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ENHANCING MANAGEMENT OF TYPE 2 DIABETES THROUGH YOGA

Yoga has a great potential in preventing and managing chronic diseases and Yogic lifestyle can make an appreciable contribution to improvement of health of our masses. Yoga has the potential to prevent progression of the disease and if started early, maybe even effecta cure (Bhavanani, 2013).

Basic Yogic principles that are used in management of DM include:
1. Psychological reconditioning and development of appropriate attitudessuch as yama-niyama, chaturbhavana, pratipakshabhavanametc
2. Stress management through counseling, jathis (loosening techniques), asanas (postures), kriyas(systematic rational breath-body coordination movements) and pranayama (breath-energy harmonizing techniques).
3. Helping utilizing the glucose better through physical activity such as surya namaskar, asanas, kriyas, pranayama etc
4. Relaxation, visualization and contemplative practices to induce a sense of inner calmness and wellbeing.

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ENHANCING MANAGEMENT OF TYPE 2 DIABETES THROUGH YOGA

  1. 1. Enhancing Management of T2 DM Through Yoga Yogacharya Dr. ANANDA BALAYOGI BHAVANANI MBBS, ADY, DSM, DPC, PGDFH, PGDY, MD (Alt Med), FIAY, C-IAYT Deputy Director Centre for Yoga Education, Therapy and Research (CYTER), Sri Balaji Vidyapeeth, Puducherry. www. sbvu.ac.in/ahs/yoga
  2. 2. SBV AIM HIGH’s Centre for Yoga Therapy, Education and Research (CYTER) Salutogenesis, our focus!
  3. 3. SBV AIM HIGH’s Centre for Yoga Therapy, Education and Research (CYTER) Salutogenesis, our focus!
  4. 4. SBV AIM HIGH’s Centre for Yoga Therapy, Education and Research (CYTER) Salutogenesis, our focus!
  5. 5. Salutogenesis, our Focus • Moving from pathogenesis, the focus on disease towards salutogenesis, the focus on health! • Under SBV AIM HIGH (Academy of Integrative Medicine for Holistic Intervention towards General Health), Faculty of Allied Health Sciences, CYTER is striding forward on an innovative path of promoting holistic health for one and all. Pathogenesis Salutogenesis
  6. 6. Bridging the experiential wisdom of Yoga with empirical modern medical science. Yoga is usually found in Physical Edu & Sports deptts of universities We at CYTER, have it in a medical institution since 2010 – quality of life enhancing benefits for ~ 29,000 patients – educating future Yoga therapists (PGDYT, M.Phil, PhD), – creating awareness amongst medical, dental and nursing students & professionals – scientifically researching Yoga, – 53 publications & 4 CMEs
  7. 7. “அண்டத்தில் உள் ப�ண்ட; ப�ண்டத்தி உள்ளேத அண்; அண்ட�ம் ப�ண்ட ஒன்ேற அறிந்�தா பார்க்�ம்ேப” - சட்ைட�ன� சித் That which lies in the macrocosm, lies in the microcosm. That which lies in the microcosm lies in the macrocosm. When we understand truly, both are indeed one. - Sattaimuni Siddhar
  8. 8. Introduction • Yoga is probably the best lifestyle ever designed • Effective in stress induced, lifestyle disorders. • Even a short lifestyle modification program based on Yoga reduces risk factors for cardiovascular disease and DM within a period of 9 days (Bijlani, 2005) • Yogic practices may have a role in prevention and management of diabetes & in co-morbid conditions like hypertension and dyslipidemia (Sahay, 2007). • Adjunct Yoga therapy may help obtain benefits at lower doses, reducing side effects of medicines – enhancing metabolic control & patient compliance.
  9. 9. • Increased insulin sensitivity & attenuation of –ve relationship between weight /WC & insulin sensitivity associated with long term Yoga practice (Chaya, 2008). • A systematic review (32 articles from 1980-2007) found Yoga interventions effective in reducing weight, BP, glucose level & high cholesterol (Yang 2007) • Improved nerve conduction (Malhothra, 2002) and biochemical profile (Lorenzo, 2008) in diabetics. • With no appreciable side effects & multiple collateral benefits, Yoga is safe, simple, & can be practiced by even ill, elderly /disabled pts (Innes &Vincent, 2007). • Being safe, simple & economical, it should be considered beneficial adjuvant in DM (Jain, 1993).
