ACornprotiw Satdy of tlu Cardiac Resporue o Bhasnika: A Yogic BreadrirgExacise ad, tlw ExerciseTobarceTac 35

A Comparative Study of the Cardiac Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 Response to Bhastrika: A Yogic Breathing Exercise and the Exercise Tolerance Test

By Kevin Hoffman and John Clarke, M.D.

Yogic breathing exercises form a spectrum this exercise, the diaphragm and abdominal muscles are employed...both inhalation and exhalation are vigorous from simple, diaphragmatic breathing to and forceful. Between seven and twenty one cycles should follow each other in quick succession.r complex exercises involving breath A wide range of benefits from the practice of Bhastrika retention and visualization. Many of the are described in The Complete Book of Yoga, by Hewitt, drawing from ancient commentaries: advanced exercises are potentially The ber,.fits of bhastrika are to clear the nasal passages, harmful if not taught and practiced purify the blood, cleanse the sinuses, remove phlegm, improve circulation, generate pranic vitality, tone the systematically. nervous system, stimulate the liver, spleen and pancreas, improve digestion, facilitate evacuation, strengthen and tone the abdominal muscles, and massage the aMominal ust as a novice climber does not attempt to scale organs (viscera).2 Mount McKinley on his or her second climb, so a beginning srudent would not practice the advanced Van Lysebeth further articulates the benefits derived exercises until after he or she has practiced and from the practice of bhastrika, suggesting that it stimulates mastered the simple exercises which regulate, strengthen, the sympathetic nervous system in particular.r and coordinate the respiratory appararus. One advanced respiratory exercise is bhastrika, which includes both a Th. eff"ct. of bhastrika have also been compared to the rapid, forceful inhalation and exhalation. The book, effects of aerobic exercise upon the body. This is an Science of Breath, by Swami Rama, explains bhastrika as interesting comparison because aerobic exercise typically follows: involves vigorous body activiry such as that found during swimming, jogging, or tennis, while bhastrika is performed Th. *ord bhastrika means "bellows" and in this sitting motionles. In aerobic exercise, the respiration rate pnmayama the abdominal muscles work like bellows. . . In increases both in depth and frequency, and heart rate 36 TIre loutruI ol Tlv Intcnatiorrol Assxiation d YogaThnapiss

(HR) increases secondary to the activation of the sympathedc nervous system in response to the body's increased need for blood flow and oxygen. Bhastrika consists of rapid, relatively shallow breathing in a very o o regular sequence. This technique has tr€ been shown to induce a decrease in gF finger pulse volume, a decrease in od finger temperature, and in one study, -o (D-o= an increase in HR . These findings are consistent with an increase in E,= Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 sympathetic arousal. HR responses, f,ft soo however, are relatively small, TSgs especially compared to HR changes during aerobic exercise. In one study of five yoga students, no significant change in HR occurred.{

Thi, ,"rporrse of HR during bhastrika is the focus of this study because it is an easily quantifiable index of at least one facet of autonomic nervous system Breaths function, because it allows for a direct Figure 1. A typical example of the phasic change in HR or sinus anhythmia comparison with aerobic exercise, and in a relaxed sublect. finally because of the ambiguiry in the literature about the nature of HR varying levels of experience with the bhastrika in the laboratory periodically response during this exercise. Also, the exercise. All three subjects were during the three months of training. previous srudies of HR changes during healthy males berween 25 and 35 years Data drawn from pre-training, mid' bhastrika are limited in their findings of age. Subject I had approximately training, and end-training testing as they discuss only the average change one year of experience of intermittent sessions are presented here. For this in HR and do not take into account practice ofbhastrika. Sublect 2 had an sublect (52), the change in sym- the time course of the changes or the intermediate level of experience with pathetic activation due to the breath- possible raining effects that occur over bhastrika. Sublect 3 had practiced ing exercise was also calibrated by a period of regular practice. These bhastrika regularly for more than four comparing it to similar changes which studies also do not observe the more years. occurred during a maximal exercise subtle aspects of the beat-to-beat tolerance test on a treadmill. variabiliry of HR, and because of the Ir, to evaluate the effect of "r, discordant findings concerning the an intense"rr..pt period of training on the Each testing session was conducted at overall response of the heart, do not performance of bhastrika, Subject 2 the same time in the early morning, clearly address the issue of the ceased pmctice for a four month period and the subject was instructed not to direction and intensity of autonomic prior to the beginning of testing. eat prior to the sessions. At the nervous system (ANS) activation. Practice of bhastrika was resumed at beginning of each session, the resting the beginning of the testing and respiration rate of the subject was Th. ..r...nt protocol was also continued during a three month recorded while he was seated in a designed to permit observation of HR period, twice daily for three to five comfortable position. The subject was response to the gradual increase in minutes gradually increasing duration instructed to practice breath repetitions of the bhastrika practice according to comfortable capacity. awareness. During the practice of during a three-month training period The repetitions of the breathing breath awareness, the subject observed of one of the subjects. exercise were limited to the number his breath and attempted to regulate that most intermediate yoga students the flow so that it became smooth and Method commonly practice so that the results even with no jerks, pauses, or noise. would be of interest to most students This respiration rate and simultaneous Th. pr"r..,t study is based upon data practicing these techniques. This beat-to-beat HR was the baseline for collected during the practice of subject (SZ) underwent additional that session. (See Figure l.) bhastrika from three subjects with evaluations of HR response to A Compruhn Sndy of tle Codirc Respotue a Blvsill<,a: A Yogb Breathing Exercise ard tl,z Exerase Tolnance Tesc 37

