The respiratory system is now known to be plastic, characterized by ongoing changes in the neural control system. These changes are based on previous experience and long-lasting expressions.

This intrinsic feature of the respiratory control network extends well beyond the development of a child’s respiratory system into adult life (1). This is a sword that cuts both ways, however, as it could either exacerbate any maladaptive responses to poor and obstructed respiratory functioning, or it could confer greater advantages when breathing is trained enhancing respiratory plasticity.

Anatomical and Functional Influence of the Respiratory System

5. Cardiac, sympathetic, and respiratory systems
   This mechanical process of respiration influences the rhythm of cardiac, sympathetic, and respiratory systems. Each inspiration creates a negative thoracic pressure that increases venous return and heart rate through cardiac stretch receptors.
   Simultaneously, pulmonary mechano-receptors and baro- and chemo-receptors provide sensory input in a feedback loop to central respiratory processing. Better trained respiratory muscles for example via breathing exercises, as part of a regular comprehensive yoga practice:
   – augment plastic adaptation of the respiratory system

   – improve heart and lung function

   – potentially aid enteric function through pressure from improved diaphragm movement
   The benefit is not only during the time of practice but, based on the learned plastic effect, leads to an improved respiratory function across a 24-hour period. This improved functionality not only increases daily well-being and sleep quality but as a byproduct of efficient mechanical respiration improves oxygen delivery and uptake across a 24-hour period.
6. Spinal Column
   Finally, trained respiration with optimal diaphragmatic usage influences the spinal column as the crura of the diaphragm are attached directly to the spine at approximately T11 to L3, where they also overlap with the attachment of the psoas muscle, considered crucial for posture. Each inspiration contracts the diaphragm and when working more deeply pulls on these crura to stimulate the spinal column and its intervertebral discs.

Link to Main Article:
The Power in Yoga’s Approach to Upgraded Breathing

Four Key Benefits of Bhramari:

1. Psychological well-being

   Bhramari’s relationship to the practice of Om places it in the context of psychological well-being to focus and clear the mind resulting in a calm, peaceful state. The recitation of Om is recommended in the classical yoga teaching to give such an effect and bhramari follows closely, giving, as noted, “an indescribable blissful experience that fills the mind” (1)

In addition to a healthy mental impact it has benefits on the body’s psychological functioning:

2. Blood pressure regulation aid

   Recent discoveries involving the molecule nitric oxide (NO) confirm humming’s valuable health-promoting effects in terms of blood pressure regulation to antimicrobial defense (2). It states the isolated practice of humming on exhalation can increase nasal NO levels 15-fold compared to quiet exhalation (3).

3. Management of anxiety

   As a dedicated breathing exercise inserted into a routine, (see Breathwork for Anxiety and Other Difficulties), Bhramari offers the advantages of regulated breathwork and the added health benefits of increased nitric oxide production in the nasal and sinus regions.

4. Sleep support

   Bhramari also provides support with sleep disturbances by helping induce a feeling of calm before bed. It is an ideal practice for the end of the day and one of your best aids to quieten the busy mind and allow genuine relaxation and proper sleep restoration to occur.

The simple yet highly effective practice of Bhramari has an all-round positive effect on both our Psychological and Physiological wellbeing. You can add this on to any existing meditative or breath practice routine. Or just practice it separately to enjoy its benefits as it’s highly portable, meaning you can do it anywhere.

Link to Main Article:
The Power in Yoga’s Approach to Upgraded Breathing

It’s too easy to take breathing for granted, allowing the respiratory system to do its thing, keeping us alive and functioning, without any conscious effort, day and night. Is your breath pattern supporting your health in the best way it could though?

Unfortunately, many of us learned at a young age to breathe incorrectly, and / or struggled with proper breathing due to asthma, allergies and congestion. Mouth breathing or even very shallow chest breathing through the nose are patterns that when carried into adulthood can cause a host of issues. The good news is that these patterns can be reversed with proper training and attention.

What’s Wrong with Mouth Breathing?

Mouth breathing is, in short, much less efficient. Apart from loss of energy, mouth breathing can cause fairly serious issues in the long term, ranging from snoring and sleep apnea, to bad breath, jaw and teeth issues, gum disease and worsening of asthma symptoms.

