Exploring the Effect of Trataka (A Yogic Cleansing Technique) and Cold Eye Pack on Eye Strain During COVID-19 Pandemic: A Randomized Three-Arm Trial.

Objective: Computer vision syndrome is a major global public health concern affecting >60 million individuals globally. Yoga and naturopathy practices can reduce visual fatigue and strain. The present study attempted to explore the effect of trataka that is, a yogic cleansing technique and cold eye pack on visual strain and fatigue. Subjects: Three hundred volunteers from an IT company were recruited following inclusion and exclusion criteria. Intervention: The subjects were randomly distributed in three groups, that is, trataka, cold eye pack, and waitlist control group with an allocation ratio of 1:1:1. Outcome measure: Visual Fatigue Scale and Visual symptoms checklist (VSC) was administered at baseline and end of 2 weeks. Repeated measures analysis of variance (RM-ANOVA) with Bonferroni corrections was used to test the difference across the groups. Results: All the variables were similar at the baseline among the groups. Significant changes in the within-group analysis occurred in both the trataka and cold eye pack groups. The RM-ANOVA revealed significant differences in the VAS and VSC (p = 0.001) and the post hoc analysis suggested that there were significant differences in both the trataka and cold eye pack group when compared with the control group (p = 0.001); however, there was no differences between the trataka and cold eye pack group in both the scales (p = 1). Conclusions: The results of the present study suggest that a trataka and cold eye pack for 14 days improves self-rated visual strain and fatigue among IT professionals with computer vision syndrome. Clinical Trial registration number: CTRI/2020/11/029003.

Effectiveness of Yoga Intervention in Reducing Felt Stigma in Adults With Epilepsy: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Persons with epilepsy are afflicted with comorbidities such as stigma, anxiety, and depression which have a significant impact on their quality of life. These comorbidities remain largely unaddressed in resource-limited countries. This randomized controlled trial (RCT) aimed to investigate whether yoga and psychoeducation were effective in reducing felt stigma (primary outcome), neuropsychiatric outcomes, and seizure frequency, as compared with sham yoga and psychoeducation in persons with epilepsy. METHODS: This was an assessor-blinded, sham yoga-controlled RCT. Patients clinically diagnosed with epilepsy, aged 18-60 years, and scoring higher than the cutoff score for felt stigma as measured by the Kilifi Stigma Scale (KSS) in our population were randomly assigned to receive either yoga therapy plus psychoeducation (intervention) or sham yoga therapy plus psychoeducation (comparator) for a duration of 3 months. The primary outcome was a significant decrease in felt stigma as compared with the comparator arm as measured by the KSS. Primary and secondary outcomes (seizure frequency, quality of life, anxiety, depression, mindfulness, trait rumination, cognitive impairment, emotion regulation) were assessed at baseline, 3 months, and 6 months. Parametric/nonparametric analysis of covariance and the χ2 test were used to compare the 2 arms. RESULTS: A total of 160 patients were enrolled in the trial. At the end of the follow-up period (6 months), the intervention arm reported significant reduction in felt stigma as compared with the control arm (Cohen's d = 0.23, 95% CI -0.08 to 0.55, p = 0.006). Significantly higher odds of >50% seizure reduction (odds ratio [OR] 4.11, 95% CI 1.34-14.69, p = 0.01) and complete seizure remission (OR 7.4, 95% CI 1.75-55.89, p = 0.005) were also observed in the intervention group. The intervention group showed significant improvement in symptoms of anxiety, cognitive impairment, mindfulness, and quality of life relative to the control group at the end of follow-up period (p < 0.05). DISCUSSION: Yoga can alleviate the burden of epilepsy and improve the overall quality of life in epilepsy by reducing perceived stigma. TRIAL REGISTRATION INFORMATION: Clinical Trials Registry of India (CTRI/2017/04/008385). CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that yoga reduces felt stigma in adult patients with epilepsy.

