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4. AIM AND OBJECTIVES
4.1 Aim of the research
1. To study and compile the available literature from traditional yogic scriptures on
Polycystic Ovarian Syndrome.
2. To find the prevalence of Polycystic Ovarian Syndrome among Indian adolescents.
3. To assess the effect of yoga based lifestyle program on adolescent Polycystic Ovarian
Syndrome, through a randomized control trial.
4.2 Objectives:
1. To explore the understanding of Polycystic Ovarian Syndrome according to traditional
yogic scriptures.
2. To estimate the prevalence of Polycystic Ovarian Syndrome among adolescent girls in
South India.
3. To investigate the effects of 12 weeks of integrated approach of yoga therapy (IAYT)
as a yoga based lifestyle program on clinical symptoms of adolescent polycystic
ovarian syndrome.
4. To study the changes in hormonal profile in PCOS adolescents after 12 weeks of
IAYT as a yoga based lifestyle program.
5. To assess the biochemical changes after 12 weeks of IAYT as a yoga based lifestyle
program on adolescent PCOS.
6. To study the effect of 12 weeks of IAYT as a yoga based lifestyle program on
psychological wellbeing of adolescent PCOS.
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4.3 Research Questions:
PART 1
Is the prevalence of PCOS in South Indian adolescents similar to the other countries?
PART 2
Is IAYT as/more effective than physical exercise therapy in improving clinical, hormonal,
biochemical and psychological functions in adolescent girls with PCOS?
4.4 Hypothesis:
4.4.1 PART 1: Prevalence of PCOS in Adolescent Girls
There was no hypothesis testing involved in the study as it was an effort to evaluate the
prevalence of the syndrome amongst the population that was being screened for the
interventional study.
4.4.2 PART 2: Effect of yoga on PCOS
The study hypothesized that in comparison to the matched control group practices, IAYT
practice would improve the clinical, hormonal, biochemical and psychological functions in
South Indian adolescent girls with PCOS.
4.4.3 Null hypothesis:
The yoga group will show changes similar to control group in clinical, hormonal,
biochemical and psychological functions.
64
5. METHODOLOGY OF EXPERIMENTAL RESEARCH
5.1 Subjects
The study was carried out on adolescent girls aged 15 to 18 years from a residential
college in Anantpur, Andhra Pradesh, India. Although they were students of one residential
college in Anantpur, they represented a larger geographical area as they were from semi-
urban and rural areas around the district.
5.1.1 Sample size
A sample size of 86 with 43 subjects in each arm of the study, was calculated keeping an
effect size of 0.61, with Type 1 error at 0.05 and power at 0.8. This effect size of 0.61 was
obtained by using mean and Standard Deviation values of testosterone after 6 months of
lifestyle modification and metformin compared to placebo in a study on obese PCOS women
(Tang T, Glanville J et al. 2006). For these calculations we used the noncommercial statistical
power analysis program G*Power (Faul F, Erdfelder E et al. 2009 Nov). The sample size that
was actually recruited was 90 subjects.
5.1.2 Source of subjects
Female students from Sri Sai residential college, Anantpur, Andhra Pradesh, South India
were screened and subsequently recruited into the study.
5.1.3 Selection Criteria
5.1.3.1 Inclusion Criteria
1. Adolescent girls aged 15-18 years
2. Girls with no prior experience of yoga.
3. Girls with BMI≥18.5.
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4. Those who satisfied the Rotterdam criterion for PCOS were included in the study.
The following were the definitions of the features:
a. Oligo/amenorrhea: absence of menstruation for 45 days or more and/or less
than eight menses per year (Kumarapeli V, Seneviratne RD et al. 2008).
b. Clinical hyperandrogenism: Modified Ferriman and Gallway (mFG) score
of 6 or higher (Chen X, Yang D et al. 2008). Using17 mF-G, some
researchers reported a value as low as 3, being abnormal. However, other
investigators have used the 95th 18 percentile of controls as the upper
normal limit, which 19 corresponds to an mF-G score of 6-8 in the
population studied. We used an mF-G score of 6 as the upper normal limit
in accordance with a study in South Asia by Chen et al (Chen X, Yang D et
al. 2008) since there are no studies defining the criteria for hirsutism in
Indian girls.
c. Biochemical hyperandrogenism: Serum testosterone level of > 82ng/dl in
the absence of other causes of Hyperandrogenism.
d. Polycystic ovaries: presence of >10 cysts, 2-8mm in diameter, usually
combined with increased ovarian volume of >10cm3, and an echo-dense
stroma in pelvic ultrasound scan (Franks S, Gharani N et al. 1997).
