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Review Article
*Corresponding Author: Ayush Chandra, MBBS Clinical Medicine, Tianjin Medical University Qixiangtai Road, 22, Heping District, Tianjin.
Citation: Amrish Thapa, Rajan Oliya, Rakesh K. Das, Vu N. Bac, Lakmitha Perera BLS, et all (2022) Integrating Yogic Practices to Conventional Medicine in Preventing and Treating Medical Disorders. J. Immunology and Inflammation Diseases Therapy. 5(2); Doi:10.31579/2637-8876/036
Copyright: © 2022 Ayush Chandra. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 04 March 2022 | Accepted: 20 April 2022 | Published: 27 April 2022
Keywords: yoga; pranayama; meditation; immunity; cardio-respiratory disorders; alternative and complementary therapy
Yoga is increasingly recognized as a mind-body therapy for the prevention and treatment of several medical disorders. Yoga is an umbrella term that incorporates physical postures, breath-regulating exercises (pranayama), and meditation, and is known to maintain physical, mental, and emotional well-being. This review summarizes the scientific evidence of the existing literature demonstrating the effects of yoga on various parameters and body systems and its role in strengthening the immune system and combat medical problems, particularly cardiorespiratory disorders, COVID-19, stress, anxiety, and depression. A growing body of evidence indicated that yoga can downregulate pro-inflammatory markers, boosts immunity, and have favorable modulating effects on the immune and genetic level. Such positive impacts of yoga have made it to be an excellent add-on therapy for a number of acute and chronic medical conditions. However, more studies are required to explain the mechanisms and beneficial effects of yoga on the cellular and molecular level.
Yoga is a science that brings perfect balance and union of the mind, body, and spirit so that one can attain optimum capacity [1,2]. Yoga fosters physical, mental, spiritual, social, and environmental harmony [3]. National Center for Complementary and Alternative Medicine (NCCAM) has classified yoga as a mind-body therapy that combines physical postures, meditations, and breathing techniques called Pranayama (“Prana” means vital force or life energy, and “ayama” means to prolong) [1,4,5]. Studies show that yogic practices induce improved cardiorespiratory performance [6], improves exercise tolerance in patients with COPD [7], reduces stress [8], decreases blood pressure in hypertensive patients [9], produces improvement in blood glucose in diabetics [10], controls symptoms in asthma patients [11], has positive effects on anxiety and depression [12], and reduces pro-inflammatory cytokines secretion [2]. Besides, yoga is effective for cancer-related conditions [13,14], chronic low back pain [15], and chronic neck pain [16]. The yogic practice also significantly increases immune-related cytokines, such as interleukin-12, and interferon-c in serum, reduces the plasma levels of adrenalin, increases plasma levels of serotonin, attenuates oxidative stress, and improves the antioxidant levels, thereby improving immune function [17].The reduction in oxidative stress and improvement in endothelial functions are also the beneficial effect of long-term meditation [18]. Singh et al. reported that the yoga association in changing hormonal levels, inflammatory outcomes, and anti-viral outcomes inside the human body could be of enormous advantage in treating infectious conditions [18]. We were motivated to write this review hypothesizing that the holistic approach of yoga could be used as an adjunct to mainstream medicine to prevent and treat various medical disorders, including the ongoing Coronavirus Disease (COVID-19).
Methodology
To conduct this literature review, we conducted an advanced search on the National Library of Medicine electronic database, PubMed using the boolean operators (i.e., “AND,” “OR,”) to connect the relevant terms like “yoga”, “yogasana”, “pranayama”, “breathing exercises”, “meditation”, “respiratory disorders”, “cardiovascular disorders”, “immunity” and “COVID-19”, “stress”, “anxiety”, and “depression” to retrieve the related articles. We used boolean operator, “NOT” to exclude such other non-conventional interventions like Qigong, Tai qi quan, etc. In this review, we have incorporated randomized controlled trials, observational studies, meta-analysis, and reviews and cross-examined them for relevant citations. The time period of articles was not specified, and only English literature was included. Subsequently, we compiled a list of studies that could provide facts and evidence to reveal the association between yoga and COVID-19.
Yoga and immunity
Yoga postures that twist and compress organs help massage and rejuvenate immune organs. For instance, Kurmasana (tortoise pose), which exercises the thymus gland, could create specific benefits to improve immune function(19). Yoga has been shown to improve the markers of immunity of the patients [20]. It has been observed that yoga is directly related to increasing levels of superoxide dismutase and lymphocytes, however, decreasing the number of eosinophils and monocytes [21]. A pilot RCT study suggests that a month of yoga intervention could increase CD4 cell counts and mean CD4/CD8 ratio as well [22]. A popularly known meditation called transcendental meditation has a direct impact on the psycho neuroendocrine axis [23]. This axis is related to the interaction between psychological factors, the central nervous system, and immune function. The practice of transcendental meditation modifies hypothalamic and hypophyseal activity and leads to the daily lowered secretion of catecholamine, β-endorphins, and adrenocorticotropic hormones. In addition, it is found to be causing a decreased percentage of functional lymphocyte beta-adrenergic receptors in practitioners and a positive effect on leukocyte deoxyribonucleic acid by modulating its repair [23]. Studies also show that yoga could influence the immune system increasing the natural killer cells [24] and cellular ATP [25]. ATP facilitates IFN production and IFN signaling, which drives the immune cells to transform them into the so-called “anti-viral state”[26].
