Effect of yogic practices and therapeutic exercise on forced expiratory volume of person with chronic obstructive pulmonary disease

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1. International Journal of Physical Education and Sports www.phyedusports.in Volume: 1, Issue: 2, Pages: 53-5 Effect of yogic practices and therapeutic exercise on forced expiratory volume of person with chronic obstructive pulmonary disease Dr. Sangeeta Singh 1 1 PDF Scholar, Department of Kayachikitsa, I.M.S. B.H.U. Varanasi, India Received August 28, 201 Objective: The purpose of the study was to find out the effect of yogic and therapeutic exercise on forced expiratory volume of person with chronic obstructive pulmonary disease. male from Varanasi those who are suffering from COPD (chronic bronchitis) and under treatment process of same at S.S. hospital, IMS, B.H.U was selected purposively as the subject of the study. The age of subjects 50 years. For the study pre test – grouped purposively into three groups (15 each). The first group 15 subjects were considered as control group, second 15 subjects were considered as experimental group A (Postural drainage with yogic practices), and last 15 subjects were considered as experimental group B (with postural drainage with therapeutic exercise). Forced expiratory volume was measured by pulmonary function test or Total lungs function test and scores was recorded in liters. technique: The data which was obtained from subject was analyzed statistically by the application of analysis of covariance (ANCOVA). The obtained “F” ratio was te the study showed that there is significant effect of yogic and therapeutic exercise program on forced expiratory volume. It is concluded that yogic exercise program have better effect therapeutic exercise. Key words: Yogic exercise, therapeutic exercise, forced expiratory volume & pulmonary function test. 1. Introduction COPD is a disease state characterized by chronic airflow limitatio Chronic obstruction must be documented before a diagnosis of COPD is made. The obstruction can be caused by chorine bronchitis or by emphysema on forced exhalation, a patients with COPD does not empty the lungs to n result, the functional residual capacity (FRC) and the residual volume (RV) are increased. Exercise induced tachypnea can then increase the amount of air increase the amount of air trapped, a phenomena called dynamic hyperinflation. The severity of exercise induced dyspnea correlates well with the degree of hyperinflation. As the lungs become more and more inflated, the diaphragm is displaced downward, increasing the amount of pressure required to move air, and decreasing the capacity of the diaphragm to generate pressure. Treatment of COPD consists of bronchodilators, antibiotics, airway clearance and nutritional therapy. About 95% of people with COPD are, or have been, cigarette smokers. There is wide variability in the rate of decline in pulmonary function in persistent smokers, with about 10 reflect a genetic susceptibility. Les s common causes of COPD are exposure to air pollution (including biomass fuels in the developing world) and inherite persistent airflow obstruction, with most people showing limited reversibility in response to a bronchodilator; however, about 10% of people with COPD do show considerable br and have a mixed inflammatory pattern in the airways, which probably represents an overlap between asthma and COPD (wheezy bronchitis). The airflow obstruction in COPD is usually s lowly progre of decreased bronchial luminal diameter (produced by wall thickening, intraluminal mucus and changes in the fluid lining the small airways) and dynamic airways collapse due to emphysema. It is often accompanied by chron (production of mucoid sputum for all or part of the year). The most frequent symptoms of COPD are gradually progressive breathlessness and cough. The cough is often productive and usually worse in the morning, but its severity is unrelated to International Journal of Physical Education and Sports 58, Year: 2016 Effect of yogic practices and therapeutic exercise on forced expiratory volume of person with chronic obstructive pulmonary disease PDF Scholar, Department of Kayachikitsa, I.M.S. B.H.U. Varanasi, India , 2016; Accepted September 22, 2016; Published September 30, 2016 Abstract The purpose of the study was to find out the effect of yogic and therapeutic exercise on forced expiratory volume of person with chronic obstructive pulmonary disease. Methods: For the purpose of this study 45 male from Varanasi those who are suffering from COPD (chronic bronchitis) and under treatment process of same at S.S. hospital, IMS, B.H.U was selected purposively as the subject of the study. The age of subjects post test randomized group design was used and involving 45 subjects who were grouped purposively into three groups (15 each). The first group 15 subjects