International Journal of Gynecology and Obstetrics 104 (2009) 218–222

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International Journal of Gynecology and Obstetrics

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / i j g o

CLINICAL ARTICLE

Effect of integrated yoga on stress and heart rate variability in pregnant women
Maharana Satyapriya a, Hongasanda R. Nagendra a, Raghuram Nagarathna a,⁎, Venkatram Padmalatha b
a
Division of Yoga and Life Sciences, Swami Vivekananda Yoga Research Foundation, Bangalore, India
b
Maiya Multispeciality Hospital and Wockhardt hospitals, Bangalore, India

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To study the effect of integrated yoga practice and guided yogic relaxation on both perceived stress
Received 20 August 2008 and measured autonomic response in healthy pregnant women. Method: The 122 healthy women recruited
Received in revised form 30 October 2008 between the 18th and 20th week of pregnancy at prenatal clinics in Bangalore, India, were randomized to
Accepted 14 November 2008
practicing yoga and deep relaxation or standard prenatal exercises 1-hour daily. The results for the 45
participants per group who completed the study were evaluated by repeated measures analysis of variance.
Keywords:
Heart rate variability
Results: Perceived stress decreased by 31.57% in the yoga group and increased by 6.60% in the control group
Normal pregnancy (P = 0.001). During a guided relaxation period in the yoga group, compared with values obtained before a
Stress practice session, the high-frequency band of the heart rate variability spectrum (parasympathetic) increased
Yoga by 64% in the 20th week and by 150% in the 36th week, and both the low-frequency band (sympathetic), and
Yogic relaxation the low-frequency to high-frequency ratio were concomitantly reduced (P b 0.001 between the 2 groups).
Moreover, the low-frequency band remained decreased after deep relaxation in the 36th week in the yoga
group. Conclusion: Yoga reduces perceived stress and improves adaptive autonomic response to stress in
healthy pregnant women.
© 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Pregnancy is a state of physiological stress that necessitates physical,
mental, and social adaptation. Animal experiments and human studies
have shown prenatal maternal stress to be associated with increased
risks of spontaneous abortion, preterm labor, fetal malformations, and
asymmetric growth restriction [1]. In a 2005 study, Weinstock [2] noted
that blood flow though the uterine arteries of very anxious women was
impaired by the 32nd week of pregnancy, a finding that strongly
correlated with increased plasma cortisol levels in both mother and
fetus. These 2 conditions may have a direct effect on the development of
the fetal brain, as permanent alterations in early neuroendocrine
programming are likely to affect responses to stress later in life,
fostering such disorders as attention deficit, hyper anxiety, and
disturbed social behavior [3]. These disorders are due to abnormal
activity in the maternal sympathetic-adrenal-medullary system and
hypothalamic-pituitary-adrenocortical axis [4].
Studies of adaptive responses of the maternal autonomic nervous
system to pregnancy have noted that the sympathetic regulation was
facilitated and the parasympathetic influence on the heart rate was
attenuated from the 11th to the 27th week [5], and that responses to
exercise stress were blunted in late pregnancy [6]. Generally, reactivity
to physiological stress appears to be dampened during pregnancy [4].
⁎ Corresponding author. Division of Yoga and Life Sciences, Swami Vivekananda Yoga
Research Foundation (Yoga University) # 19, Eknath Bhavan, Gavipuram Circle, K.G.
Nagar, Bangalore, India 560019. Tel.: +91 9342554703; fax: +91 80 26608645.
E-mail address: rnagaratna@gmail.com (R. Nagarathna).
An ancient holistic Indian science, Yoga, has been used for centu-
ries for stress reduction and health promotion [7]. Guided relaxation
techniques based on Yoga and isometric relaxation have been linked to
reduced sympathetic activity [8,9]. The practice of cyclic meditation
was found to reduce oxygen consumption and breathing frequency
[10]. Studies on heart rate variability (HRV) during vipassana (mind-
fulness) meditation showed a shift toward vagal dominance in the
autonomic balance [11].
Positive effects of integrated yoga modules have been demonstrated
even in women with high-risk pregnancies [12], but no studies have
looked at the effect of yoga on perceived stress levels and autonomic
responses during pregnancy. The objective of the present study was to
assess levels of stress—both as perceived by the participants and from
measuring HRV indices—as the response of the autonomic nervous
system to yoga modules integrating a yogic-guided deep relaxation
technique (DRT).
2. Materials and methods
A total 122 pregnant women satisfying the selection criteria were
recruited from a pool of 300 women receiving prenatal care at various
obstetric units in the south side of Bangalore, India. The recruited
women, who were aged 20 to 35 years and between the 18th and 20th
weeks of pregnancy, were randomized to the yoga or the control group.
Final data were available for 90 of these women, 45 in each group.
The optimum sample size of 44 participants per group was
calculated by fixing the probability of a type 1 error at an alpha of 0.05,
to yield 0.80 power for an effect size of 0.54. The effect size was

