Physiological and Psychological Effects of A Yoga Training Programme in Paramedical Students

PHYSIOLOGICAL AND PSYCHOLOGICAL EFFECTS OF A YOGA TRAINING PROGRAMME IN PARAMEDICAL STUDENTS
ANANDA BALAYOGI BHAVANANI1*, ZEENA S2, JAYASETTIASEELON E 3, DAYANIDY G4, VITHIYALAKSHMI L5, MADANMOHAN6
PRESENT AFILIATIONS:
1
Programme Co-ordinator, ACYTER, JIPMER, Puducherry-605006. Email:
yognat@gmail.com
2 3 4 5 6
Senior Research Fellow, ACYTER, JIPMER. Email: zeesanj@gmail.com Senior Research Fellow, ACYTER, JIPMER. Email: jss8yoga@gmail.com Yoga Instructor, ACYTER, JIPMER. Email: dayanidy@gmail.com Yoga Instructor, ACYTER, JIPMER. Email: lakshmivithiya@gmail.com Programme Director, ACYTER, JIPMER. Email: acyter.jipmer@gmail.com
Running head: psychophysiological effects of Yoga training
*Corresponding author
ACKNOWLEDGEMENTS: The authors thank the Dean, Registrar and Head, Department of Physiotherapy in the Mother Theresa Post Graduate and Research Institute of Health Sciences (MTPG&RIHS), Pondicherry for inviting ACYTER to conduct a Foundation Course in Yoga for their students and for giving permission to conduct this study. We also thank Director of Morarji Desai National Institute of Yoga (MDNIY), New Delhi and Director of JIPMER, Puducherry for establishing ACYTER as a collaborative venture between MDNIY and JIPMER with funding from Department of AYUSH, Ministry of Health and Family Welfare, Government of India.
1
Bhavanani AB et al. Physiological and psychological effects of a yoga training programme in paramedical students. Yoga Mimamsa 2013; 44 (4): 246-64.
ABSTRACT:
Introduction: The opportunity to conduct a 3 month Yoga training for undergraduate students of physiotherapy was utilized to study various physiological and psychological parameters to scientifically validate the training and its effects.
Materials and methods: Yoga training sessions were conducted twice weekly for three months for 15 students and various anthropometric, cardiovascular, heart rate variability, reaction time and psychological parameters measured before and after the training. Statistical analysis was done using Students t (paired) test between pre and post training data.
Results: There was a significant reduction in weight and BMI, as well as hip and waist circumference following training. All resting cardiovascular parameters reduced significantly with significant shortening of auditory and visual reaction time. Improvements were noted in all HRV parameters with enhancement of quality of life index scores and retrospective wellness scores.
Discussion: The above mentioned changes in psychophysiological parameters gives evidence of the normalization of cardiac autonomic function with improved central neuronal processing. Improvements in anthropometric, cardiovascular and neurological parameters coupled with the positive changes in HRV and quality of life indices signifies a healthier state of body and mind enabling them to manage their lives better. In conclusion, our study confirms the psychophysiological benefits of Yoga training in a graduate course student population. Hence it is recommended that this becomes an integral part of medical and paramedical collegiate education.
Keywords: yoga, psychophysiological effects, autonomic balance

