Yoga and heart rate variability: A comprehensive review of the literature

Anupama Tyagi, Marc Cohen, Anupama Tyagi, Marc Cohen

Abstract

Heart rate variability (HRV) has been used as a proxy for health and fitness and indicator of autonomic regulation and therefore, appears well placed to assess the changes occurring with mind.-body practices that facilitate autonomic balance. While many studies suggest that yoga influences HRV, such studies have not been systematically reviewed. We aimed to systematically review all published papers that report on yoga practices and HRV. A comprehensive search of multiple databases was conducted and all studies that reported a measure of HRV associated with any yoga practice were included. Studies were categorized by the study design and type of yoga practice. A total of 59 studies were reviewed involving a total of 2358 participants. Most studies were performed in India on relatively small numbers of healthy male yoga practitioners during a single laboratory session. Of the reviewed studies, 15 were randomized controlled trials with 6 having a Jadad score of 3. The reviewed studies suggest that yoga can affect cardiac autonomic regulation with increased HRV and vagal dominance during yoga practices. Regular yoga practitioners were also found to have increased vagal tone at rest compared to non-yoga practitioners. It is premature to draw any firm conclusions about yoga and HRV as most studies were of poor quality, with small sample sizes and insufficient reporting of study design and statistical methods. Rigorous studies with detailed reporting of yoga practices and any corresponding changes in respiration are required to determine the effect of yoga on HRV.

Keywords: Cardio-autonomic; meditation/relaxation; pranayama; vagal tone; yogic.

