Tags: Lotus Pose, Thunderbolt Pose, BREATHING TECHNIQUES, Appendix, All India Institute of Medical Sciences, QUICK RELAXATION, Shoulder rotation, shoulder stand pose, wind relieving pose, Meditation Practice, nutrition Practice, coronary artery disease, bronchial asthma, irritable bowel syndrome, Sukhasana, CORPSE POSE, psychological stress, YLMP, RAMESH LAL BIJLANI Department of Physiology, LIFESTYLE MODIFICATION PROGRAM, ROOMA BASU RAY, Venous blood samples, stress management, Oxidative stress, RAMAPRABHU VEMPATI, lifestyle modification, relaxation technique, LIPID PEROXIDATION
Content: I3n5d8ianYaJdaPvhyseitol aPlharmacol 2005; 49 (3) : 358­362 SHORT COMMUNICATION
Indian J Physiol Pharmacol 2005; 49(3)
Department of Physiology, All India Institute of Medical Sciences, New Delhi ­ 110 029
( Received on April 11, 2005 )
Abstract : oxidative stress contributes to the process of aging as well as a variety of chronic degenerative diseases. There are indications that psychological stress increases oxidative stress whereas relaxation decreases it. We have measured the concentration of thiobarbituric acid reactive substances (TBARS) in blood as an indicator of oxidative stress at the beginning and at the end of a comprehensive yoga-based lifestyle modification program (YLMP). The data was collected from 104 subjects (59 male, 45 female), 19­71 years of age (mean ± SD, 41.2 ± 14.6 years). The YLMP consisted of a nine-day educational out-patient course on the Theory and Practice of yoga and included, besides a daily one-hour practice of physical postures (asanas) and breathing exercises (pranayama), lecture and films on yoga, stress management and nutrition, practice of meditation and shavasana (a relaxation technique), and individual counseling. venous blood samples were collected on the first and last day of the course. The serum concentration of TBARS decreased significantly from 1.72 ± 0.72 nmoles/ml on day 1 to 1.57 ± 0.72 nmoles/ml on day 10 (P<0.05). The study suggests that a brief low cost lifestyle intervention based on yoga reduces oxidative stress.
Key words : reactive oxygen species oxidative stress yoga-based lifestyle
lipid peroxidation malondialdehyde modification program
INTRODUCTION While oxidation of nutrients is essential for life, one of the adverse side-effects of oxidation is generation of reactive oxygen
species (ROS). The oxidative stress imposed by ROS contributes to the process of aging as well as a variety of chronic degenerative diseases (1­3). The impact of the oxidative stress is minimized by a large number of
*Corresponding Author : E-mail : [email protected] or [email protected]
Indian J Physiol Pharmacol 2005; 49(3)
Effect of a Comprehensive Yoga Based Lifestyle 359
endogenous as well as dietary antioxidants. The level of oxidative stress depends on the balance between production of ROS and their quenching by antioxidant mechanisms. Psychosocial stress increases oxidative stress (4), possibly by increasing the production of ROS. Correspondingly, a few recent studies have shown that relaxation techniques reduce oxidative stress (5­7). Since only a few studies of this type are available, more studies are needed to establish the place of various relaxation techniques in mitigating the biochemical effects of psychosocial stress. Our study is an attempt in that direction. One of the indicators of oxidative stress is the degree of lipid peroxidation. Lipid peroxidation is thought to be a major factor in pathogenesis of many human diseases (8). Lipid peroxidation may be assessed from the blood concentration of lipid peroxidation products as measured by thiobarbituric acid reactive substances (TBARS), of which malondialdehyde (MDA) is a principal constituent. We have measured the concentration of TBARS in the blood of patients undergoing a comprehensive yogabased lifestyle modification program at the beginning and end of the program. METHODS The study is the result of data collected on patients attending a yoga-based lifestyle modification program (YLMP) at the Integral Health Clinic (IHC) of All India Institute of Medical Sciences, New Delhi. Subjects The data was collected on 104 subjects (59 male, 45 female) who attended one of
the YLMPs conducted between January and October 2003. The subjects included those having hypertension, coronary artery disease, diabetes, bronchial asthma, headache, backache, anxiety, stress, premenstrual syndrome, irritable bowel syndrome, peptic ulcer, and a variety of other conditions; a few subjects went through the intervention also for prevention of disease although they had no significant health problem. study design The study was based on a before-after design. Fasting venous blood samples were collected between 8.15 and 8.45 a.m. at the beginning (day 1) and end (day 10) of the YLMP for estimation of TBARS. The intervention Each YLMP consists of a 9-day educational out-patient course on the theory and practice of yoga. About 8 patients are enrolled for each course, and a new course begins every alternate week. The patients spend 3­4 hours each day on the course. A typical day in the course starts with a set of asanas and pranayama for one hour. After a short break for breakfast, there is a lecture or a film, following which the patients relax in shavasana or meditation for about 20 min. Two of the patients stay back each day for individualized counseling, so that by the end of the course, each patient has had at least one session on a one-to-one basis with the doctor. An outline of the protocol, and the list of asanas included in the course, have been given in appendices 1 and 2 respectively. The protocol of the intervention has been described in detail earlier (9).
