{"id":18828,"date":"2018-03-25T09:52:04","date_gmt":"2018-03-25T09:52:04","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=18828"},"modified":"2020-04-23T05:59:52","modified_gmt":"2020-04-23T05:59:52","slug":"efficacy-of-nadishodhan-pranayama-alternate-nostril-breathing-anb-on-functional-improvement-in-post-cabg-patient","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol11no1\/efficacy-of-nadishodhan-pranayama-alternate-nostril-breathing-anb-on-functional-improvement-in-post-cabg-patient\/","title":{"rendered":"Efficacy of Nadishodhan Pranayama – Alternate Nostril Breathing (ANB) on Functional Improvement in Post CABG Patient"},"content":{"rendered":"

Introduction<\/strong><\/p>\n

CAD is a narrowing or blockage of the arteries or vessels that provide oxygen and nutrients to the heart due to atherosclerotic plaque formation on the inner lining of the arteries. 50% 0f patient with CAD present with sudden death (cardiac arrest) as their first symptom.CAD is the commonest cause for death in western world. 3.8 million men& 3.4 million women in worldwide die each year because of CAD with the risk factors of Smoking, High cholesterol, Hypertension, Diabetes, Emotional stress, Obesity and Sedentary life.1\u00a0<\/sup>Coronary Artery Bypass Grafting (CABG) is the most common surgery performed in the world for CAD. The technique involves an incision down from the front of the chest through the sternum. For CABG, the heart is assessed through a midline incision. The surgery can be performed with cardio \u2013 pulmonary bypass i.e., OPCAB (On Pump CAB) or without cardio \u2013pulmonary bypass (Off Pump CAB).As with any surgery post operative morbidity does exists.3<\/sup>\u00a0The use of anesthesia, blood loss coupled with restricted mobility and pain due to incision primarily affects the oxygen transport. This leads to: Sub-optimal mucociliary escalation, Decrease lung volume and capacities, Mucus retention in lungs, Requirement of increased work of breathing. The efficacy of physiotherapy techniques used for patients following coronary artery bypass surgery (CABG) is well documented. It is a life-saving procedure which is frequently related to significant postoperative pain. Many lung defense mechanisms may become impaired, or overtly ineffective, due to intense chest pain. Although narcotics and opiates may be effective for pain control, they are associated with side effects, including respiratory depression. Therefore, there is a longstanding interest in the development of non-chemical strategies for effective pain control2<\/sup><\/p>\n

The ventilation is further affected by pain. Though various modalities and techniques are available but nevertheless none of the technique so far has been shown to produce the required improvement. Hence the postoperative treatment still remains to be optimized and lacks the much-needed standardization. Alternate nostril breathing is focused on normalizing respiratory pattern, promoting ventilation, the whole body relaxation, clearing the lung from mucus retention and reducing work of breathing.6<\/sup>\u00a0This is important to control the immediate post-operative morbidity. Pranayama is one of the eight limbs of Asthanga Yoga and includes different respiratory techniques which aim to treat various physical and psychological ailments.4<\/sup><\/p>\n

Anulom-Vilom, or alternate-nostril breathing (ANB), is a type of pranayama that involves left nostril inhalation followed by right nostril exhalation and then right nostril inhalation followed by left nostril exhalation.7<\/sup>\u00a0Several investigations have been conducted to determine the long-term effects of this technique on the cardiovascular and autonomic nervous systems in healthy and clinical populations and many of these studies have suggested that ANB leads to a shift in sympatho vagal balance toward parasympathetic dominance.5\u00a0<\/sup>Among the various yoga practices, the alternate nostril breathing (ANB) is a fairly simple and commonly performed exercise. The practice of ANB is traditionally considered to relieve mental unrest and promote physical and mental balance.9<\/sup>\u00a0There have been studies to assess the effects of ANB technique on specific physiological and cognitive functions.7<\/sup>\u00a0There is evidence for a balancing effect of ANB on the activity of both cerebral he mispheres8<\/sup><\/p>\n

Methodology<\/strong><\/p>\n

Materials<\/strong><\/p>\n

Inch tape<\/p>\n

Pen<\/p>\n

Paper<\/p>\n

Chalk<\/p>\n

Stop watch<\/p>\n

6 MWT Chart<\/p>\n

Daily assessment chart<\/p>\n

Cardio respiratory evaluation chart<\/p>\n

Selection Criteria<\/strong><\/p>\n

Inclusion criteria<\/strong><\/p>\n

Age limit: 50-60<\/p>\n

Patient who had undergone median sternotomy incision for CABG<\/p>\n

Both sexes were taken for the study<\/p>\n

Patients willing to participate on a voluntary basis<\/p>\n

Exclusion Criteria<\/strong><\/p>\n

Age below 50 and above 60<\/p>\n

Unstable vital signs<\/p>\n

COPD and other lung pathology<\/p>\n

Neuromuscular \/Musculoskeletal disorders<\/p>\n

Rib fracture<\/p>\n

Osteoporosis<\/p>\n

Metastatic cancer thorax<\/p>\n

Smokers excluded<\/p>\n

Sample Size<\/strong><\/p>\n

Total number of 60 patients were selected for the study. 30 out of them were excluded.<\/p>\n

