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Kliger Kissinger Fernandes Rocha

EFEITOS DA PRÁTICA DE YOGA NA MEMÓRIA E EM PARÂMETROS


PSICOLÓGICOS E FISIOLÓGICOS DE INDIVÍDUOS SAUDÁVEIS

Tese apresentada ao Programa de Pós-Graduação


em Psicobiologia da Universidade Federal do Rio
Grande do Norte para obtenção do grau de Doutor
em Psicobiologia - Área de Concentração: Psicologia
Fisiológica.

Natal
2011
Kliger Kissinger Fernandes Rocha

EFEITOS DA PRÁTICA DE YOGA NA MEMÓRIA E EM PARÂMETROS


PSICOLÓGICOS E FISIOLÓGICOS DE INDIVÍDUOS SAUDÁVEIS

Tese apresentada ao Programa de Pós-Graduação


em Psicobiologia da Universidade Federal do Rio
Grande do Norte para obtenção do grau de Doutor
em Psicobiologia - Área de Concentração: Psicologia
Fisiológica.

Orientadora: Dra. Regina Helena da Silva

Natal
2011
Catalogação da Publicação na Fonte. UFRN / Biblioteca Setorial do Centro de
Biociências

Rocha, Kliger Kissinger Fernandes.


Efeitos da prática de Yoga na memória e em parâmetros psicológicos
e fisiológicos de indivíduos saudáveis / Kliger Kissinger Fernandes
Rocha. – Natal, RN, 2011.

158 f. : Il.

Orientadora: Profa. Dra. Regina Helena da Silva.

Tese (Doutorado) – Universidade Federal do Rio Grande do Norte.


Centro de Biociências. Programa de Pós-Graduação em Psicobiologia.

1. Yoga – Tese 2. Atividade física – Tese. 3. memória – Tese. I.


Silva, Regina Helena. II. Universidade Federal do Rio Grande do Norte.
III. Título.

RN/UF/BSE-CB CDU 233-852.5Y


Dedico com muito amor este trabalho

A Deus,
A minha mãe e
Ao meu pai (in memorian),
Por me educarem e me ajudarem a evoluir com tanto amor e sabedoria na
minha formação como homem de bem e profissional, pela convivência
enriquecedora, e por diversos outros motivos para agradecer.
AGRADECIMENTOS

Namastê!

Meu melhor agradecimento a Deus pelas condições e oportunidades de

aprendizado na jornada evolutiva e por infinitos motivos de gratidão. Busco e

encontro em Deus a transcendência para superar minhas limitações na vida e

neste doutoramento que continua, pois me sinto um eterno aprendiz.

Agradecimentos muito especiais a minha família dedicada e amorosa

nos cuidados com meu bem-estar e minha evolução, e também na minha

formação como homem de bem e profissional competente. Em cada realização

na minha vida tem a participação especial de minha família. Destaco nesta

empreitada de doutoramento as colaborações de minha irmã Kelly Rocha e

minha mãe por terem me servido tanto e incansavelmente.

Gratidão aos voluntários que participaram das pesquisas no Brasil e no

Canadá, por estarem pré-dispostos a serem testados diversas vezes,

principalmente por confiarem em mim como facilitador de Yoga e pesquisador.

Obrigado às orientadoras no Brasil: Dra. Regina Silva e Dra. Fabíola

Albuquerque, e aos orientadores no Canadá: Martha Traverso-Yepes (PhD),

David Behm (PhD) e Duanne Button (PhD) por me apoiarem neste processo de

doutoramento.

Agradecimentos aos amigos e amigas incentivadores(as) e

facilitadores(as), principalmente pelos salutares momentos que me

fortaleceram neste período: Gilmara Susy de Aquino, Hani Helen Rafael,

Yvonne Collett, Marcos César dos Santos (in memorian), Ana Ferreira da
Rocha (in memorian), Maria Anunciada da Silva (in memorian), Frederico

Menezes, Dr. Paulo Marinho, Dra. Andrea Viana, Jomar Morais, Dr. Andre

Mendes, Rose Mendes, Simran Arora, Radha Gupta (PhD), Ayesha Fiech,

Matthew Miné-Goldring, Krista, Cristiane Cunha, e Márcia Jorge.

Agradeço à todos os educadores que contribuíram na minha formação

profissional, porque em toda conquista profissional tem um ou vários

ensinamentos recordados de um educador.

Sou grato aos Professores e funcionários do Departamento de Fisiologia

da UFRN, e do Departamento de Educação Física e do Departamento de

Promoção de Saúde da Memorial University of Newfoundland no Canadá que

colaboraram neste doutoramento. Destaco as contribuições no Brasil de Dra.

Alessandra Ribeiro, Dr. Dráulio de Araújo, Dr. Sidarta Ribeiro, Dra. Maria

Bernadete Souza, e da Dra. Fivia Lopes, e as contribuições no Canadá de

Veeresh Gadag, Tim Alkanan, Ginny Ryan e Yvonne Collett.

Gratidão ao Comandante do 7° Batalhão de Engenharia de Combate do

Exército Brasileiro, Odilon Mazzini Junior pelo apoio, incentivo, e anuência no

Batalhão Visconde de Taunay, e ao Major Carlos Cunha por facilitar toda fase

de coleta de dados no batalhão.

Sou grato à banca examinadora por terem aceitado o convite de avaliar

e contribuir com melhorias neste trabalho.

Agradecimentos a tudo, todos e todas que contribuíram na minha

evolução nesta fase de doutoramento e não foram citados. Pois, considero o

anonimato no bem de alguém a melhor expressão de amor, e reconheço

também o tesouro do aprendizado na superação dos obstáculos.

Obrigado ao CNPq pelo apoio financeiro.


"Que um dia eu esteja pronto e amadurecido no
grande meio-dia, pronto e amadurecido tal qual o
bronze ardente, a nuvem prenhe, pronto para mim
próprio e para o querer mais secreto, um arco no
ardor de sua flecha, uma flecha no ardor de seu
astro."
(Friederich Nietzsche)

"O intento humano mais importante é o empenho


pela moralidade em nossas ações. Nosso equilíbrio
interior e até mesmo a nossa própria existência
dependem disso. Apenas a moralidade em nossas
ações pode conferir beleza e dignidade à vida."
(Albert Einstein)

"Não acrediteis em coisa alguma... mas aquilo que


vós mesmos experimentastes, provastes e
reconhecestes verdadeiro, aquilo que corresponde
ao vosso bem e ao bem dos outros - isso deveis
aceitar, e por isso moldar a vossa conduta."
(Siddhartha Gautama)

"Quando a mente se aquieta, o eu repousa em sua


morada, mas quando a mente não está quieta,
quando está divagando, quando é atraída para
objetos externos, o eu vai atrás da mente, e, nesse
movimento de segui-la, não consegue repousar em
sua morada."
(Patañjali)
RESUMO

Técnicas de controle de mente e do corpo parecem beneficiar o organismo de

forma geral e em particular a cognição, porque envolvem prática de atenção

plena. No entanto, ainda há uma escassez de estudos com métodos bem

controlados para investigação dos possíveis efeitos de práticas de Yoga. Neste

trabalho, investigamos os efeitos da prática regular de Yoga, incluindo posturas

psicofísicas (asanas), técnicas respiratórias e exercícios meditativos, na

memória e em parâmetros psicológicos e fisiológicos relacionados à qualidade

de vida. Houve melhoria significante em desempenho de tarefas de memória

de curto e longo prazos. Observamos também efeitos benéficos significantes

em parâmetros psicológicos e fisiológicos, como humor, ansiedade, depressão,

estresse, e modulação de parâmetros relacionados ao sistema nervoso

autônomo, no grupo praticante de Yoga em comparação ao grupo que realizou

prática física convencional. Os resultados sugerem possíveis influências do

estresse, do estado emocional e do treinamento mental nos efeitos cognitivos

da prática de Yoga. Nossos resultados corroboram a indicação da prática de

Yoga no tratamento ou prevenção de doenças relacionadas ao estresse, de

distúrbios psicológicos e de suas possíveis consequências cognitivas.

Palavras-chave: Yoga; atividade física; memória; estresse.


ABSTRACT

Techniques of mind & body control seem to benefit human organism in general

and cognition in particular, because they involve a mindfulness practice.

However, there is still a scarcity of studies with well-controlled methods to

investigate the possible effects of Yoga practice. In this study, we investigated

the effects of regular Yoga practice, based on Yoga postures (asanas),

breathing techniques, and meditation exercises, on memory and physiologic

and psychological parameters related to quality of life. There were significant

improvements on performance tasks of short term memory and long term

memory. We also observed significant beneficial effects on psychological and

physiological parameters such as mood, anxiety, depression, stress, and

modulation of the autonomic nervous system in Yoga practitioners group

compared to the conventional physical exercises group. The results suggest the

possible influences of stress, emotional state and mental training on cognitive

effects of yoga practice. Our results support the indication of practice of Yoga

for the treatment or prevention of stress, psychological disorders and their

possible cognitive consequences.

Keywords: Yoga; physical exercises; memory; stress.


SUMÁRIO

1. Introdução .............................................................................................................. 1
1.1 A Prática de Yoga .............................................................................................. 4
1.2 Yoga e Efeitos Psicofisiológicos ........................................................................ 6
1.3 Yoga e Estresse ................................................................................................ 8
1.4 Yoga, Cognição e Estresse ............................................................................. 13
1.5 Justificativa ...................................................................................................... 20
1.6 Hipótese........................................................................................................... 23
2. Objetivos .............................................................................................................. 24
2.1 Artigo 1: Improvement in physiological and psychological parameters after six
months of yoga practice ........................................................................................ 25
2.2 Artigo 2: Meditation practice improves the performance of healthy man in a
working memory task ............................................................................................. 53
2.3 Artigo 3: Yoga Breathing Can Modulate the Autonomous Nervous System and
Mood During Physical Exercise ............................................................................. 85
3. Discussão Geral ................................................................................................ 123
4. Conclusões ........................................................................................................ 127
5. Referências Bibliográficas ............................................................................... 128
6. Anexos ............................................................................................................... 141
A. Termo de Consentimento Livre e Esclarecido ............................................... 142
B. Questionário Sócio-Demográfico .................................................................... 143
C. Prática de Yoga .............................................................................................. 144
D. Parecer do CEP-UFRN................................................................................... 146
1. Introdução

O termo Yoga, etmologicamente vem do radical Yuj em sânscrito, e significa

“integrar” (Gharote 2002). Yoga é uma disciplina antiga que objetiva promover

equilíbrio e saúde às dimensões física, mental, emocional e espiritual do indivíduo

(Ross & Thomas 2010). Atualmente, diversas práticas psicofísicas de bem-estar e

relaxamento, em especial as orientais (Raingruber & Robinson, 2007), têm sido

procuradas para administrar o estresse vivido nos centros urbanos. Entre elas, figura

o Yoga, que surgiu na Índia, e teve sua primeira sistematização escrita feita por

Patañjali (Peçanha & Campana 2011).

Registros antigos sobre o Yoga estão nos Vedas, textos sagrados do

Hinduísmo, de cerca de 1500 a.C., mas o Yoga só sofreu efetivamente uma

sistematização nos Yoga-Sutras, conjunto de 196 aforismos atribuídos ao sábio

Patañjali. Há também outros textos sobre Yoga, mas considera-se o Yoga-Sutra o

mais estudado. No contexto da tradição do Yoga, das seis escolas da filosofia hindu,

o Yoga significa especificamente a escola de Patañjali, autor ou compilador do

Yoga-Sutra. A escola de Patañjali foi a que acabou sendo reconhecida como o

sistema oficial da tradição yogue. Cada escola do Hinduísmo produziu o seu próprio

Sutra, palavra sânscrita que significa literalmente “fio”. Um sutra é uma composição

de afirmações aforísticas que, juntas, dão ao leitor como que um fio com que

amarrar todas as idéias importantes que caracterizam aquela escola de pensamento

(Feuerstein 2001).

O Yoga-Sutra de Patañjali é chamado de Ashtanga Yoga (Ashtanga significa

oito partes) por apresentar oito passos definidos para se alcançar a meta do Yoga,

ou seja, o Samadhi. São eles: yama (ética universal), niyama (ética individual),

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asana (posturas psicofísicas), pranayama (exercícios respiratórios para controle da

energia vital), pratyahara (abstração dos sentidos), dharana (concentração), dyana

(meditação), e samadhi (dissolução do ego) (Peçanha & Campana 2011; Ross &

Thomas 2010; Taimni 2004).

No Oriente, o Yoga representa, essencialmente, uma filosofia de vida. No

Ocidente, o Yoga vem caracterizando-se como um sistema de práticas, sobretudo

de posturas psicofísicas (asanas) visando à obtenção de saúde e administração do

estresse (Gharote 2002). Neste estudo abordaremos posturas, exercícios

respiratórios, concentração e meditação. No entanto, segundo a tradição, deve ser

enfatizado que estes são apenas benefícios marginais de praticar Yoga (Salagame

2011).

O Yoga engloba várias correntes ou caminhos para a realização do indivíduo,

como: Krya, incluindo Hatha Yoga (Yoga da técnica), Jnana (Yoga do

conhecimento), Bhakti (Yoga da devoção), Karma (Yoga do serviço) e Raja Yoga

(integral, pois combina os quatro tipos precedentes). Assim, costuma-se dizer que

para cada tipo de pessoa há uma modalidade de Yoga (Peçanha & Campana 2011).

Muitos anos antes de as teorias psicanalíticas surgirem, o Yoga já enfocava a

análise da consciência. Acredita-se até que os conceitos da psicanálise de Freud

trazem princípios do Yoga, que chegaram até ele por meio de Schopennhauer,

filósofo alemão que mais se inspirou nos textos clássicos da Índia (Feuerstein 2001).

De acordo com Yoga Sutra 1.2, Yoga refere-se à cessação dos “turbilhões mentais”.

Ainda, a consciência é classificada em: mente, que faz a ligação entre o mundo

sensorial e o mundo interior; intelecto, sede da memória, das impressões latentes e

o determinador da natureza dos fenômenos; e o ego, responsável pelo princípio de

individuação (Taimni 2004).

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Acredita-se que a execução de exercícios de Yoga proporcione mudanças e

benefícios no funcionamento de todo o organismo e permita a melhora das funções

psíquicas; tanto cognitivas como afetivas, melhorando a memória, reduzindo a

tensão emocional, a depressão, a ansiedade e a irritabilidade (Gonzalez &

Waterland 1998). Propõe-se também que essa prática pode trazer benefícios para o

tratamento de doenças de ordem psíquica, tais como neuroses, estados psicóticos e

pré-psicóticos, e melhora de sintomas relacionados ao estresse, promovendo

relaxamento e maior sentimento de autodomínio.

Yardi (2001) propôs que, na prática do Yoga, a hipossensibilização

sistemática dos sentidos em relação aos estímulos externos (relaxamento)

proporciona a concentração ou fixação (em sânscrito; dharana) essencial à

sensibilização para a autopercepção. E, este treinamento e aguçamento mental

associado ao trabalho de outros compartimentos de nossa esfera somatopsíquica1,

ajudam os praticantes do Yoga a melhor lidar com seu ambiente interno e externo.

Diversos fatores estressantes psicológicos ou fisiológicos, internos ou externos ao

corpo, são responsáveis pelo desequilíbrio do estado de saúde e bem-estar,

podendo causar doenças. Uma tentativa sistemática de reduzir a intensidade dos

fatores estressantes pode ser através do Yoga, de modo que os efeitos de uma

resposta somatopsíquica desarmônica a esses fatores podem ser reduzidos (Yardi

2001).

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Segundo Heinroth (1898), o fenômeno somatopsíquico se verificava quando o fator corporal modificava o
estado psíquico (Haynal & Pasini 1993).

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1.1 A prática de Yoga

Na tradição do Yoga, a prática agrega valores morais, posturas psicofísicas,

controle respiratório, concentração, meditação e estado de êxtase. Entretanto, nesta

investigação, assim como geralmente ocorre com os praticantes ocidentais, a prática

se deterá em asanas ou posturas psicofísicas, respiração e exercícios de meditação

(Anexo C). Asana refere-se à terceira parte da disciplina do Yoga (Yoga-sutra, II, 29,

Taimni 2004). A palavra “asana” deriva do radical sânscrito “ãs” e significa sentar-se.

Literalmente significa “assento” ou “postura”. (Feuerstein 2001).

A finalidade do asana é treinar a mente para a integração corpo e mente, ou

seja, é a inibição das modificações da mente. Para o Yoga clássico, o caminho mais

fácil para alcançar a consciência plena é partir dos aspectos visíveis e palpáveis,

como o corpo, em direção aos mais sutis, como a respiração e a mente.

Blay (2001) ressalta que a execução de asana dentro do Hatha Yoga segue

uma série de normas para alcançar os objetivos da prática, o que também os

distinguem de qualquer outra atividade. Para que a posição adotada realmente seja

asana, deve apresentar uma série de características, sendo que as principais são:

1. Permanência progressivamente prolongada, pois o objetivo da prática de

asanas é fazer o praticante perceber a conexão que existe entre corpo e

mente, descobrindo que as posturas provocam um efeito nas próprias

emoções e no fluxo de pensamentos. E, com o refinamento dessa percepção,

o praticante é levado a entender o inverso: os estados mentais influenciam a

saúde do corpo. Com mais consciência do corpo, ganhar-se-ia mais

consciência sobre os estados mentais. A maior parte dos asanas é executada

uma única vez, mas sua duração vai sendo aumentada, à medida que se vai

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progredindo na prática, diversamente dos exercícios da ginástica ocidental,

que são feitos sempre repetidas vezes. Segundo Blay (2001) manter a

atenção nas percepções do corpo torna a postura estável e confortável e

prepara a mente para a meditação, ocorrendo uma descontinuação

progressiva dos conteúdos mentais do cotidiano.

2. Extrema lentidão de execução. Essa lentidão permite que o praticante se

coloque no asana de forma precisa, tomando consciência de cada momento e

de cada detalhe importante (alinhamento, relaxamento ou contração dos

músculos corretos, a variação mais adequada para o seu estágio de

desenvolvimento, etc.) para que obtenha o melhor proveito possível da

posição final. A execução lenta também favorece a manutanção do estado de

interiorização obtido no asana precedente.

3. Normalmente devem realizar-se de forma suave, evitando o esforço e

promovendo a descontração e a consciência corporal. Essa regra também

garante que cada praticante seguirá o seu próprio ritmo, mantendo a posição

somente enquanto perceber que a permanência é construtiva. Com essa

atitude o praticante começa a trazer à consciência a propriocepção.

4. Absoluta necessidade de que a prática de cada asana esteja acompanhada

simultaneamente dos seguintes fatores: regularidade da respiração,

relaxamento e atitude mental adequada. A respiração, se torna mais profunda

e regular como uma necessidade natural à medida que nos concentramos na

posição, para que se exerça esse domínio da consciência sobre o corpo que

deve ocorrer no asana. A atitude mental é esse estado de interiorização

obtido, a consciência de todas essas ações internas que descrevemos e a

percepção das reações.

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Ao praticar os asanas, há oportunidade de tornar tensões musculares

conscientes para então tentar desfazê-las através do relaxamento. Além disso,

observando essa regra, pode ocorrer também um relaxamento mental e emocional

(Blay 2001).

