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Autonomic and endothelial imbalance in post menopause women raise the need to manage cardiovascular risk. Yoga poses and breathing control present controversial results on prevention and treatment of hypertension.. The aim of this study is to compare the effect of 12 week intervention based on yoga poses and their muscle contractions known as bandhas (pelvic floor, core and throat/neck) and ujjayi pranayama (victorious breath) on autonomic modulation, endothelial function, arterial stiffness, aerobic capacity and cognitive function of hypertensive post-menopausal women.
Abstract: Increased hypertension prevalence in post-menopausal women, along with cardiovascular damages such as autonomic and endothelial imbalance raise the need to include non-pharmacological interventions, such as yoga in the management of cardiovascular risk. Yoga practices are composed by several variations of techniques including physical postures (yoga poses and specific muscles contractions), breathing control (pranayamas), relaxation and meditation, beside others.The effects of each of these compounds has not been elucidated up to date and can be considered confounding effects for commonly named "yoga programs". Existing yoga based data are controversial about its effect on prevention and treatment of hypertension and point to poor methodological standards of most studies. Considering the effects of comparable interventions such as slow breathing on improving autonomic modulation, resistive and isometric exercise on endothelial function, and associations of flexibility with arterial stiffness, it´s licit to search for specific effects of yoga compounds. Thus, the aim of this study is to compare the effect of 12 week intervention based on yoga poses including their muscle contractions known as bandhas (pelvic floor, core and throat/neck), ujjayi pranayama (victorious breath) and stretching/ flexibility on autonomic modulation, endothelial function, arterial stiffness, aerobic capacity and cognitive function of hypertensive post-menopausal women.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Yoga Poses + Breath control | Active Comparator | Twice a week 75 minutes video class of yoga poses routine ( including yoga bandhas with specific muscles contractions) combined with ujjayi pranayama technique as breath control |
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| Yoga Poses | Active Comparator | Twice a week 75 minutes video class of yoga poses routine ( including yoga bandhas/ specific muscles contractions) |
|
| Stretching Exercises + Breath control | Active Comparator | Twice a week 75 minutes video class of stretching exercises routine combined with ujjayi pranayama technique as breath control |
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| Stretching Exercises | Active Comparator | Twice a week 75 minutes video class of stretching exercises routine |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Yoga Poses | Other | Yoga poses routine including specific muscles contractions known as bandhas (pelvic floor, core and throat/neck contraction) within each pose, which are advised to be done with steadiness and comfort. |
| Measure | Description | Time Frame |
|---|---|---|
| Cardiovascular autonomic control by heart rate variability(HRV) and blood pressure variability (BPV) in frequency domain acquired by Finometer | Sympathovagal balance HRV (ratio of low frequency (LF in ms2) and high frequency (HF in ms2) components of HRV = LF/HF) | 30 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Carotid -femoral pulse wave velocity (Complior) | Reduction of carotid -femoral pulse wave velocity (m/s) | 10 minutes |
| Maximal Oxygen Uptake by Cardiopulmonary Exercise Test | Increase Maximal Oxygen Uptake (VO2max ml/kg/min) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Maria Cláudia Irigoyen, PhD | Institute of Cardiology/ University Foundation of Cardiology | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cardiology Institute of Rio Grande do Sul | Pôrto Alegre | Rio Grande do Sul | Brazil |
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| ID | Term |
|---|---|
| D006973 | Hypertension |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D052580 | Muscle Stretching Exercises |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
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All participants will be told they are attending to a yoga protocol. All outcomes assessments will be taken by blind investigators to the interventions.
| Breath Control | Other | Ujjayi pranayama (Victorious breath) Inhalation and exhalation are both done through the nose. The "ocean sound" is created by moving the glottis as air passes in and out. As the throat passage is narrowed so, too, is the airway, the passage of air through which creates a "rushing" sound. The length and speed of the breath is controlled by the diaphragm, the Strengthening of which is, in part, the purpose of ujjayi. The inhalations and exhalations are equal in duration. |
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| Stretching exercises | Other | Stretching exercises routine based on dynamic and static exercises excluding those similar to yoga poses. This routine works on great range of motion of all body joints and main muscles groups/ chains. |
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| 45 minutes |
| Ambulatory Arterial Pressure Monitoring | Decrease Ambulatory Arterial Pressure Monitoring (mmHg) | 24 hours |
| Respiratory rate and movements of rib cage and abdomen by Pneumotrace respiratory belt | Reduction of respiratory rate (cycles per minute/ cpm) | 30 minutes along with Finometer |
| Blood samples laboratorial analysis | Improved blood sample analysis HDL cholesterol, glucose, creatinine, c-reactive protein (mg/dL) | 5 minutes |
| Flow mediated dilation (FMD) of brachial artery by ultrasound | Increase Flow Mediated Dilation (FMD) (%) | 20 minutes |
| Fat percentage by Bioimpedance | Reduction of fat percentage and increase of lean mass (% ) | 5 minutes |
| Cognitive function | Changes in scores of Mini Mental State Examination (0 to 30) | 40 minutes |
| Diaphragm Thickness by ultrasound | Increase diaphragm thickness (mm) | 5 minutes |
| Intima Media Thickness of carotid artery by ultrasound | Decrease of intima media thickness (IMT) (mm) | 5 minutes |
| Blood sample analysis of oxidative stress markers (Spectrophotometry) | Levels of Superoxide Dismutase (SOD) (un/SOD/mg protein) | 5 minutes along for all blood samples |
| Blood levels of sample analysis of Inflammatory markers (ELISA) | Levels of Interleukin(IL) IL 1, IL 6, IL 10 (pg/ml)Tumor Necrosis Factor (TNF) alpha (pg/ml) | 5 minutes along for all blood samples |
| Assessment of center of pressure (COP) and balance by baropodometry platform | Decreased area of COP (cm2) | 5 minutes |
| Sit and reach flexibility test | Increase flexibility levels (cm) | 5 minutes |
| D005791 |
| Patient Care |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D015444 | Exercise |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |