R. L. Bijlani

The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial

BackgroundThere is a substantial body of evidence on the efficacy of yoga in the management of bronchial asthma. Many studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life and reduction in airway hyper-reactivity, frequency of attacks and medication use. In addition, a few studies have attempted to understand the effects of yoga on exercise-induced bronchoconstriction (EIB) or exercise tolerance capacity. However, none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma.MethodsThe present randomized controlled trial (RCT) was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated randomly to either the yoga (intervention) group (n = 29) or the wait-listed control group (n = 28). The control group received only conventional care and the yoga group received an intervention based on yoga, in addition to the conventional care. The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practices at home for 6-wk. The outcome measures were assessed in both the groups at 0 wk (baseline), 2, 4 and 8 wk by using Generalized Linear Model (GLM) repeated measures followed by post-hoc analysis.ResultsIn the yoga group, there was a steady and progressive improvement in pulmonary function, the change being statistically significant in case of the first second of forced expiratory volume (FEV1) at 8 wk, and peak expiratory flow rate (PEFR) at 2, 4 and 8 wk as compared to the corresponding baseline values. There was a significant reduction in EIB in the yoga group. However, there was no corresponding reduction in the urinary prostaglandin D2 metabolite (11β prostaglandin F2α) levels in response to the exercise challenge. There was also no significant change in serum eosinophilic cationic protein levels during the 8-wk study period in either group. There was a significant improvement in Asthma Quality of Life (AQOL) scores in both groups over the 8-wk study period. But the improvement was achieved earlier and was more complete in the yoga group. The number-needed-to-treat worked out to be 1.82 for the total AQOL score. An improvement in total AQOL score was greater than the minimal important difference and the same outcome was achieved for the sub-domains of the AQOL. The frequency of rescue medication use showed a significant decrease over the study period in both the groups. However, the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group.ConclusionThe present RCT has demonstrated that adding the mind-body approach of yoga to the predominantly physical approach of conventional care results in measurable improvement in subjective as well as objective outcomes in bronchial asthma. The trial supports the efficacy of yoga in the management of bronchial asthma. However, the preliminary efforts made towards working out the mechanism of action of the intervention have not thrown much light on how yoga works in bronchial asthma.Trial registrationCurrent Controlled Trials ISRCTN00815962

Effect of Meditation on Stress-Induced Changes in Cognitive Functions

OBJECTIVES The objective of this study was to study the effects of meditation on stress-induced changes in cognitive functions. METHODS The study was conducted on 32 healthy adult male student volunteers who had never practiced meditation before the study. The study consisted of practicing 20 minutes of guided meditation and administration of psychologic stress to the subjects. The psychologic stress was administered to the subjects by asking them to play a (preselected) stressful computer game. The subjects were asked to meditate either before or after the administration of psychologic stress. For the control group measurements, the subjects were asked to wait quietly for an equivalent period of meditation time. OUTCOME MEASURES The outcome measures were galvanic skin response (GSR), heart rate (HR), electromyography (EMG), sympathetic reactivity (QTc/QS2 ratio), cortisol, and acute psychologic stress scores. The central nervous system functions were assessed using Wechsler memory scale and visual-choice reaction time (VCRT). These parameters were measured both at the beginning and at the end of the intervention, using a pre-post experimental test design. RESULTS Computer game stress was associated with a significant increase in physiologic (GSR, EMG, HR, QTc/QS2) and psychologic (acute stress questionnaire scores) markers of stress. Meditation was associated with relaxation (significant decrease in GSR, EMG, QTc/QS2, and acute stress questionnaire scores). Meditation, if practiced before the stressful event, reduced the adverse effects of stress. Memory quotient significantly increased, whereas cortisol level decreased after both stress and meditation. VCRT showed no significant change. CONCLUSIONS Practice of meditation produced a relaxation response even in the young adult subjects who had never practiced meditation before. The practice of meditation reduced the physiologic stress responses without taking away the beneficial effect of stress, namely, improved memory scores.

A comprehensive study of autonomic dysfunction in the fibromyalgia patients

ObjectivesThe hypothesis of autonomic nervous system involvement in pathophysiology in the patients with fibromyalgia has been addressed and tested time and again but the existing reports are both contradictory and inconclusive. A complete knowledge of the degree of autonomic dysfunction in fibromyalgia patients would be more substantial. We conducted a comprehensive non-invasive study to investigate the complete autonomic profile of female patients with fibromyalgia.MethodAn autonomic function test using a standard battery and heart rate variability analysis in the 42 fibromyalgia patients as well as 42 age matched healthy controls was performed. Both autonomic activity (tone) and reactivity were measured. Autonomic tone (both time and frequency domain parameters) was measured using heart rate variability (HRV) analysis. Autonomic reactivity was measured using a standard battery of autonomic function tests.ResultsResting blood pressure (both systolic and diastolic) was significantly higher in the fibromyalgia patients than controls. The time domain variables and HF% as recorded by HRV were significantly lower in the patients than the controls. The autonomic reactivity for sympathetic and parasympathetic nervous system was found to be within normal limits.InterpretationThe cardiac autonomic function is normal and the autonomic reflex arc seems to be intact in the patients with fibromyalgia.

Modulation of glycemic response by protein, fat and dietary fibre

Abstract Five healthy young male volunteers were given isocaloric meals composed of glucose alone or in combination with protein, fat, or dietary fiber. Glycemic response was blunted in case of all mixed meals, the glucose level at 2.0 h and the area under the 2-h glucose curve being significantly lower (p

Nutrient composition is a poor determinant of the glycaemic response

1. The glycaemic response of healthy males to potato, bread, rice and green gram (Phaseolus aureus Roxb.) was compared with that to meals equivalent to these foods in terms of carbohydrate, protein, fat and fibre content, but made up of maize flour, casein, maize oil and ispaghula husk. 2. Natural foods led to a higher postprandial glycaemia than their respective equivalents, but the difference was significant only in the case of potato at 0.5 h (P less than 0.05). 3. The insulin response, studied only in the case of rice and green gram, followed a trend similar to the glycaemic response but the differences between natural foods and equivalents were even more marked. 4. A food is more than the sum of its major nutrients. Several poorly understood factors may contribute to the glycaemic response to a food. In addition to the quantity of nutrients, the response may be the result of the specific type of nutrients, non-nutrient chemicals and anti-nutrients composing the food, and their unique physical arrangement within the food.

Modulation of postprandial glycaemia and insulinaemia by cellulose in mixed nutrient combinations

The present study was designed to examine the effect of cellulose (CL) on postprandial glycaemia and insulinaemia when ingested with glucose (G), casein (CS) and maize oil (CO) in various combinations. The study was conducted on five healthy male volunteers, on each of whom five meal tolerance tests were performed. The meals were isoenergetic and consisted of G; G and CL; G, CS and CL; G, CO and CL; G, CS, CO and CL. The meals were administered after an overnight fast. In addition to a fasting venous blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. The glycaemic response to G + CS + CL and G + CS + CO + CL was significantly lower, while the insulinaemic response to G + CL was significantly higher than that to G. Addition of CL to G did not alter the glycaemic response, but accentuated the insulinaemic response. Further addition of CS in isoenergetic meals attenuated the glycaemic response, which may be because of a reduction in the amount of G in the meals. Like CS, CL also seemed to have an insulinotropic effect. The mechanism of the insulinotropic effect of CL cannot be deduced from the present study, but it is possible that like G, CL also stimulates gastric inhibitory peptide (GIP) secretion from the duodenum, which in turn stimulates insulin secretion.