Article
Effects of various Prāṇāyāma on Cardiovascular and Autonomic Variables
Abstract
Cardiovascular functions are controlled by neural factors, temperature, hormones, etc., Of these, neural factors primarily concern the autonomic nervous system, which plays a significant role in maintaining and regulating cardiac functions, e.g., sign and pulse. Prāṇāyāma is one of the foremost important yogic practices. There are various review articles on Yoga and its effects but, though Prāṇāyāma could also be a a neighborhood of yoga, there's lack of review articles. To the only of our knowledge there is no known review on effect of various Prāṇāyāma on cardiovascular and autonomic variables. To provide a general overview about the effect of various prāṇāyāma (breathing techniques) on cardiovascular and autonomic variables. A narrative review was performed supported the available scientific literature. An electronic data search was performed in Medline/PubMed database to review relevant articles, using keywords like “Prāṇāyāma, Yogic breathing techniques, Unilateral nostril breathing, Alternate nostril breathing, Kapalbhati, Bhastrika and Bhramari Pranayama”. All the relevant articles published from 1988 to 06-04-2016 were included during this review. Slow kind of yogic breathing technique was reported to provide beneficial effect on cardiovascular and autonomic variables while fast breathing techniques don't produce such effects. There’s lack of consistency within the results of specific nostril yogic breathing techniques and thus the mechanisms behind the results of various prāṇāyāma. This review suggests that differing kinds of Prāṇāyāma techniques produce different effects and thus the mechanisms behind these effects aren't fully understood.
Keywords: Autonomic nervous system, cardiovascular, pranayama
Introduction
Cardiovascular functions are controlled by neural factors also as others like temperature, hormones, etc., Of these, neural factors primarily concern the autonomic nervous system (ANS), which plays a significant role in maintaining and regulating cardiac functions, e.g., systolic sign (SBP), diastolic sign (DBP) and pulse (HR). Imbalances in these cause cardiovascular disorders like hypertension, ischemia, infarction, etc., Numerous studies indicate a strong association between compromised ANS (e.g., decreased vagal activity or increased sympathetic activity) and sudden and non-sudden cardiac death.[1]
Cardiovascular disease is that the leading explanation for death for both men and ladies.[2] Lifestyle modifications are important factors within the treatment, prevention, and rehabilitation of cardiovascular disorders.[1] Yoga is one of the only lifestyle modifications and an ancient vedic science thought to possess originated in India in 5000 BC which is being applied within the sector of therapeutics.[3,4] It includes practice of specific posture (āsana), regulated breathing (Prāṇāyāma) etc., Breath is that the dynamic bridge between body and mind and Prāṇāyāma is one of the foremost important yogic practices.[5]
The word Pranayama is comprised of two components: ‘prana’ and ‘āyāma’. Prāṇa means ‘vital energy’ or ‘life force’. Āyāma is defined as ‘extension’ or ‘expansion’. Thus, the word Prāṇāyāma means ‘extension or expansion of the dimension of prāṇa’. within the Prāṇāyāma practices, there are four important aspects of breathing like (1) Pūraka (inhalation), (2) Recaka (exhalation), (3) Antaḥ kumbhaka (internal breath retention), and (4) Bahiḥ kumbhaka (external breath retention). A sophisticated stage of Prāṇāyāma which occurs during high states of meditation is known as as kevala kumbhaka (spontaneous breath retention).[6]
There are various review articles in Yoga and its effects on brain waves, structural changes and activation,[7] pulmonary function,[8] management of chronic diseases,[9] type 2 diabetes,[10] cerebrovascular attack rehabilitation,[11] disorder prevention[12] and its risk factors in general[13] and prevention of coronary heart disease[14] and thus the management of hypertension[15,16] in specific.
