Percept Mot Skills. 2003 Feb;96(1):79-80.

Effect of yoga-based and forced uninostril breathing on the autonomic nervous system.
Raghuraj P, Telles S.

Vivekananda Yoga Research Foundation, Chamarajpet, Bangalore, India.
Some reports have described the effects of forced uninostril breathing on autonomic activity as sex-specific, while other reports described selective effects of breathing through a specific nostril on the two divisions of the utonomic nervous system, irrespective of sex. There are also yoga breathing techniques which involve voluntary uninostril breathing. These techniques also influenced the autonomic activity based on the patent nostril rather than sex. These descriptions were in line with experiential observations of the ancient sages described in classical yoga texts. This paper summarizes these perspectives on uninostril breathing.

Health Technol Assess 2000;4(27):1-61
Treatments for fatigue in multiple sclerosis: a rapid and systematic review.
Branas P, Jordan R, Fry-Smith A, Burls A, Hyde C.

West Midlands Development and Evaluation Service, The University of Birmingham, Birmingham, UK.
BACKGROUND: Multiple sclerosis (MS) is an important problem both for people with the disease and for society. There is no cure, and alleviation of symptoms forms the cornerstone of care. Excessive fatigue that severely limits activity is experienced by at least two-thirds of the estimated 60,000 people with MS in the UK. OBJECTIVES: (1) To identify current treatments for fatigue in MS and their evidence-base. (2) To systematically review the evidence for those treatments that have been investigated in more than one rigorous study, in order to determine their effectiveness and cost-effectiveness. METHODS: The review was carried out in two stages: a formal scoping review (to assess the range of interventions used by people with MS), and a systematic review for treatments that had been identified as promising and that had been investigated in clinical trials (as identified in the scoping review). A systematic review of research on costs and cost-effectiveness of those interventions identified as promising was also performed. Electronic databases, including MEDLINE and EMBASE, were searched for the period 1991-June 1999 (scoping review) and 1966-December 1999 (systematic review). Reference lists from publications were also searched, and experts were contacted for any additional information not already identified. RESULTS: Interventions identified for the treatment of fatigue in MS (1) Behavioural advice. This is the main element of initial clinical management and no rigorous research of its effectiveness was identified. (2) Drugs (amantadine, pemoline, potassium-channel blockers and antidepressants). (3) Training, rehabilitation and devices (cooling vests and electromagnetic fields). (4) Alternative therapies (bee venom, cannabis, acupuncture/acupressure and yoga). Only two drugs, amantadine and pemoline, met the criteria for full systematic review. RESULTS – EFFECTIVENESS OF AMANTADINE: One parallel and three crossover trials were found, involving a total of 236 people with MS. All studies were open to bias. All studies showed a pattern in favour of amantadine compared with placebo, but there is considerable uncertainty about the validity and clinical significance of this finding. This pattern of benefit was considerably undermined when different assumptions were used in the sensitivity analysis. RESULTS – EFFECTIVENESS OF PEMOLINE: One parallel and one crossover trial were found involving a total of 126 people with MS. Both studies were open to bias. There was no overall tendency in favour of pemoline over placebo and an excess of reports of adverse effects with pemoline. RESULTS – HEALTH ECONOMIC ANALYSIS: The drug costs of amantadine and pemoline are modest (pound 200 and pound 80 per annum, respectively). No economic evaluations were identified in the systematic review, and available data were insufficient to allow modelling of cost-effectiveness in this rapid review. CONCLUSIONS: There is insufficient evidence to allow people with MS, clinicians or policy makers to make informed decisions on the appropriate use of the many treatments on offer. Only amantadine appears to have some proven ability to alleviate the fatigue in MS, though only a proportion of users will obtain benefit and then only some of these patients will benefit sufficiently to take the drug in the long term. CONCLUSIONS – RECOMMENDATIONS FOR RESEARCH: The frequency, severity and impact of fatigue, the poverty of available research, and the absence of any ongoing research, suggest that new research is an urgent priority. People with MS, clinicians and policy makers should work together to ensure that the evidence required is collected as quickly as possible by encouraging involvement in rigorous research. Research should not be restricted to the two drugs reviewed in depth in this report. All interventions identified in the scooping review (see above) should be considered, as should basic scientific research into the underlying mechanism of fatigue in MS.


Fortschr Neurol Psychiatr 1997 Dec;65(12):555-61
The use of alternative medicine by multiple sclerosis patients–patient characteristics and patterns of use

Article in German
Winterholler M, Erbguth F, Neundorfer B.

