Yoga Theses by PhD students
Permanent URI for this collectionhttp://192.168.0.109:4000/handle/123456789/12
Yoga Theses by Yoga PhD Students at SVYASA. These pages present some efforts at Scientific Validation of Yoga. You may receive full text of available yoga research papers
News
Yoga Theses
Browse
4 results
Search Results
Item YOGA AND DIABETES: A MULTI-CENTRIC RESEARCH STUDY(SVYASA, 2021-01) Venkatrao, Muralidhar; Nagendra, H. R.; Nagarathna, RaghuramType 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.Item Potential of Rasahara and yoga in treatment of pre diabetes - A controlled trial(S-VYASA, 2017) Datey, PurnimaFood which is pre-digested and full of vitamins and minerals of all kinds should be taken to ful-fill all bodily requirements. Such food is safe to eat even when blood sugar levels are increased. Food substances should be selected for easy digestion, so that the digestive system works less as for progress on the spiritual path. This thesis hypothesized that swarasa (freshly prepared herbal juices) taken as a food supplement to replace breakfast has more therapeutic value than traditional breakfast, and are therefore to be preferred. Many Āyurveda texts like Yoga Ratnākara, describe the subtle therapeutic importance of swarasa as well as whole herbs. This study discusses forms in which herbs should be taken, Guṇas of herbs and their food supplements, effects on the body, and quantities appropriate for best nutrition. Their many health benefits make raw foods like fresh fruits and vegetables, herbs, grains, nuts, and sprouted grains, with more vitamins and minerals than cooked foods. Important dietary components. All are healthy additions to a regular diet providing missing nutrients; nor do they deposit or develop disease-generating Āma (toxins). Many studies have investigated food-related ingredients, such herbs to reduce sugar levels, for newly detected Type 2 Diabetes mellitus (T2DM). Others show how meal time relates to weight loss. Some show that yoga relaxation programs like Cyclic Meditation reduce sugar levels in both new and old T2DM patients. This study reports combined effects of Rasāhāra and Yoga. In Āyurveda, diet is a primary pillar of health. Food is an internal factor contributing to health and disease. The review of ancient literature quotes texts stating the importance of Āhāra-Vihāra for Prameha. Right herbs in correct quantity can restore their health. The scientific literature review concerns importance of breakfast modification, properties of the four herbs and yoga practices used to treat early T2DM and other diseases, to restore health and wellbeing. The study aim was to conduct a 3-arm controlled trial assessing effects of Rasāhāra and Yoga, or Yoga only on T2DM, metabolic disorder, and prameha markers in early T2DM. Objectives included recruiting enough participants to obtain required significances; measuring 5 biomedical parameters every 15 days; pre-post assessment of 10 other biomedical parameters, Āyurveda doša balas and related variables; to maintain participants on a regimen restricting variations in diet and lifestyle; and to evaluate any adverse events or side effects. Methods: The study was conducted at Bhopal Central Jail on male subjects, aged 18 to 70 years. Inclusion criteria: pre-T2DM patients with blood sugar levels, FBS: 100-170; PPBS: 150-220 mg/dl. Exclusion criteria: inability to practice Yoga; very low BMI; mental disorder; already with diabetes complications. Jail Hospital authorities helped with data extraction costs. The design was a three-arm controlled trial as above, with wait-listed controls under physician’s observation. Interventions were as described above: the four Rasāhāra herbs were Wheatgrass (Triticum Aestivum), Āmalaki (Emblica officinalis Gaertn), Guḍuci (Tinospora cordifolia), and Vāsā (Adhatoda vasica Nees) The Yoga program for Diabetes to Group 1 & 2. Group 2 ate normal breakfast. Group 3 (Controls) followed their normal jail routine. Assessments measured T2DM Markers (BMI, HbA1c, FBS, & PPBS); related parameters, lipid profile, SBP, DBP & pulse rate, Haemoglobin and creatinine; Breath Holding Time (Bhrāmari), and Doṣa Balas and related Guṇas. Data collection was by blinded Jail Hospital personnel. All blood samples were analysed blind to participant groups and trial hypotheses at Śagun Pathology laboratories, Bhopal. Data analysis used Excel and Graph Pad QuickCalcs, and SPSS-20 at S-VYASA. Results were as follows: for Conventional T2DM Markers BMI no changes; FBS and PPBS decreased for Groups 1 & 2, and increased for Group 3; Hb1Ac remained steady for Groups 1 & 2, but increased for controls. Blood lipid levels Groups 1 & 2 tended to improve values of ‘good’, and decrease values of ‘bad, lipoproteins; Controls did the reverse. Heart and hypertension parameters showed consistent decrease in standard deviations for Groups 1 and 2 implying that Yoga’s influence is to normalize blood pressure, correcting hypertension and raising low blood pressure: striking results. Changes in Hb levels were good in Group 1, none in Group 2, but decrease in Group 3. Changes in Creatinine levels: Groups 1 and 2 improved, but Group 3 got worse agreeing with other studies on Yoga and CKD. Group differences imply that Yoga helps prevent nephropathy, T2DM’s deadly complication. Breath holding time increased significantly in both Groups 1 and 2 while it decreased in control group. Seasonal Change: systematic shifts at change of season were a Post hoc discovery of importance to all medical science. Though stated in Āyurveda, the phenomenon is not known to medical science. This first study of Rasāhāra and Yoga for pre-diabetes in a prison setting in India shows that prisoners can benefit from yoga prison programs, especially those with elevated blood sugar and blood pressure levels. Follow-up studies should