0020-7292/$ – see front matter © 2008 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijgo.2008.11.013
 M. Satyapriya et al. / International Journal of Gynecology and Obstetrics 104 (2009) 218–222 219

calculated by the Cohen formula [13], using the means and standard
deviations of an earlier interventional study. For these calculations we
used the noncommercial statistical power analysis program G⁎Power
[14]. The selection criteria aimed at avoiding conditions that would
heighten the adaptive responses to stress during pregnancy. The
exclusion criteria were the following: multigravidity when the
participant had no living child; multiple pregnancy; maternal physical
abnormalities; psychiatric problems; pregnancy-associated medical
problems such as diabetes and hypertension; pregnancy from in vitro
fertilization; intrauterine growth restriction in a previous pregnancy;
fetal abnormality on ultrasound scanning; and previous exposure to
yoga. Besides having a pregnancy duration between 18 and 20 weeks,
the inclusion criterion was primigravidity, or multigravidity when the
participant had at least one living child. The ethical committee of Yoga
University (SVYASA) approved the project. Signed informed consent
was obtained from all participants before randomization.
This was a prospective, randomized, 2-arm study in which all
participants engaged in supervised exercise practices from the time of
recruitment until delivery. After they were screened by the chief
obstetrician of their prenatal clinic and had provided signed informed
consent, the participants were assigned a numbered envelope con-
taining a computer-generated random number that allocated them
to the yoga group or the control group. Assessments of stress (from
a perceived-stress scale and HRV) were done between the 18th
and 20th week and during the 36th week. For HRV computing, an
electrocardiogram (ECG) was recorded continuously for 5 minutes
before, 10 minutes during, and 5 minutes after the DRT period in the
yoga group and supine rest (SR) in the control group. The yoga group
successively practiced 2 modules of integrated yoga, specifically
designed for the second and third trimesters of pregnancy. The control
group practiced standard prenatal exercises. In the first month both
groups learned the movements (in exercise routines of 4 to 10) from
trained instructors, in 2-hour sessions 3 days per week. After 1 month,
the participants continued to practice for 1 hour at home using a
prerecorded instruction cassette. Both groups also had 1-hour re-
fresher classes each time they came for their prenatal visit, once every
4 weeks up to the 28th week and every 2 weeks up to the 36th week.
Compliance for completing the 60-minute practice was ensured by
telephone calls and the maintenance of an activity diary.
As this was an interventional study, the participants and trainers
could not be blinded, but the team who did the assessments and the
statistician were blinded. The perceived stress scale (PSS) answer

