Scientific rationale of Indian AYUSH Ministry advisory for COVID-19 prevention, prophylaxis, and immunomodulation

The current outbreak of COVID-19 is caused by the SARS-CoV-2 virus that has affected > 210 countries. Various steps are taken by different countries to tackle the current war-like health situation. In India, the Ministry of AYUSH released a self-care advisory for immunomodulation measures during the COVID-19 and this review article discusses the detailed scientific rationale associated with this advisory. Authors have spotted and presented in-depth insight of advisory in terms of immunomodulatory, antiviral, antibacterial, co-morbidity associated actions, and their probable mechanism of action. Immunomodulatory actions of advised herbs with no significant adverse drug reaction/toxicity strongly support the extension of advisory for COVID-19 prevention, prophylaxis, mitigations, and rehabilitation capacities. This advisory also emphasized Dhyana (meditation) and Yogasanas as a holistic approach in enhancing immunity, mental health, and quality of life. The present review may open-up new meadows for research and can provide better conceptual leads for future researches in immunomodulation, antiviral-development, psychoneuroimmunology, especially for COVID-19.Copyright © 2021, Institute of Korean Medicine, Kyung Hee University.

The respiratory exercise significance in the olfaction restoration in the postcovid period

One of the pathognomonic COVID19 signs, occurring in 8598% of patients, is olfactory dysfunction, developing in the absence of pronounced nflammation and edema of the nasal mucosa. A promising medicine direction that helps restore microcirculation, increase blood oxygenation, improve metabolism and regenerate olfactory epithelial cells is the Nadi Shodhana breathing exercise technique. Objective: To assess the possibilities of using the pranayama technique as a method of restorative olfactory treatment in the postcovid period. Materials and methods: 79 persons aged 22 to 68 years with olfactory disturbances occurring at COVID19 and persisting in the postcovid period were examined. As a restorative treatment for olfactory disorders, the patients of the main group were offered a course of Nadi Shodhana breathing xercises, which is an alternate nostril breathing. Breathing training consisted of three such cycles performed three times a day at the same time for 5 days. The possibility of using the pranayama technique was assessed according to the visual analog scale. The control group consisted of 74 patients with olfactory disorders after COVID19 comparable in sex and age with the main group. Results: Olfactory disorders are characteristic of postCOVID patients. Using Nadi Shodhana breathing exercise course can significantly reduce the lfactory dysfunction level in this patient category. It was showen that the pranayama technique is more effective in people under 40 years of age. It was lso established that the olfaction restoration largely depends on the duration of the dysfunction period. Conclusion: The study results make it possible to recommend the using breathing exercises in patients underwent COVID19 to restore olfaction n the postCOVID period. Copyright: © 2018 Zhao Qi et al.

Overview of COVID-19 Pandemic: Its Management and Prevention in Light of the Indian Traditional Medicine System

With the global death toll nearing 3.3 million, India being amongst the top 4 countries, the condition is more than fearsome. World Health Organization (WHO) recommends one doctor per 1000 population ratio, but India lags it by one doctor to 1456 people, which sets a lot of pressure on the healthcare system. Traditional remedies are becoming increasingly popular in India as a re-sult of the lack of a proper medical system. Due to the rich diversity of medicinal herbs and drugs, India has been managing health issues with its 5000 years old medication system. Amidst all this, the traditional medicine system has given relief to plenty of diseases and remains the primary de-fence system against COVID-19. Therefore, COVID-19 is also managed by its different medicinal systems, which are collectively known as the AYUSH regime. It had been a recognized system to tackle diseases in the past. In this mini-review, we performed a deep study of the Indian traditional medicine system in managing the COVID-19 situation.Copyright © 2023 Bentham Science Publishers.

Efficacy of Pranayama in Preventing COVID-19 in Exposed Healthcare Professionals: A Quasi-Randomized Clinical Trial.

