Hatha yogic exercises for physical function in healthy individuals and patients with obstructive respiratory disorders

Background and aim: The use of hatha yogic exercises (YE) is increasing, with both healthy individuals and patients asking for alternative treatments and other means of prevention and exercise. To investigate the physical effects and experiences of practicing YE among different groups thus seem important. Specifically, this thesis aimed to investigate heart rate variability, blood pressure, cardiovascular fitness and blood parameters using different YE programs for healthy populations. Another aim was to investigate walking distance, breathlessness, lung function and health related quality of life in participants with obstructive pulmonary disease.

Participants and methods: Study I was a pilot study without a control group investigating the effects of practicing yogic inversions among 12 naïve, untrained and healthy persons (median age 51, 4 women and 8 men) while measuring cardiovascular health as heart rate variability, hand-grip strength and blood pressure. Study II used an RCT design and investigated the effects of practicing high intensity sun salutations among 44 healthy students (median age 25, 38 women and 6 men) while measuring cardiovascular fitness and blood parameters as apolipoproteins, adiponectin, leptin and glycosylated haemoglobin. Study III used an RCT design and investigated the effects of practicing an adapted YE program compared to a treatment as usual group (CTP) among 36 individuals with obstructive pulmonary disease (median age 64, 23 women and 13 men) while measuring six minute walk distance, dyspnea, lung function and disease specific quality of life. Study IV used a qualitative approach to investigate the experiences after YE (used in Study III) among 15 persons with obstructive pulmonary disease (median age 61, 10 women and 5 men).

Results: Study I showed increased heart rate variability with a significant increase in pNN50% (ES 0.45) and hand-grip strength but no effect on blood pressure. Study II showed no between-group effect and no effect on cardiovascular fitness. However, within the YE-group 35-40 minutes of high intensity sun salutation had an effect on the blood parameters as adiponectin and apoplipoproteinA1. Study III found no significant between-group effect using t-tests in any parameter after the intervention. Analysis of variance differences emerged in CRQ fatigue and emotional domains favouring the treatment as usual group (CTP). Improved six-minute walk distance in the YE-group and CTP-group emerged after 12 weeks with no between-group effects. Disease specific quality of life measuring (CRQ) showed improvement in the mastery domain in YE and in all domains in the CTP-group. The YE-group showed lower respiratory rates, the CTP-group did not. Lung function and respiratory muscle strength did not improve in YE but did in the CTP-group. Dyspnea related distress did not improve in any group. Study IV found that the power of practicing (learning by doing) seemed central to the facilitation of self-awareness, controlling symptoms, dyspnea and permitted discovery of new ways of breathing.

Conclusions: The main findings following the evaluation of different yogic programs in Studies I-III showed that the programs were feasible and safe with no documented adverse effects. Study I was a pilot study calling for caution when interpreting the results. However, there still emerged significantly increased heart rate variability and hand-grip strength. In Study II no significant effect emerged between the groups. However, the yogic exercise group (YE) showed increased levels of apolipoproteinA1 and adiponectin following YE intervention. Study III demonstrated improvement in all CRQ-domains in the CTP-group and in the mastery domain in the YE-group following a 12 week intervention. Taken together, the study resulted in significant improvements in walking distance in both groups following the 12 weeks. In the YE-group, lowered respiratory rate, improved mastery of the disease and increased oxygen saturation also emerged after the intervention. Study IV found that practicing YE can be a method used to empower individuals with obstructive pulmonary disorders and to help control symptoms and dyspnea. Yogic practice can serve as an efficient tool for learning new ways of breathing as well as strengthening one’s self-efficacy and mastery of the disease.

List of scientific papers

I. Marian Papp, Petra Lindfors, Niklas Storck, Per Wändell. Increased heart rate variability but no effect on blood pressure from 8 weeks of hatha yoga: a pilot study. BMC Research Notes. 2013 Feb 11;6:59.
https://doi.org/10.1186/1756-0500-6-59

II. Marian Papp, Petra Lindfors, Malin Nygren-Bonnier, Lennart Gullstrand, Per Wändell. Effects of high-intensity Hatha yoga on cardiovascular fitness, adipocytokines, and apolipoproteins in healthy students: a randomized controlled study. The Journal of Alternative and Complementary Medicine. 2016, 22(1): 81-87.
https://doi.org/10.1089/acm.2015.0082

III. Marian Papp, Petra Lindfors, Per E Wändell, Malin Nygren-Bonnier. Effects of yogic exercises on functional capacity, lung function and quality of life in subjects with obstructive pulmonary disease: a randomized controlled study. Eur J Phys Rehabil Med. 2016 Nov 10.
https://pubmed.ncbi.nlm.nih.gov/27830924

IV. Marian Papp; Maria Henriques; Gabriele Biguet; Per E Wändell; Malin Nygren-Bonnier. Experiences of hatha yogic exercises among patients with obstructive pulmonary disease : a qualitative study. [Submitted]