EFFECT OF SIX WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY INDIVIDUALS

By

Dr.NAGALAKSHMI V. M.B.B.S

Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, In partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE IN

PHYSIOLOGY
Under the Guidance of Dr. ARUNKUMAR V J PROFESSOR AND HEAD OF THE DEPARTMENT

DEPARTMENT OF PHYSIOLOGY

SRI SIDDHARTHA MEDICAL COLLEGE

TUMKUR 2011

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

DECLARATION BY THE CANDIDATE

I, hereby declare that this dissertation entitled, EFFECT OF SIX WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY INDIVIDUALS is a bonafide and genuine research work carried out by me, under the guidance of Dr. V.J. ARUNKUMAR, Professor and Head of the Department, Dept. of Physiology at Sri Siddhartha Medical College, Tumkur.

Date: Place: Tumkur

Signature of the Candidate (Dr.NAGALAKSHMI V.)

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CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled EFFECT OF SIX WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY INDIVIDUALS is a bonafide research work done by Dr. NAGALAKSHMI V in partial fulfillment of the requirement for the degree of DOCTOR OF MEDICINE (M.D.) in PHYSIOLOGY during the academic year 2011.

Date: Place: Tumkur

Dr. .V. J. ARUNKUMAR MD., Professor and Head Dept. of Physiology, Sri Siddhartha Medical College Tumkur.

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ENDORSEMENT BY THE HEAD OF THE DEPARTMENT

This is to certify that the dissertation entitled EFFECT OF SIX WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY INDIVIDUALS is a bonafide research work done by

Dr. NAGALAKSHMI V, under the direct guidance of Dr. V.J.ARUNKUMAR., professor and Head of Department. Department of Physiology, Sri Siddhartha Medical College, Tumkur.

Date: Place: Tumkur

Dr. V.J. ARUN KUMAR. MD., Professor and HOD Dept. of Physiology, Sri Siddhartha Medical College Tumkur.

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ENDORSEMENT BY THE PRINCIPAL / HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled EFFECT OF SIX

WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY INDIVIDUALS is a bonafide
research work done by Dr. NAGALAKSHMI V. under the direct guidance of Dr. V.J. ARUNKUMAR, Professor and Head of Department. Department of Physiology, Sri Siddhartha Medical College, Tumkur.

Date: Place: Tumkur

Dr. SRINIVAS MURTHY A.G. MD., Principal, Sri Siddhartha Medical College, Tumkur.

COPYRIGHT
DECLARATIONBY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences shall have the rights to preserve, use and disseminate this dissertation in print or electronic format for academic / research purpose.

Date: Place: Tumkur

Signature of the Candidate

(Dr. NAGALAKSHMI V)

Rajiv Gandhi University of Health Sciences, Karnataka.

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ACKNOWLEDGEMENT
The completion of this dissertation would never be possible without the guidance, assistance and constant encouragement given to me by a number of people. First of all, I deem it my proud privilege to have been blessed with the impetus to do this work by my guide Dr. V.J.ARUNKUMAR, Professor and Head of Department, Department of Physiology, Sri Siddhartha Medical College, Tumkur. I am sincerely thankful to him for his constant support, involvement, timely suggestion and corrections that have been showing me the right path since beginning. I convey my deep sense of gratitude and sincere thanks to my respected teacher Dr. G. S. NELLIGI, who with his knowledge and expertise has provided able guidance, constant encouragement, advices and genuine concern towards my work in the beginning of my study course. I am thankful to my Professors, Dr. Basavaraju K. and Dr. Padmanabha D. R., Department of Physiology, Sree Siddhartha Medical College for their valuable support, constant encouragement and incorporating discipline attitude in work and studies. I would never forget constant support, encouragement, concern and help rendered to me in all aspects throughout the work and studies by Dr. Niranjan Murthy, Dr. Sendil Kumaran. D, Dr. Ravindra, Dr. Vijaykumar Narayan, Dr. Venkatesh, Dr. Tejaswini, Mr. Sachin Ingole and would hereby like to thank them all for their timely advice, suggestions and guidance. I would also like to thank all the technical and non-technical staff of our department. Without them the journey till here would not have been so smooth. I extend my thanks to yoga teacher, Sri Nagaraju Guruji for his co-operation and help. I am thankful to my colleagues Dr. Shobha M.V, Dr. Shantala B.N, Dr. Roopa Balachander, Dr. Jiji , Dr.Chethan, Dr. Deepika, Dr. Vivek and Dr. Deepali for the timely suggestions and moral support they provided.

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I sincerely appreciate the contribution of Dr. Suresh K.P. Scientist (Biostatistician), National Institute of Animal Nutrition and Physiology, Bangalore towards statistical analysis of the acquired data. Most importantly I would like to thank Dr. Shivaprasad G. Honble Director, Sri Siddhartha Medical College, Tumkur for providing the great academic opportunity and adequate environment to pursue the course. I convey my thanks to The Principal, Dr. Srinivas Murthy A. G. for providing with all the facilities in time for the completion of this work. My special thanks to all the subjects for their co-operation and consent without which, the study would not have progressed. I would also like to thank Mr. Umer DTP center, Tumkur, for the meticulous computerized laser output of this dissertation. I would also like to thank Dr.Jaimaruthi for his cooperation, moral support and timely help during the study. I especially thank my friend Dr. Nagabhushan for his co-operation, moral support and timely help during the study. I would like to thank my parents Sri. Vijaykumar & Smt. Bhagirathi for their never ending love, care, affection, tolerance and moral support. Lastly I sincerely thank the almighty God for blessing me with wisdom courage and strength to accomplish this work.

Date: Place:Tumkur.
Dr. NAGALAKSHMI V

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ABSTRACT

Background and Aim:

The prevalence of cardiovascular disease has increased substantially over the past few decades. It has been established that low fitness is one of the attributing factor for increased cardiovascular mortality. Yoga is a science practiced in India over thousands of years. Yoga aims to bring about functional harmony between body and mind through three main practices: asanas, pranayama and meditation. It was shown that yoga practices which improve stretch flexibility and control various physiological variables improve fitness of an individual. This study was done to know the effects of six weeks of yoga training on physical fitness and aerobic capacity of healthy individuals of both genders.

Objective:

To study the effects of six weeks of yoga practice on pulse rate, blood pressure, VO2 max and physical fitness index in healthy individuals.

Methods:

The present study consisted of 50 healthy subjects, including both genders of 20-40 years age group. 28 male and 22 female participants fulfilling the inclusion and exclusion criteria underwent one hour daily yoga program for 6 weeks taught by a

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certified yoga teacher. Pre yoga and post yoga cardiorespiratory functions were assessed by measuring pulse rate, blood pressure, VO2 max and physical fitness index. The pre and post yoga parameters were analyzed by Student t test.

Results:

There was significant reduction in resting pulse rate (p<0.001), systolic blood pressure (p<0.001) and diastolic blood pressure (p<0.001) after practicing yoga for 6 weeks. The study also showed significant increase in VO2 max (p<0.001), and physical fitness index (p<0.001) compared to pre yoga practice. The response was similar in both the genders.

Conclusion:

This study showed beneficial effects of six weeks of regular yoga practice on aerobic capacity and physical fitness irrespective of gender in normal healthy individuals.

Key Words: Yoga, Aerobic Capacity, Physical Fitness Index.

LIST OF ABBREVIATIONS USED

PR SBP DBP VO2max PFI EEG FEV1 BMR UFNB GSR HIP-PNE HPA SD BY AY F M

Pulse rate Systolic Blood Pressure Diastolic Blood Pressure Maximal oxygen consumption Physical Fitness Index Electroencephalogram Flow Expiratory Volume in One Second Basal Metabolic Rate Unilateral Forced Nostril Breathing Galvanic Skin Resistance Human Information Processing- Psychoneuroendorine Hypothalamic Pituitary-Adrenal Axis Standard Deviation Before Yoga After Yoga Female Male

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CONTENTS

SL. NO. 1. 2. 3. 4. 5. 6. 7. 8. 9. Introduction

TITLE

PAGE NO. 1-2 3 4-18 19-34 35-45 46-50 51 52 53-60 61-62 63-64 65-66 67-69

Aim and Objectives of study Review of Literature Materials and methods Results Tables and Graphs Discussion Conclusion Summary Bibliography Annexure - Photographs Consent form Proforma Master chart

10. -

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List of Tables

TABLE NO. 1. 2. 3. 4. 5. 6. 7. 8.

TITLE Age distribution of subjects studied Gender distribution of subjects studied Mean and SD of age, Height, Weight and BMI of subjects studied Effect of Yoga on Pulse rate Effect of Yoga on Systolic BP Effect of Yoga on Diastolic BP Effect of Yoga on VO2 max Effect of Yoga on PFI

PAGE NO. 38 39 40 41 42 43 44 45

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List of Graphs

CHART NO. 1. 2. 3. 4. 5. 6. 7.

TITLE Age distribution of subjects studied Gender distribution of subjects studied Effect of Yoga on Pulse rate Effect of Yoga on Systolic BP Effect of Yoga on Diastolic BP Effect of Yoga on VO2 max Effect of Yoga on PFI

PAGE NO. 38 39 41 42 43 44 45

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INTRODUCTION
The prevalence of cardiovascular disease has increased substantially over the past few decades. It has been established that low fitness is one of the attributing factor for increased cardiovascular mortality. Numerous risk factors for

Cardiovascular diseases including Hypertension, Diabetes and Hypercholesteremia are suspected to be influenced by fitness and these factors may mediate the association between low cardio respiratory fitness and mortality.(1) VO2 max is an internationally accepted parameter to evaluate cardiovascular fitness. The use of direct method to measure VO2 max is restricted because of its exhausting and difficult experimental protocol and absence of well equipped laboratory. Earlier studies have established the use of Queens college step test to predict VO2 max indirectly. (2) Yoga is a practical discipline incorporating a wide variety of practices whose goal is the development of a state of mental and physical well being, inner harmony and ultimately a union of the human individual with the universal and transcendent existence. (3) With increased awareness and interest in health and natural remedies, yogic techniques are gaining importance and becoming increasingly acceptable to the scientific community. Its value is seriously realized in todays dynamic and stressful world. To meet the demands of hectic lifestyle, one has to work hard. Stresses and strains are the obvious hazards of such a lifestyle. Practice of Pranayama and Meditation arouses tremendous energy to combat stress and pain. It makes the body and mind effective for leading a happy and healthy life. (4) Growing number of evidences have claimed that yoga practices increases longevity (5), has therapeutic (6, 7, 8) and rehabilitative effects (9, 10). The
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beneficial effects of six weeks practice of different Pranayamas are well reported and has sound scientific basis. (11, 12) Different types of Pranayama along with Asanas produce different physiological responses in normal young individuals. (13) It was shown that yoga practices which improve stretch flexibility and control various physiological variables improve fitness of an individual. (14) This study was done to know the effects of six weeks of yoga training on Physical fitness and Aerobic capacity of healthy individuals of both genders.

