The Principles and Practice of Yoga in Cardiovascular Medicine

Description

This is the world’s first reference book covering the role of Yoga in Cardiovascular Diseases. It details epidemiology, physiology, pathology, prevention, and management of cardiovascular diseases based on the current scientific understanding of Yoga. Seventy-five experts from four continents, including the most notable names, contributed to this work to create the world’s first comprehensive reference literature on Yoga in cardiovascular medicine. The chapters cover information related to Yoga, both as prevention and therapy, including coronary artery disease, heart failure, and arrhythmias. In addition, important cardiovascular topics like obesity and diabetes mellitus are also included. A special chapter covers the role of Yoga in the prevention of cardiovascular complications in COVID-19 patients. Notice Foreword Foreword Contents About the Editors Part I: Introduction 1: Cardiology: A Primer for the Uninitiated 1.1 Basic Anatomy 1.2 Basic Physiology 1.3 Hypertension 1.4 Coronary Artery Disease 1.5 Valvular Heart Disease 1.6 Arrhythmias 1.7 Cardiomyopathy 1.8 Heart Failure 1.9 Congenital Heart Disease 1.10 Pericardial Disease 1.11 Infection of Heart 1.12 Pulmonary Embolism 1.13 Peripheral Arterial Disease 1.14 Conclusion References 2: Addressing the Common Risk Factors for Reducing the Burden of Cardiovascular Diseases: The Impact of Yoga 2.1 Introduction 2.2 The Global Burden of Cardiovascular Diseases 2.3 Yoga and Cardiovascular Health 2.4 Epidemiological Evidence: Yoga and Cardiovascular Diseases 2.5 Integration of Yoga: Indian Case Study 2.6 The Future Ahead 2.7 Recommendations References 3: The Nature, Meaning, and Practice of Yoga: Traditional Base Meets Scientific Rigor 3.1 Yoga: Nature and Meaning 3.2 Yoga: From the Esoteric to Practice for Research 3.3 Yoga: The Physical and Mental 3.4 Yoga: Mastery over the Senses, Skill in Execution, Mental Equilibrium 3.5 Yoga: A Plan of Action and a Life-System Approach 3.6 Yoga: Action, Attention, Openness 3.7 Hatha Yoga: Practical Techniques to Do, Research, and Offer as Therapy 3.8 Hatha Yoga: Autonomic Balance, Free from NCD 3.9 Hatha Yoga: Impact on ANS, Spine and Joints, Neuromuscular System 3.10 Āsana as Opposed to Exercise 3.11 Āsana Performed Correctly with Integrity 3.12 Yoga Practice: The Scientific Approach 3.13 Yoga Practice: Context and Situation 3.14 Yoga Practice: Established Protocols and Recommended “Dose” Options 3.15 Conclusion References 4: Yoga in the Management of Cardiovascular Disease: A Brief Introduction 4.1 Introduction 4.2 The Health Challenges of the Twenty-First Century 4.3 Stress, Allostatic Load, and NCDs 4.4 The “New” Mind-Body Medicine 4.5 Resilience, Health Promotion, and Illness Prevention 4.6 The Mind-Body Medicine Stress to Resilience Ratio 4.7 Yoga in Cardiovascular Disease 4.7.1 Mechanisms of Yoga 4.7.2 Yoga and Heart Rate Variability 4.7.3 Yoga and Heart Failure 4.7.4 Yoga and Arrhythmia 4.7.5 Yoga and Cardiac Rehabilitation 4.8 Yoga Side Effects 4.9 Conclusion References Part II: Pathophysiology 5: Mechanistic Model for Yoga as a Therapeutic Modality in Cardiovascular Disease 5.1 Introduction 5.2 The Brain 5.3 The Autonomic Nervous