Yogabharati sny report by Yoga Bharati

Research Report

Impact Of Yoga On Disease-‐Risk Profile, Performance and Quality Of Life:

An Observational Study conducted b y

Yoga Bharati SFO Bay Area Chapter, USA

In T echnical C ollaboration W ith

VYASA International, Bengaluru

Table of Contents Executive Summary .......................................................................................................................................................... 3 Abstract ................................................................................................................................................................................... 3 Methods ................................................................................................................................................................................... 3 Results ...................................................................................................................................................................................... 3 Conclusion .............................................................................................................................................................................. 3 Introduction ......................................................................................................................................................................... 4 Introduction to the practice of Sun Salutations and Community Yoga ....................................................... 5 Material and Methods ...................................................................................................................................................... 7 Intervention ........................................................................................................................................................................ 10 Data Analysis ...................................................................................................................................................................... 11 Result ..................................................................................................................................................................................... 11 COMPLIANCE AND COMMITMENT .......................................................................................................................... 17 DISCUSSION ........................................................................................................................................................................ 19 Strength and Weakness of this study ...................................................................................................................... 20 CONCLUSION ..................................................................................................................................................................... 21 ACKNOWLEDGMENTS ................................................................................................................................................... 22 REFERENCES: .................................................................................................................................................................... 22 Appendix A -‐ Sample Daily Log for SN subjects .................................................................................................. 24 Appendix B -‐ Guna Questionnaire ............................................................................................................................. 26 Appendix C -‐ Tridosha Questionnaire ..................................................................................................................... 28

Executive Summary

Abstract Effect of Sun Salutations/Surya Namaskar (SN) Practice on Quality of Life; Disease Risk Profile Metrics and Performance tasks in Adult Subjects when practiced as community yoga .

Methods Fifty three subjects, twenty two men and thirty one women participated in the pilot study. Participants were conveniently divided into the daily practice of 20 rounds (group 1) followed by 3 minutes of relaxation or 50 rounds (group 2) followed by 8 minutes of relaxation. Participants were asked to attend once a week, supervised follow-‐up sessions. This was part of an annual community activity called Sun Salutations Marathon -‐ Surya Namaskar Yajna [SNY] where members of Yoga Bharati community practice a yoga based cardio-‐pulmonary endurance exercise called sun salutations -‐ surya namaskar [SN]. Objective parameters included Body Mass Index [BMI], Respiration Rate [RR], Breath Holding Time [BHT] and Expiratory flow was tested through a yogic chant called Bhramari. Subjective tests such as Ayurvedic Body Tissue Characterization questionnaire [Tridosha], Yoga based mind characterization questionnaire [Triguna] and SF-‐36 questionnaire for general health assessment were administered. Subjects also answered survey questionnaire regarding their absenteeism, diet pattern and areas of health improvement.

Results There was a definite improvement in all the physical and mental health scores. Lung capacity was better, energy levels were better, diet pattern improved and they reported less perceived stress. There was more commitment and regularity in the practice of SNY and the reporting system than previous years of SNY period. The families reported a better time spent together, more commitment to yoga and happier and more peaceful days together.

Conclusion SN practice improves overall health, sense of wellbeing and enhances self-‐awareness at physical, mental and social levels. SN practiced as a marathon in a community with healthy competition increases compliance and commitment to the practice of yoga. Keywords: Yoga, Sun Salutation, Surya Namaskar, healthy living, General wellbeing

Introduction Modern lifestyle has contributed to alarming number of non-‐communicable diseases that are increasing in pandemic proportions. Yoga is a mindfulness practice that attempts to reduce stress caused due to modern lifestyle and attempts to build awareness about developing a healthy lifestyle and diet along with a positive attitude needed to stay healthy. The number of people practicing yoga for health benefits in India as well as abroad has increased significantly in the past decade [1]. Yoga practice has been reported to improve physical performance [2, 3], body flexibility [4] and mental health [5]. Notably, there is growing evidence that long-‐term yoga practice improves depth of breathing, oxygen saturation [6] and reduces metabolic rate in healthy subjects [7]. Its therapeutic potentials in various diseases particularly for life-‐style-‐ related ones have been extensively explored. The four leading risk factors such as overweight, high blood pressure, high blood glucose and cholesterol that are linked to life-‐style-‐related chronic diseases have been reported to reduce by yoga intervention [8-‐11]. Sun Salutations (SN) practice is an integral part of traditional yogic practices. The practice includes postures performed dynamically in synchrony with the breath. There are relatively very few studies exploring the SN practice effects. Recently Sinha and colleagues [12] studied energy cost and cardiorespiratory changes during the practice of SN, as well as Bhutkar and colleagues [13] conducted a pilot study on 6 months of SN practice on cardiorespiratory fitness parameters. Sinha et al concluded that SN is an ideal form of aerobic exercise having static, stretching and dynamic muscular movements involving all major joints [12]. In spite of continued interest of the general population and scientific community, there is still paucity of data on basic physiological and psychological responses related to yoga practice, mainly due to lack of long term commitment and motivation to practice as individuals. The present study was undertaken to study the effects of SN practice on Disease Risk Profile Metrics, Performance tasks and Quality of Life in Adult Subjects, especially when practiced as a community yoga practice.