Table 1
The 60-minute daily practices used by the 2 groups

Yoga group Trimester Control group Trimester

2nd 3rd 2nd 3rd
Lectures 15 min 10 min Lectures 15 min 10 min
Breathing exercises 10 min 5 min Loosening exercises 10 min 5 min
Hasta āyāma śvasanam Yes Yes Twisting Yes Yes
(Hands-in and hands-out breathing) Forward and backward bend Yes No
Hasta vistāra śvasan Yes Yes Side bending Yes Yes
(Hands stretch breathing) Calf-raise Yes Yes
Gulpha vistāra śvasanam Yes Yes Hamstring stretch Yes Yes
(Ankle stretch breathing) Lateral pull up and down Yes No
Vyāghra śvasanam Yes No Calf extension Yes No
(Tiger breathing) Hip abduction No Yes
Setu bandha śvasanam Yes No
(Bridge posture breathing)
Asanas 15 min 10 min Antenatal exercises 15 min 10 min
Standing Asanas Standing exercises
Tadasanas Yes Yes Thigh stretch Yes Yes
(Tree pose) Push-ups and down Yes Yes
Ardhakati-chakrasana Yes Yes Pull-downs Yes No
(Lateral Arc pose) Lower back lift Yes No
Trikonasana Yes Yes
(Triangle pose)
Sitting Asanas Sitting exercises
Vajrasana Yes Yes Inner thigh Stretch Yes Yes
(Ankle posture) Calf stretch Yes Yes
Vakrasana Yes No Dips Yes No
(Spine twist pose) Squatting No Yes
Siddhasana No Yes Hip abduction Yes Yes
(Sage pose) Shoulder-chest stretch Yes Yes
BaddhaKonasana No Yes Neck and upper-back stretch Yes Yes
(Bound Ankle pose) Rowing Yes Yes
UpavistaKonasana No Yes Oblique curis Yes Yes
(Sitting with legs apart) Kicking Yes Yes
Squatting No Yes Pelvic floor exercise Yes Yes
(Garland pose)
Supine Asanas Supine exercise
Viparita karani Yes No Pelvic Tilt Yes Yes
(Half-shoulder stand)
Ardha- pavanamuktasana Yes Yes
(Folded-leg lumbar stretch)
Pranayama and meditation 10 min 20 min Slow walking 10 min 20 min
Sectional breathing Yes Yes
Naadisuddhi Yes Yes
Sheetali, bharamari Yes Yes
adanusandhana Yes Yes
Om Meditation Yes Yes
Deep relaxation technique 10 min 15 min Supine rest 10 min 15 min
220 M. Satyapriya et al. / International Journal of Gynecology and Obstetrics 104 (2009) 218–222

sheets were coded and kept away until the end of the study, and care Table 2
was taken to prevent the participants from discussing the techniques Maternal Characteristicsa

used in their respective groups. Variable Yoga group Control group

The Integrated Approach to Yoga module used in the yoga group (n = 45) (n = 45)
was based on concepts from yoga scriptures (Patanjali yoga sutras) and Age, y 26.23 ± 2.98 25.47 ± 2.87
developed specifically for healthy pregnant women (Table 1) [12]. Height, in 63.58 ± 1.96 62.98 ± 2.04
Gravidity
These concepts govern a holistic approach to health management at
1 40 (50.6) 39 (49.4)
the physical, mental, emotional, and intellectual levels. The physical 2 5 (45.5) 6 (54.5)
postures (asanas) and breathing techniques (pranayama) improve Profession
flexibility and vitality, and balance vital energy (prana). Meditation Housewife 29 (64.4) 20 (44.4)
and relaxation techniques, such as the isomeric relaxation technique, Professional 16 (35.6) 25 (55.6)
Body weight, kg
the quick relaxation technique, and the guided deep relaxation Baseline 63.42 ± 10.16 63.33 ± 8.87
technique, enhance physiological rest [15]. The DRT used to observe 36th wk 72.02 ± 10.96 72.07 ± 8.71
the immediate effect on HRV of practicing with the integrated yoga– BMI
deep relaxation modules lasted for 10 minutes, and comprised 5 Baseline 25.05 ± 3.46 25.63 ± 3.90
36th wk 28.52 ± 3.85 29.06 ± 3.80
phases. These were (A) relaxing from the tip of the toes to the waist
BP (systolic)
while chanting the sound A; (B) relaxing from the waist to the neck Baseline 116.44 ± 8.30 116.62 ± 7.37
