YOGA – PHYSICAL & PSYCHO – SOCIAL
REVITALIZER IN CoViD ERA
DR REMYA E, PhD(AY), PGDYN
RESEARCH OFFICER (AY)
NARIP CHERUTHURUTHY
 Art and science of healthy living
 Combination of Asanas, Pranayama & Dhyana leads to a perfect
harmony between mind and body, man and nature, individual
consciousness and universal consciousness with the ultimate goal
of liberation (moksha ) of the soul.
 Several applications in rehabilitation - helps to build up psycho-
physiological health, emotional harmony, manage daily stress and
its consequences
 WHO defines Rehabilitation as ‘a set of sequence designed to
optimize functioning and reduce disability in individuals with
health conditions in interaction with environment’
YOGA
Psychosomatic Medicine, October 2010
Effect of Yoga in managing ARI
 In an RCT comparing meditation and exercise among adults aged 50
years and older found significant reductions in ARI illness during cold
season with mindfulness meditation .
 Increase mucosal immunity by increasing Salivary Beta Defensin-2 levels
in elderly population
 useful as a preventive measure in vulnerable group.
 Kriya, Yogasana and Pranayama have been shown to reduce airway
reactivity in elderly subjects with asthma
 Neti kriya is useful in acute coryza and symptoms of cold
POST – COVID COMPLICATIONS
• Wholesome nutritious freshly cooked
traditional home cooked food with plenty of
fresh vegetables and fruits with added
traditional spices
• Moderate quantities consumed at regular
timings
• Abstinence from substance abuse including
tobacco, alcohol & other additive drugs
Yogic Diet
Yoga based Lifestyle module
 To improve general immunity among the population.
 Prehabilitation of vulnerable populations (children, elderly
and those with comorbid conditions) and to those in
isolation/quarantine with or without mild symptoms.
 To add-on Yoga based interventions and Meditation practices
in covid-19 cases for psychosocial care
PHYSIOLOGICAL BASIS OF YOGA
Regeneration of pancreatic cells - increase utilization and
metabolism of glucose in peripheral tissues, liver & adipose tissues
Direct stimulation of the pancreas by the postures can rejuvenate its
capacity to produce insulin
Muscular relaxation & improved blood supply to muscles - enhance
insulin receptor expression on muscles - increased glucose uptake by
muscles - reducing blood sugar.
Glucose Metabolism
Increased hepatic lipase and lipoprotein
lipase at cellular level
Increase uptake of triglycerides by
adipose tissues
Improve lipid levels in blood
Lipid Metabolism
Yogasanas,
Pranayamas
and Meditation -
8 weeks
• Mild or moderate bronchial asthma - steady
and progressive improvement in pulmonary
functions - in case of FEV & PEFR
• A significant reduction in exercise induced
bronchoconstriction & improvement in
Asthma Quality of Life (AQOL) when
compared with control group.
Yoga training
for 6 months
• Increase in FEV, FEV1, peak expiratory flow
rate (PEFR)
• Improved lung function, strength of
inspiratory and expiratory muscles among
school children aged 12–15 years.
Respiratory System
CVS
Improve cardio-respiratory
fitness
Promote weight management
Reduction in PR, SBP, DBP,
MABP
Musculo-skeletal
Co-ordinated action of synergestic
& antagonistic muscles
Increase strength, flexibility,
endurance, better neuro-muscular
co-ordination
Strengthens bones, prevent age
related weakening & osteoporosis
31
Reproductive system
Yoga practices,
including physical
postures,
breathing, and
meditation
Resulted in decrease in preterm labor, and
decrease in IUGR either in isolation or
associated with PIH, with no increased
complications in pregnancy
32
Endocrine system
Long term yoga
practice
Reported significant decrease in fasting plasma
insulin
Increased insulin sensitivity and attenuation of
the negative relationship between body
weight or waist circumference and insulin
sensitivity.
