Alternate Nostril Breathing on Cardiorespiratory Functions in Phase 1 Post CABG Patients
Condition: Post-cardiac Surgery
MeSH terms: Respiratory Aspiration
Study type: Interventional

Summary: 
      The aim of this study is to investigate effects of Anulom vilom pranayama/ Alternate nasal
      breathing (ANB) on cardio-respiratory parameters including vitals i.e. heart rate, blood
      pressure, chest expansion, arterial blood gases (ABGs), pulmonary function test and
      functional capacity in phase 1 post CABG patients. This study will help Cardiopulmonary
      physiotherapists to incorporate evidence based protocols for Coronary Artery Bypass Graft
      Surgery (CABG) in phase 1 of cardiac rehabilitation.
    

Detailed description: 
      Breathing is essential function of the body. Learning of breath regulation permits to control
      body's different mechanisms. "Pranayama" means control of breathing. ANB training consist of
      mindful breathing. Alternate nostril breathing works on regulating respiratory pattern,
      improvement of ventilation, clearance of lungs from retaining mucus, decrease in work of
      breathing and relax the mind and body. Alternate-nostril breathing (ANB) is one type of
      pranayama that contains inhalation from left side nostril and exhalation by right nostril
      afterwards inhalation by right nostril and exhalation from left nostril. This technique
      includes inhalation, exhalation and in advance training retention is also include. Its
      duration can be vary as depends on person's own capacity. ANB is usually considered to
      release mental conflict and stimulate mental stability and physical health. There are various
      studies to evaluate the outcomes of alternate breathing technique on definite functions of
      cognitive and physiological systems. cardiovascular disorder is the foremost reason of
      passing away for both gender. Coronary Artery Disease(CAD) is narrowing or obstruction of the
      arteries/vessels (which deliver nutrients and oxygen to the heart) as a result of
      atherosclerotic plaque or clot formed in the arteries. 50% patient with CAD showed their
      first symptoms as cardiac arrest. In western world CAD is the most common root for death. In
      worldwide, with the risk factors of Smoking, High cholesterol, Hypertension, Diabetes,
      Emotional stress, Obesity and Sedentary life, each year 3.8 million men & 3.4 million women
      die due to CAD. Coronary Artery Bypass Grafting(CABG) is most common surgery performed for
      CAD. This operation can be one week of daily training of Pranayama revealed to induce
      improvement in the sympathetic tone. Yoga practice along with different breathing exercises
      improve cardiac output, reduce hepatic, renal blood flow and increases blood flow in cerebral
      peripheral vessels. Heart rate vary with every single thought and environmental situation. In
      Anulom - Vilom pranayama, practitioner not only tries to breathe, but at the same moment,
      retain his focus on the action of breathing, leading to get awareness. This act of
      attentiveness distract him from tough concerns and evokes relax response. In this stress free
      state, parasympathetic nerve action supersedes sympathetic nerve's activity lead to
      noteworthy reduction in systolic blood pressure. Short term training of Anulom vilom
      pranayama indicated a substantial impact on Systolic Blood Pressure and showed an encouraging
      outcome on mental and digestive functions. Studies conducted showed that three months Yoga
      training is highly beneficial for the improvement of blood pressure and heart rate in stage 1
      hypertensive patients. Role for ANB in hypertensive people is beneficial to perform focused
      tasks without sympathetic activation (based on an increased BP). Practice of ANB in
      Prehypertensive obese young adults for 15 min daily showed a significant improvement in
      cardiovascular parameters.

      ANB plays a significant role in improving the various ventilatory functions of lungs, vital
      capacity and PEFR in pranayama practicing subjects. Increase in VC signifies complete
      emptying and fullness of air. Blood Pressure and Pulse rate is related with Cardio Vascular
      System, which is controlled by Autonomous nervous System (ANS). Pranayama accompanied by
      breath control increases cardiac output, decreases hepatic, renal blood flow and increases
      cerebral peripheral vessels blood flow. Heart rate varies with single thought and thoughtless
      condition Blood Pressure and Pulse rate is related with Cardio Vascular System, which is
      controlled by Autonomous nervous System (ANS). Pranayama accompanied by breath control
      increases cardiac output, decreases hepatic, renal blood flow and increases cerebral
      peripheral vessels blood flow. Heart rate varies with single thought and thoughtless
      condition Blood Pressure and Pulse rate is related with Cardio Vascular System, which is
      controlled by Autonomous nervous System (ANS). ANB accompanied by breath control increases
      cardiac output, decreases hepatic, renal blood flow and increases cerebral peripheral vessels
      blood flow. Heart rate varies with single thought and thoughtless condition Blood Pressure
      and Pulse rate is related with Cardio Vascular System, which is controlled by Autonomous
      nervous System (ANS). ANB accompanied by breath control increases cardiac output, decreases
      hepatic, renal blood flow and increases cerebral peripheral vessels blood flow. Heart rate
      varies with single thought and thoughtless condition Blood Pressure and Pulse rate is related
      with Cardio Vascular System, which is controlled by Autonomous nervous System (ANS). ANB
      accompanied by breath control increases cardiac output, decreases hepatic, renal blood flow
      and increases cerebral peripheral vessels blood flow. Heart rate varies with single thought
      and thoughtless condition The worth of physiotherapy skills used for patients after coronary
      artery bypass surgery (CABG) is well recognized. It is a life-saving process which is usually
      related with substantial postoperative pain. Various lungs functions may become compromised,
      or visibly vain, because of severe chest pain and there is frequently chances to develop
      restrictive lung disease after cardiac surgery. Though painkillers may be effective to
      diminish the pain but they have side effects which include respiratory depression or
      respiratory muscles weakness. Hence, development of chemical free approaches for effective
      pain control is a long standing interest. After Coronary Artery Bypass Grafting (CABG), the
      quality of life (QOL) is main factor to morbidity and mortality. Adding of Yoga Based
      Lifestyle Program (YLSP) to cardiac rehabilitation has established a valuable and actual
      improvement in ejection fraction and decreasing in risk factor profiles.

      Many studies have been done on the efficacy of this exercise practice in healthy and clinical
      populations on cardiovascular and the autonomic functions. Numerous investigations have
      recommended that ANB improves the balance between sympathetic vagal and parasympathetic
      dominance. Training of ANB after CABG improves chest expansion, peak expiratory flow rate and
      decrease in pain. ANB along with conventional physiotherapy play a key role in improving
      Respiratory function and depression issues in CABG patients.

      Literature reviewed from different search engines has shown that alternate breathing
      technique has significant positive effects on cardiorespiratory functions but very little
      literature has been found specifically on phase 1 post CABG studies, regarding to ANB effect.
    

Intervention name(s): Standardized Physical therapy protocol; Alternate nostrils breathing
Intervention type(s): Other; Other
Intervention description(s): Standardized Phase 1 protocol without for 7 days without ANB sessions.; Alternate nostrils breathing 2 sessions per day
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Alternate nostril breathing; Cardiorespiratory parameters; Cardiovascular disease; Arterial blood gases; Pulmonary function test