while chanting the sound U; (C) relaxing the head and neck, then 36th wk 73.64 ± 5.53 73.51 ± 6.21
chanting the sound M; (D) dropping to the ground while chanting the BP (diastolic)
sound Om; and (E) visualizing space or sky to experience the body's Baseline 116.67 ± 9.77 118.44 ± 8.24
36th wk 74.58 ± 5.30 76.24 ± 6.44
apartness and expansion [16]. Other components of the yoga module
included daily 15-minute lectures and yogic counseling sessions Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by
height in meters squared); BP, blood pressure.
meant to bring about a perceivable lifestyle change, with the proper a
Values are given as mean ± SD or number (percentage). There were no statistically
understanding of oneself. The yogic texts trace all yoga benefits to the significant differences between the 2 groups except for professional activity (checked
development of “mastery over modifications of the mind” (chitta vritti by the χ2 test).
nirodhah; Sage Patanjali) through a “slowing down of the flow of
thoughts in the mind” (manah prashamana upayah yogah; Sage
Vasishta). The control group practiced standard prenatal practices, PSS questionnaire was administered before the first class, and again
which included simple stretching exercises (Table 1) approved by the before the final class.
Executive Council of the Society of Obstetricians and Gynaecologists of Heart rate variability analysis was derived from continuous heart
Canada and by the board of directors of the Canadian Society for rate recording, at a sampling rate of 1024 Hz, using an ambulatory ECG
Exercise Physiology [17], as well as supine rest. system (Niviqure, Bangalore, India). R-R intervals were computed and
The outcome measures were PSS scores and HRV measurements. A the HRV power spectrum was obtained via a fast Fourier transforma-
widely used psychological instrument for measuring perception of tion algorithm using an appropriate software program (HRV Analysis
stress [18,19], PSS is valid for use in the Indian population, with a for Windows, version 1.1; Biosignal Imaging Group and Analysis, the
Cronbach α for reliability of 0.84. This questionnaire consists of 10 University of Kuopio, Kuopio, Finland. Free download at::http://
questions about experiencing stress during the previous month and bsamig.uku.fi/winhrv.shtml) [21]. The energy in the specific frequency
coping with the stress [20], and has a 5-point scoring system, from 0 to bands of HRV were expressed as normalized units for the low
4, with reverse scoring for 4 positive items (the 4th, 5th, 7th, and 8th frequency (range, 0.05–0.15 Hz), and high frequency bands (range,
questions). The final score is a sum of the scores for all 10 items. The 0.15–0.50 Hz), as recommended by the Task Force for Pacing and
Electrophysiology [22]. The low frequency of the LF band is mainly
related to sympathetic modulation; the efferent vagal activity is a
major contributor to the high frequency HF band; and the LF/HF ratio
is a measure of sympathovagal balance [23].
Statistical analysis was done using SPSS, version 10.0 (SPSS,
Chicago, IL, USA). Since this study had a 2-group, pre-post design,
the baseline values were checked for matching between the 2 groups
by the independent samples t test and the χ2 test. The values were
checked for normal distribution by the Shapiro-Wilk test. Pre-post
differences within groups and between groups were checked using
repeated measures analysis of variance. The Spearman correlation
coefficient was used to check for correlation between PSS and HRV
values.