Background: The global outbreak of COVID-19 has created a challenging situation, especially for the frontline Health Care Professionals (HCPs), who are routinely exposed and thus are at a higher risk of infection. Pranayama, a component of Yoga, is known to improve immune function and reduce infection. However, no clinical trial on the efficacy of Pranayama in preventing COVID-19 has yet been conducted. Aim & Objective: This quasi-randomized clinical trial assessed the efficacy of Pranayama in preventing COVID-19 infection in HCPs routinely exposed to COVID-19. Methodology: The study was conducted at 5 different COVID-19 hospitals, India in year 2020. The inclusion criteria were being an HCP exposed to COVID-19 patients and being negative on antibody tests. 280 HCPs were recruited sequential and assigned to intervention and control groups. Of these, 250 HCPs completed the study. The intervention was twice daily practice, for 28 days, of specially designed Pranayama modules under the online supervision of Yoga instructors. The HCPs in the control group were advised to continue their normal daily routine, but no pranayama sessions. Participants who developed symptoms suggestive of COVID-19 were subjected to Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) or Point of Care Rapid Antigen Test (RAT) for confirmation of the diagnosis. All the participants were tested for antibodies to COVID-19 on 28th day of the intervention to detect any asymptomatic infection. Results: The intervention (123) and control (127) groups had comparable demographics and baseline characteristics. At end of 28 days of intervention, nine participants in the control group and one in the intervention group developed COVID-19 (P-value: 0.01, Odds Ratio: 0.107, 95% CI: 0.86; Risk Ratio: 0.11, 95% CI: 0.89). Conclusion: The intervention of twice daily practice of the Pranayama module for 28 days in HCPs might have made a noteworthy contribution and may have helped in preventing COVID-19 infection. CTRI Number: CTRI/2020/07/026667.

Effects of Yoga on the Cardio-Respiratory System: Socio-Technical Effect to Reduce the Impact of the Pandemic on Indian Employees

This research paper is an initiative to provide insight associated with the physiological health of employees by examining the interventions of yogic exercise on physiological health. The investigation was done to study the impact of Yoga and Pranayama on functioning of lungs (vital capacity) and functioning of heart (resting heart rate) as an ancient therapy. The study found the effect of aerobic exercise and yogic practices on resting pulse rate and vital capacity among employees of a private organization engaged in production of technical equipment for Indian railway and metro trains and other related industries. After taking due consent from the promoter and founder of PPS International, the researchers randomly selected 120 subjects, all males of age group 25-35 years. Yoga helps to improve the lives of all age groups irrespective of gender. It can be adopted at any stage of life or started at any age;yoga has shown excellent results on the physiological health-related variable of stressed working professionals. Copyright © 2022, IGI Global.

Research article A study on immediate and training effect of Bhramari pranayama on heart rate variability in healthy adolescents

Introduction and Aim: Bhramari pranayama (Humming bee breath) is the most common slow pranayama practice involving inhalation through both nostrils followed by exhalation which produces sound of humming bee. Practicing pranayama reduces the effects of stress on different systems by increasing the vagal tone. With the ongoing COVID-19 pandemic, there are heightened feelings of stress, anxiety and depression and pranayama can be an effective way to improve our mental and emotional well-being. This study has been chosen to assess the effect of Bhramari pranayama on autonomic functions and to compare the immediate and training effects of Bhramari pranayama in the study group. Materials and Methods: An observational study was conducted in a medical college among 110 students aged between 18-22 years for a period of 2 months. The participants were instructed to do 9 rounds of Bhramari pranayama every day for 3 weeks. The immediate and training effect of pranayama practice on HRV (Heart Rate Variability) was assessed. The parameters of HRV (time and frequency domains) were assessed by PHYSIOPAC-PP4 (MEDICAID SYSTEMS, Chandigarh). Results: After training of Bhramari pranayama for 3 weeks, there was a decrease in Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and PNN50 and a decrease in frequency domain parameters, LFnu and LF/HF ratio were observed significantly. Conclusion: The study shows the possibility that Bhramari pranayama has a beneficial effect on HRV in medical students, as the autonomic balance produces the improvement of parasympathetic tone.

