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Fifty sixÂ Type 2 diabetic subjects between the age group of 30-60 years were studied to see the effect of 40 days of Yoga asanas on the following parameters anthropometric, biochemical profile, pulmonary functionÂ nerve conduction velocity and electrophysiological study. The duration of diabetes ranged from few months to 10 years. Subject suffering from cardiac, renal and proliferative retinal complications were excluded from the study Yoga asanas included Suryanamskar. Tadasan, Konasan, Padmasan Pranayam, Paschimottansan Ardhmatsyendrasan, Shavasan, Pavanmukthasan, Sarpasan and Shavasan. Subjects were called to the cardio-respiratory laboratory in the morning time and were given training by the Yoga expert. The Yoga exercises were performed for 30-40 minutes every day for 40 days in the above sequence. The subjects were prescribed certain medicines and diet. The basal blood glucose, serum insulin, lipid profile, body mass index, malondialdehyde levelsÂ (MDA)as an index of lipid peroxidation, cardiac function, p300, nerve conduction velocity of the median nerve was measured and repeated after 40 days of Yogic regime. Another group ofÂ 50 Type 2 diabetes subjects of comparable age and severity, called the control group, were kept on prescribed medication and light physical exercises like walking. Their basal & post 40 days parameters were recorded for comparison. Blood sugars decreased significantly from 208.3Â±20.0 to 171.7Â±19.5 mg/dl. QTc interval decreased implying a sign of longevity. MDA levels decreased signifying a decrease in oxidative stress. Serum Insulin levels normalised indicating a idecrease in insulin resistance at the molecular leve. Pulmonary function improved after pranayama in our patients.P3 component of ERP shoed a decrease in latency from 391.16 to 331.0 msec. Right hand and left hand median nerve conduction velocity increased from 52.81ï‚± 1.1 m/sec to 52.46ï‚±1.0 m/sec and 53.87ï‚± 1.1m/sec to 54.75ï‚±1.1 respectively. Control group nerve function parameters deteriorated over the period of study, indicating that diabetes is a slowly progressive disease involving the nerves. Yoga asanas have a beneficial effect on glycaemic control and improveÂ neuroendocrine function in mild to moderate Type 2 diabetes.
The prevalence of type 2 diabetes is increasing the world over. This trend is being found both in the developed and developing countries.
Diabetes Mellitus is a slowly progressive disease effecting most systems in the body and perpetually deteriorates their normal functioning. However, specific Yoga asanas along with prescribed meditation and diet help arrest the progress of further complications of the disease and perhaps slow down it.
Further studies are required in the direction to substantiate scientific studies. Our study evaluated the status of NIDDM patients before and after 40 days of yoga asanas by assessment of some important parameters.
MATERIALS AND METHODS
The study of assessment of anthropometric, biochemical and cardio-pulmonary parameters before and after 40 days of Yogic exercises by NIDDM patients was conducted in Departments of Physiology, Biochemistry and Medicine, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi and Institute of Human Behavior of Allied Sciences, Delhi.
I. Selection of Subjects.
Fifty six patients of Type 2 Diabetes Mellitus (NIDDM) with history of Diabetes of 0 - 10 years in the age group of 30 - 60 years were selected. Diagnosis of Type 2 Diabetes Mellitus (NIDDM) patients were done according to WHO criteria Technical Report Series. The diagnostic details are given in the review of literature.
Patients selected from Endocrine Metabolic clinic, Department of Medicine, Guru Tegh Bahadur Hospital were informed about the thesis project. A written, duly signed consent was taken from the subjects according to ethical principles of Indian Council of Medical Research, New Delhi, India. No conscious effort was made to especially pick-on persons related to meditation. Once selected, the subjects were not excluded from various Yoga asanas, investigations and measurements except when the desired co-operation required for the testing procedures was not forthcoming.
