yoga (IAY) on Essential Hypertension in a sample of 120 subjects from Cardiology OPD of AIIMS, Bhubaneswar in the age group of 21 years to 65 years divided into Experimental group and Control group60 in each. The Experimental group was exposed to regular yogic practice of 1 hour 15 minutes per day in morning for a period of 3 weeks. The Control group was not exposed to any yogic exercises, rather they were advised a regular morning walk 30minutes per day 5 days a week for a period of 3 weeks. The pre and post readings on subjective and objective parameters before and after the training programme were noted for both the groups. The study showed that the experimental group showed a significant reduction in blood pressure ( S ystolic and diastolic), pulse rate, respiration rate, BMI and Hamilton Anxiety Rating Scale (HAR) (p
DOI: 10.18410/jebmh/2015/689
ORIGINAL ARTICLE
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EFFECTS OF INTEGRATED APPROACH OF YOGA (IAY) ON
ESSENTIAL HYPERTENSION
Debasish Das1, Rajesh Manik2, Rajendra Gartia3
HOW TO CITE THIS ARTICLE:
Debasish Das, Rajesh Manik, Rajendra Gartia. Effects of Integrated Approach of Yoga (IAY) on Essential
Hypertension”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 33, August 17, 2015;
Page: 4925-4938, DOI: 10.18410/jebmh/2015/689
ABSTRACT: The present study was designed to find out the effects of Integrated Approach of
Yoga (IAY) on Essential Hypertension in a sample of 120 subjects from Cardiology OPD of AIIMS,
Bhubaneswar in the age group of 21 years to 65 years divided into Experimental group and
Control group60 in each. The Experimental group was exposed to regular yogic practice of 1 hour
15 minutes per day in morning for a period of 3 weeks. The Control group was not exposed to
any yogic exercises, rather they were advised a regular morning walk 30minutes per day 5 days a
week for a period of 3 weeks. The pre and post readings on subjective and objective parameters
before and after the training programme were noted for both the groups. The study showed that
the experimental group showed a significant reduction in blood pressure (Systolic and diastolic),
pulse rate, respiration rate, BMI and Hamilton Anxiety Rating Scale (HAR) (p<0.01), however the
Control group failed to achieve it.
KEYWORDS: Yoga, Essential Hypertension, Experimental group, Control group, Morning walk,
Paired “t” test.
INTRODUCTION: India is currently experiencing a rapid epidemiological transition from
communicable to non-communicable diseases. Rapid industrialization with subsequent rise in
standard of living, obesity, stress, sedentary lifestyle, addiction etc. are posing a growing concern
to the health of nation in terms of diseases like obesity, diabetes, hypertension, restrictive lung
diseases and cardiovascular morbidities.[1] Hypertension is one of many psychosomatic diseases
which can be treated through a combination of yoga and other traditional medicines in addition to
drug therapy. The root cause of all the diseases is same: ignorance of our true nature and lack of
awareness makes us suffer from these modalities like hypertension.[2]
REVIEW OF LITERATURE: Global burden of hypertension (HTN) in general is estimated to be
as high as 15 to 20% (Braunwald) with minimal elevation in many,[3,4] with essential hypertension
being most prevalent.[5] Usefulness of yoga as an add on treatment in management in
hypertension, when compared to conventional treatment and biofeedback was evident since 1975
by Chandra et.al.[6] Mc Caffrey et.al demonstrated after eight weeks of yoga therapy, the mean
blood pressure decreased from 160/98mmHg to 136/81mmHg.[7] Asana make people more
relaxed and decreases blood pressure demonstrated by Pasek et al.[8] Saraswati et al
demonstrated that practice of Śavasana decreased mean blood pressure from 132 to 107mmHg
with decrease in drug requirement by an average 68%.[9] Yoga can significantly reduce weight,
blood sugar, cholesterol and blood pressure.[10] Meditators tend to have lower blood pressure.[11]
Yoga practitioners tend to gain less weight as compared to non-practitioners.[12][13][14] A small
randomised controlled trial of Sahaja yoga on depressive disorders showed depression scores
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reduced more in the yoga group. In a study of yoga’s effects on distress symptoms in the
survivors of 2005 Tsunami; fear, anxiety, sadness and disturbed sleep decreased significantly
among them along with heart rate.[15] Sudarsan Kriya Yoga and comprehensive yogic breathing
program decreases stress, anxiety and depression.[16][17]
OBJECTIVE: The objectives of the study are to assess the effects of IAY on blood pressure
levels(Systolic & diastolic) pulse rate, breath rate, BMI, and HAR through statistical analysis,
sequence plots and bar diagrams on the subjects of Experimental and Control groups. The
specific objectives and hypotheses of the present study are as follows:
1. To explore the data statistically and compute different statistical measures, such as mean,
standard deviation, minimum, maximum, range etc. for the experimental and control
groups.