360 Yadav et al
Appendix 1 Protocol of the Course at IHC
Day 0
Day 1: Wednesday
Fasting blood sample Introduction to one another Lecture: Introduction to yoga Practice: Shavasana
Day 2: Thursday
Practice: Asanas & Pranayama* Break Lecture: meditation practice: Meditation Individualized advice (2 patients)
Day 3: Friday
Practice: Asanas & Pranayama Break Lecture: Fundamentals in nutrition Practice: Meditation Individualized advice (2 patients)
Day 4: Saturday Practice: Asanas & Pranayama
Day 5: Sunday
Day 6: Monday
Practice: Asanas & Pranayama Break Film: Samattvam (Equanimity) Practice: Meditation/Shavasana
Day 7: Tuesday
Practice: Asanas & Pranayama Break Film: Stress management practice: Meditation/Shavasana
Day 8: Wednesday
Practice: Asanas & Pranayama Break Lecture: About your illness Practice: Meditation/Shavasana Individualized advice (2 patients)
Day 9: Thursday
Practice: Asanas & Pranayama Break Lecture: Yogic attitude in daily life Practice: Meditation / Shavasana Individualized advice (2 patients)
Day 10: Friday
Fasting blood sample Practice: Asanas & Pranayama Break Lecture: Stress management Practice: Meditation/Shavasana Closing session
*Details in Appendix 2
Indian J Physiol Pharmacol 2005; 49(3) Appendix 2 The set of asanas and pranayama included in the course I. Humming in meditative posture-Vajrasana (Thunderbolt Pose)/Padmasana (Lotus Pose)/ Sukhasana (Easy Pose) II. BREATHING TECHNIQUES 1. Dog breathing 2. Tiger breathing 3. Hands in and out breathing 4. Hands interlocked, kept on chest, stretching, in three positions 5. Ankle stretch breathing III. LOOSENING EXERCISES Warm ups: starting from the head, working towards the toes. 1. Neck rolls 2. Shoulder rotation 3. Arm rotation 4. Elbow movements 5. Wrist movements 6. Finger movements 7. Waist movements 8. Knee rotation 9. Ankle rotation 10. Toe movements IV. QUICK RELAXATION IN SHAVASANA (CORPSE POSE) V. ASANAS (a) Standing 1. Ardhakatichakrasana (lateral arc pose) 2. Padahastasana (forward bend pose) 3. Ardhachakrasana (backward bend pose) 4. Vrikshasana (Tree pose) (b) Sitting 1. Ardhamatsyendrasana (half-spinal twist pose) 2. Paschimatanasana (back stretch pose) 3. Konasana (angular pose) (c) Lying on stomach (prone) 1. Makarasana (crocodile pose) 2. Bhujangasana (cobra pose) 3. Dhanurasana (bow pose)
Indian J Physiol Pharmacol 2005; 49(3)
Effect of a Comprehensive Yoga Based Lifestyle 361
(d) Lying on back (supine) 1. Uttitapadasana (straight leg raising) 2. Sarvangasana (shoulder stand pose) 3. Matsyasana (fish pose) 4. Pavanmuktasana (wind relieving pose) 5. Setubandhasana (bridge pose) VI. Deep relaxation IN SHAVASANA (CORPSE POSE) VII. PRANAYAMA (BREATHING PRACTICES) 1. Bhastrika (rapid breathing) 2. Nadi shuddhi (alternate nostril breathing) 3. Bhramari (honeybee sound during expiration) VIII. QUICK RELAXATION IN SHAVASANA (CORPSE POSE) IX. Humming in meditative posture-Vajrasana (Thunderbolt Pose)/Padmasana (Lotus Pose)/ Sukhasana (Easy Pose)
RESULTS & DISCUSSION The physical characteristics of the subjects have been summarized in Table I. The serum concentration of TBARS at the beginning of the intervention was 1.72 ± 0.72 nmoles/ml and at the end was 1.57 ± 0.72 nmoles/ml (P<0.05).
TABLE I : Physical characteristics of subjects.
