International Journal of Yogic, Human Movement and Sports Sciences 2021; 6(2): 69-75

ISSN: 2456-4419
Impact Factor: (RJIF): 5.18
Yoga 2021; 6(2): 69-75 Effect of obesity yoga therapy on psychological
© 2021 Yoga
www.theyogicjournal.com determinants and heart rate variability in obese
Received: 20-05-2021
Accepted: 22-06-2021 individuals
Buvanasvar Manoharan
PG Student, Clinical Yoga, Buvanasvar Manoharan, Shetty Shivaprasad and Shetty Prashanth
SDM College of Naturopathy
and Yogic Sciences, UJIRE,
Karnataka, India Abstract
Background: Obesity is associated with stress, anxiety, and decreased quality of life an epidemic
Shetty Shivaprasad responsible for metabolic disorders. Yoga a holistic approach is aimed at restoring the abnormalities of
MSc. Dean Division of Yoga body and mind physiology to normal, thereby restoring health. The study aimed to assess the effect of
therapeutics, Clinical Yoga, yoga therapy on perceived stress, anxiety, quality of life, and heart rate variability in obese individuals.
SDM College of Naturopathy Materials and Methods: 60 obese individuals were recruited for the study based on inclusion and
and Yogic Sciences, UJIRE,
exclusion criteria. The study population was divided into case group (n=30) received yoga therapy for 10
Karnataka, India
days with routine lifestyle and diet, and control group (n=30) followed routine lifestyle and diet.
Shetty Prashanth Assessments were done on day 1 and day10 for both groups.
PhD. Principal, Natural Results: In the post-test assessments of the case group with the control group, there was a significant
therapeutics, SDM College of reduction in scores of perceived stress scale, and Hamilton anxiety rating scale, also reduction in mean
Naturopathy and Yogic Sciences, HR, LF, LF/HF, and a significant increase in mean R-R variables of HRV in the case group.
UJIRE, Karnataka, India Conclusion: Ten days of yoga therapy in obese individuals had a positive effect on perceived stress,
anxiety, quality of life, and heart rate variability, indicating parasympathetic dominance. Hence, yoga
therapy acts in primary and secondary prevention of obesity-associated stress and anxiety symptoms.

Keywords: Anxiety, heart rate variability, obesity, perceived stress, quality of life, yoga

Introduction
Obesity an epidemic of the 21st century is a causative factor for metabolic disorders and is
associated with depression, anxiety, and reduced quality of life [1, 2]. The prevalence of
overweight and obesity in Asian countries has increased in the past few decades. Southeast
Asia and the western pacific region are facing an epidemic of diseases associated with obesity
such as diabetes and cardiovascular diseases (CVD) [1].
In our modern society, obesity coincides with the increase in chronic stress. In the past years,
evidence is intensifying that stress plays a role in the development of obesity [3]. Obesity itself
can be a stressful status due to the high dominance of weight stigma [4] Obesity has been
associated with low levels of quality of life [5] and leads to anxiety [6].
Yoga is an ancient Indian discipline, considered holistic therapy as this system considers the
body as a whole. According to yoga, the health of an individual is characterized by good
physical health, a balanced state of mind, constructive and social surroundings, and also high
spiritual growth; this holistic approach is aimed at restoring the abnormalities of body and
mind physiology to normal, thereby restoring health [7]. Yoga has a beneficial effect through
direct influence on the autonomic nervous system, improving wellbeing, reducing stress and
anxiety. Evidence suggests, asana (physical posture), pranayama (breath regulation), dhyana
(meditation), and relaxation practices have been shown to reduce sympathetic activation,
regulates the hypothalamic-pituitary-adrenal axis and increase the quality of life by reducing
stress and anxiety [8]. Hewett et al. (2018) concluded yoga significantly improved perceived
Corresponding Author: stress in sedentary and stressed adults [9]. Chandla et al. show that pranayama for six weeks
Buvanasvar Manoharan BNYS improves anxiety and increases parasympathetic activity [10]. Cramer et al. conclude yoga
PG Student, Clinical Yoga, intervention is safe which had moderately strong positive effects on anthropometric variables
SDM College of Naturopathy and quality of life in women with abdominal obesity [11].
and Yogic Sciences, UJIRE,
Karnataka, India
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Materials and Methods Recruitment and sampling