5.1.3.2 Exclusion Criteria
1. Girls who fall under Rotterdam criteria of exclusion.
2. Girls with BMI<18.5.
3. Girls who were using oral contraceptives/hormone treatment/insulin-sensitizing
agents within previous 6 weeks.
4. Girls who were practicing yoga from a month or more.
66
5.2 Ethical clearance and consent
The study was approved by the Institutional Ethical Committee of Swāmi Vivekānanda
Yoga Anusandhāna Samsthāna (SVYASA) University. The college administration also gave
the ascent for the study. Signed Informed consent was obtained from the student and one of
the parents. The consent form had clearly stated about the randomized allotment to either of
the interventions. The utility of the control session as a conventionally accepted therapeutic
regime (not as a placebo waiting period) was clarified so that they could participate in both
the interventions with equal degree of motivation.
5.3 Screening
All female students of standard 11 and 12 attended an interactive introductory lecture
where the purpose and design of the study were elucidated. They were asked to report one
week later after obtaining the signed consent from their parents.
All girls who consented for the study were asked to fill up a short PCOS symptoms check
list that asked questions on the pattern of menstrual cycle, hirsutism, acne, alopecia,
acanthosis nigricans and information about past diagnosis or treatment of PCOS or any other
illnesses. After one week, individual interviews were conducted to confirm statements in the
check list. The research medical officer conducted a physical examination to look for external
features of PCOS and also to exclude other conditions that could mimic PCOS such as
Cushing’s syndrome, adrenal Hyperplasia or androgen producing neoplasm. Questions were
asked about the use of Oral Contraceptive Pills or any other hormones that could affect the
length of the menstrual cycle. Self–reported degree of hirsutism was assessed using modified
Ferriman-Gallwey (mF-G) scoring method. The girls were asked to compare the amount of
body hair they had with a chart of pictures displaying the degree of hair growth in nine
regions (i.e., upper lip, chin, chest, upper and lower abdomen, upper and lower back, upper
arms, and thighs). Hirsutism scores recorded by the girls were checked for accuracy during
67
clinical examination by the researcher and corrected with the consent of the participant when
deemed necessary.
Also girls were asked about the presence of acne or hair fall from the scalp although it was
not quantified. All girls with Oligomenorrhea and/or hirsutism (as per the above said
definitions) were asked to come for pelvic ultrasound and biochemical investigations.
5.4 Design of the study
This was a prospective, randomized, active interventional controlled trial in which 90
participants were randomly divided into two study arms: one arm practiced yoga based life
style modification and the other arm practiced physical exercise based lifestyle modification,
in the absence of any conventional treatment, for the same duration.
5.5 Randomization
PCOS girls were randomly assigned to two groups of 45 numbers each by using a
computer-generated random number table (www.randomizer.org ) by the pre labeled sealed
envelope method.
5.6 Blinding and Masking
Double blinding was not possible as this was an interventional study. The medical officer,
ultrasonologist and the laboratory staff were blind to the groups. Also the statistician who did
the randomization and the final analysis was blind to the source of the data. The
questionnaires’ coded answer sheets were analyzed only after completion of the study.
5.7 Variables
Variable of the study was specifically chosen to provide a comprehensive picture of the
changes that were brought about by the intervention. Since IAYT has effects at several levels,
it was deemed essential to select variables that could capture them. This battery of variables
68
would help not just to highlight the clinical effects of the intervention but also lead us to
unearth the underlying mechanisms. Also these variables would help detect the differences
between yoga and exercise as an intervention for PCOS.
5.7.1 Symptom Check List
This was developed for the present study to obtain demographic details like clinical data,
personal and family history. (Table 4) Hirsutism was assessed using the scale provided along
with the check list:
Table 4: PCOS Symptom Check List
PERSONAL INFORMATION
1 Name
2 Age
3 Date of Birth
4 Class
5 Subjects
ANTHROPOMETRIC MESAURES
6 Height (meters)
7 Weight (kilogram)
8 BMI (kg/m2)
9 Waist (centimeters)
10 Hip (centimeters)
11 Waist : Hip Ratio
CLINICAL SYMPTOMS
12 Years since diagnosis
13 Cycle Characteristics Oligomenorrhea?
Longest Amenorrhea?