Age (years) Weight (kg) Height (cm) BMI (kg/m2)
Mean±S D 41.24±14.61 66.13±11.97 163.33±9.15 24.81±4.13
Range 19 ­ 71 45 ­ 114 143 ­ 184 16.30 ­ 38.39
Measurements Serum was separated from the blood samples within 2 hours and was stored at ­16°C till analysis. Samples were analyzed within a week after blood collection. TBARS were measured by the colorimetric method at 535 nm (10). Calibration was done using 1,1,3,3-tetraethyoxypropane (Sigma) as standard. The inter-assay variability (same sample run in 10 different assays on different days) and intra-assay variability (same sample run 10 times in same assay on same day) in our laboratory was checked. The inter assay coefficient of Variation was 7.8% and intra assay coefficient of variation was 1.8%. All the samples were run in duplicates. statistical analysis The mean values on day 1 and day 9 were compared using Student's t-test for paired observations. The differences were considered significant if P<0.05.
We have earlier demonstrated the efficacy of the intervention in reducing fasting plasma glucose and improving lipid profile (11), and also in Reducing Anxiety levels (12) and improving subjective well-being (13). The present study now suggests that a yoga-based short-term intervention reduces oxidative stress in a sample that includes healthy subjects as well as those having a variety of chronic diseases. It thus confirms the results of the very few similar studies already available (5­7). The significance of the study lies in the brief duration and low cost of the intervention. After attending the structured program at IHC, the patient can continue the physical practices, relaxation techniques, dietary regulation and positive thinking in his everyday life without spending anything. On the contrary, reduction in the expenditure on medication, hospital visits, high fat or non-vegetarian foods, cigarettes and alcohol, is likely to save the patient some money.
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1. Halliwell B. free radicals, antioxidants and disease: curiosity, cause, or consequence ? Lancet 1994; 344: 721­724. 2. Gutteridge JMC. Free radicals in disease processes: A complication of cause and consequence. Free Rad Res 1993; 19: 141­158. 3. Halliwell B, Gutteridge JM, Cross CE. Free radicals, antioxidants and human disease: where are we now ? J Clin Med 1992; 119: 598­620. 4. Sivonova M, Zitnanova I, Hlincikova L, Skodacek I, Trebaticka J, Durackova Z. Oxidative stress in university students during examinations. Stress 2004 Sep.; 7(3): 183­188. 5. Schneider RH, Nidich SI, Salerno JW, Sharma HM, Robinson CE, Nidich RJ and Alexander CN. Lower lipid peroxide levels in practioners of the Transcendental Meditation program. Pschosom Med 1998; 60(1): 38-41. 6. Bhattacharya S, Pandey LJS, Verma NS. Improvement in oxidative status with yogic breathing in young healthy males. Indian J Physiol Pharmacol 2002; 46(3): 349­354. 7. Jatuporn S, Sangwatanaroj S, Saengsiri AO, Rattanapruks S, Srimahachota S, Uthayachalerm W, Kuanoon W, Panpakdee O, Tangkijvanich P, Tosukhowong P. Short-term effects of an intensive life-style modification program on lipid peroxidation and antioxidant systems inpatients
with coronary artery disease. Clin Hemorheol Microcirc 2003; 29(3­4): 429­436. 8. Halliwell B, Chirico S. Lipid peroxidation: Its mechanism, measurement and significance. Am J Clin Nutr 1993; 57: 715S­725S. 9. Bijlani RL. Body-mind medicine in action: the Integral Health Clinic of All India Institute of Medical Sciences. New Approaches to Medicine and Health (NAMAH) 2004; 12(2): 37­48. 10. Chaturvedi V, Handa R, Rao DM, Wali JP. Estimation and significance of serum and synovial fluid malondialdehyde levels in rheumatoid arthritis. Indian J Med Res 1999; 109: 170­174. 11. Bijlani RL, Vempati RP, Yadav RK, Basu Ray R, Gupta V, Sharma R, Mehta N, and Mahapatra SC. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and Diabetes mellitus. J Altern Complement Med 2005; 11(2) (ln Press). 12. Singh Y, Vempati RP, Sharma R, Yadav RK, Bijlani RL. Effect of a short term yoga based intervention on anxiety. 14th International Conference on Frontiers in Yoga Research and Applications. 18­21 Dec. 2003, Swami Vivekananda Yoga Anusandhana Samasthana, Bangalore. Abstracts, p. 97. 13. Sharma R, Manjunatha S, Bijlani RL. Effect of yoga on subjective well being. Indian J Physiol Pharmacol 2004; 48(5, Suppl): 238 (Abstract No. P. 214).

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