AIMS AND OBJECTIVES

Aim of the study To know the Effects of six weeks yoga training on Physical fitness and Aerobic capacity in healthy individuals. Objectives of the study To assess Pulse rate, Systolic Blood pressure, Diastolic Blood pressure, VO2 max and physical fitness index (PFI) in healthy individuals of 20-40 years before yoga training. To assess Pulse rate, Systolic Blood pressure, Diastolic Blood pressure, VO2 max and physical fitness index (PFI) in same individuals after six weeks of yoga training. Comparison of above parameters before and after joining yoga training

REVIEW OF LITERATURE
HISTORY Yoga is an ancient philosophical and religious tradition which is thought has originated in at least 5000 BC. The first archeological evidence of yoga existence is found in stone seals excavated from Indus valley, in the ancient cities of Mohenjodaro and Harappa. Between 1800 and 1500 BC Upanishads explained the transcend self (atman) and its relation to the ultimate reality (Brahman).The Bhagvad Gita was written about 500 BC and its first sculpture devoted entirely to yoga. It unified various traditions of yoga like Jnana yoga, Bhakthi yoga and karma yoga together. Pathanjali in 200 BC defined classical yoga. This was mainly Raja yoga or the eight fold yoga path. The yoga sutras of Pathanjali is considered the authorative text on classical yoga by all yoga schools. Yoga Definitions and classification The word yoga is derived from the Sanskrit origin YUJ which means TO BIND, TO JOIN , TO APPLY or TO CONTROL.(14) There are several schools of yoga like, Hatha Yoga, Raja Yoga, The Triple Path and Integral Yoga. But the ultimate or principle aim of yoga is same i.e., to attain the unity of mind, body and spirit through three main yoga structures; Asanas (exercise), Pranayama (breathing) and Meditation. (5) 1. Hatha yoga: Aims primarily at perfection of the body. It includes Aasanas , Pranayama and Kriyas. 2. Raja yoga: Aims primarily at the perfection of the mind. The basic technique of Raja yoga is Meditation.
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3. Triple path yoga: Jnana yoga, Bhakthi yoga , karma yoga 4. Integral yoga : It is the combination of different schools of yoga. THE YOGIC PRACTICES (14,4) 1. Asanas 2. Pranayama 3. Meditation 4. Kriyas Asanas It literally means a posture. There are more than 80 Asanas described in Hathayogapradipika and individual practitioners have introduced some variations, increasing their number still further. Since an average person does not have the time to perform so many Asanas every day, several selections of relatively easier Asanas are popular. Asanas can be performed in any place but they should be done in empty stomach. Asanas can be classified into 3 main groups 1. Asanas for relaxation 2. Asanas for physical exercise 3. Asanas for meditation. Asanas for relaxation; these Asanas provide physical relaxation and if properly performed also gives mental relaxation. These Asanas are repeated several times
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during the typical session. A typical sessions of Asanas is begins with warming up for a few minutes by stationary running, joint loosening exercises or through Surya Namaskara. Warming up is followed by five minutes of a relaxing Asana, usually Shavasana. It is repeated for a few minutes at a time between several other Asanas which provide physical exercise. The end of a session of Asanas is also usually long (about 10 minutes) Shavasana. Another common relaxing posture is Makarasana. Makarasana is sandwiched between those Asanas which are performed lying down in the prone position. Shavasana relaxes the body because the muscles are completely relaxed voluntarily. It also relaxes the mind through deep and conscious breathing. Shavasana is an extremely useful Asana, especially for busy people under stress. Shavasana is the Asana recommended to them if they do not have time and strength for any more. Asanas for physical exercise: these Asanas are the best known part of yoga. A sequence of 10-15 Asanas which would take 30-45 minutes to perform can provide exercise to almost all muscle and joints of the body, massage the visceral organ , and activate cardiorespiratory reflexes. A typical Asana starts with a starting position. From there, progress is made towards the final posture through a slow, gentle and graceful movement. In the final position, at least some parts of the body are under intense stretch. The body is held still in the final posture for some time, usually at least 10 seconds. After that the body is brought to a relaxing posture, gain through a slow and gentle movement. Asanas are different from other physical exercises in the following manner.

In case of Asanas ; a. The movements are slow, gentle and graceful. b. Every pose is followed by a counter pose. c. Alternate stretching and relaxing of group of muscles. d. The session of Asanas begins with relaxation, ends with relaxation, and is interspersed with relaxation. Asana becomes Yosasana only when performed with the right attitude. They should be preceded by purification of behavior (yama and niyama)

Some of the common Asanas performed are:Standing Sitting Prone Supine : Vrikshasana , Trikonasana and Padhahastasana : Vajrasansa , Baddhakonasana, Shashankasana and Parvatasana : Bhujangasana , Dhanurasana, and Makarasana : Pavanamuktasana, Matyasana, Chakrasana, Sarvangasana, Halasana and Shavasana

Asanas for meditation: Meditation is usually performed sitting on the floor with the eyes closed. The basic principle of the posture for meditation is that it should be steady and comfortable. Some of the recommendation postures are: Padmasana Sukhasana Vajrasana

Pranayama: Pranayama literally means control of Prana. Prana in Indian philosophy refers to all forms of energy in the universe. Life force, in an individual is symbolized by breathing. That is why Pranayama is generally considered to mean regulated breathing. A yogi, through Pranayama, can at some stage control other function of his body, and finally control manifestations of Prana even outside his body. As a technique, Pranayama can assume rather complex forms of breathing. But the essence of the practice is slow and deep breathing. Prana refer to inhalation,Rechaka to exhalation and Kumbhaka means breath holding.

A few varieties of Pranayama are : o Ujjayi Pranayama o Suryabhedana Pranayama o Nadisodhna Pranayama o Bhastrika Pranayama o Kapalabhati Pranayama o Bhramari Pranayama o Sitali Pranayama Meditation Meditation is the method of extending our ordinary consciousness and there by discovering more about ourselves. When we gain this insight we can change our habits and our deeper, inner personality as a better chance to show through. Our whole life changes for the better.

In physiological terms Meditation results in; 1. Sensory (afferent) attenuation that is minimal sensory input 2. Motor (efferent) attenuation that is minimal motor output

3. Non analytical attenuation or non targeted thinking that is minimal cortical activity involving attenuation to a specific object or topic.

The physiological effects of Meditation were 1. Decrease in heart rate 2. Decrease in respiratory rate 3. Decrease in oxygen consumption 4. Decrease in blood pressure if the basal blood pressure is high 5. Increase in percentage of time spend in alpha rhythm in EEG 6. Decrease in muscle tension 7. Decrease in blood lactate level Physiological effects of yogic practices 1. Cardiovascular effects; in general yogic practices reduces the resting heart rate and blood pressure. Following this practices, a given level of exercise is associated with a smaller rise in the heart rate and blood pressure. Studies conducted to know the physiological and biochemical responses before and after yoga training show that there was a significant decrease in heart rate and blood pressure (15,16,17) Study shown that a yogi aged 60 years who remained confined in a small underground pit for 8 days in deep meditation and for a few days, he could even stop his heart beat. (18)

Kaviraja udupa and his associates studied the effect of Pranayama training on cardiac function in normal subjects and found that after 3 months of training, Pranayama modulates ventricular performance by increasing parasympathetic activity and decrease in sympathetic activity. (19) Four weeks of Nadisuddhi Pranayama has shown significant decrease in Pulse rate, Diastolic blood pressure, Systolic blood pressure along with significant increase in pulse pressure and PEFR. (20) During OM meditation, there was a significant reduction in heart rate as compared to the control period in which non- targeted thinking was encouraged. (21, 22) In other study, it was reported that there was a significant increase in heart rate during single thought as well as during thoughtless state. (23) Murulidhara and Ranganathan demonstrated a significant increase in cardiac recovery index after two and a half months of yogic training in healthy male medical students. (24) Madanmohan and coworkers found that Pranayama type of breathing produced significant cardio-acceleration and increase in QRS axis during the inspiratory phase as compared to eupnoea in young healthy untrained subjects. (25) Study conducted by Shirley Telles and Desiraju reported an overall increase in heart rate during Vibhagiya Pranayama and Mahatyoga Pranayama, whereas Savitri Pranayama and Nadisuddhi Pranayama, the overall heart rate was not significantly altered. (26) Autonomic activities can be altered by breathing through a particular nostril. During right nostril Pranayama and alternate nostril Pranayama, the heart rate increased (27) whereas during left nostril Pranayama, there was a decrease (28, 29) or no change in heart rate. (30)

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Yogic Asanas and Pranayama have been shown to reduce the resting respiratory rate. (31) Further, they increase the chest expansion, (6, 32) the vital capacity, (33) FEV1 above 85%, (34, 35) PEFR and maximum voluntary ventilation, (36, 37) breath holding time (16) and maximal inspiratory and expiratory pressures. (38) Data suggest that training in yoga respiration selectively increase the respiratory sensation, perhaps through its persistent conditioning of the breathing pattern. (39) In a study involving comparison of athletes and yogis and individuals with sedentary lifestyles found that the highest mean FEVI and PEFR were observed in yogis. Both yogis and athletes had significantly better PEFR as compared to sedentary workers. Yogis also had significantly better PEFR as compared to sedentary workers and athletes. (40) Yogic breathing exercises, when compared with other exercise modalities, provide a much better workout for the core muscles in the body. Considering the abdominal work with yogic breathing exercise, total body workouts would be much more time efficient if yogic breathing exercises were combined and interlaced with other exercise modalities for a more efficient fitness program. (41) Different types of Pranayama may lead to different types of alterations in the oxygen consumption and metabolic rate. The short Kumbhaka Pranayama caused a statistically significant increase (52%) in the oxygen consumption and metabolic rate whereas long Kumbhaka Pranayama cause a statistically lowering (19%) of oxygen consumption and metabolism(42) A study also demonstrated that athletes after 12 weeks practice of Pranayama, showed lower respiratory rate and lowered oxygen consumption. (43)