14 Acne (refer scale1) Sites:
Grade: Mild / Moderate / Severe
15 Alopecia (refer scale2) Grade: Mild / Moderate / Severe
16 Hirsutism (refer scale3)
Lip ________
Chin ________
Chest ________
Upper Abdomen ________
Lower Abdomen ________
Arms ________
Thighs ________
Upper Back ________
Lower Back ________
TOTAL ________ out of 36
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17 Acanthosis Nigricans Sites:
18 History DM ______ CVS ______
Cancer ______ Other ______
19 Family History DM _______ Sisters? ____ CVS _______
Cancer _______ Other _____
20 Genetics?
21 Treatments if any
22 Any Other Information
HIRSUTISM GRADING SYSTEM - The Ferriman- Gallwey Model
This scale quantifies the extent of hair growth in nine key anatomic sites. Hair growth is
graded using a scale from 0 to 4 for each site. The maximum score is 36 and a score more
than 8 indicates the presence of androgen excess.
SCORE SITE 1 2 3 4
Upper Lip
Chin
Chest
Upper Abdomen
Lower Abdomen
Arms
Thighs
Upper Back
Lower Back
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5.7.2 Laboratory assessment:
After obtaining the information for symptom check list, all girls with oligomenorrhea
and/or hirsutism (as per the above said definitions) were asked to come for laboratory
assessment.
Table 5: Techniques for objective measures
S.No. Parameter Via
1. Abdominal Ultrasound Philips HD 11XE ultrasound system.
Hormonal assessment
2. Luteinizing Hormone
Fasting sample of venous blood.
3. Follicle Stimulating Hormone
4. Serum Testosterone
5. Prolactin
6. Thyroid Stimulating Hormone
7. Anti Mullerian Hormone
8. Fasting Insulin
Insulin Resistance
HOMA-IR: Glucoe X Insulin/22.5 (when
glucose is in molar units mmol/L.)
BSIN: Blood sugar/ Insulin.
Biochemical assessment
9. Fasting Blood Sugar Fasting sample of venous blood.
Lipid Profile
10.1 Triglycerides
Fasting sample of venous blood.
10.2 Total cholesterol
10.3 High Density Lipoprotein
10.4 Low Density Lipoprotein
10.5 Very Low Density Lipoprotein
10.6 Tchl/HDL Total cholesterol/High Density Lipoprotein.
5.7.3 Psychological Assessment:
Stress, anxiety, emotion and quality of life were measured using following scales.
Table 6: Techniques for Psychological Variables
S.No. Variable Via
1. Measure of Anxiety State & Trait Anxiety X1
State & Trait Anxiety X2
2. Measure of Stress Perceived Stress Scale
3. Measures of Affect or
Measures of Emotion Positive Affect Negative Affect Scale
4. Measure of quality of life Polycystic Ovarian Syndrome Quality of Life
questionnaire
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According to the World Health Organization (2006) (WHO 2006), “Normally, emotions
such as anxiety, anger, pain or joy interact to motivate a person to a goal-directed action.
However, when certain emotions predominate and persist beyond their usefulness in
motivating people for their goal-directed behavior, they become morbid or pathological.” It is
therefore essential to evaluate and monitor emotional states in diagnosis and treatment just as
physicians in medical examinations routinely measure pulse rate, blood pressure, and
temperature, the vital signs that provide essential information about physical health.
When a physician detects an abnormal pulse or elevated blood pressure during a medical
examination, these symptoms may indicate a potentially significant problem in the
functioning of the cardiovascular system. Intense anxiety and anger may be considered as
analogous to elevations in pulse rate and blood pressure.
Similarly, as high fever may indicate that the immune system is not protecting the person
from harmful viruses; symptoms of depression and anxiety often reflect the presence of
pervasive unresolved conflicts that contribute to an emotional fever.
Manifestations of anxiety, anger, and depression are critical psychological vital signs that
are strongly related to an individual's well-being. Therefore, it is essential to evaluate the
emotional health by using appropriate psychological parameters.