Study setting and participants Out of 210 participants, 60 were selected based on inclusion
The study was conducted at Sri Dharmasthala and exclusion criteria. A sampling of the study population
Manjunatheshwara (SDM) Yoga and Nature Cure Hospital, (n=60) was done by computer-generated random numbers
Dharmasthala, Dakshina Kannada, India. Participants were into the case (n=30) and control (n=30) groups.
screened from a consultation at SDM yoga and nature cure
hospital and through a survey at UJIRE town. Participants had Study design
their vital signs assessed before the test. A concurrent parallel study was conducted. Pre (day one) and
post (day ten) data of both the groups were collected. Total
Ethical approval (n=60) completed the post-assessments, there were no
Approval was obtained from the institutional ethical dropouts during the study period. Participants in, case group
committee (EC-234). A signed informed consent form was received yoga intervention along with their routine lifestyle
obtained from all the participants after explaining in detail the and diet for 10 days and the control group was asked to follow
study intervention and assessments. The study was registered their routine lifestyle and diet during the period of the study.
in the Clinical Trials Registry India CTRI/2019/10/021775. Figure 1 illustrates the study plan in detail.

Fig 1: Illustration of the study plan

Data collection process Exclusion criteria comprised individuals with acute disease
The data was collected using self-assessment rating scales (appendicitis, influenza, etc.), recent trauma and injury,
(PSS, perceived stress scale; HAM-A, Hamilton anxiety cardiovascular disease, and females during menstruation,
rating scale; QLI, Ferrans and Powers quality of life index) pregnancy, and lactation.
and polygraph equipment (BIOPAC, Montana, USA; model
no: BSL 4.0 MP 36) for heart rate variability (HRV) Intervention
spectrum. The case group was educated and practiced yoga for one-hour
duration each day from six a.m. to seven a.m. for 10 days
Inclusion and exclusion criteria continuous. Detailed descriptions of the practices are
Inclusion criteria included subjects with age group 18 to 35 tabulated in Table 1. The Control group did not practice yoga,
years, both male and female gender, and obesity (BMI greater followed their routine lifestyle during the assessment period.
than 30.0 kg/m2).
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Table 1: Obesity yoga therapy protocol

S. No Name of the Practice Rounds (No. of times repeated) Duration (Minutes)
1 Sukhasana (Easy posture) and Prarthana mantra chanting (Universal Prayer) 1 1
2 Suryanamaskara 5 10
Standing series Ardhachakrasana 1 1
3
asana Trikonasana 1 1
Uttitapadasana 1 1
Vipareetakarani 1 1
4 Supine series asana
Naukasana 1 1
Pavanamuktasana 1 1
Bhujangasana 1 1
Shalabasana 1 1
5 Prone series asana
Dhanurasana 1 1
Navasana 1 1
6 Instant Relaxation Technique (IRT) 1 2
Bhastrika (bellows breathing) 36-50 strokes 3
Kapalabhati 250-300 strokes 5
7 Pranayama’s
Anulom-vilom (alternate nostril breathing) 20-25 6
Surya bhedana (Right nostril breathing) 20-25 3
8 Deep Relaxation Technique (DRT) 20
9 Total Duration 60 (1 hour)

Assessments successive normal sinus RR interval difference, pNN50:

Perceived stress scale percentage of absolute differences between successive normal
Items within the scale were designed to trap how RR intervals that exceed 50ms, Mean R-R: the successive
unpredictable, uncontrollable, and overloaded respondents interval between R-R, HR: Heart rate. In frequency domain
find their life, also included several direct queries about analysis the assessments were LF, Low frequency; HF, High
current levels of experienced stress. Questions within the PSS frequency; LF/HF, the ratio of low frequency to high
asked about feelings and thoughts during the last month, frequency.
respondents were asked how often they felt a particular way.
Statistical analysis
Hamilton anxiety rating scale The data collected was analyzed using Statistical Package for
The scale consisted of 14items, defined by a series of Social Sciences (SPSS) version 23.0 and was checked for
symptoms, and measured both psychic and somatic anxiety. normality using the Kolmogorov-Smirnov test. The pre and
post-data of case and control groups with normal distribution
Ferrans and powers quality of life index were analyzed by parametric tests, independent t (between
This instrument consisted of two parts: the first measured groups), and paired t-tests (within-group). Comparison of pre
satisfaction with various aspects of life and the second and post-data of case and control groups with not normal
measured importance of those same aspects. Scores were distribution were analyzed using non-parametric tests, Mann
calculated for overall quality of life in four domains: health Whitney u test (between groups), and Wilcoxon signed-rank
and functioning, psychological/ spiritual, social and test (within-group). A p-value of <0.05 was considered
economic, and family. statistically significant.

Heart rate and heart rate variability spectrum (HRV): Results

The electrocardiogram (ECG) was recorded pre-test on the 1st This study was conducted to evaluate whether yoga therapy
day and post-test on the 10th day using standard bipolar limb influenced perceived stress, anxiety, quality of life, and heart
lead II configuration (BIOPAC, Montana, USA; model NO: rate variability in obese individuals.
BSL 4.0 MP 36). The ECG was digitized using a 12-bit Case group: 53% males and 47% females with mean ± SD
analogue to digital converter point event series of successive (standard deviation) age of 26.87±4.55 years and mean BMI
R-R intervals (0.6-1.2 seconds), from which the beat-to-beat (body mass index) of 29.12 kgs (kilograms).
heart rate series was computed. In time domain analysis the Control group: 40% males and 60% females with mean ± SD
assessments were RMSSD: root mean square of the age of 28.47±4.59 years and mean BMI of 29.68 kgs.

Table 2: Baseline characteristics of study groups

Variables Case Control x2 Measure of difference P Probability value
a a
Age 26.87±4.55 28.47±4.59 1.67 (df=3) 0.65 (NS)
Gender (male, female) 16,14b 12,18b 1.07 (df=1) 0.30 (NS)
BMI 29.12±2.15a 29.68±1.87a 1.9 0.28 (NS)
Data presented as a mean ± SD, b number of participants, df – degrees of freedom, NS- not significant.

In case group, comparing pre and post assessments there was p=0.511), NN50 (t=0.95, p=0.343), pNN50 (t=1.71, p=0.087)
significant improvement (p<0.0001) in PSS (sample t-test: t=- and HF (t=1.64, p=0.10) were not significant. Table 3.
10.92), HAM-A (t=-12.19), QLI (t=8.94), mean R-R (Sample t-test: t- implies hypothesis testing between means of
(p=0.0004, t=3.79), mean HR (p=0.0003, t= -3.82), LF (t=- two groups).
2.91, p=0.005), LF/HF (t=-2.41, p=0.01). RMSSD (t=0.661,

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Table 3: Comparison of pre and post-tests within the case group