The health benefits of nasal breathing, on the other hand, are vast:

• air, temperature and humidity control
• production of immune-boosting nitric oxide (2)
• better quality sleep and less likely to suffer from sleep apnea
• overall more robust lung function
• calmer mental state through activation of the parasympathetic nervous system

Emerging research indicates that nasal breathing might even be better for performance than mouth breathing during exercise (1).

All the benefits of nasal breathing are documented in Proper Breathing is Breathing Through Your Nose, clearly highlighting why this is an important issue to tackle if you are someone that tends to breathe through your mouth. Whether your pattern is constant mouth breathing, occasional gasps through your mouth, or only night time mouth breathing, it is well worth investing the time to discover the cause and to retrain your pattern to nasal breathing, all the time.

Paul discusses the purpose and value of conducting scientific research into yoga practices.

PART FOUR: The Power in Yoga’s Approach to Upgraded Breathing

Yoga, Breath and COVID-19: lifestyle behavioral support mechanisms. Approaches to manage the physical and psychological burden of stress from living through and after the current global pandemic

1. Exhalation power and lengthWhile there is an absence of a specific anti-viral cure the goal of treatment for patients suffering from COVID-19 symptoms should be an intensive maintenance of organ function that can result in lower mortality, according to a recent clinical review by Xie et al. regarding treatment of the disease (1). As a focus of treatment under this acute condition the authors suggest to supplement or replace lung function with methods such as a refined Positive End Expiratory Pressure (PEEP) that delivers an extra pressure at the end of each exhale to keep the lung vesicles open, or the administration of humidified transnasal high-flow oxygen via a tube in the nose. Comprehensive yoga’s approach to breathing involves training of respiration in bodily positions that open up the lungs so the same breath is more efficiently employed across lung function. More importantly correctly trained and practiced breathing exercises emphasize the length, force and pressure of each exhale done repeatedly and continuously on each round of breath. As previously noted other than the application of prone breathing in Part 3 of this article series, yoga’s breathing exercises are not to be applied in such acute conditions but rather serve as preventive in the long run, potentially supportive when symptoms are mild, and developmental over the long term of a robust and healthy lung and respiratory muscle function. When learned and practiced regularly they also serve as a no cost individual practice approach to support lung function. The reference to prolonged extra pressure exhalation can be found in Sanskrit texts relating to comprehensive yoga over the past 2,500 years, where it was combined with utterance of mantras on one exhale, by the 3rd century CE as a specific recommended method to calm the mind and stabilize the nervous system, and as integral in the performance of Hatha yoga breath techniques described in the past 700 years. More recent scientific research has identified pulmonary lung function as a predictor of coronary heart disease (CHD) whereby predicted forced expiratory volume was significantly inversely related to CHD (2). Additionally, the Framingham study employed their risk score algorithm that validated forced vital capacity as a measure of lung function to reveal additive predictive value over CHD for all-cause mortality (3). COVID-19 has been shown to more severely affect elderly and those with other comorbidities, particularly with respect to cardiac and lung function. Jones et al. recently showed that a slow respiratory muscle training was effective in reducing resting Blood Pressure in the elderly subjects while the inspiratory muscle strength and lung capacity were also increased. The nature and value of exhalation should be explored more in terms of well-being, lung function, and a low to no cost overall health measure.
2. Proper Breathing is Nasal BreathingNasal breathing is a product of and a contributor to Homo sapiens evolved neck and facial structure and our ability to speak. In contrast to our closest related non-human primate species the human airway is elongated with a poorly supported oropharynx, the foramen magnum is more anteriorly positioned, the maxillo-mandibular complex is regressed to allow for adequate speech, a smaller mouth with an average of 32 teeth as opposed to up to 44 in a chimpanzee, and, in response to these skeletal changes, a retreat of the tongue giving it an obstructive presence in the upper airway. Studies in children reveal poor orofacial development due to predominant mouth breathing, especially in the first two years of life (4). Both normal and healthy breathing and specific breathing exercises require nasal breathing. The nose does perform certain anatomical functions in terms of air filtration, temperature control, and humidity adjustment of the air upon inhalation. Chronic mouth breathing has been shown to underventilate the nose which may lead to an increase in inflammation in the nasal mucosa, an unwelcome feature at any time and especially during a potential COVID-19 infection. Mouth breathing also leads to sleep-disordered breathing. If one breathes through the mouth in waking hours then it is unlikely regulated nasal breathing occurs when asleep. This may lead to issues with obstructive sleep apnea, poorer quality sleep, and thus lower stress resilience (5). A nasal breath also allows the diaphragm to descend more deeply and thereby increase lung function and ventilation. Each nasal breath circulates air in the different sinuses, sites of nitric oxide production as well as stimulation of these hollow cavities in the skull whereby the sphenoid and ethmoid, paranasal sinuses, are anatomically closest to the hypohysial cavity where the pituitary gland sits, an event bypassed when mouth breathing. The opportunity to regulate and elongate the breath occurs through the nose resulting in a calmer state and even a potential whole brain stimulation that possibly modulates behavior and the state of consciousness (6). Recent research on humans revealed that nasal breathing entrained local field potential activity in the piriform cortex, hippocampus, and amygdala and diminished when respiration was diverted to the mouth (7).Read: What is Pranayama, yogic use of the breath to reveal no breath