Impact of workplace yoga on pain measures, mental health, sleep quality, and quality of life in female teachers with chronic musculoskeletal pain: A randomized controlled study.

BACKGROUND: Chronic pain conditions such as low back pain, knee pain and cervical pain are highly prevalent among female teachers. Chronic pain significantly affects the mental health, sleep and quality of life among teachers. OBJECTIVE: This study is intended to investigate the impact of a workplace yoga intervention on musculoskeletal pain, anxiety, depression, sleep, and quality of life (QoL) among female teachers who had chronic musculoskeletal pain. METHOD: Fifty female teachers aged between 25-55 years with chronic musculoskeletal pain were randomized to either the yoga group (n = 25) or the control group (n = 25). The yoga group received a 60-minute structured Integrated Yoga intervention (IY) four days a week for six consecutive weeks at school. The control group received no intervention. OUTCOME MEASURES: Pain intensity, anxiety, depression, stress, fatigue, self-compassion, sleep quality, and quality of life were assessed at the baseline and six weeks. RESULTS: A significant (p < 0.05) reduction in pain intensity and pain disability in the yoga group was observed after 6-week compared to baseline. Anxiety, depression, stress, sleep scores and fatigues also improved in the yoga group after six weeks. The control group showed no change. Post score comparison showed a significant difference between the groups for all the measures. CONCLUSION: Workplace yoga intervention is found to be effective in improving pain, pain disability, mental health, sleep quality among female teachers with chronic musculoskeletal pain. This study strongly recommends yoga for the prevention of work-related health issues and for the promotion of wellbeing among teachers.

Immediate effect of a meditation technique on blood glucose, state anxiety and relaxation in patients with type 2 diabetes: a pilot randomized crossover study.

OBJECTIVES: Type 2 diabetes mellitus (T2DM) is a major burden on global health and economy. Various Yogic techniques are found to be beneficial in the management of T2DM. Mind Sound Resonance Technique (MSRT) is one of the yoga-based meditation techniques observed to be effective in clinical settings. METHODS: Thirty-two patients with T2DM were randomized to either MSRT or supine rest (SR) sessions on two separate days separated by a washout period of one day. Fasting blood glucose levels were measured before and immediately after the sessions. State anxiety and subjective feeling of relaxation were assessed using Spielberg's state anxiety inventory (STAI) and Visual Analogue Scale (VAS) respectively. RESULTS: There were significant differences between MSRT and SR groups in fasting blood glucose (p=0.019), STAI scores (p<0.001) and subjective relaxation (p<0.001). Within group analyses revealed significant reductions (p<0.001) in fasting blood glucose and STAI scores, along with an increase in subjective relaxation following the practice of MSRT, whereas, non-significant changes were found following the SR session. CONCLUSIONS: A single session of MSRT was found to reduce blood glucose levels and state anxiety along with enhanced relaxation when compared to SR.

Tele-yoga in the management of ankylosing spondylitis amidst COVID pandemic: A prospective randomized controlled trial.

PURPOSE: Ankylosing spondylitis (AS) signficantly affect day to day activities contributing to signficant disability. Patients with AS often report to have psychological problems and poor quality of life (QoL). This study investigates the effect of a three-month tele-yogic intervention on disease activity, functional index, inflammatory markers, quality of life and mental health measures in patients with AS. METHODS: One hundred and twenty AS patients were assigned to either the yoga intervention group (YG) or the control group (CG). The YG (n = 57) received a 60-min structured yoga module online for 3 months in addition to standard medical care. The CG participants (n = 52) received only standard care during the same period. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis-Quality of Life (ASQOL) and psychological and inflammatory biomarkers were assessed at baseline and after three months. RESULTS: YG showed significant improvement in BASDAI (p = 0.001), anxiety (p = 0.0004), and depression (p = 0.001) at three months compared to baseline. The CG showed no significant change in similar outcome measures. At three months, the intervention resulted in a significant improvement in BASDI (-0.79; 95% CI (-1.3, to -0.29); p = 0.0021), BASFI (-0.86, 95% CI (-1.59, to -0.14); p = 0.0193), anxiety (-0.42, 95% CI (-0.84 to -0.01), p = 0.0468), and AS-QoL (-3.37; 95% CI (-5.21 to 1.53); p = 0.0004) compared to the CG. CONCLUSIONS: The present study suggests that yoga helps improve pain, functional index, and mental health in patients with AS. Tele-yoga intervention is feasible and effective in treating AS.

