International Journal of Yoga
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    Table of Contents - Current issue
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May-August 2021
Volume 14 | Issue 2
Page Nos. 87-172

Online since Monday, May 10, 2021

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EDITORIAL  

Ethics in Yoga Highly accessed article p. 87
TM Srinivasan
DOI:10.4103/ijoy.IJOY_40_21  
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REVIEW ARTICLES Top

Bibliometric profile and density visualizing analysis of yoga intervention in type 2 diabetes: A 44 - year study on global scientific research output from 1975 to 2019 Highly accessed article p. 89
Ramya Ramamoorthi, Daniel Gahreman, Timothy Skinner, Simon Moss
DOI:10.4103/ijoy.IJOY_17_20  
The aim of the paper is to provide an in-depth evaluation of the research output of yoga intervention on type 2 diabetes mellitus from 1975 to 2019 using large-scale data analysis, bibliometric indicators, and density equalizing mapping. Data related to yoga-diabetic research, as search descriptors were retrieved using the Scopus database. The most common bibliometric indicators were annual research output, total citations, productive countries and leading authors, journals and institutions, and frequently cited articles. The number of global research articles retrieved for yoga-diabetic research over the study period 1975–2019 was 411. The growth rate of global publications in 2015–2019 is four times as high as in 1975–2003. The total number of citations for the retrieved articles was 7189, and the average number of citations per article was 23.82. Of these journals, the Journal of Alternative and Complementary Medicine has published the highest number of papers, which accounts for 2.9% of total publications. This study showed a wide variety of journals in which yoga-diabetic articles are published; these bibliometric indicators provide useful information on performance assessment of productivity and quality of research output. Therefore, this study provides a helpful reference for endocrinologists, yoga therapists, policy decision-makers, and diabetes researchers.
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Sleep, cognition, and yoga Highly accessed article p. 100
Usha Panjwani, Sharmila Dudani, Meetu Wadhwa
DOI:10.4103/ijoy.IJOY_110_20  
Stress is one of the major problems globally, associated with poor sleep quality and cognitive dysfunction. Modern society is plagued by sleep disturbances, either due to professional demands or lifestyle or both the aspects, often leading to reduced alertness and compromised mental function, besides the well documented ill effects of disturbed sleep on physiological functions. This pertinent issue needs to be addressed. Yoga is an ancient Indian science, philosophy and way of life. Recently, yoga practice has become increasingly popular worldwide. Yoga practice is an adjunct effective for stress, sleep and associated disorders. There are limited well controlled published studies conducted in this area. We reviewed the available literature including the effect of modern lifestyle in children, adolescents, adults and geriatric population. The role of yoga and meditation in optimizing sleep architecture and cognitive functions leading to optimal brain functioning in normal and diseased state is discussed. We included articles published in English with no fixed time duration for literature search. Literature was searched mainly by using PubMed and Science Direct search engines and critically examined. Studies have revealed positive effects of yoga on sleep and cognitive skills among healthy adults as well as patients of some neurological diseases. Further, on evaluating the published studies, it is concluded that sleep and cognitive functions are optimized by yoga practice, which brings about changes in autonomic function, structural changes, changes in metabolism, neurochemistry and improved functional brain network connectivity in key regions of the brain.