PART THREE: Yogic Behavioral Support via Body, Breath and Mind

Yoga, Breath and COVID-19: lifestyle behavioral support mechanisms

Approaches to manage the physical and psychological burden of stress from living through and after the current global pandemic

A. Specific Yogic Behavioral Support Mechanisms: Prevention and Promotion

Yoga practice techniques that mainly originate from the Hatha yoga tradition over the last 1,000 years possess on the physical side a triple combination of health maintenance, disease prevention, and chronic illness management and cure, as well as being meditational techniques when done with the correct focus. These practices were closely correlated with the ancient Indian medical approach of Ayurveda whereby disease and cure were expressed in Ayurvedic terminology and subsequently Hatha yoga practices of bodily conditioning, cleansing techniques or breath regulation were prescribed as part of the healthcare solution. Since 1920, starting with the first scientific experimental research on elements of yoga by Swami Kuvalayananda, this small but valuable part of comprehensive yoga that offers physical activity and therapeutic methods was framed in the light of modern anatomy and physiology essentially ushering in what is now a century of modern yogic therapy, fully documented in his classic 1961 manuscript Yoga Therapy. From this and subsequent work done over the decades it is clear that yoga techniques offer little relief in terms of acute issues and express their full benefit in physiological and psychological support through lifestyle attitudes and behavioral mechanisms especially in terms of chronic disease but also in terms of prevention and the promotion of optimal health. Though some yoga aficionados would argue for the power of mind developed by practice to withstand acute reactions and pain this is attitudinal and does not remove the initial cause of the acute response, namely the contraction of the virus in this instance.

A recent report from the WHO calls for the adaptation of the COVID-19 response to encompass prevention and management of Non-Communicable Disease (NCD) risks given the increased vulnerability in this time to those suffering such morbidities (1). A comprehensive yoga approach’s value in terms of prevention and support as we continue with the reality of COVID-19 disease and the potential exacerbation of NCDs with a threatening comorbidity situation, is to help upregulate the immune system, strengthen the respiratory apparatus, and increase psychological and emotional resilience (2). This is encouraging given evidence that a robust immune response to COVID-19 does occur across different cell types, especially in those considered healthy. Of those infected the majority survive but experience differing severity of symptoms. Kedzierska et al. report, this robust response leads to clinical recovery in patients considered at a non-severe level of COVID-19 (3).