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INTRODUCTION: The interest in Yoga is growing globally as modern medicine begins to accept the health promoting aspects of Yoga as a result of numerous scientific studies done worldwide. (1,2,3) Yoga is primarily a spiritual science and a healthy life is by-product of Yoga as the practitioners are physically and mentally healthier than the normal population. A wide range of studies have reported heart rate variability (HRV) analyses of immediate, short and long term effects of Yoga and its different techniques with the majority providing evidence of enhanced parasympathetic activity and decreased sympathetic activity with improved sympathovagal balance (SVB). A review by Innes et al identified 42 studies with 85% of them offering some evidence that Yoga promotes a reduction in sympathetic activation, enhancement of cardiovagal function, and a shift in autonomic nervous system (ANS) balance from primarily sympathetic to parasympathetic. (2) The key changes included significant reductions in respiratory rate, heart rate (HR) and blood pressure (BP), in cortisol concentrations, catecholamine levels, and renin activity, in skin conductance, and in cardiovascular response to stress, as well as significant increases in HRV and baroreflex sensitivity. Streeter et al recently proposed a theory to explain the benefits of Yoga practices in diverse, frequently comorbid medical conditions based on the concept that Yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored.
(4)
They hypothesized that stress induces an imbalance of the ANS with decreased
parasympathetic and increased sympathetic activity, under activity of the gamma aminobutyric acid (GABA) system, the primary inhibitory neurotransmitter system, and increased allostatic load. They further hypothesized that Yoga-based practices correct underactivity of the parasympathetic nervous system and GABA systems in part through stimulation of the vagus nerves, the main peripheral pathway of the parasympathetic nervous system, and reduce allostatic load. According to their theory the decreased parasympathetic nervous system and GABA-ergic activity that underlies stress-related disorders can be corrected by Yoga practices resulting in amelioration of disease symptoms. Authorities of the Mother Theresa Post Graduate and Research Institute of Health Sciences (MTPG&RIHS), Pondicherry requested staff of ACYTER, JIPMER to impart Yoga training for students undergoing a Bachelor of Physiotherapy (BPT) course at their
3
institution. This opportunity was utilized to conduct the present study of various physiological and psychological parameters in order to help the students understand the effects of their Yoga training and to scientifically validate the training imparted to them.
MATERIALS AND METHODS: This study was conducted at the Advanced Centre for Yoga Therapy Education and Research (ACYTER) that has been established as a collaborative venture between the Morarji Desai National Institute of Yoga, New Delhi and JIPMER, Puducherry with funding from Department of AYUSH in the Ministry of Health and Family Welfare, Government of India. Fifteen students (12 F, 3 M), aged 19.13 1.25 (SD) yrs undergoing a Bachelor of Physiotherapy (BPT) course at MTPG & RIHS, Pondicherry were recruited for the study. Yoga training sessions were conducted twice weekly for three months at the institution itself. Each session consisted of 30 min of theoretical instruction in aspects of Yogic philosophy, psychology and scientific basis of Yogic practices followed by 90 min of practical instruction of various techniques given in Table 1. The overall attendance in classes was 93% and all students were able to perform the techniques adequately by the end of the training period. The following parameters were tested before and after the training period. All tests were carried out in ACYTER Yoga Research laboratory between 9 and 11 am. The environment was quiet, with comfortable temperature and subdued lighting. The subjects were briefed about the study protocol and written informed consent was obtained from them. They were advised to come at least one hour after light breakfast, with empty bowel and bladder, refrain from smoking and alcohol on the day of test to avoid interference with cardiac autonomic functions. 1. Anthropometric parameters: Height (cm) and body weight (kg) were recorded using a wall mounted stadiometer and weight with spring balance avoiding zero and parallax errors. Body mass index (BMI) was calculated using Quetlet formula. Waist circumference (WC) and hip circumference (HC) were measured using inch tape at appropriate anatomical sites and waist hip ratio (W: H) calculated.
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2. Resting cardiovascular parameters such as HR, systolic (SP) and diastolic (DP) pressure were measured after 5 minutes of supine rest using non-invasive semiautomatic BP monitor (CH 432, Citizen Systems, Tokyo, Japan) apparatus and derivative indices such as pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (DoP) were calculated as follows: PP= SP-DP, MP = DP + 1/3 PP, RPP = HR SP / 100 and Do P = HR MP / 100. 3. Heart rate variability: Short-term supine HRV was recorded using ZephyrTM BioHarnessTM USA for a duration of 400 seconds following 5 minutes of supine rest. Recommendations of the Task Force Report (1996) were followed for HRV analysis
(5)
. Ectopics and artifacts were manually edited out and artifacts free 300
seconds long RR tachogram extracted using the R ways detector. This was analysed using Kubio software V 2.0 Finland and the following time and frequency domain indices determined. a. Time domain indices: i. Mean RR in milliseconds (ms). ii. SDNN- standard deviation of normal to normal intervals in ms. iii. Mean heart rate (1/min) iv. RMSSD- root mean square of successive standard deviations in ms. b. Frequency domain indices: i. LF Power (ms2): Power in low frequency range ( 004015 Hz) ii. HF (ms2): Power in high frequency range 01504 Hz iii. LF norm (nu): LF power in normalised units - LF / (Total Power VLF)*100 iv. HF norm (nu): HF power in normalised units - HF / (Total Power VLF)*100 v. Total power (ms2): LF power + HF power vi. LF / HF Ratio: LF [ms2] / HF [ms2] 4. Reaction time (RT): Simple auditory (ART) and visual reaction time (VRT) using right and left hands. Audiovisual RT apparatus RTM 608 (Medicaid systems) was
5
used for the study. The instrument has a resolution of 0.001 sec and accuracy of +1 digit. It has two modes of providing stimulus- audio stimulus (continuous sound on speaker) and visual stimulus (shooting red, yellow and green lights). ART was recorded for auditory mid frequency sound stimuli and VRT for yellow light stimuli. The signals were given from the front of the subjects to avoid the effect of lateralized stimulus and as soon as the stimulus was perceived by the subject, they were instructed to respond by pressing the response switch using their index finger. The display indicated the response time in seconds. For statistical analysis of RT, 10 trials were recorded and the average of the lowest three similar observations was taken as a single value. (6,7) 5. Ferrans and Powers Quality of Life Index (QLI) generic III version having a total of 66 standardized questions was used to evaluate Total Quality of Life Score. This consisted of 33 questions in part I evaluating the subjects satisfaction with different aspects of the life while part II had 33 questions evaluating the importance of those aspects in the subjects life. a. Health and functioning subscale was evaluated by 13 questions dealing with health, pain, worries etc b. Social and economic subscale was evaluated by 8 questions dealing with friends, neighborhood, education etc. c. Psychological/ Spiritual subscale was evaluated by 7 questions dealing with peace of mind, faith in god, happiness etc. d. Family subscale was evaluated by 5 questions dealing with family health, family happiness and emotional support from family etc. 6. A post intervention, retrospective wellness questionnaire compiled by ACYTER was used to evaluate the comparative feelings of the participants after the training programme. Five different responses ranging from worse than before to complete relief / total satisfaction were utilized to evaluate both physical and psychological aspects of wellbeing. Data was assessed for normality using GraphPad InStat and passed normality testing by Kolmogorov-Smirnov Test. Statistical analysis was done using Students t (paired) test and
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p values less than 0.05 were accepted as indicating significant differences between pre and post intervention data.
RESULTS: The results are given in Table 2-7. There was a significant reduction in weight and BMI, as well as HC and WC measurements following the Yoga programme. There was a significant reduction in resting cardiovascular parameters such as HR, SP, RPP and DoP with it just missing significance in PP and MP. There was also a significant shortening of ART and VRT time for both hands. Improvements were noted in all HRV parameters that just missed statistical significance in SDNN and pNN50. There was a visible enhancement of quality of life index scores that just missed significance in health and functioning scale. Results of the retrospective wellness scores indicates that 10.63 % had complete relief / total satisfaction, 22.17% were much better than before and 33.34 % were better than before. 28.40% were the same as before and only 3.63% felt worse than before.
DISCUSSION: Anthropometric parameters: There was a significant reduction in body weight that resulted in a significant decrease of BMI. Both HC and WC measurements reduced significantly without any change in W: H ratio. These changes in anthropometric parameters may be attributed to an improved metabolic activity due to regular practice of the techniques as Bera and Rajapurkar have also reported significant improvements in ideal body weight, body density, cardiovascular endurance and anaerobic power after Yoga training. (8) Resting cardiovascular parameters: There was a significant reduction in HR, SP, RPP and DoP while the decrease in PP and MP just missed statistical significance. Innes and Vincent have suggested that Yoga reduces cardiovascular risk profile by decreasing activation of the sympatho-adrenal system and the hypothalamic-pituitary-adrenal axis, and by promoting a feeling of wellbeing along with direct enhancement of parasympathetic activity via the vagus nerve.
(3)
Udupa et al had reported modulation of