were considered as control group, second 15 subjects were considered as experimental group A (Postural drainage with yogic practices), and last 15 subjects were considered as experimental group B (with postural drainage with therapeutic exercise). Forced expiratory volume was y function test or Total lungs function test and scores was recorded in liters. The data which was obtained from subject was analyzed statistically by the application of analysis of covariance (ANCOVA). The obtained “F” ratio was tested at .05 level of significance. Results & Conclusion: the study showed that there is significant effect of yogic and therapeutic exercise program on forced expiratory volume. It is concluded that yogic exercise program have better effect for improvement of COPD patients in compare to Yogic exercise, therapeutic exercise, forced expiratory volume & pulmonary function test. COPD is a disease state characterized by chronic airflow limitation with or without airway hyerreactivity. Chronic obstruction must be documented before a diagnosis of COPD is made. The obstruction can be caused by chorine bronchitis or by emphysema on forced exhalation, a patients with COPD does not empty the lungs to n result, the functional residual capacity (FRC) and the residual volume (RV) are increased. Exercise induced tachypnea can then increase the amount of air increase the amount of air trapped, a phenomena called dynamic hyperinflation. The severity of exercise induced dyspnea correlates well with the degree of hyperinflation. As the lungs become more and more inflated, the diaphragm is displaced downward, increasing the amount of pressure required to move air, and the diaphragm to generate pressure. Treatment of COPD consists of bronchodilators, antibiotics, airway clearance and nutritional therapy. About 95% of people with COPD are, or have been, cigarette smokers. There is wide variability in the rate of n pulmonary function in persistent smokers, with about 10–20% showing an accelerated decline that may reflect a genetic susceptibility. Les s common causes of COPD are exposure to air pollution (including biomass fuels in the developing world) and inherited α1-antiprotease deficiency. COPD is a symptom complex that is characterized by persistent airflow obstruction, with most people showing limited reversibility in response to a bronchodilator; however, about 10% of people with COPD do show considerable bronchodilator-induced reversibility of the airflow obstruction, and have a mixed inflammatory pattern in the airways, which probably represents an overlap between asthma and COPD (wheezy bronchitis). The airflow obstruction in COPD is usually s lowly progressive and results from a combination of decreased bronchial luminal diameter (produced by wall thickening, intraluminal mucus and changes in the fluid lining the small airways) and dynamic airways collapse due to emphysema. It is often accompanied by chron (production of mucoid sputum for all or part of the year). The most frequent symptoms of COPD are gradually progressive breathlessness and cough. The cough is often productive and usually worse in the morning, but its severity is unrelated to the degree of airflow obstruction. Repeated ISSN- 2456-2963 Effect of yogic practices and therapeutic exercise on forced expiratory volume of person with chronic obstructive pulmonary disease September 30, 2016 The purpose of the study was to find out the effect of yogic and therapeutic exercise on forced For the purpose of this study 45 male from Varanasi those who are suffering from COPD (chronic bronchitis) and under treatment process of same at S.S. hospital, IMS, B.H.U was selected purposively as the subject of the study. The age of subjects was ranged between 40 to post test randomized group design was used and involving 45 subjects who were grouped purposively into three groups (15 each). The first group 15 subjects were considered as control group, second 15 subjects were considered as experimental group A (Postural drainage with yogic practices), and last 15 subjects were considered as experimental group B (with postural drainage with therapeutic exercise). Forced expiratory volume was y function test or Total lungs function test and scores was recorded in liters. Statistical The data which was obtained from subject was analyzed statistically by the application of analysis of Results & Conclusion: The results of the study showed that there is significant effect of yogic and therapeutic exercise program on forced expiratory volume. for improvement of COPD patients in compare to Yogic exercise, therapeutic exercise, forced expiratory volume & pulmonary function test. n with or without airway hyerreactivity. Chronic obstruction must be documented before a diagnosis of COPD is made. The obstruction can be caused by chorine bronchitis or by emphysema on forced exhalation, a patients with