System 5.4 Psychological Effects 5.5 Endocrine Effects 5.6 Cellular Effects 5.7 Genetic Effects 5.8 Conclusions References 6: The Anatomical, Physiological and Neurochemical Correlates of Yoga 6.1 Introduction 6.2 Anatomical Aspect of Asanas in Cardiovascular Disorders 6.3 Physiological Aspect of Pranayama in Cardiovascular Disorders 6.4 Psychological Aspect of Meditation in Cardiovascular Disorders 6.5 Biochemical Aspect of Yoga in Cardiovascular Disorders References 7: Cardiovascular Influence of Yoga Assessed with Heart Rate Variability Measures 7.1 Introduction 7.2 Cardiovascular Disease 7.3 Heart Rate Variability 7.4 Heart Rate Variability a Marker for Stress 7.4.1 Autonomic Regulation of Psychological Stress 7.4.2 Effect of Yoga on Stress 7.5 Yoga and Cardiovascular Disease 7.6 Efficacy of Yoga on HRV in Patients with CVD 7.7 Yoga for CVD Risk Factors 7.7.1 Efficacy of Yoga on Hypertension Assessed by Using HRV 7.7.2 Efficacy of Yoga on Obesity Assessed by Using HRV 7.7.3 Efficacy of Yoga on Depression Assessed by Using HRV 7.7.4 Efficacy of Yoga on Epilepsy Assessed Using HRV 7.8 Conclusion References 8: Mechanisms and Biomarkers to Understand Impacts of Yoga in Cardiovascular Diseases 8.1 Biomarkers to Understand the Impact of Yoga 8.1.1 Inflammation Markers 8.1.2 Depression 8.1.3 Oxidative Stress 8.2 Conclusion References 9: Stress and the Autonomic Nervous System: Implication of Yoga 9.1 Modern Day Stress 9.2 Autonomic Nervous System (ANS) 9.3 Cardiovascular Autonomic Control: Anatomical Aspects 9.4 Physiology of Cardiovascular Autonomic Control 9.5 Conventional Cardiac Autonomic Function Tests 9.5.1 Deep Breathing Test 9.5.2 Valsalva Maneuver 9.5.3 Orthostatic Test 9.5.3.1 Physiological Background of the Orthostatic Test 9.5.4 Isometric Handgrip Test 9.6 Heart Rate Variability (HRV) Analysis 9.7 Clinical Utility of HRV 9.8 Yoga 9.9 Studies Exploring Effect of Yoga on AFTs 9.9.1 Pranayama (Breathing Exercises or Alternate Nostril Breathing) References 10: Neurobiological Effects of Yoga on Stress Reactivity 10.1 Yoga 10.2 The Stress Response 10.2.1 Hypothalamic–Pituitary–Adrenal Axis 10.3 The Impact of Persistent Stress 10.4 Yoga Asana and Stress Regulation 10.5 Yoga Asana and Autonomic Measures 10.5.1 Blood Pressure 10.5.2 Heart Rate 10.5.3 Heart Rate Variability 10.6 Cytokines 10.7 Cortisol 10.8 Concluding Remarks References 11: Mind and Cardiovascular Disease: Mechanism of Interrelationship 11.1 Cardiology and Psychology Interface 11.2 Epidemiology of Cardiovascular Disease and Cardiovascular Health 11.2.1 Depression and Cardiovascular Disease 11.2.2 Anxiety, Anger, Hostility, Distressed Personality (Personality D), and CVD 11.2.3 Positive Psychological Well-Being (PPWB) and CVD 11.2.4 Ideal Cardiovascular Health 11.3 Mechanisms Linking Psychological States and CVD/CAD 11.3.1 Neurocardiology 11.3.2 Neurocardiac Axis 11.3.3 Psycho-Neuro-Endocrine Axis 11.3.4 Psycho-Immunology Axis 11.4 Cardiovascular Health and Yoga-Based Intervention 11.4.1 Yoga-Based Intervention and Neurobiology 11.4.2 Yoga-Based Intervention and Cardio-Metabolic Health 11.4.3 Yoga-Based Intervention and Cardiac Rehabilitation References Part III: Imaging and Laboratory Techniques 12: Next-Generation Techniques for Validating Yoga Effect on the Cardiovascular System 12.1 Introduction 12.1.1 Types of Yoga 12.1.2 Benefits of Yoga 12.1.3 Yoga and Cardiovascular Diseases 12.1.4 Mindfulness-Based Stress Reduction 12.1.5 Obesity and Yoga 12.1.6 “Transitions in Modern Nutrition Practices: Paradigms Lost and Regained” 12.1.7 The Obesity Epidemic 12.1.8 Biochemical Studies as Tools for Assessment of Yoga and Meditation 12.1.9 Neuroimaging as Tool for Assessment of Effects of Yoga and Meditation 12.1.10 Bereitschaftspotential as Tool for Assessment of Meditation 12.1.11 Modern Methodologies and Techniques for Validating Benefits of Yoga and Traditional Indian Practices 12.1.12 Functional Near-Infrared Spectroscopy (fNIRS) 12.1.13 Polysomnography as Tool for Assessment of Meditation 12.1.14 Eye Tracking as Tool for Assessment of Yoga 12.1.15 Integrated Wireless Recording as a Tool for Assessment of Effects of Yoga 12.1.15.1 Deep Breathing Test (DBT) 12.1.15.2 Heart Rate Variability (HRV) 12.1.15.3 Sympathetic Skin Response (SSR)/Electrodermal Response (EDA)/Galvanic Skin Response (GSR) 12.1.15.4 Photoplethysmography (PPG) 12.1.16 Spirometry 12.1.17 Impulse Oscillometry 12.2 Conclusion References 13: Yoga and Neuroimaging Current Status of Evidence 13.1 Introduction 13.2 Emphasis on Mind-Body Link 13.3 Role of Yoga in Brain Health and Disease 13.4 Aim of the Chapter 13.5 Mechanistic Insights to Yoga-Associated Health Benefits 13.6 Brief Introduction to Neuroimaging 13.7 Neuroimaging Evidence in Yoga 13.8 Limitations 13.9 Future Directions 13.10 Summary and Conclusion References Part IV: Yoga for Various Cardiovascular Diseases 14: Yoga: A Holistic Approach for Cardiac Arrhythmia 14.1 Introduction 14.2 Basics of Yoga 14.3 Autonomic Function and Neurohormonal Modulation (Fig. 14.1) 14.4 Cardiac Innervation 14.5 Psychiatry 14.6 Autonomic Etiology of Dysrhythmias 14.6.1 Reflex Syncope 14.6.2 Atrial Fibrillation (AF) 14.6.3 Ventricular Arrhythmia 14.7 Conclusion and Future Direction References 15: Cardiometabolic Syndrome and Effects of Yoga 15.1 Introduction 15.2 Cardiometabolic Syndrome or Diseases 15.3 Etiology of Cardiometabolic Syndrome or Diseases and Yoga 15.4 Central Obesity or Visceral Obesity or Abdominal Obesity 15.5 Dyslipidemia or Abnormal Lipid Profile and Apolipoproteins 15.6 Atherosclerosis 15.7 Dysfunctions Related to Systemic Metabolism 15.8 Metabolic Dysfunction Induced by Liver 15.9 Metabolic Dysfunction Induced by Adipose Tissue 15.10 Metabolic Dysfunction Induced by Muscle Tissue 15.11 Gastrointestinal and Endocrine Factors 15.12 Oxidative Stress 15.13 Inflammatory Markers 15.14 Scientific Exposition of Yoga and Cardiometabolic Diseases 15.15 Yogic Concept of Disease 15.16 Obesity and Yoga 15.17 Type 2 Diabetes and Yoga 15.18 Cardiovascular Disease and Yoga 15.19 Organokines and Yoga 15.19.1 Adipokines 15.19.2 Myokines 15.19.3 Hepatokines 15.20 Cardiovascular Diseases and Yoga Therapy 15.20.1 Cardiac Autonomic Dysfunction 15.20.2 Cardiac Arrhythmia 15.20.3 Coronary Artery Disease 15.20.4 Hypertension and Yoga 15.21 Cancer and Yoga 15.22 Prophylactic Role of Yoga for Better Cardiometabolic Health 15.23 Conclusion References 16: Role of Yoga in Prevention and Management of Type 2 Diabetes Mellitus (T2DM) and Its Complications 16.1 Introduction 16.2 Yoga and Blood Glucose Control in T2DM 16.3 Yoga as a Preventive Measure for T2DM 16.4 Cardio-Protective Effects of Yoga in T2DM 16.5 Prevention of T2DM Complication Through Yoga 16.6 Cognitive Enhancement in T2DM Through Yoga 16.7 Yoga and Mental Health in T2DM 16.8 Autonomic Dysfunction 16.9 Mechanism of Action: Molecular and Genetic Studies References 17: Yoga and Obesity 17.1 Definition of Obesity 17.1.1 Childhood Obesity 17.1.2 Waist Circumference as a Parameter of Central Fat Distribution 17.2 Epidemiology of Obesity 17.3 Pathogenesis of Obesity 17.3.1 Physiology of Energy Homeostasis 17.3.2 Energy Metabolism 17.3.3 Genetics and Obesity 17.3.3.1 Monogenic Causes 17.3.4 Syndromic Causes of Obesity 17.3.5 Polygenic Obesity 17.3.6 Epigenetics 17.3.7 Environmental Factors and Obesity 17.3.8 Stress and Obesity 17.4 Complications of Obesity 17.5 Management of Obesity 17.6 Yoga: Basic Principles 17.7 Yoga: Role in Obesity 17.8 Yoga for Obesity 17.9 Conclusion References 18: Yoga for Dyslipidemia 18.1 Background 18.2 Dyslipidemia: An Overview, Stress and Disease Associated Mechanisms 18.2.1 Impact of Stress on Lipid Metabolism 18.2.2 Physiological Mechanisms 18.2.3 Cardiovascular Diseases 18.2.4 Diabetes 18.3 Yoga: An Overview and Its Significance as a Therapeutic Module in Curing Diseases 18.3.1 Mechanism of Action by Yoga 18.3.2 Adverse Effects of Yoga 18.3.3 Treatment of Dyslipidemia 18.3.4 Alternative Therapies and Dyslipidemia 18.4 Conclusion References 19: Yoga for Primary and Secondary Prevention of Coronary Heart Disease 19.1 Introduction 19.2 What Is Yoga? 19.3 Yoga for Primary Prevention of CHD 19.4 Hypertension 19.5 Diabetes Mellitus (DM), Metabolic Syndrome 19.6 Obesity 19.7 Smoking Cessation 19.8 Psychosocial Stress 19.9 Dyslipidemia 19.10 Inflammation, Oxidative Stress, and Procoagulant Status 19.11 Role of Yoga in Management of CVD Risk Score 19.12 Yoga for Secondary Prevention of CHD 19.13 Regression of Atherosclerosis 19.14 Cardiac Arrhythmias and Heart Failure 19.15 Conclusion References 20: Role of Yoga in Stroke Management: Current Evidence and Future Directions 20.1 Introduction 20.2 Clinical Features 20.3 Risk Factors 20.4 Limitations of Conventional Management Care 20.5 Need for Holistic Interventions such as Yoga 20.6 Introduction to Yoga Therapy and Rationale for Its Use in Stroke Management 20.7 Understanding of Stroke from Yoga Perspective: The Concept of Five Layers of Existence 20.8 Yoga for Prevention of Stroke: Current Evidence 20.9 Current Evidence: Yoga for Post-Stroke Rehabilitation 20.10 General Guidelines to Adapt Yoga Therapy for Stroke Rehabilitation 20.11 Graduated Yoga Module for Stroke 20.12 Yoga and Ayurveda-Based Lifestyle Advices for Post-Stroke Care 20.13 Probable Mechanism of Action 20.14 Limitations of Current Evidence in Yoga and Future Directions to Overcome the Limitations in Yoga Research in Stroke 20.15 Conclusion References 21: Meditation and Yoga in the Treatment of Addictive Disorders 21.1 Introduction 21.2 Epidemiology 21.3 Pathophysiology 21.4 Treatment Options 21.4.1 Mindfulness 21.4.2 Alternative Mind–Body Practices for the Treatment of SUD 21.4.3 Transcendental Meditation 21.5 Evidence for Yoga 