Figures

Figure 1
Figure 1
Flowchart of study search and included studies

References

    1. Thayer JF, Ahs F, Fredrikson M, Sollers JJ, 3rd, Wager TD. A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev. 2012;36:747–56.
    1. Verlinde D, Beckers F, Ramaekers D, Aubert AE. Wavelet decomposition analysis of heart rate variability in aerobic athletes. Auton Neurosci. 2001;90:138–41.
    1. Oldehinkel AJ, Verhulst FC, Ormel J. Low heart rate: A marker of stress resilience. The TRAILS study. Biol Psychiatry. 2008;63:1141–6.
    1. Souza GG, Mendonça-de-Souza AC, Barros EM, Coutinho EF, Oliveira L, Mendlowicz MV, et al. Resilience and vagal tone predict cardiac recovery from acute social stress. Stress. 2007;10:368–74.
    1. Jarczok MN, Jarczok M, Mauss D, Koenig J, Li J, Herr RM, et al. Autonomic nervous system activity and workplace stressors – A systematic review. Neurosci Biobehav Rev. 2013;37:1810–23.
    1. Porges SW. New York: W. W. Norton; 2011. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation.
    1. Thayer JF, Hansen AL, Saus-Rose E, Johnsen BH. Heart rate variability, prefrontal neural function, and cognitive performance: The neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med. 2009;37:141–53.
    1. Montano N, Porta A, Cogliati C, Costantino G, Tobaldini E, Casali KR, et al. Heart rate variability explored in the frequency domain: A tool to investigate the link between heart and behavior. Neurosci Biobehav Rev. 2009;33:71–80.
    1. Habib GB. Reappraisal of heart rate as a risk factor in the general population. Eur Heart J Suppl. 1999;1:H2–10.
    1. Kelley DE. Skeletal muscle fat oxidation: Timing and flexibility are everything. J Clin Invest. 2005;115:1699–702.
    1. Berntson GG, Bigger JT, Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, et al. Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology. 1997;34:623–48.
    1. Lehrer PM, Woolfolk RL, Sime WE. New York: Guilford Press; 2007. Principles and Practice of Stress Management.
    1. Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–65.
    1. Acharya UR, Joseph KP, Kannathal N, Min LC, Suri JS. Heart rate variability. Advances in Cardiac Signal Processing. In: Acharya UR, Suri JS, editors. New York: Springer; 2007.
    1. Pagani M, Malliani A, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991;84:482–92.
    1. Reyes del Paso GA, Langewitz W, Mulder LJ, van Roon A, Duschek S. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: A review with emphasis on a reanalysis of previous studies. Psychophysiology. 2013;50:477–87.
    1. Beda A, Simpson DM, Carvalho NC, Carvalho AR. Low-frequency heart rate variability is related to the breath-to-breath variability in the respiratory pattern. Psychophysiology. 2014;51:197–205.
    1. Bernardi L, Wdowczyk-Szulc J, Valenti C, Castoldi S, Passino C, Spadacini G, et al. Effects of controlled breathing, mental activity and mental stress with or without verbalization on heart rate variability. J Hypertens. 2000;35:1462–9.
    1. Vaschillo E, Lehrer P, Rishe N, Konstantinov M. Heart rate variability biofeedback as a method for assessing baroreflex function: A preliminary study of resonance in the cardiovascular system. Appl Psychophysiol Biofeedback. 2002;27:1–27.
    1. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: A systematic review. J Am Board Fam Pract. 2005;18:491–519.
    1. Bowman AJ, Clayton RH, Murray A, Reed JW, Subhan MM, Ford GA. Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons. Eur J Clin Invest. 1997;27:443–9.
    1. Telles S, Raghavendra BR, Naveen KV, Manjunath NK, Kumar S, Subramanya P. Changes in autonomic variables following two meditative states described in yoga texts. J Altern Complement Med. 2013;19:35–42.
    1. Telles S, Singh N, Puthige R. Changes in P300 following alternate nostril yoga breathing and breath awareness. Biopsychosoc Med. 2013;7:11.
    1. Telles S, Raghuraj P, Arankalle D, Naveen KV. Immediate effect of high-frequency yoga breathing on attention. Indian J Med Sci. 2008;62:20–2.
    1. Chaya MS, Nagendra H, Selvam S, Kurpad A, Srinivasan K. Effect of yoga on cognitive abilities in schoolchildren from a socioeconomically disadvantaged background: A randomized controlled study. J Altern Complement Med. 2012;18:1161–7.
    1. Cramer H, Lauche R, Langhorst J, Dobos G, Paul A. Quality of life and mental health in patients with chronic diseases who regularly practice yoga and those who do not: A case-control study. Evid Based Complement Alternat Med 2013. 2013:702914.
    1. Tyagi A, Cohen M. Yoga and hypertension: A systematic review. Altern Ther Health Med. 2014;20:32–59.
