Analysis of immediate effect of nadishodhana pranayama in the ratio of 1:3:2 on autonomic and respiratory variables in healthy individuals

K Saisupriya; Shashikiran H Chandrappa; Shivaprasad K Shetty; Prashanth Shetty; Thittamaranahalli Muguregowda Honnegowda; Leena Hiremath

doi:10.4103/ym.ym_21_19

ORIGINAL ARTICLE

Year : 2020 | Volume : 52 | Issue : 1 | Page : 20-24

Analysis of immediate effect of nadishodhana pranayama in the ratio of 1:3:2 on autonomic and respiratory variables in healthy individuals

K Saisupriya¹, Shashikiran H Chandrappa¹, Shivaprasad K Shetty², Prashanth Shetty³, Thittamaranahalli Muguregowda Honnegowda⁴, Leena Hiremath⁵
¹ Department of Yoga, SDM College of Naturopathy and Yogic Sciences, Ujire, Karnataka, India
² Division of Yoga and Physical Therapeutics, SDM College of Naturopathy and Yogic Sciences, Ujire, Karnataka, India
³ Department of Natural Therapeutics, SDM College of Naturopathy and Yogic Sciences, Ujire, Karnataka, India
⁴ Centre of Excellence, Government of India, SDM College of Naturopathy and Yogic Sciences, Dakshina Kannada, Karnataka, India
⁵ Department of Physiology, KS Hegde Medical College, Deralakatte, Mangaluru, Karnataka, India

Date of Submission	29-Nov-2019
Date of Acceptance	28-Jan-2020
Date of Web Publication	11-Jun-2020

Correspondence Address:
Thittamaranahalli Muguregowda Honnegowda
Centre of Excellence, Government of India, SDM College of Naturopathy and Yogic Sciences, Dakshina Kannada, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ym.ym_21_19

Abstract

Background: Nadishodhana pranayama (NS) has been used extensively for relaxation as well as therapeutics by many practitioners; the physiological effects of NS in this specific ratio have not been studied yet. Hence, the present study aims to evaluate the immediate effect of NS pranayama in the ratio of 1:3:2 with a time line of 6:18:12 s and its role in clinical application.
Materials and Methods: Sixty healthy volunteers were recruited for the study. Individuals were randomly allocated into two groups, NS pranayama with antarkumbhaka (Group 1) and breathe awareness (Group 2). For case group, intervention was given for 12 rounds and for the control group, breath awareness was given for 12 rounds and assessed immediately after the practice.
Results: In the study group, a significant decrease in mean heart rate (HR) (p < 0.0001) and a significant increase in mean respiratory rate (RR), NN50 (p < 0.0001), RMSSD, and pNN50 (p < 0.0001) after the intervention compared to their prevalues and with that of the control group were noted. Frequency domain analysis of HR variability showed a significant decrease in the pre- and post-values of low-frequency (LF) power (p < 0.0001), very LF, and LF/high-frequency (HF) power (p < 0.0075) and a significant increase in the pre- and post-values of HF power (p < 0.001) after the intervention in the study group.
Conclusions: The result concludes that the immediate effect of NS pranayama in the ratio of 1:3:2 brings parasympathetic activity in the study group by decreasing RR and HR. Hence, the NS pranayama with kumbhaka is a better method to increase parasympathetic activity.

Keywords: Alternate nostril breathing, autonomic nervous system, heart rate, parasympathetic activity, pranayama

How to cite this article:
Saisupriya K, Chandrappa SH, Shetty SK, Shetty P, Honnegowda TM, Hiremath L. Analysis of immediate effect of nadishodhana pranayama in the ratio of 1:3:2 on autonomic and respiratory variables in healthy individuals. Yoga Mimamsa 2020;52:20-4