Though Prāṇāyāma could also be a a neighborhood of yoga and differing kinds of Prāṇāyāma were reported to provide different cardiovascular[3] and autonomic responses[17] in healthy individuals[3,17] and cardiovascular diseases like hypertension,[18] there's lack of reviews on Prāṇāyāma. To the only of our knowledge there is no known review on effect of various Prāṇāyāma on cardiovascular and autonomic variables. Hence, so on supply a general overview, we performed Medline/PubMed search to review relevant articles, using keywords such as: Pranayama, Yogic breathing techniques, Unilateral nostril breathing, Alternate nostril breathing, Kapalbhati, Bhastrikā and Bhramari Pranayama. Articles published from 1988 to 06-04-2016 were included during this review. Effect of various pranayama generally
The stress either physical or mental, results in cardiovascular morbidity. during a study, a 2 month practice of varied Prāṇāyāma was shown to scale back stress level; low frequency (LF) of pulse variability (HRV) spectrum (indicative of reduction in sympathetic drive to heart); and increase in high frequency (HF) of HRV spectrum (indicative of increase in parasympathetic output to the heart) alongside reduction in LF/HF ratio (indicative of a far better sympatho-vagal balance).[19] Hence, Prāṇāyāma produces relaxed state and during this state, parasympathetic activity overrides sympathetic activity.[18]
Regular practice of Prāṇāyāma was shown to supply reduction within the sympathetic tone within a period as short as 7 days.[20] Another study reported that the alteration in autonomic responses to breath holding is perhaps due to a rise in vagal tone and decreasing sympathetic discharges.[21] In patients with hypertension[18] and arrhythmia,[22] practice of Prāṇāyāma has shown to supply better control of vital sign (BP),[18] and significant reduction within the indices of ventricular repolarization dispersion[22] respectively.
Effect slow and fast pranayama
In a previous study on slow Prāṇāyāma like Nāḍi śuddhi, Mukhabhastrikā, Praṇava and Sāvitrī Prāṇāyāmas practiced for 20 minutes daily for a duration of three months had shown to modulate ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity.[23]
Different types of Prāṇāyāmas were shown to supply different physiological responses like practice of Sāvitrī Prāṇāyāma (slow, rhythmic, and deep breathing) reported to supply reduction in pulse (HR), rate pressure product (RPP) and double product (DoP), whereas Bhastrikā Prāṇāyāma (bellows type rapid and deep breathing) reported to extend it.[24]
In the other studies though both fast (Kapālabhāti, Bhastrikā and Kukkurīya Prāṇāyāma) and slow Prāṇāyāma (Nāḍi śodhana, Sāvitrī and Praṇava Pranāyāma) were shown to be beneficial in reducing stress level,[25] the beneficial effects on cardiovascular parameters was seen only after practicing slow Prāṇāyāma[25]/breathing[26] but not after fast prāṇāyāma[25]/breathing[26] techniques.
Effect of individual pranayama (Breathing Technique)
Breath awareness
Breath awareness is being conscious of or concentrating one's own breath. during a previous study on half-hour of breath awareness, no significant changes in either SBP or DBP were observed in healthy male volunteers.[17] However, another study on 10 minutes of breath awareness showed a big decrease in SBP in patients with hypertension.[27]
Slow breathing/slow deep breathing
Slow deep breathing features a therapeutic effect on autonomic tone. Repeated practice of Prāṇāyāma was shown to strengthen cardio-respiratory coupling;[28] increases within the parasympathetic activity in healthy individuals;[29] and reduction in BP and enhancement in baroreflex sensitivity in hypertensive patients.[30] there's a category II-A, level of evidence B recommendation for BP lowering efficacy conferred on slow breathing.[31] Hence, these effects appear potentially beneficial within the management of hypertension.[30]
The best technique for improving baroreflex sensitivity and reduce BP in yoga-naïve subjects is doing the slow breathing with equal inspiration and expiration.[32] Whereas, another study reported that the rise in baroreflex sensitivity depends on the slow breathing rate and not on the regularization obtained by controlling the breathing because controlled breathing at a hard and fast and faster frequency (15/min) didn't produce such effect.[31]
Fast breathing
Kapālabhāti
It involves forceful exhalation followed by passive inhalation.[6] A previous study reported a decrease in cardiac vagal tone during Kapālabhāti thanks to changes in respiratory pattern and reduced sensitivity of arterial baroreflex; and decrease in rate of respiration (RR) and increased in SBP and low frequency BP oscillations after Kapālabhāti which suggested a differentiated pattern of vegetative activation and inhibition related to Kapālabhāti exercise.[33] during a case study, a case of spontaneous pneumo-thorax caused by Kapālabhāti Prāṇāyāma was reported.[34] Hence, Prāṇāyāma especially fast Prāṇāyāma should be practiced under the supervision of qualified yoga practitioners.
