DOI Number: 10.5958/2320-608X.2018.00083.5 Effect of Balasana on Pulmonary Function Tests among Healthy Medical Students

Jabir P K1, Sadananda B2, Das K S3

1Assistant Professor, Department of Physiology, DM Wayanad Institute of Medical Sciences (DM WIMS), Naseera Nagar, Meppadi P.O, Wayanad, Kerala, India, 2Professor and HOD, Department of Physiology, Karwar Institute of Medical Sciences, Karwar, Karnataka, India. 3Professor and HOD, Department of Physiology, A.J Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India

ABSTRACT Introduction: MBBS is one of the toughest courses in the world, where students are busy with studies throughout the course. They have less chances of relaxation. and are two limbs of ashtanga of patanjali which help individual to integrate mind and body. Yoga helps to lower blood pressure, increase lung capacity, improve respiratory function and heart rate, boost circulation and muscle tone .Many medical colleges in world already introduced stress relieving program. In yoga there are a set of postures to do. If medical students are asked to do whole asanas it will be inconvenient for them to practice every day due to paucity of time. Present study focuses exclusively on one that can be incorporated in medical student’s busy schedule. Balasana is a simple relaxation position. Combined with proper regulation of breath balasana is supposed to soothe the mind. This simple asana can be introduced in regular MBBS curriculum.

Objectives To study the effect of balasana on pulmonary function test among healthy medical students. To compare the effect of balasana among study and control groups

Materials and Method: Study included 100 medical students, who were selected by volunteer participation and divided into study group (those who do only balasana) and control group ( those who lead sedentary life

without doing any asanas ). Pulmonary function test was carried out, parameters like FEV1, FVC, PEFR, FEF

25-75 were measured using HELIOS. Results: It was found that there is no significant improvement in parameters in pulmonary function test

Conclusion: Results of our study showed that balasana has no effect on pulmonary function tests.

Keywords: Yoga; Balasana; Pulmonary Function tests.

INTRODUCTION of suicidal attempts. 3 Many medical colleges in world MBBS is one of the toughest courses in the world,1 already introduced stress relieving program. Asanas and where students are busy with studies throughout the pranayama are two limbs of ashtanga yoga of patanjali 4 course. There is a high level of stress and anxiety among which help individual to integrate mind and body. Yoga medical students2 which is leading to higher incidents helps to increase lung capacity, improve respiratory function and muscle tone .5 Studies showed that regular yoga practice reduced stress levels and also reduces Corresponding author: stress in the morning hours of exam.6 Yoga improves Dr. Jabir P K, pulmonary function tests.7,8 Yoga is a practical discipline Assistant Professor, Department of Physiology, DM incorporating a wide variety of practices whose goal is Wayanad Institute of Medical Sciences (DM WIMS), the development of a state of mental and physical health, Naseera Nagar, Meppadi P.O, Wayanad, Kerala, well-being and inner harmony.9 It focus on isometric India- 673577, E mail: [email protected] exercise and stretching unlike aerobic exercises and 46 International Journal of Physiology, July-September 2018, Vol. 6, No. 3 includes meditation, regulation of breathing, physical Exclusion Criteria: exercises and postures.10 Yoga helps in sympathetic- Participants with Acute respiratory illness, parasympathetic balance by reducing sympathetic Participants on any form of respiratory medication, activity and activating parasympathetic system.11,12Yoga Congenital heart disease, Epilesy, any injury or improves respiratory functions, balances activity of immobilization, Spinal deformities, Ankle problems, antagonistic muscle groups and slows dynamic and eye or ear infections, Pregnancy, habit of smoking, static movements.13 Even in asthmatic patients if yoga practicing yoga for past 6 months. is adjunctively used with pharmacological interventions lead to significant improvement in pulmonary function After selecting the participants, they were randomly which include increase in peak expiratory flow rate grouped into control and study groups with 50 (PEFR), vital capacity (VC), forced vital capacity (FVC), participants in each group respectively. The study group forced expiratory volume in 1st sec (FEV1), maximum practiced balasana for 90 days. Pre and post parameters 14, 15,16 mid expiratory flow rate(MMFR). In yoga there are were collected from both control and study group. a set of postures to do. If medical students are asked to do whole asanas it will be inconvenient for them to practice Balasana training every day due to paucity of time. Present study focuses Training was under the supervision of Yoga therapist. exclusively on one asana that can be incorporated as a day to day activity in medical student’s busy schedule. To perform Child Pose (balasana) 17 Balasana or child pose is a simple relaxation position.17 Combined with proper regulation of breath balasana Select a clean area. Kneel on a mat with two great is supposed to soothe mind. This simple asana can be toes touching, heels spread out and buttock resting on introduced in regular MBBS curriculum. Several studies the heels. Keep chest and back straight and put the arms 20 are conducted on effect of yoga on pulmonary function forward and let the palm rest on the distal part of the tests.18,19 But there are only few studies conducted on thighs or on knees. Raise the hands above with arms effect of individual asanas on these parameters. In the touching ears and elbows straight. Start exhaling and present study pulmonary function tests including FVC, bend the body gradually forward with stomach touching thigh and forehead and palm touching the ground. Keep FEV1, FEV1/FVC, PEFR, FEF 25-75 is estimated after a period of balasana practice for 90 days. The present study both the arms backwards in a stretched condition with was undertaken to study the effect of individual simple palms facing upward. Slowly start inhaling and lift relaxing asana like balsana on pulmonary function tests head, body and arms gradually. Come back to original (PFT). position. Repeat this cycle for 10 times. Then sit in the original posture. Close the eyes lightly and try to MATERIAL AND METHOD visualize an object behind the lower end of sternum. Then slowly inhale and exhale through the object and Participants allow it to happen naturally. Stay in this position for 5 The current experimental study included 100 minutes. Then bend forward resting on right hand and male and female participants after obtaining voluntary release the knees. All the parameters were measured on informed consent. The study protocol was approved day 0 and then every 15 days till day 90. Parameters by institutional ethical committee of A.J Institute of were taken from both study and control group. Medical Sciences and Research Centre, Mangalore. The Respiratory parameters following inclusion and exclusion criteria was used for selection of the participants. a) Vital capacity in litres (FVC).