tolerance test was conducted on a Quinton treadmill, with continuous 120 o monitoring of EKG and respiration; o blood pressure was monitored each '6o 100 minute. The speed and inclination of xo uJ the treadmill was increased every three o minutes according to the Bruce o 80 C, protocol until maximum exercise .a capacity was reached.' o o 60 (r Abdominal and chest excursions were

o recorded using a Respitrace@ vest, Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 (D 40 3 recorded on a Siemans Mingograph E 5 EM 34 polygraph. HR intervals were z. 20 timed using a Coulbourn Micro- Processor and recorded by a Gultan Session #2A NP-7 digital printer. EKG for the exercise tolerance test was recorded on March April a Hewlett-Packard EKG with a bipolar 23 4 electrode placement in the CV-5 Figure 2a. Rate of increase in the number of repetitions of bhastrika tn electrode configuration. An analog successive recording sessions for Subject 2. printout of the HR intervals and an EKG were also recorded by the Mingograph. Af,.. relaxation and breath awareness first session: 30 repetitions, second were practiced for one to rwo minutes, session: 60 repetitions, third Results: Baseline Period or until HR fluctuations stabilized, the session: 80 repetitions, fourth subject was asked to perform a series of session: 100 repetitions, fifth and The ,espiratory arrhythmia (the rounds of gentle bhastrika. After the sixth sessions: 120 repetitions. normal wave-like rise and fall of HR exercise series was completed, the during a single respiratory cycle) during recovery phase was recorded, usually Th. ord". in which each exercise was the baseline determinations was for one to two minutes, until HR again performed was varied to avoid consistent, measuring 140 to 160 sabilized. Once the baseline level of habituation. The maximal exercise milliseconds (See Figure 1). The degree respiration rate and HR had been reestablished (usually within two minutes), a series of rounds of vigorous bhastrika were performed. In this second round, bhastrika was perficrmed as vigorously as possible. d) 680o Fo, Sublect 2, the protocol used for (r E (It the additional sessions, during his o three-month training period, was as T o) follows: .s (l'7na LL A tot"l of six recording sessions was (!c conducted, one every other week. All o the recording sessions were conducted at the same time (?:30 a.m.) to avoid any inherent physiological variations 60 due to time of day. The number of repetitions of the exercises was Session #2b gradually increased in each recording session according to the subject's 12345623 comfortable capacity. The increase in Figure 2b. Changes in the baseline HR during the sessions as in Figure 2a. repetitions was as follows: 38 Tlvlowvlof Thelntsrational Association dYogaTlvrqis*

o !c 8 o .9, =s o (U o d) Vigorous Bhastrika Gentle Bhastrika (It o J- o o

o Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 o o o5 c 60o (D o ea 3 o co .9.(! t*---t t ttr'-'-./'t-,'-\ o ---- 'L, - ^'\'-'ra-r T s rArr^t"^a-r-