How to cite this URL:
Saisupriya K, Chandrappa SH, Shetty SK, Shetty P, Honnegowda TM, Hiremath L. Analysis of immediate effect of nadishodhana pranayama in the ratio of 1:3:2 on autonomic and respiratory variables in healthy individuals. Yoga Mimamsa [serial online] 2020 [cited 2023 Jun 6];52:20-4. Available from: https://www.ym-kdham.in/text.asp?2020/52/1/20/286549

Introduction

Pranayama is an essential part of yogabhyasa which is the fourth limb of classical Ashtanga yoga and is increasingly being used as a yoga therapy. There are a multitude of pranayama techniques, and it is traditionally taught that each of them has different psycho-physiological benefits (Swami, 2008). A group of pranayama, namely chandra and surya nadi (CN and SN, respectively) and chandra bhedana and surya bhedana (CB and SB, respectively), have uninostril breathing and alternate nostril breathing (ANB) patterns using left and/or right nostrils, respectively. This type of yogic nostril manipulation is also furthered in nadi shuddhi (NS), a specific technique involving alternate use of both nostrils in a specific pattern (Saraswati, 2012). Unilateral and bilateral nasal breathing techniques have captured the attention of researchers across worldwide, and recent studies have reported their differential physiological and psychological effects including effects on O₂ consumption, metabolism and body weight, blood glucose, involuntary blink rates (Telles, Nagarathna, & Nagendra, 1994) and intraocular pressure (Shannahoff-Khalsa, 2002), heart rate (HR), stroke volume and end-diastolic volume (Mohan, Reddy, & Wei, 2001), and decrease in digit pulse volume and blood pressure (BP) (Shannahoff-Khalsa & Kennedy, 1993). ANB (as done in NS pattern) has been reported to rapidly alter cardiopulmonary responses and improve simple problem-solving (Telles, Nagarathna, & Nagendra, 1996). Recent studies suggested that yogic breathing through the right, left, or through both nostrils alternately produces distinct autonomic changes (Subbalakshmi, Saxena, Urmimala, & D'Souza, 2005). Nadishodhana (NS) pranayama improves vital capacity, controls HR and BP, and may contribute to enhance health status and wellness (Raghuraj & Telles, 2008). With the above in mind, we have studied the immediate effects of autonomic and respiratory parameters. The aim of the study is to determine the differential effects of NS pranayama, if any, and understand the mechanisms behind their physiological effects.

Materials and Methods

Study population and design

Ninety individuals (forty females and fifty males) regularly attending yoga sessions at the SDM College of Naturopathy and Yogic Sciences, thrice weekly for more than 3 months, were recruited for the study by convenience sampling. Their mean age and body mass index were 34.10 ± 13.62 standard deviation (SD) and 25.28 ± 7.65 (SD), respectively. All of them were right handed. All of them reported normal health status. Individuals who were taking medication which could influence the autonomic function, for example, phenylpropanolamine as a common cold remedy (Lake, Chernow, Zaloga, Labow, Quirk, & Hedges, 1988) were excluded. Female participants during their menstrual cycle will not participate in the study as menstrual cycle is known to influence the circulatory and humoral dynamic (Yildirir, Kabakci, Akgul, Tokgozoglu & Oto, 2001; Princi, Parco, Accardo, Radilla, De Seta, & Guaschino, 2005). The participants were randomly allocated to Group 1 (NS pranayama with antarkumbhaka) and Group 2 (Breath awareness) as shown in [Figure 1]. The study protocol and informed consent were issued by the institutional ethical committee.

Figure 1: Consort flowchart

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Intervention

Nadishodhana pranayama

Sit in meditative comfortable posture with head and spine upright. Adopt nasikagra mudra with the right hand and place the left hand on the knee in chin or jnana mudra. Close the right nostril with the thumb. Inhale through the left nostril for 6 s and hold the breath to capacity for 18 s (Antarkumbhaka), and then exhale through the right nostril for 12 s. Then, repeat the procedure in the right nostril, complete one round with 36 s at a ratio of 6:18:12. Perform this for 12 rounds (Saraswati, 2012).