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ORIGINAL ARTICLES Top

Global change in interest toward yoga for mental health ailments during coronavirus disease-19 pandemic: A google trend analysis p. 109
Har Ashish Jindal, Parineeta Jindal, Limalemla Jamir, Dharamjeet Singh Faujdar, Himani Datta
DOI:10.4103/ijoy.IJOY_82_20  
Background: With coronavirus disease (COVID)-19 pandemic, society is gripped with uncertainty and fear, inclining them toward Yoga to prevent mental health issues. Google Trends (GT) depicts the public interest of the community which may vary due to evolving policy dynamics of the COVID-19 pandemic. Aim: The aim was to study global public interest in Yoga for mental health during the COVID-19 pandemic. Material and Methods: Global time trends were obtained for Yoga, Anxiety, and Depression from November 1, 2019 to May 31, 2020 using GT. The time series analysis was done in three different time periods – pre-COVID-19 phase, transition period, and COVID-19 pandemic phase. Cross-correlation, Spearman rho, Friedman ANOVA test, and forecasting were used for analysis. Results: GT found a global change in the search queries for Yoga, anxiety, and depression during the three time periods. High burden COVID-19 countries – Italy, Spain, Russia, and Brazil had an increasing search trend for Yoga. During the COVID-19 phase, there was a significant positive correlation between the search trends of Yoga with depression (r = 0.232; P < 0.05) and anxiety (r = 0.351; P < 0.05), but higher anxiety and depression searches lead to lower Yoga searches at lag +6. Forecast projected a continuous increase in Yoga searches and anxiety queries. Conclusion: Google Trends captured a significant rise in interest of Yoga among the global community but diminished with time. Hence, the need for interventions to promote Yoga to be part of routine life and for making sure that people adhere to the Yoga practices on a continuous basis.
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Cardiovascular, cellular, and neural adaptations to hot yoga versus normal-temperature yoga p. 115
Kelsey Christian Bourbeau, Terence A Moriarty, Bryanne Nicole Bellovary, Gabriella F Bellissimo, Jeremy B Ducharme, Truman J Haeny, Micah N Zuhl
DOI:10.4103/ijoy.IJOY_134_20  
Context: Chronic heat exposure promotes cardiovascular and cellular adaptations, improving an organism's ability to tolerate subsequent stressors. Heat exposure may also promote neural adaptations and alter the neural–hormonal stress response. Hot-temperature yoga (HY) combines mind–body exercise with heat exposure. The added heat component in HY may induce cardiovascular and cellular changes, along with neural benefits and modulation of stress hormones. Aims: The purpose of the present study is to compare the cardiovascular, cellular heat shock protein 70 (HSP70), neural, and hormonal adaptations of HY versus normal-temperature yoga (NY). Settings and Design: Twenty-two subjects (males = 11 and females = 11, 26 ± 6 years) completed 4 weeks of NY (n = 11) or HY (n = 11, 41°C, 40% humidity). Yoga sessions were performed 3 times/week following a modified Bikram protocol. Subjects and Methods: Pre- and posttesting included (1) hemodynamic measures during a heat tolerance test and maximal aerobic fitness test; (2) neural and hormonal adaptations using serum brain-derived neurotrophic factor (BDNF) and adrenocorticotropic hormone (ACTH), along with a mental stress questionnaire; and (3) cellular adaptations (HSP70) in peripheral blood mononuclear cells (PBMCs). Statistical Analysis: Within- and between-group Student's t-test analyses were conducted to compare pre- and post-VO2 max, perceived stress, BDNF, HSP70, and ACTH in HY and NY groups. Results: Maximal aerobic fitness increased in the HY group only. No evidence of heat acclimation or change in mental stress was observed. Serum BDNF significantly increased in yoga groups combined. Analysis of HSP70 suggested higher expression of HSP70 in the HY group only. Conclusions: Twelve sessions of HY promoted cardiovascular fitness and cellular thermotolerance adaptations. Serum BDNF increased in response to yoga (NY + HY) and appeared to not be temperature dependent.
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The eight limbs of yoga can be maintained in a veteran friendly yoga program p. 127
Arlene A Schmid, Elizabeth A Sternke, Ai-Nghia L Do, Nancy Schalk Conner, Vincent R Starnino, Louanne W Davis
DOI:10.4103/ijoy.IJOY_106_20  
Background: Posttraumatic stress disorder (PTSD) may occur after a traumatic event and has deleterious effects on individuals, including decreased quality of life and function. Yoga is an intervention that may help with the management of PTSD symptoms, however yoga interventions in research studies frequently only include postures and breathwork, not all eight limbs of yoga. Aims and Objectives: The aims of this qualitative study was to examine whether participants with PTSD in a group yoga program discussed the benefits of yoga in a way that represented the eight limbs of yoga, when answering questions about their experience of the yoga program. Methods: Qualitative data were collected after participants completed a 16-week yoga intervention. Qualitative data were collected via survey, reviewed, coded, and categorized into themes representing each of the eight limbs of yoga. Results: Overall, 108 people were randomized to the yoga intervention and 67 individuals completed the intervention and follow up questions used in these analyses. The mean age of the 67 participants in this study was 52.4 years (±12.0), the majority were male (70.2%), and most had combat-related trauma (62.7%). All eight limbs of yoga were represented in the data, including each of the five yamas and niyamas, even though the yoga intervention did not explicitly include Sanskrit terms, definitions, or education about yoga philosophy or the eight limbs of yoga. Conclusion: Results may indicate that yoga, even when only including postures, breathwork, intentions, and relaxation/meditation, may still address all of the yamas, niyamas, and the other eight limbs of yoga.
