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| REVIEW ARTICLE |
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| Year : 2022 | Volume
: 54
| Issue : 2 | Page : 133-139 |
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Yoga as a complementary and alternative therapy for cardiopulmonary functions
Vipin Rathore, Nidheesh Yadav
Department of Yog Science, University of Patanjali, Haridwar, Uttarakhand, India
| Date of Submission | 16-Jul-2022 |
| Date of Decision | 15-Nov-2022 |
| Date of Acceptance | 21-Nov-2022 |
| Date of Web Publication | 15-Dec-2022 |
Correspondence Address:
Mr. Vipin Rathore
Department of Yog Science, University of Patanjali, Haridwar - 249 405, Uttrakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ym.ym_95_22
Complementary and alternatiASve therapy is a rapidly growing area in the biomedical sciences, in which Yoga therapy has arisen at the frontlines of holistic medical care and is perceived as a form of mind-body practise because of its long history of connecting physical, mental, and spiritual well-being with the coalescence of physical postures (asana), breathing exercises (pranayama), and meditation (dhyana). This study aims to review the emerging evidence assessing the physiologic and clinical effects of Yoga on cardiopulmonary functions. The authors searched the PubMed (Medline) and Science Direct databases and the Google Scholar search engine, as well as a reference list of related articles, for literature related to the effect of yoga on pulmonary function, cardiovascular function, and cardiopulmonary functions from 2000 to 2021. Yoga has been shown to have favorable effects on the various parameters of cardiovascular and pulmonary functions. Yoga has emerged as a beneficial lifestyle intervention that can be incorporated into cardiovascular and pulmonary disease management methods. Although numerous researchers have reported the clinical benefits of Yoga in reducing cardiopulmonary-related events, morbidity, and mortality, the evidence supporting these conclusions is somewhat limited, thereby stressing the requirement for large, well-designed randomised trials that limit bias and methodological drawbacks.
Keywords: Cardiopulmonary functions, cardiovascular function, complementary medicine, lung functions, Yoga therapy
How to cite this article:
Rathore V, Yadav N. Yoga as a complementary and alternative therapy for cardiopulmonary functions. Yoga Mimamsa 2022;54:133-9 |
| Introduction | |  |
Cardiopulmonary disease is a clinical term that refers to a group of serious conditions that affect both the heart and the lungs[1],[2] and is one of the leading causes of morbidity and death worldwide. Cardiovascular diseases (CVDs) are the leading cause of death worldwide, claiming an estimated 17.9 million lives per year, according to the World Health Organization,[3],[4] while chronic respiratory disorders are placed third, with a prevalence of 32% in India.[5] For a long time, people have suspected a link between heart and lung disorders.[6],[7],[8] The anatomic and physiologic coherence of the lungs with the heart and arteries suggests that deficits in any aspect of the lung capacity may have an impact on cardiovascular health.[9]
Current evidence suggests that regular practice of yoga is beneficial in the improvement of pulmonary and cardiovascular functions.[10],[11] The cardiovascular benefits of yoga have been investigated broadly in previous 50 years.[12]
There is a requirement for an efficient literature survey to decide whether standard yoga practice is in fact advantageous to human well-being. In 2013, a literature review was published that examined all experimental research conducted up to that point that investigated the effect of regular yoga practice on lung functions in healthy adults.[13] The present study collected the findings of nine such studies and discovered that yoga had a favorable impact, despite the fact that the number of studies was too small. Many researches in this field have been published since 2013. As a result, in this review, the most recent study proposes investigating the effects of yoga practice on cardiopulmonary functions in healthy adults.
| Methods | | |
Data sources
The research articles for this review were identified by assessing the Science Direct and PubMed databases and Google Scholar search engine, as well as reference list of related articles. Each of these databases was searched using the key words “Yoga AND Pulmonary function”, “Yoga AND Cardiovascular function”, “Yoga AND cardiopulmonary function”, “Pranayama AND Pulmonary function”, “Pranayama AND Cardiovascular function”, “Pranayama A'ND cardiopulmonary function”.