Knowledge, attitude and practice towards Ayurveda among patients attending cardiology and neurology clinics at a tertiary care institute in India.

Background Ayurveda, the Indian system of medicine, has been practised in India since ages. We evaluated the overall awareness regarding Ayurveda among patients attending two specialty clinics at a tertiary care institute. Methods We did a cross-sectional study on patients attending the cardiology and neurology clinics at a tertiary care hospital in India. We conducted this paper-based survey using a standardized, validated questionnaire. Statistical analysis was performed using STATA version 14.2. Results Three hundred and ninety-seven patients agreed to participate in the study. Their mean (SD) age was 45.65 (15.02) years. Among them 68.5% were men and 56.9% were from urban areas. Participants perceived that Ayurveda comprised herbal drugs (77.6%), metallic/herbo-mineral preparations (44.3%), Panchakarma therapy (22.2%) and personalized medicine (37.8%). Principal sources of information were TV promotional programmes (34.7%) and newspaper advertisements (13.9%). Nearly two-thirds (63%) of participants opined that Ayurveda is effective in chronic disorders. Although only 9.1% of participants reported the use of Ayurvedic medicines, 89.2% believed it would be beneficial if the All India Institute of Medical Sciences (AIIMS), New Delhi had Ayurveda services. Three-fourths (75.8%) of respondents were interested to participate in research studies integrating Ayurveda with modern medicine. Conclusion Imprecise knowledge and awareness towards Ayurveda appears to prevail in addition to the low practice among the patients surveyed. We found imprecise knowledge of Ayurvedic therapies and its low usage among patients attending specialized OPDs in a tertiary care hospital. The major source of information reported was promotional advertisements in the print and electronic media. Our survey shows a need for awareness programmes for general public at various levels.

The Deadly Duo of Hypertension and Diabetes in India: Further Affirmation from a New Epidemiological Study.

INTRODUCTION: Hypertension is highly prevalent in patients with type II diabetes mellitus. India has some of the highest rates of diabetes and hypertension worldwide, but there is a lack of local data on the coexistence of these two risk factors. This study determined the prevalence of hypertension in patients with, or at high risk of, type II diabetes mellitus from across India. METHODS: Data came from a nationwide trial evaluating the effects of yoga-based lifestyle modification for the prevention/management of type II diabetes. Participants were recruited based on randomized house-to-house screening in urban and rural areas from 65 districts of 29 states/union territories. Eligible individuals were aged 20-80 years and had diabetes or were at high risk of diabetes (IDRS ≥ 60). Anthropometric and demographic data were obtained, and resting blood pressure and blood glucose levels were recorded. RESULTS: This analysis included data from 14,135 individuals. Of these, 25% had self-reported diabetes, 19% were diagnosed with diabetes during the trial, and 26.8% were at high risk for type II diabetes. In these three patient groups, hypertension prevalence rates were 58%, 41.0%, and 35.8%, respectively. The prevalence of hypertension was highest in the North East region and lowest in the North West. CONCLUSION: The high prevalence of hypertension in patients with, or at risk of diabetes, highlights the urgent need for policies to manage this population, who are at high risk of cardiovascular disease and death.

Prevalence of psychological outcomes and its associated factors in healthcare personnel working during COVID-19 outbreak in India.