Subjects with nephropathy, retinopathy (proliferative) and coronary artery disease were excluded from the study. Nephropathy was excluded by a negative dipstick test for proteins in the urine. The subjects were subjected to a baseline ophamological fundus examination. A baseline complete electrocardiogram was done in every patient to rule out any coronary artery disease. In addition, the treating physician clinically diagnosed and approved them for the study. Subjects were on recommended diet and oral hypoglycemic drugs. Routine laboratory tests were done before and after Yoga asanas. All subjects had a complete physical examination and the clinical assessment was recorded in the proforma as per its format at table 4.1. Relevant parameters were recorded at the beginning (i.e. baseline values) and after forty days of Yoga asanas for the Yoga group (n1). Similarly, these parameters were recorded for the control group (n2) in the beginning (i.e. baseline values) and after forty days.
The recorded parameters were compared, statistically analysed and conclusion drawn, therefrom. All Yogic asanas were conducted under the guidance and supervision of a Yogic expert. A qualified doctor was also present during the exercises so as to attend to the patients, as and when required.
The patients were divided in to two separate groups. Group I NIDDM, the Yoga group patients were put through various Yogic asanas for 40 days together with diet plus traditional Diabetic medicines. (n1 = 26). They acted as their own controls.
Group II NIDDM, the control group patients were retained on diet plus normal walking exercise etc. plus normal medical therapy only. (n2 = 38). Controls were matched in respect of age, sex, body mass index, socio-economic status and glycaemic base line parameters. The grouping of patients provided vital data for effective comparison, statistical analysis and inferences. patients performed Yoga asanas for 40 - 60 minutes per day for 40 days under the supervision and guidance of a Yoga expert. The various asanas and pranayama along with their duration are tabulated at table 4.2.
YOGA GROUP. 26 NIDDM subjects in Yoga group (n1) were kept on prescribed diet, oral anti-diabetic medicines and performed specific Yoga asanas for 40 days under the guidance of a Yoga expert. Important parameters before the commencement of Yoga exercises (baseline values) and after Yoga were recorded. The observations and results are enumerated in the succeeding paragraphs.
Anthropometric parameters. Height (Ht.) remained same at 152.4 ï‚± 0.9 cm. There were decreases in parameters of Weight (Wt.) from 62.94 ï‚± 2.4 kg to 62.17 ï‚± 2.2 kg, Waist Hip Ratio (WHR) of 14 subjects from 0.93 ï‚± 0.1 to 0.88 ï‚± 0.1, Body Surface Area (BSA) from 45.06 ï‚± 0.8 m2 to 44.83 ï‚± 0.8 m2 and Body Mass Index (BMI) from 26.81 ï‚± 0.9 kg / m2 to 26.49 ï‚± 0.9 kg / m2. Lean Body Mass (LBM) increased from 66.53 ï‚± 2.5 kg to 66.69 ï‚± 2.4 kg. The result of WHR is significant at p value of 0.005. Remaining results are insignificant.
Plasma glucose. There was a decrease in fasting blood glucose (FBG) from 208.3 ï‚± 20.0 in mg / dl to 171.7 ï‚± 19.5 in mg / dl, which is significant at p value of 0.001. Postprandial Blood Glucose (PPG) after one hour also decreased from 295.3 ï‚± 22.0 in mg / dl to 269.7 ï‚± 19.9 in mg / dl at p value of 0.059.
Serum lipid profile. There was a decrease in values of Cholesterol (CHOL) from 222.8 ï‚± 10.2 mg / dl to 207.9 ï‚± 8.6 mg / dl, Low Density Lipoprotein Cholesterol (LDL - C) from 144.8 ï‚± 8.6 mg / dl to 140.7 ï‚± 7.9 mg / dl and Very Low Density Lipoprotein Cholesterol (VLDL - C) from 37.4 ï‚± 4.6 mg / dl to 32.1 ï‚± 3.4 mg / dl. The CHOL results are significant at p-value of 0.003. Serum Triglyceride (TG) decreased from 168.5 ï‚± 15.5 mg / dl to 146.3 ï‚± 13.5 mg / dl mg / dl, which is significant at p value of 0.001. There was almost no effect in High Density Lipoprotein Cholesterol (HDL - C) from 43.8 ï‚± 2.6 mg / dl to 40.7 ï‚± 1.9 mg / dl, which is insignificant at p value ï€¾ 0.05.
