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Research Article
Revised

Impact of yoga on the central and peripheral vascular function among desk-based workers: A single-centered trial study

[version 2; peer review: awaiting peer review]
Previously titled: Impact of yoga on the central and peripheral vascular function among desk-based workers: A single-centred trial study
PUBLISHED 10 May 2024
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REVIEWER STATUS AWAITING PEER REVIEW

This article is included in the Manipal Academy of Higher Education gateway.

Abstract

Background

The aim of this study was to observe and analyze vascular function in ‘prolonged sitting’, followed by a yoga asana routine and pranayama intervention. Participants in this study include those who work from desks in offices. The study required the participants to attend on three separate days at random, and they had to finish a computerized test on each day. On the first day, participants were required to complete a computer test while sitting still for four hours (with the exception of washroom breaks). The next day, they underwent a computerized test along with a pranayama intervention. Finally, on the last day, they underwent a computerized test along with a yoga asana intervention. At the start of the study and after two and four hours, we measured the diameter and velocity of the common carotid artery (CCA) and superficial femoral artery (SFA).

Methods

The study was a within-subjects prospective single-center trial conducted in the Department of Radio-Diagnosis and Imaging, Kasturba Medical Hospital, Manipal, India, between September 2022 and January 2023. Participants were asked to do one of the following ‘activities’ over successive weeks: Week 1 – Prolonged sitting; Week 2 – Pranayama intervention; and Week 3 – Yoga asana intervention during prolonged sitting. The baseline and follow-up variables of pulse velocity, endothelial thickness, and shear rate were assessed for normality through a Shapiro-Wilk Test.

Results

Our sample included 11 participants with moderate physical activity, five with high physical activity and one with low physical activity. Yoga asana intervention comprised participants sitting continuously for four hours, with a yoga asana intervention being provided every hour, lasting for 10 minutes.

Conclusions

Yoga asana improves vascular functions in prolonged sitting conditions. This routine can promote the concept of interrupted sitting and ways to reduce it with efficient yoga asana practice without changing the work culture and provide better physical relief.

Trial registration

Clinical Trials Registry – India ( CTRI/2022/09/045628), date of registration: 19/09/2022(CTRI/2022/9/045628)https://ctri.nic.in/Clinicaltrials/main1.php?EncHid=16349.27799,

Keywords

Physical Activity, Vascular Function, FMD, Exercise, Sedentary lifestyle

Revised Amendments from Version 1

We have made a few changes in addressing yoga as yoga asana.

Introduction

For a growing proportion of the world’s population, the impact of the digital working era combined with a tendency to adopt an overall sedentary lifestyle has resulted in people sitting for prolonged periods of time. This can lead to low energy expenditure and lower physical activity (LPA) levels. This has many adverse effects, including early onset of metabolic diseases such as hypertension, type 2 diabetes mellitus, obesity, atherosclerosis, late-life cognitive decline, loss of alertness, and a reduced reaction time.18 For an adult, according to the World Health Organization (WHO), the average individual requires at least 150 min of exercise per week.9 However, meeting this demand might not be accessible due to the pressures of modern life. As a result, extended sitting has been one strategy used to assist people in adopting a variety of postural motions, mostly in office-based working contexts.18

A root cause of the above disorders has been linked to vascular impairment; therefore, improving vascular blood flow becomes essential in minimizing the potential of developing adverse effects in later life.10 Blood vessels that are particularly affected include the superficial femoral artery (SFA) and common carotid artery (CCA).11 The seated position has a marked and negative impact on SFA blood flow, being confounded by a sedentary lifestyle and working at computers. SFA flow reduction can cause damage and acute distress12; similarly, CCA flow reduction can also have detrimental consequences.

Research has been published to investigate ways to reduce prolonged sitting and to offer interventions that can improve vascular function whilst minimizing disturbance to the working environment and work productivity.1316 Additional problems of interventions within the working environment are related to space for physical activity and the cost of any exercise-related equipment. For the workplace, a need exists to identify even more productive, feasible, convenient, cost-limited and practical exercises that increase blood flow without negative impact and at an acceptable cost.

