PRANAYAMA IN CORONARY DISEASE.
Authors: Asha Yadav, Savita Singh & KP Singh. Indian Journal of Traditional Knowledge, Vol. 8 (3), July 2009
Translated by: Aleks Papin
In regards to:
Coronary heart disease (CHD) is one of the most common diseases of the cardiovascular system, caused by stress, dietary habits and physical inactivity, which are often present in the lives of urban residents. Lung functionality is also associated with heart failure, or left ventricular dysfunction.
Breathing exercises and yoga postures play an important role in strengthening respiratory muscles, which develop cardiorespiratory endurance.
The effect of pranayama (breathing exercises) in patients with coronary heart disease has been studied using pulmonary function tests (PFTs). These tests were carried out on 20 patients diagnosed with coronary heart disease, who regularly practiced breathing exercises (pranayama) at home, twice a day. After 2 weeks an external breath test was performed again, and the performance obtained was compared to the original performance.
Basic anthropometric parameters were measured, and a standard questionnaire was administered to cardiac patients. Statistically significant improvements were observed after pranayama practice, supported by the following spirometry parameters:
FEV 1 - the forced expiratory volume in 1 second / the volume of exhaled air during the first second of forced expiration
PEFR - volumetric peak expiratory flow
FEF 25-75 - the instantaneous volumetric velocity after exhalation (25% of the forced vital capacity of the lungs, counted at the beginning of exhalation)
and MVV - the limit of lung ventilation / maximum ventilation (the maximum amount of air passing through the lungs during forced breathing for one minute).
An improvement in the following indicators was observed: FEV1, FVC and PIFR.
An improvement in lung function in patients with coronary artery disease following the practice of pranayama has been demonstrated, therefore, these breathing exercises can be recommended as a means of rehabilitation for patients with coronary artery disease.
Cardiovascular diseases - are the main cause of death in the world. Coronary heart disease ( CHD ) is the most common form of disease of the cardiovascular system. It is associated with the deposition of cholesterol plaques under the inner layer of blood vessels. As a result, it (CHD) decreases the volumetric flow of blood, and the heart muscle does not receive enough “nourishment”, especially during exercise and stress, ie, at times of high need (1).
Most patients with ischemic heart disease also have angina pectoris ( angina ), (pain, squeezing, burning sensation in the chest, pain radiating to the arm or cervix). The flow of blood to the heart muscle, not being regular, generates this pain.
Emotional stress and adverse environmental conditions play an important role in the formation of CHD conditions, accelerating its development, giving this process a chronic nature (2.3). Stress also contributes to the instability of the disease and makes it worse. A sedentary lifestyle and food preferences, which are often associated with obesity, reduce lung function and promote the development of diseases of the cardiovascular system.
The lungs are indirectly associated with the function of the heart pump. High pressure in the left atrium of the heart can also cause chronic changes in the pulmonary vasculature, and stimulate the thickening of its walls. This can also result in an increased degree of airway responsiveness (7).
Yogic breathing exercises lead to bronchodilation [iii], correcting abnormal breathing patterns, and optimize muscle tone of respiratory muscles. As a result of improved breathing patterns, the bronchi widen, allowing efficient perfusion [iv] of the greatest number of alveoli (17). Some studies show that leading the yogic life (regular yoga exercises) reduces the risk of coronary artery stenosis , reduces the number of episodes of angina pectoris, delays the development of atherosclerosis, optimizes the activity of the sympathetic nervous system, reduces stress and improves tolerance to physical exercise (18-21).
However, until now, there have been no known studies evaluating the effect of pranayama (yoga breathing exercises) on lung function tests in patients with coronary heart disease. It is for this reason that emphasis has been placed on the effect of pranayama on pulmonary function tests (PFTs) in patients with coronary heart disease.
Methods
20 patients with coronary artery disease, clinically examined (including by angiography [v]), from the Guru Teg Bahadur Hospital, were selected for this study. All patients included in the test are men, for whom coronary disease has been stationary for the past 2-6 years. All were in the age group of 35-55 years (mean age 48 ± 6.57) and adhered to self-control during the study.
The exclusion criteria for the others were as follows:
myocardial infarction or angina pectoris within the last 6 months;
patients who had a medical history of asthma;
COPD (chronic obstructive pulmonary disease)
tuberculosis or diabetes
patients who smoked (because smoking can affect lung function and cardiovascular function, which may lead to misleading study results).
All participants completed a standard questionnaire focusing on the cardio-respiratory system. Weight, height, volume of body parts and (initial) lung function were also measured. The procedure for Pulmonary Function Tests (PFT) was duly explained to all participants.
