Yoga asanas meet medicine: What medical research at AIIMS, Delhi, shows

Yoga asanas are chosen according to the requirements of patients

70-A-yoga-session Hale and hearty: A yoga session at the Centre for Integrative Medicine and Research, at AIIMS, Delhi | Sanjay Ahlawat

As I stepped into All India Institute of Medical Sciences, Delhi, I was swallowed by a maze of corridors. The queue in front of the pharmacy zigzagged between different buildings. Lanes and passages crisscrossed each other, and suddenly I had to make way for ambulances or patients being carried on stretchers. In the melee, sweepers quickly did their work. There was madness, yes, but with a method to it.

We sit with a yoga teacher and discuss which asana suits a particular patient. Each patient has to spend an hour every day, and come to the centre five days a week. There is a visible change. ―Dr Rima Dada, professor, lab for molecular reproduction and genetics, department of anatomy, AIIMS
When I present papers abroad and get their recognition for yoga, it feels as if I have won a medal for Team India at the Olympics. ―Dr Gautam Sharma, professor of cardiology and founder, professor-in-charge of the CIMR

AIIMS has been India’s leading medical facility since 1956. The top government medical college and hospital is teeming with patients―from the low-income and middle-class households who come for quality and affordable care, to the VVIPs who come for expert opinion or care.

Now, AIIMS has also become the epicentre of yoga research in the country. Doctors and researchers are exploring therapeutic effects of yoga to combine it with modern medicine, and to evolve fresh guidelines for clinical practice. As Yoga has been India’s cultural property, scientists and academicians worldwide are taking keen interest in the research at AIIMS.

In 2016, AIIMS set up the Centre for Integrative Medicine and Research (CIMR), where practitioners of modern medicine collaborate with practitioners of yoga and ayurveda. Then, there are individual researchers like Dr Rima Dada, professor at the lab for molecular reproduction and genetics, department of anatomy. Since 2008, Dada has been studying the impact of yoga on rheumatoid arthritis, glaucoma, depression and male infertility.

Yoga research in AIIMS is usually funded by the Union ministries of Ayush, science and technology, and health. In some cases, the Indian Council of Medical Research (ICMR) steps in. “These studies are funded by Ayush, ICMR, etc, and have been provided evidence for the scientific basis of yoga in management of these studies," said Dada.

Case studies are split into two groups, with one on medicines alone and the other on medicines and yoga. Said Dada, “The case studies, or the patients, come to our yoga lab and attend the yoga sessions, as advised by a certified yoga teacher. Each case is diagnosed with yoga therapist—which asana suits a particular patient, and how one should go about with a particular patient. Each patient has to spend an hour every day, and come to the centre five days a week. There is a change in their problems when they complete the yoga session, in AIIMS, at the end of three months. They are then asked to continue doing yoga at home. We keep watch on them.”

Dada said her research showed that yoga reduces the severity of many diseases and helps in the re-establishment of immunological tolerance by acting as an adjunctive treatment. “Health benefits of yoga as a mind-body intervention begins at molecular level, and it can change the reading of our DNA. There is modification of epigenetic and gene expression profiles [when a person does yoga],” said Dada.

Health is wealth: Union Minister of Health and Family Welfare Mansukh Mandaviya (third from left) leading the International Day of Yoga celebrations at AIIMS, Delhi, on June 21 | PTI Health is wealth: Union Minister of Health and Family Welfare Mansukh Mandaviya (third from left) leading the International Day of Yoga celebrations at AIIMS, Delhi, on June 21 | PTI

In her study on the effects of yoga on male fertility and offspring gene quality, it was found that by practising yoga regularly for six months, men showed not only significant reduction of free radicals and an increased expression of antioxidant activity gene, but also a gradual decline in sperms with damaged DNA, and an improvement in quality of sperms. “Our studies also show that yoga lowers the risk of gonadal tumours and transmission of de novo germ to the offspring,” said Dada.

Besides, yoga can create wonders for patients with rheumatoid arthritis. “There was improvement in quality of life. When patients with arthritis practised yoga, the blood parameters showed a decline in pro-inflammatory markers,” said Dada, “There was also an increase in the expression of anti-inflammatory cytokine TGF-Beta and HLA-G molecules, thereby re-establishing immunological tolerance. This will improve the response to treatment and alleviate symptoms. Because of the chronic and painful nature of the disease, many patients suffer from co-morbid depression, and yoga improves the mood of the patient, and increases the secretion of feel-good chemicals such as endorphins in the body.”