Variables Pre-test mean ± SD Post-test mean ± SD P Probability value
PSS 30.3±3.3 18.6±4.85 ˂0.0001**
HAM-A 33.6±4.2 18.8±5.15 ˂0.0001**
QLI 11.56±1.84 19.48±4.49 ˂0.0001**
Time-domain
Mean R-R (s) 740.7±75.98 832.64±108.9 0.0004**
Mean HR (b/min) 86.1±13.49 75.47±7.07 0.0003**
RMSSD (ms) 124.6±169.2 153.5±169.5 0.511
NN50 (ms) 72.63±97.84 97.67±104.9 0.343
pNN50 (ms) 17.95±13.9 24.52±15.3 0.087
Frequency domain
LF (Hz) 50.34±19.6 37.24±14.9 0.005*
HF (Hz) 47.59±20.28 56.6±22.05 0.10
LF/HF (Hz) 1.54±1.38 0.87±0.64 0.01*
*significant, **highly significant. PSS, Perceived stress Scale; HAM-A, Hamilton Anxiety; QLI, Ferrans and Powers Quality of Life Index; Mean R-
R, the successive interval between R-R; HR, Heart rate; RMSSD, root mean square of the successive normal sinus RR interval difference;
pNN50, percentage of absolute differences between successive normal RR intervals that exceed 50ms; LF, Low frequency; HF, High frequency;
LF/HF, the ratio of low frequency to high frequency. s, seconds; ms, milliseconds; b/min, beats per minute; Hz, hertz.

Post-test comparison between case and control groups (p=0.02) of frequency domain variables. The change was not
revealed, significant changes in PSS (95% confidence significant in mean RR (p=0.1), RMSSD (p=0.8), NN50
interval: CI,-15.5 to -10.97), HAM-A (95% CI, -18.29 to - (p=0.2) and pNN50 (p=0.1) in time domain variables of HRV.
11.7), QLI (95% CI, 7.06 to 10.04) with p-value <0.001. Table 4; figure 2 illustrate mean changes in the case and
Also, significant changes in Mean HR (p=0.03) of time control group on the 10th day.
domain variable, LF (p=0.0003), HF (p=0.01), LF/HF

PSS, Perceived stress Scale; HAM-A, Hamilton Anxiety; QLI, Ferrans and Powers Quality of Life Index; Mean R-R,
the successive interval between R-R; HR, Heart rate; RMSSD, root mean square of the successive normal sinus RR
interval difference; pNN50, percentage of absolute differences between successive normal RR intervals that exceed
50ms; LF, Low frequency; HF, High frequency; LF/HF, the ratio of low frequency to high frequency. Y-axis
represents data presented in mean values.
Fig 2: Changes after the 10 days of intervention in case and control group

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Table 4: Comparison of post-test variables of case and control groups

Variables Case mean ± SD Control mean ± SD P Probability value
PSS 18.6±4.85 32.87±3.2 ˂0.0001**
HAM-A 18.8±5.15 33.2±3.6 ˂0.0001**
QLI 19.48±4.49 10.0±2.01 ˂0.0001**
Time-domain
Mean R-R (s) 832.64±108.9 786.6±108.85 0.1
Mean HR (b/min) 75.47±7.07 81.75±13.7 0.03*
RMSSD (ms) 153.5±169.5 165.2±196.2 0.8
NN50 (ms) 97.67±104.9 68.3±85.7 0.2
pNN50 (ms) 24.52±15.3 16.56±21.4 0.1
Frequency domain
LF (Hz) 37.24±14.9 53.45±17.7 0.0003**
HF (Hz) 56.6±22.05 43.6±17.6 0.01*
LF/HF (Hz) 0.87±0.64 1.75±1.88 0.02*
*Statistically significant; **highly significant. PSS, Perceived stress scale; HAM-A Hamilton Anxiety; QLI, Ferrans and
Powers Quality of Life Index; Mean R-R, the successive interval between R-R; HR, Heart rate; RMSSD, root mean
square of the successive normal sinus RR interval difference; pNN50, percentage of absolute differences between
successive normal RR intervals that exceed 50ms; LF, Low frequency; HF, High frequency; LF/HF, the ratio of low
frequency to high frequency. s, seconds; ms, milliseconds; b/min, beats per minute; Hz, hertz.

