YOKING TOGETHER YOKING TOGETHER YOGA RESEARCH, YOGA RESEARCH, THERAPY & EDUCATION THERAPY & EDUCATION

Yogacharya Dr. ANANDA BALAYOGI BHAVANANI

MBBS, ADY, DSM, DPC, PGDFH, PGDY, FIAY, MD (AM)Deputy Director CYTER, Sri Balaji Vidyapeeth andChairman ICYER at Ananda Ashram, Pondicherry.

ananda@icyer.com/ yoga@mgmcri.ac.in

SRI BALAJI VIDYAPEETHSRI BALAJI VIDYAPEETH(Deemed University Accredited with “A” Grade by NAAC)

Centre for Yoga Therapy, Education

and Research (CYTER)Salutogenesis, our focus!

SalutogenesisSalutogenesis, our , our FocusFocus

Moving from Moving from pathogenesispathogenesis, the focus on disease , the focus on disease towards towards salutogenesissalutogenesis, the focus on health!, the focus on health!

Under Under SBV AIM HIGH SBV AIM HIGH ((Academy of Integrative Academy of Integrative Medicine for Holistic Intervention towards General Medicine for Holistic Intervention towards General HealthHealth), Faculty of Allied Health Sciences, CYTER ), Faculty of Allied Health Sciences, CYTER is striding forward on an innovative path of is striding forward on an innovative path of promoting holistic health for one and all. promoting holistic health for one and all.

Bringing together ancient experiential wisdom of Bringing together ancient experiential wisdom of Yoga with evidence based approach of modern Yoga with evidence based approach of modern medical science.medical science.

www.sbvu.ac.inwww.sbvu.ac.in

A brief qualitative survey on the utilization of Yoga research resources by Yoga teachers. This survey provided a basic picture of

a general lack of awareness of Yoga research amongst practicing Yoga teachers and therapists.

Though a majority agree research is important, few seriously update themselves on this through scientific channels. Bhavanani AB. J Intercult Ethnopharmacol. 2016; 5(2): 168-173

Requirements for the yokingRequirements for the yoking

Yoga instructors & therapists must be Yoga instructors & therapists must be up-to-dateup-to-date on on modern research and its findings.modern research and its findings.

Must be able to Must be able to understandunderstand the actual findings the actual findings through the methodology adopted and not merely through the methodology adopted and not merely “read” general news items that are often misleading “read” general news items that are often misleading and only highlight ‘news’.and only highlight ‘news’.

Must bring the knowledge so gained into their Must bring the knowledge so gained into their actualactual clinical practice and class room teaching thus clinical practice and class room teaching thus empoweringempowering next generation of instructors and next generation of instructors and therapists.therapists.

Key players

To be a competent yoga instructor and therapist, We require intelligence and empathy, be willing to share, need to understand our limitations, realize we are not perfect and be willing to embark on a continuously

expanding learning curve.

The day we stop learning The day we stop learning is the day we stop living!is the day we stop living!

Origin of research in Yoga dates back to the pre-Origin of research in Yoga dates back to the pre-historic origin of Yoga itself historic origin of Yoga itself

The ancient Rishis were truly searching and re-The ancient Rishis were truly searching and re-searching for the answer to the all important searching for the answer to the all important question, “question, “Who am I Who am I ””??

Scientific and philosophico-literary research is Scientific and philosophico-literary research is essential to essential to confirmconfirm, , validate validate & & enhance the enhance the understanding and application of Yogic concepts understanding and application of Yogic concepts and practices for the benefit of humanity.and practices for the benefit of humanity.

Swami Kuvalayananda & KaivalyadhamaSwami Kuvalayananda & Kaivalyadhama– ML Gharote, MV Bhole, PV Karambelkar, SL VinekarSL Vinekar

Medical scientists at Medical scientists at – AIIMS, BHU, JIPMER (BK Anand, GS Chinna, KN Udupa, KS Gopal, RL AIIMS, BHU, JIPMER (BK Anand, GS Chinna, KN Udupa, KS Gopal, RL

Bijlani, Madanmohan, etc) Bijlani, Madanmohan, etc) Yoga Universities: sVYASA, PYPYoga Universities: sVYASA, PYP Mainly limited to the physical aspectsMainly limited to the physical aspects Most researchers today however seem more interested in

proving themselves right than in really researching Yoga as a whole

Yoga in the “BOX” is NOT really Yoga!