1. Body support to breath and mind Both internationally and in the US physical body-based yoga classes are primarily attended by females where the majority of classes are medium to light intensity, require greater endurance than some other sporting activities, involve levels of complex body coordination, and in some cases employ attention on the breath. From 2012 to 2017 the percentage of US adults using yoga as a complementary health approach rose from 9.5% to 14.2% with women (19.8%) being twice as likely to attend yoga classes than men (8.6%) (4). These features of medium intensity, endurance, and body complexity are identified by Ludyga et al. in a recent meta-analysis as the magic zone where the cognitive mental fitness benefits pay off and may be what appeals more to women than men in the choice of activity (5). According to their analysis there are intensity differences for men and women, whereby males tend towards higher intensity, with a definite effect of complex coordination in activity. According to a comprehensive yoga-based practice approach Hatha yoga bodily postures develop strength and endurance and open up the body’s complexity to harmonize autonomic functioning over the different bodily systems (6), especially in terms of the functioning of the respiratory apparatus by increased lung capacity through a stronger and more effectively used respiratory diaphragm and intercostal muscles.Read: What is Breathwork
2. Regular breathing exercises can enhance emotional resilienceThe capacity to adapt in different stressful situations without succumbing to negative mood and affect would be considered emotionally resilient. To do so requires an agile autonomic nervous system (ANS) at its base. Controlled breathing exercises directly affect autonomic functioning by typically shifting to parasympathetic dominance seen as an improved cardiac-vagal tone (7). This is sometimes translated as an acute piece of advice to take a breath to help calm down. However, resilience is cultivated over time and needs regularity in controlled yet simple breathing exercises. The regulation of inhalation and exhalation whereby the exhale is drawn longer leading to fewer breaths per minute strengthens vagal tone which directs each heartbeat by stimulating the parasympathetic arm of the autonomic nervous system.

3. Breathing exercises are mindful in-the-moment meditative practicesThe requirement to sit, devote the time, focus on the specific regulation of inhalation and exhalation is an in-the-moment state of being. Mindfulness in practice is an essential ingredient of any comprehensive yoga approach that involves dedicated breathing exercises. The caveat of mechanical practice once familiarity of the exercises is reached warns of a loss of these benefits as a physical action would then continue with a disconnected mental state. A recent study found that a form of proactive coping by balancing living in-the-moment with the ability to plan for the future led to improved daily stress handling without succumbing to negative moods (8). Training the capacity to be in-the-moment while engaged in breath practice coupled with daily behavioral tasks to plan the day, handle work, set up meetings, or arrange the kids’ meals can potentially become key elements of a proactive coping strategy as opposed to merely aspects that make up and add to the daily stress burden. Read What are Breathing Exercises

4. The importance of supine relaxation with breath regulationAn integral and important element of a comprehensive yoga approach is frequent supine or prone relaxation time intervals. The term in Sanskrit and common in any body-based yoga class is savasana, literally meaning corpse pose. Simple in design yet difficult in proper execution, this supine relaxation method is described as an almost complete lack of movement, from both tension and restlessness, in the body with a still mind, in-the-moment with a minimal level of respiration (Breathwork and Savasana ). Yogic therapy pioneer, Swami Kuvalayananda, was the first to write about and detail savasana and breath regulation in 1926. Dr. Datey M.D, head of Cardiology at K.E.M. Hospital Bombay, and Dr. Vinekar of the Kaivalyadham, the chief researcher under Swami Kuvalayananda, published in 1969 what is most likely the first validated medical journal publication on savasana, detailed empirical results to show the positive effects of this level of relaxation on reducing hypertension. Savasana as supine relaxation with awareness is a constructive effort to allow the different bodily tissues to relax coupled with a continued concentration on the same relaxed bodily tissues. Breath regulation is added to this bodily relaxation through initial controlled inhalation and slightly longer exhalation to an eventual state of passive respiration involving focused awareness on this minimal function of breath. Relaxation with breath awareness as a meditative technique has been found to be more effective than relaxing music unaccompanied by meditation techniques in reducing anxiety (9).