Subjed 1 40 Duration ol Breathing Exercise (Seconds)

o ! c o I g 600 ,,I I = I =.E o ct o d) r(It \.. o \l I o 500 o o :to ct) c I o I o oo= e 400 f '*'u" (U \-r. z "' \-a,-_,.,r".rr-..a,r'-.,'\'\.e..re...r' J o E

Subject 2 20 40

Duraction of Breathing Exercise (seconds)

Figures 3a and 3b show the change in heart beat intervals during the vigorous and gentle pnctice of bhastrika. Note the regularity and small beat-to-beat change, especially in Subject 3, Figure 3b. AConprcaiveSnl/ry of tlpCsdirc. Resporue mBhasriLa: A yqCi" BreathingErcrcbe udtlv.ExqeseTobmccTest

!at c 8 o .92 E eoo s I(6 o co t o I o

o Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 at, ftz* U) c o .o o @ o ct P o s 600

Duration ol Breathing Exercise (seconds)

Figure 4a. Gentle Bhasnika. This is an example of gentle bhastrika by Subject 2.

!to I c o Ezm = =g 6 (U E

ad Io o 'i em oat 8 a3 \';i,n c o E tl t \ E th ii 6 a "". € soo

?o4060

Duration of Breathing Exercise (seconds)

Figure 4b. Vigorous Bhastrika. Three different sessions of recording vigorous bhasmika in Subject 2 are shown here. 40 TIrc I oun'nl of Tlu btwrctiorrlrl Ass ocbtion $ Y oga Tl.rl, apists

of variation remained constant in any rhe most highlv trained of the three, period of sustained constant HR seems one session but varied slightly from achieved a HR of 120 BPM with to be a physiological response that can session to session for Subject 2. The gentle practice and 150 BPM with be developed by coordinated and mean HR during this "breath vigorous practice. Sublect 2 (Figures 4a consistent practice of this exercise. awareness" phase also varied from and 4b) showed the smallest HR This appears to be associated with a session to session. (See Figures 2a and responses, 85 BPM with gentle l:1 synchrony between HR and 2b.) The mean resting HR remained bhastrika and 115 BPM with vigorous. respiration mte to the degree that the consistent in any given session despite There was no clear change in response heart beat occurs at the same point in the change from session to session. No over the training period, although a each respiratory cycle. Whether this trend to a lowering of the resting HR tendency toward a faster HR with each coordination of the heart beat and the was seen, as is noted in aerobic subsequent session is suggested. respiration rate is significant to the training. There was, however, an achievement of the benefits of Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 obvious increase in endurance for the Thi, i, clearly a different response bhasrrika is still unknown. Exploring exercise, consistent with a training than the change with aerobic the potential for expanding these effect on the respiratory muscles. training, in which HR required for a responses and observing any further given activity becomes slower with development due to increased pro- Results: Bhastrika training. The tendency in this study is ficiency and capacity with prolonged that prolonged training over months practice would be an interesting topic Th" b.",-ro-beat HR responses to in Subject 2, and years in Sublect 3, for further study. bhastrika performed gently and vi- lead to progressively faster heart gorously are shown in Figures 3a and responses, perhaps from an increase in The relationship beueen the actual 3b, for the subjects with some practice the strength or coordination with beating of the heart and the motion of (Sl) and with prolonged practice which rhe exercise can be performed. the diaphragm and lungs also deserves (53), respectively. In all subjects, the duration and rate additional study. During the periods of of acceleration of HR in the first greatest HR regularity, the timing A consistent two-phase pattern is phase of the response was similar and beueen the QRS wave and the torso obvious in both: did not appear to change over time excursion was consistent, with the precisely I ) The first phase was a period of HR with training. heart beat striking at the acceleration. The slope and duration same phase of each breath cycle. As of this period remained consistent A" interesting finding is the this timing changed, the interval throughout the training, whether 30, occurrence ofan increased regulariry of changes of HR again became larger 60, 80, 100 or 120 repetitions were the HR during the time the breathing and more irregular. performed. This phase lasted for about exercises were performed. After the 45 heart beats in each case, or 20 to stage in which the HR accelerated A possible explanation for this is that 30 seconds. rapidly, the second phase of the HR and breath mte are approximately exercise was first distinguished by very in phase, or synchronous at I l0 to I 15 2) The second phase consisted of a small beat-to-beat interval changes. bearc or breaths-per-minute. Thus, the period in which HR leveled off at an The decreased phasic HR change in sympathetic reflexes normally initiat- accelerated rate. As the beat-to-beat both Sl and 53, as well as the fact that ed to compensate for the drop in blood change diminished, a flatter curve this period of regularity grew longer pressure with each inhaladon may be resulted. This phase lasted for about and flatter in the later sessions of S2's compensated for by the heart beat 25 heart beats (14 seconds) before training, may indicate that the itself. larger intervals began. HR began to subject's continued practice influenced slow. This second phase grew longer this response. At th. same time that inhalation with practice and with increased occurs and the lungs are filling with number of repetitions. Discussion blood, potentially lowering the systemic blood pressure by decreasing Tn. basic difference between During vigorous aerobic exercise, the the blood retum to the heart, the heart vigorous and gentle performance of heart beats at the same relative rate is contracting and stabilizing the blood bhastrika (terms which were not given (500 to 650 milliseconds) are irregular pressure. While this respiratory- is a quantified definition) was greater HR and continue in a phasic acceleration/ pulmonary coordination maintained, response during the plateau phase deceleration relative to inhalation/ autonomic reflexes appear to be held during vigorous effort. Subject I exhalation. But during vigorous constant, and the heart and respiration achieved a HR of 100 beats per minute Bhastrika, HR stabilizes and sustains rates continue in coordination with (BPM) with gentle practice and 120 brief periods (5 to 30 heart beats) of little change. Endurance and coor- BPM with vigorous practice. Subject 3, essentially unchanging HR. This dination appear to limit this pheno- AConpauive Srudy of tfvCmdiac Respoase n Bhrrstlila: AYo{r.BreathingExercbe ard tlw ExerciseToleranceTest 4r