COPD does not empty the lungs to normal levels. As a result, the functional residual capacity (FRC) and the residual volume (RV) are increased. Exercise induced tachypnea can then increase the amount of air increase the amount of air trapped, a phenomena called dynamic hyperinflation. The severity of exercise induced dyspnea correlates well with the degree of hyperinflation. As the lungs become more and more inflated, the diaphragm is displaced downward, increasing the amount of pressure required to move air, and the diaphragm to generate pressure. Treatment of COPD consists of bronchodilators, About 95% of people with COPD are, or have been, cigarette smokers. There is wide variability in the rate of 20% showing an accelerated decline that may reflect a genetic susceptibility. Les s common causes of COPD are exposure to air pollution (including biomass fuels in antiprotease deficiency. COPD is a symptom complex that is characterized by persistent airflow obstruction, with most people showing limited reversibility in response to a bronchodilator; however, induced reversibility of the airflow obstruction, and have a mixed inflammatory pattern in the airways, which probably represents an overlap between asthma and ssive and results from a combination of decreased bronchial luminal diameter (produced by wall thickening, intraluminal mucus and changes in the fluid lining the small airways) and dynamic airways collapse due to emphysema. It is often accompanied by chronic bronchitis The most frequent symptoms of COPD are gradually progressive breathlessness and cough. The cough is often the degree of airflow obstruction. Repeated

2. Singh, 2016 Int. J. Phy. Edu. Spo., 1(2): 53-58. ISSN- 2456-2963 [54] © International Journal of Physical Education and Sports (IJPES) respiratory infections are common, and are often associated with exacerbations of the airflow obstruction and symptomatic deterioration. 2. Methodology For the purpose of study 45 male patients from Varanasi those who are suffering from COPD (chronic bronchitis) and under treatment process of same at S.S. hospital, IMS, B.H.U was selected purposively as the subject of the study. The age of subjects was ranged between 40 to 50 years. For the study pre test – post test randomized group design was used and involving 45 subjects who were grouped purposively into three groups (15 each). The first group 15 subjects were considered as control group, second 15 subjects were considered as experimental group A (Postural drainage with yogic practices), and last 15 subjects were considered as experimental group B (with postural drainage with therapeutic exercise). Control Group O1 O2 Yogic Group O3 T1 O4 Therapeutic exercise Group O5 T2 O6 O = Observation, T = Treatment Forced expiratory volume was measured by pulmonary function test or Total lungs function test and scores was recorded in liters. The experiment group A was taken 6 weeks yogic exercise training, in this training program only Pranayam exercise performed by subjects. The experimental group B was taken 6 weeks therapeutic exercise, in this program only breathing exercise performed by the subjects. The data which was obtained from subject was analyzed statistically by the application of analysis of covariance (ANCOVA). The obtained “F” ratio was tested at .05 level of significance. 3. Findings The data are analyzed and the results pertaining to Descriptive Statistics of Experimental Group (Yogic and therapeutic exercise group) and Control Group in relation to Forced expiratory volume are presented with the help of table 1. Table 1 Descriptive Statistics of Yogic exercise group, Therapeutic exercise group and Control Group in relation to Forced expiratory volume N Mean Std. Deviation Std. Error Minimum Maximum Pre Test Yogic Group 15 1.196 0.227 0.058 0.80 1.60 Therapeutic Group 15 1.148 0.211 0.054 0.80 1.40 Control Group 15 1.198 0.215 0.055 0.80 1.50 Post Test Yogic Group 15 1.390 0.200 0.051 1.08 1.77 Therapeutic Group 15 1.302 0.133 0.035 1.12 1.52 Control Group 15 1.216 0.207 0.053 0.80 1.50 Table 1 clearly indicates that the mean and standard deviations of forced expiratory volume at different groups (yogic exercise group, therapeutic exercise group, and control groups). The observed mean and standard deviation of pre test, forced expiratory volume of yogic exercise group 1.196+0.227, Therapeutic exercise group 1.148+0.211 & control group 1.198+0.215; and Post test, forced expiratory volume of yogic exercise group 1.390+0.200, Therapeutic exercise group 1.302+0.133, & Control group 1.216+0.207 are respectively. The data are further analyzed with the help of analysis of variance to find out the significance difference between means of pre-test and post test of yogic exercise group, therapeutic exercise group and control group in relation to forced expiratory volume. The results are presented in the table no 2.