Background: Care of COVID-19 patients has been shown to affect the mental health of healthcare personnel (HCP), however, there is little data reflecting psychological health of HCP in India. Aims: The present study was undertaken to assess the prevalence of psychological outcomes and its association with various sociodemographic and occupational factors among the HCP in India. Methodology: A cross-sectional, online survey, using snowball sampling method was conducted between June 1, 2020, and June 22, 2020. The HCP working in COVID-19 designated hospitals across India were invited to participate. Patient Health Questionnaire-4 and 19-item stress-related questionnaire were used to evaluate symptoms of overall anxiety, depression, COVID-19 infection specific anxiety, exhaustion, and workload. Results: In this cross-sectional study with 2334 HCP from 27 states and 7 union territories of India; 17.9% of participants had depression, 18.7% had overall anxiety, 26.5% had exhaustion, 30.3% reported heavy workload, and 25.4% had COVID-19 infection-specific anxiety, respectively. The HCP working in states with higher caseload was a common risk factor for overall anxiety (odds ratio [OR], 1.7; P < 0.001), depression (OR, 1.6; P < 0.001), COVID-19 infection-specific anxiety (OR, 2.5; P < 0.001), exhaustion (OR, 3.1; P < 0.001), and heavy workload (OR, 2.6; P < 0.001). Nurses were more at risk for depression (OR, 2.2; P < 0.001), anxiety specific to COVID-19 infection (OR, 1.3; P = 0.034), and heavy workload (OR, 2.9; P < 0.001); while doctors were more at risk for overall anxiety (OR, 2.0; P = 0.001) and exhaustion (OR, 3.1; P < 0.001). Conclusions: Frontline workers, specifically nurses and doctors, and those working in states with high COVID-19 caseload are more at risk for adverse psychological outcomes. The relatively less prevalence compared with other countries, is perhaps a reflection of measures undertaken, including early lockdown, ensuring better all-round preparedness and social norms.

Effect of Yoga on Clinical Outcomes and Quality of Life in Patients With Vasovagal Syncope (LIVE-Yoga).

OBJECTIVES: This study aims to determine the impact of yoga as an adjunct to standard therapy versus standard therapy alone on the symptomatic burden in patients with recurrent vasovagal syncope (VVS). BACKGROUND: There is a significant reduction in the quality of life (QoL) of patients with recurrent VVS. Existing management therapies have been largely ineffective. Recent trials have demonstrated the efficacy of yoga in diseases with autonomic imbalance, suggesting its possible utility in VVS. METHODS: Patients with recurrent VVS were randomized to receive either a specialized yoga training program in addition to current guideline-based therapy (intervention arm, group 1) or current guideline-based therapy alone (control arm, group 2). The primary outcome was a composite of the number of episodes of syncope and presyncope at 12 months. Secondary outcomes included QoL assessment by World Health Organization Quality of Life Brief Field questionnaire (WHOQoL-BREF) scores and Syncope Functional Status Questionnaire scores at 12 months, head up tilt test, and heart rate variability at 6 weeks. RESULTS: A total of 55 patients underwent randomization. The mean number of syncopal or presyncopal events at 12 months was 0.7 ± 0.7 in the intervention arm compared to 2.52 ± 1.93 in the control arm (P < 0.01). In the intervention arm, 13 (43.3%) patients remained free of events versus 4 (16.0%) patients in the control arm (P = 0.02). QoL at 12 months showed significant improvement of all Syncope Functional Status Questionnaire scores and 2 domains of WHOQoL-BREF scores (P < 0.05). CONCLUSIONS: Yoga as adjunctive therapy is superior to standard therapy alone in reducing the symptomatic burden and improving QoL in patients with recurrent VVS.

Comparing cognition, coping skills and vedic personality of individuals practicing yoga, physical exercise or sedentary lifestyle: a cross-sectional fMRI study.

