Effects of an 18-Week Integrated Yoga Program on Cardiac Autonomic Function in Breast Cancer Patients Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial.

BACKGROUND: Cardiotoxicity is a commonly observed adverse effect seen in breast cancer (BC) patients undergoing chemotherapy with attributes toward cardiac autonomic dysfunction (CAD). Yoga, a mind-body system of medicine that has been shown to improve cardiac autonomic nervous system (ANS) activity in various health conditions, could be an effective adjuvant approach in addressing CAD. OBJECTIVE: This study aims to investigate the protective effects of Integrated Yoga Therapy (IYT) on ANS functioning, assessed using Heart rate variability (HRV) in breast cancer patients undergoing chemotherapy. METHODS: A total of 68 (stage I-III) BC patients were randomly assigned into 2 groups: Treatment as Usual group (TAU) and TAU with Yoga Therapy group (TAUYT). All patients underwent anthracycline-based adjuvant chemotherapy for a total of 6 cycles with 21 days/cycle. During chemotherapy, the TAUYT group received IYT 5 days a week for 18 weeks, compared with usual care alone in the TAU group. Resting heart rate (RHR) and HRV, measured in both the time and frequency domains, were used to assess the cardiac ANS function of each patient before and after 6 cycles of chemotherapy. RESULTS: A total of 30 subjects in the TAU group and 29 subjects in the TAUYT group were included in the analysis. At baseline (before chemotherapy), there were no significant differences between the TAU and TAUYT groups in terms of RHR and HRV indices. However, after chemotherapy, patients in the TAU group had a significantly higher average RHR (P < .02) and lower HRV indices with reduced parasympathetic indices: RMSSD (P < .01), pNN50% (P < .04), high-frequency power (P < .001) and increased sympathetic indices: low-frequency power (P < .001) with sympathovagal imbalance: LF/HF (P < .001) compared with patients in the TAUYT group. CONCLUSION: The study showed the protective effects of yoga therapy on CAD in patients receiving anthracycline-based chemotherapy for BC, proposing yoga as a potential adjuvant intervention in improving cardiac health and preventing cardiovascular-related morbidities. TRIAL REGISTRATION: This trial is registered with the Clinical Trials Registry-India (CTRI) database (CTRI/2020/10/028446; October 16, 2020).

Impact of integrated yoga therapy on cognitive impairment and cardiac dysfunction in relation to quality of life in breast cancer patients undergoing chemotherapy: Study protocol for a two-arm randomized controlled trial.

Background: Chemotherapy-related cognitive impairment (CRCI) and cardiac dysfunction (CRCD) are common adverse effects seen in breast cancer patients undergoing chemotherapy. Even though these effects significantly influence daily functioning and overall quality of life, effective strategies to avoid and/or mitigate these adverse effects remain elusive. Yoga as a Mind-body intervention has been used increasingly by cancer patients and has undergone empirical investigations as a potential intervention for patients with cancer. Furthermore, yoga is associated with improved cognition and cardiac functioning in healthy older adults and subjects with cognitive and cardiac impairments. Accordingly, in the current study, yoga holds promise as an intervention to prevent/manage CRCI and CRCD with improved overall QOL in women receiving chemotherapy for breast cancer. Methods: The study is a two-arm, randomized controlled trial. Women diagnosed with stage I-III breast cancer and awaiting neo-adjuvant or adjuvant chemotherapy will be recruited from a tertiary care center in Bangalore, India. Following recruitment, subjects are randomized to the intervention group (integrated yoga therapy intervention during chemotherapy) or the control group (standard care during chemotherapy). The study's primary outcome is to measure the quality of life (cognitive domain) using European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The other primary objectives will include cognitive functioning using neuropsychological test battery and cardiac autonomic function testing using heart rate variability. Secondary outcomes are Brain-derived neurotrophic factor (BDNF), brain function (functional MRI), Echocardiography, serum cortisol, Functional assessment of cancer therapy-cognition (FACT-Cog V3), perceived stress scale and Ryff Scales of Psychological Well-Being. Assessments take place before, during and after chemotherapy; 16-weeks post chemotherapy and 1-year post-baseline. Discussion: Yoga is a promising intervention for preventing and/or managing chemotherapy-related adverse effects (CRAE) and enhancing the quality of life among breast cancer patients. The findings from this study may also help understand the inner mechanisms involved in the protective and restorative effects of yoga on CRAE and support the use of yoga prophylactically for breast cancer patients. In addition, the results of this study could help chemotherapy-exposed individuals with other solid cancer types who have cognitive and cardiac issues. Ethics and Dissemination: The study is approved by the ethics committee of the HealthCare Global Enterprises Ltd. Hospital (EC/434/19/01) and National Institute of Mental Health and Neurosciences (NIMH/DO/ETHICS SUB-COMMITTEE (BS&NS) 9th MEETING/2018). Clinical Trial Registration: http://ctri.nic.in/Clinicaltrials/advancesearchmain.php, identifier CTRI/2020/10/028446.

Adjunct yoga therapy: Influence on heart rate variability in major depressive disorder - A randomized controlled trial.