(9)
ventricular performance following 3 months of Pranayama training by enhancing parasympathetic activity and decreasing sympathetic activity. Madanmohan et al
7
reported that Shavasana and Savitri Pranayama decreases O2 consumption, HR and DP in
trained subjects due to their ability to achieve a state of deep psychosomatic relaxation. (10) It has also been suggested that such relaxation is due to decreased frequency and intensity of proprioceptive and enteroceptive impulse traffic reaching the hypothalamus. (11) Selvamurthy et al reported that Yogic training including inverted posture improves baroreflex sensitivity and attenuates the sympathetic and renin angiotensin activity.
(12)
The reduction in HR and BP seen in our study (Table 3) may be attributed to a similar mechanism as we have included head below the heart postures like Viparithakarani, Halasana and Sarvangasana in our Yoga schedule. Reduction in RPP and Do P (Table 3) implies a reduced load on the heart due to reduced oxygen consumption and this correlates with a previous study in our laboratory that reported a consistent and significant reduction in oxygen consumption and psychosomatic relaxation with Shavasan and Savitri Pranayama that are practices also used in the training programme being reported. (10, 13) A reduction in resting HR, BP, RPP and DoP as well as attenuated responses to exercise have been earlier also reported following two months of Yoga training in healthy subjects.
(14)
These findings are consistent with findings of Ray et al that Yoga training increases
muscular endurance, delays onset of fatigue and enables one to perform work at lesser VO2 max. (15) Bharshankar et al studied the effects of Yoga training for more than 5 years on cardiovascular function in subjects above 40 yr of age.
(16)
They found significant
reduction in resting HR, SP, DP and Valsalva ratio indicating increase in baroreflex sensitivity and concluded that Yoga reduces age related deterioration of cardiovascular functions. The RPP provides a simple measure of overall HRV and is a surrogate marker in situations where HRV analysis is not available.
(17)
It has also been shown that SDNN