Impact of a Yogic Breathing Technique on the Well-Being of Healthcare Professionals During the COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic created unprecedented challenges for healthcare providers (HCPs), resulting in stress-related disorders, insomnia, and burnout. Sudarshan Kriya Yoga (SKY), a mind-body intervention, was explored as a tool to positively impact the wellbeing of HCPs during the pandemic. METHODS: A pilot study with a single-arm pre-/post-assessment follow-up design was conducted. SKY was taught to participants in a 4-day online workshop between the months of April and June, 2020. Outcomes related to depression, anxiety, resilience, life satisfaction, and quality of sleep were measured using the following scales: Depression, Anxiety & Stress Scale, Connor- Davidson Resilience Scale, Satisfaction With Life Scale, and Pittsburgh Sleep Quality Index. RESULTS: Ninety-two patients completed the pre-/post- and 40-day assessments. A significant reduction was noted in the outcomes of stress, anxiety, depression, resilience, life satisfaction, and quality of sleep immediately after the program (P < .001). At 40 days of practice, significant improvements in resilience (P = .015) and life satisfaction (P < .001) were noted. CONCLUSIONS: SKY demonstrated a positive impact on the well-being of HCPs, even during the dire stresses of the pandemic, with improvements observed in both physical and mental health parameters. A significant, immediate reduction in stress, anxiety, and depression was noted. In addition, sustained improvements in quality of sleep, satisfaction with life, and resilience were experienced among those who practiced SKY. Interventions like SKY may serve as prudent low-cost, high-impact, easy-to-implement options for lowering stress and burnout among physicians.

Effect of yoga mudras in improving the health of users: A precautionary measure practice in daily life for resisting the deadly COVID-19 disease

COVID-19 is a deadly disease that affected millions of people around the world. Vaccines are presently being made available for curtailing the disease. However, many people lost their lives because of breathing problems associated with the virus infection. Science and technology have advanced a lot in the identification of the COVID-19 virus through RT-PCR tests and CT imaging. The ashtanga yoga focuses on the moral, intellectual, and health aspect improvement of individuals. This study notes that the role of Yoga (mudras) is inevitable in improving the health conditions of both the infected and noninfected persons. The effects of mudras in health care were scientifically proven, and many reputed works are there highlighting the merits of mudras. To this end, this research work proposed a set of mudras with a breathing exercise that focuses on the improvement of immunity and minimizes respiratory issues. A consistent practice of mudras with a breathing exercise for 30min each (morning and evening) paves the way toward a healthy life. The breathing exercise proposed in this research work is Nadi Shuddi Pranayama in Virasana position and the following mudras: garuda mudra, aswini mudra, adhi mudra, prana mudra, bronchial mudra, and apana vayu mudra. The chapter comprises of the following: introduction to yoga and its scientific evidence in improving health care, related works in improving health care by mudras, and a universal practice system comprising of breathing exercise and mudras for resisting COVID-19. In theory, the outcome of this chapter focuses on the holistic improvement of health care of people particularly during crises such as the COVID-19 pandemic. © 2022 Elsevier Inc. All rights reserved.

EFFICACY OF YOGA-BASED BREATHING INTERVENTION IN COVID-19 POSITIVE, POST-COVID AND HEALTH CARE WORKERS: A RANDOMIZED CLINICAL TRIAL

SARS-CoV-2 is highly infectious and has ability to mutate into newer, more contagious, and lethal strains. Moreover, presence of comorbidities and low immunity increases the COVID-19 susceptibility and severity. Thus, COVID-19 is challenging to treat and eradicate globally. This increase stress and anxiety among the patients, worsening their condition. Even health care workers (HCWs) are distressed and anxious while managing the COVID-19. Mental stress and depression increases risk of COVID-19. Yogic breathing techniques may be beneficial in improving immunity and reducing stress and anxiety. The present study investigated the effectiveness of short and controlled Yoga-based breathing protocols in COVID-positive, COVID-recovered and HCWs. Study subjects were recruited from Postgraduate Institute of Medical Education and Research, Chandigarh, India from 13th October, 2020 to 7th January 2021. Each group was randomly divided into intervention or yoga group and non-intervention or control group. COVID-positive practiced a 5-min routine and COVID-recovered and HCW practiced 5-min and 18-min routines for 15 days. Pre-post estimation of neuropsychological parameters and heart rate variability and baseline, 7th and 15th day estimation of biochemical parameters, 6-minute walk and 1-minute sit-stand tests were conducted. Based on Ayurveda, Prakriti-type was assessed. WBC count was elevated in COVID-positive intervention (p<0.001) and control groups (p=0.003). WBC count (p=0.002) and D-dimer (p=0.002) was decreased in COVID-recovered intervention. A non-significant reduction in perceived stress and tension was noted in COVID-positive intervention. Tension was reduced and quality of life improved in HCW intervention (p>0.05). The Kapha Prakriti (48.9 %) was dominant among COVID-19 infected (positive and recovered) subjects. Distance covered in 6-min increased after intervention in COVID-positive (p=0.01) and HCW (p=0.002). The covered distance was more after intervention in all groups than control sub-group. COVID-positive intervention group shows reduced heart rate (p>0.05) and high-frequency power (p=0.01). The interventions were capable of improving exercise capacity in patients and HCW and reduced cardiovascular risk in COVID-19. The studied breathing protocol can be integrated for the management of COVID-19 and is beneficial to HCWs.