In the control group, pre and post-data results showed also showed an insignificant difference between pre and post-
insignificant variation in PSS, HAM-A, and QLI. Short-term data. Table 5.
HRV measurements of time and frequency domain variables

Table 5: Comparison of pre and post-tests within the control group

Variables Pretest Mean ± SD Post-test Mean ± SD P Probability value
PSS 31.23±3.3 32.87±3.2 0.055
HAM-A 32.9±4.2 33.2±3.6 0.767
QLI 10.6±2.1 10.0±2.01 0.262
Time-domain
Mean R-R (s) 773.2±84.6 786.6±81.75 0.630
Mean HR (b/min) 161.3±69.87 165.2±68.3 0.420
RMSSD (ms) 17.93±105.8 16.56±108.85 0.937
NN50 (ms) 13.49±188.08 13.7±196.2 0.945
pNN50 (ms) 91.75±22.7 85.7±21.4 0.810
Frequency domain
LF (Hz) 52.33±44.83 53.45±43.6 0.823
HF (Hz) 2.30±21.9 1.75±17.7 0.812
LF/HF (Hz) 22.16±3.13 17.6±1.88 0.412
PSS, Perceived stress Scale; HAM-A, Hamilton Anxiety; QLI, Ferrans and Powers Quality of Life Index; Mean R-R, the
successive interval between R-R; HR, Heart rate; RMSSD, root mean square of the successive normal sinus RR interval
difference; pNN50, percentage of absolute differences between successive normal RR intervals that exceed 50ms; LF,
Low frequency; HF, High frequency; LF/HF, the ratio of low frequency to high frequency. s, seconds; ms, milliseconds;
b/min, beats per minute; Hz, hertz.

Discussion weight [14]. In the present study following yoga therapy (YT)
The study aimed to evaluate the effect of yoga therapy on for ten days, the stress levels decreased significantly in obese
obese individuals. In the present study, following yoga individuals.
therapy, there was a significant reduction in PSS, HAM-A, HAM-A scales mean score of anxiety decreased significantly
Mean HR, LF, and LF/HF ratio and a significant increase in in the case group. In an explorative review article, yoga
QLI, Mean RR, and insignificant increase in RMSSD, NN50, practices inhibit the areas responsible for fear, aggressiveness,
pNN50, and HF in the case group. These results of this study and rage; stimulate the rewarding pleasure centres in the
are suggestive of a sympathovagal balance. median forebrain and other areas leading to a state of bliss
In this study, the comparison of post-test variables in case and and pleasure. This inhibition leads to lower anxiety, pulse,
control groups, the mean scores of PSS significantly rate of respiration, and cardiac output [12]. The Hamilton
decreased in the case group. In the studies by Woodyard C Rating Scale for Anxiety is a widely used measure for
and Tyagi A, the sympathetic region of the hypothalamus is assessing anxiety in research [15]. The current study specified
inhibited by yoga. The hypothalamic-pituitary-adrenal (HPA) ten days of YT resulted in the reduction of the anxiety scores
axis and the sympathetic activity are downregulated and the in the case group, indicating reduced symptoms of psychic
autonomic regulatory reflex mechanism associated with stress and somatic anxiety.
is restored promoting stress relief and relaxation [12, 13]. A The mean overall scores of QLI increased significantly in the
clinical trial on adult obese individuals states, reduced levels case group in aspect to the improved person’s satisfaction of
of perceived stress are associated with lower cortisol life towards health and functioning, psychological/ spiritual,
secretion, which contributes to a reduction of obesity, social and economic, and family, by reducing stress, anxiety,
adoption to healthier dietary habits, and subsequent loss of and weight in obese individuals. A study with a large sample
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size (yoga experienced minimum one month n=298) by Telles Acknowledgement

et al., reported higher outcomes in four out of six aspects in We are thankful to Asst. Prof Dr. Shashikiran (SDM, College
quality of life (enjoyment in physical activities, ability to of Naturopathy and Yogic Sciences) for his guidance and
work, self-esteem, and social satisfaction) in yoga support and Mr. V. Mani (biostatistician) for data analysis.
experienced group compared to the yoga naïve [16].
The HRV variables in the time domain, Mean RR showed a References
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