(18)
and total power of HRV are inversely correlated with mean HR and RPP. regulation of the heart with decreased oxygen consumption and load.
Hence, the
significant post-training decrease in HR and RPP in our study indicates a better autonomic
Reaction time: All ART values were significantly shorter than respective VRT values (Table 4), and this is in agreement with previous reports. (7, 19, 20, 21) There was a significant shortening of ART and VRT for both hands following the Yoga training and this was more significant in the ART. The present study confirms the finding of earlier studies that Yoga training enhances reflexes and shortens RT. Earlier studies have reported the RT shortening effects of Pranayama as well as comprehensive Yoga training of different durations (6, 7, 19, 22) while previous studies by Bhavanani et al have reported significant and
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immediate shortening of RT following nine rounds of Mukha Bhastrika, a bellows type of Pranayama in normal school children as well as mentally challenged adolescents.
(20,21)
The faster reactivity seen post Pranayama/ Yoga training was been attributed to a modulation of activity at ascending reticular activating system and generalized alteration in information processing at the primary thalamo-cortical level. Decrease in RT signifies an improvement in central neuronal processing ability and may be due to i) greater arousal and faster rate of information processing ii) improved concentration and/or iii) ability to ignore or inhibit extraneous stimuli. Resting supine HRV: Although earlier studies have demonstrated that individual Asana and Pranayama practices can selectively affect sympathetic or parasympathetic nervous system, the overall effect of Yoga is the production of autonomic balance with a trend towards parasympathetic dominance.
(23, 24, 25)
A review by Innes and Vincent suggested
that Yoga reduces cardiovascular risk profile by decreasing activation of the sympathoadrenal system and hypothalamic-pituitary-adrenal axis and also by promoting a feeling of wellbeing along with direct enhancement of parasympathetic activity via vagus nerve. (3) In the present study, improvements were noted in all HRV parameters (Table 5) that just missed statistical significance with respect to SDNN (p=0.092) and pNN50 (p=0.051). As SDNN is a good indicator of HRV power and as pNN50 is an indicator of cardiac vagal tone modulation, this can be taken to imply a healthier parasympathetic meditated relaxatory effect occurring in our participants. There were marked changes in and % in all parameters thus signifying a healthier modulation of cardiac autonomic activity. The improvement in LH: HF can also be interpreted as a manifestation of such a healthier balance of autonomic activity in our participants. Our findings are similar to those of Chaya et al who reported that subjects who had practiced Yoga for a year had significantly higher LF power, lower HF power and higher LF/HF ratio in Yoga group. (26) Increases in LF power are traditionally interpreted as an index of enhanced sympathetic activity but recent understanding is that LF power reflects baroreflex function and not cardiac sympathetic innervation. Moak et al reported that LF power derived from the interbeat interval spectrogram predominantly reflects baroreflex-mediated, phasic changes in cardiovagal and sympathetic noradrenergic outflows. (27) Quality of life index scores: A comprehensive review by Innes and Vincent on risk factors in diabetes mellitus suggested that Yoga based training programmes provide a positive
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source of social support that may also be one of the factors reducing risk for cardiovascular diseases. (3) It has been reported that a short lifestyle modification and stress management educational program leads to remarkable improvement in subjective wellbeing scores and can therefore make an appreciable contribution to primary prevention as well as management of lifestyle diseases. (28, 29) A report on a comprehensive Yoga training programme for medicos at JIPMER showed improvements in psychological well being as well as sub scales of anxiety, depressive mood, positive well being, self control, general health and vitality following the 60 hour programme spread over 2 months.
(30)
There were also reductions in severe and moderate psychological
distress scores with enhanced positive well being. In the present study there was a visible improvement in total Quality of Life score as well as the health and functioning subscale, the social and economic subscale, the psychological/ spiritual subscale and the family subscale (Table 6). Thought there was 812 % changes in % scores, it didnt reach statistical significance and only the improvement in health and functioning scale was close to statistical significance (p=0.073). The lack of statistical significant changes can be attributed to the smaller sample size and future studies with a larger sample may provide statistical significance expected on the basis of these positive trends. Retrospective Wellness Questionnaire: A
(31)
post
training,
retrospective
wellness
questionnaire compiled by ACYTER was used to evaluate the comparative feelings of the participants after the training programme. Five different responses ranging from worse than before to complete relief / total satisfaction were utilized to evaluate the physical and psychological aspects and results are given in Table 7. The total wellbeing scores had 10.63 % responses for complete relief / total satisfaction, 22.17% for much better than before and 33.34 % for better than before. 28.40% were for same as before and only 3.63% for worse than before. Yoga may be improving mental and emotional components of the personality and the subjective improvements in feelings of wellbeing reported by our participants may be a contributing psycho-physiological factor in healthy improvements shown by them, and this aspect needs further exploration. Our findings are similar to those of Malathi and Damodaran who reported decreased anxiety levels in MBBS students.
(32)
They also reported with improvements in sense of
wellbeing, feeling of relaxation, improved concentration, self confidence, improved