Yoga maintains telomerase length and increases telomerase activity as well. Immune cell telomeres are the protein complexes that protect and stabilize the ends of eukaryotic chromosomes, which truncate during cell division [27]. Shortened telomeres are markers of immune cell aging, vulnerability to apoptosis, and related with adverse clinical outcomes and premature death in many age-related diseases [28]. Likewise, psychological stress is linked with reduced telomerase activity, short telomeres, and increased cell aging [25]. However, telomere length is protected partly by the naturally occurring enzyme telomerase, which helps slow or reverses cell aging [27]. Longer telomeres and higher telomerase activity are therefore considered to be salutogenic immune system profiles. In a study by Bhasin et al., long-term relaxation therapies like yoga are related to telomere packing, telomere maintenance, and tight junction interaction [25]. Furthermore, regular meditation tends towards an increase in Aβ40 levels, tumor necrosis factor alpha, IgG, and IgA levels while it is associated with a reduction in the activity of the cellular transcription factor NF-kB, inflammatory cytokines, and circulating levels of CRP [18, 29-31].
Sympathetic and parasympathetic modulating effect of yoga
Yoga down-regulates the hypothalamic-pituitary-adrenal axis, which in turn decreases the release of cortisol and catecholamine [29]. It has been found that the sympathetic nervous system inhibits anti-viral genes and activates pro-inflammatory genes [18], while meditation relieves psychological stress by decreasing sympathetic nervous system activity and up-regulating parasympathetic function [32]. Meditation such as Omkar meditation, characterized physiologically as a wakeful hypometabolic state of parasympathetic dominance, causes an increase in cerebral perfusion besides decreasing vascular resistance, blood levels of catecholamines, cortisol, and lactate, leading to a decline in O2 consumption and CO2 elimination with a decrease in respiratory rate and minute ventilation with no change in respiratory quotient [6].
Breath-regulation exercise (Pranayama), an integral part of yoga, is a gradual unforced cessation of breathing that uses voluntary regulation of breathing to make respiration rhythmic and calm our mind [33,34]. Among different types of pranayama, alternate nostril breathing involves voluntary regulation of breathing with attention and concentration where one nostril predominates the other and follows the definite cycle [34]. The right nostril dominance corresponds to activation of the sympathetic system, and left nostril dominance corresponds to the parasympathetic system leading to a proper balance of sympathetic and parasympathetic systems [35]. This modulation of the autonomic nervous system is due to the conditioning effects of yoga on autonomic function, mediated through the limbic system and higher areas of the central nervous system [6].The voluntary slow deep breathing during yoga sessions functionally influences the ANS through stretch-induced inhibitory signals, and hyperpolarization currents propagate through both neural and non-neural tissue, which synchronizes neural elements in the heart, lungs, limbic system, and cortex. During deep inspiration, stretching of lung tissue produces inhibitory signals by the action of slowly adapting stretch receptors and hyperpolarization current by the action of fibroblasts. Both inhibitory impulses and hyperpolarization current synchronize neural elements and modulate the nervous system and decrease metabolic activity indicative of the parasympathetic state [33]. Additionally, a significant reduction in systolic, diastolic, and mean arterial pressure after regular practice of Hatha yoga indicates a gradual shift of autonomic equilibrium toward relative parasympatho-dominance because of the reduction of sympathetic activity [6].
Yoga modulates gene expression inducing beneficial health effects
Yoga and meditation is involved in enhanced gene expression that are related with energy metabolism, mitochondrial function, telomere maintenance, and insulin secretions, and decreased gene expression associated with inflammatory response and stress-related pathways [25]. One significant among such genes is mitochondrial ATP synthase that plays an essential role in the production of adenosine triphosphate (ATP). Yoga upregulates ATP synthase and enhances mitochondrial reserve capacity resulting in decreased production of reactive oxygen species, which in turn reduces the oxidative stress of cells [25]. This is very beneficial during infection. Meditation has also been associated with the reduced expression of pro-inflammatory genes in blood cells [32] and improved cellular health with the ability to lower regulation of protein synthesis and viral genome activity [30]
Effect of yoga in respiratory disorders
Stretching yoga exercises for 90 min has been found to be increasing salivary human beta-defensins-2, an antimicrobial peptide that destroys the hydrophobic core of lipid bilayer of micro-organism which is usually found in epithelial cells of the oral cavity and respiratory tract [36]. Yogic exercises such as inversions, prone poses, and back-bends, along with strong breathing exercises strengthen the torso and initiate diaphragmatic breathing that improves respiratory performance and increases chest expansion [37]. There is some evidence that yoga may improve quality of life, symptoms, forced vital capacity, peak expiratory flow rate, and reduce medication usage in people with asthma [38]. A study by Lorenc et al. states that yoga, when performed as a moderate-intensity exercise, may stabilize the sympathetic nervous system and condition autonomic function, decrease airway resistance, and improve respiratory muscle strength, but limited data are available [39]. An RCT that enrolled asthma patients showed a considerable increase in histamine dose required to provoke 20
The preventive and therapeutic role of yogic practices can be applied as an adjuvant to conventional medicine in the management of a wide variety of medical conditions. The existing research evidence advocates the medical community to go beyond the ego and boundaries of various therapies or interventions and integrate yogic practices in modern medicine to restore health and maintain physical and psychological well-being. Despite the multi health benefits of yoga, large-scale controlled clinical trials are scarce and necessitate exploration through further studies.
The authors declare that they have no conflicts of interest.
Amrish Thapa contributed to the conception and design of the researchand coordinated the entire team in accomplishing this work. All authors participated in online discussion, searched and collected relevant articles, and played an important role in drafting specific sections of the manuscript. Amrish Thapa, Rajan Oliya, and Rakesh Kumar Das worked together to compile all the points and drafted the first manuscript. Amrish Thapa and Ayush Chandra edited and revised the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work and read and approved the final manuscript. Amrish Thapa and Rajan Oliya contributed to the work equally and should be regarded as co-first authors.
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