|Year : 2022 | Volume
| Issue : 1 | Page : 8-12
Immediate effect of simple Bhramari pranayama on blood pressure and pulse rate of hypertensive and normotensive individuals: A single-arm clinical trial
Pratibha Hemant Rajbhoj1, Satish D Pathak2, Ranjeet Singh Bhogal2, Akshata Sudesh Badave2, Santosh Pandey1
1 Department of Scientific Research, Collaborative Research Centre, Kaivalyadhama SMYM Samiti, Kaivalyadhama Yoga Institute, Lonavla, Maharashtra, India
2 Department of Scientific Research, Kaivalyadhama SMYM Samiti, Kaivalyadhama Yoga Institute, Lonavla, Maharashtra, India
|Date of Submission||01-Nov-2021|
|Date of Decision||23-Feb-2022|
|Date of Acceptance||23-Feb-2022|
|Date of Web Publication||22-Aug-2022|
Mrs. Pratibha Hemant Rajbhoj
Department of Scientific Research, Collaborative Research Centre, Kaivalyadhama SMYM Samiti, Kaivalyadhama Yoga Institute, Lonavla, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Hypertension, diabetes, and heart diseases are very common and silent noncommunicable diseases. If ignored, these will be life-threatening. As per recent yoga researches on hypertension, some of the yoga practices such as pranayama, meditation, and Kriya yoga have found to be very effective in managing hypertension and thereby controlling its adverse effects. Hence, the present study is undertaken to understand the effect of simple Bhramari pranayama on both hypertensive and normotensive individuals so as to help standardize this Pranayama and advise it as a preventive measure in the management of hypertension. Methods: The present study is a single-arm clinical trial. Ninety-seven participants, both male and females of age ranging from 30 to 60 years, were approached as the study participants. Of the 78 complying participants, 44 participants were hypertensive and 34 normotensives. A yoga expert taught Bhramari Pranayama one to one to all the participants. They were called on the following day for recording their blood pressure (BP) and pulse rate (PR) before and immediately after the thirty rounds of the practice. Results: Simple Bhramari Pranayama significantly lowered the systolic blood pressure (SBP) (P < 0.001), diastolic blood pressure (DBP) (P < 0.001*), and PR (P < 0.001*) of the hypertensive individuals (P < 0.001*). In the normotensives group also, a significant decrease in SBP (P < 0.001*), DBP (P < 0.05) and PR (P < 0.001*) was evident. However, the changes evident in normotensives were well within the normal range of BP and PR. Conclusion: The present study concludes that simple Bhramari Pranayama has significantly reduced the BP and PR in the hypertensive as well as in the normotensive participants immediately after its practice.
Keywords: Bhramari pranayama, hypertension, hypertensive, noncommunicable diseases, normotensive, yoga
|How to cite this article:|
Rajbhoj PH, Pathak SD, Bhogal RS, Badave AS, Pandey S. Immediate effect of simple Bhramari pranayama on blood pressure and pulse rate of hypertensive and normotensive individuals: A single-arm clinical trial. J Integr Health Sci 2022;10:8-12
|How to cite this URL:|
Rajbhoj PH, Pathak SD, Bhogal RS, Badave AS, Pandey S. Immediate effect of simple Bhramari pranayama on blood pressure and pulse rate of hypertensive and normotensive individuals: A single-arm clinical trial. J Integr Health Sci [serial online] 2022 [cited 2023 Jan 30];10:8-12. Available from: https://www.jihs.in/text.asp?2022/10/1/8/354231
| Introduction|| |
As per the WHO reports globally, 1.13 billion people are suffering from hypertension. Hypertension is one of the major causes of premature deaths worldwide. It significantly increases the risk of other noncommunicable diseases such as diseases of the heart, brain, and kidney. As quoted by Sliwa et al., “Hypertension as a highly modifiable antecedent for cardiovascular disease (CVD) is responsible for more deaths worldwide than any other, including tobacco use, obesity, and lipid disorders.”