5.7.3.1 State –Trait Anxiety Inventory (STAI)
STAI developed by Spielberger et al (1970) consists of 2 forms (Y1 and Y2) each
comprising of 20 items rated on a 4 point scale (Spielberger CD, Gorsuch RL et al. 1970).
Form Y1 assesses state anxiety, defined as ‘a transitory emotional state that varies in
intensity, fluctuates over time and is characterized by feelings of tension and apprehension
and by heightened activity of the autonomic nervous system’. It evaluates how the
respondents feel right now at this moment.
72
Form Y2 evaluates trait anxiety, which is ‘a relatively stable individual predisposition to
respond to situations perceived as threatening’.
The overall median alpha co-efficient is 0.92 and the tool has adequate concurrent,
convergent, divergent and construct validity (Spielberger CD, Gorsuch RL et al. 1970). It has
been extensively used in the Indian context and found to be useful.
5.7.3.2 Perceived Stress Scale
The Perceived Stress Scale is the only empirically established index of general stress
appraisal. The PSS is not a diagnostic instrument, so there are no cut-offs.
PSS-10 (Cohen S and Williamson G 1988) scores are obtained by reversing the scores on
the four positive items, e.g., 0=4, 1=3, 2=2, etc. and then summing across all 10 items. Items
4,5, 7, and 8 are the positively stated items. Scores can range from 0 to 40, with higher scores
indicating greater stress.
The Perceived Stress Scale (PSS) has adequate internal test and retest reliability is
correlated in the expected manner with a range of self-report and behavioral criteria. Cohen
and Williamson, proved internal reliability with a coefficient alpha of 0.78.
Earlier studies show that the relationships between PSS and the validity criteria were
unaffected by age and sex (Cohen S, Kamarck T et al. 1983). It was used for assessing
baseline stress scores.
5.7.3.3 The Positive and Negative Affect Schedule (PANAS):
Used as a psychometric scale, the PANAS shows relations between positive and negative
affect with personality stats and traits. Ten descriptors are used for each PA scale and NA to
define their meanings.
Participants in the PANAS are required to respond to a 20-item test using 5-point scale
that ranges from very slightly (1) to extremely (5)
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Reliability and Validity reported by Watson (Watson D, Clark LA et al. 1988) was
moderately good. For the Positive Affect Scale, the Cronbach alpha coefficient was 0.86 to
0.90; for the Negative Affect Scale, 0.84 to 0.87. Over an 8-week time period, the test-retest
correlations were 0.47-0.68 for the PA and 0.39-0.71 for the NA. The PANAS has strong
reported validity with such measures as general distress and dysfunction, depression, and state
anxiety.
5.7.3.4 Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire
(PCOSQ):
Polycystic Ovary Syndrome Questionnaire (PCOSQ), a questionnaire developed to
measure the health-related quality of life (HRQoL) of women with polycystic ovary syndrome
consists of a total of 26 items grouped into 5 domains: emotions (8 items), body hair (5
items), weight (5 items), infertility (4 items), and menstrual problems (4 items). Each question
is associated with a 7-point scale in which 7 represents optimal function and 1 represents the
poorest function. Scoring is done by dividing each domain total score by the number of items
in the domain. A score of less than 5 for any domain indicates significant adverse impact.
In year 2004, Jones et al (Jones GL, Benes K et al. 2004) showed that all PCOSQ
dimensions were internally reliable with Cronbach's a scores ranging from 0.70 to 0.97. Intra-
class correlation coefficients to evaluate test & retest reliability were high (range 0.89±0.95, P
< 0.001). Construct validity was demonstrated by high correlations for all comparisons of
similar scales of the SF-36 and PCOSQ (0.49 and 0.54).
5.7.4 Anthropometry:
Weight was measured using the research grade electronic weighing scale for pre and post
readings. Height was measured using a simple measuring tape. Body Mass Index (BMI) was
calculated using metric formula:
74
Metric BMI Formula
BMI = Weight in kilograms (kg)
Height in Meters 2 (m2)
Following are the cut off points of BMI for Asian population, as per the WHO criteria (WHO
expert consultation January 10, 2004). Therefore, all the girls with BMI ≥ 18.5 were included
in the study.
