Basics on Yoga & Its Health Benefits

1. Basics on Yoga & Its Health Benefits Dr. Rudra Bhandari, PhD University of Patanjali, Haridwar Email: rbap@uop.edu.in, uop.rudra@gmail.com Department of AYUSH All India Institute of Medical Sciences, Rishikesh 18th February 2019

2. LearningObjectives To state and comprehend the Meaning and Definitions of yoga Its Types and Significance Its Principles and Requisite factors Effects and Model of Yoga Therapy (YT) Efficacy of YT for health promotion, disease prevention, healing and age reversal.

3. Yoga • Etymological Meaning • Yoga is originated from the Sanskrit term yuj that stands for uniting Rig Veda(circa 1200 BC). • Definitions • The mental process and discipline for the fusion of self-embodied soul (jivatman) with the supreme soul (paramatman) (1). • Patanjali (circa 400 BC) defines yoga as inhibition of psychic waves (Yoga Sutra, 1:2) by compiling over 2,000 years old yoga tradition(2). • The optimal life style practices, i.e. optimal diet, recreation, dutifulness, sleep and wakefulness; to realize self and mitigate all pros and cons of human birth (Srimadbhagavad Gita, 6:17) (3).

4. A practical discipline covering an array of mind-body-spirit practices leading to optimal psycho-somatic health and well-being followed by the union of an individual existence with universal and transcendent existence (4). • In the nutshell, yoga is an amalgam of art and science for optimal living and a universal means to go beyond worldly pros and cons leading to the self-realization. • Sound health and improved faculties are inseparable by-products of persistent yoga practice (5). 1. Pradhan B. Yoga and Mindfulness Based Cognitive Therapy. New York: Springer; 2015. 2. Feuerstein G. The Yoga-sutra of Patanjali: A New Translation and Commentary. Rochester, New York: Inner Traditions International; 1989. 3. Sivananda S. Bhagavad Gita. Rishikesh, India: The Divine Life Society; 2000. 154 p. 4. Aurobindo S. The Synthesis of Yoga. Time. Pondicherry: Sri Aurobindo Ashram Press; 1999. 1-936 p. Sri Aurobindo-Synthesis of Yoga I - II (The Complete Works of Sri Aurobindo 23-24) (1996).pdf 5.Bhandari RB, Bhandari CB, Acharya B, Pandya P, Singh K, Katiyar VK, et al. Implications of Corporate Yoga: A Review. In: Applied Biological Engineering - Principles and Practice. 2012.

5. Types of Yoga Streams Pradhan B. Yoga and Mindfulness Based Cognitive Therapy. New York: Springer; 2015.

7. Yogais the highest medicine to relieve the human being from bhavaroga(the pros and cons of worldly existence). Sri Guru Gita. The Nectar of Chanting. Vol. 93. New York: SYDA Foundation; 1983

8. Yoga Therapy (YT) • Is a modern coinage and a first effort to integrate traditional Yogic concepts and techniques with Western medical and psychological knowledge. • Aims at the holistic treatment of psychological or somatic dysfunctions ranging from back problems to emotional distress. • Applies yogic principles, methods, and techniques to specific human ailments. Cohen, M. H. (2007). The Search for Regulatory Recognition of Yoga Therapy: Legal and Policy Issues. International Journal of Yoga Therapy, 17, 43-50.

9. “YT is the process of empowering individuals to progress toward improved health and well-being through the application of the philosophy and practice of Yoga”. Mohan, G. (2006). Exploring yoga as therapy. International Journal of Yoga Therapy, 16, 13-19.

10. Effects of YT Contd…….

11. Miller, R. (2013). Yoga Therapy: Definition, Perspective and Principles . Retrieved April 19, 2013 from http://www.iayt.org/site_Vx2/publications/articles/miller.aspx

12. 8 Principles of YT Contd…….

13. 1. Teach what is appropriate (yukta-shiksana). 2. Respect differences in different people (bheda). 3. Consider learner’s situation, place, or country (desha). 4. Consider individual constitution, age, disposition etc. (deha). 5. Consider the season, timing and duration etc. (kâla). Contd……. Miller, R. (2013). Yoga Therapy: Definition, Perspective and Principles . Retrieved April 19, 2013 from http://www.iayt.org/site_Vx2/publications/articles/miller.aspx

14. 6. Consider work nature (e.g., a runner would be taught differently than a administrator) (vritti). 7. Consider student’s psycho-somatic capacity- energy, endurance, memory (shakti). 8. Conform to the learner’s mindset (i.e., interests such devotion, God, chanting etc.) (mârga). Miller, R. (2013). Yoga Therapy: Definition, Perspective and Principles . Retrieved April 19, 2013 from http://www.iayt.org/site_Vx2/publications/articles/miller.aspx

15. 6 Factors of YT Contd…….