Inclusion and exclusion criteria
The article must meet the following criteria to be considered for this study: (a) be published in English; (b) be included in the databases listed below: Science Direct, PubMed, and Google Scholar are just a few of the resources available, and (c) The research was done between January 2000 and March 2021 (d) Any type or school of yoga can be used as an intervention. (e) Measure at least one of the following outcomes: heart rate (HR), blood pressure, tidal volume (TV), maximal oxygen consumption (VO2 max), forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow rate (PEFR), forced expiratory flow at 25% and 75% (FEF25–75 per cent), and maximal voluntary ventilation (MVV).
The following criteria were used to remove the articles from this review: (a) Studies that did not evaluate the intervention or used a quantitative design (b) did not contain specified outcome measures, and (c) did not recruit apparently healthy participants.
Using the aforementioned techniques, 28 studies were identified and considered for initial evaluation, of which 5 did not fulfil the inclusion criterion. Hence, 23 studies have been selected for the review and are categorized into three parts: pulmonary functions (n = 8), cardiovascular function (n = 9), and cardiopulmonary function (n = 4).
| Results | | |
The review of the literature found 21 studies on cardiopulmonary function in healthy persons. Eight of these studies looked at the effect of yoga on pulmonary function, nine on cardiovascular function, and four on both cardiopulmonary functions. [Table 1], [Table 2], [Table 3] summarizes the studies, including the authors with year of publication, study design and sample size, participant age, intervention type, intervention time, and result. Beginning with 2001, the studies are arranged in increasing order by the year of publication. Within a given year, studies are arranged alphabetically by the surname of the main author. | Table 1: Summary of studies examining the role of yoga in cardiopulmonary function
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 | Table 2: Summary of studies examining the role of yoga in cardiovascular function
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 | Table 3: Summary of studies examining the role of yoga in pulmonary function
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The most of the 21 interventions were carried out in India (n = 19),[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32] and in United States (n = 1)[33] and Bangladesh (n = 1)[34]. The average sample size calculated for 21 studies included in this review was 53.42, with a standard deviation of 23.89. Total sample sizes (n = 1122) ranged from 30 to 100, with three (3) studies having sample size of <30.[26],[29],[33] Yoga intervention ranged in duration from 30 sec[26] to 6 months,[22] with one comparison research undertaking yoga for 5 years.[18]
Effect of yoga on cardiovascular functions
Yoga has been found to reduce the risk of CVD.[35] According to a case − control study, people who had been practicing yoga for 5 years showed a substantial drop in pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and a rise in the Valsalva ratio.[18] Another research on 49 healthy volunteers aged 25–35 years found that those who practiced slow Pace Bhastrika Pranayama for 5 min had a substantial reduction in SBP, DBP, and HR (DBP).[19] Herur et al. (2011) conducted a single group design study on 50 healthy subjects, above 30 years old shows that practice of Prayer, Suryanamaskara, Asanas, Pranayama, and Dhyana (Meditation) for 1 h daily for 6 months had significantly decreased the HR, SBP, DBP, mean arterial pressure (MAP), and in the scores of General Health Questionnaire-28.[20] A study was conducted by Ankad et al. on 50 healthy subjects with an age range of 2060 years shows that regular practice of Prayer, Pranayama (Vibhagiya Pranayama, Nadishuddi, Kapalabathi, Bahya, Sitali, and Sitkari), Lecture, and Meditation for 2 hours daily for 15 days shows a significant decreased in PR, SBP, and DBP.[21] Similar study was done by Devasena and Narhare found a significant decreased in HR, SBP, and DBP.[22] Parshad et al. found that practicing Lecture, Bhujangasana, Halasana, Gomukhasana, Shavasana, Padamasana, Pranayama (alternate nostril breathing and breathing with a pause), Mantra (SOHUM), and Dhyana had a positive effect on HR, inter beat interval, stroke volume, cardiac output, total peripheral resistant, ascending aorta characteristic impedance (Zao), total arterial compliance (Cwk) and found no effect on SBP, DBP, MAP, and left ventricular ejection time LVET.