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Effect of yoga and physiotherapy on pulmonary functions in children with duchenne muscular dystrophy – A comparative study p. 133
Dhargave Pradnya, Atchayaram Nalini, Raghuram Nagarathna, Raghupathy Sendhilkumar, Tittu Thomas James, Trichur R Raju, Talakad N Sathyaprabha
DOI:10.4103/ijoy.IJOY_49_20  
Context: Abnormal respiratory function is known to be detectable almost as soon as it can be measured reliably. Studies have identified the effect of respiratory muscle training as well as breathing exercises in improving pulmonary functions in children with Duchenne muscular dystrophy (DMD). Aims: This study aims to identify the add-on effect of yoga over physiotherapy on pulmonary functions in children with DMD. Settings and Design: One hundred and twenty-four patients with DMD were randomized to two groups. Group I received home-based physiotherapy and Group II received physiotherapy along with yoga intervention. Materials and Methods: Pulmonary function test (PFT) was assessed before the intervention (baseline data) and at regular intervals of 3 months for a period of 1 year. Statistical Analysis Used: Normality was assessed using Shapiro–Wilk normality test. The baseline data were analyzed using Mann–Whitney U-test to identify the homogeneity. Repeated measures analysis of variance was used to assess significant changes in study parameters during the assessment of every 3 months, both within and between the two groups of patients. Results: A total of 88 participants completed all the 5 assessments, with a mean age of 7.9 ± 1.5 years. PFT parameters such as forced vital capacity (FVC), peak expiratory flow rate, maximum voluntary ventilation (MVV), and tidal volume during maximum voluntary ventilation (MVt) demonstrated significant improvements in Group I. In Group II, FVC and MVt significantly improved from baseline up to 1 year, whereas MVV improved from baseline up to 9 months. Tidal volume did not show any changes in both the groups. Conclusions: The findings suggest that introduction of yoga with physiotherapy intervention at an early age can be considered as one of the therapeutic strategies in improving pulmonary functions in patients with DMD.
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Effect of nasal dominance on pulmonary function test and heart rate: A pilot study p. 141
Smriti Sinha, Swati Mittal, Shilpi Bhat, Geeta Baro
DOI:10.4103/ijoy.IJOY_115_20  
Background: The nasal cycle is one of the many cyclic events in a human being. Nasal airflow is greater in one nostril at any given point in time and this alternates between right and left nostrils over time. Its periodicity ranges from 25 min to 8 h. This alteration has been known to be controlled by the autonomic nervous system. The current study was designed to assess the effect of nasal dominance during rest on pulmonary function parameters and heart rate. Materials and Methods: A cross-sectional study was done on 35 apparently healthy individuals of the age group of 18–30 years. Based on a cold mirror test, the participants were categorized into two groups of right nasal dominance (RND) and left nasal dominance (LND). The parameters recorded were forced expiratory volume in the first sec (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate, forced expiratory flow between 25%-75%, SpO2, and pulse rate. Data were expressed as mean ± standard deviation and were analyzed using SPSS version 20. Results: All pulmonary function parameters exhibited higher values in RND participants compared to LND participants and the difference was found to be statistically significant (P < 0.05). Conclusion: Nasal dominance has a measurable effect on pulmonary functions and heart rate hence emphasizing the role of autonomic control of airways. This influence can be used as adjuvant therapy for certain disorders.