It is suggested that customized yoga asana, using the pranayama routine, can improve concentration and alertness.1720 Yoga experts suggest this can improve vascular function and blood flow. However, yoga asana’s impact on CCA and SFA blood flow is unclear. Consequently, our study aimed to observe and analyse CCA and SFA blood flow in ‘prolonged sitting’, followed by a yoga asana routine and pranayama intervention.

Methods

The study was a within-subjects prospective single-centre trial conducted in the Department of Radio-Diagnosis and Imaging, Kasturba Medical Hospital, Manipal, India, between September 2022 to January 2023. After approval from the Institutional Ethics Committee, Kasturba Medical College (KMC) and Kasturba Hospital (KH) (IEC1:108/2022) (approved on 22 July 2022) and Clinical Trial Registry of India (CTRI/2022/9/045628)https://ctri.nic.in/Clinicaltrials/main1.php?EncHid=16349.27799, with prior written informed consent, 17 participants (desk based workers) were recruited for the study. This included nine males (mean age 25, age range 24–28) and eight females, mean age 25 (age range 24–28). Flyers in campus stores and adverts in Manipal University Trading & Property helpline MUTC a facebook based group were used to recruit participants for the study, which was conducted at Kasturba Hospital in Manipal. The participants had no history of cardiovascular or metabolic disorders, the females were not menstruating, none had depression during the study period, and none were taking medication, which might alter vascular function. Self-reported physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).1 The questionnaire assesses time (frequency and duration) spent on vigorous, moderate intensity, walking activities and sitting time in hours for the past seven days. Our sample included 11 participants with moderate physical activity, five with high physical activity and one with low physical activity; the IPAQ data is shown in Table 1. For this investigation, repeated measures ANOVA (parametric) or Friedman’s test (non-parametric) are used as statistical tests performed on JASP statistical software version 0.16.2 (https://jasp-stats.org/previous-versions/).

Table 1. International Physical Activity Questionnaire (IPAQ) results and Body Mass Index (BMI) of the participants.

Height (cm)WeightHeight (m)BMIIPAQ
167.64601.67421.411MODERATE
172751.7225.351HIGH
179.832701.79821.653MODERATE
167.64761.676427.043HIGH
188.976921.8825.761HIGH
189751.8920.996MODERATE
187.9701.87919.826MODERATE
189751.8920.996MODERATE
167.64501.67417.842LOW
172601.7220.281MODERATE
167.64501.6717.928MODERATE
161751.6128.934HIGH
167.64581.67420.697MODERATE
172701.7223.661MODERATE
169721.6925.209HIGH
170601.720.761MODERATE
175751.7524.489MODERATE

Over three weeks, participants were requested to do one of the following ‘activities’ over successive weeks: Week 1 – prolonged sitting; Week 2 – pranayama intervention during prolonged sitting; and Week 3 – yoga asana intervention during prolonged sitting. Vascular function was assessed for each of the three conditions including the diameter and blood velocity of the SFA and CCA were measured at the start of the study (0), two, and four hours during sitting using a Doppler ultrasound (Philips, Epiq Elite). Ultrasound machine quality assurance test results fell within manufacturer specifications. Ultrasound was performed by a competent radiologist (see Figure 1).

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure1.gif

Figure 1. CCA measurements being taken using ultrasound.

Prolonged sitting comprised of participants sitting continuously for four hours (see Figure 2). Pranayama intervention comprised participants sitting continuously for four hours, with the pranayama intervention being provided every hour, lasting 10 minutes. The yoga asana intervention comprised participants sitting continuously for four hours, with a yoga asana intervention being provided every hour, lasting for 10 minutes.

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure2.gif

Figure 2. Prolonged sitting of office worker.

Pranayama practice included Deep breathing, Nadisodhana Pranayama and Bhramari Pranayama.1719 Yoga asana practices included Tadasana, Ardha Chakrasana, Uttana Mandukasana,20 Skandha Chakra Asana, Kati Chakrasana, Prasarita Padottanasan.