3. Results

The trial profile is shown in Fig. 1. Data for 90 women were available
for final analysis. The reasons for dropping out of the study included the
inability to attend the prenatal care clinic regularly; switching from the
control group to the yoga group because of the increasing popularity of
yoga through the media; and leaving Bangalore, or the in-laws' house for
delivery and postpartum care in their parents' house.
Demographic characteristics are shown in Table 2. The 2 groups were
matched for all baseline characteristics excluding professional status
(i.e., housewife or working outside the home). Obese women were
Fig. 1. Trial profile. excluded but not overweight women (body mass index [BMI, calculated
 M. Satyapriya et al. / International Journal of Gynecology and Obstetrics 104 (2009) 218–222 221

Table 3 Table 5
Changes in perceived stress after intervention in both groups (n = 45 in each)a Changes in HRV before and after the DRT and SR periods in the 20th and 36th weeks of
pregnancy in the yoga and control groups (n = 45 in each group)a
Variable 20th wk 36th wk ES % of P valueb
change Within Between groups Week HRV Group Pre- session Post- session Pre-post % ES P value
groups Mean ± SD Mean ± S.D Pre-post Pre-post

Pre-post Pre-pre Post-post 20th LF DRT 74.76 ± 5.87 74.05 ± 6.64 - 0.9% 0.15 ns
SR 73.31 ± 7.95 70.51 ± 11.55 - 3.8% 0.32 ns
PSS
HF DRT 25.23 ± 5.87 25.95 ± 6.63 2.9% 0.15 ns
Yoga group 15.90±5.01 10.88 ±4.97 0.29 -31.57 0.001 NS 0.001
SR 26.74 ± 7.96 29.39 ± 11.60 9.7% 0.31 ns
Control group 15.43±5.70 17.33 ±5.34 0.26 6.60 0.002
LF/HF DRT 3.51 ± 0.21 3.07 ± 0.95 - 12.5% 0.50 ns
Abbreviations: ES, effect size; PSS, perceived stress scale. SR 2.89 ± 0.83 2.81 ± 1.15 - 2.8% 0.07 ns
a th
Values are given as mean ± SD or number unless otherwise indicated. 36 LF DRT 76.31 ± 4.85 72.51 ± 6.00 - 5.0% 0.63 0.001
b SR 74.17 ± 9.53 70.86 ± 7.44 - 4.5% 0.33 ns
By repeated measures analysis of variance.
HF DRT 23.24 ± 4.91 27.52 ± 5.98 18.4% 0.78 0.001
SR 25.04 ± 7.20 29.13 ± 7.44 16.3% 0.49 0.006
LF/HF DRT 3.46 ± 0.78 2.79 ± 0.75 - 9.4% 0.83 0.001
SR 3.20 ± 0.86 2.64 ± 0.90 - 17.5% 0.61 0.001
as weight in kilograms divided by height in meters squared] was less Abbreviations: see Table 4.
a
than 25.6 in both groups). Values are given as mean ± SD or number unless otherwise indicated.
b
The PSS scores are shown in Table 3. The mean baseline scores P b 0.001.
c
P = 0.015 between groups (DRT and SR) by repeated measures analysis of variance.
were 15.9 in the yoga group and 15.4 in the control group, and are
marginally higher than the mean scores (14.1) in India. The mean
perceived stress was reduced by 31.57% in the yoga group and There were no significant correlations between PSS scores and any
increased by 6.60% in the control group, and the difference was sig- of the HRV values, either in the 20th or in the 36th week.
nificant (P = 0.001).
Values for the components of the HRV spectrum (LF, HF, and the LF/ 4. Discussion
HF ratio) during the DRT period of the yoga module (yoga group) and
the SR period of the exercise session (control group) are shown in This prospective, randomized, controlled study compared the
Table 4. Compared with the values obtained before the session, the LF effect of daily practice, from the 20th to the 36th week, of an
band power (a measure of sympathetic tone) and the LF/HF ratio integrated yoga program (n = 45) and a program of standard prenatal
decreased and the HF band power increased during both DRT and SR exercises (n = 45) in healthy pregnant women. The perceived stress
(P b 0.001), with a significant difference between the 2 groups decreased by 31.6% in the yoga group and increased by 6.6% in the
(P b 0.001). In the 36th week, compared with the values obtained control group, and the difference was significant between (P b 0.001).
before the session, the degree of response to DRT was increased Measurements of the components of the HRV spectrum showed that
significantly in the yoga group whereas the degree of response to SR the sympathetic tone (LF band power and LF/HF ratio) decreased, and
was reduced in the control group. the parasympathetic tone (HF band power) increased during both DRT
The corresponding values after the DRT period of the yoga module and SR periods in the 20th week. In the yoga group, the changes in
(yoga group) and the SR period of the exercise session (control group) HRV values during and after the DRT period were significantly
are shown in Table 5. In the 36th week, compared with the values enhanced in the 36th week.
obtained before the session, the LF band power was significantly A 64% increase in the HF band power during DRT in the 20th week,
reduced after the DRT period (P b 0.001) but not after the SR period. and a 150% increase in the 36th week, demonstrate that the regular
Moreover, the reduction in the LF/HF ratio and the increase in the HF practice of the integrated yoga modules used in this study, with their
band power, which were not significant in the 20th week, were guided yogic relaxation, improves parasympathetic tone. The con-
significant after both DRT and SR in the 36th week (P b 0.001), comitant reduction in LF band power and LF/HF ratio, indicating
indicating improved autonomic response after both practices. reduction in sympathetic tone and increased autonomic balance,
