Introduction: Previous studies have suggested that yoga may have a positive impact on lung function and quality of life (QoL) and hence the present prospective two-arm single-blinded controlled study evaluated effect of adjuvant yoga therapy on pulmonary function and QoL of patients with Chronic Obstructive Pulmonary Disease (COPD).
Material and methods:In this interdisciplinary collaborative work, 72 COPD patients were recruited after obtaining informed consent and randomized to yoga group (22 M and 14 F) who received adjuvant yoga therapyin addition to standard medical management and control group (20 M and 16 F) who received only medical management. Yoga therapy protocol validated by CYTER was used and this included loosening exercises, postures (asanas), vitalising breathing techniques (pranayama) and relaxation. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1) and FEV1/FVCwere measured using standard computerized pulmonary function test ‘Trueflow (ndd)’ before and after study period of 4 weeks. Saint George Respiratory Questionnaire (SGRQ) was used to asses QoL. Changes in pulmonary function parameters were correlated with QoL (symptoms, activity, impacts and quality) scores. Intra-group comparisons were done using Student’s paired ‘t’ test and intergroup comparisons using unpaired ‘t’ test.
Results:There was significant improvement (p < 0.01) in body weight, BMI, FVC and FEV1 after four weeks of adjuvant yoga therapy while controls showedsignificant decline in all parameters. There were improvements in all QoL scores, namely symptoms score (p<0.001) and activity score (p<0.05), impacts score (p<0.01) and quality score (p<0.001)in yoga group while no significant changes in controls.Significant correlation was found between pulmonary function and QoL in Yoga group.
Discussion:Significant improvements of lung function with adjuvant yoga therapy can be attributed to comprehensive yoga therapy package administered to participants. This may be due to with decreased airway resistance and better lung compliance attributed to nonspecific broncho-protective or broncho-relaxing effect. Significant improvement in QoL scores implies patients were able to participate in more activities than earlier, and this can be attributed to improved vital capacity as well as enhanced self-confidence /self-reliance. Our results are consistent with previous such studies and we conclude that yoga has a positive and additive role as an adjuvant therapy along with standard medical management of COPD.
1. Viegi G, Pistelli F, Sherrill DL, Maio S, Baldacci S, Carrozzi L. Definition, epidemiology and natural history of COPD. Eur Respir J 2007; 30: 993-1013.
2. Liu X-C, Pan L, Hu Q, Dong W-P, Yan J-H, Dong L. Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Journal of Thoracic Disease. 2014 ;6(6):795-802.
3. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187: 347-65.
4. Georgopoulas D, Anthonisen NR. Symptoms and signs of COPD. In: Cherniack NS, editor. Chronic Obstructive Pulmonary Disease. Toronto, ON, Canada: W.B. Saunders; 1991. p. 357–63.
5. Bhavanani AB. Yoga Chikitsa: The Application of Yoga as a Therapy. Pondicherry, India: Dhivyananda Creations, 2013. p. 313-317.
6. Bhavanani AB. Yoga for breathing difficulties. Applications of yoga therapy. A collection of articles by eminent teachers and Gurus by Federation Francophone de yoga. Quebec, Canada. 2007. pg 132-48.
7. Vedanthan PK. Yoga breathing techniques (YBT) in COPD: a preliminary study. In:Program and Abstracts of the 94th International Conference of the American Thoracic Society; April 23-28, 1998; San Diego. D31; Poster A132.
8. Fulambarker A, Farooki B, Kheir F, Copur AS, Srinivasan L, Schultz S. Effect of yoga in chronic obstructive pulmonary disease. Am J Ther. 2012; 19(2): 96-100.
9. Donesky D, Melendex M, Nguyen HQ, Carrieri-Kohlman V. A responder analysis of the effects of yoga for individuals with COPD: who benefits and how? Intl J Yoga Ther. 2012; 22: 23-36.
10. Easy On-PC Spirometer for Primary Care Product Brochure. [Internet]. 1997. [cited 26 july 2018]. Available from: http://www.intermedical.co.uk/custom/upload/ pdf/0280iss02%20-%20ndd%20EasyOnPC%20Product%20Brochure%20(Primary %20Care).pdf.
11. St Georges Respiratory Questionnaire Manual. 2009. [cited 26 July 2018]. Available from:http://www.healthstatus.sgul.ac.uk/SGRQ_download/SGRQ%20Manual%20June% 202009.pdf.
12. Divekar M, Bhat M, Mulla A. Effect of Yoga therapy in diabetes and obesity. JDiab Assoc Ind 1978; 17: 75-8.
13. Kamal R, Kesavachandran CN, Bihari V, Sathian B, Srivastava AK. Alterations in Lung Functions Based on BMI and Body Fat % Among Obese Indian Population at National Capital Region. Nepal J Epidemiol. 2015 Jun 1;5(2):470–9.
14. Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. BMJ 1985; 291: 1077-79.
15. Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial. BMC Pulmonary Medicine 2009;9:37.
16. Jung YJ, Ra SW, Lee S-D, Park CS, Oh Y-M. Clinical features of subjects with an isolated FEV1 reduction. The International Journal of Tuberculosis and Lung Disease 2012; 16: 262-67.
17. Clinical Tutorials. Spirometry [Internet]. [cited 26 July 2018]. http://www.gp-therapy.net/therapy/tutorials/clinical/respiratory/spirometry.htm.
18. Singh V. Effect of respiratory exercises on asthma. The Pink City lung exerciser. Journal of Asthma 1987; 24: 355-59.
19. Tandon M K. Adjunct treatment with Yoga in chronic severe airways obstruction. Thorax 1978; 33: 514-17.
20. Bernardi L, Passino C, Wilmerding Vetal. Breathing patterns and cardiovascular autonomic modulation during hypoxia induced by simulated altitude. J Hypertens 2001; 19 : 947-58.
21. Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and chemoreflex response to hypoxia and hypercapnia. Lancet 2000; 356: 1495-96.
22. Singh S, Soni R, Singh KP, Tandon OP. Effect of Yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Indian J PhysiolPharmacol 2012; 56(1): 63-8.
23. Ranjita R, Hankey A, Nagendra HR, Mohanty S. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial. J Ayurveda Integr Med 2016 7:158–66.
24. Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med 2009; 15 (3): 225-34.
25. Clinical round up selected treatment option for bronchitis. Alternative and complementary therapies 2011; 17(6): 349-53.
26. Rodrigures MR, Carvalho CRF, Santaella DF, Lorenzi-Filho G, Marie SKN. Effects of yoga breathing exercises on pulmonary function in patients with Duchenne muscular dystrophy: an exploratory analysis. JornalBrasileiro de Pneumologia: PublicacaoOficial da SociedadeBrasileira de Pneumologia e Tisilogia 2014; 40 (2): 128-33.