Introduction to the practice of Sun Salutations and Community Yoga Sun Salutation [SN] practice is an ancient tradition of yoga practiced early morning to warm up the body and also to get the early sunrays needed to maintain good health. Sun Salutation is a flow of 10 set of postures practiced in a fixed sequence with breath synchronization. In some yoga circles in America and other nations, it is traditional to perform SN as a collective yoga event as demonstrated by Sun Salutation event in Times Square on summer solstice every year. In some yoga circles, it is traditional to perform 108 SNs on summer or winter solstice. Yoga Bharati conducts Sun Salutations Marathon [SNY] every year as a community public health initiative to engage people in physical activity and to make a conscious effort towards healthy living. The event starts on Jan 1st of each year and concludes on a specific day called Ratha Saptami day as per Hindu calendar. This day marks the seventh day following the Sun’s northerly movement (Uttarayana) of vernal equinox starting from Capricorn (Makara). Yoga Bharati encourages people to register for the marathon with the entire family. A healthy competition is setup with announcement of winners in different categories at the end of the marathon duration. Categories include adult men, women, children and seniors. It is known that, regular practice of SN helps individuals with their personal health. When practiced in a community and when the entire family is involved together in the practice as a marathon, commitment towards regular practice increases. This benefits the entire community by moving people towards a more conscious-‐healthy life, one individual at a time. Thus, SNY contributes to social transformation, as the entire group is motivated to build awareness, synergy and harmony in the society. Physiological Benefits of SN 1. One of the best energization technique, SN is a practice of stimulation and relaxation that emphasizes breath and body awareness.

2. According to yogic perspective our body and mind is constituted of one of the three qualities (gunas) -‐ Tamas (inertia), Rajas (hyperactivity) or Satva (balance). SN is said to be singularly useful for people with all three qualities (gunas). 3. Yoga, especially SN, brings a voluntary control over autonomic nervous system and brings about a balance of both stress response and relaxation response of human physiology. 4. SN is an effective cardiovascular endurance training exercise. 5. SN practice provides isotonic exercise to the body and hence is less likely to cause injuries to muscles and joints, attributed to sport injuries due to the variability of muscle length during the flow of SN. 6. The alternate expansion and contraction of the chest during the SN postures helps in regulating and deepening the breath through the practice. 7. Regular practice of SN is the best way to learn the breath synchronization [with that of the body movements] aspect of yoga practice. 8. Cyclical Practice of yogic postures in SN helps to loosen up joints and muscles in a short period of time. 9. Abdominal Organs are alternately stretched and compressed during SN postures. This ensures proper functioning of the organs. 10. SN removes nervous tension and anxiety due to the dynamic nature of the practice. This practice also has a profound positive effect on the back as it involves alternate backward and forward bends. 11. SN also improves spinal flexibility and results in improved immunity. 12. SN enhances body awareness and improves overall quality of life, improved mindfulness and better control over our emotions and reactions. Mindfulness aspects of SN

1. Due to a combination of variability and repetitive nature of SN, it allows individuals to do self-‐motivated practice without getting bored or mindless while allowing for easy self-‐ maneuvering due to its repetitive nature. 2. Breath and body synchronization aspect of SN increases mindfulness without allowing the mind to get distracted as in a regular sitting meditation practices. The constant movement allows mind to stay on the body movements and breath. 3. Practiced regularly, SN practice brings a sense of peace and wholeness in terms of living in harmony with nature.