Glaucoma is a leading cause of irreversible blindness, and yoga helps glaucoma patients, too. “When yoga is followed as an adjunct treatment for glaucoma, our studies showed that there is an increase in nerve growth, synaptic transmissions and anti-inflammatory gene activities,” said Dada. Yoga asanas, she said, help anti-inflammatory action, neurotropic action and prevent release of substances that can block trabecular networks and cause an increase of pressure within the eye. “Neuropathic factors were found to be triggering glaucoma. These can be modulated by practising asanas, the anulom vilom pranayama and meditation,” said Dada.

Jitendra Kumar, a 39-year-old Central government employee from Haryana, was not inclined towards yoga. “In 2019, I visited AIIMS after an eye strain. I was told that my optic nerve had dried up. I used to be in front of the screen for 10 to 12 hours. I was in the preliminary stages of glaucoma. That was when I agreed to join the yoga research on glaucoma. I attended around 18 sessions at Dr Dada’s department, and there was a visible change,” said Kumar, who will continue to do yoga at home every day. He said the yoga trainer in AIIMS, Richa Mishra, was proficient at her job. “She connects yoga asanas with breath. There is so much positive energy that comes out of her,” said Kumar.

Strong resolve: Richa Mishra, a yoga trainer at AIIMS, conducting a yoga session. “They [patients]  have confidence in us and are willing to take any trouble for the final result,” said Mishra | Sanjay Ahlawat Strong resolve: Richa Mishra, a yoga trainer at AIIMS, conducting a yoga session. “They [patients] have confidence in us and are willing to take any trouble for the final result,” said Mishra | Sanjay Ahlawat

Mishra said she thoroughly checks the physical and mental condition of patients and tailors the exercises accordingly. She is a native of Lucknow with a master’s in yoga science. She said it was important for one’s emotional quotient to be high while doing yoga. “Every individual’s mind and body mechanisms are unique. Yoga can create magic. There is so much in it,” she said.

Mishra has been teaching at AIIMS since 2019. She said most of her patients were from Delhi, Uttar Pradesh, Haryana, Jammu and Kashmir and Rajasthan. “They have confidence in us and are willing to take any trouble for the final result. Some patients are Muslims, and they have no problem accepting the benefits of yoga. They say yoga is helping them. What is important is commitment and some lifestyle modifications, along with regular practice,” said Mishra.

Amit Rawat from East Delhi works in a private hospital, and is the proud father of a two-year-old daughter. “I believe that the yoga training I got from Mishra, as per the advice of Dr Dada, benefited me and helped me become a father,” he said. Rawat’s sperm motility was not normal, as he was taking some medicines. “In 2020, I was referred to Dr Dada’s department and I agreed to be part of the yoga research,” he said, “I practised yoga for three months. I was told to do surya namaskar and asanas that focused on the pelvis. After completing my yoga sessions at AIIMS, I practised yoga daily at home, with some lifestyle modifications, like restricting non-vegetarian food. You won’t believe, within months my sperm motility was normal, and I was blessed with a baby girl in 2021.”

Jayshree Kumar from Chapra in Bihar, too, is banking on yoga. He has been married for eight years, and wants to have a child. Like Rawat, Kumar was referred to Dada’s department. “After attending the yoga classes for some months, my sperm count has increased,” he said, “I also had to make some modifications to my lifestyle. There is some hope now. Yoga is helping me even otherwise. I don’t get tired that easily now. I hope that I will become a father soon.”

In most cases of delayed pregnancy, the problem lies with men, said Dada. “Thirty per cent to 40 per cent of men in reproductive age have defects in sperm production. Sperm is the most vulnerable cell in the body,” she said, “Drinking alcohol, smoking and regular consumption of non-vegetarian food are a cause for concern. There is so much that yoga can offer, and it is proven. It has conquered the world, and it is about time we, Indians, realised the power of yoga.”

The Centre for Integrative Medicine and Research in AIIMS was established in 2016. Last year, Prime Minister Narendra Modi, during his Mann Ki Baat radio programme, recognised the work done by the CIMR in integrating contemporary medicine with traditional medical practices. Said Modi, “The CIMR was established to validate our traditional medical practices. The institute has earned a name for itself after 20 papers from the institute were published in international journals.”

Modi was referring to CIMR’s study published in Journal of American College of Cardiology that described the benefits of yoga for patients suffering from syncope, and another study published in Neurology, which described the benefits of yoga in patients suffering from migraine. Professor of cardiology and founder, professor-in-charge of the CIMR, Dr Gautam Sharma, was filled with pride when Modi praised his institute. “When such a praise comes from the prime minister of the country, it gives us encouragement to work harder,” he said.