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A reduction in oxygen consumption has also been demonstrated during transcendental meditation and cyclic meditation. (16,30) the long term practice of yoga using a combination of stimulatory and inhibitory yoga practices (Asana, Meditation and Pranayama) significantly reduce BMR, probably linked to reduced arousal. (44) Power spectral analysis of 24-hr EEG in those who have been practicing transcendental meditation has shown an increase in alpha/ delta power indicates a more relaxed mind during the awaken period. Further, it was found that there was a better balance and synchrony in the EEG recorded from the left and right side and from the frontal and occipital leads. (45) Recent studies have shown that unilateral forced nostril breathing (UFNB) affects cerebral hemisphere dominance. Left side UFNB leads to right hemisphere dominance and improves spatial sills. On the other, right sided UFNB induces left cerebral hemisphere dominance and increases verbal skills like written and spoken speech. (46) Studies on autonomic functions indicate that yogic practices, in general, bring about a tilt mostly from sympathetic towards parasympathetic dominance.(15,16,47) In addition, Voluntary control of autonomic function can also be achieved through yoga. (48) Galvanic skin response (GSR) has frequently been used in studies on autonomic function. Sympathetic reactivity is indicated by the magnitude of this response. It has been shown that those who practice meditation have fewer spontaneous GSRs than non meditating controls, indicating lower reactivity to stressful syllable, led to a reduction in skin resistance, whereas, there was no change during repetition of a neutral syllable or during non-targeted thinking. (22)

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Practicing Asanas, Pranayama, Meditation and attending devotional sessions for ten days led to a significant improvement in fine coordinated movements and improved delayed recall of spatial information. (49) Relaxation potential of yogic breathing exercises seems to play a vital role in establishing psycho-physical health in reversing the psycho-immunology of emotions under stress based on breath and body awareness. However, mechanism of yogic exercises for restoring health and fitness components operating through psychoneuro-immunological pathways is unknown. A hybrid model of human information processing- psychoneuroendocrine (HIP-PNE) network has been proposed to reveal the importance of yogic information processing involving cortical and hypothalamicpituitary-adrenal axis (HPA) interactions with a deep reach molecular action on cellular, neuro-humoral and immune system in reversing stress mediated diseases. (50) Yogic practices have been shown to reduce baseline and average glucocorticoid levels. But the glucocorticoid response to an acute challenge is enhanced. These findings indicate a lower level of stress and enhance capacity to face a challenge. (51) A study has shown that plasma melatonin levels were higher during night immediately following meditation as compared with those at the same time on control night. Higher melatonin levels might be one of the mechanisms through which health promoting effects of meditation can be claimed to occur. (52) Yoga has been incorporated into modern medicine during the few decades. The integration has been the result of several convergent developments. First, the diseases of modern civilization such as obesity, hypertension, coronary artery disease and diabetes mellitus are rooted in faulty life style. This realization stimulated the search
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for good lifestyles. Yoga is one of the best lifestyles ever devised by mankind. Second, psychological stress is a major contributor to the diseases of modern civilization. This discovery stimulated the search for strategies for overcoming stress. Yoga provides a new way of looking at life. Hence everything remaining the same, the person starts feeling better. A method based not on changing the circumstances but on changing our attitude to circumstances is potentially infallible. Regular practice of yoga improves arterial baroreceptor reflex sensitivity towards normal (8, 53) and reduces systolic and diastolic blood pressures in hypertensive patients. (54, 55) Follow up studies of yoga and biofeedback in the treatment of hypertension revealed a significant reduction in blood pressure and antihypertensive drug requirements. (56) Asanas, Pranayama and Meditation practiced by patients of late and recent myocardial infarcts help them in lesser need for drugs, early ambulation and quicker rehabilitation and may reduce the chances of other complications. (57) The regular decrease in all lipid parameters except HDL in subjects practicing yoga may be the reason for the beneficial effect of yoga seen in coronary artery disease. (58) Pranayama and Asanas like Dhanurasana, Sarvangasana, Paschimottasana and Halasana are effective in reducing the blood glucose level, stabilizing autonomic functions (59) and improving nerve function in mild to moderate type II diabetes with subclinical neuropathy. (60) Yoga improves glycaemia control by increasing the percentage of insulin binding receptor in type 2 diabetic patients with no significant change in cortisol and thyroid hormones. (7) Controlled trials on large series of patients having bronchial asthma indicate that a 2-4 week course in selected yogic practices reduces the frequency of asthmatic attacks,
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reduces the requirement for medication and increases the peak expiratory flow rate. (6) Yogic breathing also has an overall positive effect on patients with moderate to severe chronic obstructive pulmonary diseases. (9) CARDIORESPIRATORY FITNESS Cardiorespiratory fitness is the ability of bodys circulatory and respiratory system to supply fuel and oxygen during sustained physical activity. (61) Cardiorespiratory fitness is responsible for prolonged use of large muscles of the body which depends on cardiovascular and respiratory system. Low cardiorespiratory fitness is a risk factor for cardiovascular disease morbidity and mortality.VO2max also called aerobic capacity is most widely accepted parameter to evaluate cardiorespiratory fitness. (2) DETERMINANTS OF MAXIMAL OXYGEN CONSUMPTION: In essence there are three major factors determining maximal oxygen consumption 1. Cardiac output (the volume of blood pumped by the heart in one minute) 2. The oxygen carrying capacity of blood (determined by haemoglobin in red blood cells) 3. The amount of exercising skeletal muscle and the ability of muscle to utilize supplied oxygen. CRITERIA OF MAXIMAL OXYGEN CONSUMPTION (62) There are two main criteria showing that VO2max has been measured. There is no further increase in oxygen uptake despite further increase in work load.

The blood lactate concentration is above 70-80mg/dl of blood.

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CARDIAC OUTPUT; Cardiac output is defined as the mathematical product of heart rate times stroke volume. Heart rate is the number of times the heart contracts per minute. Stroke volume is the amount of blood ejected by each ventricle per stroke. The ventricles of the heart fill the blood during a period of time called diastole .The ventricles are maximally filled at a time just before the heart contracts called end diastole. The contraction phase is referred to as systole. When the ventricles are maximally emptied (there is still some blood remaining in them) this period is called end systole. Consequently stroke volume equals diastolic volume end systolic volume. Very healthy hearts empty a greater percentage of their end diastolic volume. Cardiac output in a resting individual of average size is about 5 litres/minute. In an untrained individual heart rate is about 72 beats per minute so stroke volume is about 70 millilitres .Maximal heart rates are related to age and appears to be unrelated to the level of fitness. The rule of predicting maximal heart rate by subtracting age from 220 is good index of maximum heart rate but it is far from precise and may differ by 20 beats or more for individuals of the same age. Stroke volume also typically increases with exercise and maximal cardiac output in highly trained individuals may attain 40 liters/minute. The ability to generate high maximal cardiac output is a major determinant of the ability to have high maximal oxygen consumption.

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OXYGEN CARRYING CAPACITY; Red blood cells the principle cellular component of the blood carry an iron containing protein called haemoglobin. Haemoglobin has binding sites for oxygen and when blood is in the presence (as in the pulmonary circulation) of oxygen is avidly bound to haemoglobin. When blood reaches portions of the circulation that utilize oxygen for energy production (such as skeletal muscle during exercise) oxygen is less avidly bound to haemoglobin and the red blood cells for consumption by the tissues. In most individuals the amount of haemoglobin in the blood is about 15 grams/l00ml of blood. Each gram of haemoglobin can bind about 1.34 millilitres of oxygen. So 15 grams/l00ml of haemoglobin carries about 20 millilitres of oxygen after it has passed through the lungs. Depending on the speed with which blood passes through metabolically active tissues oxygen levels in the blood can be below 3 millilitres per 100 millilitres. The ability of the tissues to take oxygen from the blood is referred to as extraction of oxygen. SKELETAL MUSLE MASS ; Of the three factors determining maximal oxygen consumption the most important in terms of training adaptations is the role of skeletal muscle. The larger the mass of the exercising skeletal muscle the greater the potential for increasing whole body oxygen consumption .Also the manner in which skeletal muscle is trained and the muscle fibre type will influence the ability of the muscle to extract oxygen. VO2max is the first choice in measuring a persons cardiorespiratory fitness. It is a fundamental measure of physiological functional capacity to exercise. (63)

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Effect of yoga on VO2 max Mark D Trans and his associates studied the effect of 8 weeks of Hatha yoga practice on Health-related aspects of physical fitness and shown that it causes a significant increase in VO2 max. (64) Studies have shown that 6 months of Surya Namaskara practice produces an improvement in VO2 max.(34) Studies show that 6 weeks of yoga practice bring about a significant improvement in VO2 max. (65, 66)

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MATERIALS AND METHODS

SOURCE OF DATA: The present study was conducted in the Department of Physiology, Sri Siddhartha Medical College, Tumkur from November 2008 to may 2010. Ethical clearance for the study protocol was obtained from institute ethical committee.50 healthy subjects, 28 males and 22 females of age group 20-40 years were selected randomly from a group of participants visiting the yoga centre in Tumkur who had not started practicing yoga but were keen on learning. The same subjects were chosen as both study as well as control group in order to minimize the confounding factors and make the study more reproducible. METHOD OF COLLECTION OF DATA The subjects who satisfied inclusion and exclusion criteria were selected after taking a detailed clinical history as in the proforma. The health of the subject was assessed by noting the present, family and personal history and also by a through general and systemic examination. INCLUSION CRITERIA Healthy individual from age 20-40 years with apparently no major illness joining first to yoga training were included. EXCLUSION CRITERIA A) Subject who trained in yoga before and joined again B) Subject with history of Respiratory diseases, Tuberculosis, Asthma, and Chronic obstructive pulmonary diseases
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C) Subject with history of Diabetes, Hypertension, and its complications D) Subject with history of Cardiovascular and Renal diseases E) Subject on any medication The subjects were explained about the importance and procedure of the study. An informed consent was obtained from all the members. The subjects were asked not to change their life style during the 6 weeks of the study and were instructed not to perform any other physical exercises if they were not doing the same regularly. Parameters used Data on physical characteristics such as age, height, weight and body mass index (BMI) were obtained. BMI was calculated as weight (kg)/height (m) 2. The following parameters were measured before practice of yoga. 1. Pulse rate (PR) 2. Systolic Blood pressure (SBP)