BACKGROUND: Nature and intensity of physical activity may influence cognition, coping mechanisms and overall personality of an individual. The objective of this cross-sectional study was to compare cognition, coping styles and vedic personality among individuals practicing different lifestyle. METHODS: Thirty-nine healthy young adults of both gender (27.63±4.04 years) were recruited and categorized into three groups; i.e. yoga, physical activity or sedentary lifestyle groups. Participants were assessed on cognition, coping styles and Vedic personality inventory (VPI). Verbal-n-back and Stroop tasks were performed using 3 Tesla MRI scanner. Task Based Connectivity (TBC) analysis was done using CONN toolbox in SPM. RESULTS: There were no significant differences in the cognitive domains across the groups. The planning (p=0.03) and acceptance domain (p=0.03) of the Brief COPE scale showed difference across the groups. Post-hoc analysis revealed that planning and acceptance scores were distinctly higher in the physical activity group, however, there was no difference between physical activity group and yoga practitioners. Similarly, in the VPI, Sattva (p=0.003), Rajas (p=0.05) and Tamas (p=0.01) were different across the groups, and the post hoc analysis showed superiority in Sattva scores in Yoga group, meanwhile, both Rajas and Tamas were higher in the physical activity group. Yoga practitioners preferentially recruited left Superior Frontal Gyrus in relation to the physically active group and precuneus in relation to the sedentary lifestyle group. CONCLUSION: The study revealed that yoga practitioners had a distinct higher sattva guna and preferentially recruited brain areas associated with self-regulation and inhibitory control.

A study protocol for a randomised controlled trial on the efficacy of yoga as an adjuvant therapy for patients with Ankylosing spondylitis amidst COVID-19 pandemic.

Background: Amidst the adversities of the COVID-19 pandemic, the health care system has seen a new paradigm shift towards e-health or telehealth services. In the advent of catering to the geometrically increasing health care needs of the patients suffering from various chronic health conditions when in social isolation, the need for such shifts is paramount. Patients with Ankylosing spondylitis using immunosuppressants with variable degrees of disabilities are at higher risk from this isolated status. This study aims to assess the efficacy of e-Yoga as a treatment option for these patients. Methods: The proposed study is a single-center, parallel-group prospective randomized, open-blinded end-point trial. Patients aged between 30 and 50 years will be recruited from the members of Antardhwani: A society of ankylosing spondylitis based in Ahmedabad, Gujarat. Yoga experts will administer a scientifically developed and validated Yoga module via e-Yoga modalities. A total of 135 patients will be recruited and randomly allocated to Yoga and control groups. Data will be recorded at baseline and three months on disease activity, degree of functional limitations in patients, quality of life, inflammatory biomarkers, depression, and anxiety using Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), AS Quality of Life index (ASQOL), C reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Physical health questionnaire-4 (PHQ-4), respectively. Discussion: The study will report the efficacy of e-Yoga in catering to the physical and mental insufficiencies of inpatients with Ankylosing spondylitis amidst COVID-19 pandemic. The study is prospectively registered in the Clinical Trial Registry of India (CTRI/2020/08/027215).

Designing, validation, and feasibility of a yoga module for patients with ankylosing spondylitis.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes significant disability and reduced quality of life. Scientific studies on yoga have revealed its various health benefits in chronic conditions, including autoimmune diseases. However, whether yoga is feasible for AS patients or not is not studied. Further, no validated yoga module is available for AS patients. OBJECTIVE(S): This study intended to develop a yoga module for AS patients and investigated its feasibility of use. MATERIALS AND METHODS: The study was completed in three stages. In Stage I, six yoga experts prepared a list of 64 yoga practices based on the classical and contemporary yogic literature review. Of these practices, 41 were included in the designed yoga module. In Stage II, 41 experts with a minimum of five years of experience in yoga therapy were invited for yoga module validation. The usefulness of the practices was rated by experts on a 3-point scale (1: not at all useful, 2: moderately useful, and 3: very much useful). The Lawshe content validity ratio (CVR) method was used for the content validity of the yoga module. Practices with a CVR score of > 0.3 were retained in the final yoga module. In Stage III, a certified yoga instructor administered the validated yoga module to 19 AS patients (average age: 35.5 ± 10.7 years) thrice weekly for a month. Feasibility was assessed on the basis of the attrition rate, retention rate, attendance of the participants, and the subjective response on practical sessions using a structured checklist. RESULTS: Of the 41 practices in the module, 31 had a CVR score of > 0.3 and were included in the final yoga module. Of the 25 participants, 19 (76%) completed the study while six dropped out (24%). Nineteen patients reported greater improvement in pain and flexibility. They found yoga relaxing and easy to practice. Most participants (65%) were able to practice a minimum of 30 min/day. CONCLUSION: The present study offers a validated yoga module consisting of 31 practices for AS patients. The results of the pilot suggested that the module is feasible, acceptable, and easy to practice for AS patients. We recommend that AS patients should practice this yoga module for a minimum of 30 min every day under the supervision of a yoga expert.

