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Received : 14-05-2021

Accepted : 25-05-2021

Available online : 23-06-2021



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Dayanidy, Bhavanani, Ramanathan, and Srikanth: Effect of yoga therapy on cardiovascular parameters in patients with psoriasis: A randomized control trial — pilot study


Introduction

Psychodermatologic disorder is a condition that involves an interaction between the mind and the skin.1 Psoriasis, which are not directly connected to mind, but it was precipitated or exacerbated by psychological stress. Psoriasis is a genetically determined immune-mediated inflammatory disease mediated by T-helper 1 (Th1)/Th17 T cells. With a prevalence of 0.44–2.8 percent in India, it commonly affects individuals in their third or fourth decade with males being affected two times more common than females.2 Psoriasis has greater impact on the quality of life of patients and their families leads to great physical, emotional and social burden. Yoga is the unique combination of isometric muscular contractions, stretching exercises, relaxation techniques, and breathing exercises.3, 4 Numerous studies have been done in the past few decades on psycho physiological and biochemical changes occurring following the practice of yoga.5, 6, 7 Various studies show adjuvant Yoga therapy alleviates stress in normal subjects and patients with different conditions.8

Table 1

Yoga therapy protocol

Sl. no.

Yogic Technique

Duration (min)

1.

Warm up practices

5

2.

Tala Kriya and Asana

2

3.

Trikonasana

2

4.

Meruasana / Nasarga Mukha Bhastrika

2

5.

Chatuspadasana / Vyagraha Pranayama

3

6.

Pavanmukta series

3

7.

Sethukriya and Asana

3

8.

Nadishuddhi Pranayama

5

9.

Sadanta Pranyama

3

10.

Bhramai Pranyama

3

11.

Kaya kriya

6

12.

Spandha Nishpandha Kriya

3

13.

Pranava Pranyama

10

14.

Shavasana with normal breathing

10

Total Duration

60 min

Table 2

Comparison of heart rate (HR), systolic (SP), diastolic pressure (DP), Pulse pressure (PP),mean pressure (MP), rate-pressure product (RPP), and double product (DoP) in psoriasis patients taken before (B) andafter (A) 12 weeks of yoga therapy.

Control

Yoga

P-value

HR Beats/min

Before

83 ± 16.23

78.4 ± 11.40

0.466

After

84.3 ± 12.92

76.9 ± 11.68

0.183

SP mmHg

Before

121.64 ± 9.77

120.3 ± 11.23

0.774

After

126.36 ± 7.74*

113.4 ± 18.35

0.044

DP mmHg

Before

73.18 ± 6.38

75.4 ± 10.1

0.551

After

77.46 ± 5.39

71.5 ± 12.09

0.155

PP

Before

48.45 ± 6.19

44.9 ± 7.94

0.264

After

48.91 ± 4.44

41.9 ± 8.13

0.022

MP mmHg

Before

89.33 ± 7.11

93.75 ± 5.91

0.783

After

90.37 ± 9.79

85.46 ± 13.96

0.087

RPP

Before

101.54 ± 24.25

94.69 ± 18.55

0.479

After

106.95 ± 19.71

86.87 ± 18.71

0.027

DoP

Before

7454.76 ±1772.23

7108.8±1388.41

0.626

After

7940.97 ±1495.93

6563.47±1509.72

0.049

Materials and Methods

This randomized controlled pilot trial of 12 weeks was undertaken as an interdisciplinary collaborative work between the Centre for Yoga Therapy Education and Research (CYTER) of Sri Balaji Vidyapeeth, and the Department of Dermatology of Mahatma Gandhi Medical College & Research Institute (MGMCRI), Puducherry. Institutional Human Ethics Committee, Sri Balaji Vidyapeeth (PG Dissertation/2018/06/01). The study was also registered with CTRI (CTRI/2018/08/015558). Data of 20 patients (12 female, 8 male) with a mean age of 44.40 ± 15.2y who were referred by Dept. of Dermatology and attended yoga therapy sessions at CYTER was used for analysis.

The subjects were randomized into the Yoga and control groups by simple randomization technique. Participants were undergoing appropriate yoga therapy protocols. Supervised yoga training was given an hour a day, twice a week for 12 weeks. Heart rate (HR), systolic pressure (SP), and diastolic pressure (DP) were recorded using non-invasive blood pressure (NIBP) apparatus before and after the study period. The other CV indices such as Pulse pressure (PP), mean pressure (MP), rate-pressure product (RPP), and double product (DoP) were derived using the appropriate formula. The yogic techniques given as yoga training are listed in(Table 1.) The statistical analysis was done using Student’s paired T-test for intragroup comparison and Student’s unpaired T-test for inter-group comparison between the groups as all the data passed normality testing.

Results

The inter-group comparison showed statistically significant changes (p<0.05) in Spand derived CV indices such as PP, RPP & DoP (Table 2) after 12 weeks of Yoga training. The intragroup comparison in the control group showed a significant increase in SP and DP (p<0.05).

Conclusion

There is a healthy reduction in SP and derived CV indices following 12 weeks of yoga training. The magnitude of this reduction depends on the pre-existing medical condition and intensity of the disease in each participant. RPP and DoP are indirect indicators of myocardial Oxygen consumption and load on the heart, thereby signifying a lowering of strain on the heart.9, 10 These changes may be attributed to enhanced harmony of cardiac autonomic function as a result of coordinated breath-body work and mind-body relaxation due to yoga resulting in a significant reduction in the perceived stress,11 thereby showing desirable improvement in their dermatological health status too.

Source of Funding

None.

Conflict of Interest

None.

References

1 

J Koo A Lebwohl Psycho dermatology: The mind and skin connectionAm Fam Physician20016411187381

2 

D M Thappa M Munisamy Research on psoriasis in India: Where do we stand?Indian J Med Res20171462147910.4103/ijmr.IJMR_1296_17

3 

S C Miles C Chung L H Fu S D Hunter M Dhindsa Arterial blood pressure and cardiovascular responses to yoga practiceAltern Ther Health Med20131913845

4 

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A B Bhavanani Understanding the science of yogaYoga Mimamsa20124422845

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P Vijayalakshmi Madanmohan A B Bhavanani A Patil K Babu Modulation of stress induced by isometric handgrip test in hypertensive patients following yogic relaxation trainingIndian J Physiol Pharmacol20044815964

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A B Bhavanani Z Sanjay Madanmohan G Dayanidy I V Basavaraddi Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patientsInt J Yoga20125151010.4103/0973-6131.91696

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10 

Madanmohan E S Prakash A B Bhavanani Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjectsIndian J Physiol Pharmacol20054921328

11 

A B Bhavanani Z Sanjay Madanmohan Immediate Effect of Sukha Pranayama on Cardiovascular Variables in Patients of HypertensionInt J Yoga Ther201121173610.17761/ijyt.21.1.y007g51341634172



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