3. Diastolic Blood pressure(DBP) 4. VO2 max 5. Physical Fitness Index Investigations and interventions conducted The study involved non-invasive procedures with no financial burden on the subjects. The subjects were informed about the procedures in brief and were asked to relax physically and mentally for 30 minutes in supine position in a silent room. In the same resting supine position the pulse rate and the blood pressure were recorded. The pulse rate in beats per minute was recorded in the right radial artery by palpatory method for whole one minute. Similarly three readings were taken at an interval of 15 minutes each and an average of the three values calculated. The systemic arterial
20

blood

pressure

in

millimetre

of

mercury

(Hg)

was

recorded

with

sphygmomanometer (Diamond), in the right upper limb by auscultatory method. The first and fifth korotkoffs phase were used to define systolic and diastolic blood pressure. Similarly three readings were taken at an interval of 15 minutes each and average of the three values calculated. Estimation of VO2 max by QUEENS COLLEGE STEP TEST. (67) Step test was performed using a stool of 16.25 inches (41.30 cm) height. Stepping was done for a total duration of 3 minutes at the rate of 24 cycles per minute for males and 22 cycles per minute for females. After completion of exercise the subjects were asked to remain standing comfortably and the carotid pulse rate was measured from 5th to 20th second of recovery period. This 15 second pulse rate was converted into beats per minute and the following equation was used to predict Vo2 max. Men: VO2 max (ml/kg/min) = 111.33 (0.42 pulse rate in beats per minute) Women: VO2 max (ml/kg/min) = 65.81 (0.1847 x pulse rate in beats per minute) And physical fitness index was calculated by using the following formula: PFI = 195.06 (3.09 step test pulse rate) All the subjects were given yogic training by a qualified instructor for a period of 6 weeks for one hour daily between 6 am to 7 a.m. The schedule consisted of: 1. Warm-up exercises followed by shavasana 5 minutes 2. Prayer (suryanamaskara ) 10 minutes
21

3. Asanas 20 minutes 4. Pranayama -10 minutes 5. Meditation -10 minutes 6. Shavasana 5 to 10 minutes The Asanas practiced were;I. In standing posture; 1.Vrikshasana 2.Trikonasana 3.Hastha padasana 4.Suryanamaskara II. In sitting posture; 1.Vajrasana 2.Padmasana 3.Shashankasana III. In prone posture 1.Makarasana 2.Bhujangasana 3.Dhanurasana IV. In supine position 1.Halasana 2.Chakrasana 3.Shavasana

22

The different type of Pranayamas performed were;1. Surya anuloma viloma Pranayama 2. Chandra anuloma viloma Pranayama 3. Nadisuddhi Pranayama The session was concluded by meditation and finally shavasana. Surya Namaskara Surya Namaskara is performed in 12 steps Step- I Stand erect with legs together. Bring the palms together to Namaskara mudra Step-2: Take the hands above the head while inhaling and bend the trunk backwards (Hasta utthanasana). Step-3: Bend forward while exhaling and touch the forehead to the knees. Keep the palms on the floor on either side of the legs (Padahastasana). Step-4: Inhale and stretch the right leg back to rest on the toes. At the same time bend the left leg, but keep the left foot in the same position. the arms should remain straight in the same position. The gaze is directed upwards finally (Ekapadasana). Step-5: Exhale and take the left leg back, resting only on palms and toes. Keep the body straight from head to toes inclined to the ground at about 30. Take care to maintain the position of the neck in line with the back (Dwipadasana). Step6: Without shifting the position of the hands and toes, inhale and glide the body forwards. While exhaling, rest the forehead, chest, palms, knees and toes on the ground. Raise the buttocks off the ground. Note that 8 points of the body are in contact with the ground (Shastanga namaskara).
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Step-7: Inhale and raise the trunk, making the spine concave upwards without shifting the position of the hands and feet, Arch the back as far as you can, until the elbows are straight. Keep the knees off the ground (Bhujangasana). Step-8: While exhaling, without shifting the position of hands and feet raise the buttocks; push the head down until the heels touch the ground (Parvatasana). Step-9: inhale and bring the right leg in between the two hands. Arch the back concave upwards as in step-4 until the right leg is perpendicular to the ground (Ekapadasana) Step- 10: Exhale and bring the left foot forward next to the right foot and touch the knees by the forehead as in step-2 (Padahastasana). StepI I Straighten the whole body as you inhale, and raise the arms above the head. Bend the arms, head and trunk slightly backwards (Hasta utthanasana). Step-12: This is the final pose and is same as step-1. Exhale as you assume the final pose. ASANAS VRIKSHASANA Done in standing posture. Catch the right foot with the right hand and bring it up to press against the inner side of the left thigh, just above the level of the knee. Stretch the arms above the head to namaskara mudra, Focus your vision at a point in front of you.
24

Maintain normal slow breathing for about one minute. Come down without over stretching.

In the final posture, the soles of the feet face upwards. heels are kept together and the entire weight of the body is felt on the back of the feet.

PADMASANA Done in sitting posture. Draw the right leg along the ground and bend the knee. Place the right foot on the left thigh near the left groin. In the same way, bring the left foot on the right thigh near the right groin. The soles of both feet are turned upwards with the heels almost meeting each other in front of the pelvic bones. Sit erect with hands on the thighs in chin mudra (touching the tips of the thumbs with the tips of the forefingers keeping the other fingers straight) with elbows bent. SHASHANKASANA Sit in vajrasana. Placing the hands on the knees. While inhaling, raise the arms so that they are above the head. Exhale while bending the trunk forwards, keeping the arms in line with the trunk At the end of the movement, the hands and forehead should rest on the floor.
25

Retain the breath for a short time in the final position. Breathe in while returning slowly to the upright position. Slowly return to the starting position while exhaling.

BHUJANGASANA Lie down in prone position. Bend the arms at the elbows and place the palms beside the lower chest at the level of the last rib exerting least pressure on the palms. Keep the elbows close to the body and let them not spread out. Inhale and come up. Arch the dorsal spine and neck backwards as far as you can. Keep the body below the naval in touch with the ground. Maintain the final position with normal breathing for one minute with least Pressure on the palms. While exhaling come back to prone position. Relax in Makarasana.

26

MAKARASANA Lie down on the abdomen with feet wide apart, heels touching the ground and facing each other. Bend both the elbows and place the right palm on the left shoulder and the left palm on the right shoulder. Rest the chin at the point where the forearms cross each other. Gently close the eyes.

DHANURASANA Lie down in prone position. Bend the knees and hold the ankles by the palms. As you inhale, raise the head and the chest upwards. Pull the legs outward and backwards so that the spine is arched back like a bow. Stabilize on the abdomen. Do not bend the elbows. Look up. Keep the toes together. Maintain for about half minute with normal breathing. Slowly come back to prone position while exhaling. Relax in Makarasana.
27

HALASANA Lie down in supine position. While inhaling raise the legs together slowly and gracefully (without bending the knees) till it forms about 45degree to the ground. Continue to inhale and raise the legs further to 90 degree position and simultaneously bring the arms down placing them next to the buttocks. While exhaling, raise the buttocks and the trunk without lifting the head Support the back by the palms. Rest the elbows on the ground firmly to get better support to the back. Straighten the trunk by pushing it up with the hands till the chin is well set in the suprasternal hollow. Inhale in this position. While exhaling bring down the toes further to touch the ground. Release both hands and rest the arms on the ground, fingers of both hands interlocked with each other, Maintain this position for one minute with normal breathing. While inhaling come back slowly step by step to rest the trunk on the floor. Now exhale and bring down the legs to the ground. Relax in shavasana.

28

CHAKRASANA Lie down in supine position. Take the hands up and place the palms on either side of the head on the ground under the shoulders with fingers pointing towards the back. Bend the knees and fold the legs, and place the heels on the outer side of the buttocks. With palms and the soles of the feet as four points of support, raise the trunk with an inhalation arching the entire body convex upwards to look like a wheel. Maintain the position for about half a minute with normal breathing. As you exhale, come back slowly step by step to supine position. Relax in shavasana.

SHAVASANA Lie supine on the ground with hands and feet apart. Slightly stretch the body and allow the whole body to relax completely with eyes gently closed. Become aware of different parts of the body starting from toes to head. Feel the spread of relaxation in all parts of the body progressively. With regular long practice, the relaxation will become deeper, natural and spontaneous. Then, the whole body is relaxed to the extent that one forgets the body. The mind experiences alertful rest.
29

PRANAYAMA SURYA ANULOMA VILOMA PRANAYAMA Sit in vajrasana. Adopt nasika mudra (Fold index and middle fingers of the right hand into the centre of the palm. The other fingers are extended) with your right hand. Close the left nostril with the little and ring fingers of nasika mudra. Inhale and exhale slowly through the right nostril only. Keep the left nostril closed all the time during the practice. One cycle of inhalation and exhalation forms one round. Practise nine rounds.

CHANDRA ANULOMA VILOMA PRANAYAMA Sit in vajrasana. Adopt nasika mudra with your right hand. Close the right nostril with the tip of the thumb. Inhale and exhale slowly through the left nostril only. Keep the right nostril closed all the time during the practice. One cycle of inhalation and exhalation forms one round. Practise nine rounds.

30

NADISUDDHI PRANAYAMA Sit in vajrasana. Use nasika mudra. Close the right nostril with the right thumb and exhale completely through the left nostril. Then inhale deeply through the same left nostril. Close the left nostril with your ring and little finger of the nasika mudra, release the right nostril. Now exhale slowly and completely through the right nostril. Inhale deeply through the same right nostril. Then close the right nostril and exhale through the left nostril. This is one round of nadisuddhi pranayama. Repeat nine rounds.

MEDITATION Although meditation can be performed at any time and at any place, it is preferable to do it at nearly the same time and at a fixed place every day, it may be done once or twice a day, about 20 minutes each time.

31

The progressive steps in meditation are: Assume the right posture (Asana). Close your eyes. Breathe slowly and deeply (Pranayama). Gather your thoughts; withdraw from sensory perception (Pratyahara) Concentrate on a chosen thing or set of things (Dharana) Let the mind dwell on the object of concentration (Dhyana) Come out of meditation gently.

After six weeks of yoga training once again parameters were assessed in terms of Pulse rate, Systolic blood pressure, Diastolic blood pressure, VO2 max, and PFI as before the start of yoga training. Statistical Methods: This study is pre-post study; where in the effect of six weeks of yoga on cardiorespiratory fitness have been evaluated in normal healthy individuals. Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5 % level of significance. , Student t test (two tailed, dependent) has been used to find the significance of study parameters on continuous scale within each group. Effect Size has been computed to see the effect of yoga on outcome variables.