BMI Weight Status Categories
BMI Weight Status
Below 18.5 Underweight
18.5 – 23 Normal
>23 Overweight/obese
Waist circumference was measured at the midway between the lowest rib margin and iliac
crest, and hip circumference was measured at the widest trochanters using ongoing quality
control. Waist to hip ratio (WHR) was calculated:
Waist to Hip Ratio
WHR = Waist Circumference in meters (m)
Hip Circumference in meters (m)
5.7.5 Abdominal Ultrasound:
Abdominal ultrasound scanning of the pelvis with special attention on ovaries was carried
out by a certified postgraduate medical ultrasonologist using Philips HD 11XE ultrasound
system. Vaginal ultrasound scanning was not acceptable to the girls or the parents.
5.7.6 Hormonal assessment:
Fasting sample of venous blood (10ml) was drawn in the morning (6:00-8:00am) at the
hostel premises. The samples were packed in ice (3-4o C) and transported to the laboratory
within 6 hours. Serum was separated by centrifugation and stored at -20 C until it was
analyzed at certified laboratories. Post intervention blood sample was drawn after staying 5
days off the practice to find the effect of 3 months of training and not the residual effect of the
last session.
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Hormone estimates including total testosterone (TT), luteinizing hormone (LH), follicle-
stimulating hormone (FSH) and Prolactin (PRL), were done by Fully Automated
Bidirectionally Interfaced Chemi Luminescent Immuno Assay. Thyroid Stimulating Hormone
(TSH) was measured by Ultra Sensitive Sandwich Chemi Luminescent Immuno Assay.
Serum AMH levels was assessed by using a second generation enzyme immunoassay (AMH-
EIA kit; Immunotech A Beckman Coulter Company, Marseilles, France). The intra- and inter-
assay coefficients of variation were 5.1 & 6.6% respectively for AMH, 3.8 &4.3% for FSH,
4.9 & 6.5% for LH and 4.0 & 5.6% for testosterone. Serum insulin was estimated by Solid
Phase Radio Immuno Assay with an intra and inter assay coefficient of variation of 2.2% &
6.1% and specificity of 4ng/ml.
5.7.7 Biochemical assessment:
Total cholesterol (intra-assay coefficient of variation CV 0.8%, interassay CV 1.7%),
triglycerides (intra-assay CV 1.5%, interassay CV 1.8%), and glucose (intra-assay CV 0.9%,
interassay CV 1.8%) were measured using the enzymatic calorimetric method. HDL
cholesterol (intra-assay CV 2.9%, interassay CV 3.6%) was measured using a homogenous
calorimetric assay, whereas LDL cholesterol (intra-assay CV 0.9%, interassay CV 2.0%) was
measured using a homogenous turbidimetric assay.
5.7.8 Insulin Resistance:
Insulin resistance was measured through Homeostasis Model Assessment (HOMA).
HOMA was derived by calculating the product of fasting serum insulin- fasting serum
glucose, divided by a constant (Katz A, Nambi SS et al. 2000) which have been shown to be
reliable derived indices of insulin resistance.
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5.8 Intervention
The specific modules of intervention were developed by a team of experts that included a
physiatrist, a gynecologist and yoga therapy physician. Care was taken to match the lectures,
practical classes and the type of relaxation technique used in the two modules.
5.8.1 Yoga intervention
The concepts for the intervention were taken from traditional yoga scriptures (Patanjali
yoga sutras, Upaniśads and Yoga Vasishtha) that highlight a holistic approach to health
management at physical, mental, emotional and intellectual levels (Nagarathana R and
Nagendra HR 2001). The practices consisted of āsanas (yoga postures), prāņayama,
relaxation techniques, meditation, and lectures on yogic lifestyle and stress management
through yogic counseling. The physical practices progressed from Suryanamaskāra to final
yoga postures āsanas of four categories (prone, standing, supine and sitting) to provide
activation followed by deep rest to mind body complex based on scriptural reference
(Nagendra 2007). Prāņayama included yogic breathing practices to bring about a slow
rhythmic breathing pattern with exhalation longer than inhalation. (Nagendra HR and
Nagarathna R 2004).
Table 7: General benefits of IAYT (Nagarathana R and Nagendra HR 2001)
KOŚA TECHNIQUES EFFECTS
Annamaya Kośa
(AMK)
Kriya
Activating and revitalizing the organs
Toning up their functions
Desensitization
Development of deep internal awareness.
