Brigham & Women’s Hospital Harvard Medical School

Yoga for Respiratory Function

Yoga Alliance Webinar April 28, 2020

Sat Bir S. Khalsa, Ph.D. Assistant Professor of Medicine, Harvard Medical School Director of Yoga Research, Yoga Alliance Director of Research, Kundalini Research Institute Editor in Chief, International Journal of Yoga Therapy Research Associate, Benson Henry Institute for Mind Body Medicine Research Affiliate, Osher Center for Integrative Medicine Pranayama in Patanjali’s Yoga Sutras

1.34 The mind is also calmed by regulating the breath, particularly attending to exhalation and the natural stilling of breath that comes from such practice.

2.50 … pranayama has three aspects of external or outward flow (exhalation), internal or inward flow (inhalation), and the third, which is the absence of both during the transition... These are regulated by place, time, and number, with breath becoming slow and subtle.

http://www.swamij.com/pdf/yogasutrasinterpretive.pdf Pranayama in Hatha Yoga Pradipika

Chapter 1 51. The Yogi who, sitting with Padmasana, can control breathing, there is no doubt, is free from bondage.

Chapter 2 Shatkarma and Pranayama 2. Respiration being disturbed, the mind becomes disturbed. By restraining respiration, the Yogi gets steadiness of mind.

http://www.swamij.com/hatha-yoga-pradipika.htm Anatomy of Breathing

From: The Science of Breathing, Levine J, Yoga Journal, updated Feb 28, 2018

https://www.yogajournal.com/yoga-101/science-breathing Physiology of Breathing

From: The physiological effects of slow breathing in the healthy human. Russo MA, Santarelli DM, O'Rourke D, Breathe (Sheff), 13:298-309, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709795/pdf/EDU-0098-2017.pdf Conditioning of Slow Yogic Breathing

“…[yoga respiration training] induced long- lasting modifications of the ventilatory pattern with a significant lengthening of expiratory duration and a modest tidal volume increase.”

From: Training to yoga respiration selectively increases respiratory sensation in healthy man. Villien F, Yu M, Barthélémy P, Jammes Y, Respiratory Physiology and Neurobiology, 146:85-96, 2005. Nasal Cycle

From: Is the nasal cycle an artifact? The role of asymmetrical postures, Haight JS, Cole P, Laryngoscope, 99:538-41, 1989. Breathing and Control of Attention

Caudal Medial Frontal Cortex

From: Breathing above the brain stem: volitional control and attentional modulation in humans, Herrero JL, Khuvis S, Yeagle E, Cerf M, Mehta AD, Journal of Neurophysiology, 119:145–159, 2018 Breathing, Control of Attention and the Locus Coeruleus

From: Coupling of respiration and attention via the locus coeruleus: Effects of meditation and pranayama, Melnychuk MC, Dockree PM, O’Connell RG, Murphy PR, Balsters JH, Robertson IH, Psychophysiology 55:e13091, 2018. Yoga Myth: Oxygenating the Blood

“You generate prana, and push out every ounce of carbon dioxide, replacing it with life-giving oxygen.”

“Oxygen is not only important for muscles; it’s also vital for the brain to carry out all its functions. In addition, all of the internal organs improve when they are provided with an increased amount of oxygen-rich blood.”

⚫ The blood is normally already amply saturated with O2

⚫ Increasing ventilation will reduce CO2 causing hyperventilation

⚫ Proper slow deep yogic breathing does not change O2 & CO2

Use of Yoga Breathing Practices

From: Perceived Benefits of Kripalu Yoga Classes in Diverse and Underserved Populations, Wilson AM, Marchesiello K, Khalsa SBS, International Journal of Yoga Therapy, 18:65-71, 2008.

“Prāṇāyāma is known since ancient times to relieve stress and stabilize autonomic function of the body. It is easy to learn, practice and follow in our daily life. It can be learned and practiced by patients. Its potential in reducing BP makes this technique a promising non-pharmacologic tool for BP reduction in pre-hypertensive patients.” “Different types of prāṇāyāma techniques were shown to produce different effects…” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382821/?report=printable https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709795/pdf/EDU-0098-2017.pdf “The main effects of slow breathing techniques cover autonomic and central nervous systems activities as well as the psychological status.”

https://www.frontiersin.org/articles/10.3389/fnhum.2018.00353/pdf https://www.sciencedirect.com/science/article/pii/S0975947617303224 Mechanisms – Pranayama