Long term
meditation
Increase endogenous secretion of melatonin,
which, in turn, responsible for improved sense
of well-being
33
Gastro – intestinal System
Padmasana Improves digestion – stimulating
abdominal organs to produce enough
enzymes.
Decreases blood flow to the legs &
directing them to abdominal region.
Pavana muktasana Improves digestion – massages the
abdomen.
Releases trapped gases in the
intestine, relieves constipation
Bhujangasana,
Paschimottasana,
Trikonasana, Salabhasana,
Dhanurasana, Ustrasana
Improves blood flow & oxygenation to
the digestive system
34
Yogasana &
Pranayama - 12
weeks
Improved the micronutrient absorption –
zinc, copper, iron & magnesium
35
Immunity
Integrated yoga
practice - 12
weeks
It was observed that the decrease in serum
IFN-γ in yoga group was less significant
compared with that in the control group which
indicated a decline in cellular immunity with
examination stress more among the control
group than the yoga group students.
Kurmasana
(tortoise pose)
supports the thymus gland could create
specific benefits to improve immune function.
Yoga practice
among patients
suffering from
pulmonary
tuberculosis
Potentiated the body immunity and action of
antitubercular drugs thereby improving
sputum culture, radiography, Forced Vital
Capacity (FVC), weight gain and symptoms.
Deeper
Relaxation
Neuroplasticity
Changes in
HPP axis &
Symp.NS
Pranayama
Stretches lung tissue
& produce inhibitory
signals from cardio –
resp. region
Changes in ANS, reduce
metabolism & parasymp.
Dominance, modify
homeostasis
Modify activity of ascending reticular activating
system and autonomic centers in the brainstem
Produce structural differences in brainstem regions
with cardio-respiratory control
Normalize cardio-respiratory and metabolic parameters.
Pranayama
Yoga for Covid 19 Rehabilitation
 Bhramari pranayama - Increase nitrous oxide expression due to
humming, release spasm of peripheral blood vessels, control
hormone secretion
 Yogic practices improve quality of life by promoting muscle
strength , flexibility, improving respiratory and cardiac function .
 “Matsyendrasana” and its variants emphasize on chest expansion
by improving thoracic mobility
 Asanas such as “Setubandasana”
and “Marjarasana” work on the
endurance of core muscles and
eventually provide over all stability
and endurance
 “Balasana” and
“Pavanamuktasana” can aid better
functioning of visceral organs and also
help to load diaphragm and thereby
improves respiratory function
 In case of breathlessness, “Balasana”
provides relaxation
 Yoga practice is an effective self-management
approach to cope with stress, anxiety and
depression during Covid-19 lockdown.
 Promote and improve the respiratory and
cardiovascular functions
 The improved physiological functions in turn are
believed to reduce the stress, anxiety, depression,
and enhance overall well-being of the
practitioners.
Take Home Message
Yoga   physical and psycho-social revitalized in co vid era
Yoga   physical and psycho-social revitalized in co vid era

Yoga physical and psycho-social revitalized in co vid era

  • 1.
    YOGA – PHYSICAL& PSYCHO – SOCIAL REVITALIZER IN CoViD ERA DR REMYA E, PhD(AY), PGDYN RESEARCH OFFICER (AY) NARIP CHERUTHURUTHY
  • 3.
     Art andscience of healthy living  Combination of Asanas, Pranayama & Dhyana leads to a perfect harmony between mind and body, man and nature, individual consciousness and universal consciousness with the ultimate goal of liberation (moksha ) of the soul.  Several applications in rehabilitation - helps to build up psycho- physiological health, emotional harmony, manage daily stress and its consequences  WHO defines Rehabilitation as ‘a set of sequence designed to optimize functioning and reduce disability in individuals with health conditions in interaction with environment’ YOGA
  • 6.
  • 11.