Control group

Sit in meditative comfortable posture. Keep the head and spine upright. Relax the whole body and close the eyes. During breath awareness, the participants maintained awareness of the breath without manipulation of the nostrils and attention was directed to the movement of air in and out of both nostrils. They also attempted to be aware of the air as it moved through their nasal passage (Telles, Arti, Nilima, & Sachin, 2013)

Assessments

Assessments of HR, HR variability (HRV), BP, respiratory rate (RR), and pulse rate (PR) was made before and immediately after the intervention.

Data extraction

The participants were seated comfortably on the chair with back support; the recording leads were connected to the four-channel polygraph equipment (BIOPAC, Montana, USA; model No: BSL 4.0 MP 36) and monitored in a closed, noise-free room.

Instructions were given to the participants to close their eyes and remain undisturbed during the session. Data were extracted from Fast Fourier transform (FFT) analysis was performed using a custom MATLAB program (MATLAB 8.0, The MathWorks, Inc., Natick, Massachusetts, USA).

Statistical analysis

Data were analyzed using IBM, Statistical Package for the Social Sciences (SPSS), India, Version 21.0. The data at baseline were assessed for normal distribution using Kolmogorov–Smirnov test. As the data distributed normally parametric tests, independent t and dependent t-tests were applied to assess the significant difference between the two groups. For all the analyses, p < 0.05 was considered statistically significant.

Results

Study group

Time domain analysis of HRV showed a significant decrease in mean HR (p < 0.0001) and a significant increase in mean RR, NN50 (p < 0.0001), RMSSD, and pNN50 (p < 0.0001) after the intervention compared to their prevalues. Frequency domain analysis of HRV showed a significant decrease in the pre- and post-values of low-frequency (LF) power (p < 0.0001), VLF, LF/high-frequency (HF) power (p < 0.0075) and a significant increase in the pre- and post-values of HF power (p < 0.001) after the intervention [Table 1].

Table 1: Comparison of Group 1 (nadishodhana pranayama) with respect to pre- and post-test scores

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There was a significant decrease in the respiration rate (p < 0.0001) in NS group after the intervention compared to their prevalues. There was a significant reduction in PR (p < 0.0001) in case group. There was a significant reduction in systolic BP (SBP) (p <0.0001) after NS pranayama and nonsignificant reduction in diastolic BP (DBP). There were no significant changes in body temperature in the case group [Table 1].

Control group

Time domain analysis of HRV showed a decrease in the pre- and post-values of mean HR and RMSSD and increase in the pre- and post-values of mean RR, NN50, and pNN50 which were not significant after the practice of breath awareness. Frequency domain analysis of HRV showed a nonsignificant decrease in the pre- and post-values of LF power. There was a nonsignificant increase in the pre- and post-values of VLF power and LF/HF after the practice and HF (p < 0.0212) power increased significantly. Respiration rate was found to be decreased in breath awareness group but not significantly. There was a statistically significant reduction in PR in control group (p < 0.0409). In breath awareness group, SBP and DBP reduced but not significantly. There were no significant changes in body temperature in the control group [Table 2].

Table 2: Comparison of Group 2 (breath awareness) with respect to pre- and post-test scores

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Discussion

The main aim of the study is to evaluate and compare the immediate effect of NS pranayama in the ratio of 1:3:2 and their respective changes on various autonomic and respiratory functions in normal healthy volunteers. In the present study, the results were suggestive of parasympathetic dominance might be due to slow breathing during pranayama practice, which activates the adaptation of lung receptors during tidal volume inspiration which is known as the Hering–Breuer reflex. These inhibitory impulses affect systemic vascular resistance and HR. The rhythmic breathing pattern leads to synchronization within the hypothalamus and brainstem, which induces the parasympathetic dominance (Srivastava, Jain, & Singhal, 2005)

