Browsing by Author "Nagendra, H. R."

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(S Vyasa, 2016-11-07) Nagendra, H. R.
Use of integrated approach of yoga therapy and ayurveda in the management of migraine headache
(S-VYASA, 2019) Sharma, Vasudha M.; Nagendra, H. R.
Background: There is a rise in the need for Complementary and Integrative medicine to provide long-term healing solutions in non-communicable diseases in general and Migraine Headache in particular. Knowing the limitations of conventional medical approach, the present study therefore evaluated the influence of the two Indian traditional systems of medicine, i.e., Ayurveda and Yoga as an integrative medical intervention. Changes following the use of Ayurveda and Yoga therapy were studied on symptoms, migraine-related disability, perceived stress, autonomic variables, muscle activity and quality of life in patients with migraine headache without aura. Aims and Objective: • To compile and understand the concept of migraine headache according to Ayurveda and Yoga texts. • To scientifically validate the use of Ayurveda and Yoga in the management of migraine headache without aura. Methodology: This study was a Prospective, Open labelled, matched control trial comparing an Ayurveda- Yoga group (AY) with a Control group (CT) on symptomatic conventional treatment. 30 subjects who were recruited to Ayurveda and Yoga (AY) group underwent traditional Pañcakarma (Bio-purification) using Virecana (therapeutic purgation) followed by Yoga therapy, while 30 subjects matched for age and gender belonging to the Control (CT) group continued on symptomatic treatment (NSAID's) for 90 days. The subjects of both groups were administered the Suśruta Prakṛti Inventory on day 1 to understand individual body constitution. A Comprehensive Headache-related Quality of life Questionnaire (CHQQ) and Visual analogue scale (VAS) were administered on day 1 and day 90 of the study. The symptom checklist, migraine disability assessment score, perceived stress, heart rate variability and surface electromyography of Frontalis muscle were measured on Day 1, Day 30 and Day 90 in both groups. Data were analysed using Repeated Measures of ANOVA followed by a post-hoc analysis with Bonferroni correction. Results: Out of the 60 subjects belonging to both groups, 46 (76.6%) had Pitta based Prakṛti either as pravara (primary) or as madhyama (secondary)). Following 90 days of intervention the AY group showed significant reduction in the migraine related symptoms viz., number of attacks, duration of each attack, associated with nausea and vomiting, severity of headache and analgesic requirements. The pain intensity reduced significantly (p<.001). There was a significant reduction in migraine disability and perceived stress scores were seen in AY group (P<.001). The low-frequency component of the heart rate variability decreased significantly, the high-frequency component increased and their ratio showed improved sympatho-vagal balance. The root mean square of the electromyography signal and integral electromyography of the frontalis muscle decreased in the AY group compared to the control group. There was a significant improvement in the total score of headache related Quality of Life (p<.001). Conclusion: An Integrated Yoga therapy and Ayurveda based intervention reduces symptoms, intensity of pain, migraine related disability and perceived stress. It also reduces the sympathetic arousal and muscle tension therefore improving the quality of life in migraine patients.