Bhastrikā
Bhastrikā, which comprises of rapid forced expirations followed by inspiration through the proper nostril, inspiratory apnoea with generation of intrathoracic negative pressure, and expiration through the left nostril showed a big decrease within the LF component (a marker of cardiac sympathetic modulation) of HRV in elderly healthy population.[35]
Yogic breathing techniques
In a study on 2:1 yogic breathing technique (exhalation is twice of inhalation), maintaining RR of around 6 breaths/min for a duration of 5-7 minutes twice each day for 3 months was shown to scale back SBP, DBP, HR and RR in patients with hyperpiesia. Hence, it's suggested as an efficient modality for management of hyperpiesia.[36] consistent with a previous study report, a yogic breathing technique that consists of 1 breath/minute (inspiration = 20 seconds, breath retention = 20 seconds, and expiration = 20 seconds) for 31 consecutive minutes appears to possess a singular effect on the brain stem cardio-respiratory center regulating the Mayer wave (0.1-0.01 Hz) patterns of the circulatory system.[37]
Specific nostril yogic breathing
Right, left uninostril yogic breathing and alternate nostril yogic breathing (ANYB) techniques have differential physiological effects that are in tune with the normal svara yoga concept.[38] The science of svara (nasal cycle) is an ultradian rhythm and a marker for psycho-physiological states which had been analyzed extensively by Indian yogis.[39,40,41] it's dependent upon tonic activity of the limbic ANS with hypothalamus because the control centre, also as levels of circulating catecholamines and other neuro-hormones,[39] and characterized by alternating patency of the left and right nostrils, with a periodicity of two to eight hours.[40]
Sympathetic activity is induced by left hemisphere hemisphere stimulation and parasympathetic activity by right brain stimulation.[42] Previous studies had shown that forced unilateral nostril breathing/specific nostril yogic breathing induces selective contra-lateral hemispheric stimulation[41,42,43] as measured by relative increases within the electroencephalographic amplitude within the contra-lateral hemisphere also as alternating lateralization of plasma catecholamines.[42] Forced alternate nostril breathing features a balancing effect on the functional activity of the left and right hemispheres.[44] Hence, the left nostril dominance is related to parasympathetic response and therefore the right nostril dominance is related to sympathetic response. If, thanks to some reason the nostril switching isn't proper, which will cause autonomic imbalance leading to some somatic or psychosomatic problems like hypertension.[45]
Results of a previous study suggest that breathing selectively through either nostril could have a marked activating effect or a soothing effect on the sympathetic systema nervosum.[46] In contrast, another study reported no significant changes in HR, pulse amplitude, temperature, skin conductance response, and respiration force.[47]
Right nostril yogic breathing
It involves both inhalation and exhalation through right nostril. A previous study reported that the air flow through right nostril (sūrya nāḍi/piṅgalā svara) is activatory in nature.[38]
The practice of RNYB is shown to supply increase in oxygen consumption (which might be thanks to increased sympathetic discharge to the adrenal medulla)[46] and SBP[48,49] and HR[49,50] along side significant decrease in digit pulse volume. Hence it's reported to possess a sympathetic stimulating effect.[48] In contrast, previous studies on RNYB showed, no significant changes in either SBP or DSP in healthy males volunteers;[17] and a big change in HR along side a big reduction in SBP and DBP in healthy male subjects with no significant changes in female subjects.[51]
Left nostril yogic breathing
It involves both inhalation and exhalation through left nostril. A previous study reported that the air flow through left nostril (candra nāḍi/iḍā svara) is relaxatory in nature.[38] Previous studies on LNYB had shown to supply significant reduction in RR, HR, SBP and DBP in healthy subjects[51] and significant reduction in HR and SBP in hypertensive patients on regular standard medical management.[39] In another study, increase in volar galvanic skin resistance was observed following LNYB which was interpreted as a discount in sympathetic systema nervosum activity supplying the sweat glands.[46] In contrast, previous studies on LNYB was shown to supply no significant changes in either SBP or DBP;[17] and significant increase in SBP and HR in healthy men.[49]
Alternate nostril yogic breathing
It involves inhalation through left nostril followed by exhalation through right nostril and the other way around. In previous studies a big reduction in HR, SBP in healthy;[52] significant reduction in both SBP and DBP in patients with hypertension;[27] and significant increase in parasympathetic activity during[53] and after ANYB[53,54] were reported. In contrast, the previous studies showed a big increase in HR;[55] no effect in HRV;[56] and a big increase in LF and LF/HF ratio alongside significant reduction in HF spectrum of HRV immediately after 6 and 12 minutes of ANYB in non practitioners of yogic breathing.[57]
Bhrāmarī prāṇāyāma