It is observed that diet, sedentary lifestyle, and stress are the key factors in the pathogenesis of hypertension. Recent studies have shown that lifestyle modification plays a vital role in management and prevention of hypertension and thereby the associated diseases.,, Lifestyle modification involves practices such as moderate physical activity, meditation, pranayama, mindfulness-based breath awareness, and diet regimen like DASH diet. As per Indian traditional sciences, yoga recommends and leads to healthy lifestyle and tries to bring about the mind–body balance via its simple practices, described in yogic texts, and hence, it can be a beneficial practice for the management and prevention of hypertension.
In the present study, investigators aimed to study the immediate effect of one such single practice – a simple Bhramari Pranayama on blood pressure (BP). This study was conducted on both hypertensive and normotensive individuals so as to see its immediate effect on the patients of hypertension, as well as, on normal individuals without hypertension. Recent researches on Bhramari Pranayama have proved it as a very effective tool in calming down one's heightened nervous activities, giving a much-needed relaxation to the entire mind–body complex that endorses better health. It was also observed that the immediate effect of slow-paced Bhramari Pranayama gives rise to parasympathetic dominance on the cardiovascular system.
Yoga plays an important role in achieving optimum health and helps to understand the association of yoga with many psychophysiological processes and thereby improve the psychophysical as well as biochemical parameters. Since there are hypertensive and normotensive participants in this study, it would be interesting to see the effect of the same practice on both the groups. The study hypothesizes that in hypertensive participants, the immediate effect of simple Bhramari Pranayama would help to lower BP immediately, whereas in normotensive participants, it would help to maintain it within the normal range, without disturbing the normal physiological processes of its practitioners.
| Materials and Method|| |
The present study was approved by the Independent Ethics committee (IEC) of the Kaivalyadhama Yoga Institute, Lonavla, Pune, with Reg. No.-Kdham/SRD/IEC-12/2016/05.
A single-arm before-and-after clinical trial was employed. Initially, 132 participants were screened from different parts of Lonavla. Of these, 97 participants, aged between 30 and 60 years, conforming to the inclusion criteria, were enrolled for the study. The sampling method followed here was convenient and purposive sampling. As 19 participants dropped out due to lack of time, lack of interest, and health issues, only 78 participants actually complied with the protocol requirements. Among these 78 participants, 44 were hypertensive and 34 normotensives [Figure 1].
Written informed consent was obtained from all the study participants. All the participants were examined by the medical officer of the department. Only normotensive and hypertensive participants without any other medical complications and without any background in yoga were selected in the study. Those having diabetes, pulmonary diseases, and CVDs and those who were smokers, alcoholic, and drug addicts were excluded from the study.
Blood pressure and pulse rate assessment
BP was measured using a noninvasive semi-automatic BP monitor (Model No.-BPDG 141, Diamond), whereas pulse rate (PR) was measured using Cardio Vigil apparatus (Model No.-MP3-10, Maestros). Participants were called at different time slots and they were asked to wait in a waiting area for 15 min. After that, they were called to the yoga hall and asked to relax for 10 min in a supine position, then their BP and PR were recorded. At the end of intervention, they were again asked to relax in a supine position and after 5 min of relaxation, their BP and PR were recorded. All the assessments were performed and recorded by a medical expert.
Selected demographic parameters such as age, height, body weight, and medical history of the participants were recorded at the time of screening of the participants for the project. However, participants were screened and grouped on the basis of their BP by the expert medical doctor.
Participants were trained individually to perform simple Bhramari Pranayama. Experienced yoga teacher facilitated the training session on a one-to-one basis to all the study participants a day before the experiment. In this project, investigators have taken the simple version of Bhramari Pranayama which is easier for a common man to perform.