    Effect of Yogain managing ARI  In an RCT comparing meditation and exercise among adults aged 50 years and older found significant reductions in ARI illness during cold season with mindfulness meditation .  Increase mucosal immunity by increasing Salivary Beta Defensin-2 levels in elderly population  useful as a preventive measure in vulnerable group.  Kriya, Yogasana and Pranayama have been shown to reduce airway reactivity in elderly subjects with asthma  Neti kriya is useful in acute coryza and symptoms of cold
  • 14.
    POST – COVIDCOMPLICATIONS
  • 19.
    • Wholesome nutritiousfreshly cooked traditional home cooked food with plenty of fresh vegetables and fruits with added traditional spices • Moderate quantities consumed at regular timings • Abstinence from substance abuse including tobacco, alcohol & other additive drugs Yogic Diet
  • 20.
    Yoga based Lifestylemodule  To improve general immunity among the population.  Prehabilitation of vulnerable populations (children, elderly and those with comorbid conditions) and to those in isolation/quarantine with or without mild symptoms.  To add-on Yoga based interventions and Meditation practices in covid-19 cases for psychosocial care
  • 24.
  • 25.
    Regeneration of pancreaticcells - increase utilization and metabolism of glucose in peripheral tissues, liver & adipose tissues Direct stimulation of the pancreas by the postures can rejuvenate its capacity to produce insulin Muscular relaxation & improved blood supply to muscles - enhance insulin receptor expression on muscles - increased glucose uptake by muscles - reducing blood sugar. Glucose Metabolism
  • 26.
    Increased hepatic lipaseand lipoprotein lipase at cellular level Increase uptake of triglycerides by adipose tissues Improve lipid levels in blood Lipid Metabolism
  • 27.
    Yogasanas, Pranayamas and Meditation - 8weeks • Mild or moderate bronchial asthma - steady and progressive improvement in pulmonary functions - in case of FEV & PEFR • A significant reduction in exercise induced bronchoconstriction & improvement in Asthma Quality of Life (AQOL) when compared with control group. Yoga training for 6 months • Increase in FEV, FEV1, peak expiratory flow rate (PEFR) • Improved lung function, strength of inspiratory and expiratory muscles among school children aged 12–15 years. Respiratory System
  • 28.
    CVS Improve cardio-respiratory fitness Promote weightmanagement Reduction in PR, SBP, DBP, MABP Musculo-skeletal Co-ordinated action of synergestic & antagonistic muscles Increase strength, flexibility, endurance, better neuro-muscular co-ordination Strengthens bones, prevent age related weakening & osteoporosis
  • 29.
    31 Reproductive system Yoga practices, includingphysical postures, breathing, and meditation Resulted in decrease in preterm labor, and decrease in IUGR either in isolation or associated with PIH, with no increased complications in pregnancy
  • 30.
    32 Endocrine system Long termyoga practice Reported significant decrease in fasting plasma insulin Increased insulin sensitivity and attenuation of the negative relationship between body weight or waist circumference and insulin sensitivity. Long term meditation Increase endogenous secretion of melatonin, which, in turn, responsible for improved sense of well-being
  • 31.
    33 Gastro – intestinalSystem Padmasana Improves digestion – stimulating abdominal organs to produce enough enzymes. Decreases blood flow to the legs & directing them to abdominal region. Pavana muktasana Improves digestion – massages the abdomen. Releases trapped gases in the intestine, relieves constipation Bhujangasana, Paschimottasana, Trikonasana, Salabhasana, Dhanurasana, Ustrasana Improves blood flow & oxygenation to the digestive system
  • 32.
    34 Yogasana & Pranayama -12 weeks Improved the micronutrient absorption – zinc, copper, iron & magnesium
  • 33.
    35 Immunity Integrated yoga practice -12 weeks It was observed that the decrease in serum IFN-γ in yoga group was less significant compared with that in the control group which indicated a decline in cellular immunity with examination stress more among the control group than the yoga group students. Kurmasana (tortoise pose) supports the thymus gland could create specific benefits to improve immune function. Yoga practice among patients suffering from pulmonary tuberculosis Potentiated the body immunity and action of antitubercular drugs thereby improving sputum culture, radiography, Forced Vital Capacity (FVC), weight gain and symptoms.