1.2 Yoga e Efeitos Psicofisiológicos

A Yogaterapia, como ciência, foi pioneiramente desenvolvida no Instituto de

Kaivalyadhama, em Lonavla, Índia. Seu fundador foi Swami Kuvalayananda em

1924. O primeiro periódico científico produzido foi o Yoga Mimansa que publicou

muitos estudos, tratando especialmente da relação entre Yoga e fisiologia (por ex:

prática de asanas e controle da pressão arterial) (Peçanha & Campana 2011).

No Ocidente, o pioneirismo nas pesquisas na área coube a Therese Brosse,

na França, queevidenciou os efeitos da meditação em exames eletrocardiológicos

(Peçanha & Campana 2011).

Há um estudo também sobre os efeitos fisiológicos e psicológicos do Hatha-

Yoga em mulheres saudáveis, o qual demonstrou uma diminuição significativa da

freqüência cardíaca durante sua prática. Entre os parâmetros psicológicos avaliados

(através de um inventário), as praticantes mostraram pronunciada melhoria da

satisfação com a vida, melhor capacidade de lidar com estressores, índices menores

de excitabilidade, agressividade, emotividade, menor número de queixas somáticas,

e maior extroversão (Schell et al. 1994).

Em 1998, um novo estudo pareceu confirmar a capacidade de mudanças do

estilo de vida, inclusive com a introdução da prática do Yoga, prevenirem a

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necessidade de angioplastia e cirurgia de revascularização miocárdica em

coronariopatas (Ornish et al. 1998).

Na área da ortopedia, um estudo com 42 pacientes demonstrou que um

regime de tratamento de oito semanas de duração, baseado em 11 posturas de

Yoga foi mais eficaz no alívio de alguns sinais e sintomas da síndrome do túnel do

carpo (incluindo força de pressão, intensidade dolorosa e distúrbio do sono), que a

ausência de tratamento ou a colocação de tala no pulso (Garfinkel et al. 1998).

A prática de Yoga por pacientes psiquiátricos em um Núcleo de Atenção

Psicossocial proporcionou maior integração do grupo e maior participação dos

pacientes em outras atividades promovidas pelo serviço. Em relação ao

comportamento dos clientes, auxiliou no autocontrole, reduziu a ansiedade,

promoveu relaxamento e melhorou a auto-estima (Souza 1999).

Estudos mostraram uma associação entre a prática de yoga ou meditação e

um aumento dos níveis séricos de melatonina, um antioxidante natural produzido

pela glândula pineal (Martarelli et al. 2009; Harinath et al. 2004; Coker, 1999).

Uma investigação comprovou que uma técnica meditativa desenvolvida pelo

Maharishi Mahesh Yogue, fez a resistência arterial periférica total decrescer

significativamente durante sua prática por 18 adultos de meia-idade, em comparação

com 14 adultos não-praticantes de meditação (Barnes et al. 1999).

Investigando a prática do Yoga sobre o estresse decorrente de exames

(provas) em estudantes de medicina, pesquisadores perceberam uma redução

estatisticamente significativa no número de relatos qualificados de desempenho

ruim. Correlacionaram esta redução com a melhoria de diversos parâmetros

subjetivos. Esses parâmetros foram: melhor sensação de bem-estar, sensação de

relaxamento, menor irritabilidade, melhor capacidade de concentração e de atenção,

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melhor eficiência, bom relacionamento interpessoal, autoconfiança e perspectiva

otimista em relação à vida (Malathi & Damodaran 1999).

Assim, a “Yogaterapia” parece ser favoravelmente empregada no tratamento

de uma grande variedade de condições fisiológicas, tais como dores, limitações

motoras, hipertensão e taquicardia, distúrbios cardiovasculares, doenças pépticas,

asma, sinusite, colite, diabetes, artrite, constipação, problemas da coluna, cefaléias,

distúrbios de memória, gripe, dismenorréia, distúrbios mentais – ansiedade,

dependência química, fobias, frustrações, neurose, etc. (Kligler et al. 2011; Rubia

2009; Vempati et al. 2009; Bhatia et al. 2007; Gupta et al. 2006; Bijlani et al. 2005).

O desenvolvimento da autoconsciência, durante as práticas, contribui para um

maior controle da pessoa sobre suas emoções. Assim, outra conseqüência do Yoga

é o controle de estados mentais como a ansiedade e a depressão, favorecendo um

maior bem-estar geral (Gharote, 2002), daí seu uso para fins terapêuticos.

Estudos comprovaram um efeito positivo de técnicas respiratórias do Yoga

sobre doenças cardíacas, diminuindo a variabilidade da pressão arterial e reduzindo

o risco de cardiopatias (Raupach et al. 2008; Wang et al. 2010).

1.3 Yoga e Estresse

Na literatura biomédica encontramos o termo estresse mencionado de

maneira indiscriminada, ora significando um estímulo aversivo ou ameaçador, ora

significando a resposta emocional ou fisiológica ao estímulo aversivo (Nelson 2000).

As respostas de natureza fisiológica, psicológica e comportamental geradas nos

8
organismos podem ser as respostas aos estressores. Por fim, o termo estresse pode

denominar o estado geral criado a partir das respostas aos estressores.

O fisiologista Hans Seyle foi o primeiro pesquisador a demonstrar que a

exposição de animais a diferentes fatores estressantes promovia o aparecimento de

úlceras pépticas, hipertrofia do córtex das glândulas adrenais e involução do timo e

baço (Seyle 1936). Essa resposta orgânica foi denominada de Síndrome Geral da

Adaptação e pode ser caracterizada em três etapas. Na primeira etapa, a fase de

alarme, o eixo hipotálamo-hipófise-adrenal (HPA) é ativado para produzir uma

resposta comportamental de luta ou de fuga do estímulo estressor. A segunda

etapa, denominada fase de resistência, ocorre quando o estímulo estressor continua

presente e o organismo inicia uma tentativa de adaptação. E finalmente, na terceira

etapa, a fase de exaustão, a persistência do estressor provoca um elevado consumo

energético contribuindo para o surgimento de patologias (Agarwal & Marshall 2001).

A inconstância provocada por agentes estressores em um sistema biológico

gerou uma adaptação do conceito clássico de homeostase, dando origem ao termo

“alostase”. Entende-se então por alostase, ou homeostase antecipatória, a

habilidade dos organismos em adaptar-se com êxito às mudanças impostas pelo

ambiente interno ou externo através de uma série de respostas de ordem fisiológica,

psicológica e comportamental (Sterling & Eyer 1988). Os mediadores dessas

respostas são gerados pelos sistemas alostáticos, representados pelos sistemas

neuroendócrino, imune e cardiorrespiratório. Os efeitos negativos cumulativos, que

surgem das tentativas do organismo em adaptar-se a mudanças constantemente

impostas, caracterizam a chamada carga alostática, ou seja, o potencial custo

inerente à ativação prolongada ou inadequada dos sistemas alostáticos. Esta carga

alostática, variável em função das características do estímulo estressor, pode ser a

9
base para o desenvolvimento das patologias relacionadas à exposição prolongada a

estímulos estressores (McEwen 1998).

As respostas aos estímulos estressores podem ser desencadeadas tanto por

estímulos de natureza física quanto psicológica. Modificações na proporção das

demandas físicas, como no esforço muscular, caracterizam o estressor físico. Por

outro lado, a ativação dos sistemas alostáticos pode ocorrer em resposta à

estimulação afetiva e cognitiva, na ausência de demandas metabólicas,

caracterizando assim o estressor como sendo psicológico (Lovallo & Thomas 2000).

Nesta perspectiva, Herman & Cullinan (1997) subdividem os estímulos

estressores em processivos e sistêmicos. Os primeiros são assim definidos quando

necessitam de recepção e processamento prévios, a partir de múltiplas modalidades

sensoriais, para iniciar uma resposta ao estressor. Não envolvem uma ameaça

imediata à homeostase, mas constituem estímulos que podem tornar-se estressores

somente por comparação a experiências prévias. Diferentemente, os estímulos

estressores sistêmicos são aqueles que representam uma ameaça direta e imediata

à sobrevivência do indivíduo. Os sistemas de respostas aos estressores, neste

caso, disparam sem ocorrer um processamento emocional ou cognitivo. Desta

forma, os autores caracterizam duas vias para ativação de respostas aos

estressores: (1) a via de estressores que sensibilizam o sistema límbico (via

processiva) e (2) e via que não sensibiliza o sistema límbico (via sistêmica).

Na via processiva, estruturas interligadas como a amígdala, o hipocampo e o

córtex pré-frontal, são ativadas por estressores com características cognitivas

emocionais que envolvam processamento sensorial de primeira ordem (Hatalski et

al. 2000). O hormônio estimulador da liberação de corticotrofina (CRH) é o mais

importante neuromodulador da resposta neuroendócrina ao estresse, e o glutamato

10
é o neurotransmissor responsável pelo efeito excitatório nos neurônios do núcleo

paraventricular hipotalâmico. Sabendo que CRH influencia na eficácia das sinapses

do hipocampo, sua secreção pode vir a aumentar as funções mediadoras do

hipocampo, como aprendizado e memória (Pereira et al. 2004). Resultados de

experimentos em ratos imaturos, na área do hipocampo, indicam que a estimulação

neuronal pode regular a expressão do hormônio CRH pelo hipocampo, enquanto

que a expressão de peptídeos no hipotálamo é influenciada pelos desafios

neuroendócrinos (Hatalski et al. 2000). Este hormônio, liberado localmente, atua em

neurônios de projeção da amígdala que se conectam ao hipocampo, direta ou

indiretamente, via córtex. No hipocampo, o CRH aumenta a eficácia sináptica e

influência na memória, sendo apontado como o principal mediador dos efeitos do

estresse na função neuronal em regiões límbicas (Jöels 2001).

Na via sistêmica, os agentes estressores podem causar danos fisiológicos ou

ameaça à sobrevivência, como, por exemplo, hipóxia (baixa oxigenação nos

tecidos), prejuízos cardiovasculares e/ou imunes (Herman & Cullinan 1997). Essa

resposta aos agentes estressores ativada de maneira prolongada ou muito freqüente

(cronicamente) pode acarretar em doenças relacionadas ao estresse (McEwen

2000) e, principalmente, quando a ativação não se dá por razões fisiológicas, mas

por estressores psicológicos ou sociais (Sapolsky 2002). A permanência do

organismo em um estágio fisiológico adequado a uma ação emergencial, embora

esteja inativo fisicamente, pode gerar conseqüências danosas para a saúde (Nelson

2000). O aumento na secreção dos hormônios do estresse, como o cortisol, e falhas

na regulação destes, geram exposição aumentada dos organismos aos seus efeitos,

com conseqüências patológicas. Disfunções neuroendócrinas e padrões secretórios

atípicos de cortisol são encontrados em patologias acompanhadas de estados

11
psicológicos relacionados à depressão e ansiedade (McEwen 2000; Yehuda & Wong

2000).

Em humanos, há diferenças na responsividade neuroendócrina ao estresse

entre os indivíduos. Aqueles que respondem com elevadas taxas de cortisol são

denominados de responsivos, enquanto que os que respondem com taxas menores

de cortisol são denominados não-responsivos. Estas diferenças podem estar

associadas a distúrbios da função no sistema nervoso autônomo (Kunz-Ebrecht et

al. 2003). Isso apresenta importantes implicações para as variações nas taxas

basais de cortisol e interfere na interpretação da análise de estudos de estresse em

humanos.

O estresse pode então ser compreendido como perturbação da homeostase,

mas se o organismo reage adequadamente não ocorre prejuízo na saúde do

indivíduo. Acredita-se que a prática de Yoga favoreça esta tolerância ao estresse.

Devido ao fato de praticantes do Yoga demonstrarem habilidade de administrar o

estresse fisiologistas e psicólogos ocidentais vêm tentando explicar cientificamente

estes achados, além de investigar outros possíveis efeitos do Yoga (Brown &

Gerbarg 2005; Smith et al. 2007; Vancampfort et al. 2010).

Os exercícios do Yoga estão concebidos de modo a atuar diretamente sobre

as glândulas endócrinas. Por esta razão, seus efeitos podem estar relacionados à

homeostasia da neurofisiologia do estresse (Blay 2001).

Estudos realizados com mulheres que participaram regularmente de prática

de Yoga durante três meses mostraram melhora significante na administração do

estresse e em parâmetros psicológicos, sugerindo um papel da prática de asanas

sobre a prevenção e tratamento de doenças relacionadas ao estresse (Michalsen et

al. 2005). Entretanto, outros estudos são necessários para que se possa comprovar

12
a eficácia do Yoga no controle do estresse devido ainda a escassez de estudos bem

controlados.

Um outro estudo mostrou que a prática de Yoga aprimorou a força muscular e

a flexibilidade do corpo, promoveu e melhorou as funções respiratória e

cardiovascular, promoveu a recuperação e tratamento de dependentes químicos,

reduziu o estresse, ansiedade, depressão, e dor crônica, melhorou a qualidade de

sono, bem-estar e qualidade de vida desses indivíduos (Woodyard 2011).

1.4 Yoga, Cognição e Estresse

A memória é um arcabouço composto por múltiplos sistemas que funcionam

de forma independente, porém cooperativa (Cowan 2008; Xavier 1993) e que podem

ser caracterizados por expressões no comportamento e pelo tempo de retenção e

manipulação de uma nova informação (Squire 2004; Cowan 2008). O estudo de

processos de memória vem se pautando no conceito de modularidade de funções,

isto é, da noção de que memória compreende um conjunto de habilidades mediadas

por diferentes módulos do sistema nervoso, que funcionam de forma independente,

porém cooperativa (Xavier 1993). Squire & Zola-Morgan (1991) e Squire (1992)

propuseram a distinção da memória humana em: memória explícita (ou declarativa)

e memória implícita (ou “de procedimentos”).

Uma classificação alternativa dos tipos de memória é proposta por Xavier

(1993), com base em Squire & Zola-Morgan (1991) (vide Figura 1). Desta maneira,

de acordo com Xavier (1993) a memória pode ser subdividida em:

13
1. memória de curto prazo, correspondente a um sistema que armazena

informações por curto intervalo de tempo, cuja capacidade é limitada,

sendo a informação mantida por processos de atenção e ensaio;

2. memória operacional, um tipo de memória transitória que pode manter

informações por períodos variáveis de tempo, em função da utilidade da

informação. Este sistema tem acesso aos objetivos de processamento,

planos de ação e é capaz de obter informações armazenadas nos sistemas

de curto e longo prazos;

3. A memória de longo prazo pode ser adicionalmente subdividida em:

3.1 memória explícita (ou declarativa), usualmente caracterizada pelo

acesso consciente ao conteúdo da informação, que compreende:

3.1.1. memória episódica, para eventos e fatos experienciados

em contexto espacial e temporal específicos, envolvendo

informação autobiográfica;

3.1.2. memória semântica, para conhecimentos que independem

do contexto, como conhecimentos gerais aritméticos,

geográficos e históricos, e o significado de palavras e conceitos;

3.2. memória implícita, usualmente evidenciada através do desempenho

e que corresponde a alterações nos sistemas de processamento em

função de sua utilização repetitiva. Esse processamento repetitivo

resulta na automatização, tornando o posterior processamento

independente de atenção. Depois de tornada automática, não há acesso

consciente ao conteúdo da informação. A memória implícita

compreende:

3.2.1. habilidades e hábitos, motores, perceptuais e cognitivos.

14
3.2.2. pré-ativação, viés ou facilitação do desempenho em

função da apresentação prévia do material de teste, evidenciado

através da capacidade para completar uma palavra apresentada

anteriormente, ou de reconhecer mais prontamente palavras e

figuras anteriormente apresentadas por apenas milissegundos,

3.2.3 condicionamento, expresso pela associação entre dois

estímulos arbitrários em decorrência de sua apresentação

eliciada por apenas um dos estímulos passe a ser eliciada pelo

outro.

Figura 1: Classificação alternativa para os sistemas de memória tal como proposto


por Xavier (1993).

O sistema límbico inclui o septo, a amígdala, e o hipocampo, os quais têm

uma importante função na memória de longo prazo, que permite a antecipação do

prazer, a repetição desejada das experiências interessantes, felizes, agradáveis, e a

fuga e aversão diante de outras situações. O sistema límbico também intervém no

15
controle das emoções. Recordamos melhor uma informação se ela estiver ligada a

uma emoção agradável ou desagradável do que a uma situação neutra. Neste nível

intervêm o hipocampo, a amígdala e os corpos mamilares (memória sensorial e

afetiva). Para a maioria dos pesquisadores a lembrança é uma recriação e este

processo dinâmico pode ser decomposto em três etapas: a informação é filtrada e

gravada através dos sentidos (visão, audição, tato, olfato, paladar) depois ela é

tratada e armazenada sob forma de traços mnemônicos, e por fim ela pode ser

trazida à mente consciente em qualquer momento de maneira voluntária ou não

(Carvalho & Sabbatini 2005).

Outro fator a ser considerado é que o estresse parece também ser necessário

para uma boa aquisição de memória. Todavia, o estresse crônico é também

deletério para os sistemas mnemônicos, e podemos pontuar os malefícios

produzidos pela liberação prolongada de glicocorticóides, o que possivelmente pode

acarretar até mesmo morte neuronal (Sapolsky 2002).

Após a descoberta de receptores cerebrais para corticosteróides em

estruturas límbicas como hipocampo e córtex pré-frontalcomeçou a se esclarecer a

participação significativa dos hormônios do estresse em funções como memória e

aprendizado (Pereira et al. 2004).

Os estudos têm abordado principalmente o impacto dos corticosteróides na

formação de memória, a partir da análise dos padrões de resposta de neurônios

hipocampais. Os resultados obtidos têm demonstrado que um aumento nos níveis

hormonais, seja por administração exógena ou resultante de um estímulo estressor,

ou uma redução abaixo dos níveis hormonais normais causa um impacto negativo,

com conseqüente enfraquecimento da memória declarativa, redução de

neurogênese e atrofia hipocampal (Lupien & Lepage 2001).

16
O estresse agudo aumenta a memória de eventos que são potencialmente

ameaçadores para o organismo. Por outro lado, o estresse crônico causa

plasticidade adaptativa no cérebro. Observa-se que uma exposição a concentrações

sub- ou suprafisiológicas de hormônios corticosteróides conduz a uma desregulação

na expressão gênica, comprometendo funções cognitivas e aumentando a

vulnerabilidade às perturbações neurológicas ou psiquiátricas relacionadas ao

estresse (McEwen 2000; Lupien & Lepage 2001).

Elevações nas concentrações de glicocorticóides facilitam o processo, por

meio do qual sinapses do neocórtex e do hipocampo se tornam mais sensíveis aos

sinais glutamatérgicos, gerando a potenciação de longa duração, que é a base do

aprendizado (Gonçalves 2007). Além disso, alguns estudos parecem sugerir que

concentrações elevadas de glicocorticóides podem até mesmo matar grupos de

neurônios, muito embora tais resultados sejam preliminares e controversos

(Sapolsky 2002).