Recorded pulmonary function test (PFT) parameters were as follows:
(FEV1) - forced expiratory volume in 1 second
FVC - forced vital capacity
(FEV1 / FVC,%) - the index of Votchala and Tiffno
PEFR - the volume of peak expiratory flow
FEF 25-75 - the instantaneous volumetric velocity after exhalation
PIFR - maximum flow during inspiration
MVV - the maximum measurement of ventilation of the lungs.
Each of these parameters was measured three times, and the best indicator was recorded.
After recording the initial test results (IRP), all participants were trained in breathing exercises (pranayama) - Anuloma-Viloma pranayama and Kapalabhati .
They practiced these exercises (10 minutes each), 2 times a day - morning and evening. The participants were asked to practice at home, on an empty stomach, focusing their attention on their breathing during these exercises. All also continued their treatment in accordance with the prescriptions of the doctors during the study. After two weeks of practicing the breathing exercises, pulmonary function tests (PFTs) were performed again, and the data was compared to the original measurements.
Results and discussion
The anthropometric parameters of the patients are shown in Table 1.
Table 1: Anthropometric parameters of patients with coronary artery disease
All participants continued to receive medical treatment throughout the study.
Pulmonary function tests before and after 2 weeks of breathing exercises were done.
Indicators such as:
(FEV1)% of forced expiratory volume in 1 second
PEFR - volumetric peak expiratory flow
FEF 25-75 - instantaneous volumetric velocity after exhalation
were markedly improved after 2 weeks of pranayama practice. Indicators like:
(FEV1) forced expiratory volume in 1 second
FVC - forced vital capacity
and PIFR - maximum flow during inspiration
also tended to improve (Table 2).
Table 2: Pulmonary function parameters (PFT) before and after breathing exercises (pranayama)
During pranayama practice the parameters such as:
(FEV1)% - forced expiratory volume
PEFR - the maximum flow rate during inspiration
FEF 25-75 - the instantaneous volumetric velocity after exhalation
and MVV - the maximum ventilation index
have increased considerably. This indicates some degree of bronchodilation, which leads to improved oxygenation of the alveoli. The lung strength endurance index also increased, as seen in the results of voluntary maximal ventilation.
Indicators like:
FEV1 (forced expiratory volume in 1 second)
FVC (forced vital capacity)
and PIFR (maximum flow during inspiration)
also improved slightly, probably due to the short study period. The use of pranayama in the long term could modify these parameters.
In general, various studies suggest that maintaining a “yogic” lifestyle slows progression and increases regression of coronary atherosclerosis in patients with severe coronary artery disease (17-20). Very few studies show that breathing exercises can prevent lung complications, which develop after heart surgery (22, 23). No research was found regarding the effects of pranayama (breathing exercises) on lung function in patients with coronary heart disease. Although there are studies showing the role of pranayama on CHD in patients with asthma (24).
Lifestyle change (eating habits, exercise, stress reduction techniques - relaxation, smoking cessation), have been shown to have a beneficial effect on patients with coronary heart disease (2,3,18 -20). Reduction in stenosis attacks, improvement in exercise tolerance and reduction in the number of angina pectoris attacks per week were recorded during the follow-up of “yogic life” (19,20).
The results showed an optimization of sympathetic reactivity, keeping parasympathetic activity unchanged, and a significant improvement in lung function. Pranayama breathing exercises also help to reduce stress and anxiety, which aggravate coronary heart disease, and through this, pranayama can lead to the elimination of coronary heart disease causing factors.
Yoga exercises also improve the lipid and antioxidant profile of patients with coronary heart disease (25). The practice of Kapalabhati tips the balance of metabolism towards activation of the sympathetic system, and Anuloma-Viloma pranayama - optimizes the activity of the two components by balancing them (26).
There is also evidence that muscle oxygen utilization also increases after breathing exercise, which is the improvement in muscle aerobic capacity (28,29). Also, the best results are obtained by combining the soothing exercises of pranayama (30) and stimulating practices.
The improvement in PFT (lung function) in the study may be due to a decrease in sympathetic activity, achieved through the practice of pranayama. Bronchodilation can help correct abnormal breathing patterns; in this case the bronchi can be extended, and a greater number of the alveoli can be enriched with oxygen.
Therefore, we can say that pranayama can prevent serious cardio-respiratory complications, due to the optimal physical and mental adjustment. It also helps to calm the mind, and as a result, patients feel relaxed and are more resistant to stress. Short breathing exercises have been helpful in improving lung function in patients with coronary artery disease. It can be concluded that the function of the lungs can be improved, and complications can be avoided by involving coronary patients in practicing breathing exercises on a regular basis. The results of this study can be correlated with a larger group of patients, and with more prolonged use of pranayama.