160 Resling Heart Rate = 157

Gentle Bhastrika Heart Rare N

140 Vigorous Bhastrika Heart Rate I

120 120 120 121 Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021

103 100 100

80 78 N 74 ^=N 60

40

20

Subject 1 Subject 2 Subject 3

Figure 5. A comparison of the change in HR during vigorous and gentle bhastrika. The subject with the most experience is Subject 3. menon, since 1) the subject with the HR increase is calibrated in terms of sentially represents a very high degree longest history of practice showed the the percentage of maximum HR by of activation of at least one facet of longest and most stable regularity and comparison with results of the maximal the sympathetic nervous system, and 2) 52 increased the duration of this exercise tolerance test, it represents a it has occurred voluntarily through stabilizing phase as the practice time degree of sympathetic nervous system the manipulation of the breath, in the was increased. activation comparable to what occurs absence of significant physical motion at 58 to 78Vo of maximal exercise. except for the muscles used for Bhasnika perfiormed both gently and breathing. vigorously produced a significant In all the subjects, but particularly sympathetic nervous system activation. Subject 3, the increase in HR On. *"y to compare the degree of \Uith vigorous practice, HRs increased represents a significant increase in the exercise is to calibrate it in terms of up to 120 BPM in two sub;ects and up level of sympathetic nervous system metabolic equivalents or mets (one to 157 BPM in the subject with the activation. This level of sympathetic met is equivalent to the basal most experience, in the absence of any activation is equivalent to the metabolic rate). According to this significant physical motion except for activation usually considered neces- system, Sublect 2 doing vigorous breathing. (See Figure 5.) \Uhen this sary for aerobic training. This es- bhastrika was inducing a sympathetic 42 TIrc lomal of The Intsnaional Asxiation $ YogaTlvrapists