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Effect of pranayama techniques with Marmanasthanam Kriya as yogic relaxation on biopsychosocial parameters prior to endodontic therapy: A cross sectional study p. 146
Akshaya Thiruvalluvan, Vandana Sekizhar, Meena Ramanathan, Ananda Balayogi Bhavanani, Dhanavel Chakravathy, Jagat R C. Reddy
DOI:10.4103/ijoy.IJOY_133_20  
Background: The root canal treatment is one of the common dental or endodontic therapies associated with high levels of patient anxiety. Yoga therapy (YT) is reported in medical literature as an effective modality in bringing down anxiety in clinical scenarios; however, the reports of the same for dental settings are fewer. The current study aimed to evaluate the effect of YT on biopsychosocial parameters in patients undergoing root canal therapy. Materials and Methods: A cross sectional study was conducted on 50 participants who underwent dental root canal therapy. The sample was divided into two groups: Yoga group (Group A; n = 25) who received YT and control group (Group B; n = 25) who were subjected to self-relaxation during dental procedure. The state of anxiety was measured by a 5-point single-item Likert scale and the cardiovascular (CV) parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) and CV indices (pulse pressure [PP], mean arterial pressure [MAP], rate-pressure product [RPP], and double product [DoP]) were derived and compared between both the groups. Results: The intergroup comparison showed statistically significant differences in anxiety score (P < 0.001), SBP (P < 0.001), MAP (P < 0.001), RPP (P < 0.001), DoP (P < 0.001), HR (P < 0.029), DBP (P < 0.003), and PP (P < 0.116). Conclusion: A significant reduction was recorded in terms of anxiety and primary and derived CV parameters in the yoga group. The YT can be adopted as an interventional tool for anxiety management in patients indicated for dental root canal therapy.
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PERSPECTIVE Top

A mechanistic model for yoga as a preventive and therapeutic modality p. 152
Indranill Basu-Ray
DOI:10.4103/ijoy.IJOY_136_20  
Yoga is an ancient Indian technique of healthy living. Numerous studies have corroborated yoga's beneficial effects, including a favorable influence on autonomic function and negative emotions. Extensive research in the last few decades has revealed the critical role that yoga can play in eradicating stress. This has laid to the foundation for a scientific understanding of pathophysiological changes attributed to stress, particularly at the molecular and genetic levels. This primarily has helped understand the epigenetic and genetic mechanism at play to induce and alleviate stress, particularly those related to emotional aberrations. As research has indicated, negative emotions are translated into vascular inflammation appropriately accentuated by a sympathetic predominant autonomic function. This cascade is bolstered by multiple factors, including activation of “stressor” genes and elaborating hormones, including steroids with sometimes nocuous consequences, particularly when chronic. Yoga has been categorically found to have inhibited each and every one of these baneful effects of stress. In fact, it also changes the neuronal circuits that potentiate such a plethora of pathological changes. This, in turn, has accentuated yoga's relevance as a powerful preventive intervention in noncommunicable diseases (NCD). NCDs, including heart disease, stroke, and rheumatological disorders, are essentially inflammatory diseases that perpetuate inflammation in different beds like vascular or joint spaces. The precise mechanism by which yoga induces such beneficial changes is yet to be delineated. However, a cornucopia of pointers indicates that neural, endocrine, immunological, cellular, genetic, and epigenetic mechanisms are at play. This article attempts to cobble together newfangled research to delineate a medical model for this 5000-year-old practice from India. This is imperative, as a mechanistic model of this ancient-but-complex system would enable a more comprehensive understanding of its mechanism and reveal its yet-undiscovered positive health effects.