Potential Role of Yoga in the Management of Ankylosing Spondylitis: A Retrospective Study.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory spondyloarthropathy with unclear pathogenesis. The inflammatory pain in AS leads to restricted spinal mobility and significant disability. Yoga is a nonpharmacological intervention that has positive effects on various musculoskeletal-related problems. However, its role in AS is unknown. OBJECTIVE: The present retrospective study assessed the efficacy of a two-week residential yoga intervention on spinal flexibility among AS patients. METHODS: The records for 24 male AS patients within the age range 30 to 50 years (average age 38.3 ± 10.5 years) who underwent a two-week residential yoga retreat between 2015 and 2020 were obtained from a yoga center located in South India. Yoga intervention consisted of yoga postures, breathing practices, meditation, a healthy diet, and devotional sessions. Pre and Post data of the sit-and-reach test, blood pressure, heart rate, and symptom score were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: Compared to the baseline, the post scores of the sit-and-reach test, systolic blood pressure and heart rate were found to be significantly (P < .05) lower. The symptom score and analgesic medication score also showed significant improvement after two-weeks compared to the baseline. CONCLUSION: This retrospective study indicates the positive impact of on and analgesic use among AS patients. However, additional studies using robust research designs are warranted.

Exploring knowledge, attitude and practice regarding yoga among patients attending cardiology and neurology clinics in a tertiary care hospital in northern India.

Background The use of complementary and alternative medicine, particularly yoga is increasing in non-communicable diseases (NCDs). We assessed the overall awareness regarding yoga among patients and their opinion about it as an adjunct therapy for NCDs. Methods We included 384 patients attending the cardiology and neurology clinics at a tertiary care centre in northern India. A questionnaire was developed to assess the knowledge, attitude and practice of yoga as a therapy. Results Ninety per cent of patients were aware of yoga, mainly through print and electronic media. Of the surveyed patients, 22% practised yoga. Lack of time and knowledge were cited as the main reasons for non-practice among the non-practising patients (88%), of which 82% believed that yoga could be practised along with modern medicine. In addition, 61% were ready to accept treatment if offered at the surveyed tertiary care centre. Conclusions Adequate knowledge, awareness and attitude towards yoga appears to be present in contrast to the low practice among the patient population surveyed. If implemented in an integrated fashion, the patients were willing to accept yoga as an adjunct therapy for their cardiac and neurological disorders-an encouraging sign given the burden of NCDs in India.

Effect of Mind Sound Resonance Technique (MSRT - A yoga-based relaxation technique) on psychological variables and cognition in school children: A randomized controlled trial.