response equivalent to that of exercise induced by the practice of bhasrika. slower resting HR, or progressive at seven mets (seven mets is equivalent For whatever reason, this particutar slowing over time was not demon- to walking or jogging at 5.5 mph, yogic technique clearly creates a major strated. HR response was at a level playing singles tennis, or warer skiing. activation of one branch of the ANS comparable to that required for aerobic Of note is that when exercising at that can be achieved voluntarily with training. The shorr duration of the seven mets, there is a considerable minimal physical activiry. practice of Bhastrika used in these expenditure of physical energy, i.e.: sublects (three to five minutes daily) seven times the resting oxygen The consistent finding of this degree falls short of the customary rwenty requirement). of ANS activation does, however, minutes three to five times a week, stand in bold contrast to the previously associated with aerobic naining. In bhastrika the work of breathing is reported studies, in which minimal Downloaded from http://meridian.allenpress.com/ijyt/article-pdf/7/1/35/1735875/ijyt_7_1_y354313llp003015.pdf by guest on 01 October 2021 the only activity. Because the work cf, heart acceleration occurred. The Bhastrika was perceived to have a breathing is only a small fraction of the reasons for this are unclear. The temponry stimulating, clearing effect resting oxygen consumption, the technique used in the studies of on aleftness, perhaps in part from ANS overall oxygen need is increased l0 to Wenger and Bagchi involved activation. The other benefits ascribed 207o, comparable to a met level of interposed periods of breath retention to it in the texts of yoga were not approximately l.l to 1.2, far too small between periods of bhastrika of an measured in this study. Taking into to account for HR response usually unspecified durarion, but at least l0 account the data presented, it should seen with exertion levels of seven mets seconds long. The sampling period for also be recommended thar people with or higher. So a question arises HR was also not clearly specified, and heart disease undertake this practice concerning the mechanics of HR a beat-to-beat analysis does not appear under careful guidance, and with a response. In the absence of emotional to have been undertaken. In this very gradual and gentle approach. stimuli, HR increases as more blood situation, the early acceleration of the flow is needed to supply oxygen to the heart during the 10 or so seconds of I Swami Rama, Ballentine, R., and body. If the actual oxygen needs from bhastrika may have been overlooked, Hymes, A. Science of Breath. increased physical exertion have not and the practice was not sustained long Himalayan Institute Press, Honedale, increased, then other mechanisms enough to elicit the more marked Pa:1979,p.118. must be involved. There are three response. possible of mechanisms involved: 2 Hewitt. Tlv Cunplete Book of Yoga, Conclusions Shocken, 1978, p. 95. 1) During exercise, the cardiac output is decreased. A more rapid HR is The practice of bhastrika, a standard 3 Van Lysebeth, A. Pranayama. required to maintain adequate yogic breathing exercise, induces a Unwin, 1979,p.154. circulation. The rapid motion of the sympathetic response, as measured by lungs may influence the stroke volume heart rate, equivalent to significant 4 Wenger, M. A., and Bagchi, B. K. of the heart, reducing the volume to physical exercise from approximately Studies of autonomic functions in the extent that HR must increase. 58 to 78Vo of maximal exercise practitioners of yoga in India. capaciry in the three subjecrs studied. Behavioral Science, 6:312-323, 196l 2) The rapid shallow breathing may The unique feature of this exercise is reduce the efficiency of the gas that this cardiovascular stimulation is 5 Bruce, R. A. Progress in exercise exchange in the lungs. With the achieved with no physical exerrion, cardiology. in Ya, P. N., and Goodwin, increase in the body's oxygen except for breathing. J. F. (eds.), Progress in Cardiology, requirements by l7 to 20lo and the Philadelphia: Lea & Febiger, l9?4, p. decreased efficiency of the gas Prolonged performance of this 133. exchange, HR would necessarily breathing practice leads to a two-phase increase to compensate and maintain heart response of initial acceleration We gratefully thank the Himalayan membolic equilibrium. followed by a plateau phase of an International Instirute of Yoga Science elevated, relatively constant rate. and Philosophy for allowing us to 3) The rapid motion of the lungs may Prolonged practice over months and reprint this article which originally directly (or indirectly) stimulate the years may lead to the achievement of a appeared in the Research Bulletin of sympathetic nervous system which in HR which is faster as well as more the Hi malayan Interna tional tum causes HR to increase. regular, the latter characteristic Institute/Eleanor N. Dana Laboratory, perhaps a result of a precise I to I Vol. 4, No. 2, 1982. For further O.,. o, all of the above may be synchrony berween HR and respiratory information please contact the HII at involved in the ultimate mechanics of rate. A training effect on the RD l, Box 88, Honedale, PA 18431. the physical or metabolic changes cardiovascular system evidenced by a