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SHORT COMMUNICATIONS Top

Evaluation of cardiovascular functions during the practice of different types of yogic breathing techniques p. 158
L Nivethitha, A Mooventhan, NK Manjunath
DOI:10.4103/ijoy.IJOY_61_20  
Introduction: Yoga is the science of right living practice to promote health. Many studies have documented the cardiovascular effects of various yogic breathing techniques (YBTs), comparing the cardiovascular changes before and after the practice. However, there is a lack of study reporting the cardiovascular changes during the practice of YBT. Materials and Methods: Twenty healthy individuals performed four different YBTs (Bhastrika, Bhramari, Kapalbhati, and Kumbhaka) in four different orders. Cardiovascular variables such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), pulse interval (PI), and total peripheral resistant (TPR) were assessed using a continuous noninvasive blood pressure monitoring system, before, during, and immediately after each YBT. Data were analyzed using repeated measures analysis of variance followed by post hoc analysis with Bonferroni adjustment for multiple comparisons using Statistical Package for the Social Sciences, Version 16.0. Results: Results of this study showed a significant increase in DBP, MAP, HR, and CO along with a reduction in PI during Bhastrika; a significant increase in DBP, MAP, HR, and TPR with a reduction in SV, CO, and PI during Bhramari pranayama; a significant increase in SBP, DBP, MAP, HR, and CO with a reduction in PI during Kapalbhati; and a significant increase in SBP, DBP, MAP, and TPR with a reduction in SV and CO during Kumbhaka practice. Conclusion: In healthy individuals, cardiovascular changes during the practice of Bhastrika and Kapalbhati are more or less similar to each other and are different from those of Bhramari and Kumbhaka in most of the variables.
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Effect of short-term yoga-based-breathing on peri-operative anxiety in patients undergoing cardiac surgery p. 163
Aspari Mahammad Azeez, Goverdhan Dutt Puri, Tanvir Samra, Mahinder Singh
DOI:10.4103/ijoy.IJOY_120_20  
Background: Peri-operative anxiety in patients scheduled for cardiac surgery is detrimental. This study evaluated the effect of short-term yoga based-breathing with different variations on peri-operative anxiety. Materials and Methods: A prospective randomized controlled study was conducted in patients aged 20–60 years scheduled for major cardiac surgery. Patients in Yoga group were trained for yoga based-breathing with different variations for 5 days; no intervention was done in controls. Results: We analyzed twenty patients in each group. Anxiety scores measured at baseline, presurgery, and postsurgery were entered as the within-subjects factor; group status was entered as the between-subjects factor in the RMANOVA. Baseline demographics and anxiety scores were comparable. The short-term yoga-based breathing exercise-training program had a statistically significant effect on state (F = 13.45, P < 0.0001), Trait (F = 13.29, P < 0.0001) and total anxiety scores (F = 29.44, P < 0.0001) at different time points for yoga over control group. Conclusion: Short-term yoga-based breathing for 5 days lowers presurgery and postsurgery anxiety in patients undergoing cardiac surgery.
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Role of mind–Body intervention on lipid profile: A cross-sectional study p. 168
Priya Mehra, Akshay Anand, R Nagarathna, Navneet Kaur, Neeru Malik, Amit Singh, Viraaj Pannu, Pramod Avti, Suchitra Patil, HR Nagendra
DOI:10.4103/ijoy.IJOY_51_20  
Background: Yoga is a combination of physical-breathing and meditative techniques that assist in the unification of the mind–body, which improves the quality of life. It was shown that long-term Yoga practitioners had superior control over respiratory rate, reduced stress and anxiety, and a better-controlled lipid profile. Purpose: We aimed to investigate the lipid profile of long-term yoga practitioners who were practicing yoga for more than 1 year in comparison with the nonyoga group. Methods: A nationwide survey was conducted in which the long-term yoga practitioners (n = 76) and nonyoga practitioners (n = 80) were recruited for assessment for the lipid parameters. Results: The mean (standard deviation) values of both groups were within normal range with serum cholesterol at 189.715 ± 20.4 and 180.88 ± 29.7 and triglycerides at 216.72 ± 92.5 and 207.665 ± 88.3, low-density lipoprotein at 126.65 ± 18.5 and 120.775 ± 26.5, and high-density lipoprotein at 47.17 ± 6.6 and 44.99 ± 7.0, respectively, in yoga and no-yoga groups. Conclusion: The lipid profile values were similar in yoga and nonyoga practitioners in the 2017 survey.
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