Āsana and
Suryanamaskāra
Physical revitalization,
Deep relaxation and
Mental calmness
Prāņamaya Kośa
(PMK)
Kriya Development of deep internal awareness
Titiksha – stamina building
Prāņayama
Regulation of breath
Remove the random agitations
in prāņa flows
Manomaya Kośa
(MMK) Dharāna
Culturing of mind accomplished by focusing
of the mind
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Dhyāna
Relaxed dwelling of the mind in a single
thought for longer and longer durations leads
to deep rest of the organs
Vijnānamaya
Kośa
(VMK)
Lecture & Yogic
Counseling
Knowledge burns the strong attachments,
obsessions, likes and dislikes which are the
basic reasons for the agitations of mind.
Anandamaya Kośa
(ANMK)
Working in
blissful awareness
Self-awareness and learn to maintain
equipoise (samatva) in all actions.
A module specific to PCOS was developed, keeping in mind the general benefits that
IAYT had to offer. This resulted in a fresh module, which would focus on the requirements of
PCOS girls. Table below shows the IAYT practices for PCOS and their respective benefits.
An attempt was made to elicit suggestions regarding the feasibility and applicability of
each of the practices selected as the yoga intervention for PCOS. A structured questionnaire
was prepared for this purpose and sent to 10 yoga researchers around the globe. This
questionnaire consisted of the list of practices that were included in the intervention and
responses were sought under five different factors (duration, stress reduction, androgen level
reduction, amenorrhea, weight). Of the 10 experts contacted 3 responded with opinions and
comments which is provided under (APPENDIX XIII). The resultant module has tried to
incorporate most of the feedback provided by the respondents. This effort fell short in its
purpose of obtaining adequate data to support a substantially valid intervention and if taken
forward could aide in validating a set of practices designed for an intervention. The results of
this study however, indirectly confirm the validity of the intervention.
Table 8: Benefits of IAYT practices in PCOS
PRACTICE TECHNIQUE ACTIVITY
Lecture/
counselling
To educate the mind about
ādhija vyādhi. “Awareness is half the solution”
Suryanamaskāra Exercise of all body parts.
AMK -Teasing out of fat from sub-
cutaneous tissue by repeated muscle work
outs
PMK-Harmonizing effect at prāņa level
Āsanas Sthira sukham āsanam AMK-Bring balance at prāņa level
Prone Maintain in final posture
effortlessness and expansion
AMK-Reduction of fat at shoulder and
buttock level
PMK- Balancing the prāņa
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Standing
AMK- Reduction of fat at limbs, buttocks
and abdominal regions
PMK- Opening of apāna
Supine
AMK- Reduction of fat at abdominal
region
PMK- Dislodges apāna
Sitting AMK- Reduction of fat at abdominal level
PMK- Opening of apāna
Relaxation Deep progressive relaxation
of the body/ mind
AMK, MMK- Stress reduction through
alertful rest (reduced sympathetic activity)
(Vempati RP and Telles S 2002)
Prāņayama Slowing down, improve
rhythm of breathing, AMK- Stress reduction
Vibhagiya
Prāņayama
Preparation for full yogic
breathing PMK- Balance prāņa
Kriya
(Kapalabhati)
Activate and cleanse lungs,
and brain
AMK- Vitalizes and releases locks in the
prāņic body
Suryanuloma
viloma
(evidence for weight
reduction)
AMK- Right nostril breathing increases
oxygen consumption by 28%. (Telles S,
Nagarathna R et al. 1994)
Nāḍi shuddhi
Balance surya and Chandra
nāḍis
Cleanses and balances
prāņa
PMK- Evidence for parasympathetic
dominance, useful for hypertension
(Srivastava RD, Jain N et al. 2005)
Meditation Stress reduction through
alertful rest
MMK- Increased mental alertness, even
while being physiologically relaxed shown
by the reduced heart rate (Telles S,
Nagarathna R et al. 1995)
The module of integrated approach of yoga therapy practice is prepared with following basic
structure:
1. First 8 minutes of the sessions was lectures focusing on various topics described below.
2. 12 minutes – Sunsalutation and QRT
3. 12 minutes – Yoga Āsana (prone, standing, inverted and sitting)
4. 10 minutes – Guided relaxation
5. 8 minutes – Prāņayama
6. 10 minutes - Meditation
The daily talk at the beginning of each class included topics that ensured the right
understanding of yoga as a tool for mind management and notional correction. These sessions
included specific topics as listed below
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a) Educational lectures on life style and
PCOS
b) Āsanas for mind mastery
c) Concept of yoga and health d) Prāņayama for mind mastery
e) Scriptural basis of yoga therapy f) Meditation for mind mastery
g) Definition of yoga as mind mastery h) Yogic diet for mind mastery
i) Techniques of yoga for therapy j) Yogic counselling using yama, niyama,
karma yoga and bhakti yoga for mind
mastery
All girls received at least one session (about one hour each) of individualized counseling
that was aimed at cognitive restructuring based on yoga philosophy. These interactive
sessions enhanced their ability to cope with their stresses such as interpersonal relationship
issues, peer pressure, examination tension, etc. using yogic concepts and answered their
medical queries about the prognosis of their disease, interpretation of the results of the
hormonal assays.
5.8.2 Control intervention
Table 9 shows the hour long module of practices for the control group that consisted of a
set of physical movements, non-yogic safe breathing exercises followed by supine rest
(without instructions) that were matched with the yoga module. The daily five minutes
lectures included the scientific information including causes of PCOS, life style and PCOS,
and the benefits of physical exercises. One session of counseling was ensured for the students
in the control group also. Care was taken by the counselors not to introduce any of the yogic
concepts during these sessions while addressing their concerns and educating them on healthy
life style including diet and exercise for weight and stress management.
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Table 9: Matched practices between yoga and exercise groups
YOGA GROUP Time EXERCISE GROUP Time
Group Lectures
Lectures, in the form of
cognitive restructuring based on
the spiritual philosophy
underlying yogic concepts.
8 min
Group Lectures
Lectures on conventional
modern medical concepts about
a healthy lifestyle including diet,
exercise.
15 min
Suryanamaskāra (Sun
Salutation) 12 min Brisk Walk 15 min
Prone Asanas
Cobra Pose (Bhujangasana)
Locust Pose (Salabhasana)
Bow Pose (Dhanurasana)
Prone Exercises
Prone Head Lift
Prone Leg Rising
Tiger Leg Stretch
1 min 1 min
1 min 1 min
1 min 1 min
Standing Asanas
Triangle Pose (Trikonasana)
Twisted Angle Pose (Parsva
konasana)
Spread Leg Intense Stretch
(Prasarita padottanasana)
Standing Exercises
Spread Leg Side Bending
Spread Leg Twisted Bending
Spread Leg Forward Bend
1 min 1 min
1 min 1min
1min 1 min
Supine Asanas
Inverted Pose (Viparita Karni)
Shoulder Stand (Sarvangasana)
Plough Pose (Halasana)
Supine Exercises
Straight leg raising
Straight Leg Supine Twist
Cycling (Clockwise – Counter
Clockwise)Bended knee
Crunches
1 min 1 min
1 min 1 min
1 min 1 min
Sitting Asanas
Sitting Forward Stretch
(Paschimottanasana)
Fixed angle Pose (Baddha
konasana)
Garland Pose (Malasana)
Sitting Exercises
Spread Leg Forward Bend
Spread Leg Alternate Toe
Touching
Squat pose
1 min 1 min
1 min 1 min
1 min 1 min
Guided relaxation (Savasana) 10 min Supine Rest 18 min
Breathing Techniques
(Prāņayama)
Sectional Breathing (Vibhagiya
Prāņayama) 2 min
Forceful Exhalation (Kapala
Bhati) 2 min
Right Nostril Breathing
(Suryanuloma Viloma) 2 min
Alternate Nostril Breathing
(Nāḍi Shuddhi) 2 min
Om Meditation 10 min
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6. DATA COLLECTION AND ANALYSIS
All statistical analyses were performed using SPSS version 17.0. The assumption that the
two groups have the same variances was tested by using the F-test. Kolmogorov–Smirnov test
was used to check for normal distribution which showed that the dataset was skewed and not
normally distributed.
As our hypothesis was to compare the changes after yoga with that of exercise. But the
data was not normally distributed, hence non-parametric analysis was done. Difference scores
(delta change) between the two groups was calculated by subtracting pre from post values for
each variable. Mann-Whitney U test was used to compare change score between the two
groups.