  10. 10. • A comprehensive review by Innes & Vincent (2007) found beneficial changes in several risk indices, including – glucose tolerance, insulin sensitivity, lipid profile, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, ……. as well as – improvement in specific clinical outcomes. • Suggested Yoga may improve risk profiles in adults with Type 2 DM & • May have promise for prevention and management of cardiovascular complications in this population.
  11. 11. WHAT IS YOGA ? • A mindful way of life • Union (Yuj) of – Body, emotions and mind – Jivatma with Paramatma • Skill in action • Stilling the whirlpools of the mind • Harmony of thought, word and deed • Equanimity of mind (samatwam) • Conscious evolution
  12. 12. ASHTANGA YOGA Eight limbs of Patanjali’s Ashtanga Yoga • Yama - morality for daily living • Niyama - ethics for the self • Asana - firm & comfortable posture • Pranayama - control of the vital energy • Pratyahara - sensory withdrawal • Dharana - one pointed concentration • Dhyana - state of meditation • Samadhi - absorption/ oneness
  13. 13. ADVANTAGES OF YOGA Wholistic: • Preventive, promotive, rehabilitative, curative (?) • Science, philosophy, art • Involves body, mind, spirit • Desirable +ve “side benefits” • Simultaneous improvement in health and control of other conditions • Relief from stress - the main cause of Adhija Vyadhi (psychosomatic disorders)
  14. 14. What is health? “samadoshah samaagnishcha samadhaatu malakriyah prasanna atmendriyamanah swasthityabhidheeyate” Health is a dynamic balance of the elements and humors, normal metabolic activity and efficient elimination coupled with a tranquil mind, senses and contented self. –Sushruta Samhita, Sutrasthanam, 15:41
  15. 15. • Yoga enables attain and maintain a dynamic sukha sthanam - a dynamic sense of physical, mental and spiritual well being. • Yoga helps cultivation of positive health through three integral steps *: 1. Cultivation of correct psychological attitudes, 2. Reconditioning of neuro-muscular and neuro- glandular system – in fact, the whole body – enabling it to withstand stress and strain better, 3. Laying great emphasis on appropriate diet conducive to such a peak state of health, and encouraging natural processes of elimination through various processes of shuddhi. * Swami Kuvalayananda & Vinekar S.K. Yogic Therapy (1963)
  16. 16. Yoga places great importance on a proper and healthy lifestyle whose main components are:  Achar – healthy physical activities & exercise  Vichar – right thoughts and right attitude towards life that are vital for wellbeing.  Ahar – healthy, nourishing diet with adequate intake of fresh water; balanced intake of fresh food, green salads, sprouts, unrefined cereals & fresh fruits. Satwic diet, prepared & served with love & affection.  Vihar – proper recreational activities to relax body and mind are essential for good health.
  17. 17. THE YOGIC CONCEPT OF ORIGIN OF DISEASE - Yoga Vashishta
  18. 18. Perceived Stimulus
  19. 19. PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL CORRELATES OF STRESS, ILLNESS & HEALTH NERVOUS SYSTEM ENDOCRINE SYSTEM IMMUNE SYSTEM MENTAL & PHYSICAL ILLNESS
  20. 20. PSYCHO-NEURO-IMMUNO-ENDOCRINOLOGICAL CORRELATES OF STRESS, ILLNESS & HEALTH NERVOUS SYSTEM ENDOCRINE SYSTEM IMMUNE SYSTEM HEALTH & WELLNESS
  21. 21. Illness to Wellness, the choice is ultimately ours & ours alone !
  22. 22. Yoga intervention: Pathway 1 ↓ Perceived stress ↓ Activation/reactivity of sympathoadrenal system and HPA axis Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. eCAM 2007; 4: 469-86. Postulated mechanisms of yoga in diabetes mellitus
  23. 23. Yoga intervention: Pathway 2 Vagal stimulation ↓ Parasympathetic activation Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. eCAM 2007; 4: 469-86. Postulated mechanisms of yoga in diabetes mellitus