  • 34.
    Deeper Relaxation Neuroplasticity Changes in HPP axis& Symp.NS Pranayama Stretches lung tissue & produce inhibitory signals from cardio – resp. region Changes in ANS, reduce metabolism & parasymp. Dominance, modify homeostasis
  • 35.
    Modify activity ofascending reticular activating system and autonomic centers in the brainstem Produce structural differences in brainstem regions with cardio-respiratory control Normalize cardio-respiratory and metabolic parameters. Pranayama
  • 36.
    Yoga for Covid19 Rehabilitation  Bhramari pranayama - Increase nitrous oxide expression due to humming, release spasm of peripheral blood vessels, control hormone secretion  Yogic practices improve quality of life by promoting muscle strength , flexibility, improving respiratory and cardiac function .  “Matsyendrasana” and its variants emphasize on chest expansion by improving thoracic mobility
  • 37.
     Asanas suchas “Setubandasana” and “Marjarasana” work on the endurance of core muscles and eventually provide over all stability and endurance  “Balasana” and “Pavanamuktasana” can aid better functioning of visceral organs and also help to load diaphragm and thereby improves respiratory function  In case of breathlessness, “Balasana” provides relaxation
  • 38.
     Yoga practiceis an effective self-management approach to cope with stress, anxiety and depression during Covid-19 lockdown.  Promote and improve the respiratory and cardiovascular functions  The improved physiological functions in turn are believed to reduce the stress, anxiety, depression, and enhance overall well-being of the practitioners. Take Home Message

Editor's Notes

  • #4 According to WHO “ Rehabilitation is defined as “ a set of sequence designed to optimize functioning and reduce disability in individuals with health conditions in interaction with environment Yoga is a system of physical and mental exercise designed thousands of years ago to balance and unite the mind, body and spirit Yoga is a combination of Asanas, Pranayama, Dhyana performed to attain harmony between the body , mind and soul , with the ultimate goal of liberation (moksha ) of the soul. Apart from the benefits of Yoga practices in managing and preventing diseases , yoga has several applications in rehabilitation (rehabilitate= to restore , in Latin) Yoga as a way of life , has helped persons with physical disorders to return to health Nowadays, yoga is used for its incidental benefits such as stress reduction , and managing life style related disorders Practicing of yoga has helped to improve people suffering from disease such as CVA, COPD , Parkinsonism , CHD etc Several randomized controlled studies have shown the efficacy of Yogic practices in management of non-communicable diseases like hypertension(2) , Chronic Obstructive Pulmonary disease (COPD)(3) , bronchial asthma(4)  , diabetes(5) , sleep disorders(6), depression(7) , obesity(8), etc. that can be comorbid conditions in patients with COVID 19. Yoga has also been shown to be useful in vulnerable population such as elderly, children. The function of the immune system is critical in the human response to infectious disease.
  • #12 A recent randomized trial comparing meditation and exercise with wait-list control among adults aged 50 years and older found significant reductions in ARI illness during cold season with mindfulness meditation(10) . Yoga is also known to increase mucosal immunity by increasing Salivary Beta Defensin-2 levels in elderly population(11)  Considering that they are a vulnerable group to contract such infections, yoga may be useful as a preventive measure. Yoga practices such as Kriya, Yogasana and Pranayama have been shown to reduce airway reactivity in elderly subjects with asthma and COPD(12)  . Thus, sufficient evidence exists to justify testing the hypothesis that training in Yoga /Meditation can reduce susceptibility to ARI illness. Neti kriya is useful in acute coryza and symptoms of cold (13) .