32

1. Student t-test for paired comparisons Objective: To investigate the significance of the difference between single population means. No assumption is made about the population variances ( x1 x 2) s/ n

t=

Where s =

(di d )

/ n 1

And di is the difference formed for each pair of observations

2.Effect Size

mean1 Mean 2 PooledSD

No effect (N) Small effect (S) Moderate effect (M) Large effect (L) Very large effect (VL)

d<0.20 0.20 <d<0.50 0.50 <d<0.80 0.80<d<1.20 d>1.20

33

3 .Significant figures + Suggestive significance (p value: 0.05<p<0.10) * Moderately significant ( p value:0.01<p 0.05) ** Strongly significant (p value: p0.01) Statistical software: The Statistical software namely SPSS 15.0, Stata 8.0, MedCalc 9.0.1 and Systat 11.0 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc.

34

RESULTS
Fifty subjects who practiced Pranayama, Yogasanas and Meditation for 6 weeks were analyzed for the results. The results obtained were expressed as mean standard deviation. The age of the subjects ranged from 20-40 yrs, the mean age being 27.404.51 years. There were: 18 case in the age group of 21-25 years. 21 case in the age group of 26-30 years. 7 case between 31-35 years. 4 case between 36-40 years. [Table-1, Chart-1]. Out of the 50 cases, 28 cases were males and 22 were females [Table-2, Chart-2]. On analysis of the physical characters of the 50 subjects, the mean age (years) was 27.404.51, the mean height (m) was 1.590.12 , the mean weight (kg) was 59.707.83 and the mean BMI (kg/m2) was 23.481.06. Both the genders were age matched with significant variation in height (P<0.001), weight (P<0.001) and BMI (P=0.077). [Table-3] Effect of 6 weeks practice of Pranayama, Yogasanas and Meditation on Study parameters: 1. Effect on pulse rate: The mean resting pulse rate (beats/min) before Yoga practice was 74.46 5.03 . It reduced significantly to 70.965.23 (p< 0.001) after six weeks of yoga practice. The resting pulse rate reduced significantly both in males and females. Before the yoga
35

practice, in males resting pulse rate was 71.684.12 and it reduced to 68.214.24 (p<0.001) after the regular practice. In females, the mean resting pulse rate reduced from 78.003.70 to 74.454.23 (p<0.001) [Table-4, chart-3]. 2. Effect on Systolic blood pressure (SBP): The mean resting Systolic blood pressure (mm Hg) before yoga practice was 120.3610.23 . After 6 weeks of regular yoga practice, the mean systolic blood practice reduced to 118.7210.76 (p<0.001). The mean resting systolic blood pressure reduced to a significant level in both genders. In males the mean SBP reduced from 122.2112.05 to 121.5712.48 (p<0.036) and in females it reduced from 118.006.85 to 115.096.73 (p<0.001) [Table-5, Chart-4]. 3. Effect on Diastolic blood pressure (DBP): The mean resting Diastolic blood pressure (mm Hg) before yoga practice was 78.445.97 and it reduced significantly to 76.766.80 (p<0.001) after 6 weeks of yoga practice. The decrease in the mean DBP was significant both in males and females. In males, mean DBP reduced from 78.506.90 to 77.507.86 (p<0.013) and in females, it decreased from 78.364.69 to 75.825.16 (p<0.001) [Table-6, Chart-5]. 4. Effect on VO2 max: The meanSD of VO2 max (ml/kg/min) of the participants before the yoga practice was 36.153.73 . It was found that the mean VO2 max significantly increased to 38.514.44 (p<0.001) at end of 6 weeks yoga practice. In males there was a significant increase in mean VO2 max from 38.133.81 to 41.254.03 (p<0.001) and in females the mean VO2 max increased significantly from 33.641.38to 35.621.50 (p<0.001) [Table-7, Chart-6].

36

5. Effect on physical fitness index: Before the yoga practice, the physical fitness index was 60.466.43. At the end of 6 weeks regular yoga practice, the physical fitness index increased significantly to 66.216.87 (p<0.001). In both the genders there was a significant increase in the physical fitness index. In males the physical fitness index increased significantly from 60.427.01 to 66.167.42 (p<0.001) and in females, it increased from 60.505.78 to 66.266.28 (p<0.001). [Table-8, Chart-7]

37

TABLES AND CHARTS

Table -1; Age distribution of subjects studied Age in years 21-25 26-30 31-35 36-40 Total Number 18 21 7 4 50 % 36.0 42.0 14.0 8.0 100.0

Chart 1; Age distribution of subjects studied

50 45 40 35 Percentages 30 25 20 15 10 5 0 21-25
36

42

14

26-30

31-35

36-40

Age in years

38


Table 2: Gender distribution of subjects studied

Gender Male Female Total

Number
28 22 50

%
56.0 44.0 100.0

Chart 2 ; Gender distribution of subjects studied

39

Table 3: Mean and SD ofAge, Weight , Height and BMI of the subjects studied
Total(n=50) 27.404.51 1.590.12 59.707.83 23.481.06 Male(n=28) 28.074.51 1.680.08 65.295.66 23.251.27 Female(n=22) 26.554.47 1.490.03 52.592.70 23.780.58 pvalue 0.239 <0.001** <0.001** 0.077+

Age (yrs) Height (m) Weight (kg) BMI (kg/m2)

40


Table 4: Effect of six weeks of yoga on Pulse rate (beats / min) Pulse rate Male(n=28) (bpm)
71.684.12 78.003.70 74.454.23 74.465.03 70.965.23

Female(n=22)

Total(n=50)

Before
68.214.24

After

Significance

t=16.59;p<0.001** t=9.567;p<0.001** t=17.635;p<0.001**

Chart-3: Effect of six weeks yoga on Pulse rate (bpm)

90 80

**

**

Pulse rate 70
60 50 40 30 20 10 0

BEFORE AFTER

Male

Female

41

Table 5: Effect of Yoga on Systolic BP

Systolic BP Male(n=28) (mm Hg)

122.2112.05 118.006.85 115.096.73 120.3610.23 118.7210.76

Female(n=22)

Total(n=50)

Before
121.5712.48

After

Significance

t=2.202;p<0.036*

t=6.456;p<0.001** t=5.454;p<0.001**

Chart 4: Effect of Yoga on Systolic BP

**

42

Table 6: Effect of six weeks Yoga on Diastolic BP

Diastolic Male(n=28) BP(mm Hg)

78.506.90 78.364.69 75.825.16 78.445.97 76.766.80

Female(n=22)

Total(n=50)

Before
77.507.86

After

Significance

t=2.646;p=0.013*

t=6.763;p<0.001** t=5.838;p<0.001**

Chart 5: Effect of six weeks Yoga on Diastolic BP

43

Table 7: Effect of six weeks Yoga on VO2 max VO2 max Male(n=28) (ml/kg/min)
38.133.81 33.641.38 35.621.50 t= 24.78;p<0.001** 36.153.73 38.514.44 t= 14.44;p<0.001**

Female(n=22)

Total(n=50)

Before
41.254.03

After
t=

Significance
16.63;p<0.001**

Chart 6: Effect of six weeks Yoga on VO2 max

**

44

Table 8: Effect of six weeks Yoga on PFI

PFI

Male(n=28)
60.427.01

Female(n=22)
60.505.78 66.266.28 t= 24.886;p<0.001**

Total(n=50)
60.466.43 66.216.87 t= 26.550;p<0.001**

Before
66.167.42

After
t=

Significance
16.630;p<0.001**

Chart 7: Effect of six weeks Yoga on PFI

45

DISCUSSION
The present study involved 50 healthy subjects (22 females, 28 males) of 20-40 years who underwent yoga training which included Asanas, Pranayama and Meditation six days in a week for 1 hour daily for a period of six weeks. The cardiorespiratory functions were analysed in pre and post period by measuring resting Pulse rate, Systolic blood pressure, Diastolic blood pressure, VO2 max and Physical fitness index. On analysis of results, there was highly significant decline in PR, SBP, DBP in addition there was highly significant increase in VO2 max and PFI after six weeks of yoga practise. Cardiorespiratory fitness is the ability of bodys circulatory and respiratory system to supply fuel and oxygen during sustained physical activity. Cardiorespiratory fitness is responsible for prolonged use of large muscles of the body which depends on cardiovascular and respiratory system. VO2max also called aerobic capacity is most widely accepted parameter to evaluate cardiorespiratory fitness. DETERMINANTS OF MAXIMAL OXYGEN CONSUMPTION: The major factors determining maximal oxygen consumption are1. Pulmonary ventilation. 2. Cardiac output (the volume of blood pumped by the heart in one minute) 3. The oxygen carrying capacity of blood (determined by haemoglobin in red blood cells) 4. The amount of exercising skeletal muscle and the ability of muscle to utilize supplied oxygen.
46

Effect of yoga on respiratory system Usually breathing is not a conscious event and is regulated automatically by the nervous system through the respiratory centres located in the medulla oblongata and pons. These are the dorsal and ventral group of neurons located in the medulla, the pneumotaxic centre and the apneustic centre located in the pons. The activity of these respiratory centres is in turn modified by supra-pontine influences, in the conscious being. While the basic respiratory rhythm in normal situations is maintained by the impulses discharged by the dorsal group of neurons, the pneumotaxic centre indirectly controls the duration of inspiration and helps in relaying the suprapontine impulses which promote voluntary inspiration and expiration. During daily practice of pranayama the basic activity of the bulbo-pontine complex is modified in such a way as to slow down its rhythm. Thus after continuous practice of pranayama for few weeks, the bulbo-pontine complex is adjusted to the new pattern of breathing which is slower than its basal rhythm. Also by voluntarily prolonging the phase of inspiration and expiration, the respiratory muscles are stretched to their full extent and the respiratory apparatus is able to work to their maximal capacity represented by increased chest wall expansion and lung volumes. (68) Yoga promotes diaphragmatic breathing which is most efficient and it uses least energy for respiration and enables the most absorption of oxygen. This is because surface area of lungs is more in lower ribs resulting in large quantity of oxygen to be utilized. Yoga improves lung expansion at all three levels(upper,middle and lower ),but increase in lung expansion at the lower levels which increases ventilation ,improves
47