The technique of simple Bhramari Pranayama is as mentioned below:
- Participants were instructed to sit in any comfortable meditative (Swastikasana/Padmasana/Sukhasana) pose
- Keeping hands in Dhyana Mudra
- While practising the simple Bhramari Pranayama, they were instructed to gently close the eyes to facilitate inner awareness
- Puraka: They were asked to inhale slowly with both the nostrils
- Rechaka: While exhaling they were asked to press the tongue against the palate gently and make a low pitched humming sound like that of a female bee
- During Rechaka, the flow of air striking the edges of the soft palate and nasal passage was slower and the sound produced was gentler. It was lower in pitch like that of a female bee.
The intervention session constituted three rounds of 10 repetitions of simple Bhramari Pranayama. The total intervention time required to do practice was 15–20 min. After performing simple Bhramari Pranayama, participants were asked to relax in a supine position for 5 min.
Statistical analysis was done using SPSS (Statistical Package for the Social Sciences, IBM, Chicago, IL, U.S), version 18.0 statistical software. Data were analyzed using paired sample t-test and descriptive statistical method. The pre–post data are represented in the form of mean values ± standard deviation for the demographic parameters in [Table 1] and study variables in [Table 2].
|Table 2: Pre-post-test results on blood pressure and pulse rate with immediate effect of Bhramari Pranayama in hypertensive and normotensive population|
Click here to view
| Results|| |
The demographic data of the study participants are presented in [Table 1]. The results of the within-group comparison on study parameters are described in [Table 2].
In hypertensive population immediately after doing Bhramari Pranayama for 15–20 min, systolic blood pressure (SBP) significantly (P < 0.001***) decreased from 144.23 ± 5.96 to 133.07 ± 6.52 mmHg. There was a statistically significant (P < 0.001***) fall in diastolic blood pressure (DBP), it reduced from 94.64 ± 5.45 to 86.36 ± 5.37 mmHg. In addition, the PR fell from 91.57 ± 9.07 to 80.84 ± 8.14 beats/min (P < 0.001***) [Table 2].
In normotensive healthy study subjects also, there was a significant decrease in the SBP from 125.82 ± 11.88 to 121.41 ± 7.74 mmHg (P < 0.001***). There was also a significant decrease in DBP from 82.12 ± 10.59 to 79.56 ± 6.12 mmHg (P = 0.054*). In addition, PR showed a significant reduction from 81.65 ± 10.35 to 73.41 ± 5.49 beats/min (P < 0.001***) [Table 2].
| Discussion|| |
The present study has been conducted to find out the immediate effect of simple Bhramari Pranayama on hypertensive patients, as well as, on people having normal levels of BP. Results of the current study revealed that the practice of simple Bhramari Pranayama was found to reduce the SBP, DBP, and PR significantly in hypertensive, as well as, in normotensive individuals. The results of the present study on SBP, DBP, and PR of hypertensive individuals are consistent with previous studies., Furthermore, the results of the normotensive population pertaining to SBP and DBP are in line with the previous studies.,,
Reduced PR is an indication of reduced heart rate (HR) which ultimately indicated increased activity of parasympathetic nervous system. Hence, it can be concluded that Bhramari Pranayama results in a parasympathetic shift in autonomic nervous system that leads to regularizing BP in a normal range.
Previous studies were done either on hypertensive or normotensive population, whereas the present study includes both hypertensives and normotensives. Both the groups were given the same intervention, at the same time, in similar conditions. As well, all the readings were taken by the same medical officer in a supine position. Even though the mean BP of these two groups at the baseline was different, there was a significant reduction pertaining to the SBP, DBP, and PR in all the participants. However, in the normotensive group, reduction in SBP, DBP, and PR was found to be within the normal range. This indicates that Bhramari Pranayama can be performed by hypertensive participants to manage hypertension, as well as, by the normotensive participants to prevent the possible risk of hypertension and also to avail all other benefits of Bhramari Pranayama.