Results

The study comprised 17 participants in the 25–35 age range. Nine males (mean age 25, age range 24–28) and eight females (mean age 25, age range 24–28) made up the participants.25 None of the participants experienced depression throughout the study period, none had a history of cardiovascular or metabolic diseases, and none were taking any medications that would affect vascular function. Additionally, none of the female participants were menstruating. The IPAQ was used to evaluate self-reported physical activity. For the previous seven days, the questionnaire measures the amount of time (frequency and duration) spent on walking activities that are vigorous or moderately intense as well as hours spent sitting down.

CCA diameter

Figure 3 illustrates how the results of the CCA reveal that the artery’s width decreases with each set of interventions. In comparison with time, the first and second hours exhibited statistical significance with a p value<0.001, whereas the third and fourth hours do not exhibit statistical significance (p value=0.020). Although the yoga asana intervention shows significance, it does not show statistical significance when compared to pranayama group and prolonged sitting (p value=0.014). Table 2 represents the data of CCA diameter at different time points.

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure3.gif

Figure 3. CCA diameter over the study time.

(In figure X axis represents Time, Y axis represents vascular diameter (cm).)

Table 2. Common carotid artery (CCA) diameter at different intervention time points.

CCA diameter
Intervention0 hour Mean ± SD2nd hour Mean ± SD4th hour Mean ± SD
Sitting intervention0.670 ± 0.0620.579 ± 0.0590.537 ± 0.067
Pranayama intervention0.636 ± 0.0770.585 ± 0.0590.577 ± 0.054
Yoga asana intervention0.606 ± 0.0670.639 ± 0.1150.726 ± 0.111

In addition, the yoga asana intervention did not show statistical significance when compared to the pranayama intervention and prolonged sitting (p value=0.017).

CCA velocity

In the CCA, a reduction in velocity was observed after the pranayama and yoga asana intervention. However, when it comes to prolonged sitting, there was a decrease in velocity at the start of the study and at two hours, followed by an increase in velocity during the final hour as shown in Figure 4. With CCA velocity, neither time nor blood velocity were statistically significant. Table 3 represents the data of CCA velocity at different time points.

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure4.gif

Figure 4. CCA Velocity in different time points.

(In figure X axis represents Time, Y axis represents velocity (m/s).)

Table 3. Common carotid artery (CCA) blood velocity at different intervention time points.

CCA blood velocity
Intervention0 hour Mean ± SD2nd hour Mean ± SD4th hour Mean ± SD
Sitting intervention116.365 ± 19.713123.176 ± 11.485130.206 ± 21.310
Pranayama intervention124.941 ± 13.797109.953 ± 25.810107.482 ± 25.806
Yoga asana intervention127.294 ± 28.458115.524 ± 25.495107.506 ± 17.020

SFA diameter

The diameter of the SFA decreased each hour during prolonged sitting and pranayama intervention. However, during the yoga asana intervention, there was a reduction in diameter at the beginning of the study and at 2 hours, but an increase in diameter was observed in the 4th hour, shown in Figure 5. Neither time nor group showed any significance. Hence the group has not demonstrated any substantial response to any intervention. Tables 4 & 5 represents the data of SFA diameter and velocity at different time points respectively.

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure5.gif

Figure 5. SFA diameter at different intervention time points.

(In figure X axis represents Time, Y axis represents diameter in cm.)

Table 4. Superficial femoral artery (SFA) diameter at different intervention time points.

SFA Diameter
Intervention0 hour Mean ± SD2nd hour Mean ± SD4th hour Mean ± SD
Sitting intervention6.833 ± 25.5556.339 ±23.6215.796 ± 21.570
Pranayama intervention0.635 ± 0.0510.591 ± 0.0730.589 ± 0.072
Yoga asana intervention0.626 ± 0.0490.650 ± 0.0580.677 ± 0.076

Table 5. Superficial femoral artery (SFA) Velocity values for different interventions.