Other Biochemical parameters like fasting serum Malondialdehyde (MDA) of 26 NIDDM subjects and plasma Glycosylated Hemoglobin (GHb) values of 15 NIDDM subjects. There was a decrease of serum MDA from 6.7 ï‚± 0.7 n mol / ml to 3.4 ï‚± 0.5 n mol / ml, which is significant at p value of 0.000. There was a decrease of glycosylated hemoglobin from 9.98 ï‚± 0.5 % to 9.82 ï‚± 0.7 %.
Serum insulin level. Serum insulin levels increased from 13.9 ï‚± 4.9 ï IU / ml to 19.7 ï‚± 4.8 ï IU / ml in four NIDDM subjects with Body Mass Index (BMI) < 25 at p value of 0.079. It decreased from 36.1 ï‚± 11.3 ï IU / ml to 11.0 ï‚± 2.0 ï IU / ml in seven NIDDM subjects with Body Mass Index > 25, within normal range.
Cardiac parameters. There was a decrease in Diastolic Blood Pressure (DBP) from 86.7 ï‚± 2.5 mm of Hg to 75.5 ï‚± 2.1 mm of Hg, which is significant at p value of 0.000. There were decreases in Systolic Blood Pressure (SBP) from 142.0 ï‚± 3.9 mm of Hg to 126.0 ï‚± 3.2 mm of Hg, which is significant at p value of 0.000, Pulse Rate (PR) from 86.45 ï‚± 2.0 pulse / min to77.65 ï‚± 2.5 pulse / min, significant at p value of 0.001. Corrected QT interval (QTc) decreased from 0.42 ï‚± 0.0 to 0.40 ï‚± 0.0.
Pulmonary function values. There were increases amongst 22 NIDDM subjects of Slow Vital Capacity (SVC) from 2.11 ï‚± 0.1 lt to 2.21 ï‚± 0.1 lt, Forced Vital Capacity (FVC) from 2.14 ï‚± 0.1 lt / sec to 2.20 ï‚± 0.1 lt / sec and Maximal Voluntary Ventilation (MVV) from 55.19 ï‚± 4.7 to 57.48 ï‚± 4.0 lt / sec amongst 20 subjects. Forced Expiratory Volume (FEV1) increased from 1.83 ï‚± 0.1 lt / sec to 1.93 ï‚± 0.1 lt / sec, which is significant at p value of 0.003. There were increases in FEV1/ FVC (RATIO) in 20 subjects from 0.84 ï‚± 0.0 to 0.86 ï‚± 0.0 and Peak Expiratory flow rate (PEFR) from 3.7 ï‚± 0.3 lt / sec to 4.4 ï‚± 0.6 lt / sec among 20 subjects. These changes are insignificant.
Nerve conduction parameters. The distal amplitude of the right hand (RWA) decreased from 6.73 ï‚± 0.5 mV to 6.55 ï‚± 0.5 mV. The distal amplitude of the left hand (LWA) increased from 7.02 ï‚± 0.4 mV to 7.78 ï‚± 0.6 mV. The proximal amplitude of the right hand (REA) decreased from 6.65 ï‚± 0.5 mV to 6.22 ï‚± 0.4 mV. The proximal amplitude of the left hand (LEA) decreased from 6.90 ï‚± 0.4 mV to 6.66 ï‚± 0.4 mV. The proximal latency of the left hand (LEL) had practically no change from 7.81 ï‚± 0.2 milli sec to 7.81 ï‚± 0.2 milli sec. The proximal latency of the right hand (REL) decreased from 7.48 ï‚± 0.4 milli sec to 7.30 ï‚± 0.3 milli sec. The distal latency of the right hand (RWL) increased from 4.02 ï‚± 0.1 milli sec to 4.26 ï‚± 0.3 milli sec. The distal latency of the left hand (LWL) decreased from 4.34 ï‚± 0.3 milli sec to 4.27 ï‚± 0.3 milli sec. The left hand velocity (LV) increased from 52.46 ï‚± 1.0 m / sec to 55.75 ï‚± 1.0 m / sec, which is significant at p value of 0.033. The right hand velocity (RV) increased from 52.81 ï‚± 1.0 m / sec to 53.87 ï‚± 1.0 m / sec.