Material and Methods Participants Healthy adults were invited to participate in the study as part of yearly Suryanamaskar Marathon program from 1st Jan 2013 till 23rd Feb 2013, promoted through “Yoga Bharati” website or email list. Participants residing in the Bay area, California were enrolled after obtaining the signed informed consent. Healthy volunteers and those with minor lifestyle related conditions such as minor back-‐ pain and minor stress related issues were selected for the study. Subjects with history of major medical illness such as tuberculosis, hypertension, diabetes mellitus, bronchial asthma in the past and history of major surgery in the recent past were excluded from the study. More than five hundred people signed up for SNY 2013. Of them, one hundred and thirty three participants signed up for the study. Among them, eighty-‐seven were selected for the study. Thirty-‐four participants dropped out and fifty-‐three subjects completed the study (22 male and 31 female). Reasons for drop out included work pressure and domestic issues (13), illness (8), travel (3), past injuries that aggravated due to SNY (5). One hundred and thirty three participants signed up for the study of which eighty-‐seven were selected for the study. Thirty-‐three participants dropped out and fifty-‐three subjects

completed the study (22 male and 31 female). Reasons for drop out included work pressure, illness, travel, etc

Design This was a prospective population based observational study. The participants were recruited across a period of time and completed the said duration for the study.

Methods Pre-‐assessment was carried within the window of a week before commencing the intervention and post-‐assessment was done after 6 weeks of regular practice. Subjects compulsorily attended 5 yoga sessions under the supervision of trained instructors, following which they were allowed to practice either with the video provided to them or following the self guided sequence. Participants were conveniently divided into the daily practice of 20 rounds (group 1) followed by 3 minutes of relaxation or 50 rounds (group 2) followed by 8 minutes of relaxation. Participants were asked to attend once a week, supervised follow-‐up sessions.

Assessments Respiratory Rate: An inhalation followed by a complete exhalation makes one breath. Respiratory rate is measured as number of breaths taken per minute by watching the subject’s chest rise and fall in resting position. Brahmari Rate: An inhalation followed by a complete exhalation while making a humming sound as buzzing of bee, makes one round of brahmari. Brahmari rate is measured as time taken in seconds for the subject to complete one round of brahmari. Breath Holding Rate: Inhalation Holding: Inhalation holding rate is measured as the time taken in seconds holding the breath in before the next exhalation.

Exhalation Holding: Exhalation holding rate is measured as the time taken in seconds holding the breath out before the next inhalation. Sit and Reach Test: A straight line two feet long is marked on the floor as the baseline. A measuring line four feet long is drawn perpendicular to the midpoint of the baseline extending two feet on each side and marked off in half-‐inches. The point where the baseline and measuring line intersect is the “0” point. Subjects were asked to place bottom of feet (10 to 12 inches apart) against the baseline at point “0” with knees straight. That is followed by placing one hand over the other to reach as far as possible without bending knees as that distance is recorded [14]. SF-‐36 Health Survey-‐ The short form SF-‐36 is a generic instrument, with scores ranging from 0 (complete dissatisfaction) to 100 (full satisfaction) for eight domains: physical functioning (PF), role-‐ physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-‐ emotional (RE) and mental health (MH). The correlated physical (PCS) and mental (MCS) summary components were computed following the standardized procedure [15-‐16]. Triguna (Guna): This inventory has ten questions to evaluate Tamas (lethargy), Rajas (hyper-‐ activity), and Sattva (balance) Gunas. The score value of weightage of an item indicating Sattva is 3, for an item indicating Rajas is 2, and for an item indicating Tamas is 1. It classifies people as being predominantly of Sattva, Rajas, or Tamas type, depending on their total score on the test [17]. Details about the questionnaire and scoring key is at [Appendix B -‐ Guna Questionnaire]. The relationship between the guna type and the score is summarized below: Score

< 24 24–28 > 28

Guna Type Tamas Rajas Sattva Tridosha: This multidimensional Ayurveda questionnaire has 60 items with three sections of 20 items each and three subscales in the form of statements with three answers: Does not 0 -‐Apply/ 3-‐

Applies sometime/6 -‐ Applies always. Assessment is done on a to evaluate the tissue type to be Ayurvedic dosha (humor) vata, pitta and kapha. A higher score indicates greater predominance of that dosha. Scoring ranges from 0-‐120 in each of the three sections. Appendix C has the Tridosha Questionnaire details. A similar assessment model is presented by Suchitra et al [18]. Physical Activity Weekly: Physical activity of the studied subjects was assessed with use of a short form International Physical Activity Questionnaire (IPAQ, last 7 days recall). The purpose of the International Physical Activity Questionnaires (IPAQ) is to provide a set of well-‐developed instruments that can be used internationally to obtain comparable estimates of physical activity. IPAQ comprises a set of 4 questionnaires. Long (5 activity domains asked independently) and short (4 generic items) versions for use by either telephone or self-‐administered methods are available. The purpose of the questionnaires is to provide common instruments that can be used to obtain internationally comparable data on health–related physical activity [19]. Daily Log: Participants were asked to enter daily log regarding their practice, health and diet. Details are at [Appendix A -‐ Sample Daily Log for SN subjects]

