Alternate Nostril Breathing on Cardiorespiratory Functions in Phase 1 Post CABG Patients

Study Overview
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Brief Summary
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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
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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.

Official Title
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Effects of Anulom-Vilom Pranayama/ Alternate Nostril Breathing on Cardiorespiratory Functions in Phase 1 Post CABG Patients

Conditions
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Post-cardiac Surgery

Intervention / Treatment
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* Other: Standardized Physical therapy protocol
* Other: Alternate nostrils breathing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Patient's undergoing CABG surgery. Exclusion Criteria: With any difficulty in communication. Unstable vital signs Those who are smokers. Other severe complications like diabetes, stroke or cancer. Patient with any respiratory / other pathologies will not be included

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional treatment protocol group<br>Standardized treatment protocol including chest physical therapy as well as limb physical therapy and functional mobility was addressed. | Other: Standardized Physical therapy protocol<br>* Standardized Phase 1 protocol without for 7 days without ANB sessions.<br>|
| Experimental: ANB group<br>2 sessions per day was added to the standardized treatment protocol | Other: Alternate nostrils breathing<br>* Alternate nostrils breathing 2 sessions per day<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peak expiratory flow rate (PEFR) | Peak expiratory flow rate (PEFR) measured through digital spirometer. Peak Expiratory Flow Rate (PEFR) measured through digital spirometer. Three zones of measurement are commonly used to interpret peak flow rates. Normal value of PEFR is (80-100%). Green zone indicates 80 to 100 percent of the usual or normal peak flow reading, yellow zone indicates 50 to 79 percent of the usual or normal peak flow readings, and red zone indicates less than 50 percent of the usual or normal peak flow readings. | 7 days | 
| Forced vital capacity (FVC) | Forced vital capacity (FVC) measured through digital spirometer. If the value of FVC is within 80% of the reference value, the results are considered normal. | 7 days | 
| Forced expiratory volume in 1sec (FEV1) | Forced expiratory volume in 1sec (FEV1) measured through digital spirometer. If the value of FEV1 is within 80% of the reference value, the results are considered normal. | 7 days | 
| FVC/FEV1 | FVC/FEV1 measured through digital spirometer. The normal value for the FEV1/FVC ratio is 70% (and 65% in persons older than age 65). | 7 days | 
| Arterial Blood Gases | An arterial blood gas (ABG) test measures oxygen and carbon dioxide levels in the blood. It also measures body's acid-base (pH) level, which is usually in balance when a person is healthy. | 7 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Chest expansion | Chest expansion at xiphoid level measured by finding the difference in measurements during inhalation and exhalation. | 7 days | 
| Heart rate | Heart rate is measured as part of vitals through heart rate monitor. | 7 days | 
| Systolic and diastolic blood pressure | Blood pressure is measured through sphygmomanometer | 7 days | 
| Oxygen Saturation (SPO2) | Oxygen saturation measured through pulse oximeter as part of vitals | 7 days | 
| Six Minute Walk Test (6MWT) | 6MWT is used to assess the functional capacity of patients by calculating the distance covered in a time period of 6 minutes. | 7 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Alternate nostril breathing, Cardiorespiratory parameters, Cardiovascular disease, Arterial blood gases, Pulmonary function test