Neurologische Klinik der Universitat Erlangen-Nurnberg.
The use of alternative medicine is growing in all Western countries. Little is known about the modalities and patterns of use of alternative medicine by patients suffering from multiple sclerosis. PATIENTS AND METHODS: We analysed an anonymous questionnaire that was sent to and answered by 129 former inpatients who had multiple sclerosis diagnosed by typical clinical and laboratory findings. RESULTS: 82 of 129 patients (63.6%) have been using alternative therapies. They were treated with a total of 87 different alternative healing methods or substances. Some patients used up to 9 different methods. The mean duration of the alternative treatment was 2.6 (0-20) years. Most patients used homoeopathy (n = 35), herbs (29 different substances, 32 users), different relaxation methods like yoga (n = 38) and various diets (n = 21). The most important motivation to look for alternative medicine was the aim to participate actively in the healing process. Most patients thought that there was some positive effect from the alternative treatment but did not inform their general practitioner or neurologist about it. DISCUSSION: Like in other chronic diseases many MS-patients use alternative medicine. The experiences of these treatments forms part of the patient’s coping with the disease.


Eur J Clin Invest 1997 May;27(5):443-9
Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons.
Bowman AJ, Clayton RH, Murray A, Reed JW, Subhan MM, Ford GA.

Department of Pharmacological Sciences, University, Newcastle upon Tyne, UK.
It is unclear whether the age-associated reduction in baroreflex sensitivity is modifiable by exercise training. The effects of aerobic exercise training and yoga, a non-aerobic control intervention, on the baroreflex of elderly persons was determined. Baroreflex sensitivity was quantified by the alpha-index, at high frequency (HF; 0.15-0.35 Hz, reflecting parasympathetic activity) and mid-frequency (MF; 0.05-0.15 Hz, reflecting sympathetic activity as well), derived from spectral and cross-spectral analysis of spontaneous fluctuations in heart rate and blood pressure. Twenty-six (10 women) sedentary, healthy, normotensive elderly (mean 68 years, range 62-81 years) subjects were studied. Fourteen (4 women) of the sedentary elderly subjects completed 6 weeks of aerobic training, while the other 12 (6 women) subjects completed 6 weeks of yoga. Heart rate decreased following yoga (69 +/- 8 vs. 61 +/- 7 min-1, P < 0.05) but not aerobic training (66 +/- 8 vs. 63 +/- 9 min-1, P = 0.29). VO2 max increased by 11% following yoga (P < 0.01) and by 24% following aerobic training (P < 0.01). No significant change in alpha MF (6.5 +/- 3.5 vs. 6.2 +/- 3.0 ms mmHg-1, P = 0.69) or alpha HF (8.5 +/- 4.7 vs. 8.9 +/- 3.5 ms mmHg-1, P = 0.65) occurred after aerobic training. Following yoga, alpha HF (8.0 +/- 3.6 vs. 11.5 +/- 5.2 ms mmHg-1, P < 0.01) but not alpha MF (6.5 +/- 3.0 vs. 7.6 +/- 2.8 ms mmHg-1, P = 0.29) increased. Short-duration aerobic training does not modify the alpha-index at alpha MF or alpha HF in healthy normotensive elderly subjects. alpha HF but not alpha MF increased following yoga, suggesting that these parameters are measuring distinct aspects of the baroreflex that are separately modifiable.


Percept Mot Skills 1997 Feb;84(1):251-7
Comparison of changes in autonomic and respiratory parameters of girls after yoga and games at a community home.
Telles S, Narendran S, Raghuraj P, Nagarathna R, Nagendra HR.

Vivekananda Kendra Yoga Research Foundation, Bangalore, India.
The heart rate, breathing rate, and skin resistance were recorded for 20 community home girls (Home group) and for 20 age-matched girls from a regular school (School group). The former group had a significantly higher rate of breathing and a more irregular breath pattern known to correlate with high fear and anxiety, than the School group. Skin resistance was significantly lower in the School group, which may suggest greater arousal, 28 girls of the Home group formed 14 pairs, matched for age and duration of stay in the home. Subjects of a pair were randomly assigned to either yoga or games groups. For the former emphasis was on relaxation and awareness, whereas for the latter increasing physical activity was emphasized. At the end of an hour daily for six months both groups showed a significant decrease in the resting heart rate relative to initial values (Wilcoxon paired-sample rest), and the yoga group showed a significant decrease in breath rate, which appeared more regular but no significant increase in the skin resistance. These results suggest that a yoga program which includes relaxation, awareness, and graded physical activity is a useful addition to the routine of community home children.