A study done by Pramanik et al. on normotensive healthy individuals showed no significant reduction in the SBP of all the study participants, as their SBP was already toward the lower end of the normal range of the SBP, whereas DBP showed significant reduction. In another study done by Kuppusamy et al., there was a significant reduction in both SBP and DBP although in the normal range. The study done by Taneja on hypertensive population showed a significant reduction in SBP, DBP, and PR, whereas another study done by Sathe et al. showed that there was a significant reduction in the SBP, but there was only a trend of reduction seen in the DBP, as both SBP and DBP were in the normal range at the baseline.
The results of the present study are in line with the previous studies done on Bhramari Pranayama in hypertensive, and normotensive, population. As Bhramari Pranayama is known to achieve normal status of BP, in our study, we did not find any further reduction from the normal level of BP in normotensive participants, as well. In the previous studies, the mode of Bhramari Pranayama was not as per the process described in traditional texts of yoga. The present study has ensured to administer the traditional mode of Bhramari Pranayama as per Swami Kuvalayananda and Swami Digambar. However, as the study participants include both normotensives and hypertensive participants, and they were beginners in pranayama practice, the Bhramari Pranayama was administered without kumbhaka (breath hold).
It is well studied and documented that the vibrations, produced during humming in Bhramari Pranayama, enhance the natural production of nitric oxide (NO), in the paranasal sinuses. Therefore, the regular practice of Bhramari Pranayama might be very helpful in the management and prevention of hypertension.,, NO produced in the paranasal sinuses which get mixed with the inhaled air, while reaching out to the alveoli, thus causing vasodilatation helping to reduce the pulmonary hypertension. Endothelium-derived NO is found to modulate and regulate hypertension and it also plays a key role in many other biological processes. It also modulates a variety of neurotransmitters involved in neurological processes. It improves the ventilation to perfusion ratio in the lungs. It is evident that chronic stress affects NO production, adversely may result in high BP. NO has been reported to have a potent role in the regulation of BP. Many studies on animals and human population showed that reduced levels of NO are associated with hypertension in animals, as well as, in primary and secondary hypertension in human population. NO also dilates blood vessels, in general, all over the body, hence proving to be an important controller of BP.
It was also observed that if Bhramari Pranayama is practised regularly, it helps in the release of acetylcholine from vagal nerve terminals which inhibits the release of norepinephrine from sympathetic nerve terminals, thus enhancing the vagal nerve activation that, in turn, results in a reduction in HR, PR, and BP.,
| Conclusion|| |
The present study shows the immediate effect of simple Bhramari Pranayama in lowering the SBP, DBP, as well as, PR. On the basis of the results of this study, Bhramari Pranayama can be used as an adjuvant therapy in hypertensive population and as a preventive measure in the normotensive population. However, a long interventional study with follow-up and additional parameters will give more insight on the effect of simple Bhramari Pranayama in managing and preventing hypertension.
The authors are thankful to the Industrial Estate, Lonavla, for their help in providing a place to run the yoga intervention. Also, they are thankful to all the participants for their cooperation. The authors are grateful to Kaivalyadhama Yoga Institute, Lonavla, and CCRYN for their continuous encouragement.
Financial support and sponsorship
This study was financially supported by the Central Council for Research in Yoga and Naturopathy (CCRYN), Delhi, and Kaivalyadhama Yoga Institute, Lonavla.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sliwa K, Stewart S, Gersh BJ. Hypertension: A global perspective. Circulation 2011;123:2892-6.
Alsaigh SA, Alanazi MD, Alkahtani MA. Lifestyle modifications for hypertension management. Egypt J Hosp Med 2018;70:2152-6.
Thiyagarajan R, Pal P, Pal GK, Subramanian SK, Trakroo M, Bobby Z, et al.
Additional benefit of yoga to standard lifestyle modification on blood pressure in prehypertensive subjects: A randomized controlled study. Hypertens Res 2015;38:48-55.