Control Group. In the control group, 36 NIDDM subjects were on diet, mild exercises like walking and medical therapy as prescribed by the clinician. Various baseline and after 40 days parameters of the control group not on Yoga regimes were recorded. The observations are results are enumerated in the succeeding paragraphs.
Anthropometric parameters. Height (Ht.) decreased from 152.4 ï‚± 1.1 cm to 149.5 ï‚± 3.1 cm for 35 NIDDM patients. There were increases in parameters of Weight (Wt.) from 64.37 ï‚± 2.3 kg to 65.50 ï‚± 0.9 kg for 27 NIDDM patients and Body Mass Index (BMI) from 27.11 ï‚± 0.85 kg / m2 to 27.40 ï‚± 0.98 kg / m2 for 14 NIDDM patients. There were increases in the Waist Hip Ratio (WHR) of 20 subjects from 0.87 ï‚± 0.00 to 0.90 ï‚± 0.00 and Body Surface Area (BSA) of 27 NIDDM subjects from 45.45 ï‚± 0.9 m2 to 45.87 ï‚± 1.2 m2. Lean Body Mass (LBM) of 27 NIDDM subjects decreased from 47.74 ï‚± 1.15 kg to 42.55 ï‚± 0.8 kg, which is significant at p value of 0.000.
Plasma glucose values There was an increase in fasting blood glucose (FBG) from 154.15 ï‚± 9.14 mg / dl to 160.38 ï‚± 11.11 mg / dl among 26 subjects. There was decrease in postprandial blood glucose (PPG) from 245.33 ï‚± 12.5 mg / dl to 243.11 ï‚± 13.6 mg / dl among 24 subjects. The results are not significant.
Fasting serum lipid profile values. There were decreases in values of Cholesterol (CHOL) from 202.27 ï‚± 8.72 mg / dl to 200.46 ï‚± 9.3 mg / dl and Low Density Lipoprotein Cholesterol (LDL - C) from 132.0 ï‚± 7.8 mg / dl to 126.62 ï‚± 7.6 mg / dl. There was an increase in High Density Lipoprotein Cholesterol (HDL - C) from 40.73 ï‚± 1.7 mg / dl to 43.54 ï‚± 2.1 mg / dl. There were also increases in Very Low Density Lipoprotein Cholesterol (VLDL - V) from 29.23 ï‚± 2.8 mg / dl to 30.15 ï‚± 2.4 mg / dl, Triglyceride (TG) from 133.08 ï‚± 8.1 mg / dl to 159.31 ï‚± 14.7 mg / dl. These results are not significant except for Triglyceride TG, which is significant at p value of 0.050.
Other Biochemical parameters Fasting serum Malondialdehyde (MDA) of 9 NIDDM subjects and plasma Glycosylated Hemoglobin values (GHb) values of 20 NIDDM subjects are as follows. There was an increase of serum MDA from 4.85 ï‚± 0.93 n mol / ml to 7.32 ï‚± 0.8 n mol / ml. There was a decrease of glycosylated hemoglobin from 8.62 ï‚± 0.26 % to 8.47 ï‚± 0.17 %. The results are not significant.
Fasting serum insulin level. The levels increased from 13.06 ï‚± 2.3 ï IU / ml to 14.03 ï‚± 2.5 ï IU / ml. The results are significant in four NIDDM subjects.