    1. Hagins M, States R, Selfe T, Innes K. Effectiveness of yoga for hypertension: Systematic review and meta-analysis. Evid Based Complement Alternat Med 2013. 2013:649836.
    1. Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17:21–35.
    1. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: The research evidence. J Affect Disord. 2005;89:13–24.
    1. McCall MC, Ward A, Roberts NW, Heneghan C. Overview of systematic reviews: Yoga as a therapeutic intervention for adults with acute and chronic health conditions. Evid Based Complement Alternat Med 2013. 2013:945895.
    1. Tyagi A, Cohen M. Oxygen consumption changes with yoga practices: A systematic review. J Evid Based Complement Alternat Med. 2013;18:290–308.
    1. Posadzki P, Kuzdzal A, Lee MS, Ernst E. Yoga for heart rate variability: A systematic review and meta-analysis of randomized clinical trials. Appl Psychophysiol Biofeedback. 2015;40:239–49.
    1. Jadad AR, Enkin MW. Randomized Controlled Trials: Questions, Answers and Musings. New Jersey: Wiley; 2008.
    1. Vempati RP, Telles S. Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels. Psychol Rep. 2002;90:487–94.
    1. Markil N, Whitehurst M, Jacobs PL, Zoeller RF. Yoga Nidra relaxation increases heart rate variability and is unaffected by a prior bout of Hatha yoga. J Altern Complement Med. 2012;18:953–8.
    1. Travis F, Wallace RK. Autonomic and EEG patterns during eyes-closed rest and transcendental meditation (TM) practice: The basis for a neural model of TM practice. Conscious Cogn. 1999;8:302–18.
    1. Travis F. Autonomic and EEG patterns distinguish transcending from other experiences during transcendental meditation practice. Int J Psychophysiol. 2001;42:1–9.
    1. Vempati RP, Telles S. Yoga based isometric relaxation versus supine rest: A study of oxygen consumption-breath rate and volume and autonomic measures. J Indian Psychol. 1999;17:46–52.
    1. Santaella DF, Lorenzi-Filho G, Rodrigues MR, Tinucci T, Malinauskas AP, Mion-Júnior D, et al. Yoga relaxation (Savasana) decreases cardiac sympathovagal balance in hypertensive patients. Med Express. 2014;1:233–38.
    1. Yunati MS, Deshp VK, Yuwanate AH. Dynamics of heart rate induced by Sahaja yoga meditation in healthy normal subjects above 40 years. Natl J Physiol Pharm Pharmacol. 2014;4:80–5.
    1. Madanmohan, Bhavanani AB, Prakash ES, Kamath MG, Amudhan J. Effect of six weeks of shavasan training on spectral measures of short-term heart rate variability in young healthy volunteers. Indian J Physiol Pharmacol. 2004;48:370–3.
    1. Monika, Singh U, Ghildiyal A, Kala S, Srivastava N. Effect of Yoga Nidra on physiological variables in patients of menstrual disturbances of reproductive age group. Indian J Physiol Pharmacol. 2012;56:161–7.
    1. Travis F, Haaga DA, Hagelin J, Tanner M, Nidich S, Gaylord-King C, et al. Effects of Transcendental Meditation practice on brain functioning and stress reactivity in college students. Int J Psychophysiol. 2009;71:170–6.
    1. Paul-Labrador M, Polk D, Dwyer JH, Velasquez I, Nidich S, Rainforth M, et al. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. 2006;166:1218–24.
    1. Stancák A, Jr, Kuna M, Srinivasan, Dostálek C, Vishnudevananda S. Kapalabhati – Yogic cleansing exercise. II. EEG topography analysis. Homeost Health Dis. 1991;33:182–9.
    1. Peng CK, Henry IC, Mietus JE, Hausdorff JM, Khalsa G, Benson H, et al. Heart rate dynamics during three forms of meditation. Int J Cardiol. 2004;95:19–27.
    1. Raghuraj P, Ramakrishnan AG, Nagendra HR, Telles S. Effect of two selected yogic breathing techniques of heart rate variability. Indian J Physiol Pharmacol. 1998;42:467–72.
    1. Telles S, Singh N, Balkrishna A. Heart rate variability changes during high frequency yoga breathing and breath awareness. Biopsychosoc Med. 2011;5:4.
    1. Santaella DF, Devesa CR, Rojo MR, Amato MB, Drager LF, Casali KR, et al. Yoga respiratory training improves respiratory function and cardiac sympathovagal balance in elderly subjects: A randomised controlled trial. BMJ Open. 2011;1:e000085.
    1. Peng CK, Mietus JE, Liu Y, Khalsa G, Douglas PS, Benson H, et al. Exaggerated heart rate oscillations during two meditation techniques. Int J Cardiol. 1999;70:101–7.
    1. Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L, Wdowczyc-Szulc J, et al. Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: Comparative study. BMJ. 2001;323:1446–9.
    1. Ghiya S, Lee CM. Influence of alternate nostril breathing on heart rate variability in non-practitioners of yogic breathing. Int J Yoga. 2012;5:66–9.
    1. Raghavendra B, Telles S, Manjunath N, Deepak K, Naveen K, Subramanya P. Voluntary heart rate reduction following yoga using different strategies. Int J Yoga. 2013;6:26–30.