16. 1. Body (Postures, Cleansing Techniques, 5 elements purificatory practices) 2. Breath (Breath Regulations, Neuromuscular Locks, Gestures) 3. Mind (Mantras, Concentrations, Meditations, Self-study, Senses Withdrawal, 5 subtle elemental practices) 4. Diet (Quality, Quantity, Frequency, Season, Timings & Duration) 5. Lifestyle (Sleep, Wakefulness, Romance, Feeling, Thinking & Doings) 6. Environment (Ecological, Societal, Cultural & Political) Mohan, G. (2006). Exploring yoga as therapy. International Journal of Yoga Therapy, 16, 13-19.

17. (Satyananda, 2002)

18. Classical Model of YT Contd…….

19. a) Physique: Postures, Optimal Diet, Discipline, Fasting and PanchaTattwaSadhna b) Mind: Pranayam, Gestures, Psychic Locks, Mantra, Tratak, Study of Self Introspective Literatures , TanmatraSadhana c) Heart: Meditation, Atamabodha, Tattwabodha, CSR d) Spirit: Donation, Service, Kirtan, Prayer, Soham Sadhana, Nadyog

21. 101 Health Conditions Benefitted by Yoga. Accessed on 19 June 2018 from http://www.drmccall.com/uploads/2/2/6/5/22658464/101healthconditionshelpedbyyoga.pdf

22. Jeter, P. E., Slutsky, J., Singh, N. & Khalsa, S. B. (2015). Yoga as a Therapeutic Intervention: A Bibliometric Analysis of Published Research Studies from 1967 to 2013. The Journal of Alternative and Complementary Medicine, 21(10), 586-592. DOI: 10.1089/acm.2015.0057

23. Jeter, P. E., Slutsky, J., Singh, N. & Khalsa, S. B. (2015). Yoga as a Therapeutic Intervention: A Bibliometric Analysis of Published Research Studies from 1967 to 2013. The Journal of Alternative and Complementary Medicine, 21(10), 586-592. DOI: 10.1089/acm.2015.0057

24. Predicted Modes of Yogic Health Benefits • Impacts of YI to improve somatic and emotional indicators of distress can be better explained from bio-psycho-socio-spiritual perspectives as argued by Evans et al. (2009) and Herrick and Ainsworth (2000): • Practice of the YI might improve musculoskeletal functioning, cardiopulmonary status, ANS response and endocrine functioning at physical level; enhance self-esteem, coping, social support and positive mood at psychosocial level; and • elevate compassionate understanding and mindfulness at spiritual level (Evans et al., 2009). • Well-rounded yoga practice may have benefits on structural, physiological, psycho-emotional, and spiritual levels (Herrick & Ainsworth , 2000) .

25. Nervous System Activity Substantial studies have shown yoga to have an immediate down-regulating effect on both the SNS/HPA axis response to stress. Decreased levels of salivary cortisol (Michalsen, 2005; West, 2004), blood glucose (Gokal & Shillito, 2007; Khatri et al. 2007), plasma rennin, 24-hour urine nor-epinephrine and epinephrine (Selvamurthy et al., 1998) as the consequences of yoga practice well support the preceding presumption.

26. Yoga exercises cause a shift toward PSNS dominance • Possibly via direct vagal stimulation (Innes, Bourguignon & Taylor, 2005); • Significant reductions in low-frequency HRV in depressed patients following an 8-week yoga intervention (Shapiro et al., 2007); • Decrease in anxiety (Gupta et al., 2006; Michalsen, 2005; Telles et al., 2006; West, 2004) and • Increase in emotional, social, and spiritual well-being (Moadel et al., 2007) (as cited in Ross & Thomas, 2010).

27. Cheema, Marshall, Chang, Colagiuri, and Machliss (2011) also argued that a worksite based yoga program will increase HRV, reflective of greater PSNS (vagal) tone, accompanied by improvements in physical fitness and psychological health status, including quality of life, anxiety, and job satisfaction.

28. Empowered Cardio-pulmonary Health • Stimulation of the vagus nerve →release of Ach into all of the organs except the adrenal glands, • The ACh released onto the SA node → ↓HR through the opening of channels allowing an outward flow of K+ and inward flow of Ca++→ hyper-polarization of the membrane and inhibition of the postsynaptic cell → ↓HR (Hardy, 2009, p. 12).

29. Slow and controlled breathing as practiced in yoga nidra immediately ↑HRV and improves baroreflex sensitivity (Bernardi, 2001, as cited in Hardy, 2009). • PP might have similar impact on cardio-pulmonary function (to ↑HRV and improve barorelflex). • Consistent citation was also made by Ornish et al. (1983) that concluded that bio-behavioral techniques such as yoga (meditation, pranayama, and progressive relaxation ) may ↓some of the cardiovascular risk factors- BP (Bensen, 1977) and plasma cholesterol (Patel, 1976; Cooper & Aygen, 1979), independent of dietary changes.