5. Prone breathing, an established yogic breathing preparation practiceA condition known as “happy hypoxia” by clinicians has been showing up with some COVID-19 positive patients (10). Carbon dioxide levels are unaffected and the lungs inflate but oxygen saturation levels, measured by a finger device, show as low as 70s, 60s or even 50s. Human respiratory physiology is designed to read rising or falling levels of carbon dioxide, which impels us to breathe in or out, but does not sense oxygen levels. Normal blood-oxygen saturations range between 95-98%. Other lung or respiratory tract diseases, such as pneumonia, exhibit diminishing saturation levels with poor functioning, often stiff, lungs that cannot expel carbon dioxide efficiently and thus leave the patient short of breath. A recent research report by NY hospital-based clinicians Caputo et al. showed early self-proning in awake COVID-19 positive patients demonstrated improved oxygen saturation (11). Prone breathing has been a staple yogic breathing preparation practice, as an acute yogic therapy recommended in cases of anxiety or panic attack, and now, based on this recent research, to offer a degree of acute support to COVID-19 infected patients. Caputo et al. report that they administered prone breathing to a 50 patient low oxygen saturation cohort and recorded significantly raised average saturation levels. It is also one of the most convincing and simplest breath techniques to expect compliance in. When done with arms folded and head straight a slight elevation to the ribs is caused. This allows for deeper diaphragmatic work that makes more complete use of lung capacity, thereby increasing ventilation and thus greater oxygen delivery. In acute COVID-19 cases it helps relieve reliance on electronic ventilators needed by more severe patients. From a comprehensive yoga approach done regularly it is a preventive and supportive measure over the long term on respiratory quality that is easy to do and continue. A prone breathing practice is described in this article Breathwork for Anxiety and Other Difficulties

Read the other parts of this article:
Yoga, Breath and COVID-19: lifestyle behavioral support mechanisms
Approaches to manage the physical and psychological burden of stress from living through and
after the current global pandemic

PART ONE: the initial facts
PART TWO: drugs, infrastructure, and yogic self-awareness
PART FOUR: the Power in Yoga’s Approach to Upgraded Breathing

Increase your understanding about the breath and explore the recommended practices

9 Benefits of Correct Breathing and Doing Breathing Exercises

Breathwork for Anxiety and Other Difficulties

Breathwork in Times of Stress

Breathwork and Savasana

Specific Guided Ratio controlled Breathing Exercises:

Bi-Ratio Breath Exercise
Tri-Ratio Breath Exercise
Quad-Ratio Breath Exercise

PART TWO: drugs, infrastructure, and yogic self-awareness

Yoga, Breath and COVID-19: lifestyle behavioral support mechanisms. Approaches to manage the physical and psychological burden of stress from living through and after the current global pandemic

A. Non-Behavioral Approaches Dominate the Literature

1. Inflammation Mitigating Drugs and Vaccine Trials
   Howard Hughes investigator Vogelstein and colleagues at Johns Hopkins are one of the first to trial a drug approach, in this case using the alpha-1 adrenergic receptor antagonist (1), to mitigate symptoms of inflammation before a full blown cytokine response takes place (2). Meanwhile in the ongoing confusion around the efficacy of certain drugs a major journal’s publication on May 22, 2020, concluding chloroquine an antimalarial drug and its analog, hydroxychloroquine, used to treat autoimmune diseases including lupus and arthritis does not benefit patients with COVID-19 (3). Had to be retracted due to what appears to be fabricated statistical evidence. Science reports on May 15th, 2020, that several African governments are investing in an unproven herbal tonic, branded Covid-organics, using the chief ingredient in the antimalarial drug artemisinin, the plant sweet wormword (Artemesia annua). Such speedy opportunistic product development may also have its own consequences as scientists warn it could fuel drug-resistant malaria (5a). Science also reports on Operation Warp Speed that ignores the conventional wisdom timeline needed over at least a year to responsibly develop a vaccine for COVID-19. Instead it aims to have 300 million vaccines in place by January 2021, initially for US use only (5b). Such a timeline represents a heroic effort to pull resources together across development, supply and manufacturing, and distribution but will no doubt fall far short of adequate efficacy and safety testing protocols only fueling the antivaccine debate about products rushed to market inadequately. However, the Lancet on May 22, 2020 published an article that details the first COVID-19 vaccine to reach phase 1 clinical trial and is able to generate an immune response against the virus SARS-CoV-2 in humans, being found to be safe and well tolerated in a 28-day trial in 108 healthy adults (6). Though it will take six months to fully evaluate the results and more trials needed to tell if the immune response it reports is actually effective against infection of SARS-CoV-2.
2. Institutional and Infrastructural Advice to Mitigate COVID-19 Effects
   There have been several responses to the current pandemic and the mounting mental health burden both arising now in healthcare workers and expected to exacerbate amongst the general public in coming months to years. The majority of advice and recommendations are targeted at the institutional and infrastructural level. Sasangohar et al. offer several recommendations to reduce provider burnout and fatigue (7). Holmes et al., a collective team of academics and researchers across multiple countries and disciplines, position a call for action for mental health and neuroscience research priorities now, to be reviewed and evolve with the pandemic (8). One of their long term strategic program objectives is to understand how to harness positive social resources, employ lifestyle and behavioral mechanisms to enhance stress resilience and coping such as altruistic and prosocial behavior, adequate sleep, family-and-friends support networks, and anxiety mitigating immediate and long term strategies. Lifestyle and behavioral mechanisms are essential moving ahead.