3. Singh, 2016 Int. J. Phy. Edu. Spo., 1(2): 53-58. ISSN- 2456-2963 [55] © International Journal of Physical Education and Sports (IJPES) Table 2 Analysis of Variance of Comparison of Means of Yogic exercise group, Therapeutic exercise group and Control Group in Relation to forced expiratory volume Source of variance Sum of Squares df Mean Square F Sig. Pre Test Between Groups 0.024 2 0.012 0.256 0.775Within Groups 1.999 42 0.048 Total 2.024 44 Post Test Between Groups 0.227 2 0.114 3.347* 0.045Within Groups 1.425 42 0.034 Total 1.652 44 Table 2 revealed that, the pre test obtained ‘F’ value of 0.256 is found to be no significant at 0.05 level, explains the random assignment of subjects to yogic exercise group, Therapeutic exercise group and control group is quite successful. In relation to post test, significant difference is found among yogic exercise group, Therapeutic exercise group and control group pertaining to forced expiratory volume. Table 3 Adjusted post test means of yogic exercise group, Therapeutic exercise group and control group in relation to forced expiratory volume Groups Mean Std. Error Yogic Group 1.378 0.016 Therapeutic Group 1.329 0.016 Control Group 1.202 0.016 From the table 3, it is revealed that mean of yogic exercise group is 1.378 with the standard error of 0.016 and mean of therapeutic exercise group is 1.329 with the standard error of 0.016, whereas the mean of control group is 1.202 with the standard error of 0.016. The data are analyzed and the results pertaining to analysis of co-variance among yogic exercise group, Therapeutic exercise group and control group of COPD person in relation to forced expiratory volume for pre test -post test respectively and the results are presented in table 4. Table 4 Analysis of Covariance of Comparison of Adjusted post test means of yogic exercise group, Therapeutic exercise group and Control Group in relation to forced expiratory volume Sum of Squares df Mean Square F Sig. Contrast 0.248 2 0.124 33.764* .000 Error 0.150 41 0.004 Table 4 revealed that, the obtained ‘F’ value of 33.764 is found significant at 0.05 levels. This result indicates that the treatment (yogic and therapeutic exercise) is given to subjects has increase forced expiratory volume of subjects, but which treatment group is better to other treatment group, LSD post hoc test is applied. Table 5 LSD Post-hoc Test for the comparison of paired means of yogic exercise group, Therapeutic exercise group and Control Group in relation to forced expiratory volume (I) Group (J) Group Mean Difference (I-J) Std. Error Sig. Control Yogic 0.176* 0.022 .000 Therapeutic 0.127* 0.022 .000 Yogic Therapeutic 0.049* 0.022 .033 It is evident from table 5 that significant difference is found between adjusted final mean scores of control group & yogic exercise group, control group & therapeutic exercise group and Yogic group and therapeutic exercise

4. Singh, 2016 Int. J. Phy. Edu. Spo., 1(2): 53-58. © International Journal of Physical Education and Sports (IJPES) group, it is evident that both yogic and therapeutic exercise program have effect on forced expiratory volume of subjects, after comparison of mean scores of yogic group, therapeutic exercise group and control group, yogic exercise group have higher mean compare to therapeutic exercise g is better exercise program for the improvement of forced expiratory volume of subjects. The Graphical representation of mean of yogic group, therapeutic exercise group and control group in to forced expiratory volume is presented with the help of figure. The Graphical representation of mean scores of yogic exercise group, therapeutic exercise group and control group 4. Discussion of Findings In this present study, there is significant effect of yogic and therapeutic exercise program on forced expiratory volume. Significant difference between the adjusted means of the control group and yogic exercise group on the data of forced expiratory volume during post testing. Significant difference between the adjusted means of the control group and therapeutic exercise group on the data of forced expiratory volume during post testing. Significant difference between the adjusted means of the y during