Com relação aos efeitos do Yoga sobre a memória, Canter & Ernst (2003)

realizaram uma revisão sobre o efeito da meditação na melhoria da cognição. Esse

estudo teve critérios rígidos de inclusão e dos 107 artigos pesquisados somente 10

foram incluídos na revisão. A maioria dos trabalhos foi excluída devido à ausência

de controles ou de randomização de praticantes entre as intervenções. Dos dez

trabalhos incluídos somente quatro trabalhos reportaram efeitos positivos da

meditação sobre a memória, concluindo assim que a meditação teria um efeito

cumulativo e específico na função cognitiva.

Não se sabe, entretanto, se os possíveis efeitos benéficos do Yoga sobre a

memória estão associados a uma redução do estresse, efeito esperado com a

Yogaterapia.

17
É interessante ressaltar, pacientes ansiosos e indivíduos com altos níveis de

ansiedade têm mostrado diferir de pessoas não-ansiosas na maneira de processar

informações. Similarmente aqueles que reportam depressão processam informações

diferentemente daqueles não-depressivos (Lang et al. 1999).

Estudos mostram que Yoga, meditação e práticas contemplativas de atenção

plena diminuem a incidência de pensamentos intrusivos (Mendelson et al. 2010;

Winbush et al. 2007; Fabbro et al. 1999). Pessoas com altos níveis de ansiedade e,

depressão e com transtorno de estresse pós-traumático sofrem com os

“pensamentos intrusivos” os quais provocam distúrbios na vida afetiva e cognitiva

destes pacientes (Perpiñá et al. 2011; Schweizer & Dalgleish 2011; Boals et al.

2008). Desta maneira torna-se importante a investigação da influência destes fatores

sobre a memória.

Além disso, muitas investigações têm mostrado os efeitos benéficos da

prática de Yoga na cognição (memória e atenção) humana (Rangan et al. 2009a,b,

2008; Jensen & Kenny 2004). Os efeitos benéficos do Yoga em tratar e prevenir

Distúrbio de Déficit de Atenção e Hiperatividade (ADHD) melhorou a atenção e o

comportamento de garotos (Jensen & Kenny 2004). Um programa educacional de

estilo de vida baseado no Yoga reduz fatores de risco para doenças

cardiovasculares e Diabetes Mellitus (Bijlani et al. 2005). O sistema educacional

Gurukula apresentou melhores efeitos benéficos na memória de jovens quando

comparado ao sistema moderno de educação (Rangan et al. 2009b, 2008) e

também observaram melhor desempenho na atenção (Rangan et al. 2009a).

Micheline Flak (PhD) introduziu com sucesso técnicas de Yoga no sistema

educacional francês e criou a instituição de Pesquisa em Yoga na Educação (RYE)

em 1978. Ela declara que yama promove a pacificação, observando regras morais e

18
de aprendizado para viver como parte de um grupo, respeitando e aprendendo com

os outros. Outra disciplina ética é o Niyama, que elimina toxinas e emoções

negativas por manter a saúde do corpo e da mente, e promover pensamentos

positivos, elevar a auto-estima e o bom humor. Respiração é também muito

importante no Yoga, que confere controle sobre os pensamentos e pode

desenvolver a auto-confiança, assertividade e a habilidade de resolver conflitos e

monitorar agressão (Jefferson-Buchanan 2006). Yoga aumenta a tolerância ao

estresse, melhorando o desenvolvimento do aprendizado, aumentando a

concentração, atenção, coordenação, relaxamento reduzindo o peso corporal,

aumentando a vitalidade, melhorando a memória e previne distúrbios de ansiedade

e depressão (Kauts & Sharma 2009). Na Franca, RYE tornou-se sinônimo de

técnicas de ensino avançadas, pois correspondem as últimas pesquisas de práticas

educacionais. Subseqüentemente, RYE tornou-se um fenômeno internacional que

possui centros na Europa, America do Sul e Estado Unidos (Jefferson-Buchanan

2006).

Por fim, sugere-se que a intervenção do Yoga como benéfica para

estudantes, professores e administradores de escola no impacto da resposta ao

estresse, incluindo distúrbios emocionais (Mendelson et al. 2010).

19
1.5 Justificativa

A definição de saúde como “completo bem-estar físico, mental e social, e não

apenas a ausência de doença ou enfermidade”, é defendida pela Organização

Mundial de Saúde (THE WORLD HEALTH ORGANIZATION 1998). Os Institutos

Nacionais de Saúde dos E.U.A., através do Centro Nacional para a Medicina

Complementar e Alternativa atualmente conduzem quatro amplos ensaios clínicos2

(NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE

2004) sobre os benefícios do Yoga para a saúde humana.

No Brasil, apesar da prática do yoga ser mais difundida em escolas e clínicas

particulares, já há indícios de incorporação dessa prática integrativa no contexto das

políticas públicas de saúde. No Rio Grande do Norte, por exemplo, a PORTARIA Nº

274/GS, de 27 de junho de 2011 aprovou a Política Estadual das Práticas

Integrativas e Complementares (PEPIC) no Sistema Único de Saúde do RN e já está

sendo atualmente implementada a Yoga no programa de práticas corporais

transdisciplinares. Nesta portaria a Diretriz VI apóia a implantação da prática da

meditação em hospitais e Unidades que promovam saúde (Sobrinho 2011).

Cientistas têm pesquisado a influência da prática de Yoga na saúde devido

aos seus supostos benefícios e emergentes indicações médicas. Atualmente, o

aspecto terapêutico do Yoga tornou-se mais popular em todo o mundo devido aos

problemas psicológicos enfrentados pelo homem, causados pelas mudanças sócio-

ambientais muito rápidas as quais somos constantemente submetidos. A prática de

Yoga opera no nível psicofisiológico e, portanto, boa candidata para combater as

2
“Evaluating Yoga for Chronic Low Back Pain”, coord. Karen J. Sherman: “Yoga as a Treatment for Insomnia”,
coord Sat B. S. Khalsa: “Yoga: Effect on Attention in Aging and Multiple Sclerosis”, coord. Barry S. Oken, e
“Yoga for Treating Shortness of Breath in Chronic Obstrutive Pulmonary Disease”, coord. Virginia L. Carrieri-
Kohlman.

20
doenças psicossomáticas. Então, há uma grande possibilidade de incorporação da

Yogaterapia em métodos terapêuticos modernos para a prevenção e cura de

doenças. Entretanto, para explorar o forte potencial do Yoga em aliviar sofrimentos

humanos, os efeitos do Yoga devem ser pesquisados por métodos controlados e

cientificamente aceitos.

Em virtude das restrições feitas (Vickers & Smith 1997) à metodologia

empregada em boa parte dos estudos até agora conduzidos na área das “terapias

integrativas” como o Yoga (estudos com prospecção inadequada nos grupos

testados), tornam-se necessárias investigações mais extensas e rigorosas, e que

contemplem uma aplicabilidade prática a problemas cotidianos, como é o caso, por

exemplo, do estresse mal-compensado e de perturbações da função somática

(disfunções e doenças), tanto num nível terapêutico, quanto, idealmente, num nível

preventivo. A escassez de investigações rigorosamente conduzidas sobre os efeitos

físicos e mentais do Yoga – praticado em modalidades envolvendo técnicas

diferentes, por pessoas das mais diversas idades, com os mais diferentes perfis

somatopsíquicos, torna essa necessidade ainda mais premente e mandatória.

Conseqüentemente torna-se necessária a realização de estudos experimentais

controlados, a fim de se verificar se algumas variáveis que compõe a qualidade de

vida em questão podem produzir alterações comportamentais e cognitivas que

sugerem a efetividade da prática de Yoga como agente terapêutico ou preventivo.

Práticas de atenção plena são capazes de reduzir o estresse em pessoas

saudáveis. Entretanto, limitações importantes dos estudos e a falta de evidências

sobre os efeitos específicos possíveis das práticas contemplativas em comparação a

outros tratamentos não específicos enfatizam a necessidade de pesquisas (Chiesa &

Serreti 2009).

21
A maioria das pesquisas usa praticantes veteranos de Yoga com supostas

mudanças fisiológicas e psicológicas já estabelecidas. Neste estudo, avaliamos os

grupos teste e controle compostos de não-praticantes de Yoga e que realizassem

atividades cotidianas similares em um ambiente comum. Isso permite deixar claro e

mais realista a evolução dos parâmetros psicológicos e fisiológicos dos praticantes

nesta pesquisa longitudinal e avaliar um grupo comum de estressores.

22
1.6 Hipótese

Nossa hipótese é que a prática regular de Yoga beneficie o desempenho em

tarefas de memória dos voluntários, e diminua os níveis de estresse, ansiedade,

depressão, e aumente a estabilidade de humor. Essa hipótese é fundamentada nas

seguintes premissas:

 A prática regular de Yoga contribui para o bem estar físico e mental,

influenciando na melhoria subjetiva e objetiva de parâmetros

psicológicos e fisiológicos de saúde no ser humano (Woodyard 2011;

Vempati et al. 2009; Dunn 2008; Sharma et al. 2008).

 Uma melhora cognitiva pode advir da prática de Yoga (Rangan et al.

2009a,b, 2008; Jensen & Kenny 2004).

 Há alguns mecanismos pelos quais a prática de Yoga pode melhorar a

memória, como por exemplo, indiretamente por um maior controle

emocional e a redução do estresse (Mendelson 2010; Birdee et al.

2009; Subramanya & Telles 2009; Gloster et al. 2008; Rajesh, et al.

2006; Sharma et al. 2006).

 A depressão é geralmente associada com déficits cognitivos e a prática

de Yoga parece melhorar o humor de forma comparável aos exercícios

aeróbios (Berger et al. 1992).

 A prática de Yoga valoriza a atenção ao corpo na respiração e

músculos específicos de partes do corpo, remetendo-se a uma

melhoria das capacidades atencionais gerais (Oken et al. 2006).

23
2. Objetivos

O objetivo geral do presente trabalho é investigar os efeitos da prática de

Yoga sobre a memória e sobre parâmetros psicológicos e fisiológicos em homens

saudáveis sem experiência prévia de práticas contemplativas durante seis meses de

prática regular. Além disso, se configura desmembrado nos seguintes objetivos

específicos:

2.1 Avaliar as possíveis alterações de parâmetros psicológicos e fisiológicos

relacionados ao estresse em voluntários sem experiência prévia de Yoga

submetidos a seis meses de prática regular e comparados a praticantes de

exercícios físicos convencionais. Além disso, testar os efeitos da prática de Yoga

sobre a memória de curto prazo e memória de longo prazo em um teste de memória

de reconhecimento de palavras. Os resultados relativos a esse objetivo específico

foram apresentados na forma de um artigo científico submetido a publicação (Artigo

1 - Improvement in physiological and psychological parameters after six months of

yoga practice).

2.2 Verificar os efeitos da prática de Yoga por seis meses na memória

operacional avaliada no teste Torre de Hanói, comparando os desempenhos após

meditação de atenção plena e depois de um período de sono. Apresentamos os

resultados deste objetivo específico em forma de um artigo científico (Artigo 2 -

Meditation practice improves the performance of healthy man in a working memory

task).

2.3 Investigar os efeitos de técnicas de respiração do Yoga na modulação do

sistema nervoso autônomo e na estabilidade de humor, cujos resultados foram

apresentados em forma de artigo científico (Artigo 3 - Yoga Breathing Can Modulate

the Autonomous Nervous System and Mood During Physical Exercise).

24
2.1 - ARTIGO 1:

Improvement in physiological and psychological parameters after six months

of yoga practice

1
Rocha, K. K. F., 1Ribeiro, A. M., 1Rocha, K. C. F., 2Sousa, M. B. C.,
1,3
Albuquerque, F. S., 4Ribeiro, S., 1Silva, R. H.

1
Memory Studies Laboratory, Federal University of Rio Grande do Norte (UFRN),

Natal, RN, Brazil.


2
Behavioral Endocrinology Laboratory, Federal University of Rio Grande do Norte

(UFRN), Natal, RN, Brazil.


3
Department of Physiology and Pathology, Federal University of Paraíba (UFPB),

João Pessoa, PB, Brazil.


4
Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.

Periódico: Consciousness and Cognition

Qualis A Internacional para Saúde Coletiva

Status da publicação: Publicado

25
Resumo

A prática de yoga parece beneficiar a cognição, melhorar o controle emocional e

diminuir o nível de estresse. Estudos anteriores foram realizados principalmente com

praticantes experientes orientais, ou com indivíduos não-saudáveis submetidos a

terapias convencionais associadas. É necessária mais investigação sobre os efeitos

da prática de yoga propriamente dita, assim como os possíveis benefícios desta

prática preventiva em indivíduos saudáveis. Foram investigados os efeitos da prática

de yoga na memória e nos parâmetros psicofisiológicos relacionados ao estresse,

comparando a prática de Yoga com exercícios físicos convencionais em homens

saudáveis (previamente inexperientes na prática de Yoga). Testes de memória, de

níveis de cortisol salivar, e de inventários de estresse, ansiedade, depressão foram

avaliados antes e após seis meses de prática de yoga. Praticantes de Yoga

mostraram melhora do desempenho da memória, bem como melhorias nos

parâmetros psicofisiológicos. Os resultados sugerem que a prática regular de yoga

pode melhorar aspectos da cognição e de qualidade de vida para indivíduos

saudáveis. Uma influência indireta do estado emocional na melhoria cognitiva

promovido pela prática de yoga pode ser proposto.

Palavras-chave: Yoga; memória; estresse; ansiedade; depressão; níveis de cortisol


Abstract

Yoga is believed to have beneficial effects on cognition, attenuation of emotional

intensity and stress reduction. Previous studies were mainly performed on eastern

experienced practitioners or unhealthy subjects undergoing concomitant conventional

therapies. Further investigation is needed on the effects of yoga per se, as well as its

possible preventive benefits on healthy subjects. We investigated the effects of yoga

on memory and psychophysiological parameters related to stress, comparing yoga

practice and conventional physical exercises in healthy men (previously yoga-naïve).

Memory tests, salivary cortisol levels and stress, anxiety, and depression inventories

were assessed before and after 6 months of practice. Yoga practitioners showed

improvement of the memory performance, as well as improvements in

psychophysiological parameters. The present results suggest that regular yoga

practice can improve aspects of cognition and quality of life for healthy individuals.

An indirect influence of emotional state on cognitive improvement promoted by yoga

practice can be proposed.

Keywords: Yoga, Memory, Stress, Anxiety, Depression, Cortisol levels

27
1. Introduction

Yoga is an ancient Indian system of philosophy designed to bring balance and

health to the physical, mental and emotional dimensions of the individual. The

practice consists of a set of physical postures (asanas), which are maintained for a

certain time (Telles et al, 1993; Gimbel, 1998; Ross & Thomas, 2010; Uebelacker et

al., 2010). Yoga also involves practice of voluntary breath control (pranayama),

voluntary concentration of thoughts (meditation) and/or repeated recital of phrases

(mantra). Since its introduction into the Western culture, yoga has becoming more

popular as a complementary way to achieve healthy living (Jayasinghe, 2004).

A growing body of evidence supports the belief that certain yoga techniques

may improve physical and mental health (Ross & Thomas, 2010). Moreover,

investigations have shown the beneficial effects of yoga on cognition (Birdee, Yeh,

Wayne, Phillips, Davis, & Gardiner, 2009; Chattha, Nagarathna, Venkatram &

Hongasandra, 2008). Rangan and colleagues (2009), for example, verified that the

Gurukula Education System school, based on a yoga way of life, was more effective

in increasing performance on visual and verbal memory in students when compared

with students of the Modern Education System. Another study showed that yoga-

based relaxation techniques improved memory scores in volunteers immediately after

the practice (Subramanya & Telles, 2009).

Among practitioners and instructors, it is believed that yoga practice provide

benefits in both cognitive and affective aspects of psychological functions such as

memory improvement and the reduction of emotional tension, depression, anxiety

and irritability (Andrade & Pedrão, 2005). In general, mind and body control

techniques can have potential beneficial effects on cognition because they involve

28
active attention exercises. For example, it has been shown that yoga practice

enhances the subject’s attention on breathing and specific body muscles, referring to

a general improvement in attentional capacity (Oken et al., 2006). On the other hand,

cognition improvement could be indirectly achieved by the attenuation of emotional

intensity and stress reduction induced by the regular practice of Yoga. Indeed, stress,

anxiety, depression and other psychologically debilitating conditions have been

associated with cognitive deficits (Birdee et al., 2009; Rajesh, Jayachandran,

Mohandas, & Radhakrishnan, 2006; Sharma, Das, Mondal, Goswami, & Gandhi,

2006; Subramanya & Telles, 2009). Additionally, many studies support the idea that

yoga benefits physical and mental health via down-regulation of the hypothalamic–

pituitary–adrenal (HPA) axis and the sympathetic nervous system (SNS) activity

(Ross & Thomas, 2010 for review). In this respect, the practice of yoga was shown to

improve mood in a way comparable to aerobic exercise (Berger & Owen, 1992).

In general, physical exercises have been considered an acceptable method for

improving and maintaining physical and emotional health (Ross & Thomas, 2010).

Studies comparing the effects of yoga and conventional physical exercise seem to

indicate that, in both healthy and unhealthy subjects, yoga may be as effective as, or

even better than, exercise at improving a variety of health-related outcome measures

(Chattha, Nagarathna, Venkatram & Hongasandra, 2008; Yurtkuran, Alp, Yurtkuran,

& Dilek, 2007).

Despite the growing number of studies on the subject, the lack of evidence

based on rigorous scientific study has limited application of yoga as an accepted

method for health improvement or even disease treatment. Indeed, although one can

find in the scientific literature an increasing number of studies designed to clarify the

validity of the practice, important methodological limitations of the studies emphasize

29
the need for further research (Chiesa & Serret, 2009; Birdee, Yeh, Wayne, Phillips,

Davis, & Gardiner, 2009; Tsang, Chan, & Cheung, 2008). Research protocols of

these studies were varied in yoga practice, subject age and different physical and

psychological profiles, usually presenting physical or mental disorders (Ross &

Thomas, 2010). Additionally, long term yoga practitioners are included in the studies

that lack information about the subjects’ evaluations before yoga practice. Other

studies fail to provide a control group when measuring variables such as the effects

of physical exercise, use of relaxation or even inactivity at all. (Vickers & Smith, 1997,

Ross & Thomas, 2010). Most studies have focused on yoga practice as an adjuvant

therapy, i.e., the conclusions are based on the effects of yoga practice associated

with medication, special diets, conventional physical therapies, and others (Birdee,

Yeh, Wayne, Phillips, Davis, & Gardiner, 2009). Finally, most of the yoga studies are

performed in eastern populations, where individuals are culturally predisposed to this

kind of practice. In this respect, one might ask if the adaptation of yoga practice to

western way of life is equally effective.

Clearly, further investigation is needed on the effects of yoga practice per se,

as well as the possible preventive benefits of this practice on healthy subjects.

Therefore, the aim of this study is to examine the effectiveness of yoga practice on

behavioral and physiological measures related to emotional and cognitive aspects of

yoga-naive subjects, who undergo similar daily activities in a common environment,

and hence submitted to a common set of daily stressors. Specifically, this study

investigated the effects of yoga practice on memory, psychological measures and

salivary cortisol levels of healthy adult, Brazilian military men.