    1. Jovanov E. On spectral analysis of heart rate variability during very slow yogic breathing. Ann Int Conf IEEE Eng Med Biol Proc. 2005;7:2467–70.
    1. Raghuraj P, Telles S. Immediate effect of specific nostril manipulating yoga breathing practices on autonomic and respiratory variables. Appl Psychophysiol Biofeedback. 2008;33:65–75.
    1. Selvaraj N, Shivplara NB, Bhatia M, Santhosh J, Deepak KK, Anand S. Heart rate dynamics during Shambhavi Mahamudra – A practice of Isha yoga. J Complement Integr Med. 2008;5:1–9.
    1. Muralikrishnan K, Balakrishnan B, Balasubramanian K, Visnegarawla F. Measurement of the effect of Isha Yoga on cardiac autonomic nervous system using short-term heart rate variability. J Ayurveda Integr Med. 2012;3:91–6.
    1. Telles S, Sharma SK, Balkrishna A. Blood pressure and heart rate variability during yoga-based alternate nostril breathing practice and breath awareness. Med Sci Monit Basic Res. 2014;20:184–93.
    1. Bhimani NT, Kulkarni NB, Kowale A, Salvi S. Effect of Pranayama on stress and cardiovascular autonomic function. Indian J Physiol Pharmacol. 2011;55:370–7.
    1. Jaju DS, Dikshit MB, Balaji J, George J, Rizvi S, Al-Rawas O. Effects of pranayam breathing on respiratory pressures and sympathovagal balance of patients with chronic airflow limitation and in control subjects. Sultan Qaboos Univ Med J. 2011;11:221–9.
    1. Kharya C, Gupta V, Deepak KK, Sagar R, Upadhyav A, Kochupillai V, et al. Effect of controlled breathing exercises on the psychological status and the cardiac autonomic tone: Sudarshan Kriya and Prana-Yoga. Indian J Physiol Pharmacol. 2014;58:211–21.
    1. Howorka K, Pumprla J, Heger G, Thoma H, Opavsky J, Salinger J. Computerised Assessment of Autonomic Influences of Yoga Using Spectral Analysis of Heart Rate Variability. In Engineering in Medicine and Biology Society, 1995 and 14th Conference of the Biomedical Engineering Society of India. An International Meeting, Proceedings of the First Regional Conference, IEEE; 1995
    1. Manjunath NK, Telles S. Effects of sirsasana (headstand) practice on autonomic and respiratory variables. Indian J Physiol Pharmacol. 2003;47:34–42.
    1. Pitale R, Tajane K, Phadke L, Joshi A, Umale J. Characteristics of HRV Patterns for Different Yoga Postures. In 11th IEEE India Conference: Emerging Trends and Innovation in Technology. INDICON 2014. 2015
    1. Melville GW, Chang D, Colagiuri B, Marshall PW, Cheema BS. Fifteen minutes of chair-based yoga postures or guided meditation performed in the office can elicit a relaxation response. Evid Based Complement Alternat Med 2012. 2012:501986.
    1. Sarang SP, Telles S. Effects of two yoga based relaxation techniques on heart rate variability (HRV) Int J Stress Manag. 2006;13:460–75.
    1. Vempati RP, Telles S. Baseline occupational stress level and physiological response to a two day stress management program. JIndian Psychol 2000. 2000:33–7.
    1. An H, Kulkarni R, Nagarathna R, Nagendra H. Measures of heart rate variability in women following a meditation technique. Int J Yoga. 2010;3:6–9.
    1. Patra S, Telles S. Heart rate variability during sleep following the practice of cyclic meditation and supine rest. Appl Psychophysiol Biofeedback. 2010;35:135–40.
    1. Khattab K, Khattab AA, Ortak J, Richardt G, Bonnemeier H. Iyengar yoga increases cardiac parasympathetic nervous modulation among healthy yoga practitioners. Evid Based Complement Alternat Med. 2007;4:511–7.
    1. Shapiro D, Cook IA, Davydov DM, Ottaviani C, Leuchter AF, Abrams M. Yoga as a complementary treatment of depression: Effects of traits and moods on treatment outcome. Evid Based Complement Alternat Med. 2007;4:493–502.
    1. Dolgoff-Kaspar R, Baldwin A, Johnson MS, Edling N, Sethi GK. Effect of laughter yoga on mood and heart rate variability in patients awaiting organ transplantation: A pilot study. Altern Ther Health Med. 2012;18:61–6.
    1. Papp ME, Lindfors P, Storck N, Wändell PE. Increased heart rate variability but no effect on blood pressure from 8 weeks of hatha yoga – A pilot study. BMC Res Notes. 2013;6:59.
    1. Shankarappa V, Prabha V. Study on effect of streching exercises and pranayama on heart rate variability (HRV) in healthy volunteers. Int J Pharma Bio Sci. 2013;4:120–26.
    1. Singh N, Telles S. Heart rate variability and state anxiety in hypertensives and diabetes after one week of yoga. JIndian Psychol. 2009;27:13–20.
    1. Venkatesh D, Vinay AV. Cardiac-respiratory response to short term practice of yoga. Res J Pharm Biol Chen Sci. 2014;5:1226–31.
    1. Niranjan M, Bhagyalakshmi K, Ganaraja B, Adhikari P, Bhat R. Effects of yoga and supervised integrated exercise on heart rate variability and blood pressure in hypertensive patients. JChin Clin Med. 2009;4:139–43.
