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PREKSHA
By
Swami Darmanand ji
RESEARCH
STUDY OF REVERSAL OF CORONARY HEART DISEASE THROUGH PREKSHA MEDITATION WITH REFRENCE TO
-
CORONARY ATHEROSCLEROTIC REVERSAL POTENTIAL OF YOGA LIFE STYLE INTERVENTION
S.C.Manchanda
MD. R. Narang MD, K.S. Reddy MD, U Sachdeva MD, D. Prabhakaran MD, S. Dharmananda BA, M. Rajani MD, R.L. Bijalani MD.
Abstract
Background: It is not clear if lifestyle modification has any role in
control of symptoms, progression of coronary lesions and prognosis in patients with
advanced obstructive coronary artery disease.
Methods: In the prospective, randomised, controlled trial, 42 men
with angiographically proven coronary obstructive disease were randomized to control
(n=21) and yoga intervention group (n=21) and were followed for 1 year. The yoga
lifestyle programme was a user friendly program consisting of strict control of risk
factors, diet control (15% calories from fat, mostly mono-and polyunsaturated 65% from
carbohydrate, mostly complex, 20% from proteins, high fiber (> 50 g/day) and
antioxidants), moderate aerobic physical exercise, health rejuvenating exercises,
breathing and relaxation exercises, stress management, meditation and reflection on
moral values. The patients were taught various yogic exercises at yoga centre which they
later practiced everyday at home. The control group was managed by conventional methods,
i.e. risk factors control and AHA step I diet.
Results: At the end of 1 year, the yoga groups showed significant
improvement in number of anginal episodes, improved exercise capacity and decrease in
body weight, and total and LDL cholesterol and serum triglyceride levels as compared to
controls. Coronary angiography repeated at 1 year showed that significantly more lesions
regressed (20% versus 2% and less lesion progressed (5% versus 37%) in the yoga group
(chi-square = 24.9; P<0.0001). Revascularisation procedures (coronary angioplasty or
bypass surgery) were much less frequent in the yoga group (1 versus 8 patients; relative
risk 5.45; P=0.01) The compliance of the total programme was excellent and no side
effects were observed.
Conclusions: Yoga lifestyle intervention is beneficial in improving the
symptoms and exercise capacity, lowering weight and serum lipid levels. It also retards
the progression of coronary atherosclerosis in-patients with severe coronary artery
diseases and reduces revasularisation procedures.
Introductions
A
number of studies have documented that a change in lifestyle (chiefly consisting of
dietary modifications, physical exercises and stress relaxation techniques) results in
reduction of cardiac events in patients with coronary artery disease (CAD). However,
there is a paucity of studies to determine whether lifestyle modification can result in
regression of the coronary atherosclerotic plaques. Ornish et al observed a regression
of coronary aterosclerotic obstruction by strict lifestyle intervention. However the
coronary stenoses were mild (40% and 43% diameter stenosis in treatment and control
groups. Respectively) and the diet prescribed in their study was also very stringent.
With only 5mg of cholesterol allowed per day. It is likely that such strict control of
diet may not be practical for most patients.
The
present study was designed to assess the effects of strict but "user friendly"
intervention using yoga lifestyle methods (with strict control of risk factors) on the
angioraphic severity of atherosclerotic obstructions in patients with advanced CAD
(>70% luminal diameter stenosis in at least 1 vessel). The effects on symptoms,
exercise capacity serum lipids and cardiovascular events were also analyzed.
Aims & objectives
The
objective of this study was to determine whether a user-friendly yogic lifestyle
intervention program (including yogic exercises, dietary management, moderate aerobic
exercise and stress management) with control of other risk factors can reverse the
atherosclerotic obstructions in patients known to have coronary artery disease.
Material and Methods
Forty-two
male patients (mean age 51.0 + 9.5 range 32-72 years) with angiographically proven CAD
were included in this prospective, randomized, controlled trial. At baseline detailed
clinical assessment, serum lipid profile, treadmill exercise testing using modified
Bruce protocol and coronary arteriography were performed.