30
2. Methods

2.1. Participants

Thirty-six men (aged 20 – 40 years old) from the Brazilian army participated in

this study. The participants' health conditions are periodically checked as part of the

military routine and they were all healthy during the period of the study. All subjects

were submitted to conventional physical exercises, and kept to the same daily work

conditions (military quarter’s routine). Exclusion criteria were the presence of

psychiatric illness, history of drug abuse, current treatment with drugs acting on the

central nervous system, use of steroid hormones or analogues, and previous

experience with yoga or similar practices. All subjects signed a consent form and the

research protocol was approved by the local Institutional Ethics Committee. Subjects

were assigned to either yoga practice or conventional physical exercise (control)

groups balanced for age and rank in military hierarchy. The yoga group (n = 17)

attended two yoga classes a week plus two physical exercise classes, while the

control group (n = 19) attended only physical exercises (four classes a week) for a

period of six months. All classes lasted 60 minutes. Outcome assessments were

performed at baseline and at the end of the 6-month period. These evaluations

consisted of standard inventories, salivary cortisol levels and memory tests (word list

recognition). Both collection and data analysis were conducted in a blind manner.

Subjects were specifically instructed to avoid telling the assessor what intervention

group they were in.

31
2.2. Inventories

At admission, all individuals were required to answer a personal information

questionnaire. In addition, the BDI (Beck Depression Inventory), the BAI (Beck

Anxiety Inventory) and the LSSI (Lipp Stress Symptom Inventory) were applied at

baseline and after the six months of practice.

The BDI is one of the most widely used and reliable instrument for detecting

and assessing intensity of depression in normal populations (Beck, Ward,

Mendelson, Mock, & Erbaugh, 1961; Javnbakht, Hejazi & Ghasemi, 2009). The 21-

item BDI self-report questionnaire assesses any depressive and affective symptoms

in the previous week and rates their intensity on a scale from 0 to 3 (total score range

0 - 63). The final score can indicate four possible depression mood levels: 0 - 11

(minimally depressed mood), 12 - 19 (lightly depressed mood), 20 - 35 (moderately

depressed mood), and 30 – 63 (severely depressed). Most items describe clinical

symptoms of depression, specifically the presence and intensity of emotional,

cognitive, and somatic aspects (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961;

Gorenstein & Andrade, 1996; Javnbakht, Hejazi & Ghasemi, 2009).

The BAI, another commonly used measures to assess the construct of anxiety

(Gorenstein & Andrade, 1996), includes 21 items that reflect affective and somatic

symptoms of anxiety, and are rated on a 4-point scale for how much the individual is

bothered by these symptoms during the past week: 0 (not at all) to 3 (severely), with

a possible range of total scores from 0 to 63. Higher scores represent a higher

intensity of anxiety (Gorenstein & Andrade, 1996; Cunha, 2001).

The LSSI, a psychological evaluation tool validated for use in Brazil, was used

to identify the symptoms of stress presented by the subjects by registering the

32
prevalence of physical or psychological symptoms as well as the stress stage (alert

stage, resistance, almost-exhaustion, or exhaustion) (Costa, Accioly, Oliveira, &

Maia, 2007; Lipp, 2000).

2.3. Memory Tests

Memory tests comprised short- and long-term memory of word recognition, in

both easy and difficult contexts. The protocol consisted of two lists of 15 common

concrete nouns (Portuguese language version). Each word was displayed

individually on a computer screen and subsequently a word recognition test was

carried out, with the target words mixed with distracting words (distracters). Word list

presentation and word recognition test were repeated for three trials (T1, T2, and

T3). For the “easy” context coding, a new set of distracters was used in each

repetition of the word list recognition test, while the same set of distracters was used

in all trials for the “difficult” context coding. In order to increase interference in

recollection of short-term memory, the Forward Span Digit and the Backward Span

Digit tests were applied between T1 and T2 and between T2 and T3, respectively

(data not shown). One week later, a word recognition test of each list was conducted

to evaluate long-term memory. This whole procedure was performed twice: before

commencing the practicing period and after six months deadline. Target words

recalling was analyzed by the discrimination accuracy index Pr from the two-high

threshold theory (Corwin, 1994), which reflects the ability to discriminate target words

from distracters. Data were computed separately for easy and difficult contexts.

33
2.4. Salivary Cortisol Determination

The collection of samples was carried out in the morning (7:00 a.m.) and

participants were instructed not to drink or eat anything, nor brush their teeth for at

least two hours prior to the testing. All subjects rinsed their mouth with water prior to

saliva collections to minimize contamination of the samples. Saliva was collected in

Salivette® (Sarstedt/German) containers and subsequently stored at – 80 ºC until

analysis. Prior to analysis, samples were centrifuged at 10,000 g for 20 minutes and

analyzed for cortisol concentration using a commercially available kit DSL-10-671000

ACTIVE® cortisol enzyme immunoassay (EIA).

2.5. Statistical Analysis

The Statistical Package for Social Sciences (Version 16.0) was used to

conduct all statistical analyses. Kolmogorov-Smirnov test of normality was applied to

data from inventories, memory tests and cortisol levels. Overall non-normal

distribution was found overall. Comparisons of the parameters between experimental

groups were performed by Mann-Whitney U-test and Wilcoxon test was used to

compare basal and after practice outcomes within the groups. A significance level of

0.05 was considered to reflect significant differences for all comparisons made.

34
3. Results

3.1. Inventories

Data obtained before yoga intervention through the BDI showed that most of

the subjects from both groups presented minimum level of depressive symptoms,

and about 30% of the individuals in each group presented slight levels of depression.

After yoga, intervention, all yoga-practitioners showed minimum level in the

depressive symptoms, whereas the percent of control subjects with slight depression

levels had not changed in relation to the baseline (Table 1). The analysis of the

scores of the BDI (Figure 1A) did not reveal differences between yoga and control at

baseline (U = 155.5, p = 0.85), but yoga group presented significantly lower scores

after 6 months of practice (U = 60.0, p = 0.001). Moreover, comparison between

baseline and after practice scores showed a significant reduction for yoga-

practitioners (z = -3.21, p = 0.001) but not for control group (z = -0.39, p = 0.69).

As shown in Table 1, the percentage of yoga practitioners presenting minimum

anxiety levels as evaluated by the BAI increased, while the percentage of

practitioners presenting slight or moderate anxiety levels decreased after 6 months of

practice. The analysis of the scores of the BAI (Figure 1B) showed that before

intervention, anxiety levels were not different between the groups (U = 134.5, p =

0.39), while yoga group showed decreased scores when compared to controls after

the period of practice (U = 39.0, p < 0.001). Furthermore, comparisons between

baseline and after intervention scores showed significant decrements for yoga-

practitioners (z = -3.41, p = 0.001), but not for non-practitioners (z = -0.86, p = 0.39).

35
The results from the LSSI showed that most of the subjects were in the

resistance stage of stress symptoms in both control (63.2 %) and yoga (94.1 %)

groups before intervention. However, after six months of practice, no stress

symptoms were found in yoga-practitioners, whereas 79.0 % of non-practitioners

were in the resistance or in the almost exhaustion stages (Table 1). The analysis of

the scores of the LSSI (Figure 1C) showed that before intervention, stress levels

were not different between groups (U = 127.0, p = 0.27), while yoga-practitioners

showed decreased scores when compared to non-practitioners after the period of

practice (U = 10.5, p < 0.001). Additionally, comparisons between baseline and after

intervention scores showed a significant decrement for yoga-practitioners (z = -3.65,

p < 0.001) and a significant increase for control subjects (z = -2.55, p = 0.01).

3.2. Memory Tests

The mean of the three sequential recollection trials in the first day of test was

used for evaluation of short-term memory. No significant differences were found at

baseline measures in any of the codification contexts. After the 6-month period of

practice, yoga group performed significantly better in the word recognition test in the

easy context when compared to controls [t(34) = 2.11, p ≤ 0.05]. When the same

analyses were applied to the difficult context, once again, the performance of yoga

practitioners showed improvement when compared to control subjects [t(34) = 3.53, p

= 0.001]. No differences were found in the comparisons between baseline and after

practice performances. Data from the short-term memory tests are displayed in Table

2.

36
Long-term memory was evaluated in a recollection trial performed 7 days after

the first test day. The analysis of the baseline data did not show differences between

groups [easy context: t(34) = 0.07, p = .94; difficult context: t(34) = 0.45, p = .65].

After 6 months of practice, the yoga group performed significantly better in the easy

context when compared to control group [t(34) = 4.75, p ≤ 0.001]. In the difficult

context, the difference between controls and yoga practitioners was marginally

significant [t(34) = 1.95, p = 0.059]. Moreover, paired-samples t test revealed

significant improvement only within yoga practitioners when recollection after practice

was compared to baseline performance [t(16) = 2.28, p = 0.03]. Data from the

longterm memory tests are displayed in Table 3.

3.3. Salivary Cortisol Levels

The analysis of cortisol levels (Figure 4) before intervention showed increased

values in the group of yoga practitioners compared to control group (U = 65.5, p =

0.002). After six months, the analysis showed increased salivary cortisol levels (z = -

2.41, p = 0.01) within controls, as opposed to a decrease in the salivary cortisol of

yoga-practitioners (z = -3.62, p < 0.001), both compared to respective baseline

values. Additionally, cortisol levels of yoga practitioners were significantly lower when

compared to controls after the period of practice (U = 43.0, p < 0.001).

37
Table 1. Percentage of control subjects and yoga practitioners in each category of the
depression (BDI), anxiety (BAI) and stress (LSSI) inventories at baseline and after six
months of practice.

Baseline After 6 months

CONTROL YOGA CONTROL YOGA


Inventory Category n % n % n % n %
Minimum 12 63.2 11 64.7 12 63.2 17 100
Slight 7 36.8 5 29.4 7 36.8 0 0
BDI
Moderate 0 0 1 5.9 0 0 0 0
Serious 0 0 0 0 0 0 0 0

Minimum 9 47.4 10 58.8 7 36.8 15 88.2


Slight 6 31.6 4 23.5 10 52.6 2 11.8
BAI
Moderate 4 21.0 3 17.6 2 10.6 0 0
Serious 0 0 0 0 0 0 0 0

Alert 0 0 0 0 0 0 0 0
Resistance 12 63.2 16 94.1 13 68.5 0 0
LSSI
Almost exhaustion 2 10.5 0 0 0 10.5 0 2
Exhaustion 0 0 0 0 0 0 0 0
No symptoms 5 26.3 1 5.9 4 0 17 100

A B C

#
#
*
*
#
*

Figure 1. Score of the inventories applied at baseline and after six months of yoga
practice for control and yoga groups. (A) Beck depression inventory (BDI); (B) Beck

38
anxiety inventory (BAI), and (C) Lipp stress symptom inventory (LSSI). *p < 0.001
compared to control group (Mann-Whitney U-test) and #p < 0.001 compared to baseline
(Wilcoxon test).

(A) Easy Context

* *

(B) Difficult Context

* * *

Figure 2. Short-term memory of control and yoga groups evaluated by word recognition
task in three trials (T1, T2, and T3) in easy (A) and difficult (B) contexts at baseline and
after six months of practice. *p < 0.001 compared to control group (Mann-Whitney U-test).

39
A B

Figure 3. Long-term memory of control and yoga groups evaluated by word recognition
task in easy context (A) and difficult (B) contexts at baseline and after six months of
practice. *p < 0.001 compared to control group (Mann-Whitney U-test).

Control Yoga

#
# *

Figure 4. Salivary cortisol levels of control and yoga groups at baseline and after six
months of practice. *p < 0.01 compared to control group (Mann-Whitney U-test) and #p <
0.001 compared to baseline (Wilcoxon test).

40
4. Discussion

In summary, the results of our study indicated that a six-month period of

regular yoga practice by healthy male volunteers reduced parameters related to

stress, depression and anxiety, as well as improved the performance in recognition

memory tasks. Importantly, the effects of the practice do not seem to be merely

related to a physical practice, since all volunteers underwent regular sessions of

conventional physical exercise. Further, the practitioners were previously yoga-naïve,

nor were culturally predisposed to it, and did not search for this kind of practice in

order to obtain a therapeutic effect. These features, in our opinion, minimize

(although do not abolish) the possibility that our results are due to a placebo effect.

According to the scores obtained with the application of the inventories, the

health status of the volunteers comprised minimal to moderate levels of stress,

anxiety, and depression at baseline. Regardless, these scores were reduced in the

yoga group after six months of regular practice (Table 1). These findings corroborate

previous investigations that indicated yoga intervention is effective in reducing

anxiety (Javnbakht, Hejazi & Ghasemi, 2009; Michalsen et al., 2005), depression

(Sharma et al., 2005), and stress (Carmody & Baer, 2008). Moreover, another study

showed that yoga can more effective than a relaxation technique in reducing stress,

anxiety, depression and improving general health status (Smith, Hancock, Black-

Mortimer, & Echert, 2007). Further, anxiety improvement has been considered to be

a good indicator of effectiveness of mind–body interventions (Nakao et al., 2001).

The data from salivary cortisol analysis indicated that under our experimental

conditions yoga practice was effective in reducing this physiological parameter

41
indicative of stress levels (Figure 2), corroborating the results obtained in the

inventories (Table 1 and Figure 1). It seems relevant to point out that the magnitude

of the decrease in the cortisol levels of yoga group after six months of practice was

higher than those observed in other experimental studies (Kunz-Ebrecht, Mohamed-

Ali, Feldman, Kirschbaum, & Steptoe, 2003; Biondi & Picardi, 1999). In this respect,

one might speculate that the subjects of this study are submitted to a certain level of

stress inherent to military routine which could explain the large responses observed.

Alternatively, all participants of the study are also used to regular practice of

conventional exercises, a factor that might also increase cortisol levels (Mastorakos,

Pavlatou, Diamanti-Kandarakis, & Chrousos, 2005; Viru & Viru, 2004).

The results of the recognition memory tasks showed that control and yoga

groups did not differ at baseline. Nevertheless, the performance of yoga group was

significantly better after 6 months of practice for both short-term (Table 2) and

longterm (Table 3) retrieval tests. This result is in line with few previous studies

showing the improvement of cognitive parameters after yoga practice. However,

these previous studies were mostly performed with subjects presenting previous

deficits (Michalsen et al., 2005) or without appropriate control groups (Berger &

Owen, 1992; Smith et al., 2007; Subramanya & Telles, 2009; West, Otte, Geher,

Johnson, & Mohr, 2004). Additionally, the present study contributes to the field

showing these positive effects upon healthy adults, controlled for the variable of

physical exercise, which has also shown to improve cognitive function in previous

studies (Colcombe & Kramer, 2003; Kramer et al., 1999).

The mechanisms underlying improvement in cognitive tasks induced by yoga

practice are not completely understood. It has been suggested that this effect arises

from the improvement in mental concentration (Subramanya & Telles, 2009). Usually,

42
yoga and similar practices are strongly related to increased levels of attention, as

well as an improved ability to direct attention (Chiesa, Calati, & Serretti, 2011; Lutz,

Greischar, Rawlings, Ricard, & Davidson, 2004). Indeed, attention improvements

could lead to better performance in several kinds of cognitive tasks. This hypothesis

seems to be corroborated by electrophysiological and imaging studies (Lakey, Berry,

& Sellers, 2011; Slagter, Davidson, & Lutz, 2011).

From another standpoint, studies suggest that a memory task can be

essentially a measure of inability to inhibit erroneous implicit recall, which would be

related to hypothesis of unconscious thought theory. In other words, the involvement

of conscious thought in solving a task would be not unequivocal, that is, a

deliberation without conscious attention may occur when solving tasks (Dijksterhuis,

Bos, Nordgren, & van Baaren, 2006). In this respect, since we used interference

tasks between the trials in the short-term memory evaluation, it is possible that an

unconscious deliberation occurred and this could have been the target for the

improvement by yoga practice.

Alternatively, the effects of yoga practice in the psychophysiological

parameters related to stress and general emotional health could have an indirect

effect on cognition. Indeed, it has been shown that stress levels interfere with

memory performance (Lupien, Maheu, Tu, Fiocco, & Schramek, 2007). For example,

Elzinga and Roelofs (2005) verified that participants showed impaired working

memory while performing a psychosocial stress during which both cortisol levels and

sympathetic activity (heart rate and blood pressure) were elevated. Other study have

demonstrated a correlation between the presence of high cortisol levels and

impaired memory retrieval in healthy volunteers exposed to a social stressor

(Buchanan & Tranel, 2008). In this respect, interventions based on mind–body

43
techniques have been suggested as a strategy for transforming behavioral responses

to life events (Astin, 1997). Further, increased anxiety is known to affect the

performance on tasks requiring attention (Fox, 1993). Finally, although our study was

conducted with healthy subjects, cognitive alterations are part of the symptoms of

several psychiatric disorders, such as depression and anxiety (Hindmarch &

Hashimoto, 2010; Mantella et al., 2007). In summary, the improvement in general

mind and body health showed in this study and by other studies might account for a

secondary amelioration in cognitive functions as a whole.

Finally, it is worth mention that three kinds of intervention were included in the

yoga program applied in the study. This could be a limitation to possible conclusions

of the effectiveness of each intervention (pranayamas, meditation or asanas), and

further investigation with protocols focused in each technique would be of great

interest. From another standpoint, most of the yoga classes attended by practitioners

in the western include the three procedures. In this context, the present results

contribute to the investigation of the effectiveness of the yoga program that would be

usually available for the general population. On the other, it is also important to

mention that the volunteers of the present study are probably different of the general

population as regards the dedication to the program. Indeed, civilians are less likely

to demonstrate the same adhesion in carrying out a task when compared to military

individuals. As a consequence, the positive results of the practice might vary

according to the regularity of attendance.

44
5. Conclusions

In conclusion, the data presented here indicate that yoga can effectively

improve memory after six months of practice, along with psychophysiological

measurements related to anxiety, depression and stress in healthy subjects.

Regardless, although speculatively, we suggest that the results provide interesting

starting evidence that yoga could be an effective treatment of anxiety, depression

and stress, and their cognitive consequences. Nevertheless, the results generate at

least possible applications at the preventive level. Additional studies with larger

samples and longer periods of follow up would be of great interest to further

corroborate these findings.

Acknowledgements

We would like to thank all the military men who volunteered for this study, and

Colonel Odilon Mazzine Junior for allowing this study in Batalhão Visconde de

Taunay, Rio Grande do Norte/Brazil. We are also grateful to Martha Traverso-Yepez

for her helpful suggestions. This research was supported by fellowships from

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ);

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); Pró-

reitoria de Pesquisa da Universidade Federal do Rio Grande do Norte

(PROPESQ/UFRN) and Fundação de Apoio à Pesquisa do Estado do Rio Grande do

Norte (FAPERN).

45
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52
2.2 - ARTIGO 2:

Meditation practice improves the performance of Military healthy men in a

working memory task

1
Rocha, K. K. F., 1Ribeiro, A. M., 1Rocha, K. C. F., 2Ribeiro, S., 1*Silva, R. H.

1
Memory Studies Laboratory, Federal University of Rio Grande do Norte (UFRN),

Natal/RN.
2
Brain Institute, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.