ventilation /perfusion ratio (V/P Ratio) which in turn increases gas exchange across the lungs.(33) Yoga improves respiratory muscle strength and endurance. In addition, increased development of respiratory musculature due to regular practice of Pranayama delays the onset of fatigue. Effect of yoga on cardiovascular system The decrease in resting Pulse rate, SBP and DBP after yoga practice in the present study is in accordance with the findings of other studies on physiological effects of yoga practise on healthy individuals. (16, 5) similar reduction in resting pulse rate and blood pressure after yoga practice were also reported in Hypertensive patients (54,55,56,57), in Diabetic patients. (60,61) In the present study a highly significant reduction in PR, SBP and DBP can be attributed to modulation of autonomic activity with parasympathetic predominance and relatively reduced sympathetic tone. This autonomic modulation in yoga is mediated through modification of breathing patterns which triggers various central and autonomic mechanisms as well as mechanical and hemodynamic adjustments causing both tonic and phasic changes in cardiovascular functioning. (11) As a technique, Pranayama can assume rather complex forms of breathing. But the essence of the practice is slow and deep breathing. Slow breathing induces a generalized decrease in the excitatory pathways regulating respiratory and cardiovascular systems. As Respiratory and Cardiovascular systems have similar control mechanisms, alteration in one system will modify the functioning of the other. (8) During slow and deep breathing lung inflates to the maximum. This stimulates
48

pulmonary stretch receptors which bring about withdrawal of sympathetic tone in skeletal muscle blood vessels leading to widespread vasodilatation and decrease in peripheral resistance and thus decrease diastolic blood pressure. (21) While practicing pranayama one concentrates on the act of breathing which removes attention from worries and de-stresses him. This stress free state of mind evokes relaxed responses in which parasympathetic nerve activity overrides sympathetic activity After yoga training, during exercise there will be more increase in cardiac output due to decreased resting heart rate, as a result the subject can perform better and a given level of exercise is less taxing for the heart causing milder cardiovascular response, suggesting better exercise tolerance (39) Effect of yoga on skeletal muscle Various studies shown that yoga improves skeletal muscle strength due to holding static postures in Asanas and controlled movement from one Asanas to another. It also improves muscle endurance due to alternating recruitment of muscle fibres from different motor units to execute specific task and improved peripheral blood flow .(65) studies also shown that yoga converts fast twitch muscles to slow twitch muscles thereby increasing oxygen utilization.(66) Probably integrated effects of yoga on pulmonary ventilation, cardiac functions and on skeletal muscle produces a significant improvement in VO2 max after the training. In the present study, the responses to 6 weeks of regular practice of yoga were also assessed with respect to gender. It revealed that both males and females responded similarly to the yoga practice.

49

Study limitations Although the present study observed the effects of yoga practice for 6 weeks, it remains to be seen how long these changes persist after discontinuation of the yoga practice.

50

CONCLUSION
Yoga practice has shown to have widespread effects on various body systems, in particular Cardiorespiratory functions. Several studies on yoga practice have aroused hope for cardiac diseases like Hypertension, Coronary artery disease, Respiratory diseases like Asthma and systemic diseases like Diabetes mellitus to reduce complications and medication. The present study revealed the effects of six weeks of yoga training on aerobic capacity and physical fitness in healthy individuals. There was Significant decrease in pulse rate and blood pressure after yoga practice indicating a shift in cardiac autonomic balance in favour of parasympathetic division. Significant improvement in VO2 max after yoga practice which are considered to be reasonably sensitive indices of the aerobic capacity and also significant improvement in PFI. Also, the response was similar in both genders.

Thus in a nutshell, with this study, it is proved beyond doubt, that regular practice of yoga for minimum of 6 Weeks is beneficial in improving the Cardiorespiratory fitness even in healthy individuals irrespective of gender.

51

SUMMARY
The present study was done to know the effects of six weeks yoga practice on Aerobic capacity and Physical fitness in normal healthy individuals. 50 healthy individuals of 20 40 years age were selected randomly and given yoga training which included Asanas ,Pranayama and Meditation. The

Cardiorespiratory status of the subjects was assessed clinically by measuring resting Pulse rate, Blood Pressure, VO2 max and PFI before the start of yoga practice and again after six weeks of regular yoga practice. The results were compared and analyzed with respect to gender. There was significant reduction in resting Pulse rate (p<0.001), Systolic blood pressure (p<0.001) and Diastolic blood pressure (p<0.001) after practicing yoga for six weeks. The study also showed significant increase in VO2 max (p<0.001) and PFI (p<0.001) compared to pre yoga practice. The response was similar in both the genders. It can be concluded that yoga practice results in shift of the autonomic equilibrium towards a relative parasympathetic dominance and reduced sympathetic tone. Also, regular practice of yoga is beneficial in improving Aerobic capacity and Physical fitness of healthy individuals. Finally these results and their explanations would justify the incorporation of yoga as part of our lifestyle in promoting health and thereby preventing various Cardiorespiratory diseases.

52

REFERENCES
1. Park K. Preventive and social medicine. 20th ed. Jabalpur: Banarsidas Bhanot;2009. P.315-6. 2. Chatterjee S, Chatterjee P ,Mukharjee PS, Bandyopadhyay A. Validity of Queens college step test for use with Young Indian men. Br J Sports Med, 2004; 38:289-91. 3. Khalsa SS. Yoga as a therapeutic intervention: A bibilometric analysis of published research studies. Indian J Physiol Pharmacol, 2004; 48(3):269-85. 4. Iyengar BKS. Light on yoga. 7th ed. New Delhi: Harpercollins Publishers; 2002. 5. Bharshankar JR, Bharshanker RN, Deshpande VN, Kaore SB, Gosavi GB. Effect of yoga on cardiovascular system in subjects above 40 years. Indian J Physiol Pharmacol, 2003; 47(2):202-6. 6. Khanam AA, Sachdev V, Guleria R, Deepak KK. Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian J Physiol Pharmacol, 1996; 40(4):318-24. 7. Gordon L, Morrison EY, McGrowder D, Penas YF, Zamoraz EM, Garwood D et al. Effect of yoga and traditional physical exercises on hormones and percentage insulin binding receptor in patients with type 2 diabetes. Am J. Biochem. & Biotech., 2008; 4(1):35-42. 8. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension, 2005; 46:714-8.

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9. Katiyar SK, Bihari S. Role of pranayama in rehabilitation of COPD patients a randomized controlled study. Indian J Allergy Asthma Immunol, 2006; 20(2):98-104. 10. Jayasinghe, Satyajit R. Yoga in cardiac health. European Journal of Cardiovascular Prevention and Rehabilitation, 2004; 11(5):369-75. 11. Raghuraj P, Ramakrishnan AG, Nagendra HR, Shirley Telles. Effect of two selected yogic breathing techniques on heart rate variability. Indian J Physiol Pharmacol, 1998; 42(4):467-72 12. Joshi LN, Joshi VD, Gokhale LV. Effect of short term pranayama on breathing rate and ventilatory functions of lungs. Indian J Physiol Pharmacol, 1992; 36(2):105-8. 13. Madanmohan, Udupa K, Bhavani AB, Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayamas on reaction time and cardiorespiratory variables. Indian J Physiol Pharmacol, 2005; 49(3):313-8. 14. Bjlani RL. Understanding medical physiology. 3rd ed. New Delhi: Jaypee Brothers; 2004. p. 871-910. 15. Selvamurthy W. Nayar HS, Joseph NT, Joseph S. Physiological effects of yogic practice. Nimhans Journal, 1983 Jan; 1(1):71-80. 16. Bhargava R, Gogate MG, Mascarenhas JF. Autonomic responses to breath holding and its variations following pranayama. Indian J Physiol Pharmacol, 1988; 32(4):257-64. 17. Joseph S, Sridharan K, Patil SKB, Kumaria ML, Selvamurhy W, Joseph NT et al. Study of some physiological and biochemical parameters in subjects undergoing yogic training. Indian J Med Res, 1981; 74:120-4.

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18. Kothari LK, Bordia A, Gupta OP. The yogic claim of voluntary control over the heart beat: an unusual demonstration. Am Heart J, 1973; 86(2):282-4. 19. Kaviraja U, Madanmohan, Ananda BB, Vijayalakshmi P, Krishnamurthy N. Effect of pranayama training on cardiac function in normal young volunteers. Indian J Physiol Pharmacol, 2003; 47(1):27-33. 20. Upadhay KD, Malhotra V, Sarkar D, Prajapati R. Effect of alternate nostril breathing exercise on cardiorespiratory functions. Nepal Med Coll J, 2008; 10(1):25-7 21. Telles S, Nagarthna R, Nagendra HR. Autonomic changes during OM meditation. Indian J Physiol Pharmacol, 1995; 39(4):418-20. 22. Telles S, Nagarthna R, Nagendra HR. Autonomic changes while mentally repeating two syllables-one meaningful and the other neutral. Indian J Physiol Pharmacol, 1998; 42(1):57-63. 23. Telles S, Desiraju T. Heart rate and respiratory changes accompanying yogic conditions of single thought and thoughtless states. Indian J Physiol Pharmacol, 1992; 36(4):293-4. 24. Muralidhara DV, Ranganathan KV. Effect of yoga practice on cardiac recovery index. Indian J Physiol Pharmacol, 1982; 26(4):279-83. 25. Madanmohan, Sarvanane C, Surange SG, Thombre Dp, Chakrabarty AS. Effect of yoga type breathing on heart rate and cardiac axis of normal subjects. Indian J Physiol Pharmacol, 1986; 30(4):334-40. 26. Telles S, Desiraju T. Heart rate alterations in different types of pranayamas. Indian J Physiol Pharmacol, 1992; 36(4):287-8. 27. Shannahoff-Khalsa DS, Kennedy B. The effects of unilateral forced nostril breathing on the heart. Int J Neurosci, 1993 ; 73(2):47-60.
55

28. Varun M, Tandon OP, Rajkumar P, Tarun KS, Stany WL, Nagamma T et al. Suryanadi anuloma viloma pranayama modifies autonomic activity of heart. JOY: the journal of yoga, 2009 spring; vol8. No.1 29. Dane S, Caliskan E, Karasen Murat, Oztasan N. Effects of unilateral nostril breathing on blood pressure and heart rate in right handed healthy subjects. Int J Neurosci, 2002; 112(1):97-103. 30. Telles S, Nagarthna R, Nagendra HR. Breathing through a particular nostril can alter metabolism and autonomic activities. Indian J Physiol Pharmacol, 1994; 38(2):133-7. 31. Gopal KS, Bhatnagar OP, Subramanian N, Nishit SD. Effect of yogasanas and pranayamas on blood pressure, pulse rate and some respiratory functions. Indian J Physiol Pharmacol, 1973; 17(3):273-6. 32. Chanavirut R, Khaidjapho K, Jaree P, Pongnaratorn P. Yoga exercise increases chest wall expansion and lung volumes in young healthy Thais. Thai Journal Of Physiological Sciences, 2006; 19(1):1-7. 33. Birkel DA, Edgren L. Hatha yoga: improved vital capacity of college students. Altern Ther Health Med, 2000; 6(6):55-63. 34. Bhutkar PM, Bhutkar MV, Taware GB, Doijad V, Doddamani BR. Effect of suryanamaskar practice on cardio-respiratory fitness parameters: a pilot study. Al Amen J Med Sci, 2008; 1(2):126-9. 35. Swami G, Singh S,Singh KP,Gupta M. Effect of yoga on pulmonary function tests of hypothyroid patients. Indian J Physiol Pharmacol, 2009; 54(1) : 51-6. 36. Austin DM. The effects of a two weeks yoga program on pulmonary function. Bio 493, 2008.

