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ARTICLES
 Efets ansuervisetetevariability and blood pressure in hypertensive patients
Murthy Niranjan
Bhagyalakshmi K
Ganaraja B
Prabha Adhikari
倡倡
Ramesh Bhat
Abstract
Objective
 
Heart rate variability
HRV
is a marker of cardiovascular autonomic status
The auto
nomic status has a relationship with cardiovascular disorders and physical as well as mental activities
Determinationof HRV is used as a technique to assess the autonomic control of heart
The objective of this study was to study theeffects of yoga and supervised integrated exercise on HRV and blood pressure in hypertensive patients
Methods
 
The study group consisted of 
47
moderately hypertensive patients
divided into
experimental groups
viz
16
in yogagroup
16
in exercise group and
15
yoga
exercise group
and
31
normal controls
The three groups underwent yo
ga
exercise
both yoga and exercise together respectively for 
months
The time domain HRV during deep breathingand blood pressure were measured at
0,3,6,
and
months in all the groups
Results
 
significant improvement of HRV was found during the entire duration of exercise
±
vs
±
at
months
Nosignificant change in HRV was found in yoga group at the end of 
months
Supervised integrated exercise
yogafor 
months showed a significant HRV improvement in this group
±
at
months vs
±
at
months
The systolic blood pressure
SBP
and diastolic blood pressure
DBP
in these hypertensive pa
tients corrected towards normalcy in different groups
except in yoga group
There was no significant effect on HRVand BP in control group in the intervening period
Conclusion
 
Supervised integrated exercise improves HRV andBP significantly in hypertensive subjects
Yoga does not cause any significant change in HRV and SBP
Yoga com
bined with regulated exercise was found be very effective in improving HRV and reducing BP
Key words
hypertension
exercise
yoga
heart rate variability
INTRODUCTION
As age advances the physiological parameters undergomany changes
Somdeleterious changeleads to de
cline in the quality of life in geriatric people
Aging hasa profound impact on the interacting neural and endo
crine mechanismtharegulate heart rate
Thpara
sympathetic and sympathetic influences get attenuated
renin and angiotensin ievels fall
circadian hormonalantemperature rhythmlosamplitud
[1
This re
flects on cardiovascular system too
thuaffecting thquality olifin old age
This results in increase inblood pressure
hypertension
anreductioin heartrate variability
HRV
are among them
In the ECG
RRvarianchabeen showto decreasas agincrea
ses
[2
Heart rate variability
[3 6]
is a noninvasive elec
trocardiographic marker reflectinthe activity of thesympathetic and parasympathetic components of auto
nomic nervous system
ANS
on the sinus node of theheart
It expresses the total amount of variations of bothinstantaneous hearrate
HR
anRR intervals
Thevalue of HRV reflects the autonomic functions and canbe used as a clinical tool for monitoring autonomic sta
tus on heart
The sympatho
vagal imbalance can be de
tected by HRV in patients with hypertension
[7,8]
Lower 
Department of Physiology
KMC
Mangalore
India
Department of Physiology
SSMC
Tumkur 
India
倡倡
Department of Medicine
KMC
Mangalore
India
Correspondence to
Dr Ganaraja B
PhD
Associate Professor 
Department of Physiology
KMC
Centre for Basic Sciences
Bejai
Mangalore
575 004,
India
mail
ganaraj
gmail
com
rajb
62@
rediffmail
com
JOURNAL of CHINESE CLINICAL MEDICINE VOLUME
NUMBER
March
2009
 
HRV is a significant predictor of cardiac mortality andmorbidity
[3
Pharmacological intervention
exercisetraining
smoking
[9
are known to affect HRV marked
ly
The question now is whether the HRV can be in
creased and whether the improved HRV will lead to abetter outcome in hypertensive patients
Yoga
as prescribed by the ancient Indian scripts
is understood to have influence on the autonomic con
trol
There is a dearth of prospective studies in assess
ing the effects of yoga and exercise on HRV in hyper 
tensive patients
The present study was taken up to de
termine and compare the effects of supervised
integrat
ed exercise and yoga on HRV in hypertensive patientsafter regular practice
METHODS
Forty seven hypertensive patients and
31
age
matchedhealthy subjects who attended hypertension camp
dia
betic camp and geriatric camp were selected
A detailed history of subjects wataken
Generalphysicaexamination including heigh
weight
bloodpressure
pulse rate and respiratory rate
and a completesystemic examinatiowadone
An electrocardiogramwas also recorded
Untreated patients with systolic bloodpressure of 
mm Hg and
 /
or diastolic blood pressureof 
90
mm Hg and all hypertensives on treatment re
gardlesof duratioof ailenwere includein thstudy
All the hypertensive patients with congestive car 
diac failure
acute myocardial infarction
cardiac arrhyth
mias
serum creatinine
>1
mg
and those who wereunable to undergo deep breathing test were excluded
All the
47
patients were requested to come to our center regularly for 
days week anpracticdailyexercises or yoga
under the guidance of a physiothera
pist and a yoga teacher 
They were divided into threegroups viz
Group
Ⅰ[
16
Group
16
andGroup
15
Group I patients enrolled for exer 
cise program at our centre
and all of them practiceexercise for at least
days per week
for 
months du
ration
under the guidance of a physiotherapist
Group
patients enrolled for 
months of yoga asana practicefor at least
days a week under the guidance of a yogateacher 
Group
performed both yoga and exercise for nine months
An informed consent was taken from all these pa
tients before enrolling them in the study
The clearancefrothe Institutional Ethics Committee waobtainedand all the experiments were carried out by strictly ad
hering to the guideline
by qualifiedoctor and yogtherapist and physiotherapist
Exercise Program
The types of exercises taught to the subjects under theguidance of a physiotherapist were as follows
Warmingup exercise for 
minutes
followed by cycling or tread
mill exercise
dependinon exercisincapacity of thepatients
for 
30
minutes
Flowing the exercise
coolingdown exercise was done for 
10
minutes
The entire du
ration of the exercise was not more than
45
minutes
Yoga Program
The yoga was taught to the subjects by a yoga teacher 
It included Meditation and Yogasanas
The sessionbegan with the subjects sitting down on the floor in acomfortable position with their back straight
Chants of 
OM
were repeated for fetimes
It was followedwith a prayer 
The selected yoga asanas included Tadasan
Pa
dahasthasana
Vrikshasana
Trikonasana
Viparitakari
ni
Vajrasana
Sputa
vajrasana
Vakrasana
Uthanapada
sana
Pavanamukthasana
Bhujangasana
Shalabhasana
Dhanurasana and Makarasana
Thesyogic postures were followed by AnulomaPranayamand VilomPranayam
breathing tech
niques
and Savasana
body relaxation by lying
pine
Thentirduratioof yoga practicwanomore than
60
minutes
Methods to test HRV
Before beginning the test
the subjects were instructedto breathe at a rate of 
respiratory cycles per minute
;5
secondfor eaccycle
inhalatioand exhalatio
ECG in lead II was then recorded at a speed of 
25
mmper second for 
60
seconds with the patient breathing asinstructed
Beginning of each inspiration and expirationwas noted down on the ECG
ECG was recorded on Day
1,
and at intervals of 
months
(3
rd
month
,6
th
month and
th
month
JOURNAL of CHINESE CLINICAL MEDICINE VOLUME
NUMBER
March
2009
 