SFA Velocity
Intervention0 hour Mean ± SD2nd hour Mean ± SD4th hour Mean ± SD
Sitting intervention100.836 ± 42.41094.120 ± 39.23297.401 ± 46.217
Pranayama intervention98.859 ± 25.08288.276 ± 23.90585.288 ± 15.356
Yoga asana intervention110.847 ± 24.281106.024 ± 25.73998.224 ± 21.270

CCA shear and stress

In the CCA, the shear rate increased each hour during prolonged sitting, whereas it decreased in both the pranayama and yoga asana interventions (Figure 6). All interventions showed a reduction in stress in CCA (Figure 7). However, in terms of shear and stress, neither the time nor the group showed any significant difference. Table 6 represents the data of CCA shear and stress at different time points.

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure6.gif

Figure 6. CCA shear at different intervention time points.

(In figure X axis represents Time, Y axis represents velocity (m/s).)

164bd97e-5e66-45c3-8d52-f3a43c53c428_figure7.gif

Figure 7. Shows CCA stress at different intervention time points.

(In figure X axis represents Time, Y axis represents velocity (m/s).)

Table 6. Common carotid artery (CCA) shear and stress at different intervention time points.

CCA ShearCCA Stress
Intervention0 hour Mean ± SD2nd hour Mean ± SD4th hour Mean ± SD0 hour Mean ± SD2nd hour Mean ± SD4th hour Mean ± SD
Sitting intervention643.633 ± 235.083642.379 ± 258.007698.348 ± 277.646700.154 ± 137.83861.576 ± 127.689987.954 ± 208.107
Pranayama intervention630.400 ± 183.076612.781 ± 197.767591.701 ± 145.139794.020 ± 201.092763.876 ± 211.299757.151 ± 214.785
Yoga asana intervention713.502 ± 172.524664.485 ± 194.142596.131 ± 184.105860.253 ± 268.289750.484 ± 233.039605.912 ± 133.750

Discussion

Our study aimed to determine whether yoga asana affects vascular function in desk-based workers. Exercise will maintain and enhance both physical and mental health. By controlling the sympathetic nervous system and hypothalamus pituitary adrenal axis, yoga asana can improve physical and psychological health.21

Yoga asana intervention

In our study, yoga asana intervention improves the vascular function of the carotid and superficial femoral artery diameter. Comparing time, the first and second hours exhibited statistical significance with a p value of <0.001. Compared to the group, the yoga asana intervention showed effectiveness but no statistical significance in the carotid artery. Significance is shown in both the 0th and 2nd hours in the superficial femoral artery, with a p-value of 0.026 and 0.004*, respectively. Although they are not statistically significant. A study by Ross and Thomas (2010) found that both yoga asana and exercise significantly reduced fasting blood glucose levels at three and six months (29.48%, 27.43%; p<0.0001), with yoga asana showing better results in social and occupational functioning compared to the exercise group. The study also found that both yoga asana and exercises improved total serum cholesterol (p<0.0001) and low protein level (p=0.030).19 So, when we compare this to our study it proves that yoga asana shows significant changes.

In a study by Pearson and Smart (2017), participants underwent aerobic exercise with an intervention duration ranging from four weeks to six months, with the frequency of sessions varying from daily to two days per week, and the time of exercise sessions ranged from 10 to 60 minutes. The study concluded that aerobic exercise training significantly improved endothelial function.21 As compared to our study, the yoga asana intervention showed improvement in both carotid and superficial femoral artery diameter.

A study conducted by Cortez-Cooper examined the effect of different types of intervention on cardiovascular health. The study included three groups: a strength training group, a combination group that received both strength training and aerobic exercise, and a stretching group. The results showed that the strength training and combination groups experienced significant changes in cardiovascular health markers, including carotid artery pulse pressure. The study also found that carotid artery compliance decreased slightly in the strength training and combination groups and increased in the stretching group. However, the study found no carotid-femoral pulse wave velocity changes in the strength training and combination groups. Overall, the combination of strength training and aerobic exercise may be more effective than stretching alone in improving cardiovascular health.22 When compared to our study, the yoga asana intervention gave significant changes.