AN INNOVATIVE INTERVENTION TO IMPROVE FELLOW WELLNESS USING PRANAYAMA BREATHING TECHNIQUE

SETTING AND PARTICIPANTS: Medicine subspecialty fellows at Washington University School of Medicine in St. Louis, Missouri DESCRIPTION: Multiple studies show that the wellness of trainees has been negatively affected by the COVID-19 pandemic. Trainees often lack necessary resources and skills to intentionally work on their wellness. In addition, wellness initiatives for trainees are often limited by time, space, and financial barriers. Studies have shown that slow intentional breathing techniques have psycho-physiological benefits like increased comfort, relaxation, and alertness, as well as reduced anxiety, anger, depression, and confusion. Hence, a 3-step Pranayama (deep breathing) technique was selected as a potentially effective tool to improve the wellness of fellows at our institution. The goal of the session was to introduce fellows to beginner level Pranayama, augmenting relaxation and a sense of well-being. Fellows from various subspecialties (n = 11) participated in the pilot session, which lasted 12 minutes and included cognitive, affective and psychomotor learning activities. The large group facilitated session explored participants' attitudes, perceptions, and experience with breathing exercises. The fellows then watched a video about Pranayama, followed by a demonstration of the technique by the facilitator and a knowledge check activity. Subsequently, all fellows performed Pranayama with guidance first, then independently. Due to the success of the pilot, a second iteration of the activity was incorporated into a wellness intervention for the Division of Infectious Diseases fellows (n = 7) as part of “Wellness Week”. EVALUATION: This is a mixed-methods study. The cumulative survey response rate from both sessions was 72% (13/18). Qualitative feedback included “Great, relaxed. Definitely going to try to remember to use this!”, “more relaxed than prior”, “relaxed, like I am on a beach in Australia”, “loved the applicability and digestibility”, and “overall I thought this was great! Super practical for us to incorporate easily into our busy lives”. Using a Likert scale, 61.5% (8/13) and 38.4% (5/13) reported “definitely” and “probably” learned something new, respectively;38.4% (5/13) reported being “extremely comfortable” and 53.4% (7/13) “somewhat comfortable” performing Pranayama after this session. On a multiple-choice quiz, 60% of respondents correctly identified the hand gesture used for Pranayama. DISCUSSION / REFLECTION / LESSONS LEARNED: Breathing exercises are quick, easy to learn and perform. In particular, Pranayama is an effective, efficient way for trainees to relax when resources and time are limited. The pilot session assessed trainee attitudes and perceptions at Kirkpatrick level 1. The knowledge check during the intervention served as a Kirkpatrick level 2 assessment. Longitudinal follow up surveys are required to determine if participants continued to use Pranayama and to assess long term impact on wellness.

Effect of Bhramari Pranayama intervention on stress, anxiety, depression and sleep quality among COVID 19 patients in home isolation.

Background: COVID-19 outbreak is considered to be a major public health concern as it has a negative impact on the patient's psychological health. In addition, patients under home isolation might be more panic and in stress. In this study, we examined the effect of Bhramari Pranayama (Bhr.P) intervention on patients' psychological distress during home isolation. Methods: Ninety-two asymptomatic COVID-19 patients were recruited from the host hospital and willing patients who satisfied the inclusion criteria (n = 42) were selected for the study. The patients were given Bhr.P intervention (20 min) through online for 15 days. Participants were assessed with Depression Anxiety and Stress Scale-21 (DASS-21), Pittsburgh Sleep Quality Index (PSQI), and Quality of life (WHOQOL-BREF) at baseline and post-intervention. Results: Bhr.P practice has shown a significant (P < 0.05) reduction in DASS-21 score of depression, anxiety and stress. In addition, the patients stated significant improvement in quality of sleep (PSQI; p < 0.05) and quality of life (WHOQOL-BREF; p < 0.05) after the intervention. Conclusion: Our findings indicate that Bhr.P intervention had a positive impact on psychological health as well as quality of sleep among the COVID-19 patients during home isolation. However, it needs to be confirmed by multi-site randomized controlled trials.Clinical trial registration: CTRI/2021/04/032845.