Intervention Starting Position: Tadasana with Namaskara mudra

1. Ardha Chakrasana [breathe in] 2. Pada Hastasana [breathe out] 3. Ashva Sanchalanasana [breathe in] 4. Chaturanga Dandasana [breathe out] 5. Ashtanga Namaskar -‐ 8 parts (forehead/chin, chest, palms, knees, toes) touching the ground [hold breath or shallow breathing] 6. Bhujangasana [breathe in] 7. Parvatasana (inverted V-‐shape) [breathe out] 8. Ashva Sanchalanasana [breathe in]

(Same as step 3 but with the opposite leg) 9. Pada Hastasana [breathe out] (Same as step 2) 10. Ardha Chakrasana [breathe in] (Same as step 1) and Come to starting position [breathe out and relax]

Data Analysis Data was analyzed using Paired sample t-‐test was used to compare the pre and post data. Differences in means were considered statistically significant when the one-‐tailed P value was<0.05.

Result Most participants (66%) were between 40-‐64 years of age and there were 2 subjects over 65. Eighty five percent of the subjects were in the income group above $70,000. Ninety percent of them had a minimum of a college/university degree completed and seventy five percent of them were vegetarian (by birth). The age distribution is presented in Figure 1. Figure 1: Demography of participants (age)

In the present study, there was a statistically significant improvement in SF 36 Mental health score (MH); reduction in BMI, improvement in spinal flexibility as demonstrated by sit and reach test. The improvement in breathing was noted as demonstrated by a statistically significant improvement in breath holding time. A non-‐significant decrease in respiratory rate and non-‐significant improvement in Bhramari time was reported. The mean values and SD with statistical significance for all the varaibles are presented as Table 1.

Table 1: The mean values with SD for all the variables before and after the intervention

Variable

Before

After

Vata Dosha

57.62±16.59

55.25±16.60

Pitta Dosha

57.62±17.63

56.21±18.06

Kapha Dosha

49.92±16.15

50.04±16.63

Triguna

53.02±14.97

25.96±2.27*

Physical function domain of SF36

88.87±18.80

90.94±17.68

88.21±26.22

91.98±21.80

87.42±27.13

92.45±20.29

Body pain domain of SF36

80.66±21.48

82.88±16.89

Emotional wellbeing domain of SF36

79.17±14.24

82.49±12.01*

Energy/fatigue domain of SF36

71.60±16.86

74.81±13.30

Social functioning domain of SF36

86.79±17.58

84.67±17.79

General health domain of SF36

75.57±15.37

76.79±12.01

Limitation due to physical function domian of SF36 Limitation due to emotional problem domian of SF36

Values are mean ± S.D. *p < 0.05, After yoga compared to Before, t-‐test for paired data, one-‐ tailed SF-‐36 Scores SF-‐36 Physical Functioning showed non-‐significant improvement. Since the practice of SNs was done by mostly healthy volunteers, there was not a significant change in the general physical capabilities. The changes for different domains of SF-‐36 is illustrated in Figure 2.

Figure 2: Results of SF-‐36 Physical Health Function before and after the intervention

SF-‐36 Mental Health Function showed some improvement, especially MH parameter and a non-‐ significant improvement in Vitality score. Figure 3: Results of SF-‐36 Mental Health Function before and after the intervention

BMI Scores BMI showed significant reduction after the intervention.

Figure 4: Results of BMI before and after the intervention

Respiration and lung capacity: While breath holding time showed significant improvement, the respiratory rate and bhramari chanting time showed slight improvement. Figure 5: Results of Respiration and Lung capacity before and after the intervention

Survey Results Apart from standard health questionnaire such as SF-‐36, also conducted a general survey regarding their perceived health and lifestyle changes.

Energy Level: 67% of the Subjects reported a slight improvement in their energy levels. Figure 6: Results of Energy Level Subjective survey before and after the intervention

Diet Habits: 38% of the Subjects reported that they were watching their diet and eating more healthy whereas 36% felt no difference in their diet pattern. 22% said they were eating the same but with more awareness. Figure 7: Results of Diet Habit Survey before and after the intervention

Areas of Health Improvement: Many reported that their fatigue levels came down. Apart from this, the subjects reported improved symptoms with their stress (19%), back pain (17%), irritability (17%) and headache (11%).