HRV is inversely proportional to severity of depression. Effect of 12-weeks adjunct yoga therapy on HRV in patients with MDD was assessed through a randomized controlled trial. Sixty-eight subjects (40 females) with mean age 31.58 ± 8.79 years, scoring ≥ 18 on HDRS were randomized to either (YG; n = 35) or (WG; n = 33). Linear mixed model analysis showed no significant difference between groups. On comparing change in mean percentage, substantial more decrease could be elicited only for LF/HF ratio in YG compared to WG, while being comparable for other variables across the groups. Findings suggest Yoga therapy may help in bringing parasympathetic dominance in patients with MDD.

Evaluation of the influence of ayurvedic formulation (Ayushman-15) on psychopathology, heart rate variability and stress hormonal level in major depression (Vishada).

INTRODUCTION: Ayurveda (Indian-complimentary and alternative medicine) is still most sought after in India and has promising potential in management of Vishada [major depressive disorder (MDD)]. But, systematic research is lacking. In this study we evaluated of influence of ayurvedic treatment (Panchakarma and Ayushman-15) on psychopathology, heart rate variability (HRV) and endocrinal parameters in patients with major depression. METHODS: 81 drug naive patients diagnosed as Vishada by ayurvedic physician and MDD according to DSM IV-TR were given ayurvedic Virechana module (therapeutic purgation) and were randomized into two groups. Patients in group A (n=41) received Ayushman-15A while group B (n=40) received Ayushman-15B for two months and Shirodhara (forehead-oil pouring therapy). Patients were assessed with Hamilton Depression Rating Scale (HDRS), Montgomery Asberg Depression Rating Scale (MADRS), Heart Rate Variability (HRV). Cortisol and adrenocorticotropic hormone (ACTH) were estimated at baseline and after ayurvedic therapy. HRV and endocrinal parameters were compared with age and gender matched healthy volunteers. RESULTS: HRV parameters showed significant sympathetic dominance in patients compared to healthy volunteers. Two months of ayurvedic treatment significantly decreased psychopathology, showed increase in vagal tone, decrease in sympathetic tone and reduced cortisol levels. However, there was no significant difference between groups receiving Ayushman A and B. CONCLUSION: This study provides evidence for antidepressant, cardiac (HRV) and beneficial neuroendocrine modulatory influence of Ayurveda therapy in patients of Vishada (MDD). Further studies are needed to confirm these findings. Greater insight into the neurobiology behind this therapy might provide valuable information about newer drug target.

Interactions between short latency afferent inhibition and long interval intracortical inhibition.

Peripheral nerve stimulation inhibits the motor cortex and the process has been termed afferent inhibition. Short latency afferent inhibition (SAI) at interstimulus intervals (ISI) of approximately 20 ms likely involves central cholinergic transmission and was found to be altered in Alzheimer's disease and Parkinson's disease. Cholinergic and GABA(A) receptors are involved in mediating SAI. The effects of SAI on other intracortical inhibitory and facilitatory circuits have not been examined. The objective of the present study is to test how SAI interacts with long interval cortical inhibition (LICI), a cortical inhibitory circuit likely mediated by GABA(B) receptors. We studied 10 healthy volunteers. Surface electromyogram was recorded from the first dorsal interosseous muscle. SAI was elicited by median nerve stimulation at the wrist followed by transcranial magnetic stimulation (TMS) at ISI of N20 somatosensory evoked potential latency + 3 ms. The effects of different test motor evoked potential (MEP) amplitudes (0.2, 1, and 2 mV) were examined for LICI and SAI. Using paired and triple-pulse paradigms, the interactions between SAI and LICI were investigated. Both LICI and SAI decreased with increasing test MEP amplitude. Afferent stimulation that produced SAI decreased LICI. Thus, the present findings suggest that LICI and SAI have inhibitory interactions.

Effect of slow and fast pranayams on reaction time and cardiorespiratory variables.

We planned to undertake a comparative study of the effect of short term (three weeks) training in savitri (slow breathing) and bhastrika (fast breathing) pranayams on respiratory pressures and endurance, reaction time, blood pressure, heart rate, rate-pressure product and double product. Thirty student volunteers were divided into two groups of fifteen each. Group I was given training in savitri pranayam that involves slow, rhythmic, and deep breathing. Group II was given training in bhastrika pranayam, which is bellows-type rapid and deep breathing. Parameters were measured before and after three week training period. Savitri pranayam produced a significant increase in respiratory pressures and respiratory endurance. In both the groups, there was an appreciable but statistically insignificant shortening of reaction time. Heart rate, rate-pressure product and double product decreased in savitri pranayam group but increased significantly in bhastrika group. It is concluded that different types of pranayams produce different physiological responses in normal young volunteers.

Modulation of cardiovascular response to exercise by yoga training.