Inclusion Criteria: b) Forced expiratory volume at the end of first second in litres ( FEV ). Apparently healthy, wiling medical students of age 1 group 17-25 years were included in the study. c) Forced expiratory volume at the end of first

second in litres ( FEV1)/Forced vital capacity. (FEV1/ FVC) International Journal of Physiology, July-September 2018, Vol. 6, No. 3 47

d) Peak Expiratory flow rate (PEFR) life) was undertaken to study the effect of balasana on pulmonary function test. Pulmonary function tests e) Forced Expiratory flow 25-75 (FEF25-75) (FVC, FEV1 /FVC, PEFR, FEF 25-75) of each subject were All these pulmonary functions were measured recorded at baseline and then every 15 days till day 90. using RMS HELIOS (a self calibrating computerized Table 1: Demographic characteristics of control spirometer that fulfils the criteria for standardized lung and study group function tests) available at the Department of Physiology, A J Institute of Medical Science and Research Centre, Study (n=50) Control (n=50) Mangalore. Subjects were asked to relax, then take a 30 deep breath and then to blow hard into the mouthpiece of Age (yrs) 18.26±0.63 18.06±0.59 the flow meter with a sharp blast and then again to take deep inspiration (nose was closed with nose clip). Two BMI 23.48±4.31 24.31±2.91 recordings were taken at one-minute interval and best of two was selected. Data was presented as mean ± SD

Statistical analysis: Data was analysed by using Table 2: Gender distribution of subjects studied spss 22.0 version. To compare the significance of Study Control difference paired t test was applied. The significance (n=50) (n=50) group group level was accepted at P<0.05. No % No % RESULTS Male 21 42 21 42 A randomized controlled study consisting of 100 Female 29 58 29 58 medical students of AJIMS, divided into study group Total 50 100 50 100 (who undergo balasana training) and control group (who do not undergo balasana training and is living a sedentary Data was presented as frequency and percentage.