Figure 8: Results of Heath Problems survey before and after the intervention

Family and Work Relationships: There was a slight improvement in relationships due to SN practice (53%) Figure 9: Results of Relationships survey before and after the intervention

Absenteeism: Since most of the subjects were healthy volunteers, there was no significant improvement in work related absenteeism.

Figure 10: Results of Absenteeism survey previous season to this season

COMPLIANCE AND COMMITMENT Yoga Bharati conducts Surya Namaskar Yagna (SNY) every year. By virtue of this study the enrollment percentage increased by 100 percent in this year (2013) compared to 2012. Though all of them did not qualify for studies, they continued to participate in the SNY. Many of the regular participants reported that they were more committed to the practice of SN this year compared to the years before due to participation in the study. For comparison, in 2012, 235 participants reported approx. 50,000 SNs in total, an average of 209 SNs per person for 6 weeks. In 2013, more than 500 participants reported approx. 120,000 SNs an average of 240 SNs per person for 6 weeks.

Figure 11: Results of SN total count for the community -‐ year to year comparison

Figure 12: Results of number of SNY participants -‐ year to year comparison

Figure 13: Average SNs per participant -‐ year to year comparison

DISCUSSION SN practice and Health Improvement Subjects with mild symptoms of anxiety and insomnia reported improvement in their sleep and well being. About 3-‐4 participants reported decrease in their mild back, neck and knee pain. About 4-‐5 participants reported that they became better at the sports they were playing including ski-‐ing. SN practice and Personality Change “Does regular practice of SN help people become better?” This was the question posed to the participants during their closing day parameter collection period. Many reported being happier, showing lesser restlessness during their commute time, lesser road-‐rage and better ability to handle situations. One participant said -‐ “I participated in SN Research and practiced 50 rounds per day. I felt very good. One day, I got lost in Santa Cruz and I had to drive around for 3 hours. On other days, I would have been very stressed out and upset, but thanks to Surya Namaskars, I feel more relaxed and positive and I was able to handle this event much better.” SN and Family commitment to Yoga Families usually participate in the SNY together every year. They report an excellent time together spent on positive activity. Kids enjoy SN together with their parents as SN is a dynamic and moving practice and does not get boring. They have a motivation to practice in a healthy competition as they are asked to report their scores. One of the mothers reported -‐ “I just wanted to share that both my daughters (7 years and 5 years) have developed this habit of doing Surya Namaskar with me because of your Yagna. We had a goal of doing 12 SNs daily. Of course, initially for a week or so, I had to push them a bit especially during the weekdays in the morning. But now it is a habit and they do enjoy doing it and that is what I love about. And today, when I was taking a bath, I asked them to go and finish the SN and before when I came down, they were so happy and told me that they did 30 SNs. The happiness in their face is still in my mind's camera.”

Motivation One of the major motivations for this study was a self evolving and motivated cohort that was growing each year with Yoga Bharati’s Surya Namaskar Yagna. The participants were reporting excellent improvement in their energy levels, minor physical conditions and their stress levels. Another motivation was the support of a research team by Yoga Bharati’s affiliate organization – Vivekananda Yoga Research Foundation (VYASA ), Bengaluru, a premier yoga university in India, with its rich 25 years of background on research in yoga. Dietary/Lifestyle Choices for health Yoga is well-‐known for its ability to increase awareness about healthy lifestyle choices such as good diet, positive thinking and active lifestyle and hence preventing many ailments such as diabetes, heart disease, cancer, etc. Since Yoga Bharati’s self-‐evolving cohort was primarily ethnic South Asian Indian, prevalence of diabetes and heart disease among Indian Americans is at alarming proportions. SN is a good practice for this community, both as disease management and preventative therapy modality. SN-‐related Injuries SN is a safe form of physical exercise as it does not cause injuries compared to other forms of aerobic exercises like running. In our study, we did come across subjects that reported increased back pain and wrist injuries and had to discontinue SN practice (n=5). But we noted that this was not the injury due to SN, but the previous conditions that got aggravated due to the practice of SN.

Strength and Weakness of this study A major characteristic of this study is that the group was homogenous in its ethnicity, culture, income levels and age group. Weakness related to the self-‐selecting sample, non-‐rigorous tools to measure anthropometric parameters, non-‐medical staff to measure the parameters, lack of good

quality data reporting and analyzing tools due to lack of funds. Another major limitation was the lack of denominator – inability to compare the results with a similar group that did not practice SN.