The R
R intervals between adjacent QRS comple
xes resulting from sinus node depolarization were meas
uremanually witscaled caliper 
The R
R intervalwas measured in each respiratory cycle and an average
intervawaconsiderefor the measuremenof HR
The variability in the heart rate was calculated asthe difference between the shortest and longest R
in
tervals
HRV
1,500
mean of shortest R
R intervals
(1,5
mean of longes
intervals
measured inbeats per minute
Statistics
The statistical analysis was done by using
ANOVA
Analysis of Variance
Fisher 
s F Test
Chi Squaretest
Paired
test and student unpaired
test
value was taken as significant at
percent confidencelevel
 P
RESULTS
The HRV and BP from three study group comprised pa
tients doing exercise alone
yoga alone and a combination of these two for 
months and the parameters fromcontrosubjects were compareafter 
3,
and
months
31
healthy persons were taken as control grouponly for baseline studies as they were not compliant for a follow
up study
Table 1
 
Basal parameters
Control group
31
Hypertensive group
49
HRV
±±
SBP
mm Hg
125畅48 ±8畅50±
DBP
mm Hg
8354 ±5畅30±
 
Note
Values mean
±
SD
 P
control vs hypertensive group
The analysis showed that the heart rate variability
HRV
systolic blood pressure
SBP
and diastolicblood pressure
DBP
wersignificantly higher in hy
pertensive group than the control group
The analysis of follow
up HRV after 
months of yoga showed statistically significanimprovement atthe end of 
monthcompared to
months
,3
monthsand
months HRV
Table 2
 
HRV during exercise and yoga training in different groups
yogaBaseline
(0
months
±±±
months
±
±±
months
±
NS
±±
倡#
months
±
# $
±±
倡# $
 
Note
Values mean
±
SD
 P
compared to baseline HRV vs
3,6
and
months HRV
 P
<0
vs
months HRVand
months group
Table 3
 
Systolic blood pressure
SBP
and diastolic blood pressure
DBP
during various durations of training in differentgroups
Duration of trainingGr 
Ⅰ唱
ExerciseSBP
mm Hg
DBP
mm Hg
Gr 
Ⅱ唱
YogaSBP
mm Hg
DBP
mm Hg
Gr 
Ⅲ唱
Exercise
YogaSBP
mm Hg
DBP
mm Hg
Baseline
(0
months
144畅94 ±14畅31 89畅41 ±8畅82 137畅41 ±13畅63 85畅76 ±6畅55 137畅41 ±13畅63 85畅76 ±6畅55
months
±
NS
±
倡倡
13647 ±-1171 85畅05 ±5畅24 13647 ±11畅71 85畅05 ±5畅24
months
±
±
倡倡倡##
±±
135 ±14±
倡倡
months
±
倡# $
±
倡倡倡 ###Ω
136畅±9畅8210 ±6畅±
倡# $
±
倡倡倡 §
 
Note
 P
vs
months
months
 P
Significant
months SBP vs
months SBP
倡倡
 P
Significant baseline DBP vs
month DBP
倡倡倡
 P
Highly significant baseline DBP vs
months and
months DBP
##
 P
Significant
month DBP vs
month and
monthDBP
###
 P
Very highly significant
months DBP vs
months DBP
Ω
 P
<0畅
Significant
month DBP vs
month DBP
NS Not significant
month SBP vs baseline and
month SBP
Values mean
±
SD
JOURNAL of CHINESE CLINICAL MEDICINE VOLUME
NUMBER
March
2009
of 00

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