So yoga has been existed in this world forever but unfortunately the importance is getting realized only now and this year we celebrated the international yoga day. Today we have Dr. Manchanda who is going to tell us more about the role of yoga in cardiology, especially preventive cardiology and also interventional cardiology.
First of all, I must clarify the term yoga because it is not well understood. Yoga is not a few postures or asanas but it is a complete way of life. It is a method which can keep us physically, mentally, emotionally and spiritually healthy and lot of scientific data has accumulated to show that yoga is extremely good for promotive, preventive and curative health. It has been tested extensively in cardiovascular diseases. We have also done studies in cardiovascular diseases of this yoga. Now yoga I must remove the confusion which many doctors have. It is not a physical exercise. It is a method of stress management. Actually, it is a holistic lifestyle which includes vegetarian low-fat diet which is a good diet. It involves exercises. It involves stopping of tobacco and the most important think it involves the stress management and therefore it is a holistic lifestyle because these four factors, the diet, lack of exercise, smoking and stress are the leading factors for non-communicable diseases especially the cardiovascular diseases. Now yoga has been used for prevention of cardiovascular diseases. All the risks factors like hypertension, diabetes, etc have been shown to be controlled by yoga. They are several studies in hypertension and recently even the American Heart Association has accepted that there is evidence that meditation can reduce blood pressure. So meditation could be used as a non-pharmacological method to control hypertension. In diabetes also, it can be used in addition to the usual drugs and many patients have been taking stopped taking insulin, etc. It has been found to be very good in obesity. It has been found to very good in smoking cessation and also in obesity and even dyslipidemia. So there are several studies to show that the risks factors could be controlled. We also conducted some studies to show that the risk factors like lipids, like smoking and stress can be markedly reduced. We have also done studies to show that yoga can regress atherosclerosis. You know metabolic syndrome is very common in our country and we do not know the real treatment for this. We did a randomized study. We published it last year in which we showed that yoga practices for one year were able to regress early atherosclerosis which occurs in the metabolic syndrome that means the carotid intimal medial thickness was reduced significantly by practice of yoga. In addition, of course, yoga also reduced the insulin sensitivity. It also reduced the blood pressure. It also reduced the HbA1c and the central obesity. So we found it extremely useful and reversal of early atherosclerosis. There have been several studies to show that reversal of heart disease can occur in advanced atherosclerosis by regular practices of yoga and these studies were done by initially Dean Ornish, he did in patients who have 40% blockages. We did a study of more than 70% blockages for the first time and this institution where this preventive cardiology conference being held, the Raj yoga has also shown that it is possible to control advanced atherosclerosis. All the three studies have similar results. This means in all the studies the body mass index reduced, the lipid profile reduced, the angina reduced, on angiography there was a regression-although small but it was significant. The stress was markedly reduced in this patient. The treadmill test also showed marked improvement. So we have data to show that even advanced atherosclerosis could be reversed or the progression of the disease could be stopped. There are studies done on transcendental meditation which show that it is possible even to decrease the mortality after myocardial infarction. This study done from United States seven years follow up those people who were given meditation they had 48% reduction in myocardial infarction, mortality and stroke which is very significant. Yoga has also been shown to be extremely good for arrhythmias. In paroxysmal atrial fibrillation, it has been shown it can reduce the frequency, ventricular ectopic and recent studies show that it could even control heart failure at all. Even the mechanisms are being studied. We do not know the exact mechanism how yoga is help in cardiovascular disease but it seems that it balances the autonomic nervous system. It increases the parasympathetic activity, decreases the sympathetic activity that is how it helps many of the arrhythmias and in hypertension, etc. It also changes the neurohormonal profile and all. Some of the bad hormones like the catecholamines, cortisol are decreased and the antioxidants like endorphins, etc have been shown to be increased and all. So there is evidence in the cardiovascular literature that yoga is able to prevent and even retard the progression or even reverse advanced disease. I believe in our country and throughout the word it could be used as a cheap modality because it does not cost anything to control cardiovascular disease. Of course, we need large studies still because these are small-small studies but the information is enough. Because it is safe, it has no side effects and it can be practiced by anybody and in any state or the condition of the patient, I think it could be a useful modality for primary as well as secondary prevention of coronary heart disease. Not only coronary heart disease, all non-communicable disease like benefit has been shown as I said in diabetes, in hypertension and other chronic diseases like depression, anxiety and so on and so forth.
Thank you so much sir, you mentioned a lot of conditions and you also mentioned about lot of upcoming data. So as a patient if I have a heart attack and I want to start practicing yoga, what precautions I should take? How should I start? Under whose guidance I should start doing that?
You see, we are using yoga for cardiac rehabilitation after myocardial infarction. Most of the patients with myocardial infarction have stents, etc. So after about two weeks of that we start them gradually increasing yoga. We start with little breathing exercises and then little meditation and gradually build it up. Yoga I must say is very easy to learn. It is not difficult at all because it has three components most of the yoga that is used. One is some stretching exercises called asanas, the other is breathing and the third is meditation part. Now these asanas or the exercises may not been done in elderly people as some of them cannot sit on the floor, but it does not matter as we have done it sitting on the chair, but everybody can do breathing exercises called pranayam, everybody can do meditation and the effect is equally good. In our studies, many patients could not these asanas which are difficult if you start at the age of 60-70 years, but you can do other things like br eathing exercises sitting on the chair, you can do meditation and we found that the benefit was equal. So it is very easy to do. It has to be gradually taught to the patients in cardiac rehabilitation. We are actually doing a very large study, Indo-UK study, in which we are using now yoga as cardiac rehabilitative very cheap method and we will have the results in next two or three years to show that it could be a useful modality.
Thank you sir. So yoga must be done by all the patients depending on their capability, how much they can do and there are various types of exercises which can be tried and which are tested also in the evidence in the clinical trial. Any other thing you would like to highlight about yoga specifically when it comes to patient with hypertension, diabetes and stress because those are the three conditions which you also mentioned.
You see that is true, if the patient is having mild hypertension, if the blood pressure is less than 160 or having mild diabetes HbA1c is 7.5 or so, then one should include yoga as a nonpharmacological method for at least three months and we have seen extremely good results because yoga as I said s a lifestyle policy. This means it has to be used in addition to exercise, diet control, no smoking and then stress management. So I think many people can be controlled without any drugs. But if the patient has advanced disease, then you have to give drugs like in post myocardial infarction all our patients were getting all the four drugs which are necessary after myocardial infarction. So in addition to the conventional treatment, if you add yoga, the results are much better. That is what we have shown and others have also shown.
Thank you so much for enlightening us on the knowledge of yoga which already existed but unfortunately was ignored, now it is becoming popular and more and more patients should use this.