Patients
in the control group (n=21) were managed on conventional medical therapy (with control
of risk factors, AHA step 1 diet, moderate aerobic exertion), while those in the yoga
group (n=21) were advised strict lifestyle modifications and yogic exercises as detailed
below. The medications for angina were continued. No patient was receiving
lipid-lowering drugs. The patients were
2
followed
for 1 year with regular assessments. At the end of 1 year, the patients
again
underwent detailed clinical assessment, serum lipid profile, treadmill exercise test and
repeat coronary arteriography. Coronary arteriography was analyzed quantitatively using
the caliper method. All arteriograms were analyzed by two independent blinded observers.
For coronary angiography the effect on individual lesions was compared in the 2 groups.
Ethical clearance was obtained from the institutional ethics committee and all patients
gave informed consent to take part in the study.
The baseline characteristics of the patient population are detailed in table 1.
Most patients were in NYHA functional class II(52% patients) or class III
(41% patients). The patients in both groups had elevated mean total and
low-density lipoprotein cholesterol. The study was conducted before the results of major
trials of statins in coronary artery disease were published and none of the patients
were on lipid lowering therapy. All patients had at least 1 mm ST segment depression
during exercise testing. Coronary arteriography showed majority (81%) of patients to be
have triple vessel disease.
Yoga lifestyle intervention
program
After
inclusion in the yoga group, patients, alongwith their spouses, spent 4 days at a yoga
residential centre, where they underwent training in various yogic lifestyle techniques.
The yogic lifestyle intervention program consisted of:
·
Yogic lifestyle
methods
1.
Health rejuvenating
exercises: a set of movements for improving the general tone of the body and to improve
coordination.
2.
Relaxation exercise (Kayotsarg):
a method of complete relaxation to prepare the body and mind for meditation.
3.
Breathing exercises (Pranayama)
4.
Yogic postures for
stretch relaxation (Asanas)
5.
Preksha meditation (Preksha
means seeing deeply within)
6.
Reflection on moral
values (Anuvrat and Anupreksha)
·
Stress management
(relaxation, breathing exercises and Preksha meditation)
·
Dietary control.
·
Moderate aerobic
exercises.
Patients
visited the yoga centre every fortnight for monitoring and evaluation. The compliance as
reported by patients themselves and by spouse, was recorded. In addition, the patients
were followed every month in cardiac clinic of the hospital for clinical examination and
investigations.
Dietary Control
Patient
were advised take a low fat (mostly poly-or monounsaturated,
3
providing15%of
calories), low cholesterol (<50 mg/d), high carbohydrate (mostly complex, providing
65% of calories) diet. Patients were also encouraged to have high soluble fiber diets
(>50gm/d) consisting of vegetable and fruits, oat bran, soybeans, gram and other
beans, They were also prescribed 15gm psyllium husk (almost entirely fiber) daily. In
addition, the diet advised was rich in antioxidants (carrots for beta-carotene, fruits,
for vitamin C, nuts like almonds and walnuts for vitamin E and flavonoids from onions,
coloured fruits and vegetables). Illustrative recipes and menus with known nutritional
values were provided to avoid monotony.
The
compliance of patients was assessed in a quantitative manner using a standard
questionnaire and the score could range from 0 to 100.
Statistical Analysis
All
data are presented a mean ± SD unless stated otherwise. The results at the end of 1year
were compared with those at the baseline. The changes in the yoga group were compared
with those in the control group. The P values were calculated using student's t-test for
paired data. Chi-square analysis using Yate's correction was performed wherever
appropriate.
Results
Both
groups were similar at baseline with respect to mean age, weight, serum lipid profile,
and mean lesion severity (Table1). However, patients in yoga group had significantly
more.