2. To study if there is a significant reduction of systolic blood pressure, diastolic blood
pressure, pulse rate, breath rate, BMI, and HAR after the intervention of yoga in the
Experimental and Control groups.
3. To identify the parameters showing significant correlations on the Experimental and Control
group through correlation analysis.
4. To build up regression models for the parameters showing significant correlation.
5. To study the effects of IAY on experimental and control groups through sequence charts
and bar diagrams.
METHODOLOGY: To achieve the purpose of the study 120 subjects attending the Cardiology
OPD of AIIMS, Bhubaneswar between 21-65years were randomly selected. The subjects were
divided in to 2 groups such as the Experimental group and the Control group comprising of 60
subjects in each. The Experimental group underwent a regular yogic practice of 1 hour 15
minutes per day in the morning time for a period of 3 weeks. The yogic intervention for
Experimental group included asanas like Pawanamuktasana series, Tadasana, Tiriyakatadasana,
Katicakrasana, Vajrasana, Sasankasana and Pranayama techniques. Pawanamuktasana series
included toes bending, ankle bending, ankle crank (Rotation), knee bending, purnatitali
(Butterfly) asana, Mustikabandhana (Finger stretching), wrist bending, elbow bending, shoulder
and neck rotation. In Tadasana, Tiriyakatadasana, Katicakrasana (TTK) entire body is extended,
stretched up and it relaxes the arteries. In Vajrasana and Sasankasana, knees are bent below the
thighs and spine is extended which brings peace in mind and brings down the sympathetic drive.
The golden Pranayama techniques used in this study included Nadishodhana, Sitali and Bhramari.
Nadishodhana which means alternate nostril breathing practice brings down the central
sympathetic drive. Sitali which means inhalation through mouth and exhalation through both the
nostrils calms the mind, decreases the sympathetic drive and renin angiotensin surge. Bhramari
which means producing humming sound like a bee impacts the cardiovascular system as music
does.
Apart from that, Yoga nidra in which patient lies down in sound sleep quietly being away
from the surrounding surge the parasympathetic and calm down the sympathetic and
Mahamrityunjay mantra were also practiced. The subjects of Control group were not ́exposed to
yoga rather did morning walk of 1 hour 15 minutes (Early morning) every day for 3 weeks. The
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parameters under study were measured before and after the intervention of Yoga and practices
of morning walk for the Experimental and the Control group respectively. The objective
parameters such as systolic blood pressure and diastolic blood pressure measured by
sphygmomanometer, pulse rate (Beats/minutes), respiration rate (Cycles/minute). The BMI (Body
Mass Index) was computed by using the formula BMI = weight(kg)
height(m)2. The anxiety was measured by
questionnaire called “Hamilton Anxiety Rating Scale” (HAR). Paired ʹtʼ test was used to compare
the results of pre and post IAY on systolic and diastolic blood pressure, heart rate, respiration and
BMI. p<0.05 was considered to be significant.
Name of the
Practices
Frequency
Duration
Total
Time
Asana
Pawanamuktasana series I
1. Toes bending
2. Ankle Bending
3. Ankle Crank
4. Knee Bending
5. Purnatitali asana
6. Mustikabandhana
7. Wrist Bending
8. Elbow Bending
9. Shoulder rotation
10. Neck rotation
3 weeks
10 rounds
each
15mins
Standing Group
1. Tadasana
2. Tiriyaka Tadasana
3. Katicakrasana
3 weeks
10 rounds
each
10mins
Vajrasana Group
1. Vajrasana
2. Sasankasana
3 weeks
2.5mins each
5mins
Relaxation Group
Savasana
3 weeks
1mins
3mins
Pranayama
1. Nadisodhana
2. Sitali
3. Bhramari
3 weeks
3.5mins each
10mins
Relaxation
Yoganidra
3 weeks
20mins
20mins
Mantra
Mahamrtyunjaya
3 weeks
27 rounds
10mins
Yoga Practice Protocol for Experimental Group
Intervention for Control Group: The control group was advised to do morning walk only for 3
weeks. They were not practicing any yoga, aerobics or any physical exercises.