[23] Sharma et al. conducted a randomized control trial study on 90 healthy subjects with an age range of 1825 years divided into three groups; Control vs. group 1 fast Pranayama (Kapalabhati, Bhastrika, Kukkriya); group 2 slow Pranayama (Nadishodhana, Pranava, Savitri). Results showed that HR, DBP, MAP, Rate Pressure Product (RPP), double product (DoP), and post systolic shortening found significantly decreased in Group 2 and pulse pressure, RR, and SBP found nonsignificant.[24] Telles et al. conducted a comparative control study on 41 male participants with an age range of 1833 years revealed that there is a significant decreased in respiration rate (RR) after the practice of alternate nostril breathing and breath awareness and no such changes were seen on other parameters.[25]
Another single group repeated measure study conducted by Nivethitha et al. on 9 healthy volunteers found that the practice of Bahir Kumbhaka (external retention of air) significantly increased the SBP, DBP, MAP, RPP, and DoP.[26]
Effect of yoga on pulmonary functions:
Yadav and Das conducted a single group design study on 60 healthy females aged 1728 years and discovered that practicing Prayer, Asanas, Pranayama, and Meditation for one hour per day for 12 weeks significantly increased the force vital capacity (FVC), force expiratory volume in first second (FEV l), and PEFR.[27] According to Sayyed et al., practicing Sudarshan Kriya Yoga for 3040 minutes per day for 8 days reduced total cholesterol, low-density lipoproteins (LDLs), and increased high-density lipoproteins, maximum voluntary ventilation (MVV), serum triglyceride (TG), very LDL, FVC, FEV1, and PEFR in 55 healthy subjects.[28] Sivakumar et al. reported that doing deep breathing exercise for 2, 5, and 10 min at a rate of 6 breaths per minute substantially increased Vital capacity (VC) at Slow maneuver PFT and FVC at forced maneuver PFT; no similar improvements were detected in other parameters.[29] Mullur et al. conducted a comparative prospective study on 52 healthy individual's aged 20 to 65 years divided into two groups: Group I: young adults (age = 2040 years, n = 29) and Group II: middle aged (age = 5065 years, n = 23). They found that practicing Yogasana, Pranayama, Dhyana, and spiritual lectures for 2 h per day for 2 weeks significantly increased the breath holding time (BHT), 40 mm Hg Endurance Test, VC, FEV1 and PEFR in both the groups.[30] Panwar et al. conducted a pretest-posttest experimental control group design study on 75 medical students and discovered that practicing Pranayama (Bhastrika, Kapalbhati, Anuloma-viloma, Ujjayi) for 30 min per day for three months significantly increased the TV, VC, MVV, PEFR, FEV1, FVC, and FEF by 25-75 per cent.[31] Similar result was found by Jahan et al. that the practice of alternate nostril breathing for 10 min/day for 4 weeks had significantly increased the FVC, FEV1, and PEFR.[34] Karthik et al. demonstrated a single group design study on 50 medical students age between 17 and 19 years revealed that Suryanamaskar and Pranayama (Nadisuddi, Kapalbhati, Bhastrika, Bramhari, and Pranava Pranayama) for 30 min daily for 2 months had significantly increased the VC, TV, expiratory reserve volume, BHT, 40 mm endurance and PEFR.[32] A randomized controlled pilot study conducted by Kupershmidt and Barnable on 25 volunteers showed that FEV1and PEF were significantly increased after the practice of Dirga svasam, Kapalabhati, and Nadhisuddhi Pranayama for 6 weeks.[33]
Effect of yoga on cardiopulmonary functions
Harinath et al. conducted a pretest-posttest design study on 30 healthy men age ranging 2535 years to examined the effect of morning and evening yoga module; result showed that SBP, DBP, and MAP was significantly decreased and FVC, FEV1, FEV%, PEFR, MVV, and Wellbeing inventory score was increased significantly.[14] Another study was conducted by Subbalakshmi et al. (2005) revealed that the practice of Nadi-shodhana Pranayama for 20 minutes had significantly decreased the HR, SBP, problem-solving ability (PSA) and significantly increased the PEFR.[15] Manna conducted a pretest–posttest design study on 60 female participants with an age between 18 and 20 years found that the practice of prayer, Yogic sukshma vyayam (joint loosening exercises), Suryanamaskar, Yogasana, Pranayama, Meditation for 60 min/d, 06 d/week for 12 weeks had significantly decreased the SBP, resting HR, RR and significantly increased the FVC, FEV1%, PEFR, MVV, and BHT.[16] Similar result was found by Manna and Chowdhury.[17]
| Discussion | | |