B. General Yogic Behavioral Support Mechanisms: the value of SELF-AWARENESS

A requirement for the development of a vaccine for SARS-CoV-2 through Controlled Human Infection studies (CHIs) needs to demonstrate high social value (9). Behavioral approaches need to be assessed under similar criteria. A reasonable account of the social value can be demonstrated via ease of doing, low cost of entry for the consumer, low risk-high benefit outcome in terms of effectiveness in aiding prevention of symptoms and supporting the psychological burden of a pandemic. This can range from mass action social distancing to a greater cultivation of awareness in terms of personal behavior with ourselves, with others, and with the environment. The CDC’s recommendations to manage stress in such a challenging time highlights personal and social care and awareness, in essence a yogic meditative approach as an extremely balanced way forward for us all (10). They specifically draw attention to limiting social media exposure, bodily care with breath and meditation, healthy food, relaxation and recreational time, adequate sleep and exercise, and time to connect with others.

1. Behavioral Change in Touch
   In addition to social or physical distancing three personal protective behaviors of handwashing, not touching the T-zone of the face, and tissue use, have almost become required to control the pandemic. Holmes et al. discuss the necessity of ensuring people know what to do, are motivated to do it, and have the skills and opportunity to enact the changed behaviors (8). In a society conditioned on handshakes, questionable handwashing use, supermarket open food free sampling, indiscriminate handle and button touching the almost orthodox and Eastern approaches are potential remedies. In many South and Southeast Asian countries, such as India and Thailand, a handshake is considered crude and instead the prayer hand pose acknowledgement to the other party, often associated with the Hindi greeting of Namaste, is both an extremely polite and non-contact greeting. Similarly, a slightly more orthodox approach in these regions limits open-hand touching of common objects. A door can be opened using the edge of one’s sleeve or directly with a handkerchief. Though many supermarkets, delis and restaurants right now will limit or cut out open food and buffet counters be aware of the return of the indiscriminate public consumption, open air, free sample tray that is both unclean and extremely unhygienic. An awareness on food contamination by multiple hands is ideally motivational enough to engender self-control.
2. Prioritize Sleep
   A lack of proper sleep or staying in bed too long increases brain inflammation, changes prefrontal activity, which is a pure stress response, and reduces emotional resilience whereby reactionary responses such as anger or frustration become frequent. Good sleep and rest can aid brain inflammation and support psychological resilience of such a stress burden (11). Our modern society undervalues the need of and for relaxation and instead focuses on more work time or more physical workouts. A comprehensive yoga practice both emphasizes quality sleep and aids it as well as employing direct relaxation to manage fatigue and thereby improve psychological and physiological conditioning.
3. Improve Responsiveness with a Partner
   Though lock-downs have forced family units to spend more time together, a cause of anxiety, conflict or psychological stress for some, there is potential for couples to deepen their relationship. Several studies carried out by Ong and Slatcher reveal the nature of relationship within a couple and the positive outcomes of increased partner responsiveness in terms of stress resilience and improved sleep lead to reduced anxiety. Support from a spouse can be the most effective resource in stressful times if each partner validates, cares, and conveys understanding to the other. Opportunities exist daily in the current uncertain climate to share and ideally respond enthusiastically, leading potentially to greater intimacy and trust (12). A behavioral approach starts with the awareness of the nature and quality of a response.
4. Vitamin D levels through Awareness of Diet and Sun Exposure
   Bachman et al. analyzed COVID-19 publicly available patient data globally and discovered a strong correlation between the cytokine storm and vitamin D levels as well as mortality and vitamin D deficiency