RESULTS AND DISCUSSION: The data so collected were analyzed by using the statistical
software SPSS 16.0 under Windows XP environment.
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Variable
(Parameters)
Number(N)
Experimental Group
Control Group
Range
Mean ±S.D
Range
Mean±SD
Min
Max
Min
Max
Age
60
21
61
35.33±11.280
21
65
45.38±.318
Sys(pre)
60
124
196
141.33±11.094
120
170
139.17±10.153
Sys(post)
60
110
180
130.80±11.005
120
170
138.70±10.237
Dia(pre)
60
90
110
93.73±4.836
90
150
94.87±9.112
Dia(post)
60
70
100
87.73±6.112
88
100
92.50±3.908
BMI(pre)
60
18
34
25.23±2.890
14
30
20.62±4.322
BMI(post)
60
18
32
24.40±2.338
15
30
20.57±4.208
Pulse(Pre)
60
70
100
82.50±7.160
88
90
79.93±13.108
Pulse(post)
60
70
92
79.18±5.685
75
90
81.78±3.622
BR(pre)
60
14
27
21.02±3.089
14
23
17.65±2.065
BR(post)
60
13
24
17.92±2.396
12
24
17.15±2.711
HAR(Pre)
60
16
30
23.42±3.868
17
30
23.43±3.770
HAR(POST
60
12
30
18.87±3.591
15
30
23±3.849
Table 1. Descriptive Statistics for the Experimental and Control Groups
Paired t-test: To examine if intervention of IAY and morning walk have significant effect on
both objective and subjective parameters, of Experimental and Control group, a paired t test was
conducted for both the groups and the result is depicted in table 2.
Experimental
group
Variable Pair
N
Mean
SD
“t”
df
P-value
Sys(pre)-Sys(post)
60
10.533
6.897
11.829
59
0.000
Control group
Sys(pre)-Sys(post)
60
0.467
3.022
1.196
59
0.236
Experimental
group
Dia(pre)-Dia (post)
60
6.000
4.913
9.460
59
0.000
Control group
Dia(pre)-Dia(post)
60
2.367
8.328
2.201
59
0.256
Experimental
group
BMI(pre)-BMI(post)
60
0.833
1.237
5.217
59
0.000
Control group
BMI(pre)-BMI(post)
60
0.050
0.982
0.395
59
0.695
Experimental
group
Pulse(pre)-Pulse (post)
60
3.317
2.281
11.263
59
0.000
Control group
Pulse(pre)-Pulse(post)
60
-1.850
11.764
-1.218
59
0.228
Experimental
group
Resp rate(pre)-Resp rate (post)
60
3.100
1.559
15.402
59
0.000
Control group
Resp rate(pre)-Resp rate(post)
60
0.500
1.384
2.799
59
0.007
Experimental
group
HARS(pre)-HARS (post)
60
4.550
1.808
19.494
59
0.000
Control group
HARS(pre)-HARS(post)
60
0.433
2.037
1.648
59
0.105
Table 2
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As the “p” value of Experimental group is highly significant (p<0.01), thus it may be
inferred that intervention of IAY has significant effect in the reduction of systolic blood pressure,
diastolic blood pressure, heart rate, respiration rate and BMI in the Experimental group. Similarly
we found that ‘’p” value is insignificant (p>0.05) for control group, thus it may be inferred that
there would be no significant reduction of systolic blood pressure, diastolic blood pressure, heart
rate, respiration rate and BMI after the morning walk in the control group.
The sequence of changes in the objective and subjective parameters for the experimental
and control group after intervention yoga and morning walk respectively are presented through
the following sequence plots.
SEQUENCE PLOT:
(Experimental group)
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(Control group)
(Experimental group)
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(Control group)
From the above two plots it is seen that the graphs for systolic and diastolic blood
pressure in the Experimental group after the intervention of IAY(Green colored line) runs below
that of before intervention of yoga(Velvet colour line).