post testing. The pulmonary function tests before and after 6 weeks of Yogic (Pranayama) and therapeutic exercises were assessed. Forced expiratory volume (FRV1) is therapeutic exercises. This indicates that there is some degree of broncho oxygenation of the alveoli. Endurance power of the lungs also improved as voluntary ventilation. Improvement in PFTs in the study could be because of reduction of sympathetic reactivity attained with Pranayama training. This may allow bronchio reducing the muscle tone of inspiratory and expiratory muscles. Due to improved breathing patterns, respiratory bronchioles may be widened and perfusion of a large number of alveoli can be carried out efficiently. In response to variations in breathing patterns a number of central and autonomic nervous system mechanisms as well as mechanical (heart) and hemodynamic adjustments are also triggered, thereby causing both tonic and phasic change in cardiovascular functioning. Hence, it can be said that complications by emphasizing optimal physical and mental conditioning. The result of the study is in consonance with the findings of Sud Sushant Sud Khyati S (2013), The benefits includes the prol in PEFR (Peak Expiratory Flow Rate), FVC (Forced Vital Capacity), FEV1 (Forced Vital capacity in 1 second), MVV (Maximum Voluntary Ventilation) and lowered respiratory rate. Patients of chronic lung diseases like A Emphysema, COPD, etc. may derive immense benefits from these changes in pulmonary functions. 5. Conclusion On the basis of the interpretation of data the following conclusion were drawn from this study. It is concluded that there is volume. • It is concluded that there is a significant difference between the adjusted means of the control group and yoga group on the data of forced expiratory volume during po 1.1 1.2 1.3 1.4 Yogic Group © International Journal of Physical Education and Sports (IJPES) ogic and therapeutic exercise program have effect on forced expiratory volume of subjects, after comparison of mean scores of yogic group, therapeutic exercise group and control group, yogic exercise group have higher mean compare to therapeutic exercise group and control group, which is indicate that yogic exercise is better exercise program for the improvement of forced expiratory volume of subjects. The Graphical representation of mean of yogic group, therapeutic exercise group and control group in to forced expiratory volume is presented with the help of figure. Figure The Graphical representation of mean scores of yogic exercise group, therapeutic exercise group and control group in relation to forced expiratory volume In this present study, there is significant effect of yogic and therapeutic exercise program on forced expiratory volume. Significant difference between the adjusted means of the control group and yogic exercise group on the data of atory volume during post testing. Significant difference between the adjusted means of the control group and therapeutic exercise group on the data of forced expiratory volume during post testing. Significant difference between the adjusted means of the yogic group and therapeutic exercise group on the data of forced expiratory volume The pulmonary function tests before and after 6 weeks of Yogic (Pranayama) and therapeutic exercises were assessed. Forced expiratory volume (FRV1) is found significantly improved after 6 weeks of Yogic (Pranayama) and therapeutic exercises. This indicates that there is some degree of broncho-dilatation, which is leading to better oxygenation of the alveoli. Endurance power of the lungs also improved as shown by improvement in maximum voluntary ventilation. Improvement in PFTs in the study could be because of reduction of sympathetic reactivity attained with Pranayama training. This may allow bronchio-dilatation by correcting the ab-normal breathing patte reducing the muscle tone of inspiratory and expiratory muscles. Due to improved breathing patterns, respiratory bronchioles may be widened and perfusion of a large number of alveoli can be carried out efficiently. In response to thing patterns a number of central and autonomic nervous system mechanisms as well as mechanical (heart) and hemodynamic