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efficiency, good interpersonal relationship, increased attentiveness, lowered irritability levels, and an optimistic outlook in life. They concluded that Yoga had reduced basal anxiety levels and attenuated increase in anxiety score in stressful states. It was postulated that the decrease in anxiety scores following Yoga led to better adjustment adaptability towards environmental and internal stressors, enabling the participants to perform their duties with a calm disposition thus improving their performance. Harinath et al reported improvements in both cardiorespiratory performance and psychological profile after three months of yogic practice and this was accompanied by increases in plasma melatonin.
(33)
They suggested that Yoga acted as a
psychophysiological stimulus to increase endogenous secretion of melatonin, which in turn improved the sense of well-being. Another large scale study in the USA of 239 employee volunteers reported that the mind-body interventions showed significantly greater improvements on perceived stress, sleep quality, and the heart rhythm coherence ratio of HRV.
(34)
It was concluded that both mindfulness-based and therapeutic Yoga
programs may provide viable and effective interventions to target high stress levels, sleep quality, and autonomic balance in employees. In conclusion, our study confirms the psychophysiological benefits of Yoga training in a graduate course student population. Improvements in anthropometric, cardiovascular and neurological parameters coupled with the positive changes in HRV and quality of life indices signifies a healthier state of body and mind enabling them to manage their lives better.
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4. Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB et al. Yoga asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med 2007; 13: 419-26. 5. Guidelines. Heart rate variability standards of measurement, physiological interpretation and clinical use. Task force of the European society of cardiology and the North American society of pacing and electrophysiology. European Heart Journal 1996; 17: 354-381. 6. Madanmohan, Thombre DP, Balakumar B, Nambinarayanan TK, Thakur S, Krishnamurthy N et al. Effect of Yoga training on reaction time, respiratory endurance and muscle strength. Indian J Physiol Pharmacol 1992; 36: 229-33. 7. Madanmohan, Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A. Effect of slow and fast pranayams on reaction time and cardio respiratory variables. Indian J Physiol Pharmacol 2005; 49:313-18. 8. Bera TK and Rajapurkar MV. Body composition, cardiovascular endurance and anaerobic power of yogic practitioner. Indian J Physiol Pharmacol 1993; 37: 225228. 9. Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. Effect of pranayama training on cardiac and autonomic function in normal young adults. Indian J Physiol Pharmacol 2003; 47: 27-33. 10. Madanmohan, Rai UC, Balavittal V, Thombre DP, Swami Gitananda. Cardiorespiratory changes during savitri pranayama and shavasan. The Yoga Review 1983; 3: 25-34. 11. Datey KK, Deshmukh SN, Dalvi CP, Vinekar SL. Shavasana: A yogic exercise in the management of hypertension. Angiology 1969 ; 20: 325-333. 12. Selvamurthy W, Sridharan K, Ray US, Tiwary RS, Hegde KS, Radhakrishan U et al. A new physical approach to control essential hypertension. Indian J Physiol Pharmacol 1998; 42: 205-13. 13. Madanmohan, Bhavanani AB, Prakash ES, Kamath MG, Amudhan J. Effect of six weeks of shavasan training on spectral measures of short term heart rate variability in young healthy volunteers. Indian J Physiol Pharmacol 2004; 48:370-3.
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14. Madanmohan, Udupa K, Bhavanani AB, Shathapathy CC, Sahai A. Modulation of cardiovascular response to exercise by Yoga training. Indian J Physiol Pharmacol 2004; 48: 461-465. 15. Ray US, Mukhopadhyaya S, Purkayastha SS, Asnani V, Tomer OS, Prashad R et al. Effect of exercises on physical and mental health of young fellowship trainees. Indian J Physiol Pharmacol 2001; 45: 37-53. 16. Bharshankar JR, Bharshankar RN, Deshpande VN, Kaore SB, Gosavi GB. Effect of Yoga on cardiovascular system in subjects above 40 years. Indian J Physiol Pharmacol 2003; 47: 202-206. 17. Prakash ES, Madanmohan, Sethuraman KR, Narayan SK. Cardiovascular autonomic regulation in subjects with normal blood pressure, high-normal blood pressure and recent-onset hypertension. Clin Exp Pharmacol Physiol 2005; 32: 488-94. 18. Madanmohan, Prakash ES, Bhavanani AB. Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjects. Indian J Physiol Pharmacol 2005; 49: 132-8. 19. Malathi A, Parulkar VG. Effect of yogasanas on the visual and auditory reaction time. Indian J Physiol Pharmacol 1989; 3: 110-2. 20. Bhavanani AB, Madanmohan, Udupa K. Acute effect of mukh bhastrika (a yogic bellows type breathing) on reaction time. Indian J Physiol Pharmacol 2003; 47: 297-300. 21. Bhavanani AB, Ramanathan M, Harichandrakumar K T. Immediate effect of mukha bhastrika (a bellows type pranayama) on reaction time in mentally challenged adolescents. Indian J Physiol Pharmacol 2012; 56 : 174180 22. Borker AS, Pednekar JR. Effect of pranayam on visual and auditory reaction time. Indian J Physiol Pharmacol 2003; 47: 229-30. 23. Telles S, Nagarathna R, Nagendra HR, Desiraju T. Physiological changes in sports teachers following 3 months of training in yoga. Indian J Med Sci 1993; 47: 235-8.