This study reports the effects of yoga training on cardiovascular response to exercise and the time course of recovery after the exercise. Cardiovascular response to exercise was determined by Harvard step test using a platform of 45 cm height. The subjects were asked to step up and down the platform at a rate of 30/min for a total duration of 5 min or until fatigue, whichever was earlier. Heart rate (HR) and blood pressure response to exercise were measured in supine position before exercise and at 1, 2, 3, 4, 5, 7 and 10 minutes after the exercise. Rate-pressure product [RPP = (HR x SP)/100] and double product (Do P = HR x MP), which are indices of work done by the heart were also calculated. Exercise produced a significant increase in HR, systolic pressure, RPP & DoP and a significant decrease in diastolic pressure. After two months of yoga training, exercise-induced changes in these parameters were significantly reduced. It is concluded that after yoga training a given level of exercise leads to a milder cardiovascular response, suggesting better exercise tolerance.

Effect of pranayam training on cardiac function in normal young volunteers.

Systolic time intervals (STI) are non-invasive and sensitive tests for measuring the ventricular performance. It has been reported that practice of pranayam modulates cardiac autonomic status and improves cardio-respiratory functions. Keeping this in view, the present study was designed to determine whether pranayam training has any effect on ventricular performance as measured by STI and cardiac autonomic function tests (AFT). Twenty four school children were randomly divided into two groups of twelve each. Group I (pranayam group) subjects were given training in nadishuddhi, mukh-bhastrika, pranav and savitri pranayams and practiced the same for 20 minutes daily for a duration of 3 months. Group II (control group) subjects were not given any pranayam training. STI (QS2, LVET and PEP) and AFT (RRIV and QT/QS2) were measured in both the groups at the beginning and again at the end of three months study period. Pranayam training produced an increase in RRIV and a decrease in QT/QS2, suggesting an enhanced parasympathetic and blunted sympathetic activity respectively. QS2, PEP and PEP/LVET increased significantly, whereas LVET was reduced significantly in pranayam group. In contrast, the changes in STI and AFT were much less marked in the control group. Our study shows that three months of pranayam training modulates ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity. Further studies on a larger sample size may illustrate the underlying mechanism(s) involved in this alteration.

Effect of yoga training on handgrip, respiratory pressures and pulmonary function.

Although there are a number of reports on the effect of yoga training on pulmonary functions, very few studies have been undertaken on the effect of yoga training on respiratory pressures and handgrip endurance. Hence the present work was planned to study the effect of yoga training on hand grip strength (HGS), hand grip endurance (HGE), maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), forced expiratory volume (FEV), forced expiratory volume in first second (FEV1) and peak expiratory flow rate (PEFR). 20 school children in the age group of 12 to 15 years were given yoga training (asans and pranayams) for 6 months. 20 age and gender-matched students formed the control group. Yoga training produced statistically significant (P < 0.05) increase in HGS and HGE. MEP, MIP, FEV, FEV1 and PEFR also increased significantly (P < 0.001) after the yoga training. In contrast, the increase in these parameters in the control group was statistically insignificant. Our study shows that yoga training for 6 months improves lung function, strength of inspiratory and expiratory muscles as well as skeletal muscle strength and endurance. It is suggested that yoga be introduced at school level in order to improve physiological functions, overall health and performance of students.

Acute effect of Mukh bhastrika (a yogic bellows type breathing) on reaction time.

Reaction time (RT) is an index of the processing ability of central nervous system and a simple means of determining sensory-motor performance. It has been reported that yoga training improves human performance including central neural processing. Earlier studies from our laboratories have shown that yoga training produces a significant decrease in visual reaction time (VRT) and auditory reaction time (ART). The present work was planned to determine if mukh bhastrika (a yogic technique in which breath is actively blasted out in 'whooshes' following a deep inspiration) has any effect on central neural processing by studying its effect on RT. 22 healthy schoolboys who were practising yoga for the past three months were recruited for the present study. VRT and ART were recorded before and after nine rounds of mukh bhastrika. Mukh bhastrika produced a significant (P < 0.01) decrease in VRT as well as ART. A decrease in RT indicates an improved sensory-motor performance and enhanced processing ability of central nervous system. This may be due to greater arousal, faster rate of information processing, improved concentration and/ or an ability to ignore extraneous stimuli. This is of applied value in situations requiring faster reactivity such as sports, machine operation, race driving and specialised surgery. It may also be of value to train mentally retarded children and older sports persons who have prolonged RT.

Modulation of cold pressor-induced stress by shavasan in normal adult volunteers.

Shavasan is known to enhance one's ability to combat stressful situations. The present study was planned to determine if shavasan could modulate the physiological response to stress induced by cold pressor test (CPT) and the possible mechanisms involved. Ten normal adults were taught shavasan and practiced the same for a total duration of seven days. RR interval variation (RRIV), deep breathing difference (DBD), and heart rate, blood pressure & rate-pressure-product (RPP) response to CPT were measured before and immediately after shavasan. Shavasan produced a significant increase in DBD and an appreciable but statistically insignificant increase in RRIV suggesting an enhanced parasympathetic activity. Significant blunting of cold pressor-induced increase in heart rate, blood pressure and RPP by shavasan was seen during and even five minutes after CPT suggesting that shavasan reduces the load on the heart by blunting the sympathetic response. It is concluded that shavasan can enhance one's ability to withstand stress induced by CPT and this ability can be achieved even with seven days of shavasan training.