CONCLUSION Yoga Bharati’s community of yoga participants who regularly sign up for Surya Namaskar Yagna (SN marathon) participated in a study for 6 weeks where they practiced either 20 or 50 SNs based on their abilities and reported their experiences, answered qualitative parameter questionnaire and participated in quantitative parameter measurements. All the measurements were taken by Yoga Bharati volunteer research coordinators. There was a definite improvement in all the physical and mental health scores. Lung capacity was better, energy levels were better, diet pattern improved and they reported less perceived stress. There was more commitment and regularity in the practice of SNY and the reporting system than previous years of SNY period. The families reported a better time spent together, more commitment to yoga and happier and more peaceful days together.

ACKNOWLEDGMENTS Our acknowledgement to Vivekananda Yoga Research Foundation, Bengaluru for its’ guidance and resources in conducting the study. Thanks to Yoga Bharati volunteers for putting in enormous time and effort in making this happen. Thanks to Ajit Kulkarni, Dr. Nidhi Ram and Amrit Ram for their help with data analysis. Special Thanks to Dr. Naveen Vishweshwaraiah of VYASA, Bengaluru for his constant guidance in the study and Ashwini Surpur for leading the study and writing this report.

REFERENCES: 1. H. A. Tindle, et al., Trends in use of complementary and alternative medicine by US adults: 1997-‐ 2002. Alternative Therapies in Health and Medicine, 2005. 11(1): p. 42-‐49. 2. U. S. Ray, K. S. Hegde, and W. Selvamurthy, Improvement in muscular efficiency as related to a standard task after yogic exercises in middle aged men. Indian Journal of Medical Research, 1986. 83: p. 343-‐348. 3. U. S. Ray, et al., Aerobic capacity & perceived exertion after practice of hatha yogic exercises. Indian Journal of Medical Research, 2001. 114: p. 215-‐221. 4. U. S. Ray, K. S. Hegde, and W. Selvamurthy, Effects of yogic asanas and physical exercises on body Flexibility in middle aged men. Yoga Review, 1983. 3: p. 76. 5. Ray US, et al., Effect of yogic exercises on physical and mental health of young fellowship course trainees. Indian Journal of Physiology and Pharmacology, 2001. 45(1): p. 37-‐53. 6. Heather Mason, et al., Cardiovascular and Respiratory Effect of Yogic Slow Breathing in the Yoga Beginner: What Is the Best Approach? Evidence-‐Based Complementary and Alternative Medicine, 2013. 7. M. S. Chaya and H. R. Nagendra, Long-‐term effect of yogic practices on diurnal metabolic rates of healthy subjects. International Journal of Yoga, 2008. 1: p. 27-‐32. 8. K. Yang, A review of yoga programs for four leading risk factors of chronic diseases. Evidence-‐ Based Complementary and Alternative Medicine, 2007. 4(4): p. 487-‐491. 9. Bijlani RL, et al., A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. Journal of Alternative and Complementary Medicine, 2005. 11: p. 267-‐274.

10. Cohen DL, et al., Iyenger yoga versus enhanced usual care on blood pressure in patients with prehypertension to stage 1 hypertension a randomized controlled trial. Evidence-‐Based Complementary and Alternative Medicine. 11. R. McCaffrey, et al., The effects of yoga on hypertensive persons in Thailand. Holistic nursing practice, 2005. 19(4): p. 173-‐180. 12. Sinha B, et al., Energy cost and cardiorespiratory changes during the practice of Surya Namaskar. Indian J Physiol Pharmacol, 2004. 48(2): p. 184-‐90. 13. Bhutkar MP, et al., Effect of suryanamaskar practice on cardio-‐respiratory fitness parameters: A Pilot Study. Al Ameen J Med Sci, 2008. 1: p. 126-‐9. 14. Wells K.F. and Dillon E.K., The sit and reach. A test of back and leg flexibility. Research Quarterly, 1952. 23: p. 115-‐118. 15. Ware JE, Jr, Sherbourne CD. The MOS 36-‐item short-‐form health survey (SF-‐36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83. 16. 36-‐Item Short Form Survey from the Rand Medical Outcome Study. 17. Deshpande, et al., A randomized control trial of the effect of yoga on Gunas (personality) and Self esteem in normal healthy volunteers. 2009 Jan;2(1):13-‐21. 18. Suchitra et.al., Measuring the tridosha symptoms of unmāda (psychosis): a preliminary study. 2010 Apr;16(4):457-‐62 19. International Physical Activity Questionnaire