From above two plots it is seen that the graphs for the systolic and diastolic blood
pressure for the Control group after the intervention of morning walk (Green coloured line) do not
run below that of before morning walk (Velvet colored line).
SEQUENCE PLOT:
(Experimental group)
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(Control group)
(Experimental group)
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(Control group)
From the above sequence plots it is evident that graphs for BMI and pulse rate in
Experimental Group after yoga therapy (green colored line) run below the graph indicative of
before yoga therapy.
From the above sequence plots it is evident that graphs for BMI and pulse rate in Control
Group after morning walk (green colored line) run at the same level with the graph indicative of
before morning walk(velvet colored line).
SEQUENCE PLOT: (Experimental group)
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(Control group)
(Experimental group)
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(Control group)
From the above plots we find that the sequence plots for respiration rate and HAR in the
experimental group after yoga (Green colored line) constantly runs below the plot for that of
before yoga (Velvet colored line).
From the above plot we find that the sequence plots for respiration rate and HAR in the
control group after morning walk (Green colored line) constantly runs at the same level with the
plot for that of before morning walk (Velvet colored line).
From the above sequential plots it is evident that yoga therapy decreases the systolic and
diastolic blood pressure, heart rate, respiration, BMI and HAR while simple morning walk fails to
do so.
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From figure no.1 it is evident that there has been a significant reduction in the mean
values of systolic blood pressure, diastolic blood pressure, pulse rate, BMI, breath rate after the
intervention of IAY. Thus it may be inferred that IAY has significant effect in reducing blood
pressure levels, pulse rate, breath rate, BMI and HARs in the Experimental group.
However from figure no.2 above it is found that there has been no significant reduction in
the mean values of all parameters such as systolic blood pressure, pulse rate, BMI, breath rate,
HARS after the morning walk for the control group. Thus the very objectives of the study are
justified through statistical analysis, sequence plot and bar diagram.
Yoga is more beneficial than simple exercise; a simple statement can justify it-̒̒ ̒ yoga is
the physiologic exercise .Its principle varies across organs and physiologic needs. The above
mentioned yogic techniques bring down the sympathetic surge, drop down the cardiotrophic
neurohormones, relax the vessel wall, reverse the adiposity and finally transmit it into the
decrease in blood pressure. Pranayam, the God practiced Yoga is believed to halt the vascular
senescence, keep the persons live long and healthier. American Heart Association advocates 150
min exercise programme per week to have a healthy heart. Exercise pours down nitric oxide (NO)
into blood, the golden molecule that preserves vasomotion. Therefore it is the time for awareness
of practicing physiologic exercise i.e. yoga therapy. Regular exercise builds up the vagal tone,
keep the heart rate quite low and decrease the vascular resistance. The need of various
techniques as described above are justified as each has unique influence on vasomotor tone and
cardiac performance that would combinedly translate into decrease in blood pressure. European
Society of Cardiology recommends life style modification (LSM) as a powerful initial strategy to
reduce blood pressure; we can add simple yoga therapy in the LSM to bring down our vascular
tragedy.
Even non therapeutic interventions can decrease blood pressure up to 30mmHg i.e.
exercise by 6-8 mmHg, salt restriction by 2-4mmHg, decreasing blood pressure by 1mm Hg per 1
kg reduction of body wt, being away from alcohol and nicotine by 5mmHg, fruits and fiber rich
diet by2-4mmHg. Our study delineated decrease in SBP and DBP by around 10mmHg. It is a
lesson from hypertension clinics that increase in blood pressure by 20/10mmHg increases the
cardiac mortality by 2 fold, hence it is an accepted fact that practicing yoga therapy and
decreasing BP by 10mmHg can translate into a huge mortality benefit. When we ask for evidence
people call for scientific evidence; if at all we want to advocate exercise why it is not age old,
proved and scientific exercise- the yoga therapy. Simple exercise can make organs healthy but it
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is yoga therapy that makes organs happy and healthy together. Pranayama is the yogic exercise
that the sick cardiacs can even practice. As evidenced in our study yogic practice decreases the
heart rate and respiration, the integral part of cardio respiratory rehabilitation as heart rate and
respiration runs in the symbiosis of 1:4 ratio. Yoganidra cools down the sympathetic surge,
makes our heart beat slower and decreases our anxiety parameters as person undergoes a sound
sleep away from surrounding in Yoganidra practice. The Vedic Mahamrityunjay mantra has
unique sedating effect on autonomic madness that turns the heart beat slower, steadier and
longer.