Modern yoga researchModern yoga research

Most Yogic phenomena are beyond the mere Most Yogic phenomena are beyond the mere physical manifestation of their effectsphysical manifestation of their effects

To conclude that Shavasana has To conclude that Shavasana has ONLYONLY the physiological the physiological effect of lowering BP and HR is to sight merely the effect of lowering BP and HR is to sight merely the

iceberg’s tip, missing 90% iceberg’s tip, missing 90%

The real effects of Shavasana as the ultimate The real effects of Shavasana as the ultimate relaxation & true renunciation may have more far-relaxation & true renunciation may have more far-reaching effects than we would have been led to reaching effects than we would have been led to

believebelieve

Recent trendsRecent trends Yoga Research–now a global phenomenon Yoga Research–now a global phenomenon Increased number of blinded, randomized and Increased number of blinded, randomized and

controlled trials controlled trials Improved planning and implementationImproved planning and implementation Better understanding of the mechanisms by which Better understanding of the mechanisms by which

various practices cause their effectsvarious practices cause their effects Increased number of research studies are being Increased number of research studies are being

published in indexed journals with peer reviewpublished in indexed journals with peer review– a better standard of research at least at the physical a better standard of research at least at the physical

levellevel Greater funding available nowadaysGreater funding available nowadays

Do we have equipment to quantitatively and Do we have equipment to quantitatively and qualitatively measure effects of Yoga? qualitatively measure effects of Yoga?

What to do in most aspects of Yoga that are What to do in most aspects of Yoga that are beyond our present day capacity?beyond our present day capacity?

How to keep the “Yoga” in Yoga research?How to keep the “Yoga” in Yoga research? How to enable the knowledge gained of How to enable the knowledge gained of

modern research to modern research to percolatepercolate down into down into clinical practice and Yoga education?clinical practice and Yoga education?

Some questionsSome questions

Is not just gathering information on Yoga Is not just gathering information on Yoga Is not just the re-arranging of known facts on Is not just the re-arranging of known facts on

YogaYoga Must be continual and expandingMust be continual and expanding

– most modern research seems to be just repeating most modern research seems to be just repeating ad-nauseamad-nauseam earlier works earlier works

Must not be a sales pitch Must not be a sales pitch – a lot of research today seems geared at attracting a lot of research today seems geared at attracting

people to specific techniques and institutions than people to specific techniques and institutions than to benefiting Yoga as a wholeto benefiting Yoga as a whole

Yoga researchYoga research

True research is a quest driven by a specific question True research is a quest driven by a specific question which needs an answer leading to a new question which needs an answer leading to a new question

Most research in Yoga today however seems either to Most research in Yoga today however seems either to be for curing diseases and disorders that are rampant be for curing diseases and disorders that are rampant in modern world or to publicize their own techniques.in modern world or to publicize their own techniques.

Basic research is lacking- not as attractive as clinical Basic research is lacking- not as attractive as clinical trails and the publicity thereoftrails and the publicity thereof

Most researchers lack an ‘experience’ of Yoga –are not Most researchers lack an ‘experience’ of Yoga –are not living it, hence have no clue about what they are living it, hence have no clue about what they are studying.studying.

Need of the hourNeed of the hour – focus attention on core concepts of Yoga focus attention on core concepts of Yoga – find newer methods to unravel its secretsfind newer methods to unravel its secrets

Extensive basic research is requiredExtensive basic research is required– not much money in it !not much money in it !

A lot of Yoga research today resembles A lot of Yoga research today resembles pharmaceutical companies trying to find wonder pharmaceutical companies trying to find wonder drugs for newer diseases.drugs for newer diseases.

Most modern Yoga researchers seem to be trying Most modern Yoga researchers seem to be trying to find out “a single Yoga pill for each ill”.to find out “a single Yoga pill for each ill”.

SOME INTERESTING SOME INTERESTING YOGA RESEARCH IN YOGA RESEARCH IN

RECENT TIMESRECENT TIMES

Telles S, Desiraju T. IJMR 1991; 94: 357-63. Telles S, Desiraju T. IJMR 1991; 94: 357-63.

Short kumbhak pranayamic breathing increase (52%) in the O2 consumption & metabolic rate

Long kumbhak pranayamic breathing lowering (19%) of the O2 consumption & metabolic rateApplication of kumbhak may be different and varied in potential cases accordingly

Shannahoff-Khalsa DS, Kennedy B. Int J Shannahoff-Khalsa DS, Kennedy B. Int J Neurosci. 1993 ; 73: 47-60 Neurosci. 1993 ; 73: 47-60

Right UFNB increases HR compared to left. Right UFNB increases HR compared to left. Stroke volume was higher in left UFNB Stroke volume was higher in left UFNB

compensating for lower HR. compensating for lower HR. Left UFNB significantly increased end diastolic Left UFNB significantly increased end diastolic

volume volume Demonstrated unique unilateral effect on Demonstrated unique unilateral effect on

sympathetic stimulation of the heart that may sympathetic stimulation of the heart that may have therapeutic value.have therapeutic value.