Indian J Physiol Pharmacol 1996 Jan;40(1):58-64
Svara (nostril dominance) and bilateral volar GSR.
Mohan SM.

Institute for Yoga and Consciousness, Andhra University, Visakhapatnam.
The Svara yoga concept of Ida, Pingala and Susumna svara representing rest, active and turbulent states was examined in this study by recording nostril dominance (svara) and bilateral volar GSR (galvanic skin resistance) as an indicator of sympathetic activity under field and laboratory conditions. The sympathetic activity was low in Ida svara, followed by Pingala svara and was maximum in Susumna svara group of subjects under both field and laboratory conditions which agreed with the traditional Svara yoga description. The volar GSR on the right side more readily varied with svara, particularly so in the physically relaxed subjects of laboratory condition than the left volar GSR. The latter observation was worth noting because the subjects were right handed. The right side could be recommended as the standard site for recording volar GSR to closely reflect the sympathetic activity, particularly so when physical rest was given to subjects.


J Altern Complement Med 1996 Winter;2(4):479-84
Physiological measures of right nostril breathing.
Telles S, Nagarathna R, Nagendra HR.

Vivekananda Kendra Yoga Research Foundation, Bangalore, India.
This study was conducted to assess the physiological effects of a yoga breathing practice that involves breathing exclusively through the right nostril. This practice is called surya anuloma viloma pranayama (SAV). Twelve volunteers (average age 27.2 years +/- 3.3 years, four males) were assessed before and after test sessions conducted on two consecutive days. On one day the test session involved practicing SAV pranayama for 45 minutes (SAV session). During the test period of the other day, subjects were asked to breathe normally for 45 minutes (NB session). For half the patients (randomly chosen) the SAV session was on the first day and the NB session on the next day. For the remaining six patients, the order of the two sessions was reversed. After the SAV session (but not after the NB) there was a significant (P < .05, paired t test) increase in oxygen consumption (17%) and in systolic blood pressure (mean increase 9.4 mm Hg) and a significant decrease in digit pulse volume (45.7%). The latter two changes are interpreted to be the result of increased cutaneous vasoconstriction. After both SAV and NB sessions, there was a significant decrease in skin resistance (two factor ANOVA, Tukey test). These findings show that SAV has a sympathetic stimulating effect. This technique and other variations of unilateral forced nostril breathing deserve further study regarding therapeutic merits in a wide range of disorders.


Indian J Physiol Pharmacol 1995 Oct;39(4):418-20
Autonomic changes during „OM“ meditation.
Telles S, Nagarathna R, Nagendra HR.

Vivekananda Kendra Yoga Research Foundation, Bangalore.
The autonomic and respiratory variables were studied in seven experienced meditators (with experience ranging from 5 to 20 years). Each subject was studied in two types of sessions–meditation (with a period of mental chanting of „OM“) and control (with a period of non-targetted thinking). The meditators showed a statistically significant reduction in heart rate during meditation compared to the control period (paired ‚t‘ test). During both types of sessions there was a comparable increase in the cutaneous peripheral vascular resistance. Keeping in mind similar results of other authors, this was interpreted as a sign of increased mental alertness, even while being physiologically relaxed (as shown by the reduced heart rate).


Indian J Physiol Pharmacol 1994 Apr;38(2):133-7
Breathing through a particular nostril can alter metabolism and autonomic activities.
Telles S, Nagarathna R, Nagendra HR.

Vivekananda Kendra Yoga Research Foundation, Chamarajpet, Bangalore.
There is increasing interest in the fact that breathing exclusively through one nostril may alter the autonomic functions. The present study aimed at checking whether such changes actually do occur, and whether breathing is consciously regulated. 48 male subjects, with ages ranging from 25 to 48 years were randomly assigned to different groups. Each group was asked to practice one out of three pranayamas (viz. right nostril breathing, left nostril breathing or alternate nostril breathing). These practices were carried out as 27 respiratory cycles, repeated 4 times a day for one month. Parameters were assessed at the beginning and end of the month, but not during the practice. The ‚right nostril pranayama‘ group showed a significant increase, of 37% in baseline oxygen consumption. The ‚alternate nostril‘ pranayama group showed an 18% increase, and the left nostril pranayama group also showed an increase, of 24%. This increase in metabolism could be due to increased sympathetic discharge to the adrenal medulla. The ‚left nostril Pranayama‘ group showed an increase in volar galvanic skin resistance, interpreted as a reduction in sympathetic nervous system activity supplying the sweat glands. These results suggest that breathing selectively through either nostril could have a marked activating effect or a relaxing effect on the sympathetic nervous system. The therapeutic implications of being able to alter metabolism by changing the breathing pattern have been mentioned.


