Effect of 12-week Practice of Anulom Vilom Pranayama as Adjunctive Therapy on the Cardiac Autonomic Balance, Cognition, Psychological Status, and Quality of Life in Individuals with Mild-to-Moderate Parkinson's Disease: A Randomized Controlled Trial.

Context: Patients with Parkinson's disease (PD) commonly experience cardiac autonomic dysfunction, cognitive impairment, and psychological disturbances. Limitations in current treatment modalities warrant the need for simple, cost-effective adjuvant therapies. Pranayama, a fundamental component of yoga, has been proven to be beneficial for several medical disorders.

Aim: This study aimed to assess the effects of the 12-week practice of Anulom Vilom Pranayama (AVP) or Alternate Nostril Breathing (ANB) as an adjunctive therapy on the cardiac autonomic balance, cognition, psychological status, and quality of life (QoL) in individuals with PD.

Subjects and methods: This randomized controlled trial involved 86 individuals (55 males, 31 females, aged 35-70 years) with mild-to-moderate PD. Participants were randomized into the control group receiving conventional treatment only or the test group receiving AVP as an adjunctive therapy to the conventional treatment. Cardiac autonomic status (heart rate variability [HRV]), cognition (P300, Reaction Time), affect, psychological status, and QoL were assessed in all the participants at baseline and after 12 weeks of respective intervention.

Statistical analysis: The change in study parameters (0-12 weeks) was compared between the control and test groups using the Mann-Whitney U test or Independent samples t-test. The correlation between the change in low-frequency (LF)/high-frequency (HF) ratio and QoL and its effect at 12 weeks was assessed using the Spearman correlation coefficient test. P < 0.05 was considered statistically significant.

Results: The test group revealed significantly high total HRV (standard deviation of normal-to-normal intervals [SDNN], total power) and HRV indices of cardiac parasympathetic activity (square root of the mean of the sum of the squares of differences between adjacent NN intervals [RMSSD], percentage of NN50 [pNN50], HF power, HF normalized unit) and significantly low HRV indices of cardiac sympathetic activity (LF normalized unit) and cardiac sympathovagal balance (LF/HF ratio) compared to the control group. Similarly, significant improvement in cognition, psychological status, and QoL was also observed in the test group. While significant correlations were observed between the change in LF/HF ratio and QoL in both the groups, a significant correlation between the change in LF/HF ratio and positive affect was observed only in the test group.

Conclusions: Twelve weeks of practice of AVP significantly improved the cardiac sympathovagal balance, cognition, positive affect, and QoL and decreased the negative affect, depression, stress, and anxiety in patients with mild-to-moderate PD.