Periódico: International Journal of Yoga

Qualis B Internacional para Saúde Coletiva

Status da publicação: a ser submetido

53
Resumo

Alguns estudos têm proposto que a prática de meditação pode promover ativação do

hipocampo, e a meditação de atenção plena pode melhorar a capacidade de

memória operacional. Nosso estudo avaliou os efeitos da meditação de atenção

plena em um teste de memória operacional (Torre de Hanoi). Nós comparamos os

desempenhos do teste de memória após a prática de meditação e após um período

de sono. Vinte quatro homens foram divididos aleatoriamente em um grupo

submetido a 6 meses de prática de Yoga (prática de meditação de atenção plena) ou

exercícios físicos convencionais. As avaliações foram realizadas no início e no final

de 6 meses de prática. Não houve diferença de desempenho antes do início do

período de prática. Na avaliação realizada ao final dos seis meses, o desempenho

no teste de memória operacional após a meditação de atenção foi melhor para o

grupo de prática de Yoga. Propomos que o desempenho em um teste de memória

operacional pode ser melhorado pela prática da meditação de atenção plena.

Palavras-chave: Meditação de Atenção Plena, Memória Operacional, Sono,Torre de

Hanoi.

54
Abstract

Some studies have proposed that meditation practice can activate the hippocampus,

and mindfulness meditation can improve working memory capacity. Our study

evaluated the effects of mindfulness meditation in a working memory test (Tower of

Hanoi). We compared the performance of memory test after meditation practice and

after a sleep period. Twenty four men were randomly divided into two groups

according to 6 months of yoga practice (mindfulness meditation practice) or

conventional physical exercise. Outcome assessments were performed at baseline

and at the end of the 6-month period. No differences were found for baseline

evaluation. The performance in the working memory test after mindfulness meditation

was improved to Yoga practitioners after the 6-month period of yoga practice. We

propose that the performance of working memory test can be improved by

mindfulness meditation practice.

Keywords: Mindfulness Meditation, Working Memory, Sleep, Tower of Hanoi.

55
1. Introduction

Meditation is a mental process to achieve an altered state of awareness in

both religious and nonreligious practitioners (Engstrom et al. 2010). A growing body

of evidence has widely recognized meditation as an effective tool for mental and

physical health (Birdee et al. 2009; Chattha et al. 2008; Ross & Thomas 2010). In the

study of Engstrom et al. (2010), using functional magnetic resonance imaging,

hippocampal activation was shown during meditation. It proposed that the

hippocampus is activated even after moderate meditation practice and also during

different modes of meditation (Engstrom et al. 2010).

Mindfulness is a way of paying attention that originated in Eastern meditation

practices. It has been described as “bringing one’s complete attention to the present

experience on a moment-to-moment basis” (Marlatt & Kristeller 1999, p. 68).

Mindfulness meditation practices are a subgroup of meditation practices which are

receiving growing attention (Chiesa & Serretti 2009).

Bishop et al. (2004) proposed a two-component model of mindfulness. The

first component involves the self-regulation of attention so that it is maintained on

immediate experience, thereby allowing for increased recognition of mental events in

the present moment. The second component involves adopting a particular

orientation toward one’s experiences in the present moment, an orientation that is

characterized by curiosity, openness, and acceptance.(Bishop et al. 2004)

Jha et al. (2010) investigated the impact of mindfulness training on working

memory capacity and affective experience, and used one group of marines who

practiced regular mindfulness meditation while another group had no mindfulness

training. The marines who practiced mindfulness for longer periods presented a slight

56
increase in working memory capacity and also experienced more positive moods and

fewer negative moods compared with who didn't have the training.

One of the practices related to meditation is yoga. Among practitioners and

instructors, it is believed that yoga practice provide benefits in both cognitive and

affective aspects of psychological functions such as memory improvement and the

reduction of emotional tension, depression and anxiety (Kozasa et al. 2008). In

general, mind and body control techniques can have potential beneficial effects on

cognition because they involve active attention exercises. For example, it has been

shown that yoga practice enhances the subject’s attention on breathing and specific

body muscles, referring to a general improvement in attentional capacity (Oken et al.,

2006).

Rangan and colleagues (2009) verified that the Gurukula Education System

school, based on a yoga way of life, was more effective in increasing performance on

visual and verbal memory in students when compared with students of the Modern

Education System. Another study showed that yoga-based relaxation techniques

improved memory scores in volunteers immediately after the practice (Subramanya &

Telles, 2009).

From another stand point, irrespective to the meditation component of yoga

practice, physical exercises have been considered an acceptable method for

improving and maintaining physical and emotional health (Ross & Thomas, 2010).

Studies comparing the effects of yoga and conventional physical exercise seem to

indicate that, in both healthy and unhealthy subjects, yoga may be as effective as, or

even better than exercise at improving a variety of health-related outcome measures

(Chattha, Nagarathna, Venkatram & Hongasandra, 2008; Yurtkuran, Alp, Yurtkuran,

& Dilek, 2007).

57
Working memory has been the most investigated memory system, which is

assumed to be necessary for the maintenance of information in mind while

performing complex tasks such as reasoning, comprehension and learning (Baddeley

2010). Working memory has traditionally been divided into three distinct components

which are corroborated by imaging studies (Smith & Jonides 1999): one processing

and storing phonologic information, one processing and storing spatial information,

and an executive system allocating attentional resources (Baddeley 1998).,

Additionally, under the label of executive functions higher-order cognitive abilities that

facilitate the flexible modification of thought and behavior in front of novel cognitive or

environmental demands are usually comprised. Hence, executive functions include a

number of abilities such as problem solving, planning, concept formation and

decision making, attention and working memory that have been recently

distinguished from emotional/motivational executive functions (Ardila 2008). Among

them, three core abilities have been reported to be clearly separable, even if

moderately correlated with one another as well: information updating and monitoring,

response inhibition (inhibitory control), and shifting (cognitive flexibility) (Miyake et al.

2000). In particular, information updating and monitoring capacities correspond to the

above described executive component of working memory, whereas the other two

executive functions are partially overlapping with attention models (McCable et al.

2010).

Tower of Hanoi is a cognitive test influenced by fluid intelligence, working

memory and inhibitory control (Zook et al. 2004). Davidson (2003) states that the

Tower of Hanoi task is a prototypical example of problem-solving research has

traditionally focused on so-called insight problems. In working memory the success in

many tasks is predicated on the ability to maintain goals, action plans, and other

58
task-relevant information in a highly activated and accessible state, and when

necessary, to inhibit activation of irrelevant or distracting information. During

performance of the Tower of Hanoi task, what one must keep active are the rules of

the task and sub goals created en route to the solution. In addition, discovery of a

solution may depend on the ability to activate information from multiple, unsuccessful

solution attempts, and to maintain that activation until the information is integrated

(Davidson 2003).

There was a significant, positive correlation between working memory capacity

and increase in memory performance after sleep but not after a period of

wakefulness (Fenn & Hambrick 2011). Stickgolg (2005) suggested that after the

initial encoding of a sensorimotor experience, a series of cellular, molecular and

systems-level alterations develop over time, automatically and outside of awareness,

that stabilize and enhance the initial memory representation, converting it into a long-

lasting and optimally integrated memory. These include not only cellular and

molecular processes occurring at the local synaptic level, but systems-level

reorganizations of individual memories as well. These additional memory-

consolidation processes show the greatest evidence of sleep dependence.

Naps (brief sleeps) are a global and highly prevalent phenomenon, thus

warranting consideration for their effects on cognitive functioning. Naps can reduce

sleepiness and improve cognitive performance. The benefits of brief (5-15 min) naps

are almost immediate after the nap and last a limited period (1-3h). Longer naps (>

30 min) can produce impairment from sleep inertia for a short period after waking but

then produce improved cognitive performance for a longer period (up to many hours).

Other factors that affect the benefits from the nap are the circadian timing of the nap

with early afternoon being the most favourable time (Lovato & Lack 2010). After

59
some 30 minutes of cognitive activity, there were no longer performance differences

between the waking and napping groups. Subjective Task Difficulty and Mental Effort

requirements were less affected by sleep inertia and dissociated from objective

measures when participants had napped in the afternoon. Executive functions take

longer to return to asymptotic performance after sleep than the performance of

simpler tasks which are less reliant on executive functions (Groeger et al. 2011).

The objective of this study is to evaluate the effects of mindfulness meditation

in a working memory test in occidental healthy men. We compared the performance

of memory test after meditation practice with the performance after a sleep period

specifically.

2. Methods

2.1. Participants

Twenty four healthy men (aged 30 – 40 years old) from the Brazilian army

were randomly assigned to 6 months of Yoga class (with mindfulness meditation

training) or conventional physical exercises. Outcome assessments were performed

at baseline and at the end of the 6-month. We collected and analyzed data from

working memory test,

All subjects were submitted to conventional physical exercises, and kept to the

same daily work conditions (military quarter’s routine). Exclusion criteria were the

presence of psychiatric illness, history of drug abuse, current treatment with drugs

acting on the central nervous system, use of steroid hormones or analogues, and

previous experience with yoga or similar practices. All subjects signed a consent form

60
and the research protocol was approved by the local Institutional Ethics Committee.

Subjects were assigned to either yoga practice or conventional physical exercise

(control) groups balanced for age and rank in military hierarchy. The yoga group (n =

12) attended two yoga classes a week plus two physical exercise classes, while the

control group (n = 12) attended only physical exercises (four classes a week) for a

period of six months. All classes lasted 60 minutes.

2.2. Tower of Hanoi

We used a computational freeware Tower of Hanoi program, whose

participant can move the blocks by using a pointing device (mouse) to drag and drop

graphic elements. There are three towers and seven blocks. The initial state is that

the blocks are set on middle tower, with the smallest block on the top and the largest

block on the bottom. The goal is to move the all blocks from middle tower to one of

side towers, but the rules state that only one block can be moved at a time, that only

the top block can be moved, and that a disk can never be placed on a smaller block.

Once the target configuration of towers is achieved, the problem is solved. The best

performance is to achieve the smallest quantity of movements of blocks to get the

goal state. Perhaps the most salient aspect of task such as Tower of Hanoi is that the

solution must be discovered. That is, although the initial state and the goal state are

clear, how to transform the initial state into the goal state is unclear (Davidson 2003).

The Tower of Hanoi program was a freeware application for Windows

Operational System made by Durango Hasselmann and available with a friendly

interface to move blocks from one tower to another, resulting in a configuration

identical to the original game. That application quantified the number of movements

61
and time of trial (see Figure 1). The application prevents the placement of a larger

block on a smaller block and to move more than one block a time. This control is

important to guide the participant to plan a strategy to end the game.

Figure 1. Tower of Hanoi interface screen showing the number of block movements
and play time. The Tower of Hanoi program is available in public domain site:
www.kuadrus.com.br. The Portuguese version was used (tempo: time; movimentos:
movements).

2.3. Testing Protocol

The volunteers were tested at a sleep laboratory, which follows the rules and

standards of the Brazilian Society of Sleep. We avoided sleep inertia after nap using

62
another game and awakening properly the volunteers. We collected data in the

afternoon. Yoga practitioners underwent the following events:

1. Tower of Hanoi trial (with 40-minute limit time);

2. guided relaxation with one volunteer seated in a chair (for a period of

ten minutes);

3. meditation technique that cultivate mindfulness in volunteer seated in

a chair (10 minutes);

4. Tower of Hanoi trial (with 40-minute limit time);

5. sleep of volunteer in bed for a period of 50 minutes;

6. awakening the volunteer and play another game (Free Solitaire/

Patience game for Windows) to avoid sleep inertia experience (10

minutes).

7. Tower of Hanoi trial (with 40-minute limit time);

Conventional physical exercise practitioners were submitted to the following

events:

1. Tower of Hanoi trial (with 40-minute limit time);

2. rest of volunteer for 20 minutes to correspond relaxation event for

yoga practitioners;

3. Tower of Hanoi trial (with 40-minute limit time);

4. sleep of volunteer in bed for a period of 50 minutes;

5. awakening the volunteer and play another game (Free Solitaire/

Patience game for Windows) to avoid sleep inertia experience (10

minutes).

6. Tower of Hanoi trial (with 40-minute limit time);

63
2.4. Statistical Analysis

The Statistical Package for Social Sciences (Version 16.0) was used to

conduct all statistical analyses. Kolmogorov-Smirnov test of normality was applied

and overall non-normal distribution was found . Comparisons of the parameters

between experimental groups were performed by Mann-Whitney U-test and Wilcoxon

test was used to compare basal and after practice outcomes within the groups. A

significance level of 0.05 was considered to reflect significant differences for all

comparisons made.

3. Results

There were no significant differences between groups at baseline

measurements. After the 6-month period of practice, yoga practitioners group

performed significantly better performance in the working memory test when

compared to physical exercise group. The Mann-Whitney test showed significant

differences in relation to the data memory performance between groups obtained

after a semester of practice (U = 87.5, *p = 0.01), after the meditation technique (U =

62.0, *p = 0.001, for yoga practitioners) and after sleep (U = 1.5, *p = 0.006) (see

Figure 2).

The intragroup comparison was significant only for yoga practitioners on

measures of memory performance between baseline and semester periods (U =

289.0, #P = 0.004), after meditation (U = 289.0, #P = 0.004) and after sleep (U =

0.500, #P = 0.005) (Figure 2).

64
NUMBER OF MOVEMENTS

* *
*
# #
#

Baseline Meditation Sleep Semester Meditation Sleep Baseline Meditation Sleep Semester Meditation Sleep

Figure 2. Working memory in yoga (yoga practitioners) and control (physical


exercises practitioners) groups, obtained from application of the Tower of Hanoi by
Hasselmann Durango. Within the yoga group by the Wilcoxon test between
baseline and semester events (* p <0.05, # p <0.05) compared to control group
(Mann-Whitney U-test).

4. Discussion

The results of our study indicated that a six-month period of regular yoga

practice by healthy male volunteers improved the performance in a working memory

task. Importantly, the effects of the practice do not seem to be merely related to a

physical practice, since all volunteers underwent regular sessions of conventional

physical exercise. Further, the practitioners were previously yoga-naïve, nor were

culturally predisposed to it, and did not search for this kind of practice in order to

obtain a therapeutic effect. These features, in our opinion, minimize (although do not

abolish) the possibility that our results are due to a placebo effect.

The results of the Tower of Hanoi tasks showed that control and yoga groups

did not differ at baseline, while the performance of yoga practitioners group was

65
significantly better after six months of practice (Figure 2). This suggests that

meditation can improve the processes of working memory, and six months of yoga

practice or mindfulness meditation are sufficient to cause improvement in

performance of working memory. This result is in line with few previous studies

showing the improvement of cognitive parameters after yoga practice or meditation.

However, these previous studies were mostly performed with subjects with previous

deficits (Michalsen, Grossman, Acil, Langhorst, et al. 2005; Chattha, Nagarathna,

Padmalatha, & Nagendra, 2008) or without appropriate control groups (Smith,

Hancock, Blake-Mortimer, & Eckert, 2007; Subramanya & Telles, 2009). Additionally,

the present study contributes to the field showing these positive effects upon

population of healthy western adults, controlled for the variable of physical exercise,

which has also shown to improve cognitive function in previous studies (Kramer,

Erickson & Colcombe, 2006; De Moor, Beem, Stubbe, Boomsma, & De Geus, 2006;Ross

& Thomas, 2010).

The mechanisms underlying improvement in cognitive tasks induced by yoga

practice or meditation are not completely understood. It has been suggested that this

effect arises from the improvements in concentration and mindfulness (Subramanya

& Telles, 2009). Usually, yoga and mindfulness meditation practice are strongly

related to increased levels of concentration and attention, as well as an improved

ability to direct attention (Chiesa & Serretti, 2009). Indeed, attention improvements

could lead to better performance in several kinds of cognitive tasks. This hypothesis

seems to be corroborated by electrophysiological and imaging studies (Gimbel,

1998).

Some studies have proposed that meditation practice, including relaxation,

can activate the hippocampus, and mindfulness meditation can improve working

66
memory capacity (Engstrom et al. 2010; Khalsa et al. 2009; Lou et al. 2005). Our

study corroborated these proposals and evaluated the effects of mindfulness

meditation in a working memory test after meditation practice and after sleep inertia.

As shown by the results, the working memory performance after mindfulness

meditation was better than after sleep inertia.

Our data did not show an improvement of performance after the nap. This

result does not corroborate previous studies. However, while the exact role of sleep

in the consolidation of the different types of memory remains poorly understood

(Stickgold 2005), the conduction of electrophysiological measurements would be

helpful to evaluate the amount of sleep took by patients during the phases of our

protocol. This issue is currently under investigation in our laboratory.

5. Conclusions

The data presented here indicate that yoga and mindfulness meditation can

effectively improve memory after six months of practice in healthy subjects. We

suggest that the results provide interesting starting evidence that yoga could improve

working memory. Nevertheless, the results generate at least possible applications at

the preventive level.

The significant improvements of cognitive function in the Yoga group

compared to the physical exercise group and between baseline and semestral events

indicate working memory after mindfulness meditation is more effective than working

memory after sleep. Additional studies with larger samples and longer periods of

sleep would be of great interest to further corroborate these findings.

67
Acknowledgements

We would like to thank all the military men who volunteered for this study, and

Colonel Odilon Mazzine Junior for allowing this study in Batalhão Visconde de

Taunay, Rio Grande do Norte/Brazil. We are also grateful to Martha Traverso-Yepez

for her helpful suggestions. This research was supported by fellowships from

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ);

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES); Pró-

reitoria de Pesquisa da Universidade Federal do Rio Grande do Norte

(PROPESQ/UFRN) and Fundação de Apoio à Pesquisa do Estado do Rio Grande do

Norte (FAPERN).

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72
International Journal of Yoga

Instructions to Authors

International Journal of Yoga is an open access online journal dedicated to scientific

research in Yoga and its applications.

Types of Manuscripts

Original articles: Basic studies in the field of yoga and Life sciences, Randomized

controlled trials, studies of screening and diagnostic tools based on Indian systems of

medicine and allied health sciences, outcome studies, cost effectiveness analyses,

case-control series, and surveys with high response rate. Up to 3000 words

excluding references and abstract.

Short communications: Up to 1500 words excluding references and abstract and up

to 15 references.

Case reports: new/interesting/very rare cases treated through Yoga therapy and

allied sciences, scientific evaluation of special abilities of Yogis, can be reported.

Cases with clinical significance or implications will be encouraged. Up to 1000 words

excluding references and abstract and up to 10 references.

Review articles (including yoga and its applications in the areas of medicine, physical

sciences, spirituality, management and education): Systemic critical assessments of

literature and data sources. Up to 4000 words excluding references and abstract.

73
Letter to the Editor: Should be short, decisive observation. They should not be

preliminary observations that need a later paper for validation. Up to 400 words and 4

references.

Announcements of conferences, meetings, courses, awards, and other items likely to

be of interest to the readers should be submitted with the name and address of the

person from whom additional information can be obtained. Up to 100 words.

Authorship Criteria

All persons designated as authors should qualify for authorship, and all those who

qualify should be listed. Each author should have participated sufficiently in the work

to take public responsibility for appropriate portions of the content. One or more

authors should take responsibility for the integrity of the work as a whole, from

inception to published article.

Authorship credit should be based only on

1. substantial contributions to conception and design, or acquisition of data, or

analysis and interpretation of data;

2. drafting the article or revising it critically for important intellectual content; and

3. final approval of the version to be published.

Conditions 1, 2, and 3 must all be met. Acquisition of funding, the collection of data,

or general supervision of the research group, by themselves, do not justify

authorship.

The order of authorship on the byline should be a joint decision of the co-authors.

Authors should be prepared to explain the order in which authors are listed. Once

submitted the order cannot be changed without written consent of all the contributors.