Cardiac parameters. There was an increase in Diastolic Blood Pressure (DBP) from 77.70 ï‚± 2.2 mm of Hg to 79.40 ï‚± 2.6 mm of Hg among 20 subjects. There was a decrease in Systolic Blood Pressure (SBP) from 128.10 ï‚± 3.2 mm of Hg to 132.70 ï‚± 5.4 mm of Hg among 20 subjects. There was an increase in Pulse Rate (PR) from 80.00 ï‚± 2.7 pulse / min to 86.57 ï‚± 3.6 pulse / min among 21 subjects, which is significant at p value of 0.030. There was an increase in Corrected QT interval (QTc) from 0.40 ï‚± 0.4 to 0.42 ï‚± 0.0 among 23 subjects.
Pulmonary function. There were decreases of Slow Vital Capacity (SVC) from 2.12 ï‚± 0.1 lt to 2.01 ï‚± 0.1 lt among 23 NIDDM subjects, Forced Expiratory Volume (FEV1) from 1.83 ï‚± 0.1 lt / sec to 1.66 ï‚± 0.1 lt / sec and Forced Vital Capacity (FVC) from 1.95 ï‚± 0.1 lt / sec to 1.89 ï‚± 0.1 lt / sec, among 24 patients. Peak Expiratory Flow Rate (PEFR) also reduced from 3.83 ï‚± 0.3 lt / sec to 3.41 ï‚± 0.3 lt / sec among 23 subjects, which is significant at p value of 0.035. Besides, there were decreases in Maximal Voluntary Ventilation (MVV) from 53.41 ï‚± 2.7 lt / min to 47.51 ï‚± 3.1 lt / min among 22 subjects, and FEV1/ FVC (RATIO) from 0.96 ï‚± 0.1 to 0.88 ï‚± 0.0 among 24 subjects.
Nerve conduction parameters. The distal amplitude of the right hand (RWA) decreased from 7.23 ï‚± 0.5 mV to 6.71 ï‚± 0.6 mV. The distal amplitude of the left hand (LWA) decreased from 7.06 ï‚± 0.6 mV to 6.19 ï‚± 0.5 mV. The proximal amplitude of the right hand (REA) decreased from 6.81 ï‚± 0.5 mV to 5.92 ï‚± 0.5 mV, which is significant at p value of 0.016. The proximal amplitude of the left hand (LEA) decreased from 6.30 ï‚± 0.3 mV to 5.84 ï‚± 0.4 mV. The proximal latency of the left hand (LEL) decreased 7.66 ï‚± 0.2 milli sec to 7.59 ï‚± 0.2 milli sec. The proximal latency of the right hand (REL) changed from 7.84 ï‚± 0.3 milli sec to 7.84 ï‚± 0.2 milli sec. The distal latency of the right hand (RWL) increased from 4.09 ï‚± 0.1 milli sec to 4.12 ï‚± 0.1 milli sec. The distal latency of the left hand (LWL) increased from 3.74 ï‚± 0.1 milli sec to 4.02 ï‚± 0.2 milli sec. The left hand velocity (LV) decreased from 54.53 ï‚± 1.0 m / sec to 53.31 ï‚± 1.3 m / sec. The right hand velocity (RV) increased from 53.75 ï‚± 1.0 m / sec to 54.03 ï‚± 0.8 m / sec.
LEVENE'S TEST FOR EQUALITY OF VARIANCES. The analysis of the recorded results by Levene's test showed that there was equality of variances in both groups. In that, in both groups, there were significant decreases in waist hip ratio at p value of 0.019, trigylcerides at p value of 0.030, serum MDA at p value of 0.000, FEV1 at p value of 0.037, QTC at p values of 0.045 and LV at p value of 0.036. These analysis are statistically significant. The analysis of the other results by the said test was not significant.