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24. Vempati RP, Telles S. Yoga based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep 2002; 90: 487-94. 25. Vijayalakshmi P, Madanmohan, Bhavanani AB, Patil A, Kumar Babu P. Modulation of stress induced by isometric handgrip test in hypertensive patients following yogic relaxation training. Indian J Physiol Pharmacol 2004; 48: 59-64 26. Chaya MS, Ramakrishnan G, Shastry S, Kishore RP, Nagendra H, Nagarathna R et al. Insulin sensitivity and cardiac autonomic function in young male practitioners of Yoga. Natl Med J India 2008; 21: 215-6. 27. Moak JP, Goldstein DS, Eldadah BA, Saleem A, Holmes C, Pechnik S et al. Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Cleve Clin J Med 2009; 76: S51-9. 28. Sharma R, Gupta N, Bijlani RL. Effect of Yoga based lifestyle intervention on subjective well-being. Indian J Physiol Pharmacol 2008; 52: 123-31. 29. Michalsen A, Grossman P, Acil A, Langhorst J, Ldtke R, Esch T et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive Yoga program. Med Sci Monit 2005; 11: CR555-561. 30. Madanmohan. Introducing Yoga to medical students: the JIPMER experience. Yoga Vijnana 2008; 2: 71-78. 31. Madanmohan, Bhavanani AB, Zeena S, G Dayanidy, L Vithiyalakshmi, E Jayasettiaseelon. Results of a survey of participant feedback at ACYTER, JIPMER Pondicherry. Yoga Life 2011; 42 (Nov): 11-13. 32. Malathi A, Damodaran A. Stress due to medical exams- role of Yoga. Indian J Physiol Pharmacol 1999; 43: 218-24. 33. Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC et al. Effects of Hatha Yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med 2004; 10:261-68. 34. Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CAet al. Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. J Occup Health Psychol 2012; 17: 246-58.
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Table 1: Yoga training syllabus for paramedical students Theory topics Yoga philosophy Yoga psychology Scientific basis of yoga practices Healthy lifestyle Yogasanas Jattis (loosening practices) Breath body coordination practices Surya Namaskar Pranayama Sukha Pranayama Chandra / Surya Pranayama Pranava Pranayama Nadishuddhi Pranayama Bhramari Pranayama Relaxation Kayakriya Shavasana with Savitri pranayama Talasana Trikonasana Ardhakati Chakrasana Prasaritha Uttanasana Veerasana I & II Vrikshasana Sukhasana / Padmasana Vajrasana Ushtrasana Matsyasana Janusirasana Vakrasana / Ardhamatsyendra Asana Makarasana Bhujangasana Shalabasana/Ardhashalabasana Dhanurasana /Ardhadhanurasana Ekapada / Dwipada Uttanasana Pavana Muktasana I & II Viparithakarani Halasana Sarvangasana
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Table 2: Anthropometric parameters: Height (Ht), weight (Wt), body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist hip ratio (W: H) before (B) and after (A) the yoga training programme.
B Ht (mt) Wt (kg) BMI (kg/mt2) WC (cm) HC (cm) W: H ratio 1.59 0.07 54.07 5.59 21.43 2.75 72.93 7.53 84.73 4.95 0.86 0.05
A 1.59 0.07 53.20 5.44 21.10 2.74 69.60 5.05 82.67 4.24 0.84 0.04
0.00 0.00 -0.87 1.36 -0.33 0.53 -3.33 5.50 -2.07 3.79 -0.02 0.05
% 0.00 0.00 -1.56 2.59 -1.56 2.59 -4.13 6.56 -2.31 4.29 -1.82 5.912
p 0.027 0.029 0.034 0.053 0.221
Values are given as mean SD for 15 subjects.
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Table 3: Resting cardiovascular parameters: Heart rate (HR), systolic pressure (SP), diastolic pressure (DP), pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP) and double product (Do P) before (B) and after (A) the yoga training programme.
B HR (1/min) SP (mm Hg) DP (mm Hg) PP (mm Hg) MP (mm Hg) RPP (units) DoP (units) 83.47 11.34 112.93 8.41 69.80 5.77 43.13 6.82 84.18 5.95 94.75 17.61 7051.40 1248.61
A 78.53 10.20 106.73 10.63 67.80 9.69 38.93 7.86 80.78 9.30 84.29 16.64 6373.91 1270.72
-4.93 7.80 -6.20 8.72 -2.00 7.89 -4.20 8.13 -3.40 7.22 -10.46 10.57 -677.49 858.14
% -5.41 9.16 -5.39 7.94 -2.88 11.70 -8.41 20.78 -4.06 8.79 -10.66 10.32 -9.36 11.43
p 0.028 0.016 0.343 0.065 0.090 0.002 0.009
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Table 4: Auditory reaction time (ART) and visual reaction time (VRT) before (B) and after (A) the yoga training programme. B ART (ms) Right Left VRT (ms) Right Left 241.20 37.80 253.07 45.27 217.00 24.90 220.89 18.93 -24.20 40.92 -32.18 42.65 -8.55 14.36 -10.31 16.94 0.038 0.011 228.27 33.94 228.24 31.13 200.24 23.84 198.67 24.25 -28.02 22.81 -29.58 29.25 -11.48 9.14 -12.03 11.45 < 0.001 0.002 A % p
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Table 5: Resting heart rate variability (HRV) parameters before (B) and after (A) the yoga training programme.
B Mean RR (ms) SDNN (ms) Mean HR (1/min) RMSSD (ms) NN50 (count) pNN50 (%) VLF (ms2) LF (ms2) HF (ms2) LF (n.u) HF (n.u) Total Power (ms2) LF: HF 746.72 117.62 45.54 31.27 82.53 11.80 54.51 44.72 101.67 82.74 26.21 24.98 68.40 84.64 920.40 1313.24 1618.00 2927.86 44.71 18.11 55.29 18.11 2538.33 3651.38 1.08 1.02
A 764.75 119.73 54.03 27.32 80.65 11.33 59.73 28.89 124.27 71.85 33.37 21.36 77.73 93.28 1325.67 1614.53 1496.80 1804.46 45.79 20.93 54.21 20.93 2822.33 2778.96 1.30 1.39
18.03 59.15 8.49 18.21 -1.88 6.31 5.22 28.34 22.60 50.61 7.16 13.00 9.33 53.87 405.27 1137.19 -121.20 2059.48 1.08 19.88 -1.08 19.88 284.00 2569.54 0.21 0.95
% 2.73 7.86 29.72 42.59 -1.97 7.84 28.26 44.33 100.75 204.02 94.02 217.66 60.78 112.99 113.65 284.16 107.19 198.45 13.37 56.30 2.58 42.58 96.44 182.62 49.53 126.22
p 0.257 0.092 0.268 0.487 0.106 0.051 0.513 0.189 0.823 0.836 0.836 0.675 0.395
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Table 6: Ferrans and Powers Quality of Life Index scores before (B) and after (A) the yoga training programme. B Total quality of life score 21.68 4.01 21.06 3.71 22.23 4.89 21.60 5.92 23.06 5.07 A 22.94 3.46 22.87 3.30 22.39 3.09 22.97 5.15 24.26 5.01 1.25 4.01 1.81 3.63 0.16 5.15 1.37 5.69 1.21 5.10 % 8.48 24.97 10.54 19.66 8.32 45.96 12.99 43.67 9.07 28.11 0.375 0.366 0.907 0.073 p 0.246
Health and functioning subscale
Social and economic subscale
Psychological/ Spiritual subscale
Family subscale
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Table 7: Responses of participants to ACYTER retrospective wellness questionnaire