74
For a study carried out in a single institute the number of contributors should not

exceed six. For a case-report and for a review article the number of contributors

should not exceed four. A justification should be included, if the number of

contributors exceed these limits.

Only those who have done substantial work in a particular field can write a review

article. A short summary of the work done by the contributor(s) in the field of review

should accompany the manuscript. The journal expects the contributors to give post-

publication updates on the subject of review. The update should be brief, covering

the advances in the field after the publication of article and should be sent as letter to

editor, as and when major development occur in the field.

Contribution Details

Contributors should provide a description of what each of them contributed towards

the manuscript. Description should be divided in following categories, as applicable:

concepts, design, definition of intellectual content, literature search, clinical studies,

experimental studies, data acquisition, data analysis, statistical analysis, manuscript

preparation, manuscript editing, and manuscript review. Authors' contributions will be

printed on the first page of the article. One or more author should take responsibility

of the integrity of the work as a whole from inception to published article and should

be designated as 'guarantor'.

Submitting the Manuscript to the Journal

75
Manuscripts to the International Journal of Yoga should be submitted online through

journalonweb.com It should include a covering letter, scanned copy of the

contributors' form signed by all the contributors (Original has to be faxed to

+91.80.26608645), Tables, illustrations, photographs and video clips has to be

attached along with the manuscript through the online submission process.

The covering letter must include

1. Title of the article

2. Names of the authors (including surnames) and qualifications, institutional

affiliations,

3. Information on prior or duplicate publication or submission elsewhere of any

part of the work/study; and

4. A statement of financial or other relationships that might lead to a conflict of

interest.

Copies of any permission(s) to reproduce published material, and to use illustrations

or report information about identifiable people must accompany the manuscript.

Preparation of the Manuscript

Templates for writing original papers, case reports and review articles have been

provided below. These can be followed for writing the articles as per the instructions.

The text of observational and experimental articles should be divided into sections

with the headings: Introduction, Methods, Results, Discussion, References, Tables,

Figures, Figure legends, and Acknowledgment.

Use double spacing throughout. Number pages consecutively, beginning with the title

page. The language should be US English

76
Title Page

The title page should carry

1. Type of manuscript

2. The title of the article, which should be concise, but informative;

3. Running title or short title not more than 50 characters;

4. The name by which each contributor is known (Last name, First name and

initials of middle name), with his or her highest academic degree(s) and

institutional affiliation;

5. The name of the department(s) and institution(s) to which the work should be

attributed;

6. The name, address, phone numbers, facsimile numbers and e-mail address of

the contributor responsible for correspondence about the manuscript;

7. The total number of pages, total number of photographs and word counts

separately for abstract and for the text (excluding the references and abstract).

Abstract Page

The second page should carry the full title of the manuscript and an abstract (of no

more than 150 words for case reports, brief reports and 250 words for original

articles). The abstract should be structured and states the Context (Background),

Aims, Methods and Material, Results and Conclusions. Below the abstract should

provide 3 to 6 key words.

Introduction

State the purpose of the article and summarize the rationale for the study or

observation.

77
Methods

Describe the selection of the observational or experimental subjects (patients

including controls) clearly. Identify the age, sex, experience in yoga and other

important characteristics of the subjects. Identify the methods, apparatus (give the

manufacturer's name and address in parentheses), and procedures in sufficient

detail. Give references to established methods, including statistical methods; provide

references and brief descriptions for methods that have been published but are not

well known; describe new or substantially modified methods, give reasons for using

them, and evaluate their limitations.

Reports of randomized clinical trials should present information on all major study

elements, including the protocol, assignment of interventions (methods of

randomization, concealment of allocation to treatment groups), and the method of

masking (blinding), based on the CONSORT statement (Moher D, Schulz KF, Altman

DG: The CONSORT Statement: Revised Recommendations for Improving the

Quality of Reports of Parallel-Group Randomized Trials. Ann Intern Med.

2001;134:657-662, also available at http://www.consort-statement.org).

Authors submitting review manuscripts should include a section describing the

methods used for locating, selecting, extracting, and synthesizing data. These

methods should also be summarized in the abstract.

Ethics

While reporting experiments on human subjects, indicate whether the procedures

followed were in accordance with the ethical standards of the responsible committee

on human experimentation (institutional or regional) and with the Helsinki Declaration

78
of 1975, as revised in 2000 (available at http://www.wma.net/e/policy/17-c_e.html).

Do not use patients' names, initials, or hospital numbers, especially in illustrative

material. When reporting experiments on animals, indicate whether the institution's or

a national research council's guide for, or any national law on the care and use of

laboratory animals was followed.

Statistics

When possible, quantify findings and present them with appropriate indicators of

measurement error or uncertainty (such as confidence intervals). Report losses to

observation (such as dropouts from a clinical trial). Put a general description of

methods in the Methods section. When data are summarized in the Results section,

specify the statistical methods used to analyze them. Avoid non-technical uses of

technical terms in statistics, such as 'random' (which implies a randomizing device),

'normal', 'significant', 'correlations', and 'sample'. Define statistical terms,

abbreviations, and most symbols. Use upper italics (P < 0.05).

Results

Present the results in logical sequence in the text, tables, and illustrations. Do not

repeat in the text all the data in the tables or illustrations; emphasize or summaries

only important observations.

Discussion

Emphasize the new and important aspects of the study and the conclusions that

follow from them. Do not repeat in detail data or other material given in the

Introduction or the Results section. Include in the Discussion section the implications

79
of the findings and their limitations, including implications for future research. Relate

the observations to other relevant studies.

In particular, contributors should avoid making statements on economic benefits and

costs unless their manuscript includes economic data and analyses. Avoid claiming

priority and alluding to work that has not been completed. State new hypotheses

when warranted, but clearly label them as such. Recommendations, when

appropriate, may be included.

Acknowledgments

As an appendix to the text, one or more statements should specify

1. contributions that need acknowledging but do not justify authorship, such as

general support by a departmental chair;

2. acknowledgments of technical help; and

3. acknowledgments of financial and material support, which should specify the

nature of the support. This should be the last page of the manuscript.

References

References should be numbered consecutively in the order in which they are first

mentioned in the text (not in alphabetic order). Identify references in text, tables, and

legends by Arabic numerals in superscript. References cited only in tables or figure

legends should be numbered in accordance with the sequence established by the

first identification in the text of the particular table or figure. Use the style of the

examples below, which are based on the formats used by the NLM in Index Medicus.

The titles of journals should be abbreviated according to the style used in Index

Medicus. Use complete name of the journal for non-indexed journals. Avoid using

80
abstracts as references. Information from manuscripts submitted but not accepted

should be cited in the text as "unpublished observations" with written permission from

the source. Avoid citing a "personal communication" unless it provides essential

information not available from a public source, in which case the name of the person

and date of communication should be cited in parentheses in the text. For scientific

articles, contributors should obtain written permission and confirmation of accuracy

from the source of a personal communication.

Articles in Journals

1. Standard journal article:

Kulkarni SB, Chitre RG, Satoskar RS. Serum proteins in tuberculosis. J

Postgrad Med 1960;6:113-20.

List the first six contributors followed by et al.

2. Volume with supplement:

Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and

occupational lung cancer. Environ Health Perspect 1994; 102 Suppl 1:275-82.

3. Issue with supplement:

Payne DK, Sullivan MD, Massie MJ. Women's psychological reactions to

breast cancer. Semin Oncol 1996; 23(1, Suppl 2):89-97.

Books and Other Monographs

1. Personal author(s):

Ringsven MK, Bond D. Gerontology and leadership skills for nurses. 2nd ed.

Albany (NY): Delmar Publishers; 1996.

2. Editor(s), compiler(s) as author:

81
Norman IJ, Redfern SJ, editors. Mental health care for elderly people. New

York: Churchill Livingstone; 1996.

3. Chapter in a book:

Phillips SJ, Whisnant JP. Hypertension and stroke. In: Laragh JH, Brenner

BM, editors. Hypertension: pathophysiology, diagnosis, and management. 2nd

ed. New York: Raven Press; 1995. pp. 465-78.

Tables

 Tables should be self-explanatory and should not duplicate textual material.

 Tables with more than 10 columns and 25 rows are not acceptable.

 Type or print out each table with double spacing on a separate sheet of paper.

If the table must be continued, repeat the title on a second sheet followed by

"(contd.)".

 Number tables, in Arabic numerals, consecutively in the order of their first

citation in the text and supply a brief title for each.

 Place explanatory matter in footnotes, not in the heading.

 Explain in footnotes all non-standard abbreviations that are used in each table.

 Obtain permission for all fully borrowed, adapted, and modified tables and

provide a credit line in the footnote.

 For footnotes use the following symbols, in this sequence: *, †, ‡, §, ||, , **, ††,

‡‡

Illustrations (Figures)

 Figures should be numbered consecutively according to the order in which

they have been first cited in the text.

82
 Symbols, arrows, or letters used in photomicrographs should contrast with the

background

 Titles and detailed explanations belong in the legends for illustrations not on

the illustrations themselves.

 When graphs, scatter-grams or histograms are submitted the numerical data

on which they are based should also be supplied.

 If photographs of people are used, either the subjects must not be identifiable

or their pictures must be accompanied by written permission to use the

photograph.

 If a figure has been published, acknowledge the original source and submit

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illustrations.

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 Explain the internal scale and identify the method of staining in

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83
Protection of Patients' Rights to Privacy

Identifying information should not be published in written descriptions, photographs,

sonograms, CT scans, etc., and pedigrees unless the information is essential for

scientific purposes and the patient (or parent or guardian) gives written informed

consent for publication. Informed consent for this purpose requires that the patient be

shown the manuscript to be published. When informed consent has been obtained, it

should be indicated in the article and copy of the consent should be attached with the

covering letter.

Copyrights

The whole of the literary matter will be the copyright of the Editorial Board. The

Journal, however, grants to all users a free, irrevocable, worldwide, perpetual right of

access to, and a license to copy, use, distribute, perform and display the work (either

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to make small numbers of printed copies for their personal non-commercial use.

84
2.3 - ARTIGO 3:

Yoga Breathing Can Modulate the Autonomic Nervous System and Mood

During Physical Exercise

1
Rocha, K. K. F., 2Traverso-Yepez, M., 3Alkanan, T., 3Button, D. e 3*Behm, D.

1
Memory Studies Laboratory, Federal University of Rio Grande do Norte (UFRN),

Natal/RN.
2
Center for Community Health Promotion Research and Practices, Memorial

University of Newfoundland, St. John´s, Canada.


3
School of Human Kinetics and Recreation, Memorial University of Newfoundland, St.

John´s, Canada.

Periódico: Health Psychology

Qualis A Internacional para Saúde Coletiva

Status da publicação: a ser submetido

85
Resumo

Estudos anteriores mostraram que técnicas de respiração do yoga através de uma

única narina pode causar diferentes respostas fisiológicas quando praticada na

condição de repouso. A prática da técnica de respiração do yoga pela narina direita

(RNYB) em repouso por alguns minutos por dia durante um mês pode resultar em

aumento do metabolismo, da freqüência cardíaca e da pressão arterial em

praticantes de yoga. Em contrapartida, praticar a respiração do yoga pela narina

esquerda (LNYB) pode apresentar efeitos opostos. Neste estudo, os efeitos da

respiração narina direita e esquerda yoga foram comparados com a respiração

normal (RN) durante o exercício físico. A prática de respiração alternada do yoga ou

anuloma viloma (ANYB) foi usada para equilibrar os efeitos dos sistemas nervoso

simpático e parasimpático e manter a estabilidade de humor. Variáveis

cardiovasculares e alongamento muscular foram estudadas em 12 homens e 12

mulheres voluntárias entre 20 e 45 anos de idade. Seis participantes treinados e não

treinados de cada sexo foram avaliados em quatro sessões experimentais em quatro

dias separados. Os indivíduos foram aleatoriamente designados para uma sessão

experimental e pelo menos um dia foi deixado para descansar entre as sessões. As

avaliações incluíram variabilidade da freqüência cardíaca, pressão arterial,

flexibilidade, e escalas de humor. Durante a LNYB houve um aumento significativo

na freqüência cardíaca, pressão arterial sistólica e diastólica e uma diminuição

significativa na flexibilidade. Em contraste, maior flexibilidade e pressão arterial

frequência cardíaca sistólica e diastólica diminuíram após RNYB. Durante a prática

da ANYB houve estabilidade de humor significante apenas para os praticantes de

86
Yoga. Esses resultados apontam para possíveis aplicações importantes de técnicas

de respiração do Yoga na saúde, na estabilidade emocional, e na melhoria geral do

desempenho durante exercício físico.

Palavras-chave: Yoga, Exercício Físico, Sistema Nervoso Autônomo, Humor,

Alongamento

87
Abstract

Previous studies have shown that yoga breathing techniques through a single nostril

can cause different physiological responses when practiced at rest. The practice of

yoga breathing technique through the right nostril (RNYB) can increase metabolism,

heart rate and blood pressure for a few minutes a day during a month in practitioners

of yoga at rest. On the other hand, practicing yoga breathing through the left nostril

(LNYB) can show opposite effects. In this study, the effects of right and left nostril

yoga breathing were compared with normal breathing (NB) during physical exercise.

The alternate nostril yoga breathing practice or anuloma viloma (ANYB) was used to

balance the effects of parasympathetic and sympathetic nervous systems and to

maintain mood stability. Cardiovascular and muscle stretching variables were studied

in 12 male and 12 female volunteers between 18 and 50 years old. Six trained and

six untrained participants of each sex were evaluated in four experimental sessions

on four separate days. Subjects were randomly assigned to an experimental session

and at least one day was left to rest between sessions. The assessments included

heart rate variability, blood pressure, flexibility, and mood scales. During LNYB a

significant increase in heart rate, systolic and diastolic blood pressures and a

significant decrease in flexibility. In contrast, greater flexibility, heart rate and blood

pressure decreased after RNYB. Mood stability was significant only for yoga

practitioners during ANYB practice. These results point to possible important

applications of yoga breathing techniques in health, emotional stability, and

improving overall performance during physical exercise.

Keywords: Yoga, Physical Exercise, Autonomic Nervous System, Mood, Stretching

88
1. Introduction

There are basically two kinds of exercises which yogis use to control nostril air

flow, both done by using the fingers or thumb to occlude one nostril at a time: 1.

'Alternate-nostril breathing': the two nostrils alternate, breath by breath, in an attempt

to balance nasal air flow and equalize stimulation of each hemisphere. 2. 'Unilateral-

nostril breathing': air flow is directed through one nostril (Pal et al. 2004). The effects

of uninostril breathing have been described in ancient Indian yoga texts, where the

flow of air through the nostrils is in the form of energy and is called swara (=sound in

Sanskrit) (Swami Muktibodhananda 1999). Hence, Swara Yoga explains how the

flow of subtle energy through the nostril changes at regular intervals and also

describes its’ importance. When the breath flows through the left nostril (lunar swara),

it is said that the energy is flowing through the left subtle energy channel (ida

nadi).While when breathing through the right nostril (solar swara), it flows through the

subtle energy channel on the right (pingala nadi). When breathing through both

nostrils, it flows through the middle channel (sushumna). These subtle energy

channels (nadis) are not anatomically distinct entities but were described based on

experiential observations of the ancient sages.

Previous studies have demonstrated that unilateral breathing techniques from

the yoga tradition have differential physiological responses in yoga practitioners

during the rest condition. Breathing through the right nostril only has been reported to

increase heart rate (Shannahoff-Kalsa and Kennedy, 1993; Raghuraj and Telles,

2003). Participant’s emotional state of mind can change the breathing patterns, and

the control of breathing can modulate the emotional state (Boiten, 1994). Outcomes

of studies comparing Yoga to physical exercise based on health status indicated

yoga practice to be more beneficial to control heart rate variability, flexibility

89
(Bowman, 1997; Khattab, 2007; Oken et al. 2006), and blood pressure (Telles et al.

1996). RNYB for a few minutes a day over a month resulted in increased baseline

oxygen consumption (Telles et al. 1994). Breathing through the left nostril generally

had opposite effects. However, in previous studies, all these measures were taken at

rest. It is not known what effect unilateral breathing techniques will have upon

exercise conditions. Indeed, as the unilateral breathing techniques are hypothesized

to selectively activate or inhibit the sympathetic nervous system (unilateral right

versus left nostril breathing), they could have significant effects upon exercise

efficiency and caloric consumption.

Anuloma vilom involved breathing from one nostril slowly across the vital

capacity with the order of breathing through the nostrils for inhalation and exhalation

being reversed every time. That yoga breathing technique seems to be an effective

alternative modality for treating children with attention deficit hyperactivity disorder

(Akhila 2010). Anulom vilom have been used to energize and cleanse the respiratory

system (Sharma et al. 2006). Alternate nostril yoga breathing can reduce the systolic,

diastolic, and mean pressure values suggestive of lower sympathetic nervous system

activity, reducing sadness or preventing the yoga practitioners from anxiety (Telles et

al. 2010). Meditation associated with breathing exercises caused a significant

reduction in scores on anxiety, depression, and tension in yoga practitioners, as well

as an increase in well-being in comparison with the control group (Kozasa et al.

2008).

It is recognized that nasal blood vessels influence nasal airflow and hence

nasal airflow is regulated by autonomic and central controls (Eccles 2000).This is

related to the fact that sympathetic nerves supplying the nose are regulated by the

hypothalamus and vasomotor areas of the brainstem. Despite this need for clarity in

90
understanding the nasal cycle there is an interest in understanding the physiological

changes associated with spontaneous changes in nasal patency and those

associated with unilateral forced nostril breathing (Raghuraj & Telles 2008).

Handedness was assessed as there is a report supporting a handedness by nostril

interaction (Searleman et al. 2005). Because of this, we tested only right handle

subjects and verified the dominant nostril in testing protocol.

The objective of this study is to analyse the effects of right and left nostril yoga

breathing on parameters related to autonomous nervous system function, as well as

alternate nostril yoga breathing on mood stability during physical exercise.

2. Methods

2.1. Participants

Based on previously published research using similar measures (Murphy et al.

2010, Chaouachi et al. 2010) a statistical power analysis was conducted which

determined that approximately 24 recreationally active subjects would provide an

alpha of p<0.05 with a power of 0.8. Participants between the ages of 18-50 years

were verbally informed of the procedures and read and signed a consent form, and a

physical activity readiness questionnaire (PAR-Q), before participation. Exclusion

criteria would include age (<18 or >50 years), answering yes to any PAR-Q

questions, and lower limb strains or sprains within the previous three months. The

Memorial University of Newfoundland Human Investigation Committee approved the

study. All of them were in normal health based on a routine clinical examination and

none of them had a history of smoking or respiratory ailments including

91
nasopharyngeal abnormalities. They were all right handed dominant based on their

response to the Edinburgh handedness inventory (Oldfield 1971). Also none of them

were taking medication and they did not use any other wellness strategy. The

variables to be recorded and the study design were described to the participants after

which their signed consent to participate in the study was obtained. None of them

was aware of the hypothesis of the study. Subjects were distributed in two groups:

trained in Yoga (12 Yoga teachers) and unttrained in Yoga (12 athletes).