Sample Format<\/strong><\/p>\n

The study was conducted as experimental pre test and post test study design and \u00a0received Nadishodan pranayama along with conventional physiotherapy.<\/p>\n

Interventions<\/strong><\/p>\n

Study Duration and Schedule\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong><\/p>\n

The study was carried out for a duration of 2 months and the treatment duration was carried out for the period of 7 days. The patients were treated daily for 30 minutes once daily and the values of the parameter selected were assessed on the 2nd<\/sup>post operative day ,4th<\/sup>post operative day and 6th<\/sup> post operative day.<\/p>\n

Outcome Measures<\/strong><\/p>\n

The parameters recorded were,<\/p>\n

Chest expansion three levels<\/p>\n

Visual Analogue Scale<\/p>\n

Peak expiratory flow rate<\/p>\n

Description of Technique<\/strong><\/p>\n

Alternate Nostril Breathing (ANB)<\/p>\n

Chest Physiotherapy<\/p>\n

Percussion<\/p>\n

Vibration<\/p>\n

Shaking<\/p>\n

Statistical Tools<\/strong><\/p>\n

The was conducted in a pre test and post test study design with a multivariate formate.<\/p>\n

The \u201dt\u201d test used to analyse the variable<\/p>\n

The \u201ct\u201d value was calculated using the formulae,<\/p>\n

\"Formula<\/p>\n

Table 1: Visual Analogue Scale<\/strong><\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl No<\/strong><\/td>\nPretest<\/strong><\/td>\nPretest<\/strong><\/td>\nDiff<\/strong><\/td>\n<\/tr>\n
1<\/td>\n9<\/td>\n3<\/td>\n6<\/td>\n<\/tr>\n
2<\/td>\n7<\/td>\n3<\/td>\n4<\/td>\n<\/tr>\n
3<\/td>\n10<\/td>\n6<\/td>\n4<\/td>\n<\/tr>\n
4<\/td>\n8<\/td>\n3<\/td>\n5<\/td>\n<\/tr>\n
5<\/td>\n6<\/td>\n2<\/td>\n4<\/td>\n<\/tr>\n
6<\/td>\n9<\/td>\n4<\/td>\n5<\/td>\n<\/tr>\n
7<\/td>\n7<\/td>\n3<\/td>\n4<\/td>\n<\/tr>\n
8<\/td>\n10<\/td>\n5<\/td>\n5<\/td>\n<\/tr>\n
9<\/td>\n7<\/td>\n3<\/td>\n4<\/td>\n<\/tr>\n
10<\/td>\n6<\/td>\n2<\/td>\n4<\/td>\n<\/tr>\n
11<\/td>\n9<\/td>\n3<\/td>\n6<\/td>\n<\/tr>\n
12<\/td>\n8<\/td>\n4<\/td>\n4<\/td>\n<\/tr>\n
13<\/td>\n10<\/td>\n5<\/td>\n5<\/td>\n<\/tr>\n
14<\/td>\n9<\/td>\n3<\/td>\n6<\/td>\n<\/tr>\n
15<\/td>\n6<\/td>\n4<\/td>\n2<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Table 2: Chest Expansion<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl no<\/strong><\/td>\nPre test<\/strong><\/td>\nPost test<\/strong><\/td>\nDiff<\/strong><\/td>\n<\/tr>\n
1<\/td>\n1<\/td>\n1.8<\/td>\n0.8<\/td>\n<\/tr>\n
2<\/td>\n1.5<\/td>\n3<\/td>\n1.5<\/td>\n<\/tr>\n
3<\/td>\n1.8<\/td>\n2.2<\/td>\n0.4<\/td>\n<\/tr>\n
4<\/td>\n1.5<\/td>\n3.2<\/td>\n1.7<\/td>\n<\/tr>\n
5<\/td>\n1.5<\/td>\n2<\/td>\n0.5<\/td>\n<\/tr>\n
6<\/td>\n1<\/td>\n2.7<\/td>\n1.7<\/td>\n<\/tr>\n
7<\/td>\n1.9<\/td>\n2.5<\/td>\n0.6<\/td>\n<\/tr>\n
8<\/td>\n1.5<\/td>\n2<\/td>\n0.5<\/td>\n<\/tr>\n
9<\/td>\n1.8<\/td>\n3.3<\/td>\n1.5<\/td>\n<\/tr>\n
10<\/td>\n1.5<\/td>\n3.2<\/td>\n1.7<\/td>\n<\/tr>\n
11<\/td>\n1<\/td>\n2.7<\/td>\n1.7<\/td>\n<\/tr>\n
12<\/td>\n1.8<\/td>\n2.9<\/td>\n1.1<\/td>\n<\/tr>\n
13<\/td>\n1.3<\/td>\n2.9<\/td>\n1.6<\/td>\n<\/tr>\n
14<\/td>\n1.0<\/td>\n2.9<\/td>\n1.9<\/td>\n<\/tr>\n
15<\/td>\n1<\/td>\n2.7<\/td>\n1.7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Table 3: Peak Expiratory Flow Rate<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Sl no<\/strong><\/td>\nPre test<\/strong><\/td>\nPost test<\/strong><\/td>\nDiff<\/strong><\/td>\n<\/tr>\n
1<\/td>\n60<\/td>\n240<\/td>\n-180<\/td>\n<\/tr>\n
2<\/td>\n100<\/td>\n190<\/td>\n90<\/td>\n<\/tr>\n
3<\/td>\n60<\/td>\n270<\/td>\n210<\/td>\n<\/tr>\n
4<\/td>\n120<\/td>\n240<\/td>\n120<\/td>\n<\/tr>\n
5<\/td>\n100<\/td>\n290<\/td>\n190<\/td>\n<\/tr>\n
6<\/td>\n60<\/td>\n240<\/td>\n180<\/td>\n<\/tr>\n
7<\/td>\n150<\/td>\n290<\/td>\n140<\/td>\n<\/tr>\n
8<\/td>\n60<\/td>\n240<\/td>\n180<\/td>\n<\/tr>\n
9<\/td>\n120<\/td>\n190<\/td>\n70<\/td>\n<\/tr>\n
10<\/td>\n150<\/td>\n270<\/td>\n120<\/td>\n<\/tr>\n
11<\/td>\n100<\/td>\n190<\/td>\n90<\/td>\n<\/tr>\n
12<\/td>\n100<\/td>\n190<\/td>\n90<\/td>\n<\/tr>\n
13<\/td>\n100<\/td>\n270<\/td>\n170<\/td>\n<\/tr>\n
14<\/td>\n150<\/td>\n290<\/td>\n140<\/td>\n<\/tr>\n
15<\/td>\n100<\/td>\n290<\/td>\n190<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Discussion<\/strong><\/p>\n