The parasympathetic dominance in the present study might be due to the influence of breathing through one or both nostrils on the autonomic nervous system. It is mediated by mechanical receptors in the nasal mucosa, which are activated by air flow into the nostril from where the signal is unilaterally transmitted to specific regions within the hypothalamus regulating the autonomic nervous system (Telles, Verma, Sharma, Gupta, & Balkrishna, 2017). In this study, the results show decrease in RR after the intervention. A decrease in breath rate has been associated with relaxation, and it is related with the increased vagal tone and overall reduction in arousal during and after ANB (Telles, Kumar, & Acharya, 2014). Slow breathing reduced chemoreflex sensitivity to both hypoxia and hypercapnia, which attributes an inverse relationship with baroreflex sensitivity. The decline in RR in the study can be explained by the influence of a probable hypocapnea on medullary respiratory center and persistent voluntary effort of breathing (ANB), producing inhibition of rhythmic spontaneous breathing by a phenomenon like overdrive suppression (Srivastava, Jain, & Singhal, 2005). In this study, the results showed a significant decrease in HR and SBP after the intervention. The HR is regulated by dual innervation (sympathetic and vagal) as well as humoral factors (Telles, Singh, & Balkrishna, 2011). Slow breathing is known to increase the vagal modulation of sinoatrial and atrioventricular nodes and enhances baroreceptor sensitivity. This may be responsible for reduction in HR and the BP indices (Vempati, & Telles, 2002). The SBP varies more within a short period than the DBP (Liye, et al., 2018). SBP is determined by the cardiac output (Subbalakshmi, 2005). A previous study done by Telles et al. is in accordance with our present study, which concludes that 18 min of alternate-nostril yoga breathing in 26 healthy volunteers was found to lower the SBP by an average of 4.5 mmHg as an immediate effect (Telles, Verma, Sharma, Gupta, & Balkrishna, 2017).

In this study, there was no significant decrease in DBP. DBP is influenced more by peripheral vascular resistance (Begleiter, Porjesz, Chou, & Aunon, 1983). DBP mainly varies with the degree of peripheral resistance and HR. The nonsignificant change in DBP observed in the present study suggests that pranayama might have no immediate effect on peripheral vascular resistance (Bodhe, Bhave, & Jankar, 2015). The alteration in autonomic responses to breathe holding is probably because of an increase in vagal tone and decreasing sympathetic discharges (Nivethitha, Mooventhan, & Manjunath, 2016). The present study results showed a significant decrease in LF and LF/HF ratio and a significant increase in HF of HRV. Our results are in accordance with those of the earlier study done by Bhimani et al., which conclude that practice of pranayama reduces the LF of HRV spectrum, which is indicative of reduction in sympathetic drive to heart, and increase in HF of HRV spectrum is indicative of increase in parasympathetic output to the heart and reduction in LF/HF ratio is indicative of better sympatho-vagal balance (Bhimani, Kulkarni, Kowale, & Salvi, 2011). The results of this study indicate the short-term practice of NS pranayama induces parasympathetic dominance (Jovanov, 2005).

Limitations of the study

Room temperature was not maintained during the assessment
Diurnal variations might have influenced the results
Long-term effects of NS pranayama on HRV and respiratory variables were not assessed.

Conclusions

The present study concludes that the immediate effect of NS pranayama in the ratio of 1:3:2 enhances the parasympathetic activity and can be applied in clinical practices mainly for stress reduction and health promotion, thereby preventing the disease by inducing the relaxed state of mind.

Acknowledgment

We immensely thank Dr. Yashoverma Ph.D., Secretary, Shri Dharamastahala Manjunatheshwara Society of Educational Institution, Ujre, for the financial support.

Financial support and sponsorship

This study was financially supported by Dr Yashoverma Ph.D, Secretary, Shri Dharamastahala Manjunatheshwara Society of Educational Institution, Ujre.

Conflicts of interest

There are no conflicts of interest.[25]

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