Recent studies by Raghuraj 2008, Rajajeyakumar 2014, Bhavanani 2014 further substantiated these findings.

Telles S et al. IJPP 1994; 38 : 133-7. Telles S et al. IJPP 1994; 38 : 133-7.

OO22 consumption increased by consumption increased by– 37% after right nostril pranayama 37% after right nostril pranayama – 18% after alternate nostril pranayama 18% after alternate nostril pranayama – 24% after left nostril pranayama 24% after left nostril pranayama

Left nostril pranayama increased volar GSR Left nostril pranayama increased volar GSR signifying reduction in sympathetic activitysignifying reduction in sympathetic activity

Breathing selectively through either nostril has Breathing selectively through either nostril has marked activating or relaxing effect on the marked activating or relaxing effect on the sympathetic nervous system. sympathetic nervous system.

Selvamurthy W et al. IJPP 1998; 42: Selvamurthy W et al. IJPP 1998; 42: 205-213

Helped understand physiological mechanism Helped understand physiological mechanism underlying effects of selected yogic exercises in underlying effects of selected yogic exercises in the treatment of essential hypertensionthe treatment of essential hypertension

3 weeks course of tilt and head down yogic 3 weeks course of tilt and head down yogic exercise (sarvangasan) clearly indicated gradual exercise (sarvangasan) clearly indicated gradual improvement in baroreflex sensitivityimprovement in baroreflex sensitivity

Progressive attenuation of sympatho-adrenal Progressive attenuation of sympatho-adrenal and renin-angiotensin activityand renin-angiotensin activity

Raghuraj P et al. IJPP 1998 ; 42: 467-72 Raghuraj P et al. IJPP 1998 ; 42: 467-72

Studied HRV in fast and slow breathing Studied HRV in fast and slow breathing techniquestechniques– Kapalabhati and NadishuddhiKapalabhati and Nadishuddhi

Kapalabhati modifies autonomic status Kapalabhati modifies autonomic status – increasing sympathetic activity increasing sympathetic activity – with reduced vagal activity. with reduced vagal activity.

Kaviraja Udupa et al. IJPP Kaviraja Udupa et al. IJPP 2003; 47 : 27-33

Increased QSIncreased QS22, PEP, PEP/LVET & decreased , PEP, PEP/LVET & decreased LVET, QT/QSLVET, QT/QS22 indicate decreased adrenergic indicate decreased adrenergic tonetone

Increased RRIV -enhanced parasympathetic Increased RRIV -enhanced parasympathetic activity.activity.

Pranayam training produced subtle changes in Pranayam training produced subtle changes in LV systolic performance probably by modulat-LV systolic performance probably by modulat-ing cardiac autonomic tone.ing cardiac autonomic tone.

Vijayalakshmi P et al. IJPP 2004; 48: 59-64.Vijayalakshmi P et al. IJPP 2004; 48: 59-64.

4 week yoga relaxation training for HT patients 4 week yoga relaxation training for HT patients Response to IHG test subnormal initiallyResponse to IHG test subnormal initially Yoga relaxation training produced significant Yoga relaxation training produced significant

decrease in BP, HR & RPP from 2decrease in BP, HR & RPP from 2ndnd week onwards week onwards and peaked by 4 weeksand peaked by 4 weeks

Significant Significant in BP, HR & RPP with IHG after in BP, HR & RPP with IHG after training indicated training indicated restoration of cardio-vascular restoration of cardio-vascular reflex mechanismsreflex mechanisms. .

Findings confirmed in recent RCT by Punitha P Findings confirmed in recent RCT by Punitha P et al et al (Nat J Physiol Pharm Pharmacol, 2015).(Nat J Physiol Pharm Pharmacol, 2015).

Madanmohan et al. IJPP 2005Madanmohan et al. IJPP 2005; 49: 313-18.; 49: 313-18.

Slow Pranayama training– Significant increase: MIP MEP, BHT & 40 mm Hg test.

Significant decrease in DP Fast Pranayam training

– Significant increase in HR, RPP & double product (Do P). HR, RPP & Do P decreased (NS) in group I & increased (NS)

in group II Varied therapeutic applications Finding confirmed in recent RCTs by Dinesh Finding confirmed in recent RCTs by Dinesh 2014 2014 and and

Sharma Sharma 20152015

Manjunatha S et al. IJPP 2005; 49: 319-24.Manjunatha S et al. IJPP 2005; 49: 319-24.