Table 3: Comparison of day 0 and day 90 PFT in control group (n=50)

Parameter Day 0 mean ± SD Day 90 mean ±SD P value

FVC(L) 2.84±0.54 2.84±0.54 0.966

FEV1(L) 2.54±0.45 2.54±0.45 0.911

PEFR(L/S) 5.56±1.33 5.56±1.32 0.793

FEF(L/S) 3.40±0.84 3.41±0.84 0.785

FEV1/FVC(%) 89.67±3.49 89.66±3.54 0.846 *P<0.05 is significant

Table 4: Comparison of day 0 and day 90 PFT in study group (n=50)

Day 0 mean±SD Day 90 mean±SD P value

FVC(L) 3.25±0.68 3.21±0.58 0.621

FEV1(L) 2.82±0.50 2.84±0.49 0.318

PEFR(L/s) 6.36±1.60 6.35±1.58 0.595

FEF(L/s) 3.73±0.93 3.74±0.92 0.307

FEV1/FVC 88.24±3.52 88.42±4.00 0.410 48 International Journal of Physiology, July-September 2018, Vol. 6, No. 3

*P<0.05 is significant airway zone. While performing Balasana upper airway zone ventilation and perfusion may increase for which DISCUSSION ventilation perfusion studies are needed. Health of medical student is a topic of great concerned. For mental and physical recreation CONCLUSION extracurricular activities like yoga is a must.21 Balasana In the present study we have not observed significant is one of asana in Yoga which is a relaxing posture. changes in the pulmonary function tests of intervention The present study was conducted to evaluate the effect group. We recommend further detailed study in this area of balasana on pulmonary function test among healthy to explore and confirm therapeutic effects of balasana. medical students. Limitations Till date lots of studies have been conducted to find The major limitation in this study is low sample out relation between yogic postures and PFT. But there size. Further, results may not be generalized as the study are only few studies that conducted on a specific yogic was conducted at one centre. postures and PFT. To our knowledge this is the first study examining the effect of balasana on pulmonary Conflict of Interest –Nil function tests. Source of Funding- Self In our study there was no significant change in pulmonary function tests in study group after practicing REFERENCES for 90 days. Even though Bhattacharya and Krishnaswami 1. Manjunath R, Kulkarni P. Mental Health Status observed 22 that yoga intervention has less physical and and Depression among Medical Students in physiological changes Raj kumar yadav and shoba das23 Mysore, Karnataka–An Untouched Public Health in their study found such interventions increased FVC, 24 Issue. Depression. 2013;96(45.5):38–7. FEV1 and PEFR. Similarly, Prakash etal in their study found significant difference only in PEFR in yogis while 2. Sherina MS, Rampal L, Kaneson N. Psychological Dee Ann Birkel and Lee edgren25 observed and stated stress among undergraduate medical students. that yogic asanas alone is not the cause for improvement Med J Malaysia. 2004;59(2):207–211. of vital capacity. In a study conducted by Kaushik 3. Kitchen LW. Suicide among medical students. Halder etal 26among BSF personnel yogic practices West J Med. 1978;129(5):441. didn’t change FVC and FEV values significantly. 1 4. BKS Iyengar. . 41st ed. Noida,Uttar Respiratory system uses many muscles for the Pradesh,India: HarperCollins; 2012. 31 p. movement of thoracic cage. Regular yogic practices can 5. Bijilani RL. Textbook of medical physiology. help in the improvement of total pulmonary function by 3rd ed. New Delhi: Jaypee Brothers Medical increasing efficiency and performance of these muscles Publishers (p) Ltd; 2007. 884-910 p. and movements.27 Effect of pranayama include release of lung surfactant that helps in increasing total lung 6. Malathi A, Damodaran A. Stress due to exams in capacity.28 Appropriate yogic breathing manoeuvres can medical students-a role of Yoga. Indian J Physiol improve pulmonary muscular strength and efficiency , Pharmacol. 1999;43:218–24. which can ultimately help in the improvement of lung 7. Bhavanani AB. Effect of yoga training on handgrip, volumes and capacities.29 Balasana as such is not causing respiratory pressures and pulmonary function. stretching of chest muscles. So don’t improve PFT. From Indian J Physiol Pharmacol. 2003;47(4):387–92. above statements it can be postulated that practicing 8. Santaella DF, Devesa CRS, Rojo MR, Amato balasana is not improving pulmonary function, probably MBP, Drager LF, Casali KR, et al. Yoga respiratory because balasana is not stretching chest muscles so that training improves respiratory function and cardiac do not increase performance of these muscles. It can be sympathovagal balance in elderly subjects: a postulated in balasana upper ribs move while lower part randomised controlled trial. BMJ Open. 2011 Jan of chest is compressed. Postulated effect of Balasana 1;1(1):e000085. may be in ventilation-perfusion ratio (VA/Q) in upper International Journal of Physiology, July-September 2018, Vol. 6, No. 3 49

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