YOGA AND DIABETES: A MULTI-CENTRIC RESEARCH STUDY
(SVYASA, 2021-01) Venkatrao, Muralidhar; Nagendra, H. R.; Nagarathna, Raghuram
Type 2 diabetes mellitus (T2DM) is a highly prevalent public health problem and a significant cause of morbidity and mortality in India. With over 77 million individuals diagnosed with T2DM, the burden of this disease is already huge. But there are two additional dimensions which make the potential public health burden of T2DM even greater: (a) studies indicate that about a third of the cases of diabetes remain undiagnosed and (b) the risk of progression from prediabetes to diabetes, and the pace of this progression, are both much higher among Indians as compared to other populations. Thus, there is urgent need to quantify the scale of the problem – that is, to get a robust estimate of the prevalence of diabetes – so that proper public policy can be shaped. Equally important is to implement preventative protocols for individuals at high-risk of progressing to diabetes. Aiming for prevention at prediabetes stage (which is the stage of increased diabetes risk) may be too late for the Indian population, given the much quicker progression to diabetes from this stage. It is more efficacious to aim preventative protocols at an earlier stage, before prediabetes. This points to the need for a simple, widely implementable, multi-variate risk score for identifying high-risk individuals, potentially even before the stage of prediabetes. The Indian Diabetes Risk Score (IDRS), which is widely used in India, needs to be validated at a nationwide level, and potentially improved to consider better measures of obesity. Once an individual is deemed to be in the high-risk category, there exist several preventative interventions including (but not limited to) Metformin therapy, increased physical activity, and dietary control. Another intervention is the ancient technique of Yoga. In ancient Yoga texts, repeated mention is made of the efficacy of Yogic practices to benefit diabetes risk factors such as reducing obesity, mitigating effects of chronic stress, fostering an active lifestyle and encouraging better dietary choices. This is especially the case with the practices of Haöha Yoga, including techniques that have made Yoga famous the world over: äsana (physical postures), ñaö-karma (purification practices), präìäyäma (breathing exercises), etc. A thorough examination of Haöha Yoga Pradépika reveals that these techniques reduce β cell dysfunction and increase insulin sensitivity via multiple pathways, thereby bringing about diabetes risk reduction and glycemic control. Existing scientific studies provide a preponderance of evidence to back the claims of Yogic texts. Specifically, we find studies reporting that (a) Yoga is effective in mitigating diabetes risk factors such as obesity and stress (b) Yoga effects glycemic control in individuals with diabetes and (c) the mind-body integrative aspect of Yoga fosters behavioral modifications that help one sustain better nutritional habits and a more active lifestyle. These findings hint strongly that a Yoga-based Lifestyle Protocol (YLP) can be a very effective adjunct to both prevention of diabetes and for glycemic control among individuals with diabetes. While YLP has been studied in smaller cohorts and/or in controlled circumstances where it is easier to ensure adherence to the protocol, it has not yet been studied in a large community setting to determine whether it has the necessary characteristics of simplicity, accessibility, and inexpensiveness so that it can be applied as a mitigation to a public health problem (diabetes risk reduction and glycemic control). AIMS AND OBJECTIVES The present study seeks to analyze data from Niyantrita Madhumeha Bharata Abhiyaan 2017 (Diabetes Free India Study 2017, hereinafter simply NMB-2017) to (a) improve the screening characteristics of the Indian Diabetes Risk Score (IDRS) by incorporating a better anthropometric measure of obesity, so that it can be used in the field to identify individuals who have a high risk of developing diabetes (b) test the potency of yoga-based lifestyle protocol (YLP) against diabetes risk reduction among high-risk individuals who are not yet in the prediabetes stage, in a large community setting and (c) test the efficacy of yoga as an adjunct to standard care for glycemic control among individuals with diabetes. METHODS PARTICIPANTS This study included three separate analyses: (a) Using a better measure of obesity to increase specificity of IDRS Using data from a nationwide randomized cluster sample survey (NMB-2017 Phase 2), 7496 adults at high risk for type 2 diabetes (as determined by IDRS ≥ 60) were analyzed. Waist Circumference (WC), Body Mass Index (BMI), and a composite obesity measure