30. Pullen et al. (2009) also reported improved cardiovascular endurance and ↓inflammatory markers (Interleukin-6 and C- reactive protein) in heart failure patients thereby showing similar effects of yoga .

31. Joshi et al. (1992) reported significant ↑in FVC, forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV), as well as a significant ↓in breathing frequency (fB), and prolongation of breath-holding time in the practitioners of 6 week yoga breath-control exercises. • Teaching of yoga postures, breath control, and relaxation techniques for 15 weeks significantly improved FVC of the lungs measured by spirometry (Birkel & Edgren, 2000).

32. In case of deep breathing, we inhale 3000 cc and exhale 1500 cc more air in addition to tidal volume . This implies that deep breathing enhances vital capacity (VC) and total lung capacity (TLC). • Moreover, the continuous contraction and relaxation of the lung tissues during the practice of BP, NSP and PP might enhance their elasticity and hence surface area too. • Both of these actions result in increased absorption of oxygen in alveoli and most possibly increased diffusion of oxygen from alveolus to pulmonary capillary thereby causing increased oxygenation of the blood and eventually increasing oxygen supply to cellular level of the body.

33. Atmospheric pressure = 760 mmHg Atmospheric pressure = 760 mmHg Alveolar pressure = 760 mmHg Alveolar pressure = 758 mmHg Intrapleural pressure = 756 mmHg Intrapleural pressure = 754 mmHg 1. At rest (diaphragm relaxed) 2. During inhalation (diaphragm contracting) Atmospheric pressure = 760 mmHg Alveolar pressure = 762 mmHg Intrapleural pressure = 756 mmHg 3. During exhalation (diaphragm relaxing)

34. 6000 mL Inhalation 5000 mL INSPIRATORY RESERVE VOLUME 3100 mL (1900 mL) INSPIRATORY CAPACITY 3600 mL (2400 mL) VITAL CAPACITY 4800 mL (3100 mL) TOTAL LUNG CAPACITY 6000 mL (4200 mL) Exhalation 4000 mL 3000 mL TIDAL VOLUME 500 mL EXPIRATORY RESERVE VOLUME 1200 mL (700 mL) 2000 mL End of record Start of record FUNCTIONAL RESIDUAL CAPACITY 2400 mL (1800 mL) 1000 mL RESIDUAL VOLUME 1200 mL (1100 mL) LUNG VOLUMES LUNG CAPACITIES

35. CO2 exhaled Atmospheric air: PO2 = 159 mmHg PCO2 = 0.3 mmHg O2 inhaled Alveolar air: PO2 = 105 mmHg PCO2 = 40 mmHg Alveoli CO2 O2 Pulmonary capillaries (a) External respiration: pulmonary gas exchange To lungs To left atrium Deoxygenated blood: PO2 = 40 mmHg PCO2 = 45 mmHg Oxygenated blood: PO2 = 100 mmHg PCO2 = 40 mmHg To right atrium To tissue cells (b) Internal respiration: systemic gas exchange Systemic capillaries O2 CO2 Systemic tissue cells: PO2 = 40 mmHg PCO2 = 45 mmHg

36. Transport of CO2 7% dissolved in plasma 23% as Hb-CO2 70% as HCO3– Transport of CO2 1.5% dissolved in plasma 98.5% as Hb-O2 Alveoli CO2 O2 23% 7% 1.5% 98.5% 70% Pulmonary capillaries O2 (dissolved) HCO3– Hb + O2 CO2 + Hb Hb Red blood cell Hb–O2 Hb–CO2 (a) External respiration: pulmonary gas exchange Plasma CO2 (dissolved) To lungs To left atrium To right atrium To tissue cells (b) Internal respiration: systemic gas exchange Hb–CO2 Hb–O2 O2 Hb Systemic capillaries O2 (dissolved) HCO3– 7% Hb 23% Interstitial fluid 70% 1.5% Systemic tissue cells CO2 O2

37. Practice of postures- padahastasana, pashimuttanasana, parvatasana and marjari; and breath control exercises- BP under the YI might be responsible to create negative pressures (-20-80 mmHg) inside the visceral cavities like urinary bladder, colon (Gore, 2008, p. 145) and possibly in kidneys by restricting blood flow to them leading to cellular hypoxia. Hypoxia (during UddiyanBandha) in the kidneys might promote the process of erythropoiesis.

38. Immune System Empowerment • Yoga reverses the negative impact of stress on the immune system by increasing levels of IgA (Stuck et al., 2003) & NK cells (Rao et al., 2008) (as cited in Ross & Thomas, 2010). • Yoga has been found to decrease inflammatory markers such as high sensitivity C-reactive protein, cytokines: interleukin-6 (Pullen et al., 2008; Singh, Bhandari & Rana, 2011) and lymphocyte-1B (Schultz et al., 2007) (as cited in Ross & Thomas, 2010).