21.5.1 Qigong 21.5.2 Conclusion and Recommendations References 22: Yoga and Cardiovascular Disease Prevention in African Americans and Hispanics 22.1 Introduction 22.2 Yoga and the African American Community 22.3 Yoga Trials with African American Participants 22.4 Yoga and the Hispanic Community 22.5 Yoga Trials with Hispanic Participants 22.6 Limitations to Yoga Trials and Cardiovascular Disease in African American and Hispanic Individuals 22.7 Conclusion References 23: Yoga in the Management of Arterial Hypertension 23.1 Epidemiology of Hypertension 23.2 Pathophysiology of Hypertension 23.3 Mechanisms of Yoga in Hypertension Management 23.3.1 Psycho-physiological Mechanisms 23.3.2 Psychological and Neurocognitive Mechanisms 23.4 Types of Yoga Studied 23.5 Evidence About the Efficacy of Yoga in Hypertension Management 23.5.1 Efficacy of Yoga and Allied Interventions 23.5.2 Efficacy of Pranayama-Specific Interventions 23.5.3 Efficacy of Yoga in Other Psycho-physiological Parameters Associated with Hypertension 23.5.4 Feasibility of Yoga as an Adjuvant Therapy in Hypertension Management 23.6 Clinical Practice of Yoga in Hypertension Management 23.7 Conclusion References 24: Meditation in Prevention and Treatment of Cardiovascular Disease: An Evidence-Based Review 24.1 Introduction 24.2 The Transcendental Meditation (TM) Technique 24.2.1 Effect of TM on CVD Risk Factors 24.2.2 Effect of TM on Surrogate Markers of CVD 24.2.3 Effect of TM on CV Clinical Events and Mortality 24.3 Mindfulness-Based Stress Reduction (MBSR) 24.3.1 Effect of MBSR on CVD Risk Factors Hypertension 24.3.2 Psychosocial Stress and Negative Emotional States 24.3.3 Effects of MBSR on Surrogate Markers of CVD 24.3.4 Effect of MBSR on CVD Clinical Events 24.4 Yoga 24.4.1 Effects of Yoga on CVD Risk Factors 24.4.2 Effect of Yoga on Left Ventricle Function 24.4.3 Psychological Stress and Negative Affective States 24.4.4 Effect of Yoga on Surrogate Markers of CVD 24.4.5 Effect of Yoga on Cardiovascular Clinical Events 24.5 Other Meditation Techniques 24.6 Qigong 24.7 Zen Meditation References 25: Yoga for Heart Failure 25.1 Introduction 25.2 Exercise Intolerance in Heart Failure 25.3 Benefits of Exercise and Cardiac Rehabilitation in Heart Failure 25.4 Complementary and Integrative Strategies 25.5 Benefits of Yoga in Heart Failure 25.6 Implicated Mechanisms in Yoga 25.7 Conclusion References 26: Yoga for Mental Health and Comorbidities 26.1 Introduction 26.2 Common Mental Health Co-Morbidities in CVDs: Epidemiology Burden and Clinical Symptoms 26.2.1 Depression and CVD 26.2.2 Anxiety and CVD 26.2.3 Post-Traumatic Stress Disorder and CVD 26.3 Syndemic Relation Between CVDs and Mental Disorders 26.3.1 Cardiac Disorders and Stress 26.3.2 The Heart-Brain Connection 26.4 Introduction to Yoga 26.5 Yoga for Mental Disorders: Current Evidence 26.6 Yoga for Mental Health Co-Morbidities in CVDs: Current Evidence 26.7 Probable Mechanisms 26.8 Role of Lifestyle in Mental Health Co-Morbidities in CVDs 26.9 Clinical Yoga Practices for Mental Health Disorders in CVDs 26.9.1 Tentative Yoga Module for Management of Mental Health Co-Morbidities in CVDs 26.10 Future Directions References 27: Role of Yoga and Meditation in Palliative Care 27.1 Core Concept 