2.2. Materials

The Physical Activity Readiness Questionnaire (PAR-Q; Thomas, Reading, &

Shephard, 1992) was used to screen participants for any history of physical problems

that would contraindicate aerobic exercise. The PAR-Q, developed by the British

Columbia Ministry of Health, is a simple checklist of symptoms commonly used by

fitness centers to screen enrolees in exercise classes or by other organization that

conduct exercise fitness testing. The PAR-Q is also useful for screening research

participants (Thomas et al., 1992).

The Edinburgh Handedness Inventory, a professionally administered, valid

and reliable measure of handedness based on 12 different tasks, 10 of which

measure hand preference. We used the resulting quantitative data as a continuous

measure as well as a categorical measure (Deep-Soboslay et al. 2010).

The Profile of Mood States (POMS) (McNair, Lorr, & Dropplemenn, 1992) is

comprised of 65 adjectives that are reflected on a 5-point scale to measure six

identifiable mood or affective states and a total mood disturbance score. Scores on

the six mood subscales include; tension-anxiety, depression-dejection, anger-

92
hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment. The profile has

been shown to be suitable for individuals from 18 years to adulthood and internal

consistency reliability has ranged from .84 to .95 (McNair & Lorr, 1964). Test-retest

reliability has ranged from .65 to .74. The immediate "how do you feel right now"

response was used for the current study, in order to measure psycho-physiological

appraisal of effort sense throughout the ride conditions, Buckley & Borg (2011)

Rating of Perceived Exertion Scale was used to evaluate subjects' perceptions of

exercise. The POMS has been widely used in the assessment of mood changes

resulting from a variety of interventions.

2.3. Intervention

There were three conditions including unilateral breathing through the right, or

left nostril and alternate breathing techniques based on yoga traditions. Using a

randomized procedure, subjects would complete each condition on separate days,

separated by at least 48 hours. Tests were conducted at the same time of day to limit

diurnal variations. Participants implemented the specific breathing condition while at

rest for 5 minutes at a self-selected breathing rate. The breathing routine continued

throughout the exercise test period. Exercise involved a 10 minute walk on a

treadmill at a self-selected pace. The individual’s selected pace remained the same

for all three conditions.

93
2.4. Testing Protocol

Proposed alterations in sympathetic activation with unilateral breathing

(Shannahoff -Kalsa and Kennedy 1993, Telles et al. 1996) may affect neuromuscular

efficiency (stretching activity).

Skin preparations included shaving the area of interest when necessary, and

cleansing with isopropyl rubbing alcohol (70%). Two electrodes (Ag/AgCl, disc

shape, 10mm in diameter; Kendall; Medi-Trace 130; ECG conductive adhesive

electrodes) were placed back to back (approximately 2 cm apart) over the marked

midpoints on both the anterior and posterior aspects of the thigh.

Heart rate (indication of changes in sympathetic nervous system activity) as

well as blood pressure was monitored using mean value from electrocardiogram

measurements on a specific event. Cardiovascular measures were taken pre-

intervention, following the rest intervention, 5 and 10 minutes of the treadmill walk, as

well as 5 and 10 minutes post-treadmill walk.

Participants answered POMS and achieved flexibility test before intervention,

after anulom vilom practice and after intervention an each day. The flexibility test

consisted of participants sat on the floor with legs straight in front. A 12-inch sit-and-

reach box was placed against the soles of the feet with the zero end of the

measuring device toward the participants. Participants stretched arms in front of the

body to establish the starting position. Bending forward at the waist and maintaining

straight legs, participants performed three trials by sliding their firgertips along the top

of the measuring device. The best of the three trials was used as the final score

(Hoeger & Hoeger 2003).

94
2.5. Design

The subjects were assigned to four sessions. These were Sequence 1:

alternate nostril yoga breathing and normal breathing; Sequence 2: alternate nostril

yoga breathing and right nostril yoga breathing, Sequence 3: alternate nostril yoga

breathing and left nostril yoga breathing, Sequence 4: normal breathing and alternate

nostril yoga breathing. The four sessions were conducted on four different days for

each sequence. Each session was for 40 minutes including in order: 5 minutes rest,

10 minutes walking and doing alternate nostril yoga breathing, 5 minutes rest, 10

minutes walking and doing any breathing practice (NB, RNYB and LNYB), and 5 and

10 minute rests. In the control session the subject practiced normal breathing

followed by 10 minutes of alternate nostril yoga breathing. Subjects practiced breath

manipulation standing in each “rest period”. Heart rate, blood pressure,

electrocardiogram, breathing and stretching measures were collected.

2.6. Statistical Analysis

All data were analyzed using the Statistical Package for Social Sciences

(Version 16.0). Descriptive statistics were used to characterize the sample. A p-value

below 0.05 was considered to be indicative of statistical significance. The was used

to conduct all statistical analyses. Kolmogorov-Smirnov test of normality was applied

to data. Statistical Analysis was conducted T-Test and Pearson’s chi-square test to

demographic data, paired samples T-Test to cardiovascular and muscle stretching

variables, and independent T-Test to mood scores. Descriptive statistics included

means and standard deviations.

95
3. Results

3.1. Participant demographics

The demographic data of the participants including their age, body mass

index, sex, dominant nostril, handedness, race, and education were shown in Table

1. None of these variables were significantly different between the control (untrained

in yoga) and the experimental (trained in yoga) groups. All the participants were right

handedness and more than 80% had right dominant nostril in all experiments. We

combined men and women because there was not a significative difference between

sexes inside a same group, but there was a significative difference between trained

and untrained groups.

3.2.Cardiologic and muscle stretching variables

Results were analyzed with paired samples t-tests between NB and LNYB or

between NB and RNYB during physical exercise (see Table 2). Left nostril breathing

significantly increased heart rate (mean increase = 7.15 beats per minute, t=4.36,

p<0.0001), and the opposite effect occurred with right nostril breathing (mean

increase = 4.72 beats per minute, t=3.92, p=0.001). During the LNYB practice there

was a increase in blood pressure, but it was significant only in systolic pressure (t=-

3.59; p=0.002). And, during RNYB practice there was a significant decrease in blood

pressure (systolic t=3.36; p=0.003 and diastolic t=5.43; p<0.0001). We observed

using a sit and reach device a significant decrease in flexibility after LNYB practice

(mean decrease =1.71 centimeters, t=5.12, p<0.0001). In contrast, after RNYB

practice, flexibility increased (mean increase = 1.45 cm, t=-7.09; p<0.0001).

96
3.3. Profile of mood states

There were some significant differences between the trained and untrained

groups in the POMS scores (Table 3). The trained yoga group showed a lower total

mood disturbance and others variables in the POMS (p < 0.0001). There was a trend

toward a higher vigor score in the trained yoga group than in the untrained group (p <

0.0001).

TABLE 1. Demographic of the control (yoga untrained) and yoga practitioners


(trained) groups
Untrained Trained
Caracteristics Statistic p-value
(n=12) (n=12)
Age
34.56 ± 7.90 35.22 ± 8.18 t=0.33 0.743
(mean ± standard deviation)

Body mass index


22.01 ± 4.20 22.03 ± 4.50 t=0.01 0.99
(mean ± standard deviation)

Sex (%) Men 50 50


Women 50 50

Dominant nostril (%) Right 83.33 91.66


Left 16.66 8.33

 =0.958
2
Handedness (%) Right 100 100 0.812

Race (%) White 100 100

Education (%) College Graduate 100 100

The unpaired t-test was used to sex and Pearson’s chi-square test were used to
others variables

97
TABLE 2. Paired samples T-Test significance between normal breathing and left or

right nostril yoga breathing for untrained, trained, and untrained Vs trained, men and

women combined subjects.

Untrained Trained Untrained Vs Trained


Dependent Breathing
Variable Technique
Mean ± SD Mean ± SD Mean ± SD

NB 96.25 ± 11.01 90.42 ± 13.39 93.33 ± 12.35

Heart Rate LNYB 100.67 ±10.71 98.75 ± 14.61 99.70 ± 12.56**

RNYB 91.67 ± 10.64 87.42 ± 14.02 89.54 ± 12.36*

NB 103.50 ± 9.38 103.92 ± 11.62 103.71 ± 10.33


Systolic
Pressure
LNYB 105.50 ± 10.05 106.08 ± 13.16 105.79 ± 11.45*

RNYB 101.75 ± 9.42 101.75 ± 11.00 101.75 ± 10.01*

NB 71.08 ±6.28 73.92 ±8.62 72.50 ±7.52


Diastolic
Pressure
LNYB 71.58 ± 6.61 77.42 ± 11.99 74.50 ± 9.93

RNYB 69.58 ±6.34 72.42 ±8.83 71.00 ± 7.66

NB 26.29 ±6.43 32.20 ±7.60 29.25 ± 7.52

Stretching LNYB 23.58 ± 6.57 31.33 ± 8.28 27.45 ± 8.31

RNYB 28.87 ± 7.02 33.83 ± 7.40 31.35 ± 7.50**


Results are presented as the means ± standard deviation (SD), and significance
(*:p<001, **:p<0001) is related comparisons between NB and LNYB or between NB
and RNYB during physical exercise.

98
TABLE 3. Total Scores of three Profile of Mood States (POMS) tests for untrained,
and trained men and women combined subjects

Untrained Trained
Variable
Mean ± SD Mean ± SD

Total mood disturbance score 50.58 ± 30.29 23.50 ± 4.55*

Tension-Anxiety 15.75 ± 3,27 12,25 ± 1,38*

Depression 16,66 ± 2,87 14.91 ± 0.28*

Anger-Hostility 14.83 ± 2.44 11.58 ± 0.51*

Vigor 21,75 ± 4.39 31.58 ± 4.20*

Fatigue 13,08 ± 3,96 7.58 ± 1,16*

Confusion 13.16 ± 4.45 9.50 ± 1.83*

Results are presented as the means ± standard deviation (SD) and Independent-
Samples T-Test significance *:p<0001.

4. Discussion

4.1.Cardiologic and muscle stretching variables

During the LNYB practice there was a significant increase in heart rate, and

blood pressure, and a significant decrease in flexibility. In contrast, flexibility

increased and heart rate, systolic and diastolic blood pressures decreased after

RNYB (see Table 2).

99
A previous research partially corroborated our results (Dane et al. 2002). In

that research the effects of left nostril breathing on heart rate while running for 10

minutes at 30% of maximum capability were tested on 88 male and 41 female right-

handed sports and physical training students from Ataturk University aged 18 to 24.

A same-subject controlled repeated measurements design was used. The results

suggested that there may be a nostril laterality affecting the autonomous nervous

system differentially (Dane et al. 2002). However, this may have simply been due to

increased work of breathing (Mailoo 2008).

Our results also agreed with the suggestion of another study which states that

sympathetic stimulation may be of use for the treatment of weakness or lethargy and

parasympathetic stimulation may be of use for the treatment of anxiety or stress-

related health problems (Mailoo 2008). It was also shown that the patients who

received yoga practice (a combination of physical postures along with right nostril

yoga breathing), practiced two times a day for two months showed a significant

decrease in bowel movements (measured by standard electrophysiological

recordings) and state anxiety. Hence, the physiological effects of yoga breathing

practices on autonomic activity suggest therapeutic applications in conditions

affecting autonomic balance. However, further studies are essential to substantiate

the findings and understand the underlying mechanisms (Raghuraj & Telles 2008).

Other studies did not corroborate with our results, probably because they

tested subjects practicing RNYB and LNYB in rest state. They have shown a trend of

sympathetic activation following breathing exclusively through the right nostril.

Investigations with subjects in rest state, right unilateral forced nostril breathing

increased the heart rate compared with left unilateral forced nostril breathing

(Shannahoff-Khalsa and Kennedy 1993) suggesting an increase in cardio-

100
sympathetic activity. A month of right nostril yoga breathing practice compared to

alternate nostril yoga breathing resulted in a significant increase in the heart rate and

oxygen consumption and a decrease in the body weight (Telles et al. 1994). Another

study which compared the immediate effects of right nostril yoga breathing with

normal breathing, both practiced for 45 minutes, showed an increase in systolic blood

pressure (9.1 mm Hg) following right nostril breathing (Telles et al. 1996). Left nostril

yoga breathing practice resulted in a significant reduction in both systolic blood

pressure and mean pressure, and possibly increased activity in some other

subdivisions of sympathetic nervous system activity. The reduction in systolic blood

pressure following left nostril yoga breathing may be related to a combination of

effects such as changes in cardiac output, peripheral vascular resistance, and

humoral factors (Telles 2008).

Our results can also be explained according with Yoga Tradition. Energy flow

through ida (during LNYB practice) is supposed to be ‘heat dissipating (cooling)’

whereas energy flow through pingala (during RNYB practice) is ‘heat generating’.

Swara Yoga specifically mentions that when the breath flows through ida, one should

carry out ‘passive activities’, such as rendering service and performing religious rites

(Shiva Swarodaya, V: 102–113). When the breath flows through pingala, one should

perform ‘energetic’ activities, such as studying scriptures, hunting and controlling an

elephant, horse or chariot (Shiva Swarodaya, V: 114–123). When the breath flows

through both nostrils (sushumna), it has been mentioned to avoid activity and remain

relaxed (Shiva Swarodaya, V: 128) (Raghuraj and Telles 2003).

We suggest that sympathetic neural mechanisms are activated through right

nostril yoga breathing, performing supply of energy and metabolic activity inside the

muscles fibers providing energy to physical exercises and increasing muscle

101
flexibility. Because of this, it was not necessary to increase heart rate or blood

pressure to attend the needs of oxygen and energy to metabolic reactions during

RNYB practice concomitant with physical exercise. And the LNYB practice had the

opposite effects; activated parasympathetic mechanism and relaxed the body, but

during physical exercise metabolic reactions to supply oxygen and energy were

required and neurochemical reactions increased heart rate and blood pressure to

prepare the body to stressful condition.

4.2. Profile of mood states

The present study demonstrated that trained yoga subjects have lower mental

disturbance in the POMS test in comparison to untrained participants. Our results

were similar another study about mood states and stress-related biochemical indices

in long-term yoga practitioners using POMS (Yoshihara et al. 2011). These findings

suggest that ongoing yoga training reduces the level of mental disturbance. Yoga

was found to be as effective as relaxation in reducing anxiety (Smith et al. 2007). A

systematic review of the use of yoga to treat anxiety suggested that yoga may be

beneficial for different anxiety disorders (Kirkwood et al. 2005). Yoga and exercise

have beneficial effects on mood and anxiety, but yoga practice was more effective to

mood stability and reduce anxiety (Streeter et al. 2010).

Mood stability was significant only for yoga practitioners during ANYN practice

(see Table 2). It was speculated that alternate nostril breathing directly affects the

lateralized sympathetic and vagal input to the heart, hence inducing a balance in

autonomic nervous system activity (Taneja et al. 2004).

102
The 12-week yoga intervention was associated with greater improvements in

mood and anxiety than a metabolically matched walking exercise.

It is widely accepted that there is a relationship between emotions and

autonomic nervous system activity. Madanmohan et al. (2004) published an

investigation about effect of short-term practice of breathing exercises on autonomic

functions in normal human volunteers. They state about effects of yoga breathing

techniques on emotional states. Emotional tone, or affectivity, was found in one study

(Schiff & Rump 1995) to be more negative with left-nostril breathing (the right

hemisphere is known from other research to be more associated with negativity, low

mood, caution, and pessimism). Subjects also scored higher on ratings of anxiety

when the left nostril was dominant.

Together with previous studies, the data indicate that sympathetic nervous

system dominance can be manipulated to some degree (Telles et al., 1994, 1996;

Shannahoff-Kalsa and Kennedy, 1993; Raghuraj and Telles, 2008). Indeed,

selectively boosting verbal or spatial skills or even altering emotional tone can be

done by switching the dominant nostril (Joshi and Telles, 2008). A few minutes of

unilateral-nostril breathing is sufficient to switch dominance (Raghuraj and Telles,

2008).

4. Conclusion

The yoga breathing techniques seem to modulate the autonomic nervous

system and to influence emotional states, showing an improved mood. This suggests

an important relationship between emotions and autonomic nervous system activity.

Those effects suggest possible therapeutic applications, but more investigations to


103
study the mechanisms of yoga breathing techniques and their therapeutic

applications are required.

Acknowledgements

We would like to thank all volunteers for this study, Ginny Ryan, Veers Gadag

and Yvonne Collette. This research was supported by Emerging Leaders in the

Americas Program (ELAP) and School of Human Kinetics and Recreation from

Memorial University of Newfoundland in Canada.

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Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status,

and the survival times of terminally ill patients. Health Psychology, 24, 225–

229. doi: 10.1037/0278-6133.24.2.225

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Mitchell, T. R., & Larson, J. R., Jr. (1987). People in organizations: An

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Bjork, R. A. (1989). Retrieval inhibition as an adaptive mechanism in human

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3. Discussão Geral

A proposta geral deste estudo foi avaliar se a prática regular de Yoga contribui

para o bem estar físico e mental, influenciando na melhoria de parâmetros

psicológicos e fisiológicos de saúde e cognitivos no ser humano. A análise dos

resultados indicou que a prática regular de Yoga melhorou parâmetros de qualidade

de vida e a cognição de indivíduos saudáveis como mostram várias investigações

prévias (Carson et al. 2010; Kyizom et al. 2010; Oken et al. 2006; Berger et al.

1992). A melhoria de qualidade de vida neste estudo está relacionada à diminuição

dos níveis de estresse, ansiedade, depressão e perturbação de humor.

A prática de Yoga valoriza a atenção ao corpo na respiração e músculos

específicos de partes do corpo, remetendo-se a uma melhoria das capacidades

atencionais gerais (Oken et al. 2006). Assim, com relação aos resultados do primeiro

artigo, discutimos alguns mecanismos pelos quais a prática de Yoga pode melhorar

a cognição: indiretamente por um maior controle emocional e a redução do estresse,

depressão e ansiedade (Berger et al. 1992) ou diretamente pelo treinamento mental

(Oken et al. 2006).

Quanto aos resultados dos níveis de cortisol, foram encontradas diferenças

significativas entre os grupos tanto em relação aos dados basais de dosagem de

cortisol, quanto após um semestre de prática. Entretanto, na medida basal, o grupo

praticante de yoga apresentou nível de cortisol elevado em relação ao grupo

controle, enquanto que o padrão oposto foi encontrado após seis meses de prática.

Os resultados obtidos para esse parâmetro fisilógico em relação aos dados do

semestre de estresse estão em consonância com os resultados de parâmetros

psicológicos relatados pelos sujeitos no inventário de Lipp. Houve diferenças

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significativas importantes entre os dados basais e semestrais na comparação

intragrupo, e entre grupos com benefícios para os praticantes de Yoga. Esses

resultados indicam que os níveis de cortisol baixaram de modo significante com seis

meses de prática de Yoga. Isso era esperado segundo Carlson et al. (2004) e

Kamey et al. (2000), que observaram os mesmos resultados após dois meses de

prática regular de Yoga.

Os resultados do teste de memória operacional, Torre de Hanói, mostraram

que os grupos não diferiram no início do estudo, mas o desempenho do grupo de

praticantes de yoga foi significativamente melhor após seis meses de prática. Isso

sugere que um período de seis meses de prática regular de yoga duas vezes por

semana com sessões de uma hora parece melhorar o desempenho em tarefas de

memória operacional de modo significativo. Parece que os benefícios na memória

estão mais relacionados a prática de atenção plena e concentração, já que todos os

voluntários foram submetidos a sessões regulares de exercício físico convencional.