OBJECTIVE: School children undergo stress, which could impact their psychological functions and cognitive abilities. Yoga practices have been found useful in enhancing psychological functions and performance. The current study was planned to evaluate a yoga-based relaxation technique's efficacy as an extracurricular activity on psychological state and cognitive function. DESIGN AND SETTING: This study was a parallel-group randomized controlled trial conducted at a government school in south India. PARTICIPANTS: Sixty students with age ranging between 14-16 years (mean age ± SD; 15.3 ± 0.71 years) satisfying the inclusion and exclusion criteria were randomized to experimental and control groups with an allocation ratio of 1:1. INTERVENTION: Experimental group received Mind Sound Resonance Technique (MSRT), whereas the control group performed supine rest (SR) for two-weeks. OUTCOME MEASURES: Participants were assessed with State trait anxiety inventory - short form, Mind Wandering Questionnaire, State Mindfulness Attention Awareness Scale, and Trail making task at baseline and post-intervention. RESULTS: Experimental group showed a reduction in state anxiety and mind wandering with improvement in state mindfulness and performance in the Trail-making task compared to the control group. CONCLUSION: Results of the current trial indicate the beneficial role of MSRT in enhancing psychological and cognitive functions in children. Further, large-scale trials are warranted to ascertain the usefulness of the technique.

A randomized trial of the immediate effect of Bee-Humming Breathing exercise on blood pressure and heart rate variability in patients with essential hypertension.

OBJECTIVES: Bee-Humming Breathing (BHB) exercise is a simple yogic practice recommended for its favorable effect on cardiac physiology, including blood pressure (BP) and autonomic nervous system. However, strong evidence supporting its effectiveness is lacking. The present study was designed to evaluate the immediate effect of BHB exercise on blood pressure parameters and heart rate variability (HRV) in patients with essential hypertension. STUDY METHODS: We conducted a randomized control trial including 70 patients with essential hypertension, randomly allocated to perform either BHB exercise (n=35) or placebo slow breathing exercise (n = 35) for 5-minutes duration. Blood pressure and HRV were measured before, during, and after the practice. RESULTS: There was no significant decrease in systolic [effect size (95% CI): 2.22 (-13.20, 17.64); p 0.77], diastolic [4.54 (-17.40, 26.48); p 0.68] and mean blood pressures [1.37 (-8.78, 11.52); p 0.78] after BHB exercise in comparison to the control group in our study. The HRV analysis showed a significant increase in the HF power [6.8 (1.47, 12.12); p 0.01], and decrease in the LF power [-26.47 (-34.25, -18.68); p < 0.01] during the recovery phase of the 5-minute BHB exercise in comparison to the control group. CONCLUSIONS: This is the first randomized controlled trial to show that though a single short session of BHB exercise in hypertensive patients does not significantly reduce BP, it significantly augments the parasympathetic tone as indicated by a significant improvement in HRV parameters. CLINICAL TRIAL REGISTRATION NUMBER: CTRI/2018/08/015215.

Trends of Hypertension and Neurological Diseases in India: A Nationwide Survey Reporting the Distribution Across Geographical Areas.

BACKGROUND: Hypertension has remained an imperative risk factor for cardiovascular and cerebrovascular diseases, increasing the national burden of premature deaths over the decades. PURPOSE: There is limited data on the prevalence of hypertension and its distribution across all geographic regions in India. This nationwide survey was conducted in 2017 to assess the prevalence of hypertension and prehypertension among the Indian adults. METHODS: A multilevel stratified cluster sampling technique, with a random selection among the urban and rural populations, was adopted to achieve a sample of 70,031 adults from 24 states and 4 union territories. Blood pressure was measured twice using automated oscillometric machines with a minimum of 3-min gap, and the average was recorded. This was later categorized into prehypertension (elevated blood pressure) and hypertension subgroups as defined by the new 2017 American Heart Association guidelines. RESULTS: The prevalence of prehypertension and hypertension in our study population across all ages was found to be 18.2% and 24%, respectively. Prehypertension was common at a younger age, whereas the prevalence of hypertension was higher in the older age groups. The urban population (24.4%) and males (24.7%) were positively associated with prehypertension and hypertension. The western zone had the highest prevalence of hypertension, whereas the eastern population had the lowest. CONCLUSION: Our study revealed an alarmingly high prevalence of hypertension, accounting up to one hypertensive in every four adults in India. There is a need for more robust national strategies for identifying and treating hypertension to reduce the national and the global burden of hypertension by 25% before 2025.