This review tries to include all type of studies which shows the effect of yoga intervention on cardiopulmonary functions and implies that yoga may be beneficial to cardiopulmonary functions, although additional study is needed for almost all of them to be conclusive. Yoga as a therapeutic intervention has just recently been studied, with only a few studies published in the last four decades. Individual studies on yoga for various disorders are usually small, low-quality trials with multiple biases. In addition, the demographics studied, yoga therapies, length and frequency of yoga practice, comparison groups, and outcome measures for a variety of conditions are all extremely diverse. To better understand the efficiency of yoga therapy in various contexts, it is challenging to untangle the effects of this diversity. Meta-analyses for several disorders were not possible due to the heterogeneity and low quality of the original trials. However, several higher-quality RCTs indicated that yoga had favorable effects on cardiovascular illnesses and their risk factors,[35],[36] as well as pulmonary disorders,[37] and some noted the risks and benefits connected with it.[38] More research is needed in this field, especially given the validity of the underlying psychophysiological explanation, which includes the usefulness of frequent physical exercises (asana), breathing practices (Pranayama), mental relaxation (meditation), and so on.
Asanas, for example, are thought to improve strength and flexibility with a subsequent influence on psychological state, whereas Pranayama and meditation methods are thought to improve awareness, reduce stress, and improve overall health and standard of living. This, however, will have to be demonstrated in well-conducted future investigations.
According to Innes et al., the majority of studies came from India, where “yoga is an integral part of a longstanding cultural and spiritual tradition.”[39] As a result, it is unclear whether the compliance of Western participants is comparable. Although such adherence would be impossible to obtain with patient groups outside of India, several Indian clinical research, done in community settings not typically found in India, incorporated yoga class intervention 5-7 days/week. Such behavior is unlikely to sustain, at least at this degree of intensity. If, as some yoga practitioners think, the intensity of the practice should be raised at the start of therapy; such programming would be a good method to start yoga treatment.
As a result, more research is needed to identify whether patients would benefit from the therapies and, if so, which aspects of the yoga interventions (physical exercise or meditation, followed by lifestyle changes) or certain yoga forms were more beneficial than others. Yoga has the potential to be embraced as a cost-effective, safe, and beneficial supportive/adjunct treatment. Larger-scale, more in-depth research is strongly recommended.
Although the extent to which yoga interventions can be used as curative therapies has yet to be determined, it is acceptable to believe that yoga can be a useful adjunct treatment at this time. According to Jayasinghe, “yoga can be advantageous in the primary and secondary prevention of CVD, and it can play either a primary or a supplementary function in this respect.”[40] Yoga may be a useful alternative in cardiac rehabilitation, depending on the patients' abilities and willingness to engage in regular yoga practices, due to the low risk of side effects when choosing appropriate poses for the population and the potential for true therapeutic side effects.
Limitation
The present review only included healthy participants, which make it less applicable for the persons suffering from various types of cardiopulmonary diseases. Another limitation is the small sample size of some studies. The research design used in most of the studies is pretest-posttest design and some studies does not include control group. Due to the variability of yogic intervention across the studies and limited number of studies, it is difficult to draw conclusions on the optimal timing and form for yoga interventions. Future studies should consider this issue.
| Conclusion | | |
This review showed that yoga has a beneficial effect on blood pressure, HR, FVC, forced expiratory volume in the first second, FEV1/FVC ratio, PEFR, and MVV. Well-design randomized trials with large sample size are needed to improve the understanding of underlying mechanism of yoga on cardiopulmonary functions. Future studies should also address the optimal duration, frequency, and form of yoga intervention and further systematic review can also be promoted which included the patients suffering from various cardiopulmonary disorders.
Acknowledgments
Self - funded research.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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