combining the two (BMIWC) were evaluated using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy). These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI and BMIWC, and calculating Sensitivity, Specificity, and Accuracy. (b) YLP for diabetes risk reduction In a cluster randomized trial (NMB-2017 Phase 2) in 80 clusters from India, participants with normal HbA1c (< 5.7%) but screened for diabetes risk (IDRS ≥60) were randomly assigned in a 1:1 ratio to intervention and control groups, n=2316:2134, respectively. The primary outcome was conversion from normoglycemia to diabetes. Absolute and Relative risk reductions were estimated based on marginal probabilities. (c) YLP for glycemic control In a cluster randomized trial (NMB-2017 Phase 2) in 80 clusters from India, participants with prior diagnosis of diabetes and/or HbA1c levels in diabetes range (≥ 6.5%) were randomly assigned in a 1:1 ratio to intervention and control groups, n=1820:1572, respectively. Mean HbA1c reduction was calculated for each group, and independent samples t-test was used to test significance. Heterogeneity of treatment effects were calculated for subgroups with fair and poor glycemic control. DESIGN NMB-2017 was a pan-national, two-phased study. Phase 1 was a nationwide cross sectional survey using a multi-level stratified cluster sampling technique with random selection among urban and rural populations, with the objective of collecting data on diabetes status and diabetes risk. Phase 2 was a sub-sample of phase-1 participants who were deemed high-risk (as determined by IDRS ≥ 60) or had a previous diagnosis of diabetes. Phase 2 participants went through further assessments in the form of blood tests and more detailed questionnaire. ASSESSMENTS i. Anthropometric measures (ordinal): Height (in cm), Weight (in kg), and Waist Circumference (in cm) ii. Derived measures (ordinal): BMI [Weight(in kg)/Height(in m)2 ] iii. Blood HbA1c levels (in DCCT %) (Ordinal) iv. Via questionnaire (Categorical): Age, Family history of Diabetes, and levels of physical activity. Note: The questionnaire collected more information than detailed here (see Appendix 5), but they were not used in this analysis. INTERVENTION Intervention included practice of yoga-based lifestyle modification protocol (YLP) for 9 consecutive days, followed by daily home and weekly supervised practices for 3 months. In the diabetes risk reduction study, the control-cluster received standard of care advice for diabetes prevention. In the glycemic control study, the control-cluster received standard care for T2DM. RESULTS Study 1 BMIWC had higher OR (2·300) compared to WC (1·87) and BMI (2·26). WC, BMI, and BMIWC were all highly Sensitive (0·75, 0·81, 0·70 resp.). But BMIWC had significantly higher Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and IDRSBMIWC were all highly Sensitive (0·87, 0·88, 0·82 resp.). But IDRSBMIWC had significantly higher Specificity (0·39) compared to IDRSWC and IDRSBMI (0·30, 0·31 resp.). Study 2 Among individuals at high risk for diabetes (as determined by IDRS ≥ 60) but with normal glycemic levels at baseline, the YLP was found to be significantly effective in halting progression to diabetes as compared to standard of care (RRR 68.64%, 95% CI 64.73 – 73.48). Study 3 Among individuals with diabetes, YLP showed a significantly greater reduction in HbA1c levels (µ=1.31, σ=1.40) compared to control arm (µ=0.45, σ=0.55); t(∞) = 22.68, p < 0.001. This effect was even more pronounced in individuals with poor glycemic control at baseline, with the difference in mean reduction of HbA1c levels between yoga and control being significantly higher (µ=1.61, σ=1.29) compared to individuals with fair glycemic control at baseline (µ=0.35, σ=0.83); t(∞) = 15.73, p < 0.001. COLCULSIONS Both WC and BMI are good predictors of risk for T2DM, but BMIWC is a better predictor, with higher Specificity; this may indicate that Indians with high values of both central (high WC)and general (BMI> 23) obesity carry higher risk for type 2 diabetes than either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and Specificity. Substantive influence of yoga-based lifestyle intervention was observed against diabetes risk reduction on the high-risk Indian cohort. Among individuals with diabetes, YLP reduced glycemic levels, with the effect being more significant in people who had poor glycemic control to begin with. This might indicate that YLP can be very valuable clinically as an adjunct to standard treatment for individuals whose serum glucose levels are not responsive to standard care. Overall, our findings point to the efficacy of YLP as an effective strategy to combat the epidemic of diabetes from both preventative and treatment perspectives.
Yoga Sudha
(S Vyasa, 2015-05-01) Nagendra, H. R.
Yoga Sudha
(S-Vyasa, 2017-03-06) Nagendra, H. R.; Arathi, Jagannathan
Notwithstanding the great contributions of modern medical system its failure to cure NCDs has necessitated integration of traditional systems of health care. Yoga provides a robust platform for such integration. In Prashanti Kutiram, Arogyadhama has shown the usefulness of add on Yoga Therapy to allopathy over 3 decades. Further integration of Ayurveda, Naturopathy, Physiotherapy, Acupuncture has shown not only greater effectiveness but also faster recovery towards normalcy.
Yoga Sudha
(S Vyasa, 2017-01-12) Nagendra, H. R.; Arathi, Jagannathan
Yoga Sudha
(S Vyasa, 2016-11-09) Nagendra, H. R.; Arathi, Jagannathan
Yoga Sudha
(Nagendra, H. R., 2016-03-03) Nagendra, H. R.; Arathi, Jagannathan
We saw in the editorial last month that the Panchakosha Model can provide a nice philosophical, scientific basis for Integration of the Modern Allopathic System with our ancient Indian AYUSH System. The need of the hour is to develop a Holistic Pluralistic Health-care Delivery System which provides evidence based modalities for prevention, promotion of positive health, immediate relief to the patients, effective treatment with least side effects, long term rehabilitation on one hand and cost effective, sustainable system which can be replicated and scaled up all over the country in both urban and rural sectors. So far over the last 4 decades, VYASA / S-VYASA have been able to use Yoga as an effective adjunct to modern medical system to deal with modern NCDs and developed a nice model in Arogyadhama as a residential 250 beds treatment centre in Prashanti Kutiram campus. We also have developed the outpatient clinical model for integrated system in cities as VH, VYG, etc which have started fast spreading. Andhra Government has come forward to ask us to set up such centres in 7 temple cities of the state. Shanghai centre in China has started operating with wonderful results.
Yoga Sudha
(Mahadevappa B. on behalf of S-VYASA, 2024-04-06) Nagendra, H. R.; Aarti Jagannathan
Yoga Sudha
(S Vyasa, 2015-12-03) Nagendra, H. R.
In modern times, management of noncommunicable diseases has become an enormous challenge to the medical fraternity worldwide. It is increasingly being recognized that non-communicable diseases are multifactorial problems and therefore the solutions to these have to be multi-faceted. Evidence based approach is of utmost importance to provide the best possible care for the patients. Equally important is to develop cost-effective treatments.
Yoga Sudha
(S Vyasa, 2015-02-01) Nagendra, H. R.
Yoga Sudha
(Nagendra, H. R., 2016-04-03) Nagendra, H. R.; Arathi, Jagannathan
Integration of all systems of health care is the necessity of the new era. No single system has been found to deal with all ailments both contagious and NCDs. Pluralistic system of health care is emerging. Our conference in January brought the best findings of both allopathic and the AYUSH systems. The Indo-US conference in Delhi also highlighted the same. Our experience in Arogyadhama is helping us to understand the process of integration. As a pilot study the experiments over the last 5 years has clearly shown that integration can bring better and quicker results than Yoga Therapy and allopathy combination. With this experience we have now planned for a Multi-speciality, tertiary care integrative medical hospital of about 1500 beds in Prashanti Kutiram campus. We seek all assistance to make it a reality by your financial support for this unique project which will become a role model for future hospitals in India and all over the world.
Yoga Sudha
(Nagendra, H. R., 2016-02-03) Nagendra, H. R.; Arathi, Jagannathan
EDITORIAL Modern medicine rooted in the bio-medical model with a matter-based paradigm will offer proven solutions to most communicable diseases, to diagnose NCDs, large number of surgeries for setting right abnormalities and even replacing different parts of our body as we do it in machines. Due to the inadequacy of modern medical system in curing NCDs and escalating costs of treatment, integrative processes are being increasingly accepted. Integration of modern medicine and AYUSH systems is the need of the hour to deal with communicable and noncommunicable diseases. AYUSH systems rooted in consciousness based approach deals with human beings in totality and origin of NCDs as Adhis at mind level becoming Vyadhis at physical level. Can we provide a basic philosophy for this integration or symbiosis? Then we can use the best of each system to give the best results. It is time to evolve a pluralistic Health Care delivery system with modern system as an aggressive fore-front and using AYUSH as a strong defense to bring a symbiotic combination to deal with all diseases. H. R. Nagendra
Yoga Sudha
(S Vyasa, 2015-08-03) Nagendra, H. R.