Worse than before Ability to concentrate Control of anger / loss of temper Appetite Confidence level Ease of breathing Energy level Enjoyment of life Feeling calm & fresh Feeling of hopelessness Feeling of loneliness General flexibility General mood General sense of relaxation General wellbeing Joint mobility Nervousness Pain levels Performance of dayto-day activities Normality of menstrual cycle Sleep quality / duration Stress levels Total wellbeing score 6.25% 6.25% 3.63 % 12.5% 6.25% 12.5% 20% 6.25% 6.25% Same as before 12.5% 12.5% 43.75% 18.75% 18.75% 18.75% 37.5% 25% 25% 43.75% 6.25% 25% 33.33% 33.33% 13.33% 18.75% 43.75% 37.5% 53.84% 37.5% 37.5% 28.40 % Better than before 62.5% 37.5% 12.5% 31.25% 56.25% 50% 18.75% 31.5% 25% 12.5% 37.5% 50% 33.33% 33.33% 31.25% 43.75% 25% 37.5% 23.07% 37.5% 31.25% 34.34 % Much better than before 25% 37.5% 25% 37.5% 18.75% 18.75% 18.75% 37.5% 18.75% 6.25% 43.75% 18.75% 26.67% 6.25% 37.5% 25% 12.5% 12.5% 7.69% 12.5% 18.75% 22.17 % 12.5% 12.5% 15.38% 6.25% 6.25% 10.63 % 6.25% 6.25% 12.5% 6.25% 6.25% 25% 6.25% 18.75% 12.5% 12.5% 6.25% 6.25% 26.67% 18.75% Complete relief / Totally satisfied
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Physiological and Psychological Effects of A Yoga Training Programme in Paramedical Students