Cohen DL, Boudhar S, Bowler A, Townsend RR. Blood pressure effects of yoga, alone or in combination with lifestyle measures: Results of the Lifestyle Modification and Blood Pressure Study (LIMBS). J Clin Hypertens (Greenwich) 2016;18:809-16.
Parati G, Steptoe A. Stress reduction and blood pressure control in hypertension: A role for transcendental meditation? J Hypertens 2004;22:2057-60.
Satyanand V, Reddy B, Lilly N, Shaik MV, Shaik A. Studying the role of yogic Pranayama in the management of blood pressure. Int J Biomed Adv Res 2014;5:609-11.
Steinberg D, Bennett GG, Svetkey L. The DASH diet, 20 years later. JAMA 2017;317:1529-30.
Pramanik T, Pudasaini B, Prajapati R. Immediate effect of a slow pace breathing exercise Bhramari pranayama on blood pressure and heart rate. Nepal Med Coll J 2010;12:154-7.
Sengupta P. Health impacts of yoga and pranayama: A state-of-the-art review. Int J Prev Med 2012;3:444-58.
Himashree G, Mohan L, Singh Y. Yoga practice improves physiological and biochemical status at high altitudes: A prospective case-control study. Altern Ther Health Med 2016;22:53-9.
Kothari CR, Garg G. Research Methodology: Methods and Techniques. 4th
Multi Colour ed. New Delhi: New Age International (P) Limited, Publishers; 2019.
Digambarji S, Kokaje RS, editors. Hathpradipika of Svatmarama. 2nd
ed. Lonavla: Kaivalyadhama SMYM Samiti; 1998.
Kuvalayananda S. Pranayama by Swami Kuvalayananda. 12th
ed. Lonavla: Kaivalyadhama SMYM Samiti; 2016.
Taneja M. Role of bhramari pranayam in management of hypertension. Glob J Res Anal 2020;9:19-22.
Sathe S, Thodge K, Rajandekar T, Agrawal A. To find out immediate effect of bhramari pranayama on blood pressure, heart rate and oxygen saturation in hypertensive patients. IJCRR 2020;12:193-7.
Nivethitha L, Manjunath NK, Mooventhan A. Heart rate variability changes during and after the practice of bhramari pranayama. Int J Yoga 2017;10:99-102.
] [Full text]
Kuppusamy M, Kamaldeen D, Pitani R, Amaldas J. Immediate effects of bhramari pranayama on resting cardiovascular parameters in healthy adolescents. J Clin Diagn Res 2016;10:C17-9.
Maniscalco M, Sofia M, Weitzberg E, Carratu L, Lundberg JO. Nasal nitric oxide measurements before and after repeated humming maneuvers. Eur J Clin Invest 2003;33:1090-4.
Maniscalco M, Sofia M, Weitzberg E, De Laurentiis G, Stanziola A, Rossillo V, et al.
Humming-induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: Pilot study. Eur J Clin Invest 2004;34:555-60.
Lundberg JO, Maniscalco M, Sofia M, Lundblad L, Weitzberg E. Humming, nitric oxide, and paranasal sinus obstruction. JAMA 2003;289:302-3.
Taneja MK. Nitric oxide bhramari pranayam and deafness. Indian J Otol 2016;22:1. [Full text]
Schulz E, Jansen T, Wenzel P, Daiber A, Münzel T. Nitric oxide, tetrahydrobiopterin, oxidative stress, and endothelial dysfunction in hypertension. Antioxid Redox Signal 2008;10:1115-26.
Bernatova I. Endothelial dysfunction in experimental models of arterial hypertension: Cause or consequence? Biomed Res Int 2014;2014:598271.
Tankhiwale N, Nimse R, Tankhiwale A. Effect of bhramari pranayam on resting blood pressure in healthy individuals: RCT. Int J Sci Res 2020;9:921-3.
[Table 1], [Table 2]