Do yoga asanas increase insulin secretion from the Do yoga asanas increase insulin secretion from the pancreas?pancreas?

Serum insulin levels after asanas were lower than Serum insulin levels after asanas were lower than those before the asanasthose before the asanas

Serum insulin level 0.5 h after post-asana oral 75 g-Serum insulin level 0.5 h after post-asana oral 75 g-glucose challenge was higher glucose challenge was higher

The performance of asanas led to increased sensitivity The performance of asanas led to increased sensitivity of the of the ββ cells of pancreas to the glucose signal cells of pancreas to the glucose signal

Raghavendra Rao et al.Complementary Therapies in Medicine 2009; 17: 1—8

Compared anxiolytic effects of Yoga & supportive Compared anxiolytic effects of Yoga & supportive therapy in Ca breast patients undergoing therapy in Ca breast patients undergoing conventional treatment.conventional treatment.

Overall decrease in both self-reported state Overall decrease in both self-reported state anxiety & trait anxiety in Yoga group anxiety & trait anxiety in Yoga group

Positive correlation between anxiety states and Positive correlation between anxiety states and traits with symptom severity and distress during traits with symptom severity and distress during conventional treatment intervals.conventional treatment intervals.

Yoga has a role in palliative care in terminal Yoga has a role in palliative care in terminal cases too.cases too.

Bhavanani AB et al. Int J Yoga 2011; 4: 71-76. Bhavanani AB et al. Int J Yoga 2011; 4: 71-76.

Effects of 6 months of training given in Slow Surya Namaskar (SSN) at 6 rounds /30 min and Fast Surya Namaskar (FSN) at 15 rounds ‘30 min for school children.

Cardiovascular (HR, BP) and muscular physiological (HGS, HGE) effects studied.

Effects of FSN are similar to physical aerobic exercises Effects of FSN are similar to physical aerobic exercises whereas effects of SSN are similar to those of Yoga whereas effects of SSN are similar to those of Yoga training.training.

Kalyani BG et al. IJOY 2011; 4(1): 3-6. Kalyani BG et al. IJOY 2011; 4(1): 3-6.

Neurohemodynamic correlates of audible ‘OM’ chanting were examined by functional MRI.

Significant limbic deactivation observed during ‘OM’ chanting with bilateral changes in orbitofrontal, anterior cingulate, para-hippocampal gyri, thalami and hippocampi.

As similar observations have been recorded with vagus nerve stimulation used in depression and epilepsy, the study findings argue for a potential role of ‘OM’ chanting in clinical practice.

Streeter CC et al. Streeter CC et al. Med Hypotheses 2012; 78: 571-9 Med Hypotheses 2012; 78: 571-9

Stress induces autonomic imbalance Stress induces autonomic imbalance Decreased para-sympathetic & increased Decreased para-sympathetic & increased

sympathetic activity, under activity of GABA sympathetic activity, under activity of GABA system, the primary inhibitory neuro-system, the primary inhibitory neuro-transmitter, and increased allostatic load. transmitter, and increased allostatic load.

Yoga helps correct the underactivity of para-Yoga helps correct the underactivity of para-sympathetic nervous system and GABA systems sympathetic nervous system and GABA systems in part through stimulation of vagus nerves with in part through stimulation of vagus nerves with reduction in the allostatic load. reduction in the allostatic load.

Ornish D et al. Lancet Oncol 2013; 14:1112-20

““Our genes, and our telomeres, are not necessarily Our genes, and our telomeres, are not necessarily our fate,” - Dean Ornishour fate,” - Dean Ornish

Telomere shortness is a prognostic marker of ageing, Telomere shortness is a prognostic marker of ageing, disease, and premature morbidity.disease, and premature morbidity.Previous studyPrevious study (2008) (2008) showed association between 3 showed association between 3 months of comprehensive lifestyle changes and months of comprehensive lifestyle changes and increased increased telomerase activity telomerase activity in immune cells. in immune cells. A comprehensive lifestyle intervention was associated A comprehensive lifestyle intervention was associated with with increases in relative telomere length increases in relative telomere length after 5 years of after 5 years of follow-up.follow-up.