56

37. Yadav RK, Das S. Effect of yogic practice on pulmonary functions in young females. Indian J Physiol Pharmacol, 2001; 45(4):493-6. 38. Madanmohan, Sivasubramanian KM, Balakrishnan S, Gopalakrishnan M, Prakash ES. Effect of six weeks yoga training on weight loss following step test, respiratory pressures, handgrip strength and handgrip endurance in young healthy subjects. Indian J Physiol Pharmacol, 2008; 52(2):164-70. 39. Villien F, Melody Y, Pierre B, Jammes Y. Training to yoga respiration selectively increases respiratory sensation in healthy man. Respiratory Physiology and Neurobiology, 2005; 146(1):85-96 . 40. Prakash S, Meshram S, Ramtekkar U. Athletes, yogis and individuals with sedentary lifestyles; do their lung functions differ? Indian J Physiol Pharmacol, 2007; 51(1):76-80. 41. Petrofsky JS, Cuneo M, Russel D, Morris A. Muscle activity during yoga breathing exercise compared to abdominal crunches. The Journal of Applied Research, 2005; 5(3):501-7. 42. Telles S, Desiraju T. Oxygen consumption during pranayamic type of very slow-rate breathing. Indian J Med Res, 1991; 94:357-63. 43. Madhavi S, Raju PS. Comparison of the effects of yoga and physical exercise in athletes. Indian J Med Res, 1994; 100: 81-7. 44. Chaya MS, Kurpad AV, Nagendra HR, Nagarathna R. The effect of long term combined yoga practice on the basal metabolic rate of healthy adults. BMC Complementary and Alternative Medicine, 2006; 6(28). 45. Banquet JP. Spectral analysis of the EEG in meditation,

Electroencephalography and Clinical Neurophysiology, 1973; 35(2):143-51.

57

46. Naveen KV, Nagarathna R, Nagendra HR, Telles S. Yoga breathing through a particular nostril increases spatial memory scores without lateralized effects. Psycho Rep, 1997; 81(2):555-61. 47. Pal GK, Velkumary, Madanmohan. Effect of short term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res, 2004; 120:115-21. 48. Anand BK. Yoga and medical sciences. Indian J Physiol Pharmacol, 1991; 35(2):84-7. 49. Manjunath NK, Tellles S. Spatial and verbal memory test scores following yoga and fine arts camps for school children. Indian J Physiol Pharmacol, 2004; 48(3):353-6. 50. Kulkarni DD, Bera TK. Yogic exercises and health- a psycho-neuro immunological approach. Indian J Physiol Pharmacol, 2009; 53(1):3-15. 51. Udupa KN, Singh RH. The scientific basis of yoga. JAMA, 1972; 220(10):1365. 52. Kasiganesan H, Malhotra AS, Pal K. Rajendra P, Rajesh K, Kain TC et al. Effects of hatha yoga and omkar meditation on cardiorespiratory performance, psychologic profile and melatonin secretion. The Journal of Alternate and Complementary Medicine, 2004; 10(2):261-8. 53. Selwamurthy W, Sridharan K, Ray US, Tiwary RS, Hegde KS, Radhakrishnan U et al. A new physiological approach to control essential hypertension. Indian J Physiol Pharmacol, 1998; 42(2):205-13. 54. Murugesan R, Govindarajulu N, Bera TK. Effect of selected yogic practices on the management of hypertension. Indian J Physiol Pharmacol, 2000; 44(2):207-10.
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55. Damodaran A, Malathi A, Patil N, Shah N, Suryavanshi, Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. JAPI, 2002; 50:633-40. 56. Patel C. 12 month follow up of yoga and biofeedback in the management of hypertension. The Lancet, 1975; 11:62-4. 57. Tulpule TH, Tulpule AT. Yoga a method of relaxation for rehabilitation after myocardial infarction. Indian Heart Journal, 1980; 32(1):1-7. 58. Khare KC, Rai S. Study of lipid profile in post myocardial infarction subjects following yogic lifestyle intervention. The Ind Pract, 2002; 55(6):369-73. 59. Singh S, Malhotra V, Singh KP, Tandon OP. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. JAPI, 2004; 52:203-6. 60. Malhotra V, Singh S, Tandon OP, Madhu SV, Atul P, Sharma SB. Effect of yoga asanas on nerve conduction in type 2 diabetes. Indian J Physiol Pharmacol, 2002; 46(3):298-306. 61. Jain AK. Cardiorespiratory response to steady state exercise in sedentary men 20-30 years old men. Ind J Chest Dis And Allied Sci, 1983; 25:172-85. 62. Jain AK.Text book of physiology.4th ed. New Delhi:Bhanarsidas Bhanot;2009. p.305-6. 63. Mcardle WD, Katch FI. Essentials of Exercise Physiology. 2nd ed. Phildelphia,PA:Lippincot Williams and Wilkins:2000. 64. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha yoga practice on the Health-related aspects of Physical fitness. Preventive Cardiology,2007;4(4):165-70.

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65. Balasubramanian B, Pansare MS . Effect of yoga on aerobic and anaerobic power of muscles. Indian J Physiol Pharmacol, 1991; 35(4):281-2. 66. Bowman AJ, Clyton RH, Murray A, Reed JW, Subhan MF,Ford GA. Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons. European Journal of Clinical Investigation, 1997;27(5):443-9. 67. Chatterjee S, Chatterjee P, Bandyopadhyay A. Cardiorespiratory fitness of obese boys. Indian J Physiol Pharmacol, 2005; 49:353-7. 68. Makwana K, Khirwadkar N, Gupta HC. Effect of short term yoga practice on ventilatory function tests. Indian J Physiol Pharmacol, 1988; 32(3):202-8.

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VRIKSHASANA

NADISHUDDHIPRANAYAMA

61

 MEDITATION

QUEENSCOLLEGESTEPTEST

62

Sri Siddhartha Medical College

Agalkote,B H road,Tumkur-57201 (Recognised by Medical Council of India & Affiliated to Bangalore University/R.G.U.H.S) Ph:0816-278867 Fax:0816-2752110 email: SSMC_tmk@hotmail.com

INFORMED CONSENT FORM Title of the study: EFFECT OF SIX WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY

INDIVIDUALS Name of the participant:_______________________________ Name of the principal investigator: Dr Nagalakshmi V. Name of the Guide : Dr Arun Kumar V J (Professor & HOD)

Name of the institution: Sri Siddhartha Medical College Hospital and Research Centre I ________________________aged______yrs referred to Sree Siddhartha Medical College, Hospital and Research Center, Tumkur, from Yoga center have been explained in my own language the need for the study and Queens College step test will be done. Hereby give my consent to be included as a participant in the study : EFFECT OF SIX WEEKS YOGA TRAINING ON PHYSICAL FITNESS AND AEROBIC CAPACITY IN HEALTHY INDIVIDUALS

63

The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes. I am able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks. My questions and concerns have been discussed and answered to my satisfaction. I understand that a doctor other than the Consultant may conduct the procedure. I understand this could be a doctor undergoing further training. I CONSENT TO HAVE THE PROCEDURE Name _____________________ Date ______________ Name _____________________ Date ______________ Name _____________________ Date ______________ Signature of the subject _____________ Time ____________ Signature of the impartial witness _________ Time ____________ Signature of the Investigator _____________ Time ____________

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Sri Siddhartha Medical College & Research Hospital, Tumkur Department of Physiology CLINICAL PROFORMA

Title

: Effect of six weeks yoga training on physical fitness and aerobic capacity in healthy individuals.

Name: Age: Sex; Address: Serial number: Occupation: Phone number: History of presenting illness: Past history: Family history: Drug history: Personal history:
65

General Physical Examination: Temperature: Wt: Systemic Examination : Cardiovascular system : Respiratory system: Central nervous system: Per abdomen : Ht:

I PR:

L BP:

PARAMETERS FOR STUDY Parameters 1.Blood pressure A) Systolic Blood pressure(mm Hg ) B) Diastolic Blood pressure(mm Hg ) 2.Pulse rate (beats/min) 3. Physical fitness index (PFI) 4. Aerobic capacity using VO2max (ml /kg/min) Before yoga training After yoga training

66

MASTER CHART
Sex Sl No NAME Age Height (m) Weight (kg) BMI (kg/m2) Pulse Rate (BPM) BY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Rekha Ashwini Bhagirathamma Roopashree Roopa S N Ramadevi Sumangala Nigersultana Madhura Sujathabhai Annapoorna Pavithra T N Sulochana Suma T S 26 29 36 28 26 27 24 24 21 24 36 28 34 30 F F F F F F F F F F F F F F 1.56 1.52 1.48 1.56 1.44 1.6 1.45 1.52 1.46 1.53 1.45 1.52 1.48 1.47 52 56 53 56 50 61 50 56 52 56 50 56 52 52 21.37 24.24 24.20 23.01 24.11 23.83 23.78 24.24 24.39 23.92 23.78 24.24 23.74 24.06 72 82 86 76 86 78 66 74 74 74 74 80 82 82 AY 70 80 82 74 80 76 64 70 70 70 72 76 82 80 SBP (mmHg) BY 110 118 118 120 134 110 110 120 122 122 120 120 130 124 AY 108 116 112 118 128 108 106 118 118 114 118 116 132 120 DBP (mmHg) BY 70 84 72 84 84 80 80 80 82 80 80 80 80 82 AY 68 84 70 82 80 78 80 78 78 74 76 76 82 80 VO2 max PFI (ml/kg/min) BY 33.30 32.56 31.83 32.56 33.30 33.30 34.04 34.04 35.52 34.04 31.83 32.56 31.83 32.56 AY 34.78 34.04 33.30 34.04 34.78 34.78 35.52 35.52 37.00 35.52 32.56 34.04 33.30 34.04 BY 59.10 56.01 52.92 56.01 59.10 59.10 62.19 62.19 68.37 62.19 52.92 56.01 52.92 56.01 AY 65.28 62.19 59.10 62.19 65.28 65.28 68.37 68.37 74.55 68.37 56.01 62.19 59.10 62.19