Yogic Breathing and Guided Meditation for Post-COVID Syndrome (PCS)

Methods: This is a six-week, waitlisted, Randomized Controlled Trial where participants are referred to study team by physicians at the BIDMC COVID clinic. Consenting participants are blindly randomized into either the intervention group or the waitlisted control. Intervention group participants learn the practices in the first week while waitlisted participants receive the intervention at the third week. Assessments evaluating changes in stress (Perceived Stress Scale), mood disturbance (Profile of Mood States), quality of life (SF-12), breathing discomfort (Multidimensional Dyspnea Profile) and physical symptoms (Somatic Symptoms Scale) were collected at 3 timepoints for both groups. Results: Currently, 57 participants are enrolled, of which 17 completed the study. Of the 17 completed participants, 88% routinely practiced Isha Kriya, 82% Simha Kriya & 94% Nadi Shuddhi. Average overall study satisfaction was reported as 7.6 on a scale on 1-10. Testimonials suggest that the intervention has been useful in managing symptoms. Data collection is ongoing. Background: Of those that are diagnosed with COVID-19, 10- 20% experience Post-COVID-19 Syndrome (PCS), where they continue to have symptoms such as fatigue, dyspnea, brain fog, stress, anxiety, and depression for months post-infection. Simha Kriya, Nadi Shuddhi, and Isha Kriya are yogic breathing and guided meditation practices that help maintain physical and mental wellbeing and reduce stress, anxiety, and fatigue.We hypothesized that these simple, safe, and scalable online practices may hold significant potential to improve the quality of life of PCS patients. Conclusion: To our knowledge, this is the first RCT to study the feasibility of a multicomponent, online delivered yogic practices for PCS. Results from this study will provide a better understanding of the impact of complementary treatments on PCS symptoms. The protocol for this study (2021P000552) was approved by BIDMC's IRB. This trial (NCT05139979) was registered with US NIH on clinicaltrails.gov. There were no conflicts of interest.

Assessment of Risk Factors for COVID-19 in Medical Interns at a Dedicated COVID-19 Hospital: A Case Control Study

Background/Justification: In spite of considerable efficacy, breakthrough infection after covishield vaccine is not uncommon. This study was conducted to see the risk factors for infection among medical interns after covid vaccination and factors associated with it, so that corrective measures could be taken to further reduce the transmission. Objective: To observe the risk factors for covid-19 infection among the medical interns in a dedicated covid-19 hospital after vaccination. Secondary objective: To observe the correct and consistent use of PPE among interns doing covid duty, to observe overcrowding at the place of work/stay, to observe that whether they are using any kind of preventive measures in terms of breathing exercise or vitamin supplement. Method: Data collection was done using online questionnaire administration and telephonic discussion. A hospital-based case control study was done. Results: Rate of covid 19 infection was 11% among the medical interns. Inconsistent use of PPE, overcrowding at the place of work were associated with infection. Other than PPE and covid appropriated behaviour breathing exercise/pranayam did show some protective effect.

Yoga, immunity and COVID-19: A scoping review.

Yoga is recognized and practiced for different levels of prevention since antiquity. The current scoping review aimed to identify and document the evidence reporting the effect of yoga interventions on immunity against COVID-19 infection. Three databases--PubMed, Cochrane, and Google Scholar, were searched to identify eligible studies. Articles published in English after 2010 and assessing the impact of any form of yoga (such as yogasanas, meditations, or pranayamas) on immunological markers were included in the review. The studies without information of the intervention on immunity markers, and experience sharing reviews were excluded. The search yielded 45 eligible articles with majority of the studies being published from the USA and India. Most of the studies were randomized controlled trials, enrolling the adult population with a specific focus on diseases like HIV, cancer, and heart failure. It was observed that a variety of yoga interventions along with meditation and pranayama, in different combinations were used by the authors. However, all these studies unanimously reported improvement in immunological profile (indicated by improved biochemical markers) of an individual (irrespective of disease state and type) with yoga. Moreover, the beneficial effects of these traditional Indian interventions were also found to have a positive impact on overall physical and physiological wellbeing and quality of life. Findings from the existing literature indicate that the practice of yoga has the potential to strengthen cell-mediated immunity and hence could be used as an effective preventive measure against COVID-19 where immunity plays a critical role.