  24. 24. Yoga intervention: Pathway 2 Yoga intervention: Pathway 1 ↓ Inflammatory cytokines ↓ Heart rate, blood pressure Reduced risk for: Type 2 diabetes and its complications Improved coagulation / fibrinolytic profile ↓ Oxidative stress ↑ Endothelial function Enhanced metabolic and psychological profile ↑ Insulin sensitivity ↑ Glucose tolerance Improved lipid profile ↓ Visceral adiposity Improved mood ↓ Perceived stress ↓ Activation/reactivity of sympathoadrenal system and HPA axis Vagal stimulation ↓ Parasympathetic activation Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. eCAM 2007; 4: 469-86. Postulated mechanisms of yoga in diabetes mellitus
  25. 25. All aspects of human psycho- physiological functioning improved When the breath is steady, emotions become more balanced When the body is stilled, the mind starts to calm down Conscious focus on the present moment-the NOW Integration breath pattern with coordinated smooth body movements
  26. 26. Basic Yogic principles used in management of DM • Psychological reconditioning and development of appropriate attitudes such as yama-niyama, chaturbhavana, pratipaksha bhavanam etc • Stress management through counseling, jathis (loosening techniques), asanas (postures), kriyas (breath-body coordination movements) and pranayama (breath-energy harmonizing techniques). • Helping use glucose better through physical activity: surya namaskar, asanas, kriyas, pranayama etc • Relaxation, visualization and contemplative practices to induce a sense of inner calmness and wellbeing.
  27. 27. Kriya Asana Meditation Pranayama Relaxation Yoga therapy practices 30
  28. 28. Recommended practices that are modified as per individual needs & /abilities. Counseling of yogic lifestyle, diet and attitudes • Jathis & Kriyas (loosening & breath body coordination practices ) • Suryanamaskar • Tala asana • Trikona asana • Parshvakona asana • Veera asana • Pawanmukta asana • Nava asana • Ardhamatsyendra/ vakra • Viparitakarani • Agnisara kriya • Kapalbhati • Chandra nadi pranayama • Bhramari pranayama • Pranava pranayama & dhyana • AUM Japa with Mudras • Kaya kriya • Marmanasthanam kriya
  29. 29. Uninostril / alternate nostril pranayamas Suryanadi asana Chandranadi asana
  30. 30. Whooshing tensions away-nasarga mukha bhastrika
  31. 31. Tension relaxation coupling: Spanda nishpanda
  32. 32. Chakra MeditationChakra dhyana Inhale Exhale
  33. 33. References: • Bhavanani AB. Yoga Chikitsa: The application of Yoga as a therapy. Pondicherry, India: Dhivyananda Creations, 2013. • Bijlani RL, Vempati RP, Yadav RK, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med 2005; 11:267–74. • Chaya MS, Ramakrishnan G, Shastry S, et al. Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga. Natl Med J India 2008; 21:217–21. • Gordon LA, Morrison EY, McGrowder DA, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes.BMC Complementary and Alternative Medicine 2008; 8: 21. • Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evid Based Complement Alternat Med 2007; 4: 469–86. • Jain SC, Uppal A, Bhatnagar SO, Talukdar B. A study of response pattern of non-insulin dependent diabetics to yoga therapy. Diabetes Res ClinPract 1993; 19: 69–74. • Madanmohan, Bhavanani AB, Dayanidy G, Sanjay Z, Basavaraddi IV. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. International Journal of Yoga 2012; 5: 10-15. • Malhotra V, Singh S, Tandon OP, Madhu SV, Prasad A, Sharma SB. Effect of Yoga asanas on nerve conduction in type 2 diabetes. Indian J Physiol Pharmacol 2002; 46: 298-306. • Sahay BK. Role of yoga in diabetes. J Assoc Physicians India 2007; 55:121–6. • Yang K. A Review of yoga programs for four leading risk factors of chronic diseases. Evid Based Complement Alternat Med 2007; 4: 487–91.
  34. 34. Accredited with ‘A’ grade by NAAC

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