  • #17 Forty-Five-minute module: Safe practices to improve physical, mental, emotional and spiritual health of the population. (Regular practice on empty stomach) Twenty and ten minute modules are recommended for children, adults, Youths and the elderly population to be repeated twice a day (morning and evening). Apart from CYP; Jalaneti, Sutraneti and Bhastrika Kriyas are recommended once or twice in a week and Yoga nidra for 20-30 minutes twice or thrice a week.
  • #23 This cross-sectional research aims to study the effect of yoga practice on the illness perception, and wellbeing of healthy adults during 4–10 weeks of lockdown due to COVID19 outbreak. A total of 668 adults (64.7% males, M = 28.12 years, SD = 9.09 years) participated in the online survey. The participants were grouped as; yoga practitioners, other spiritual practitioners, and non-practitioners based on their responses to daily practices that they follow. Yoga practitioners were further examined based on the duration of practice as; long-term, mid-term and beginners. Multivariate analysis indicates that yoga practitioners had significantly lower depression, anxiety, & stress (DASS), and higher general wellbeing (SWGB) as well as higher peace of mind (POMS) than the other two groups. The results further revealed that the yoga practitioners significantly differed in the perception of personal control, illness concern and emotional impact of COVID19. However, there was no significant difference found for the measure of resilience (BRS) in this study. Yoga practitioners also significantly differed in the cognitive reappraisal strategy for regulating their emotions than the other two groups. Interestingly, it was found that beginners -those who had started practicing yoga only during the lockdown period reported no significant difference for general wellbeing and peace of mind when compared to the mid- term practitioner. Evidence supports that yoga was found as an effective self- management strategy to cope with stress, anxiety and depression, and maintain wellbeing during COVID19 lockdown.
  • #24 We report a high-risk case of a coronavirus disease 19 (COVID-19)-positive patient with comorbidities including diabetes mellitus (DM), hypertension (HTN), hypothyroidism and chronic kidney disease (CKD), treated successfully using an integrative therapy plan based on Ayurveda and Yoga, along with government-mandated compulsory modern western medicine (MWM) treatment. developed symptoms including fever (which was resolved by the time integrative therapy was started), sore throat, dry cough, body aches, weakness, bad taste and smell, and heaviness in the abdomen. Based on the patient’s symptoms and comorbidities, a treatment plan including Ayurvedic medicines, Yoga protocol, dietary recommendations and lifestyle modifications was prescribed by a registered Ayurveda doctor and a Yoga consultant. The patient started experiencing improvement in all the symptoms within 2 days after starting the treatment; he reported approximately 75% relief from the symptoms after 5 days, and almost complete relief within 9 days. Also, the blood sugar levels (both fasting blood sugar [FBS] and postprandial blood sugar [PPBS]) exhibited significant improvement after 5 days, and decreased to within the normal range within 12 days. Besides relief in symptoms, the patient’s real-time reverse transcription polymerase chain reaction (RT-PCR) test done on the 19th day returned negative results. Integrative therapy based on the classical texts of Ayurveda and Yoga may offer a promising and scalable treatment option for COVID-19 patients
  • #25 This quasi experimental study was conducted among 130 Covid-19 positive patients admitted in a tertiary care hospital. Yoga and Naturopathic intervention was given for 60 min a day for two weeks. Hospital anxiety depression scale (HADS) and Corona anxiety scale (CAS) was used to assess the generalized anxiety and depression among the patients. Results: Average age of the patients participated was 44 with the range from 36 to 53 years. Among them 85 were male and 45 were female. Of all 130 patients, 33% had symptoms of borderline depression, 9.2% had severe depression, 40% had borderline anxiety and 12.3% had severe anxiety. In CAS, 59 patients (45.38%) reported Covid-19 related dysfunctional anxiety. All the patients showed a significant reduction in the HADS- anxiety (P < 0.01), HADS-depression (p < 0.01) and CAS (p < 0.01) score after the intervention. Conclusion: The present study showed significant reduction of anxiety and depression level among the Covid-19 patients. These interventions can be added to the conventional care for better mental and physical wellbeing of the patients after validating the findings with justified study design. 1