Effects of Asthanga Yoga & Dietary Program on Physical and Mental well being of Under Graduate Students

Introduction: Sedantary life style among undergraduate medical students is leading to non communicable diseases like under nutrition and over nutrition (obesity), common mental disorders including stress and anxiety. Prevalence of non communicable and mental illness in India is 9.3-23.0%. Sedentary behaviour, primarily assessed as time spent viewing mobile phones, and electronic devices increases risk for overweight and obesity in students. The sedantary time spend by students is an average of 6 and 8 hours per day. The activities with these devices have further increased due to Covid -19 online classes increasing the usage time further. Yoga increases awareness, which often leads practitioners to start making changes in every part of their lives. Methods: Formation of an IP (Inter Professional) team and developing Yoga module and nutritional diet chart module. After developing online modules, zoom online Yoga sessions were implemented. The sample size selected was 60 MBBS Students, out of which 30 were considered under test and 30 students under control. Students under case study have received Yoga module with dietary program. Students under control have received Yoga module without dietary program. Asthanga yoga zoom online classes were conducted. The session lasted for 1 hour. Four such sessions per week were conducted for one and half months (6 weeks). Each session comprised of forty minutes of Yoga Asanas (postures), ten minutes of Pranayama (breathing exercises), and ten minutes of Meditation. The sessions were video recorded. RESULTs: The interprofessional team was formed and the Yoga and nutritional modules were developed and validated. After study results were statistically analysed. Following the Yoga sessions and nutritional intervention, the parameters have shown significant P value interpreting the intervention has helped. Chi square test determined that the difference in the proportion of pre- and post sessions were statistically significant, X2 (1) = 13.25, p < .0005. Conclusion: The study intends to educate the students regarding effects of Asthanga Yoga & dietary program on physical and mental well being. It brings about improved quality of life individually and knowledge gained thus helps during medical practice. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Yoga-Based Breathing Techniques for Health Care Workers During COVID-19 Pandemic: Interests, Feasibility, and Acceptance.

Objectives: The authors explored the feasibility of virtual yoga-based breathwork and meditation among health care workers (HCW) during the COVID-19 pandemic. Methods: Consented employees of a large cancer center accessed a video of breathwork called "Simha Kriya" to be practiced for 4 weeks. Results: Of 217 participants who expressed interest within 2 weeks, 90 were recruited to the study in 1 month and 100 in 2 months. Of 69 participants who provided data between weeks 1 and 4, 77% perceived the intervention as useful. Conclusions: Yoga-based breathing practices were feasible and acceptable among HCW in the setting of a pandemic. ClinicalTrials.gov ID: NCT04482647.

Breathing exercises and pranayamas to decrease perceived exertion during breath-holding while locked-down due to COVID-19 online randomized study.

AIM: to compare anulom vilom pranayama (AVP), kapal bhati pranayama (KBP), diaphragmatic breathing exercises (DBE), and pursed-lip breathing (PLB) for breath holding time (BHT) and rating of perceived exertion (RPE). Methods- Participants were assessed for BHT and RPE, before training on any one intervention using online platforms, for one week during lockdown from COVID-19.15 participants in each group total N = 60 at- (α - 0.05), (1- ß - 0.90) & (effect size - 0.55); were analysed. Results - AVP & DBE decreased RPE (p < 0.000). KBP & PLB did not decrease RPE as compared to AVP & DBE (p. > 0.05). DBE increased BHT more than KBP & PLB interventions (p < 0.05), but not more than AVP (p > 0.05). One-way ANOVA of four interventions revealed significant variation for RPE change (p < 0.05), for AVP. Conclusions - AVP reduces RPE maximally during breath-holding, whereas DPE increases BHT more.