    1. Satyapriya M, Nagendra HR, Nagarathna R, Padmalatha V. Effect of integrated yoga on stress and heart rate variability in pregnant women. Int J Gynaecol Obstet. 2009;104:218–22.
    1. Patil SG, Mullur LM, Khodnapur JP, Dhanakshirur GB, Aithala MR. Effect of yoga on short-term heart rate variability measure as a stress index in subjunior cyclists: A pilot study. Indian J Physiol Pharmacol. 2013;57:153–8.
    1. Huang CJ, Webb HE, Zourdos MC, Acevedo EO. Cardiovascular reactivity, stress, and physical activity. Front Physiol. 2013;4:314.
    1. Krishna BH, Pal P, Pal GK, Balachander J, Jayasettiaseelon E, Sreekanth Y, et al. Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure. J Clin Diagn Res. 2014;8:14–6.
    1. Sawane MV, Gupta SS. Resting heart rate variability after yogic training and swimming: A prospective randomized comparative trial. Int J Yoga. 2015;8:96–102.
    1. Nagendra H, Kumar V, Mukherjee S. Cognitive behavior evaluation based on physiological parameters among young healthy subjects with yoga as intervention. Comput Math Methods Med 2015. 2015:821061.
    1. Wolever RQ, Bobinet KJ, McCabe K, Mackenzie ER, Fekete E, Kusnick CA, et al. Effective and viable mind-body stress reduction in the workplace: A randomized controlled trial. J Occup Health Psychol. 2012;17:246–58.
    1. Telles S, Singh N, Joshi M, Balkrishna A. Post traumatic stress symptoms and heart rate variability in Bihar flood survivors following yoga: A randomized controlled study. BMC Psychiatry. 2010;10:18.
    1. Bidwell AJ, Yazel B, Davin D, Fairchild TJ, Kanaley JA. Yoga training improves quality of life in women with asthma. J Altern Complement Med. 2012;18:749–55.
    1. Cheema BS, Houridis A, Busch L, Raschke-Cheema V, Melville GW, Marshall PW, et al. Effect of an office worksite-based yoga program on heart rate variability: Outcomes of a randomized controlled trial. BMC Complement Altern Med. 2013;13:82.
    1. Chaya MS, Ramakrishnan G, Shastry S, Kishore RP, Nagendra H, Nagarathna R, et al. Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga. Natl Med J India. 2008;21:217–21.
    1. Friis AM, Sollers Iii JJ. Yoga improves autonomic control in males: A preliminary study into the heart of an ancient practice. J Evid Based Complement Alternat Med. 2013;18:176–82.
    1. Satin JR, Linden W, Millman RD. Yoga and psychophysiological determinants of cardiovascular health: Comparing yoga practitioners, runners, and sedentary individuals. Ann Behav Med. 2014;47:231–41.
    1. Lehrer P, Vaschillo E, Trost Z, France CR. Effects of rhythmical muscle tension at 0.1 Hz on cardiovascular resonance and the baroreflex. Biol Psychol. 2009;81:24–30.
    1. Vaschillo EG, Vaschillo B, Pandina RJ, Bates ME. Resonances in the cardiovascular system caused by rhythmical muscle tension. Psychophysiology. 2011;48:927–36.
    1. Lehrer PM, Vaschillo E, Vaschillo B. Resonant frequency biofeedback training to increase cardiac variability: Rationale and manual for training. Appl Psychophysiol Biofeedback. 2000;25:177–91.
    1. Wang SZ, Li S, Xu XY, Lin GP, Shao L, Zhao Y, et al. Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. J Altern Complement Med. 2010;16:1039–45.
    1. Vaschillo EG, Vaschillo B, Lehrer PM. Characteristics of resonance in heart rate variability stimulated by biofeedback. Appl Psychophysiol Biofeedback. 2006;31:129–42.
    1. Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. J Hypertens. 2001;19:2221–9.
    1. Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and chemoreflex response to hypoxia and hypercapnia. Lancet. 2000;356:1495–6.
    1. Lehrer P, Sasaki Y, Saito Y. Zazen and cardiac variability. Psychosom Med. 1999;61:812–21.
    1. Green EG. New York: Delacorte Press/S. Lawrence; 1977. Self regulation: East and west. Beyond biofeedback.
    1. Benson H. Body temperature changes during the practice of g Tum-mo yoga. Nature. 1982;298:402.
    1. Kozhevnikov M, Elliott J, Shephard J, Gramann K. Neurocognitive and somatic components of temperature increases during g-tummo meditation: Legend and reality. PLoS One. 2013;8:e58244.
    1. Cromie WJ. Meditation change temperature. Harvard University Gazette [Internet] 2002. Available from: . Cited on 2015 April 10.
    1. Khalsa SB. Yoga as a therapeutic intervention: A bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004;48:269–85.
    1. Chong CS, Tsunaka M, Tsang HW, Chan EP, Cheung WM. Effects of yoga on stress management in healthy adults: A systematic review. Altern Ther Health Med. 2011;17:32–8.

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