Recent research @ PondicherryRecent research @ Pondicherry1. Immediate cardiovascular effects of a single yoga session in different conditions. Altern Integ Med

2013; 2: 144. 2. Immediate effect of suryanamaskar on reaction time and heart rate in female volunteers. Indian J

Physiol Pharmacol 2013; 57 (2): 199–204.3. Effect of 8 weeks of pranav pranayama training on pulmonary function test parameters in young

healthy, volunteers of JIPMER population. Int Res J Pharm App Sci 2013; 3 (4):116-18.4. Effect of 12 weeks of kapalabhati pranayama training on cardio-respiratory parameters in young,

healthy volunteers of JIPMER population. International Journal of Medical & Pharmaceutical Sciences Research and Review 2013; 1 (4): 53-61.

5. Hematological, biochemical and psychological effects of a yoga training programme in nursing students. Int Res J Pharm App Sci 2013; 3(6):17-23

6. Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time. Int J Yoga 2014; 7: 60-65.

7. Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers. Journal of Clinical and Diagnostic Research 2014; 8 (1) : 10-13.

8. Immediate effect of alternate nostril breathing on cardiovascular parameters and reaction time. Online International Interdisciplinary Research Journal 2014; 4; (Special Issue): 297-302.

9. Immediate effect of chandra and suryanadi pranayamas on cardiovascular parameters and reaction time in a geriatric population. International Journal of Physiology 2014; 2 (1): 59-63.

10. Immediate effect of different pranayam on short term heart rate variability in health care students. A preliminary study. International Journal of Physiology 2014; 2 (1): 39-43.

Recent research @ Recent research @ PondicherryPondicherry

11. Effect of different pranayamas on respiratory sinus arrhythmia. Journal of Clinical and Diagnostic Research 2016; 10 (3): CC04-CC06.

12. Immediate effect of chandranadi pranayam on heart rate variability and cardiovascular parameters in patients of diabetes mellitus and hypertension. Yoga Mimamsa 2013; 45 (1&2): 1-13.

13. Effect of slow and fast pranayama training on handgrip strength and endurance in healthy volunteers. Journal of Clinical and Diagnostic Research 2014; 8 (5): BC01-03.

14. Comparative immediate effect of different yoga asanas on heart rate and blood pressure in healthy young volunteers. International Journal of Yoga 2014; 7: 89-95.

15. Comparative effect of 12 weeks of slow and fast pranayama training on pulmonary function in young, healthy volunteers: A randomized controlled trial. Int J Yoga 2015; 8: 22-26.

16. Single session of integrated ‘silver yoga’ program improves cardiovascular parameters in senior citizens.. J Intercult Ethnopharmacol 2015; 4(2): 134-37.

17. Randomized controlled trial of 12-week yoga therapy as lifestyle intervention in patients of essential hypertension and cardiac autonomic function tests. Natl J Physiol Pharm Pharmacol 2016; 6: 19-26.

18. Comparative study on the effect of yogic relaxing asanas and pranayamas on cardiovascular response in healthy young volunteers. National Journal of Physiology, Pharmacy and Pharmacology Online First: 25 Aug, 2016.

19. Effect of a 12 Week Yoga Therapy Program on Mental Health Status in Elderly Women Inmates of a Hospice (Online first IJOY)

But be careful!!But be careful!!Some studies have Some studies have

NO yoga in them at all !NO yoga in them at all !

Lana Skoro-Kondza et al. BMC Health Services Lana Skoro-Kondza et al. BMC Health Services Research 2009; 9:33Research 2009; 9:33

There was a small statistically insignificant fall in There was a small statistically insignificant fall in HbA1c - not sustained > 6 months, no change in other HbA1c - not sustained > 6 months, no change in other outcome measures.outcome measures.

Around Around 2/32/3 of patients on GP diabetic registers proved of patients on GP diabetic registers proved ineligible, & 90% of the remainder declined to ineligible, & 90% of the remainder declined to participate. participate.

Only 50% attendance at classes -Only 50% attendance at classes -Nobody did the Nobody did the exercises regularly at homeexercises regularly at home. .

Most participants -Most participants -unsuitableunsuitable for 'standard' Yoga - for 'standard' Yoga - limited flexibility, lack of basic fitness, co-morbidity limited flexibility, lack of basic fitness, co-morbidity and lack of confidence. and lack of confidence.

Basically no yoga in the study at all!Basically no yoga in the study at all!

Make sure it was Make sure it was done in humans!!done in humans!!

Lateral Sleeping Position Influences Clean-Up Of Brain's Metabolic Waste Products, Halts Neurological Diseases

Everyone started talking about all the possible benefits of humans sleeping on their side without even reading the full paper!

Rodent models were used to examine the glymphatic pathway — where CSF filters through the brain and exchanges with interstitial fluid to clear waste.

The Journal of Neuroscience,The Journal of Neuroscience, 5 August 2015, 35(31): 11034-11044

Accredited with ‘AA’ grade by NAAC