Table 2.
Effect of yoga practices on hypertension and their mechanism of action
|
Yoga Practice
|
Effect on hypertension
|
Mechanism of action
|
| Shatkriya (Cleansing practices) | ||
| Trataka kriya | Significant reduction in BP and HR in patients with primary hypertension[8] | Induces calmness similar to a mental state during meditation[8] |
| Neti kriya | Clear up the head and neck region producing a sense of lightness[6]; Beneficial in reducing anxiety and depression | Reduce toxic accumulation in head and neck region |
| Sharir Sanchalana (Warm-up practices) | ||
| Sharir Sanchalana | Warm-up exercises prepare the body for the practice of asana | Removes stiffness in the muscles and joints; Improve blood circulation |
| Surya Namaskara (Sun salutations) | ||
| Slow practice of Surya Namaskara | Recommended for pre and stage I hypertension[10] | Produce psychosomatic harmony[6] |
| Asana (Yoga postures) | ||
| Asana practiced with awareness and breath synchronization | Prevent and attenuate the age-related deterioration of physical health, muscular strength, and flexibility[36]; Capable of bringing about the stability of body and mind; Improves the flow of vital energy through the body, resulting in a positive sense of well-being; Preparatory practice for meditation that fosters a quieting of the mind | Holding yoga postures for a few seconds build strength by using body weight for resistance, which in turn slows the onset of sarcopenia[36]; Mental relaxation and a state of “restful awareness”; Changes the long-held patterns of feelings and emotions; Exert controlled pressure on the kidneys and the adrenals, which regulates BP through secretions of hormones like renin, angiotensin, adrenaline, etc.[31] |
| Restorative Yoga | More effective with significantly greater reductions in BP and HR as compared to stretching[11] | Facilitates stretching, provides support, and induces relaxation. Releases habitual stress patterns that are stored in the body as areas of tension |
| Shavasana (corpse pose) with breath awareness | Effective in BP reduction[12] | Reduction in the load on the heart by blunting the sympathetic response along with an enhanced parasympathetic activity[12]; Allows the body and mind to integrate through mindful stillness |
| Forward bending poses | “Head-down” postures confer stress-reducing, calming, and mind-quietening benefits | Forward bends with head supported brings a sense of calm |
| Backward bending poses | Elevate low mood and have energizing effect | Chest opening poses that allow expansive inhalation; Stimulate the heart chakra associated with emotions and balance |
| Twisting postures | Release tension, and energize; Helps in de-stressing, relaxing, and unwinding | Relieve spinal stiffness and clear emotional blockages |
| Meditative postures | Maintain a steady comfortable position for a long time without conscious effort; Improve concentration and peace of mind | The heart rate and the breath slow down, which lowers the BP. Enhance feelings of being grounded, centred, and balanced |
| Pranayama (Regulated breathing practices) | ||
| Slow-paced pranayama | A modest reduction in BP[14] | Optimally balances sympathovagal stress response [27]; Baroreceptor sensitivity can be enhanced significantly by slow breathing[18] |
| Deep slow abdominal breathing | Effective in reduction of systolic BP | Improve vagal tone, increase parasympathetic dominance, and decrease sympathetic discharges[30] |
| Sukha pranayama (Easy, comfortable breathing) | A significant reduction in Heart rate, systolic pressure, pulse pressure, and mean arterial pressure[16] | Normalization of autonomic cardiovascular rhythms as a result of increased vagal modulation and/or decreased sympathetic activity and improved baroreflex sensitivity[16] |
| Immediate Effect of Nadi shodhana pranayama (Alternate nostril breathing) | Reduce the BP and HR[17] | Activating the parasympathetic nervous system and enhancing healthy cardiovascular functioning[17] |
| Slow pace (respiratory rate 6/min) bhastrika pranayama (Bellows breath) | Reduction in systolic and diastolic BP[18] | Enhanced parasympathetic activity[18] |
| Chandra nadi pranayama (Left unilateral forced nostril breathing) | An immediate decrease in cardiovascular parameters with the decrease in HR, systolic pressure, and pulse pressure[19] | Normalization of autonomic cardiovascular rhythms with increased vagal modulation and/or decreased sympathetic activity along with improvement in baroreflex sensitivity[19] |
| Bhramari pranayama (Humming breath) |
Immediate positive effect on reducing the systolic BP[20] | Parasympathetic dominance[20] |
| Ujjayi pranayama (Ocean breath) without breath retention or bandhas | Significantly decreases stress-induced changes in cardiorespiratory parameters and decreases BP[15] | Shift autonomic nervous control toward the parasympathetic side[15]; Exerts gentle pressure on the carotid sinuses that regulates BP through homeostatic mechanisms |
| Sheetali pranayama (Cooling breath) | The immediate effect: reduce the systolic and diastolic BP in hypertensive patients[21] | Decreasing the sympathetic activity[21] |
| Pranava pranayama/AUM chanting | Five min of AUM chanting reduces systolic and diastolic BP[13]; Reduces depression, anxiety, and stress[24]; Improves quality of sleep[24]; Promotes relaxation, and provides calmness | Improvement in baroreflex sensitivity resulting in the normalizing of autonomic cardiovascular rhythms[24] |
| Mudra (Subtle gestures) | ||
| Brahma mudra (Divine spiritual gesture) | Induces a sense of relaxation and reinvigoration in the head and neck region that reduces stress[6] | Cultivates psychosomatic harmony, induces relaxation, reduces stress |
| Apaan vayu mudra (Mudra of the heart) |
Reduction in systolic and diastolic BP | The finger position sensitizes nerves in the palm and wrist area resulting in a systemic effect on the cardiovascular system |
| Shanmukhi mudra (Closing the 7 gates) | Produces a sense of inner calm[6] | This mudra encourages ‘pratyahara’, which means withdrawing the mind inwards by blocking some of the sensory distractions of the surroundings |
| Gyan mudra (Mudra of wisdom) | Reduces mental stress, indicated in hypertension | Deepens awareness; Enhances meditation experience; Regulates the fire and air elements in the body |
| Meditation | ||
| Formal meditation | ||
| Concentration meditation | Significant decrease in the HR and systolic and diastolic BP[22]; Reduces stress and anxiety; Induces relaxation | Modulates the physiological response to stress via neurohumoral activation[22]; Decreases the arterial tone and the peripheral resistance |
| Mindfulness Meditation (Non-judgmental awareness of the present moment with kindness, acceptance, and curiosity) | Significant effect on reducing systolic and diastolic BP in patients with hypertension[23] | Focus on the moment with “acceptance” and “non-criticism” helps in regulating the emotional state. Emotional stability relieves the somatization symptoms and the BP is reduced[23] |
| Informal meditation | ||
| Mindfulness | Helps to cope face day-to-day challenges and stressful situations | Serves as a ‘micro-meditation’ technique for quick stress relief |
| Yoga nidra (Yogic sleep or effortless relaxation) | ||
| Yoga nidra | Reduces systolic and diastolic BP[29]; Reduces depression, anxiety, and stress[24]; Improves quality of sleep[24] | Improve autonomic functions[24,29]; Influence the brain’s electrical rhythms[29] |
BP: Blood pressure; HR: Heart rate.