Thanks to the tremendous support of the Prime Minister Shri Narendra Modi Ji, the whole world became ‘Yoga mayam Jagat’ and Rajpath became Yoga Path on 21st June. National Council of Teacher Education (NCTE) has prepared the curriculum to introduce Yoga education for teachers from preprimary to Med. Even NCERT has introduced Yoga for students and is made compulsory for students from 6th to 12th standard. The standard Yoga Teachers competency model has been developed by AYUSH Ministry and Quality Council of India (QCI), on success full completion of the exam based on the competency model evolved one can become a Yoga teacher. For all these rapid developments, especially with Yoga, we thank the Prime Minster for his support. After, we being entrusted with the responsibility of Chairman of the Technical Expert Committees S-VYASA has come to the forefront. Now it’s our greatest responsibility to take all these yoga related activities in the right direction and to the forefront to attain success, as done during International Day of Yoga (IDY) by creating two world records, and this could be attributed to the co-operations of all Yoga masters in our country. We are proud to place on record their vital contributions for the success and seek their continued co-operation, in all our future endeavors.
Yoga Sudha
(S Vyasa, 2015-04-01) Nagendra, H. R.
Yoga Sudha
(S Vyasa, 2016-10-09) Nagendra, H. R.; Arathi, Jagannathan
Yoga Sudha
(2015-03-01) Nagendra, H. R.
Yoga Sudha
(S Vyasa, 2016-12-09) Nagendra, H. R.; Arathi, Jagannathan
Yoga Sudha
(S Vyasa, 2015-11-03) Nagendra, H. R.
Thanks to our team, the preparations for 21st INCOFYRA are in full swing. Development of infrastructure on one front and the speakers list on the other. Normally, in any modern medicine conferences there is one subject – Diabetes / cardiology / Hypertension / Psychiatry /Oncology. Never together to create a holistic outlook and integration. The modern medical practice has become so specialised that the holistic view is totally lost. But most pharmaceutical interventions are done to tackle only one organ. So this conference of specialists from all four different areas of common ailments is the first of its kind. The scenario is not much different even in AYUSH. This conference intends in bringing Specialist / Researchers from all these fields for integration.
Yoga Sudha
(Nagendra, H. R., 2016-06-03) Nagendra, H. R.; Arathi, Jagannathan
"Making India the preferred destination for Holistic Health care" for the world has been the theme of the Ministry of Tourism as also the Ministry of External Affairs (MEA). This week there was a meeting of 5 medical experts from USA, one each from UAE, Malaysia, South Africa apart from the top medical experts from India in Delhi as a part of the Bharatiya Pravasi Diwas (Jan 9-11) organized by MEA chaired by MoS for MEA General V K Singh (Rtd.) in Jawaharlal Nehru Bhavan in Janpath Road, New Delhi. The interest shown by all the participants to join hands to facilitate this aspect of the MEA brought out clear means for achieving the same. The role of AYUSH was highly appreciated especially in the treatment of Modern NCDs by all which can give India a big edge. However the limitations and bottle necks for the same on one hand and tremendous potentialities on the other hand were delineated. Need of research, quality treatment assurance by well trained professionals of Holistic health care was emphasized. Hospitals offering holistic health care have to be identified for the same and put on the web of MEA and promoted in all mission centres of MEA, ease of getting VISA for medical treatment, for getting training in holistic health care, research collaborations, etc. were the key issues discussed. It has been decided to form a Google team to interact each other to take things further.