adjustments are also triggered, thereby causing both tonic and phasic change in cardiovascular functioning. Hence, it can be said that Pranayama breathing may prevent serious cardio complications by emphasizing optimal physical and mental conditioning. The result of the study is in consonance with the findings of Sud Sushant Sud Khyati S (2013), The benefits includes the prolongation of breath holding time, increase in PEFR (Peak Expiratory Flow Rate), FVC (Forced Vital Capacity), FEV1 (Forced Vital capacity in 1 second), MVV (Maximum Voluntary Ventilation) and lowered respiratory rate. Patients of chronic lung diseases like A Emphysema, COPD, etc. may derive immense benefits from these changes in pulmonary functions. On the basis of the interpretation of data the following conclusion were drawn from this study. It is concluded that there is significant effect of yoga and therapeutic exercise program on forced expiratory It is concluded that there is a significant difference between the adjusted means of the control group and yoga group on the data of forced expiratory volume during post testing. Yogic Group Therapeutic Group Control Group Mean ISSN- 2456-2963 [56] © International Journal of Physical Education and Sports (IJPES) ogic and therapeutic exercise program have effect on forced expiratory volume of subjects, after comparison of mean scores of yogic group, therapeutic exercise group and control group, yogic exercise roup and control group, which is indicate that yogic exercise The Graphical representation of mean of yogic group, therapeutic exercise group and control group in relation The Graphical representation of mean scores of yogic exercise group, therapeutic exercise group and control group In this present study, there is significant effect of yogic and therapeutic exercise program on forced expiratory volume. Significant difference between the adjusted means of the control group and yogic exercise group on the data of atory volume during post testing. Significant difference between the adjusted means of the control group and therapeutic exercise group on the data of forced expiratory volume during post testing. Significant difference ogic group and therapeutic exercise group on the data of forced expiratory volume The pulmonary function tests before and after 6 weeks of Yogic (Pranayama) and therapeutic exercises were found significantly improved after 6 weeks of Yogic (Pranayama) and dilatation, which is leading to better shown by improvement in maximum voluntary ventilation. Improvement in PFTs in the study could be because of reduction of sympathetic reactivity attained normal breathing patterns and reducing the muscle tone of inspiratory and expiratory muscles. Due to improved breathing patterns, respiratory bronchioles may be widened and perfusion of a large number of alveoli can be carried out efficiently. In response to thing patterns a number of central and autonomic nervous system mechanisms as well as mechanical (heart) and hemodynamic adjustments are also triggered, thereby causing both tonic and phasic change in Pranayama breathing may prevent serious cardio-respiratory complications by emphasizing optimal physical and mental conditioning. The result of the study is in consonance with ongation of breath holding time, increase in PEFR (Peak Expiratory Flow Rate), FVC (Forced Vital Capacity), FEV1 (Forced Vital capacity in 1 second), MVV (Maximum Voluntary Ventilation) and lowered respiratory rate. Patients of chronic lung diseases like Asthma, Bronchitis, Emphysema, COPD, etc. may derive immense benefits from these changes in pulmonary functions. On the basis of the interpretation of data the following conclusion were drawn from this study. significant effect of yoga and therapeutic exercise program on forced expiratory It is concluded that there is a significant difference between the adjusted means of the control group and Yogic Group Therapeutic Group Control Group