The present study was conducted in mild to moderate cases of NIDDM. It is observed that there was a significant fall in the fasting and postprandial blood glucose, cholesterol and triglyceride. Besides, MDA and glycosylated hemoglobin levels also came down (tables 5.2, 5.3 and 5.4). Very few studies are available on the effect of Yoga asanas on different parameters in NIDDM patients. In fact, only  have conducted the studies and have shown the beneficial effects of Yoga asanas in NIDDM cases. The present study has, however, tried to cover various / important parameters to show the effect of few specific Yoga asanas in Diabetes.
Effect of Yoga Asanas on Anthropometric Parameters. In the present study, there was a reduction in the weight and even distribution of fat in the body space, as shown by a significant decrease in waist hip ratio in NIDDM patients on Yoga asanas. There was a noticeable decrease in body mass index and increase in lean body mass (table 5.1 )  have reported a significant decrease in lean body mass with significant change in the weight of normal healthy volunteers after Yoga asanas. Yoga helps reduction of fat from waist, change from central obesity ('apple shape' or 'android') to peripheral obesity ('pear shape' or 'gynoid') due to change in insulin resistance.
Effect of Yoga Asanas on Biochemical Profile.
Glucose. There occurred a significant fall in the fasting blood glucose. One hour postprandial blood glucose level also decreased after 40 days of Yoga asanas (table 5.2) and the subjects developed a sense of well being within 10 days and there was a lowering of dosage of oral anti-diabetic drug (s). Data from some patients who discontinued Yogic practices for some time and restarted, showed poor control during the interval with return to normal values after restarting the Yoga practices, which confirms "Cause and Effect Relationship between Yoga asanas and the Blood Glucose Levels". These findings are similar to those reported by [2[, ,.
Lipid Profile. In the present study, there occurred a significant reduction in total cholesterol. There was a noticeable decrease in triglyceride, LDL and VLDL cholesterol. There is an improvement in glycemic control in NIDDM patients associated with an improvement in serum lipid profile (table 5.30) and Studies on the effect of Yoga asanas on lipid profile have been reported. have reported a significant decrease in free fatty acids, LDL and VLDL cholesterol with an increase in HDL cholesterol. Desai has also reported a significant reduction in serum lipase activity after Yoga asanas in Diabetics. This helps to maintain normal concentration of circulating free fatty acids.
Oxidative Stress. In the present study, there was a significant fall in fasting malondialdehyde levels within 40 days of Yoga asanas. This indicates that the level of lipid peroxidation / oxidative stress was reduced The subjects felt better and were relieved of their stresses and had improvement in their day to day performance. Studies regarding the effect of Yoga on oxidative stress in Type 2 diabetics are virtually notexistent. In Diabetes Mellitus, there is increased oxidative stress because of prolonged exposure to hyperglycemia due to improper utilisation of blood sugar by the tissues , . This results in an increase in free radical production and insufficient antioxidants in the body. The increased oxidative stress can be measured by estimating the status of malondialdehyde (MDA), a marker of lipid peroxidation. Yogic exercises require low amount of oxygen consumption and produce high oxygen tension in blood leading to the postponement of fatigue (anaero
bic threshold) .
Glycosylated Hemoglobin. In the present study, there occurred a decrease in glycosylated hemoglobin in the NIDDM patients undergoing Yoga practice. Glycosylated hemoglobin is abnormally high in Diabetics with chronic hyperglycemia and reflects their metabolic control. have reported a decrease in glycosylated hemoglobin to normal levels after Yoga asanas indicating a smooth and good control of Diabetes. Glycosylated hemoglobin did not show much change in as the patients did Yoga asanas for 40 days only and it represents a three months control ( table 5.4 ).