It involves inhalation through both nostrils and producing humming sound of a bee while exhaling.[5] Five minutes of slow paced Bhrāmarī Prāṇāyāma are reported to influence parasympathetic dominance on circulatory system thanks to its effects in reducing SBP, DBP, mean arterial BP and HR.[58]
Praṇava prāṇāyāma
Praṇava Prāṇāyāma may be a slow and deep yogic breathing techniques which was shown to be effective in reducing HR, SBP, pulse pressure, RRP and DoP in hypertensive patients within five minutes of the practice. The result was said to flow from to a normalization of autonomic cardiovascular rhythms as a results of increased vagal modulation and/or decreased sympathetic activity and improved baroreflex sensitivity alongside an augmentation of endogenous gas production.[59]
Sukha prāṇāyāma
Sukha Prāṇāyāma consists of a conscious, slow and deep breathing with equal duration of inhalation and exhalation at the speed of 6 breaths/minute which was shown to scale back the HR and BP in hypertensive patients within 5 minutes of practice.[60]
Mukha bhastrikā
It involves inhalation and exhalation quickly for ten times just like the bellows of the blacksmith i.e., with a hissing sound. Starting with rapid expulsion of breath following each other in rapid succession, after ten expulsions, the ultimate expulsion is followed by the deepest possible inhalation. Breath is suspended as long because it are often through with comfort. Deepest possible exhalation is completed very slowly. This Prāṇāyāma technique has shown to extend the parasympathetic activity (i.e., reduce basal HR, increase Valsalva ratio and deep breathing difference in HR) and reduce sympathetic activity (i.e., reduction in fall of SBP on posture variation). Hence, Mukha Bhastrikā was reported as having beneficial effect on cardiac autonomic reactivity, when practiced for a extended duration.[61]
Slow pace bhastrikā
It involves inhalation through both nostrils slowly up to the utmost for about 4 seconds then exhalation slowly up to the utmost through both nostrils for about 6 seconds (at the speed of 6 breaths/min). The breathing must not be abdominal. These steps complete one cycle of Slow Pace Bhastrikā Prāṇāyāma. Five minutes practice of slow bhastrikā was shown to supply significant reduction in both SBP and DBP with a small fall in HR unlike volunteers who performed an equivalent breathing exercise for an equivalent duration following oral intake of hyoscine-N-butylbromide (Parasympathetic blocker). Hence, Slow Pace Bhastrikā Prāṇāyāma is effective in improving ANS through enhanced activation of the parasympathetic system.[62]
Prāṇāyāma with meditation
Short term (15 days) practice of normal Prāṇāyāma and meditation practice was shown to enhance cardiovascular functions, regardless of age, gender, and BMI in normal healthy individuals.[3]
The hypothesis and therefore the possible mechanism
The mechanism of how Prāṇāyamic breathing interacts with the systema nervosum affecting metabolic and autonomic functions was hypothesized by Jerath et al. it's their hypothesis that the voluntary slow deep breathing functionally resets the ANS through stretch induced inhibitory signals and hyperpolarization currents propagated through both neural and non-neural tissue which synchronizes neural elements within the heart, lungs, visceral brain and cortex. During inspiration, stretching of lung tissue produces inhibitory signals by action of slowly adapting stretch receptors (SARs) and hyperpolarization current by action of fibroblasts. Both inhibitory impulses and hyperpolarization current are known to synchronize neural elements resulting in the modulation of the systema nervosum and decreased metabolic activity indicative of the parasympathetic state.[63]
Another study reported that the Prāṇāyāma practices increase the frequency and duration of inhibitory neural impulses by activating pulmonary stretch receptors during above tidal volume inhalation as in Hering Bruer reflex, which cause withdrawal of sympathetic tone within the striated muscle blood vessels, resulting in widespread vasodilatation, thus causing decrease in peripheral resistance and thus decreasing the BP. After hyoscine-N-butylbromide, the parasympathetic blocker, it had been observed that vital sign wasn't decreased significantly as a results of Prāṇāyāma, because it was observed when no drug was administered. Thus this means the parasympathetic activation during the practice of prāṇāyāma.[62]
Advantage
Prāṇāyāma is understood since past to alleviate stress and stabilize autonomic function of the body.[19] it's easy to find out, practice and follow in our lifestyle. It are often learned and practiced by patients. Its potential in reducing BP makes this system a promising non-pharmacologic tool for BP reduction in pre-hypertensive patients.
Conclusion
Prāṇāyāma is one among the foremost important parts of the traditional traditional Yoga practices. Differing types of prāṇāyāma techniques were shown to supply different effects, during which slow sort of yogic breathing techniques were reported to enhance cardiovascular and autonomic variables which could be useful for the prevention and therefore the management of cardiovascular disorders. there's lack of consistency within the results of specific nostril yogic breathing and therefore the mechanisms behind the consequences of varied prāṇāyāma. Hence, future studies are required within the field of Prāṇāyāma to explore its precise effect with the underlying mechanisms.
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