Read the other parts of this article:

Yoga, Breath and COVID-19: lifestyle behavioral support mechanisms
Approaches to manage the physical and psychological burden of stress from living through and
after the current global pandemic

PART ONE: the initial facts
PART THREE: Yogic Behavioral Support via Body, Breath and Mind
PART FOUR: the Power in Yoga’s Approach to Upgraded Breathing

Increase your understanding about the breath and explore the recommended practices

9 Benefits of Correct Breathing and Doing Breathing Exercises

Breathwork for Anxiety and Other Difficulties

Breathwork in Times of Stress

Breathwork and Savasana

Specific Guided Ratio controlled Breathing Exercises:

Bi-Ratio Breath Exercise
Tri-Ratio Breath Exercise
Quad-Ratio Breath Exercise

PART ONE: the initial facts

Approaches to manage the physical and psychological burden of stress from living through and after the current global pandemic

The emergence of a novel coronavirus SARS-Cov-2, the cause of the disease now known globally as COVID-19, has infected over 6 million people in 188 countries, of whom at least 369,433 have died as of May 31, 2020 (1). As a result governments around the world have taken unprecedented measures socially and economically, deemed appropriate to “flatten the curve” of this pandemic. With the goal to curb the spread of infection and help prevent healthcare systems from being overwhelmed social distancing, stay-at-home orders, mandatory mask wearing, travel restrictions, and isolated ways of living and daily behavior have become both the norm and a necessary mass action to tame a global crisis.

A. The Broader Psychological and Physiological Impact of the COVID-19 Pandemic

The description so far only tells us of the physical cost in terms of disease risk, infection, and mortality and the measures countries have taken to prevent this from infecting more people. Given the number of countries that have implemented shut-downs and similar actions the true number of people affected by the crisis is more likely over 6 billion. Everyone is deemed at risk for infection and so are all candidates for the ongoing physical measures and upcoming vaccines. What is not reported in the data charts for this disease are the lifestyle challenges, the psychological stress burden, and the possible future mental health crises that may emerge in the coming months to years.

Beyond the economics of the global crisis, what is the psychological and emotional burden of these events now, a year from now, and even a generation from now, and how can they be addressed from the point-of-view of the living individual? The latest Stress in America 2020 report from the American Psychological Association predicts long lasting and serious negative mental health effects from the coronavirus pandemic (2). It particularly highlights the stress burden on parents of children under 18 who are faced with childcare, work and schooling demands. Certain sub-populations have been shown to be more vulnerable, such as lower socio-economic groups, the elderly, and males to name a few.

B. Yoga as Comprehensive and Regular: beyond yoga’s ‘pose’ and ‘flow’ dilution

Yoga as a philosophy and body of practice techniques is referenced and documented in more or less greater detail across primarily Sanskrit-based texts for the past 2,500 years (3). The traditional explanation of yoga and delivery of its teachings has been most frequently presented in a context of human psychological and physiological suffering: mental difficulty, emotional instability, psychological burden, uncontrolled senses, a distracted mind, an inability to focus, an incapacity for situational appraisal, anxiety and stress, and physical illness. A consistent description of the experience of yoga throughout the literature at different historical timepoints is mental equilibrium, a centered state of being, the meditative state. The Sanskrit word for meditation (‘dhyana’) is deeply embedded within yogic philosophy and teachings whereby it is quite clear that the yogic process and meditative process are the same: a skillful management of the mental faculties till the yogic, or meditative, experience is reached, a complete centeredness, which we may translate as mental equilibrium and harmony within a normal range of change across physical and psychological aspects of being.

The process of yoga involves yogic-meditative practices that cultivate this experience and state. However, the shifting emphasis on different practice techniques over the centuries was in response to societal needs rather than the efficacy and value of one technique over another. The past 100 years has witnessed the main attention on practices cultivated in the previous 700-900 years on body and breath meditative practices, known as Hatha yoga. Starting 90 years ago, but most commercially and popularly effective in the past 20 years, a minor element of this approach gained strong association with the physical activity market and as such has seen worldwide growth where a diluted translation of yoga has become synonymous with ‘pose’ (posture, asana) and ‘flow’ (erroneous interpretation of vinyasa).

