Role of Yoga in Modifying Certain Cardiovascular …

1 JAPI VOL. 52 MARCH ArticleRole of Yoga in Modifying Certain CardiovascularFunctions in Type 2 diabetic PatientsSavita Singh*, V Malhotra*, KP Singh#, SV Madhu#, OP Tandon**AbstractObjectives : 1. To study the effect of forty days of Yogic exercises on cardiac functions in Type 2 Diabetics. 2. To study the effect of forty days of Yogic exercises on blood glucose level, : The present study done in twenty-four Type 2 DM cases provides metabolic and clinicalevidence of improvement in glycaemic control and autonomic functions. These middle-aged subjectswere type II diabetics on antihyperglycaemic and dietary regimen. Their baseline fasting and postprandialblood glucose and glycosylated Hb were monitored along with autonomic function studies.

2 The expertgave these patients training in yoga asanas and they pursued those 30-40 min / day for 40 days underguidance. These asanas consisted of 13 well known postures, done in a sequence. After 40 days of yogaasanas regimen, the parameters were : The results indicate that there was significant decrease in fasting blood glucose levels frombasal in mg / dl to in mg / dl after yoga regimen. The post prandial bloodglucose levels decreased from in mg / dl to in mg / dl, glycosylatedhemoglobin showed a decrease from % to % after yoga regimen. The pulse rate,systolic and diastolic blood pressure decreased significantly (from to pulse /min, from to mm of Hg and from mm of Hg to mm of Hgafter yoga regimen respectively).

3 Corrected QT interval (QTc) decreased from to : These findings suggest that better glycaemic control and stable autonomic functions canbe obtained in Type 2 DM cases with yoga asanas and pranayama. The exact mechanism as to how thesepostures and controlled breathing interact with somato-neuro-endocrine mechanism affecting metabolicand autonomic functions remains to be worked out. INTRODUCTIONIt is known that patients with Type 2 diabetes mellitus (Type2 DM) have a high mortality rate. Most of them die due todiseases such as myocardial infarction, heart failure, or have linked QT lengthening to an increased risk ofunexpected deaths in Type 2 DM patients with severeautonomic lengthening is associated with high insulin levels(Metabolic Syndrome) that cause Na reabsorption, andenhance smooth muscle contractility.

4 This results inhypertension. Hypertension in diabetic patients aggravatesDepartments of Physiology *, #Medicine,** Biochemistry, UniversityCollege of Medical Sciences and GTB Hospital, Shahdara, Delhi -110 : ; Revised : ; Accepted : macro and microvascular disease, especiallynephropathy. It is essential to lower blood pressure to below135/85 mm Hg in diabetic patients. This may be done withmedicines and or in combination or alone by non-pharmacological means in mild has been applied in the field of therapeutics in moderntimes. Yoga has given the patient hope to reduce medicationand slow the progress of disease. Yoga employs stablepostures or asanas and breath control or pranyama.

5 Throughregular practice of these, the autonomic equilibrium shiftstowards a relative parasympathetic balance is essentially concerned withconserving and restoring bodily resources and energies. Thisis achieved by inhibiting the heart and alimentary activity,promoting addition of dietary management and physical exercise,5, JAPI VOL. 52 MARCH 20046 the possible role of yoga merits study and so in order to findother ways of reducing the ensuing complications of diabeteswe studied Type 2 DM patients for heart rate, rhythm, andblood pressure before and after yoga AND METHODSS election of subjectsPatients of type 2 diabetes mellitus of 30-60 years withhistory of diabetes of 1 - 10 years were selected.

6 Patients ofnephropathy, retinopathy (proliferative) and coronary arterydisease were excluded. The patients were recommended ondiet and oral hypoglycemic drugs as per standard clinicalpractice. The patients were assessed before and after 40 daysof Yoga asanas for biochemical and autonomic parametersFasting and postprandial plasma glucose levels wereestimated by glucose oxidase method of Plasmaglycosylated hemoglobin (GHb) was estimated by fast ion-exchange resin separation method using human GmbH parametersThe pulse rate was recorded. Blood pressure wasmeasured using mercury sphygmomanometer by standardmethod. QT interval was also measured in lead II ECG by BPLmachine. QT interval was measured from the onset QRS tothe end of T wave.

7 Since ventricular depolarization (diastole)is affected by change in heart rate, QT interval is standardizedfor rate, by corrected QT interval Bazett formula QTc = QT / RR AND OBSERVATIONSFig. 1 shows the yoga asanas and pranayama. Table 1shows the different asanas and pranayama done with theirtime Table 2 shows glycaemic control, glycosylatedhemoglobin and autonomic function values before and after40 days of yoga blood glucose (FBG) reduced from in mg / dlto mg / dl (p < ), 2 hours postprandial blood glucose(PPG) from mg / dl to mg / dl (p < ), andplasma glycosylated hemoglobin (HbA1) values from (p < ), indicating a better glycaemic blood pressure (SBP) from to mm ofHg, (p < ), diastolic blood pressure (DBP) decreased to mm of Hg, (p < ).

8 No patients doing yogashowed a pressure rate (PR) from to pulse / min (p< ) and corrected QT interval (QTc) from , indicating a shift towards was a statistically significant decrease in heart rate,decreases in systolic, and diastolic blood pressure, and QTcinterval after yoga interval is measured from the starting of Q wave to endof T wave. This interval represents ventricular depolarizationand repolarisation. It is purely an indicator of ventricularfunction. The ventricles receive sympathetic nerves QT interval is an indicator of sympathetic function change in the interval represents a change in autonomicfunction for example a decrease in QT interval indicates adecrease in sympathetic system depolarisation and repolarisation varies withchanges in heart The interval is corrected over time and After YogaFasting Plasma GlucosePostPrandial PlasmaGlucoseFig.

9 1 :Fig. 3 :Fig. 4 :Fig. 2 : JAPI VOL. 52 MARCH 1 : Name and duration of various asanas included in Namaskar - 1 Out of 12 asanas of suryanamaskar-4 comfortable postureswere done, the pose being maintained for ten minute to one minute for each side adding minute per minute to one minute for each side, adding minute per minute to one minute, adding minute per minute to one minute, adding minute per Pranayama5 15 minutes per minute to one minute for both sides, adding minute per minute to one minute for each side, adding minute per minute to one minute, adding minute per minute to one minute for both sides, adding minute per 7 turns of each, the pose being maintained for ten seconds addingone turn each.

10 Every 7 turns of each, the pose being maintained for ten seconds addingone turn each, every 7 turns of each, the pose being maintained for ten seconds addingone turn each, every - 10 minutes, adding 2 minutes per weekTable 2 : Fasting blood glucose (FBG), postprandialblood glucose (PPG), Cardiovascular function, andglycosylated hemoglobin (GHb) values before and after40 days of yoga asanasNMean * FBG (mg%) * * PPG (mg%) * * SBP (mm Hg)20142 *126 * DBP (mm Hg) * * PR (beats/min) * * * GHB (%) * *Significant at p value of < (mg/dl)Fasting blood glucosePPG (mg/dl)Post prandial blood glucoseSBP (mm Hg)Systolic blood pressureDBP (mm Hg)Diastolic blood pressurePR (beats/min)Pulse rateQTcCorrected QT intervalGHB (%)Glycosylated hemoglobinusing Bazett rate adjusted QT interval (QTc)