Prolonged sitting

A study by Thosar et al. (2015) involved 12 men participating in two randomized three-hour sitting trials. The first trial was a sitting trial where the subject was seated in one position without interruption The second trial was a sit-walk trial where the subjects walked on treadmills for five minutes at two mph for 30 minutes, 1.5-hour and 2.5-hour intervals during the sitting period. The study assessed the flow mediated dilation (FMD) of the SFA at baseline, one hour, two hours, and three hours in each trial. The results showed that there was no significant decline in the sitting trial in the FMD at each hour from baseline. The mean shear rate also showed a substantial decrease in the baseline across time. The sit-walk trial, however, showed a significant difference in the FMD and mean shear rate compared to the sit trial, indicating that walking during prolonged sitting may benefit arterial health.23 As compared to our study, both CA and SFA are measured. In our study all interventions – aside from the prolonged sitting – showed a minor decrease in CA velocity over time. When the seated intervention reached the last four hours, it will rise. Compared to time, the first and second hours exhibit statistical significance with a p value of <0.001, whereas the third and fourth hours exhibit significance but do not exhibit statistical significance (p value=0.020). There is no significant difference in SFA. But in our study, yoga asana showed effectiveness in both CA and SFA.

When people sit for lengthy periods, their CA shear increases, whereas pranayama and yoga asana interventions showed decreases in CA shear for each hour. In CA shear, both time and group will not show any significance.

Long periods of sitting have been shown to reduce stress in SFA, and yoga asana and pranayama interventions have also been shown to reduce stress over time. Both time and group do not exhibit any significant differences when compared.

The study by Carter et al. (2018) recruited 15 office workers (10 male). The participants sat for hours with two minutes of light intensity treadmill walking every 30 minutes and four hours sitting with an eight-minute light intensity treadmill walking break every 120 minutes. Middle cerebral artery measures were taken, and it was found that there was no significant difference in cardiorespiratory and hemodynamic measures, but a significant main effect was observed in cerebral blood flow. Post hoc analysis revealed a greater change in middle cerebral artery (MCA) during sitting compared to walking, with a considerable reduction in MCA observed in both the sitting and walking conditions.24 Compared to our study, the diameter significantly decreases in the sitting intervention, but velocity will increase similarly in SFA diameter and velocity decreases during the sitting intervention. Compared to time, the first and second hours exhibit statistical significance with a p value of <0.001, whereas the third and fourth hours demonstrated significance but did not exhibit statistical significance (p value=0.020). The yoga asana intervention showed significance compared to pranayama and prolonged sitting, though it didn’t reach statistical significance (p-value=0.014). In contrast, the yoga asana intervention showed significance but not statistical significance when compared to the group in pranayama intervention and prolonged sitting (p value=0.017). While in CA velocity, neither time nor velocity were significant.

The yoga asana intervention demonstrated improvement in SFA diameter; however, there was no difference between time and group when compared side by side. Each hour of the intervention resulted in a drop in velocity. The time points at the study’s start (0th hour) and at the 2nd hour demonstrate significance (p-value=0.026). However, while both the 0th and 2nd hours show significance with a p-value of 0.004, they still do not reach statistical significance. The group did not demonstrate any substantial response to any intervention. Hence, it shows that yoga asana will improve vascular function.

Conclusions

Based on the results, we can observe that yoga asana improved vascular functions in prolonged sitting conditions. Many organizations in India and globally are promoting the practice of yoga asana in the workplace. This routine can promote the concept of interrupted sitting and ways to reduce it with efficient yoga asana practice without changing the work culture and provide better physical relief.

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Shruthi P P, Kamath K, K V et al. Impact of yoga on the central and peripheral vascular function among desk-based workers: A single-centered trial study [version 2; peer review: awaiting peer review] F1000Research 2024, 13:277 (https://doi.org/10.12688/f1000research.135239.2)
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VERSION 2 PUBLISHED 15 Apr 2024
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Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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