Insulin Kinetics. Insulin levels increased with the increase in BMI (index of obesity). These levels decreased after 40 days of Yoga asanas. There is a reduction in insulin resistance with an improvement in insulin sensitivity. Thereby it is inferred that Yoga asanas and pranayama produce beneficial effects on insulin kinetics, prevent ï¢ cells exhaustion, thus avoid the development of insulin resistance (Syndrome X) in obese NIDDM. In normal weight NIDDM on Yoga asanas insulin levels increased from a basal value, suggesting an increase in secretion of serum insulin. The other changes included normalisation of insulin levels suggesting beneficial effects of Yoga asanas in both obese and notobese NIDDM patients. The mechanism that contribute to improvement of status in both subgroups seem to be variable. The improvement in insulin sensitivity was probably receptor mediated in obese NIDDM. However future studies at receptor levels need to confirm this. Increase in insulin levels in non-obese diabetes need to be confirmed by further studies at the cellular gene level. Rughmini et al have postulated that Yoga asanas, help release stored insulin or freeing bound insulin from the pancreas when pressure is applied on the abdomen. In the present study, serum insulin increased in non-obese NIDDM who were on Yoga asanas for 40 days. Thus normalisation of serum insulin helps NIDDM patients by directly increasing the utilisation and metabolism of glucose in peripheral tissues, liver and adipose tissues through the effect on enzymatic processes. have also shown a significant increase in insulin sensitivity and decrease in insulin resistance by reporting a significant rise in the insulin receptors. Diabetic subjects have demonstrated a decrease in body fat percentage, increase in the lean body mass, normalisation of the insulin glucagon (I/G) ratios and up-regulation of insulin receptors. They thus suggested a better utilisation of insulin and decreased peripheral resistance to insulinhave also analysed insulin / glucose ratio and have reported a significant fall in the fasting state in these patients suggesting thereby that asanas and pranayama help in bringing about a near physiological response to stress in Diabetic patients. In their study, the increased fasting insulin concentrations have been found to correlate positively with the degree of obesity and with the insulin resistance.(table 5.5).
Effect of Yoga Asanas on Cardiovascular System. In the present study, it was observed that there was a significant decrease in heart rate besides decrease in systolic & diastolic blood pressure. QTc intervals were also seen to have decreased. The subjects felt relaxed too. These observations suggest that Yoga exercises shift the autonomic equilibrium to the parasympathetic side. have shown reduction in both systolic and diastolic blood pressure in hypertensive subjects after two to three weeks of Yoga practice with significant reduction in drug requirements The diastolic blood pressure was low in trained subjects, especially after Yogic exercise. This has been associated with decrease in sympathetic tone and consequently, a decreased peripheral resistance in trained subjects . It has been established that certain Yogis can alter the patterns of their cardiovascular functions voluntarily ,. Changes of heart rate and respiration accompanying a Yogic subjective activity are intended to alter the state of mind alone . There is rapid decrease of whole blood and red cell glycotic rate during meditation . There is a small but significant increase of cardiac output reported during Meditation (15%) coupled with a significant decline of renal and hepatic blood flow . It seems that blood pressure changes due to meditation are mainly dependent on peripheral resistance. Blood pressure may not change acutely during Meditation . It leads to an improvement in vagal tone as shown by a decrease in Voluntary control over heartbeat has been claimed . Heart rate adjusted QT interval (QTc) predicts mortality in Diabetic patients with coronary heart disease along with nephropathy and autonomic neuropathy. It may be associated with an imbalance of sympathetic nervous system . In Diabetics QT lengthening has been linked to an increased risk of unexpected deaths. . Reduction of P wave in ECG in a group practicing Yoga asanas has also been noted . Other types of voluntary control of heart such as tachycardia, bradycardia, achieving T-wave amplitude more than that of R-wave and atrial flutters have also been recorded . (table 5.6)
Effect of Yoga Asanas on Respiratory System and Energy Metabolism. In the present study, regular practice of Yogic asanas in NIDDM Diabetics over a period of 40 days have been observed to lower rate of respiration, increase FEV1 / FVC, increase slow vital capacity, and maximal voluntary ventilation, increase peak expiratory flow rate with reduction in bronchial hyperactivity, increase expansion of chest, vital capacity and ability to hold breath. These changes were not significant as pranayama was carried out for 40 days only as their blood sugar did not decrease.(table 5.7)
Effect of Yoga Asanas on Nerve Functions. In the present study, there was an increase in left hand nerve conduction velocity. The distal amplitude in the diabetic subjects who were on Yoga asanas also increased. This was mainly due to decrease in blood sugar. The other reasons were proper utilisation of oxygen by the nerves as measured by decrease in oxidative stress, a reduction of the weight and even distribution of fat in the body space, as shown by a decrease in waist hip ratio in these patients. The vibration sense as measured by a tuning fork was better appreciated and the motor reflexes also improved. The latency decreased. Other parameters were insignificant because of intra observed variations such as placement of electrodes etc. Studies regarding the effect of Yoga on the nerve conduction velocity in Type 2 Diabetics are virtually nonexistent. This study of this parameter is one of the firsts of its kind. It has been established that Yogic exercises reduce blood sugar and serum lipid peroxide thereby decreasing toxicity of oxygen free radicals .It is, therefore, hypothesised that practice of Yoga asanas can decrease nerve injury and control or improve Diabetic neuropathy.