A melhoria cognitiva em função da prática de Yoga foi mostrada em estudos

anteriores (Michalsen, Grossman, ACIL, Langhorst, et al. 2005; Chattha,

Nagarathna, Padmalatha, & Nagendra, 2008). No entanto, esses estudos foram em

sua maioria realizados com indivíduos com déficits cognitivos ou sem grupo controle

apropriado (Smith, Hancock, Blake- Mortimer, & Eckert, 2007; Subramanya & Telles,

2009). O presente estudo contribui mostrando esses efeitos benéficos sobre a

população ocidental de adultos saudáveis, controlado para a variável de exercício

físico, que também tem demonstrado melhorar a função cognitiva (Kramer, Erickson

& Colcombe, 2006; De Moor , Beem, Stubbe, Boomsma, & De Geus, 2006; Ross &

Thomas, 2010).

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Os mecanismos subjacentes a melhoria em tarefas cognitivas induzidas pela

prática de yoga ou meditação não são completamente compreendidos. Tem sido

sugerido que esse efeito surge a partir da melhoria da concentração e da atenção

plena (Subramanya & Telles, 2009). A prática de Yoga e de meditação de atenção

plena estão relacionadas ao aumento dos níveis de concetração, bem como uma

melhor capacidade de atenção direta (Chiesa & Serretti 2009). Isso parece ser

corroborado por estudos eletrofisiológicos e de imagem (Gimbel, 1998).

Alguns estudos anteriores e o presente estudo têm proposto que a prática de

meditação de atenção plena, incluindo o relaxamento, pode ativar o hipocampo, e

pode melhorar a capacidade de memória operacional (Engstrom et al. 2010; Khalsa

et al. 2009; Lou et al. 2005). Alternativamente, como já mencionado, os efeitos da

prática da atenção plena nos parâmetros psicofisiológicos relacionados ao estresse

e na saúde emocional geral poderia ter um efeito indireto sobre a cognição

(Subramanya & Telles 2009).

Com relação aos resultados mostrados no terceiro artigo, durante a prática da

respiração unilateral esquerda do Yoga houve um aumento significativo da

freqüência cardíaca, da pressão arterial e uma diminuição significativa na

flexibilidade humana, como vemos na investigação de Dane et al. (2002). Em

contraste, diminuição da pressão arterial e frequência cardíaca, e maior flexibilidade

ocorreram na prática da respiração unilateral direita. Nossos resultados também

concordaram com outro estudo que indica a estimulação simpática para o

tratamento da fraqueza ou letargia, e estimulação parassimpática para o tratamento

de problemas de ansiedade ou estresse relacionados à saúde (Mailoo 2008), porque

testamos as técnicas respiratórias com indivíduos em exercício físico. Assim, os

efeitos fisiológicos das práticas de respiração do Yoga na atividade autonômica

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sugerem aplicações terapêuticas em condições que afetam o equilíbrio autonômico

(Raghuraj & Telles 2008). No entanto, mais estudos são essenciais para

fundamentar as conclusões e compreender os mecanismos subjacentes.

Outros estudos não corroboram com os nossos resultados, porque eles

testaram sujeitos praticando as técnicas respiratórias do Yoga em estado de

repouso (Raghuraj & Telles 2008, Telles et al. 1996, 1994). Nossos resultados

foram de acordo com as indicações das técnicas respiratórias da Tradição do Yoga;

respiração unilateral esquerda para "atividades passivas", e respiração unilateral

direita para "atividades energéticas", e respiração alternada para evitar a atividade e

permanecer relaxado (Raghuraj & Telles, 2003).

A nossa descoberta sobre os efeitos da respiração unilateral esquerda e

direita do Yoga na flexibilidade muscular pode ser reforçada por muitos estudos

sobre os benefícios do yoga nos distúrbios osteomusculares (Ulger & Yağli 2011;

Evans et al. 2011; Tuzun et al. 2010; Sherman et al. 2005).

O presente estudo demonstrou também que praticantes de Yoga apresentam

maior estabilidade de humor em comparação com praticantes de atividades físicas,

semelhante a outro estudo sobre estados de humor e estresse relacionados com

índices bioquímicos em praticantes experientes de Yoga (Yoshihara et al. 2011).

Estes achados sugerem que a prática de Yoga reduz o nível de perturbação mental

e da ansiedade (Smith et al. 2007; Kirkwood et al. 2005). A prática de Yoga tem sido

mais eficaz do que os exercícios físicos na estabilidade de humor e na diminuição do

nível de ansiedade (Streeter et al. 2010). Esses resultados corroboram também os

dados provenientes dos questionários aplicados no primeiro artigo relativos à

depressão, estresse e ansiedade, embora os protocolos experimentais tenham sido

diferentes.

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4. Conclusões

 A prática regular de Yoga no regime de uma hora por sessão duas vezes

por semana durante seis meses foi eficaz na melhoria cognitiva e na

diminuição dos níveis de depressão, ansiedade e estresse.

 Após um período de seis meses de práticas meditativas foi possível

melhorar tanto o desempenho de memória operacional e a consolidação

de memória do tipo episódica. A melhoria cognitiva pode advir

diretamente do treinamento mental, e/ou indiretamente pela diminuição

dos níveis de depressão, ansiedade e estresse.

 A respiração alternada do Yoga pode influenciar na estabilidade de humor

de praticantes de Yoga experientes. A respiração unilateral direita ou

esquerda do Yoga pode modular o sistema nervoso autônomo tanto para

experientes como inexperientes na prática de Yoga.

 Houve influência das técnicas de respiração do Yoga na atividade

muscular, o que pode sugerir outras pesquisas com aplicações

importantes em indivíduos saudáveis ou com problemas musculares.

Por fim, as contribuições deste trabalho são importantes em dois aspectos:

1. sugerem aplicações preventivas e possivelmente terapêuticasda prática de Yoga

na melhoria da cognição e de sintomas de ansiedade, depressão e estresse; e

2. sugerem que três técnicas respiratórias do Yoga podem influenciar a modulação

do sistema nervoso autônomo, o humor, e a flexibilidade em praticantes de

exercícios físicos.

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140
ANEXOS

141
Anexo A - Termo de Consentimento Livre e Esclarecido

Pesquisa: INFLUÊNCIA DA PRÁTICA DE YOGA SOBRE O DESEMPENHO COGNITIVO


E PARÂMETROS PSICOFISIOLÓGICOS.
Com este documento, pretendemos esclarecer a você sobre o que é essa pesquisa e como será feita.
Objetivo: Essa pesquisa procura investigar se a prática regular do Yoga (um tipo de atividade física
com exercícios de alongamento, de respiração e relaxamento) resulta em mudanças na memória, no
funcionamento do cérebro e no grau de estresse de nosso organismo.
Participação: O participante realizará testes em 4 dias diferentes (dois no início e dois no final da
pesquisa). A pessoa preencherá questionários com informações pessoais. Posteriormente, será coletada
uma amostra de saliva (por um procedimento indolor e utilizando-se material descartável). Em
seguida, a pessoa realizará testes de memória que consistem em ler uma lista de palavras e
posteriormente ler uma palavra por vez para dizer se ela estava ou não na lista que estudou e escutar e
repetir seqüências de números. O participante será então apresentado a um jogo de computador e
informado sobre o funcionamento. Após um breve período de prática, o participante passará por um
relaxamento conduzido e então dormirá e o seu sono será monitorado por um Eletroencefalógrafo
(aparelho que capta a atividade elétrica do cérebro), num procedimento também totalmente indolor.
Em todas as etapas dos testes, o pesquisador dará todas as explicações possíveis, respondendo a todas
as dúvidas que surgirem. No intervalo de aproximadamente 4 meses entre o início e o final da
pesquisa, os participantes realizarão, duas vezes por semana, gratuitamente, a prática de Yoga, a ser
dirigida por um professor qualificado, em sessões de uma hora de duração.
Riscos e Benefícios: caso seja de seu interesse, poderemos lhe informar o resultado que você obteve
nos testes, em caráter privado, mas alertamos que esses testes não têm nenhuma função de
diagnóstico. Os riscos de sua participação são mínimos. Como benefício, a prática de Yoga poderá
resultar em bem-estar físico e mental.
Garantias: sempre estaremos disponíveis para lhe esclarecer dúvidas, qualquer que seja o momento
da pesquisa. Em qualquer momento, você poderá desistir da colaboração, sem que isso lhe traga
nenhum prejuízo ou penalidade. Todos os dados que você fornecer à pesquisa serão sigilosos, ficarão
guardados em segurança e só serão utilizados para fins de pesquisa. Os resultados serão publicados
sem nenhuma identificação dos voluntários. Caso você tenha algum gasto decorrente da pesquisa, nós
faremos o ressarcimento dele e caso você venha a ter algum dano, comprovadamente decorrente dessa
pesquisa, os pesquisadores Profª Dra. Regina Helena da Silva e Kliger Kissinger Fernandes Rocha,
juntamente com a UFRN, serão responsáveis por sua indenização. Caso você tenha alguma dúvida,
poderá entrar em contato com os responsáveis pelos telefones: 3215-3409 e 99545271 ou no
Departamento de Fisiologia, Centro de Biociências, UFRN, Campus Universitário, s/nº, Lagoa Nova,
Natal-RN ou pelos e-mails: kligerk@yahoo.com e reginasilva@cb.ufrn.br. Caso você tenha alguma
dúvida ética da nossa pesquisa, pode entrar em contato com o Comitê de Ética em Pesquisa da UFRN
pelo fone: 3215-3135.

Declaro estar ciente e informado sobre os Assumo o compromisso de cumprir todos os


procedimentos de realização da pesquisa, procedimentos descritos acima respeitando a
conforme explicitados acima, e aceito participar legislação da ética na pesquisa.
voluntariamente da mesma.
Natal, ____/____/2008
NOME: ______________________________
_____________________________________

Natal, ____/ ____/2008 Profª Dra. Regina Helena da Silva

ASSINATURA:________________________
Kliger Kissinger Fernandes Rocha

142
Anexo B - Questionário Sócio-Demográfico

Local da aplicação: ___________________ Data:___/___/________ Hora:__________


Nome: ________________________________________________________________
Endereço: ______________________________________________________________
Bairro: _____________________ Cidade: _________________ CEP: ______________
Data de nascimento: ____/___/_______ Idade: _____________
Estado Civil: ______________________ Naturalidade: ________________________
Escolaridade: ___________________________________________________________
Atividade(s) como militar:_________________________________________________
______________________________________________________________________
Há quanto tempo exerce a profissão ou atividade? ______________________________
Jornada de Trabalho em média de horas/dia ___________ e dias/semana ____________
Turno(s): ______________________________________________________________
Lazer: sim( ) não ( ) Qual/quais? ___________________________________________
______________________________________________________________________
Uso de tabaco, álcool ou outras drogas: sim ( ) não ( ) Especifique quais e freqüência
de uso:_________________________________________________________________
Religião: sim ( ) não ( ) Qual? _____________________________________________
Freqüência de participação: ________________________________________________
Pratica(ou) alguma atividade física ou meditação? sim ( ) não ( ) Qual/quais? _______
______________________________________________________________________
Com que freqüência? _____________________________________________________

Doença(s) atual(is): sim ( ) não ( ) Qual/quais? _______________________________


______________________________________________________________________
Uso atual de remédios: sim ( ) não ( ) Qual/quais?
______________________________________________________________________

Freqüência Cardíaca (bpm) _____________ Pressão arterial (mmHg) ______/______


Peso:___________ Altura: ____________ IMC: ______________

Sono – qualidade: ruim ( ) regular ( ) boa ( ) há quanto tempo? _______


Número de horas habitualmente dormidas _____

Atividade sexual: sim ( ) não ( ) - qualidade: ruim ( ) regular ( ) boa ( )

Eliminação das fezes (vezes por dia)______ Consistência das fezes ________________

Crises de dor de cabeça – presentes ( ) ausentes ( )


Intensidade: severa ( ) moderada ( ) leve ( ) Intervalo entre crises ______________

Crises de asma - presentes ( ) ausentes ( ) Intensidade: severa ( ) moderada ( )


leve ( ) Intervalo entre crises _____________________________________________

Problemas de pele - presentes ( ) ausentes ( )

Problemas nos ossos e nas articulações _______________________________________

Tonturas - presentes ( ) ausentes ( ) Intensidade: severa ( ) moderada ( ) leve ( )

143
Anexo C - Prática de Yoga

INSTRUÇÕES BÁSICAS DA AULA DE YOGA:


Orienta-se a consciência corporal em todos as posturas, alongamentos, exercícios das articulações, exercícios
respiratórios e exercícios meditativos. Alem de alertar constantemente aos praticantes para as seguintes
recomendações:
1. Respeito às limitações físicas do corpo é um dos princípios básicos do Yoga. Não fazer esforço se há
limitações orgânicas para a postura, como a flexibilidade. Evitar a expectativa de uma postura esteticamente perfeita,
mas trabalhar o conforto e estabilidade da postura.
2. Prática com treinamento na atenção e concentração: perceber o corpo descontraindo as tensões musculares
mentalmente e usando a respiração lenta como apoio, para em seguida trabalhar a atenção na respiração, sentindo
como se respira; depois passar para a audição procurando ouvir sons, pulando de um som para o outro buscando
abstrair dessa forma os sentidos. Fechar os olhos e perceber as sensações mais concretas às mais abstratas.
3. Coordenar e ajustar os seguintes fatores: respiração coordenada com o movimento do exercício,
relaxamento muscular com respiração lenta e consciência corporal.
4. Extrema lentidão de execução: para executar um movimento ou asana deve-se primeiro imaginar-se na
postura. Depois lentamente mover os membros para realizar a postura, percebendo a pressão dos órgãos internos e a
respiração, e finalmente desfazer a postura também lentamente seguindo uma ordem lógica para não causar danos
físicos.
I. PREPARO MENTE E CORPO:
Percepção da respiração, postura em pé, contato da roupa do corpo, percepção do estado emocional e percepção do
estado mental. Mantendo esta consciência corporal executar movimentos lentos das articulações, em seguida duas
posturas que trabalhem o equilíbrio, e posturas que trabalhem a coluna vertebral para todos os sentidos. Em seguida
executar a saudação ao sol.
II. PRÁTICA PARA A MEMÓRIA:
Procurou-se sempre uma série de posturas para melhorar a memória, como o exemplo do protoco segundo a
seguinte referência: Khalsa, K. G. & Maxwell, A. M. 1988. Relax and Renew. In: For the memory, pp 49. San
Diego, Calif. Yoga Technology Press.
01. Em postura sentada de pernas cruzadas e dedos entrelaçados nas
costas. Inspirar e aplicar pressão no osso sacro com as mãos, e exalar
movimentando o umbigo para dentro do abdome, flexionando o
corpo para frente para aproximar a testa do colchonete. Erguer o
corpo até a postura inicial inspirando. O número de vezes sugerido é
quatro, mas sempre depende de como estão as limitações orgânicas
do voluntário. Sinais de desconforto e dor são avaliados. Há
adaptações das posturas de acordo com as limitações apresentadas e
diminui-se a freqüência.
02. Postura sentada sobre os calcanhares dedos entrelaçados atrás do
pescoço. Inspirar e inclinar o corpo para trás 60º vagarosamente, e
exalar voltando a postura de 90º.
03. Ainda na postura sentada sobre os calcanhares, esticar braços
lateralmente e deixá-los paralelos ao chão com as palmas das mãos
para cima e ponta do dedo indicador unida à ponta do polegar.
Flexionar a cabeça para trás. Executar 10 expirações vigorosas e
sucessivas sem investir na inspiração (a respiração de fogo), em
seguida inspirar e segurar a respiração. Exalar lentamente relaxando.
04. Na postura deitada decúbito ventral, flexionar as pernas para trás
04
e tentar segurar os pés elevando o queixo e o peito do colchonete.
Executar a respiração de fogo 10 vezes.
05. Ainda em decúbito ventral, pousar as mãos abaixo dos ombros e
esticar os braços elevando o queixo e o peito do colchonete. Executar 05
a respiração de fogo.

06. Em postura sentada, esticar as pernas e pousar as mãos nos


joelhos. Em seguida flexionar o corpo lentamente para frente 06
passando as mãos sobre as pernas, para sentir pouco a pouco o
alongamento da musculatura das costas e da nuca. Deixar a ação da
gravidade atuar sobre a cabeça e as costas para alongar aproximando
a testa ao joelho. Desfazer a postura lentamente.

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07. Em postura sentada pousar as palmas das mãos atrás das costas
com ponta dos dedos em direção as nádegas e braços esticados,
levantar os quadris com as pernas esticadas até o corpo ficar em
forma de plataforma. As palmas das mãos e os pés devem estar 07
apoiados no chão. Deixar a cabeça alinhada com a coluna vertebral.
Virar o queixo para o ombro esquerdo inspirando, em seguida virar o
queixo para o ombro direito exalando. Executar este exercício por
cinco vezes. Em seguida erguer a perna esquerda deixando-a
08
paralela ao chão e repetir o exercício mais cinco vezes. Pousar o pé
esquerdo, erguer a perna direita deixando-a paralela ao chão e repetir
o exercício mais cinco vezes.
08. Sentar-se sobre os calcanhares e esticar os braços acima da 09
cabeça, de modo que os cotovelos abracem as orelhas. Unir as
palmas das mãos. Inalar e contrair o umbigo na direção da coluna
vertebral. Exalar relaxando o abdome.
09. Postura sentada com as pernas cruzadas e coluna alinhada, mãos
sobre os joelhos. Inspirar profundamente e reter o ar nos pulmões
contraindo o umbigo e os esfíncteres genitais na direção da coluna
vertebral. Exalar relaxando o abdome.
III. RELAXAMENTO:
O praticante é convidado a perceber os efeitos da mente sobre o corpo em postura deitada com a coluna alinhada,
braços e pernas afastados (em shavasana). Tentando relaxar com o controle mental e encontrar conforto. O
praticante entra num estado situado entre o sono e a vigília.
IV. EXERCÍCIOS RESPIRATÓRIOS:
Respiração Alternada. Sentar-se com as pernas cruzadas e manter a coluna vertebral
alinhada, ombros relaxados e olhos fechados. Pousar a mão esquerda sobre o joelho
esquerdo. Com a mão direita, flexionar os dedos indicador e médio e manter o
mínimo, anelar e polegar alongado. Levar esse mudra diante do nariz e com o
polegar obstruir a narina direita. Iniciar a série inspirando pela narina esquerda,
obstruir a narina esquerda com os dedos anelar e mínimo e expirar pela narina
direita. Ainda inspirar pela narina direita, obstruí-la e exalar pela narina esquerda.
Em seguida mais 5 minutos de execução de qualquer outro pranayma.

V. EXERCÍCIO PARA A MEDITAÇÃO DE ATENÇÃO PLENA:


Sentar-se com as pernas cruzadas, manter a coluna vertebral alinhada, e ombros e
braços relaxados. Concentrar-se no fluxo da respiração: inspirando e exalando
naturalmente procurando sentir a temperatura do ar que entra e sai pelas narinas por
10 minutos.

VI. FINALIZAÇÃO:
Prática de mantra e saudação (Namastê!).

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Anexo D - Parecer do CEP-UFRN

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