67

15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Bhagya N Usha V M Priyanka G Sahana Salmakhanum Radha Madhura Pallavi Amarkumar Krishnamurthy Mahesh KR Shivaprasad Gopalkrishna Rajesh Abhishek Nagendrappa Mohankumar Jayram T R

24 28 21 24 28 22 23 21 21 30 33 26 28 30 28 27 25 34

F F F F F F F F M M M M M M M M M M

1.5 1.44 1.47 1.52 1.47 1.49 1.46 1.46 1.68 1.72 1.56 1.54 1.76 1.7 1.74 1.62 1.73 1.75

53 48 49 56 52 53 48 52 68 70 58 58 73 65 64 64 57 73

23.56 23.15 22.68 24.24 24.06 23.87 22.52 24.39 24.09 23.66 23.83 24.46 23.57 22.49 21.14 24.39 19.05 23.84

74 70 76 78 71 76 68 76 71 71 82 74 86 64 76 80 70 72

70 68 74 76 70 72 64 70 68 68 78 72 82 62 70 78 66 68

120 116 122 118 114 112 104 112 140 140 124 124 134 120 122 126 128 136

118 112 120 116 110 110 104 110 140 140 124 124 134 120 122 126 128 136

80 72 84 72 76 74 70 78 84 84 80 80 86 80 76 88 70 84

78 68 82 70 72 70 68 74 84 84 80 80 86 80 76 88 70 84

34.78 32.56 35.52 34.04 32.56 35.52 35.52 36.26 45.81 35.73 34.05 39.09 39.09 35.73 35.73 35.73 39.09 34.05

36.26 33.30 37.00 35.52 33.30 37.00 37.00 37.74 49.17 39.09 37.41 40.77 42.45 39.09 39.09 35.73 42.45 39.09

65.28 56.01 68.37 62.19 56.01 68.37 68.37 71.46 74.55 56.01 52.92 62.19 62.19 56.01 56.01 56.01 62.19 52.92

71.46 59.10 74.55 68.37 59.10 74.55 74.55 77.64 80.73 62.19 59.10 65.28 68.37 62.19 62.19 56.01 68.37 62.19

68

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Sridharsingh Pramod S Nagendrappa Manjunatha D Rudresh Manjunath Mahesh K R Umesh S A Nelofer Shankara Shakeel Ahmed Rajesh singh Nagabhushan Raju K V Lokesh Nagaraju Santhoshkumar Vijaykumar D

22 22 33 36 30 22 28 26 26 25 28 37 31 24 32 26 22 34

M M M M M M M M M M M M M M M M M M

1.81 1.74 1.73 1.67 1.71 1.72 1.63 1.7 1.73 1.8 1.68 1.68 1.56 1.6 1.58 1.62 1.58 1.58

75 60 71 67 70 68 61 70 70 75 67 65 57 60 60 62 60 60

22.89 19.82 23.72 24.02 23.94 22.99 22.96 24.22 23.39 23.15 23.74 23.03 23.42 23.44 24.03 23.62 24.03 24.03

74 80 74 84 86 68 78 68 70 84 74 83 74 70 78 74 76 74

70 78 72 80 82 66 76 64 68 80 70 80 70 68 72 68 70 70

120 88 132 136 132 106 128 106 106 132 122 130 116 110 118 116 118 112

120 88 132 136 132 106 128 106 106 132 122 130 112 110 114 110 116 110

82 60 84 86 80 80 84 70 70 86 78 86 72 70 80 74 74 70

82 60 84 86 80 80 84 70 70 86 78 86 68 66 74 70 70 64

44.13 44.13 34.05 34.05 35.73 42.45 39.09 39.09 39.09 40.77 39.09 34.05 35.73 44.13 34.05 35.73 44.13 34.05

47.49 47.49 37.41 37.41 39.09 47.49 40.77 40.77 42.45 44.13 42.45 37.41 39.09 47.49 35.73 39.09 47.49 37.41

71.46 71.46 52.92 52.92 56.01 68.37 62.19 62.19 62.19 65.28 62.19 52.92 56.01 71.46 52.92 56.01 71.46 52.92

77.64 77.64 59.10 59.10 62.19 77.64 65.28 65.28 68.37 71.46 68.37 59.10 62.19 77.64 56.01 62.19 77.64 59.10

69

MASTER CHART
Sl No Height (m) Weight (kg) BMI (kg/m2) Pulse Rate (BPM) BY 72 82 86 76 86 78 66 74 74 74 74 80 82 82 74 70 76 78 71 76 68 76 71 71 AY 70 80 82 74 80 76 64 70 70 70 72 76 82 80 70 68 74 76 70 72 64 70 68 68 SBP (mmHg) BY 110 118 118 120 134 110 110 120 122 122 120 120 130 124 120 116 122 118 114 112 104 112 140 140 AY 108 116 112 118 128 108 106 118 118 114 118 116 132 120 118 112 120 116 110 110 104 110 140 140 DBP (mmHg) BY 70 84 72 84 84 80 80 80 82 80 80 80 80 82 80 72 84 72 76 74 70 78 84 84 AY 68 84 70 82 80 78 80 78 78 74 76 76 82 80 78 68 82 70 72 70 68 74 84 84 V02 max (Ml/kg/min) BY 33.30 32.56 31.83 32.56 33.30 33.30 34.04 34.04 35.52 34.04 31.83 32.56 31.83 32.56 34.78 32.56 35.52 34.04 32.56 35.52 35.52 36.26 45.81 35.73 AY 34.78 34.04 33.30 34.04 34.78 34.78 35.52 35.52 37.00 35.52 32.56 34.04 33.30 34.04 36.26 33.30 37.00 35.52 33.30 37.00 37.00 37.74 49.17 39.09 BY 59.10 56.01 52.92 56.01 59.10 59.10 62.19 62.19 68.37 62.19 52.92 56.01 52.92 56.01 65.28 56.01 68.37 62.19 56.01 68.37 68.37 71.46 74.55 56.01 PFI

NAME

Age

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Rekha Ashwini Bhagirathamma Roopashree Roopa S N Ramadevi Sumangala Nigersultana Madhura Sujathabhai Annapoorna Pavithra T N Sulochana Suma T S Bhagya N Usha V M Priyanka G Sahana Salmakhanum Radha Madhura Pallavi Amarkumar Krishnamurthy

26 29 36 28 26 27 24 24 21 24 36 28 34 30 24 28 21 24 28 22 23 21 21 30

1.56 1.52 1.48 1.56 1.44 1.6 1.45 1.52 1.46 1.53 1.45 1.52 1.48 1.47 1.5 1.44 1.47 1.52 1.47 1.49 1.46 1.46 1.68 1.72

52 56 53 56 50 61 50 56 52 56 50 56 52 52 53 48 49 56 52 53 48 52 68 70

21.37 24.24 24.20 23.01 24.11 23.83 23.78 24.24 24.39 23.92 23.78 24.24 23.74 24.06 23.56 23.15 22.68 24.24 24.06 23.87 22.52 24.39 24.09 23.66

AY 65.28 62.19 59.10 62.19 65.28 65.28 68.37 68.37 74.55 68.37 56.01 62.19 59.10 62.19 71.46 59.10 74.55 68.37 59.10 74.55 74.55 77.64 80.73 62.19

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Mahesh KR Shivaprasad Gopalkrishna Rajesh Abhishek Nagendrappa Mohankumar Jayram T R Sridharsingh Pramod S Nagendrappa Manjunatha D Rudresh Manjunath Mahesh K R Umesh S A Nelofer Shankara Shakeel Ahmed Rajesh singh Nagabhushan Raju K V Lokesh Nagaraju Santhoshkumar Vijaykumar D C

33 26 28 30 28 27 25 34 22 22 33 36 30 22 28 26 26 25 28 37 31 24 32 26 22 34

1.56 1.54 1.76 1.7 1.74 1.62 1.73 1.75 1.81 1.74 1.73 1.67 1.71 1.72 1.63 1.7 1.73 1.8 1.68 1.68 1.56 1.6 1.58 1.62 1.58 1.58

58 58 73 65 64 64 57 73 75 60 71 67 70 68 61 70 70 75 67 65 57 60 60 62 60 60

23.83 24.46 23.57 22.49 21.14 24.39 19.05 23.84 22.89 19.82 23.72 24.02 23.94 22.99 22.96 24.22 23.39 23.15 23.74 23.03 23.42 23.44 24.03 23.62 24.03 24.03

82 74 86 64 76 80 70 72 74 80 74 84 86 68 78 68 70 84 74 83 74 70 78 74 76 74

78 72 82 62 70 78 66 68 70 78 72 80 82 66 76 64 68 80 70 80 70 68 72 68 70 70

124 124 134 120 122 126 128 136 120 88 132 136 132 106 128 106 106 132 122 130 116 110 118 116 118 112

124 124 134 120 122 126 128 136 120 88 132 136 132 106 128 106 106 132 122 130 112 110 114 110 116 110

80 80 86 80 76 88 70 84 82 60 84 86 80 80 84 70 70 86 78 86 72 70 80 74 74 70

80 80 86 80 76 88 70 84 82 60 84 86 80 80 84 70 70 86 78 86 68 66 74 70 70 64

34.05 39.09 39.09 35.73 35.73 35.73 39.09 34.05 44.13 44.13 34.05 34.05 35.73 42.45 39.09 39.09 39.09 40.77 39.09 34.05 35.73 44.13 34.05 35.73 44.13 34.05

37.41 40.77 42.45 39.09 39.09 35.73 42.45 39.09 47.49 47.49 37.41 37.41 39.09 47.49 40.77 40.77 42.45 44.13 42.45 37.41 39.09 47.49 35.73 39.09 47.49 37.41

52.92 62.19 62.19 56.01 56.01 56.01 62.19 52.92 71.46 71.46 52.92 52.92 56.01 68.37 62.19 62.19 62.19 65.28 62.19 52.92 56.01 71.46 52.92 56.01 71.46 52.92

59.10 65.28 68.37 62.19 62.19 56.01 68.37 62.19 77.64 77.64 59.10 59.10 62.19 77.64 65.28 65.28 68.37 71.46 68.37 59.10 62.19 77.64 56.01 62.19 77.64 59.10