The purpose of the study is to determine \u201cEfficacy of Nadishodhan Pranayama – Alternate Nostril Breathing (ANB) on Functional Improvement in Post Cabg Patient\u201d The study was conducted out for a period of\u00a0 8 weeks. Pain has been pointed out as one of the chief concerns of patients following CABG.<\/p>\n

In the present study, it was found that conventional chest physiotherapy including deep breathing exercise, secretion removal maneuvers , assisted coughing and Nadishodhan Pranayama significantly decrease Pain and improved PEF rate, chest expansion and VAS score<\/p>\n

In our study PEF rate, chest expansion and VAS measurement was performed post operatively on 2nd<\/sup> POD and repeated on the 4th<\/sup>and 6th<\/sup> POD<\/p>\n

The patients were encouraged to perform the deep breathing exercises once per hour throughout the day. In our study\u00a0 all patients in the experimental group found the breathing technique easy to perform and\u00a0 most of the patients experienced a subjective benefit of the exercises; this is important for completion of the treatment.<\/p>\n

We studied the effect of alternate nostril breathing in post CABG subjects using . Three outcome measures were used to evaluate the effect of the intervention, Visual Analog\u00a0 Scale , chest expansion and peak expiratory flow rate. The results of the study show that there was a significant phase effect on the VAS scores, suggesting that ANB did induce significant reduction in pain, increases chest expansion and peak expiratory flow rate in the study subjects.<\/p>\n

Conclusion<\/strong><\/p>\n

Practice of ANB after uncomplicated CABG maximizes chest expansion, peak expiratory flow rate and reduction in pain which may be attributed to improvement in positive affect, decrease in stress, anxiety, depression and negative affect. Continued follow up of these cases is planned.<\/p>\n

Conflict of Interest<\/strong><\/p>\n

Authors don\u2019t have any conflict of interest and no funding has been obtained for conducting the study.<\/p>\n

Acknowledgement<\/strong><\/p>\n

M. Manikumar , A.Pahinian participated in the design of the study, A. Jeganathan performed the statistical analysis and contributed to draft the manuscript\u00a0 <\/sup>,\u00a0 Aparna Krishnakumar.K participated in the design of the study and the gathering of data Monisha.R, contributed to the design of the study, collaborated in gathering of data and helped to draft the final manuscript and Authors signed the contribution form and have read and approved the final manuscript design.<\/p>\n

Reference<\/strong><\/p>\n

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    Introduction CAD is a narrowing or blockage of the arteries […]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[55],"tags":[],"class_list":["post-18828","post","type-post","status-publish","format-standard","hentry","category-vol11no1"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/18828","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=18828"}],"version-history":[{"count":6,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/18828\/revisions"}],"predecessor-version":[{"id":32194,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/18828\/revisions\/32194"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=18828"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=18828"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=18828"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}