Today pills are many but we should look in the pockets of our ancestry who have left the
golden practice of Yoga. A pill has a limited half-life but the half-life of regular yogic practice is
undetermined, it gets embedded in our vaso and cardio tonic genes just like the Pavlov’s
conditioned reflex of ringing bell for food. The basis of all Asanas is that it decreases the venous
return, the preload and the Frank Starling law operates at low end diastolic volume generating
low systolic blood pressure, pours the vasodilators, decreases the vascular tone and decreases
the DBP, enhances the endurance and the vagal tone decreasing heart rate and respiration,
burns the adipose tissue consuming much ATP and thereby decreasing BMI and keeping people
happy by releasing Anandamide, the molecule of happiness in brain.
CONCLUSION: Yoga is the ancient science practiced and advocated since ages and years
together to keep people healthy and live long. Our study, a small one to evaluate its effects in
treating hypertension besides modifying physiologic parameters achieved paramount success.
Although American Heart Association recommends 150 min exercise programme per week to
have a healthy heart, our study achieved superiority of yogic practice to that of regular morning
walk in achieving a better cardiovascular profile. In the beginning of the International Yoga Day
we should come forward to encourage regular yogic practice to beat our heart longer with a
happy smile.
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NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Debasish Das,
Assistant Professor,
Department of Cardiology,
AIIMS, Bhubaneswar.
E-mail: dasdebasish54@gmail.com
Date of Submission: 23/07/2015.
Date of Peer Review: 24/07/2015.
Date of Acceptance: 06/08/2015.
Date of Publishing: 13/08/2015.
AUTHORS:
1. Debasish Das
2. Rajesh Manik
3. Rajendra Gartia
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of
Cardiology, AIIMS, Bhubaneswar.
2. Yoga Trainer, Department of Ayush,
AIIMS, Bhubaneswar.
3. Faculty, Department of Statistics,
Sambalpur University.
Chapter
Thirty-four hypertensive patients were assigned at random either to 6 weeks’ treatment by yoga relaxation methods with biofeedback or to placebo therapy (general relaxation). Both groups showed a reduction in blood pressure (from 168/100 to 141/84 mm Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group). The difference was highly significant. The control group was then trained in yoga relaxation, and their blood pressure fell to that of the other group (now used as controls).
Article
34 hypertensive patients were assigned at random either to six weeks' treatment by yoga relaxation methods with bio-feedback or to placebo therapy (general relaxation). Both groups showed a reduction in blood-pressure (from 168/100 to 141/84 mm. Hg in the treated group and from 169/101 to 160/96 mm Hg in the control group). The difference was highly significant. The control group was then trained in yoga relaxation, and their blood-pressure fell to that of the other group (now used as controls).
Article
ssential hypertension remains a major modifiable riskfactor for cardiovascular disease (CVD) despite impor-tant advances in our understanding of its pathophysiology andthe availability of effective treatment strategies. High bloodpressure (BP) increases the risk of CVD for millions ofpeople worldwide, and there is evidence that the problem isonly getting worse. In the past decade, age-adjusted rates ofstroke incidence have risen, and the slope of the age-adjustedrate of decline in coronary disease has leveled off. Theincidence of end-stage renal disease and the prevalence ofheart failure have also increased. A major contributor to thesetrends is inadequate control of BP in the hypertensivepopulation. This review of current concepts regarding thedefinition, etiology, and treatment of essential hypertension isintended to aid the clinician in identifying those individuals athigh risk who need to undergo evaluation and treatment, aswell as in selecting optimal treatment strategies for hyperten-sive patients with comorbid conditions and/or target organdamage. The part of the review that deals with the geneticbasis of hypertension and the gene/environment interactionthat may lead to elevated BP is still a work in progress.Information gained from the Human Genome Project andfrom ongoing studies of the genetic basis of hypertensionboth in animal models and human populations may revolu-tionize the treatment of hypertension by replacing currentempirical therapy with more effective, targeted treatmentsbased on the genotype of the patient. Concepts introduced inthis review form the basis for such “pharmacogenomic”approaches to antihypertensive therapy.
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Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.
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