Yoga identified as ‘pose’ and ‘flow’, often executed in terms of physical fitness, is only one element of a comprehensive yoga practice approach outlined in the original texts to manage and balance both the physiological and psychological aspects of our being. ‘Yoga’ as a popularly engaged in recreational activity has been published in the scientific literature with documented benefits to health and well-being. As a recreational activity it is a subjective decision with no greater efficacy and value than walking, running, chess, free-diving to satisfy and achieve a degree of personal well-being. If we are to discuss yoga practice as a behavioral lifestyle aid to the current psychological burden of stress then it needs to be framed within a comprehensive approach that engages the practitioner across a mixture of techniques capable as a whole to cultivate physiological and psychological resilience, not at just one measured time point of a typical body-based approach at the end of four weeks, for example, but developing over the long term. This is the position of the original teachings.

The key elements of such an approach are one, comprehensiveness with mental awareness, and two, regularity. Any guidance from a qualified instructor should be on the specifics of what to do and the encouragement to build a regular routine for it. Therefore, it can still occupy a recreational equivalent time commitment but with an emphasis on quality over quantity, ‘how’ more so than ‘what’. To reliably advise yoga practice, which includes breath and meditative techniques, for lifestyle behavioral effects, either through therapy or as part of research, to both relieve the burden of, and increase the resilience to, stress then these key elements are the focus and not the popularly perceived ‘pose’ and ‘flow’ effort. In short, 7 days of 10 minutes of a comprehensive yoga practice is worth more than 70 minutes one day in that week. The remaining challenge is having the skillful guidance to instruct 10, 20, 40-minute practices to be done very regularly incorporating a correct approach to posture, breath, and inner awareness.

C. COVID-19 Disease Burden: high inflammation, organ dysfunction, psychological trauma

Wang et al. recently identified three primary drivers of cardiac injury that can occur when infected (4): direct infection of cardiac tissue possibly due to the increased expression of ACE2 receptors in the heart; an excessive immune response that triggers a cytokine storm that can lead to multiple organ dysfunction; pre-existing cardiovascular morbidities that become aggravated and can lead to some of the aforementioned serious issues. This and other recent studies indicate inflammation as both an initial outcome of an overzealous immune response and a prime culprit in worsening the condition further. Infected individuals can experience high fever, blood clotting, blood vessel leakiness, abnormally low blood pressure and a lack of oxygen which leads to excessive acidity of the blood, to a potential pleural effusion where fluid builds up in the lungs (5). The majority of deaths due to COVID-19 are a result of respiratory failure originating in the inflammatory response. Inflammation ultimately affects healthy tissue leading to Multiple Organ Dysfunction Syndrome (MODS) eventually causing the lungs to shut down under Acute Respiratory Distress Syndrome (ARDS). Complicating the scenario even further is that COVID-19 can cause serious cardiovascular issues such as heart attacks, heart failure, and strokes due to blood clots (6).

This burden of health care handling by professionals has led to added stress on health care workers from multiple areas. Longer shifts, greater loss of life, a lack of personal protective equipment, increased isolation from a typical support structure of family out of fear of infecting them, and anxiety over job security has led to increased mental strain and greater burnout and fatigue (7). Attention is now being drawn to the impending psychological trauma amongst health care workers as the next crisis (8).

Read the other parts of this article:
Yoga, Breath and Covid-19: lifestyle behavioral support mechanisms
Approaches to manage the physical and psychological burden of stress from living through and
after the current global pandemic

PART TWO: drugs, infrastructure, and yogic self-awareness
PART THREE: Yogic Behavioral Support via Body, Breath and Mind
PART FOUR: the Power in Yoga’s Approach to Upgraded Breathing

Increase your understanding about the breath and explore the recommended practices

9 Benefits of Correct Breathing and Doing Breathing Exercises

Breathwork for Anxiety and Other Difficulties

Breathwork in Times of Stress

Breathwork and Savasana

Specific Guided Ratio controlled Breathing Exercises:

Bi-Ratio Breath Exercise
Tri-Ratio Breath Exercise
Quad-Ratio Breath Exercise