27.2 Magnitude of the Problem 27.3 Physiological Rationale for the Use of Yoga and Meditation 27.4 Yoga and Meditation for Palliative Care Need of Transition from “Cafeteria Approach” to “Tailor Made Approach” 27.5 Evidence Supporting Yoga and Meditation in Palliative Care 27.6 Evidence Gaps and Future Directions References 28: Yoga-Based Cardiac Rehabilitation Program for Cardiovascular Health 28.1 Introduction 28.2 Cardiac Rehabilitation 28.3 Yoga-Based Cardiac Rehabilitation Programme 28.4 Yoga in Cardiac Health 28.4.1 Underlying Mechanisms 28.5 Yoga-Based Cardiac Rehabilitation Programme in Patients with Established Cardiovascular Diseases 28.5.1 Effects of Yoga in Cardiovascular Events 28.5.2 Effects of Yoga on Revascularisation 28.5.3 Effects of Yoga in Coronary Atherosclerosis 28.5.4 Effects of Yoga on Angina 28.5.5 Effects of Yoga on Cardiovascular Risk Factors 28.5.6 Effects of Yoga on Patient-Reported Outcomes 28.6 Landmark Trials Evaluating Yoga-Based Comprehensive Programmes in Coronary Atherosclerosis 28.6.1 Lifestyle Heart Trial 28.6.2 Indian Lifestyle Heart Trial 28.6.3 Trial of Stress Reduction by Transcendental Meditation 28.6.4 Yoga-CaRe Trial 28.7 Demonstration Projects of Comprehensive Rehabilitation Programmes Involving Yoga 28.8 Components and Structure of Yoga-Based Cardiac Rehabilitation Programme 28.9 Conclusion References 29: Yoga as a Potential Intervention for Preventing Cardiac Complications in COVID-19: Augmenting Immuno-Modulation and Bolstering Mental Health 29.1 Introduction 29.2 SARS-COV-2 Infection 29.2.1 The Role of Immunity 29.2.2 Cardiovascular Effects 29.2.3 Mechanisms of Cardiac Damage 29.2.3.1 Cytokine Release Syndrome 29.2.3.2 Direct Myocardial Cell Injury 29.2.3.3 Acute Coronary Syndrome 29.3 Pandemics, Immunity, and Mental Health 29.3.1 Stress 29.3.2 Anxiety 29.3.3 Depression 29.4 Yoga and Immunity 29.5 Yoga and Psychosocial Health 29.6 Yoga and Cardiorespiratory Protection 29.7 Conclusions References Part V: Appendix 30: Dinacharya the Daily Routine and Ritucharya the Seasonal Routine for Yogic Lifestyle 30.1 Yogic and Ayurvedic Clock 30.1.1 First Cycle 30.1.2 Second Cycle 30.2 Morning 30.2.1 Proper Hydration 30.2.2 Elimination 30.2.3 Cleansing of the Senses 30.2.4 Eyes and Face 30.2.5 Mouth 30.2.6 Nasal Passages 30.3 Yoga and Exercise 30.3.1 Yoga 30.3.2 Exercise 30.4 Cleansing the Body 30.4.1 Massage 30.4.2 Bath/Shower 30.4.3 Ears 30.4.4 Prayer and Meditation 30.4.5 Breakfast 30.4.6 Work/Study 30.5 Afternoon 30.5.1 Midday Meal 30.5.2 Work/Study 30.5.3 Siesta 30.5.4 Exercise and Snacking 30.6 Evening 30.6.1 Dinner 30.6.2 Bedtime 30.7 Ritucharya 30.8 Yoga Protocol for Cardiac Health Further Reading 31: Yogic Diet and its Anti-inflammatory Effect in Relation to CVD 31.1 Introduction 31.2 Role of Traditional Diet and Lifestyle Practices 31.3 Beneficial Effects on Atherosclerosis and Lipid Metabolism 31.4 Benefits on Hypertension and Actions on Vascular Smooth Muscles 31.5 Beneficial Effects on Myocardial Infarction (MI) Through Action on Cardiac Muscle and Vasculature 31.6 Beneficial Effects on Microangiopathy and Cardiac Myopathy in Diabetes Mellitus 31.7 Conclusion and Future Prospects References 32: Principles of Diet for a Yogic Lifestyle References