TABLE 1. Baseline characterics of
yoga and control groups
|
Parameter |
Yoga
group |
Control
group |
P
values(Yoga Vs Control |
|
Age (years) |
51±9 |
52±10 |
Ns |
|
Hypertensive |
43% |
38% |
Ns |
|
Diabetic |
29% |
24% |
Ns |
|
Smokers |
19% |
24% |
Ns |
|
Previous MI |
33% |
29% |
Ns |
|
Previous CABG |
10% |
5% |
Ns |
|
NYHA functional class |
2.62±0.67 |
2.33±0.58 |
Ns |
|
Anginal episodes/Wk |
6.71±2.95 |
4.10±2.14 |
0.002 |
|
Weight |
72.1±12.5 |
72.81±9.84 |
Ns |
|
Total Cholesterol |
257±43.6 |
236.86±40 |
Ns |
|
LDL Cholesterol |
156±32.7 |
145±30.5 |
Ns |
|
HDL Cholesterol |
40.81±6.25 |
38.81±4.34 |
Ns |
|
Triglycerides |
193±58.1 |
169±47.13 |
Ns |
|
LDL/HDL ratio |
3.84±0.89 |
3.78±0.87 |
Ns |
|
Exercise Duration |
349±147 |
430±19.29 |
0.056 |
|
**Double Product achieved (*10 ) |
23.62±2.66 |
24.13±2.41 |
Ns |
|
ST segment depression during exercise
test |
2.62±0.62 |
2.23±0.53 |
0.044 |
|
Mean Lesion Severity |
62.4±14.5 |
59.7±17.7 |
Ns |
4
Ns = Not Significant
* All patients were men
** Product of heart rate and systolic
blood pressure
|
Parameter |
Yoga group |
Control group |
P
values* |
||||||||
|
|
Baseline |
After 1 years |
Change at 1 year |
% Change |
P (before
VS after) |
Baseline |
After 1 year |
Change at 1
year |
% change |
P(before vs after) |
Change at 1 year |
|
NYHA
functional class |
2.62±0.67 |
1.43±0.6 |
-119±51 |
-46±15% |
<0.0001 |
2.33±0.53 |
2.86±0.75 |
0.52±0.75 |
29±37% |
0.004 |
.0001 |
|
Anginal |
6.71
± 2.95 |
2.14±2.65 |
-4.57±2.36 |
-73.2±2.27% |
<0.0001 |
4.10±2.14 |
5.38±2.29 |
1.29±2.15 |
47±67% |
0.01 |
.0001 |
|
Episodes/wk |
|
|
|
|
|
|
|
|
|
|
|
|
Weight |
72.1±12.5 |
66.5±8.3 |
-5.62±7.2 |
-6.8±8.2% |
0.0019 |
72.81±
9.84 |
72.4±9.65 |
-0.38±3.35 |
0±5% |
0.61 |
0.0005 |
|
Total
Cholesterol |
257±43.6 |
203±33.9 |
-54.14±36 |
-20.2±6.12% |
<0.0001 |
236.86±40 |
236±35.1 |
-1.29±17.5 |
0±8% |
0.74 |
.0001 |
|
LDL
Cholesterol |
156±32.7 |
118±29.8 |
-38.1±33 |
-23.2±17% |
0.00004 |
145±30.5 |
142±27.17 |
-3.29±16.83 |
-2±12% |
0.38 |
0.0002 |
|
HDL
Cholesterol |
40.81±6.25 |
41.29±4.47 |
0.48±5.6 |
2.8±14.9% |
0.70 |
38.81±4.34 |
39.8±5.99 |
0.95±4.41 |
3±12% |
0.33 |
0.76 |
|
Triglycerides |
193±53.1 |
148±49.9 |
-45.7±66 |
-20.1±26% |
0.005 |
169±47.13 |
174±51.06 |
4.76±27.33 |
3±17% |
0.43 |
0.003 |
|
LDL/HDL
ratio |
3.84
±0.89 |
2.81±0.66 |
-1.03±0.99 |
-24.3±22% |
0.0001 |
3.78±0.87 |
3.66±1 |
-0.11±0.53 |
4±13% |
0.33 |
0.0008 |
|
Exercise
Duration |
3.49±147 |
413±132 |
63.8±73.7 |
28.0±44.7% |
0.0008 |
430±119.29 |
374±150.86 |
-56.67±117 |
-17±23% |
0.055 |
0.0007 |
|
Double
Product Achieved(*10) |
23.62±2.66 |
23.79±2.75 |
0.17±2.08 |
1.0±8.5 |
0.71 |
24.13±2.41 |
236±2.79 |
-57±148 |
-3±5% |
0.12 |
0.14 |
|
ST
segment Depression during exercise test |
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