Appendix A -‐ Sample Daily Log for SN subjects Please enter the log of your Suryanamaskar Count, diet and physical activity related information. No need to answer all questions if they don't apply to you. * Required Name: _______________________ Reg No:_________________ Date ____________ Number of Suryanamaskars * ____________ Time taken to Practice (mins) * ____________ Did you practice SNs as per your protocol? * ____________ The number of rounds, the time slot, eating before, etc.... ____________ If not per pre-‐determined protocol, reason?If something changed in your regular pracrtice, please select or state the reason... •

I have been sick or under weather

•

I did not get time

•

I am in menstruation

•

I am travelling

•

Other:

Time spent on other Physical Activity (mins) *____________ (Walking, Jogging, Yoga class, Gym, etc ) How many meals did you eat outside today? * ____________ (Example: Enter 2 if it is breakfast and Lunch ) Did you eat more or less than usual portion of meal ? *____________ (10% variation in your food habits is okay. But a big meal in a party or a fasting is considered as YES) •

YES

•

Do you have any ailments today? •

YES

•

Medication Score If you have taken medicines today please enter this section Number of Medicines taken today *____________ Prescription and OTC total number of tablets ____________ DetailsPrescription and OTC -‐ Enter medicine name and dosage ____________ If you have any ailments, please go to respective section *

•

Diabetes

•

Back/Neck/Knee or other Pain

•

Hypertension

•

Fatigue, Metabolic and Other Ailments

•

NONE -‐ I am done

Diabetes Section If you have Diabetes, please enter this data Fasting Blood Glucose ____________ Random Blood Glucose ____________ Pain Section If you have Back/Neck/Knee or otherm pain, please enter this data Pain Area 1 * ____________ (Pain Level (0-‐10) *0 is no pain and 10 is severe pain) Pain Area 2 ____________ (Pain Level (0-‐10) *0 is no pain and 10 is severe pain) Pain Area 3 ____________ (Pain Level (0-‐10) *0 is no pain and 10 is severe pain) Hypertension Section If you have high blood pressure, enter this section BP -‐ Systolic pressure ____________ BP -‐ Diastolic pressure ____________ Pulse ____________ Fatigue, Metabolic Disorders or Other Ailments Please report any issues with your present condition such as Thyroid, Metabolic, Fatigue, Headache, Menstrual Issues etc Please list any issues you had today___________________ (Any abnormalities can be reported)

Appendix B -‐ Guna Questionnaire Name: _____________________________ Date: ____________________ Instruction: Given below are TEN triplets, each consisting of three items, each item indicating an attitude or activity.Please attempt each of the triplets and tick off only one item in each triplet which you think to be most applicable to yourself. May be you practice them or just prefer them. Please remember that none of the items is good or bad. The items simply imply certain differences among persons. Please attempt all ten triplets. A. Regarding my Sufferings: (a) I have no grudge against myself or anybody else for my sufferings. (b) I hold myself responsible for my sufferings (c) I hold others and / or my circumstances responsible for my sufferings. B. If I am compelled to choose one among the following three alternatives I would like to spend my leisure hours mostly by (a) Playing games and/ or visiting friends. (b) Sleeping or idling way the time. (c) Reading books on philosophy and/ or religion C. I Prefer (a) Visiting places of worship and prayer. (b) Hunting, watching bullfights, visiting psychic places. (c) Watching games, going to fairs or outing D. I Prefer (a) preparation of red meat like beef, pork, lamb (b) preparation of dried fish or poultry (c) fruits and/ or milk preparation E. At Work (a) In my work I feel encouraged when I am praised and depressed when criticised. (b) Praise or criticism does not generally affect my work. (c) Generally I feel no urge to work, no matter whether I am praised or criticised. F. In most cases I give alms to beggers/sympathise with the poor. (a) with a sense of service. (b) with a spirit of rendering help. (c) with an attitude of disgust or indifference. G. Right and Wrong: (a) I believe that right and wrong are moral values that I have to follow. (b) Right and wrong practically carry no sense for me. (c) I believe that right and wrong are only social values, better if followed

H. At my work:

(a) Ordinarily I do not like to work unless compelled by circumstances. (b) I like to work and in most cases my action is guided by reason. (c) I like to work and in most cases I act impulsively.

I. My work style (a) I can seldom work with determination even in encouraging situations.

(b) I can work with determination without expectation of any return. (c) I can work with determination only when some return is assured. J. Happiness: (a) I am ready to undergo pains, but mainly for attaining worldly happiness. (b) I am ready to undergo pains mainly for attaining spiritual progress.