Effect of Yoga Asanas on Central Nervous System. The subjects felt better and were relieved of their stresses and had improvement in their day to day performance. The subjects develop a sense of well being. Yoga relaxes, relieves stress and makes the patient feel good, alert, active and exhilarated by releasing opioids and altering adrenocortical activity that gives pleasurable sensations and keeps the body fit , reported dominance of alpha rhythm in the EEG activity of the persons trained in Yoga. The subjects were more aware and restful. Presence of alpha waves (8-13 Hz) and theta waves is not correlated to the numbers of years of Yoga practice. Yoga enhances the physical threshold to withstand every adverse state of the body and achieve a mental stamina to ignore the most painful physical sensations. Exercises lead to efficiency and perfection. A person by the practice of Yoga acquires knowledge of human physiology and psychology and thus is able to govern the physiological and psychological aspects of his life.(table 5.8)
Findings of Diabetic Controls. The control group of Diabetics comprised subjects of comparable age and severity who did other physical exercises and who were on diet regime & drug therapy with mild physical exercise i.e. walking in place of Yoga asanas. The changes in the various parameters were recorded.
There was a general increase in weight and increased distribution of fat in abdominal region. This is associated with an increase in body mass index and decrease in lean body mass.
An increase in the fasting and postprandial blood glucose with an increase in total cholesterol, triglyceride, LDL and VLDL cholesterol. Thus there was a poor glycemic control in these NIDDM patients associated with deterioration in serum lipid profile.
There occurred an increase in glycosylated hemoglobin in the NIDDM patients not undergoing Yoga practice. An increase in the glycosylated hemoglobin was observed thereby indicating that the Diabetes in the subjects of the control group is progressing uncontrollably.
It has been observed that there was no change in insulin levels. There occurred a rise in fasting malondialdehyde levels after 40 days of the study. Thereby indicating that the level of lipid peroxidation / oxidative stress was increased.
However, there occurred a decrease in flow volumes.
It was observed that there was an increase in heart rate besides increase in systolic & diastolic blood pressure. QTc intervals were also seen to have increased. The lung function also deteriorated. These observations suggest that physical exercises the subjects were on shift the autonomic equilibrium to the sympathetic side.
The patients suffered a progressive loss of function of the nerves, which was confirmed by analysing their nerve conduction velocity of the median nerve. There occurred a slowing of the conduction velocity along with a decrease in the distal amplitude. This shows that Diabetes is a progressive disease affecting not only the myelin sheaths but also the axons.
These findings conform to the general view in the medical fraternity that Diabetes Mellitus is a slowly progressive disease effecting most systems in the body and perpetually deteriorates their normal functioning. However, specific Yoga asanas along with prescribed meditation and diet help arrest the progress of further complications of the disease and perhaps slow down it.
Further studies are required in the direction to substantiate receptor studies & hormonal assays in more number of cases. Cognitive function studies need to be done to support the subjective feeling of well being among the NIDDM patients.