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Physiological and Psychological Effects of A Yoga Training Programme in Paramedical Students

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PHYSIOLOGICAL AND PSYCHOLOGICAL EFFECTS OF A YOGA TRAINING PROGRAMME IN PARAMEDICAL STUDENTS

Programme Co-ordinator, ACYTER, JIPMER, Puducherry-605006. Email:

Running head: psychophysiological effects of Yoga training

Keywords: yoga, psychophysiological effects, autonomic balance

Udupa et al had reported modulation of

reported that Shavasana and Savitri Pranayama decreases O2 consumption, HR and DP in

They found significant

It has also been shown that SDNN

A review by Innes and Vincent suggested

There were also reductions in severe and moderate psychological

They also reported with improvements in sense of

wellbeing, feeling of relaxation, improved concentration, self confidence, improved

They suggested that Yoga acted as a

It was concluded that both mindfulness-based and therapeutic Yoga

p 0.027 0.029 0.034 0.053 0.221

Values are given as mean SD for 15 subjects.

p 0.028 0.016 0.343 0.065 0.090 0.002 0.009

Values are given as mean SD for 15 subjects.

Values are given as mean SD for 15 subjects.

Values are given as mean SD for 15 subjects.

Health and functioning subscale

Social and economic subscale

Psychological/ Spiritual subscale

Values are given as mean SD for 15 subjects.

Table 7: Responses of participants to ACYTER retrospective wellness questionnaire

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