corroborate the beneficial effect of these yogic practices on the auto-
nomic nervous system.
There was no change from the 20th week to the 36th week in the
Table 4 LF band values (sympathetic) or HF band values (parasympathetic)
Changes in HRV before and during the DRT and SR periods in the 20th and 36th weeks of
pregnancy in the yoga and control groups (n = 45 in each group)a
obtained before the yoga or standard exercise sessions, which may be
due to the natural dampening of autonomic responses, an expected
Week HRV Group Pre During Pre- ES P value phenomenon as pregnancy advances [4]. In the yoga group, the
during, % Pre/during Pre/during
reduction in sympathetic tone (with an increase in parasympathetic
20th LF DRT 74.76 ± 5.87 58.64 ± 11.72 – 21.6 1.74 0.001
tone) during the DRT period was significantly higher in the 36th than
SR 73.31 ± 7.95 40.84 ± 15.42b – 44.3 2.65 0.001
HF DRT 25.23 ± 5.87 41.35 ± 11.73 63.9 1.74 0.001 in the 20th week. In the control group, compared with the values
SR 26.74 ± 7.96 59.28 ± 15.35b 121.7 2.66 0.001 obtained in the 20th week, these responses were dampened in the
LF/HF DRT 3.51 ± 0.21 1.59 ± 1.07 – 54.7 2.49 0.001 36th week. This finding shows that yoga was better than standard
SR 2.89 ± 0.83 0.92 ± 0.87b – 68.2 2.32 0.001 prenatal exercises in improving autonomic nervous system response
36th LF DRT 76.31 ± 4.85 41.97 ± 12.17 – 45.0 3.71 0.001
in the third trimester of pregnancy.
SR 74.17 ± 9.53 51.23 ± 14.03b – 30.9 1.91 0.001
HF DRT 23.24 ± 4.91 58.02 ± 12.17 149.7 3.75 0.001 Yogic relaxation techniques are known to improve sympathovagal
SR 25.04 ± 7.20 49.44 ± 15.15b 97.4 2.06 0.001 balance by reducing the sympathetic tone in normal volunteers.
LF/HF DRT 3.46 ± 0.78 0.88 ± 0.49 –74.6 3.96 0.001 Guided relaxation has been shown to be more effective in reducing
SR 3.20 ± 0.86 1.23 ± 0.80c – 61.6 2.37 0.001
physiological arousal than supine rest [24]. Vempati and Telles [8]
Abbreviations: DRT, guided deep relaxation technique; ES, effect size; HF, high showed a significant reduction in sympathetic activity, with a de-
frequency; HRV, heart rate variability; LF, low frequency; NS, not significant; SR, crease in the LF band power and increase in the HF band power
supine rest.
a
Values are given as mean ± SD or number unless otherwise indicated.
during DRT, as well as a significant reduction in breath rate, volume of
b
P b 0.001. air inhaled, and oxygen consumption [9]. The stress reduction and
c
P = 0.015 between groups (DRT and SR) by repeated measures analysis of variance. healthier autonomic responses observed in this study may point to an
222 M. Satyapriya et al. / International Journal of Gynecology and Obstetrics 104 (2009) 218–222
all-important effect of yoga, that of enhancing the plasticity of the
autonomic nervous system—thereby improving the system's ability to
quickly restore its basal state of relaxation after it has responded to a
stressor.
The components of pranayama integrated in the yoga program, ie,
meditation and other mindfulness practices aimed at physiological
rest, may explain the better parasympathetic tone observed during
and after DRT in the 36th week. During pregnancy, stressors activate
the whole system of stress regulation (the hypothalamic-pituitary-
adrenal axis) [1], releasing large quantities of corticotropin-releasing
hormone, corticotropin, cortisol, and noradrenalin into the systemic
circulation, causing profound changes in the functioning of virtually
every regulatory system in the body. The stress reduction and better
autonomic response achieved by practicing yoga may be mediated
through these pathways. Many pregnancy complications are traceable
to biopsychosocial stresses, which involve neuro-endocrine-immuno-
histochemical pathways. As a multidimensional, natural, nonpharma-
cologic, self-corrective intervention, yoga can be a tool to prevent
these stress-related complications of pregnancy.
The strengths of this study were (A) its randomized, controlled
design and its good sample size; (B) its measuring yoga-induced stress
reduction objectively; and (C) its objective finding of improved
autonomic response to guided relaxation in the third trimester in
women practicing yoga. We may thus recommend that all women be
screened for stress in early pregnancy using the PSS questionnaire, and
add yoga to all prenatal programs.
Limitations of the study were that some interaction between the
2 groups could not be avoided, and that we could only rely on the
diaries and verbal reports of the participants when checking for home
compliance with the assigned practice.
In future studies, these inexpensive yoga techniques may be tried
in different cultures for the self-management of excessive stress. Such
studies would throw more light on the generalizability of yoga
practice and the reproducibility of the effects of yoga worldwide.
In conclusion, practicing integrated yoga as early as the 18th or
20th week of a normal pregnancy reduces perceived stress better than
standard prenatal exercises. The parasympathetic tone is increased
and the sympathetic tone decreased during and after the guided deep
relaxation period used in this study.
Acknowledgment
We thank SVYASA University for funding this project.
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