Holist Nurs Pract 1994 Jan;8(2):36-42
Use of alternative health therapies by people with multiple sclerosis: an exploratory study.
Fawcett J, Sidney JS, Hanson MJ, Riley-Lawless K.
Sixteen people with multiple sclerosis (MS) responded to a semi-structured questionnaire about their experiences with alternative therapies. No definition of alternative therapies was provided. Physical therapy, counseling, nutrition, and massage were the most frequently used alternative therapies. Other therapies included acupuncture, occupational therapy, aquatic therapy, Therapeutic Touch, yoga, passive exercise, and removal of mercury alloy tooth fillings. Almost two thirds of the respondents reported seeking an alternative health practitioner because traditional physicians offered no cure for MS. Just under one third of the respondents stated that the quality of their lives was improved by alternative therapies.


Int J Neurosci 1993 Nov;73(1-2):47-60
The effects of unilateral forced nostril breathing on the heart.
Shannahoff-Khalsa DS, Kennedy B.

Department of Medicine, University of California, San Diego 92103-8341.
Three experiments are described that employ impedance cardiography to monitor the effects of unilateral forced nostril breathing (UFNB) on the heart. Experiment 1 includes 7 subjects (4 males, 3 females) with a respiratory rate of 6 breaths/min (BPM). Experiment 2 includes 16 trials using one subject to examine the intraindividual variability, at 6 BPM. Experiment 3 includes 10 trials with the same subject in experiment 2, but with a respiratory rate of 2-3 breaths/s. This rapid rate of respiration is a yogic breathing technique called „breath of fire“ or „kapalabhatti“ and employs a very shallow but rapid breath in which the abdominal region acts like a bellows. All 3 experiments demonstrated that right UFNB increases heart rate (HR) compared to left. Experiment 1 gave 7 negative slopes, or lowering in HR with left nostril breathing and 7 positive slopes, or increases in HR with right nostril breathing, p = .001. The second and third experiments showed differences in HR means in which right UFNB increases HR more than left, p = .013, p = .001, respectively. In experiment 2 stroke volume was higher with left UFNB, p = .045, compensating for lower HR. Left UFNB increased end diastolic volume as measured in both experiments 1 and 2, p = .006, p = .001, respectively. These results demonstrate a unique unilateral effect on sympathetic stimulation of the heart that may have therapeutic value.


Int J Neurosci 1993 Nov;73(1-2):61-8
The effects of unilateral forced nostril breathing on cognitive performance.
Jella SA, Shannahoff-Khalsa DS.

Department of Psychiatry University of California, Davis 95817.
This study describes the effects of 30 minutes of unilateral forced nostril breathing on cognitive performance in 51 right-handed undergraduate psychology students (25 males and 26 females). A verbal analogies task modeled after the Miller Analogies and SAT Tests was used as a test of left-hemispheric performance and mental rotation tasks based on the Vandenburg and Kuse adaptation of Shepard and Metzler’s tests were used as spatial tasks for testing right-hemispheric performance. Spatial task performance was significantly enhanced during left nostril breathing in both males and females, p = .028. Verbal task performance was greater during right nostril breathing, but not significantly p = .14. These results are discussed in comparison to other cognitive and physiological studies using unilateral forced nostril breathing. This yogic breathing technique may have useful application in treating psychophysiological disorders with hemispheric imbalances and disorders with autonomic abnormalities.


Indian J Med Sci 1993 Oct;47(10):235-8
Physiological changes in sports teachers following 3 months of training in Yoga.
Telles S, Nagarathna R, Nagendra HR, Desiraju T.

Vivekananda Kendra Yoga Research Foundation, Chamarajpet, Bangalore, India.
1. This report shows that in a group of 40 physical education teachers who already had an average of 8.9 years physical training, 3 months of yogic training produced significant improvement in general health (in terms of body weight and BP reduction and improved lung functions).

2. There was also evidence of decreased autonomic arousal and more of psychophysiological relaxation (heart rate and respiratory rate reduction), and improved somatic steadiness (decreased errors in the steadiness test). 3. The changes at the end of 3 months in volar GSR in different directions (increase/decrease/no change), depending on the initial values, suggests that practising yoga may help to bring about a balance in different autonomic functions, so that functioning is optimised.


Int J Psychophysiol 1993 Sep;15(2):147-52
Autonomic changes in Brahmakumaris Raja yoga meditation.
Telles S, Desiraju T.

Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
This report presents the changes in various autonomic and respiratory variables during the practice of Brahmakumaris Raja yoga meditation. This practice requires considerable commitment and involves concentrated thinking. 18 males in the age range of 20 to 52 years (mean 34.1 +/- 8.1), with 5-25 years experience in mediation (mean 10.1 +/- 6.2), participated in the study. Each subject was assessed in three test sessions which included a period of meditation, and also in three control (non-mediation) sessions, which included a period of random thinking. Group analysis showed that the heart rate during the meditation period was increased compared to the preceding baseline period, as well as compared to the value during the non-meditation period of control sessions. In contrast to the change in the heart rate, there was no significant change during meditation, for the group as a whole, in palmar GSR, finger plethysmogram amplitude, and respiratory rate. On an individual basis, changes which met the following criteria were noted: (1), changes which were greater during meditation (compared to its preceding baseline) than changes during post meditation or non-meditation periods (also compared to their preceding baseline); (2), Changes which occurred consistently during the three repeat sessions of a subject and (3), changes which exceeded arbitrarily-chosen cut-off points (described at length below). This individual level analysis revealed that changes in autonomic variables suggestive of both activation and relaxation occurred simultaneously in different subdivisions of the autonomic nervous system in a subject. Apart from this, there were differences in patterns of change among the subjects who practised the same meditation.

Indian J Physiol Pharmacol 1993 Jan;37(1):45-50
Energy expenditure and ventilatory responses during Virasana–a yogic standing posture.
Rai L, Ram K.

Department of Physiology, Central Research Institute for Yoga, New Delhi.
Energy expenditure and ventilatory responses to yogic standing posture of Virasana were studied on 10 healthy men (25-37 years of age). The results of various responses respectively to the horizontal supine, Chair-sitting and Virasana were: Minute Ventilation (VE) 7.64, 8.61 and 18.67 L/min; Respiratory Frequency (FR) 15.71, 15.70 and 21.45 Breath/min; Tidal Volume (VT) 0.496, 0.544 and 0.827 L/min; Oxygen consumption (VO2) 0.127, 0.234 and 0.573 L/min; Carbondioxide Elimination (VCO2) 0.127, 0.134 and 0.420 L/min; Respiratory Exchange Ratio (RER) 0.58, 0.57 and 0.69; Heart Frequency (FH) 65.2, 74.5 and 104.4 beats/min; Oxygen Pulse (O2P) 3.32, 3.17 and 5.45 ml/beat; Ventilatory Equivalent (VE-EQ) 36.78, 37.12 and 33.85; Multiple of Resting VO2 (METS) 0.96, 1.05 and 2.53 and Metabolic Cost (MC) 1.04, 1.13 and 2.76 Cal/min. Virasana posture was characterised by higher VE, FR, VT, VO2, VCO2, FH and O2P with lesser VE-EQ. The observations suggest that Virasana induces temporarily a hypermetabolic state characterised by enhanced sympathetic nervous system activity which gets inhibited during the adoption of resting supine shavasana posture


Indian J Physiol Pharmacol 1989 Apr-Jun;33(2):110-2
Effect of yogasanas on the visual and auditory reaction time.
Malathi A, Parulkar VG.

Department of Physiology, Topiwala National Medical College, Bombay.
Visual and auditory reaction time (VRT, ART) was studied in 83 healthy male subjects of 30-40 years of age who had never practiced yogasanas before. These subjects were divided into two groups viz. Group A whose VRT and ART was determined after 1 hr. yogasanas and Group B whose ART and VRT was determined after 6 weeks yogasanas training programme. VRT and ART showed a significant reduction in Group A (P less than .05) and Group B (P less than .001).


Indian J Physiol Pharmacol 1988 Oct-Dec;32(4):257-64
Autonomic responses to breath holding and its variations following pranayama.
Bhargava R, Gogate MG, Mascarenhas JF.

Department of Physiology, Goa Medical College, Bombolim.
Autonomic responses to breath holding were studied in twenty healthy young men. Breath was held at different phases of respiration and parameters recorded were Breath holding time, heart rate systolic and diastolic blood pressure and galvanic skin resistance (GSR). After taking initial recordings all the subjects practised Nadi-Shodhana Pranayama for a period of 4 weeks. At the end of 4 weeks same parameters were again recorded and the results compared. Baseline heart rate and blood pressure (systolic and diastolic) showed a rendency to decrease and both these autonomic parameters were significantly decreased at breaking point after pranayamic breathing. Although the GSR was recorded in all subjects the observations made were not conclusive. Thus pranayama breathing exercises appear to alter autonomic responses to breath holding probably by increasing vagal tone and decreasing sympathetic discharges.


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