⚫ Increases in physiological pulmonary function

⚫ Improvement in respiratory efficiency

⚫ Increase in heart rate variability

⚫ Changes in chemoreflex characteristics

⚫ Reduction in oxygen consumption

⚫ Reduction in oxidative stress levels

⚫ Regulation of psychophysiological arousal

⚫ Regulation of blood pressure

⚫ Regulation of psychological state Mechanisms – Pranayama

⚫ Increases in physiological pulmonary function

⚫ Improvement in respiratory efficiency

⚫ Increase in heart rate variability

⚫ Changes in chemoreflex characteristics

⚫ Reduction in oxygen consumption

⚫ Reduction in oxidative stress levels

⚫ Regulation of psychophysiological arousal

⚫ Regulation of blood pressure

⚫ Regulation of psychological state Pranayama Mechanics Overall, pulmonary function appears to improve with a minimum of 10 weeks of regular yoga practice, and the magnitude of this improvement is related to fitness level and/or the length of time the subjects spend practicing pranayama (i.e., breathing exercises). Physiology of Bhastrika & Kapalabhati

During HFB, respiratory rate increased to 232 cycles/min with a tidal volume of 0.35 liter. This resulted in a more than 10-fold increase in expired minute ventilation to approximately 90 l/min. Respiratory work increased more than 200-fold in comparison with resting ventilation. Arterial oxygen and carbon dioxide tension remained normal. …we consider that these two breath-control forms of HFB constitute harmless (normal blood gases) and possibly beneficial (e.g., breathing muscle training hyperventilation exercises, which after further study, could have a place in physiotherapy.

From: Effects of high-frequency breathing on pulmonary ventilation and gas exchange, Frostell C, Pande JN, Hedenstierna G., Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology, 55:1854-61, 1983. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726186/?report=printable Student Use of Yoga Breathing Practices

“Interestingly, breathing was the most frequently cited tool that athletes applied outside of yoga class. Athletes applied different breathing techniques, including deep diaphragmatic breathing, breath linked with body motion, and simple awareness of breath in different scenarios. Some instances included: preparing mentally before games, recuperating in between plays, and resting after activity had ceased.”

“It helped me with running definitely. Especially the breath exercises, I was able to apply those before races . . . Mainly the idea of focusing on the breath but some of the sun breaths and the deeper stuff I did practice before track meets. (Male, 9th grade)”

From: Qualitative evaluation of a high school yoga program: Feasibility and perceived benefits, Conboy LA, Noggle JJ, Frey JL, Kudesia RS, Khalsa SBS, Explore: The Journal of Science & Healing, 9:171-180, 2013. Pranayama Heart Rate Variability Effects of Mantra on Breath & HRV

Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study, Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L, WdowczycSzulc J, Lagi A, British Medical Journal, 323:1446-1449, 2001. Respiratory Sinus Arrhythmia

Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study, Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L, WdowczycSzulc J, Lagi A, British Medical Journal, 323:1446-1449, 2001. Heart Rate Variability as a Function of Respiratory Frequency

Modulatory effects of respiration. Bernardi L, Porta C, Gabutti A, Spicuzza L, Sleight P, Autonomic Neuroscience: Basic and Clinical 90:47–56, 2001. Pranayama Gas Exchange Respiratory Efficiency

From: Reduced hypoxic ventilatory response with preserved blood oxygenation in yoga trainees and Himalayan Buddhist monks at altitude: Evidence of a different adaptive strategy? Bernardi L, Passino C, Spadacini G, BonWchi M, Arcaini L, Malcovati L, Bandinelli G, Schneider A, Keyl C, Feil P, Greene RE, Bernasconi C, European Journal of Applied Physiology 99:511–518, 2007 Slow Breathing at Altitude

From: Hypoxic ventilatory response in successful extreme altitude climbers, Bernardi L, Schneider A, Pomidori L, Paolucci E, Cogo A, European Respiratory Journal, 27:165– 171, 2006. Effects of Slow Breathing on Ventilatory Chemoreflex in Yoga Trainees

Modulatory effects of respiration, Bernardi L, Porta C, Gabutti A, Spicuzza L, Sleight P, Autonomic Neuroscience: Basic and Clinical 90:47–56, 2001. Respiratory Changes to Yogic Breathing

Hyperapnic

From: Yoga and chemoreflex response to hypoxia and hypercapnia, Spicuzza L et al, Lancet 356:1495, 2000.