5. Singh, 2016 Int. J. Phy. Edu. Spo., 1(2): 53-58. ISSN- 2456-2963 [57] © International Journal of Physical Education and Sports (IJPES) • It is concluded that there is a significant difference between the adjusted means of the control group and therapeutic exercise group on the data of forced expiratory volume during post testing. • It is concluded that there is a significant difference between the adjusted means of the yoga group and therapeutic exercise group on the data of forced expiratory volume during post testing. 6. Practical Applications The results of this study provide insight into yogic and therapeutic exercise program for improvement of forced expiratory volume of COPD patients. However COPD patients are suffering from breathing problem in during period of disease. This research paper provides better knowledge for improvement of COPD patients through Yogic exercise and therapeutic exercise program. 6. References [1]. Bandy William D., & Barbara Sanders., (2008). Therapeutic Exercise for physical Therapist Assistants techniques for intervention. Lippincott Williams & Wilkins Ltd., China. [2]. Barnes Peter J., Drazen Jeffery M., Rennard Stephen I., & Thomson Neil C., (2009). Asthma and COPD. Academic Press. London. [3]. Cazzola Mario, Sethi Sanjay, Blasi Francesco, Anzueto Antonio. (2009). Therapeutic Strategies; Acute Exacerbations in COPD. Clinical Publishing, Oxford, UK. [4]. Colson John H. C. & Collison Frank W. (1983). Progressive Exercise therapy in rehabilitation and physical Education. John Wright & Sons Ltd, England. [5]. Fields Gregory P. (2001). Religious Therapeutics; Body and Health in Yoga, Ayurveda, and Tantra. State University of New York Press, Albany. [6]. Hanania Nicola A. & Sharafkhaneh Amir. (2011). COPD; A Guide to Diagnosis and Clinical Management. Humana Press, London. [7]. Kisner Carolyn & Colby Lynn Allen. (2002). Therapeutic Exercise; Foundations and Techniques. Library of Congress Cataloging-in-Publication, Philadelphia. [8]. Vinay A V, and Venkatesh D (2014). Cardio-Respiratory Changes in Response to Short Term Practice of Yoga. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 1226-1231. [9]. E Beekman, I Mesters, EJ Hendriks, JW Muris, G Wesseling, SM Evers, GM Asijee, A Fastenau, HN Hoffenkamp, R Gosselink, OC van Schayck, RA de Bie (2014). Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial. BMC Pulmonary Medicine;14:71. [10].ÉKh Akhmetzianova, VV Gaĭnitdinova, AB Bakirov, OA Bogoroditskaia, IR Timershina. (2012). Effect of ivabradine on pulmonary hypertension in chronic obstructive pulmonary disease. Kardiologiia.52(2):41-6. [11].Sonali S. Sakhare and B. H. Pawar (2012). Roll of Pranayam breathing on human electrocardiogram at different temperatures. International journal of computing and corporate research. Volume 2, Issue 2. [12].Soni R, Munish K, Singh K, Singh S (2012). Study of the effect of yoga training on diffusion capacity in chronic obstructive pulmonary disease patients: A controlled trial. International Journal of Yoga, 5(2):123-7. [13].SS Akrabawi, S Mobarhan, RR Stoltz, PW Ferguson. (1996). Gastric emptying, pulmonary function, gas exchange, and respiratory quotient after feeding a moderate versus high fat enteral formula meal in chronic obstructive pulmonary disease patients. Nutrition. 12(4):260-5. [14].ST Cheng, YK Wu, MC Yang, CY Huang, HC Huang, WH Chu, CC Lan. (2014). Pulmonary rehabilitation improves heart rate variability at peak exercise, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease. Heart & Lung: The journal of critical care,43(3):249-55. [15].Sud Sushant and Sud Khyati S (2013). Effect of Pranayama on Pulmonary Functions - An Overview. International Ayurvedic Medical Journal, 1(2). [16].Taneja DK (2014).Yoga and health. Indian Journal of Community Medicine. 39(2):68-72.

6. Singh, 2016 Int. J. Phy. Edu. Spo., 1(2): 53-58. ISSN- 2456-2963 [58] © International Journal of Physical Education and Sports (IJPES) [17].Umang Shah, Jayalakshmi T.K, Lavina Mirchandani, Aparna Iyer, Abhay Uppe and Girija Nair (2014). COPD Phenotypes according to HRCT findings. D Y Patil Journal of Health Sciences. Volume 1 Issue 2 : 1-6. [18].Usmani ZA, Carson KV, Cheng JN, Esterman AJ, Smith BJ. (2011). Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. (11):CD008483. Corresponding Author: Dr. Sangeeta Singh, PDF Scholar, Department of Kayachikitsa, I.M.S. B.H.U., Varanasi (U.P), India.

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