Studies at the CIMR have proven the benefits of yoga in patients with heart failure, rhythm disorders, depression, sleep disturbances, diabetes, blood pressure and episodic migraine. There were also studies on how prenatal yoga helped pregnant women to stay calm to changes that take place in the body during pregnancy.

Said Sharma, “We have a good team of doctors and researchers at the CIMR, with yoga labs where sessions are held regularly. We get patients from every department who are willing to be a part of yoga research. We have yoga physicians here, and mainstream doctors will ask them for suggestions. We work together as a team. We ask yoga physicians about meditation techniques. Like what asanas to do during a migraine. Discussions happen over days, weeks and months. Finally, we make a module and see if it is working, and then we take the module to 10 national yoga experts, and take their consensus. The final onus is on us, the doctors at the CIMR. If we feel some asana is not suitable for a particular disease, we won’t take it.”

Yoga asanas are chosen according to the requirements of patients, said Sharma. “The problem with yoga is that patients are initially excited. Over the first three months they practise it properly. But that does not continue,” he said. “Now, all our study is done real time online. We have six yoga instructors, and he or she does video call a patient. In the induction phase they are taught at the centre for a week. Once they are here, on an average, they need to practise yoga four days a week, depending on the module. Heart patients can’t do yoga for an hour. So, we limit it to 30 minutes.”

“I have been a cardiologist for more than 25 years. We compete with the best in the world,” said Sharma, “When I present papers abroad and get their recognition for yoga, it feels as if I have won a medal for Team India at the Olympics.” Top universities, he said, have invited him for talks on research on yoga. The CIMR is a self-sustained department, he said. “All our staff are hired for some research; grants come from science and technology ministries, Ayush and health ministries,” said Sharma.

The aim of the CIMR is to bring yoga under an official protocol and give clinical services to treat various health conditions with an integrated medical system. “Soon new guidelines to combine mainstream and alternative medicines in ways that work best for the patient would be drafted based on our findings,” said Sharma.

Research at the CIMR happens round the clock. In 2020, a group of doctors from departments of neurology and cardiology at AIIMS evaluated the effectiveness of yoga as an add-on to medical management of migraine. Between April 2017 and August 2018, they chose 160 patients with episodic migraine and divided them into medical and yoga groups. The yoga group showed significant mean delta value reduction in headache frequency as compared with the medical group.

There was another study on the effect of yoga on clinical outcomes and quality of life in patients with vasovagal syncope, where it was proven that yoga improved autonomic balance and alleviated stress.

AIIMS has been in the vanguard of yoga research from the 1960s. Dr B.K. Anand, Dr Baldev Singh and Dr G.S. Chinna were the first few doctors from the institute to do research on yoga. These doctors, in 1961, studied the relationship of yoga to the body, mind and consciousness, and persuaded yogis to cooperate with them.

Interestingly, there were investigations on yogis who claimed they could stop their heartbeat. Though the research at AIIMS found out that they could not do it, they were able to bring down cardiac output by decreasing the venous return to the heart. The yogis achieved it by raising the intra-thoracic pressure by taking a deep inhalation or exhalation followed by closure of glottis and tightening of the chest and abdominal muscles.

The research on Swami Ramanand Yogi is talked about even today. Doctors at AIIMS studied him inside an air-tight, sealed box on two separate occasions―first for eight hours and second for 10 hours. Yogi’s oxygen content decreased and carbon dioxide increased. But he, to everyone’s surprise, was not taking deeper breaths; there was no rapid heartbeat. Also, his electroencephalogram (EEG) resembled early stages of sleep.

Most of the researches that were carried out at the hospital in the 1980s and 1990s were clinically oriented, like the efficacy of yoga and meditation on epilepsy. On February 3, 2000, the department of physiology under the guidance of Dr Ramesh Bijlani provided structured nine-day lifestyle modification courses on yoga for prevention of chronic diseases such as diabetes and high blood pressure.

Said Bijlani, “Although yoga is not a system of medicine, it has several elements that are relevant to medicine.” He said if yoga was adopted in its true spirit, it would help promote health and prevent diseases. “Yoga makes a person physically fit, emotionally stable, intellectually agile, and gives him a way of looking at the world that can fill life with love, peace and joy. That is why yoga has become a valuable tool in the practice of mind-body medicine, which is the last incarnation of modern medicine,” said Bijlani. He took voluntary retirement from AIIMS in 2005, and has been a motivational speaker at the Sri Aurobindo Ashram, Delhi, where he conducts yoga classes.