obtain more robust data so that Yoga may be added to India’s prison programs. The study was the first to confirm Rasāhāra’s value as a food supplement replacing normal breakfast. Those not practicing yoga regularly increased BP and pulse rates. Initially, all participants showed increased Kapha-Pitta Doṣa Balas confirming Āyurveda texts. Group 1 improved in Kapha-Pitta more than Group 2, both did better on all Dosha Balas than controls, confirming the values of their interventions. Results point to the efficacy of IAYT Yoga practice combined with strict āhāra-vihāra for treatment of newly diagnosed T2DM, especially benefits of breakfast modification. Addition of Rasāhāra herbal juices is a cheap alternative to long-term use of chemical drugs, which fail to improve underlying pathology. They support all study hypotheses. Further studies of Rasāhāra treatment are merited, particularly in rural areas, where it would be easy to implement.Item EFFECT OF YOGA ON AMBULATORY GLUCOSE PROFILE IN TYPE 2 DIABETES MELLITUS(S-VYASA, 2019-01) Venugopal, V.; Mavathur, Ramesh; Sharma, Manjunath N KManagement of diabetes and its complications are laying a huge burden in the economy of developing nations like India, with the annual expenditure for the management of diabetes accounting to US$ 727 billion, of which major portion is spent on the direct and indirect costs related to the ‘complications’ of diabetes. There is growing interest in alternative and holistic model of care which is evidence-based. Yoga is a mind/body practise which is increasingly used in the management of many modern non-communicable diseases (NCDs) including type 2 diabetes and its complications. Glycemic variability is an emerging target for diabetes management, along with HbA1C and plasma glucose levels. Glycemic variability is known to induce excessive oxidative stress and is an independent risk factor for the complications of diabetes and increased risk of mortality. AIM AND OBJECTIVES To study the effect of yoga on glycemic variability and mean daily glucose levels in patients with type 2 diabetes in comparison to the active control group (walking). The objectives were to study the effect of (i) Intraday variability (ii) Interday variability and (iii) mean daily glucose levels. METHODS Participants A total of 60 participants with diagnosed type 2 diabetes with HbA1C between 7% - 8.5% were recruited for the study from a private diabetes specialty hospital in Chennai.Design Participants were randomly assigned either to the intervention group or the active control group of walking using a computer generated block randomisation, with six participants per block. Allocation concealment was carried out using sequentially numbered opaque sealed envelope (SNOSE), maintained by a person who was not directly involved in the project. Assessments Continuous glucose monitoring (CGM) was carried out using flash glucose monitoring system, Freestyle Libre Pro (Abbott Diabetes Care Ltd., Oxon, UK), applied on the non-dominant backside upper arm of the participants, which measures glucose levels every 15 minutes for a period of 14 days continuously. Of which, the first 7 days were utilised for establishing baseline in the glycemic variability, while in the following 7 days, the participants underwent either yoga sessions or the control sessions. Data was extracted using the EasyGV software to calculate various measures of glycemic variability. Intervention During the experimental yoga sessions, a validated yoga module was taught for duration of one hour including breathing practices, relaxation, asanas, pranayama and meditation. Control group went for walking for a similar duration of one hour everyday as well. Log book was maintained to know the adherence rate. Data Analysis Data analysis was done using statistical package for social sciences (SPSS)- version 24.0. Earlier glycemic variability was calculated using the EasyGV sotware (version 9.0) (www.phc.ox.ac.uk). RESULTS AND DISCUSSIONS Of the 60 participants included in the study, 57 participants completed the study, with three drop outs. After seven days of intervention, the mean daily glucose levels reduced by 23.99 mg/dL (p<0.001) when compared to 8.69 mg/dL (p<0.05) in the control group, with statistically insignificant difference between groups (p>0.05). However, glycemic variability between groups was statistically significant in the measures of intraday glycaemic variability, inter-day glycemic variability and also overall glycemic variability. CONCLUSION Glycemic variability strongly correlates with β-cell dysfunction and yoga thus might be helpful in better management of in β-cell dysfunction T2DM. The need for an effective and cost-efficient treatment strategy in the secondary prevention of T2DM is increasing. Future implications of yoga in the management of T2DM and preventing complications of T2DM are very promising, with lesser risk of hypoglycaemia and glycemic variability.Item Management of obesity and diabetes mellitus through yoga and naturopathy(S Vyasa, 2015-01-12) Shetty, PrashanthMetabolic syndromes is a disorder of energy utilization and storage, diagnosed by a co-occurrence of three out of five of the following medical conditions: sdbominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and high-density cholesterol (HDL) levels. non-communicable diseases, which include diabetes mellitus and cardiovascular disease, are world's biggest killer diseases, estimated to cause 3.5 million deaths each year. Eighty percent of them are found in the low and middle-income countries. The WHO has developed an action plan for complementation of global strategies in prevention and control of non-communicable diseases. One of the objectives of this plan is develop simple strategies to identify those at risks together with appropriate and cost effective interventions.