Guna Scoring Table showing the GUNA based distribution of the items of the inventory ITEM GROUPS IN THE INVENTORY Individual Items

SATVA-‐3

RAJAS-‐2

TAMAS-‐1

SCORING: The score value of weight age of an item indicating SATVA-‐3, RAJAS-‐2, AND TAMAS-‐1 Table showing the type of personality and norm of the inventory Type of personality

Norms of the Inventory

Tamasika

Scores below 24

Rajasika

Scores ranging from 24 to 28

Satvika

Scores above 28

Appendix C -‐ Tridosha Questionnaire Instruction: Given below questions indicating an attitude or activity.Please attempt each of them. 0 – Does not Apply to me. 3 – Applies to me somewhat or some of the time. 6. Applies to me mostly or nearly all the time. Please remember that none of the items is good or bad. The items simply imply certain differences among persons. Section 1 (V) Sl No Personality Trait 1 2 3 4 5 6 7 8 9 10 11 12

Does not apply

Applies Sometimes

Applies Always

I perform activity very quickly I am not good at memorizing things I am enthusiastic and vivacious by nature I have a thin physique-‐I don’t gain weight easily I have always learned new things very quickly My characteristics gait while walking is light and quick I tend to have difficulty in making decisions I tend to develop gas or become constipated easily. I tend to have cold hands and feet I become anxious or worried frequently I speak quickly and my friends think that I am talkative My moods change easily and I am somewhat emotional by nature. 13 I often have difficulty in falling asleep or having a sound night sleep 14 My skin tends to be very dry, especially during winter 15 My mind is very active, sometimes restless, but also very imaginative 16 My movements are quick and active, my energy tends to come in bursts. 17 I am easily excitable 18 I tend to be irregular in my eating and sleeping habits. 19 I learn quickly, but I also forget quickly. 20 I don’t tolerate cold weather as well as most people. Section 1 TOTAL SCORE = ____________ Section 2 (P) Sl No Personality Trait Does not Applies Applies apply Sometimes Always 1 I consider myself to be efficient 2 In my activities, I tend to be extremely precise and orderly 3 I am strong-‐minded and have a somewhat forceful manner 4 I tend to perspire easily 5 Eventhough I might not always show it, I become irritable or angry quite easily 6 If I skip a meal or meal is delayed, I become uncomfortable 7 One or more of the following characteristics describes my hair: . Early graying or balding .Thin, fine, straight hair

. blonde, red, or sandy colored hair 8 I have a strong appetite, If I want to, I can eat quite a large quantity 9 Many people consider me stubborn 10 I am very regular in my bowel habits-‐it would be more common for me to have loose stools than to be constipated. 11 I become impatient very easily 12 I tend to be perfectionist about details 13 I get angry quite easily, but then quickly forget about it 14 I am very fond of cold foods like icecream and ice cold drinks 15 I am more likely to feel that a room is too hot than too cold. 16 I am not as tolerant of disagreement as I should 17 I enjoy challenges and when I want something I am very determined in my efforts to get it 18 I tend to be very critical of others and also of myself 19 I feel uncomfortable or become easily fatigue in hot weather more so than other people 20 I don’t tolerate foods that are very hot and spicy Section 2 TOTAL SCORE = ____________ Section 3 (K) Sl No Personality Trait Does not Applies Applies apply Sometimes Always 1 My natural tendency is to do things in a slow and relaxed fashion 2 I gain weight more easily than most people and loose it more slowly 3 I have a placid and calm disposition-‐I am not easily ruffled 4 I can skip meals easily without significant discomfort 5 I have a tendency towards excess mucus, phlegm, chronic congestion, asthama or sinus problem 6 I must get atleast 8 hrs of sleep in order to be comfortable 7 I sleep very deeply 8 I am calm by nature and not easily angered 9 I have a tendency to become plump – I store extra fat easily 10 Weather that is cool or damp bothers me 11 My hair is thick, dark, and wavy 12 I have smooth soft skin with a somewhat with a somewhat pale complexion 13 I have a large solid body build 14 The following words describe me well: Serene, sweet natured, affectionate and forgiving 15 I have slow digestion, which make me feel heavy after eating 16 I have very good stamina and physical endurance as well as steady level of energy 17 I generally walk with a slow measured gait 18 I have a tendency towards oversleeping, grogginess upon awakening and am generally slow to get going in the morning 19 I am a slow eater and am slow and methodical in my actions 20 I don’t learn as quickly as some people, but I have excellent retention and a long memory Section 3 TOTAL SCORE = ____________