This article appeared in a journal published by Elsevier.

The attached
copy is furnished to the author for internal non-commercial research
and education use, including for instruction at the authors institution
and sharing with colleagues.
Other uses, including reproduction and distribution, or selling or
licensing copies, or posting to personal, institutional or third party
websites are prohibited.
In most cases authors are permitted to post their version of the
article (e.g. in Word or Tex form) to their personal website or
institutional repository. Authors requiring further information
regarding Elsevier’s archiving and manuscript policies are
encouraged to visit:
http://www.elsevier.com/copyright
 Author's personal copy

Complementary Therapies in Medicine (2011) 19, 122—127

available at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/ctim

Effect of yogic practices on lipid profile and body fat

composition in patients of coronary artery disease
Ajay Pal a, Neena Srivastava a,∗, Sunita Tiwari a, N.S. Verma a, V.S. Narain b,
G.G. Agrawal c, S.M. Natu d, Kamakhya Kumar e

a
Department of Physiology, CSMMU UP (Chhatrapati Shahuji Maharaj Medical University (erstwhile KGMU) Uttar Pradesh), India
b
Department of Cardiology, CSMMU UP (Chhatrapati Shahuji Maharaj Medical University (erstwhile KGMU) Uttar Pradesh), India
c
Department of Statistics, Lucknow University, Lucknow, India
d
Department of Pathology, CSMMU UP (Chhatrapati Shahuji Maharaj Medical University (erstwhile KGMU) Uttar Pradesh), India
e
Human Consciousness and Yogic Sciences, D. S. V. Shantikunj, Haridwar, India

KEYWORDS Summary
Yoga; Objectives: To observe the effect of regular yogic practices and self-discipline in reducing body
Coronary artery fat and elevated lipids in CAD patients.
disease; Method: In this study one hundred seventy (170) subjects, of both sexes having coronary artery
Body fat; disease were randomly selected form Department of Cardiology. Subjects were divided in to
Lipid profile two groups randomly in yoga group and in non-yoga group, eighty five (85) in each group. Out
of these (170 subjects), one hundred fifty four (154) completed the study protocol.
Time line: The yogic intervention consisted of 35—40 min/day, five days in a week till six months
in the Department of Physiology CSMMU UP Lucknow. Body fat testing and estimation of lipid
profile were done of the both groups at zero time and after six months of yogic intervention in
yoga group and without yogic intervention in non yoga group.
Results: In present study, BMI (p < 0.04), fat % (p < 0.0002), fat free mass (p < 0.04), SBP
(p < 0.002), DBP (p < 0.009), heart rate (p < 0.0001), total cholesterol (p < 0.0001), triglycerides
(p < 0.0001), HDL (p < 0.0001) and low density lipoprotein (p < 0.04) were changed significantly.
Conclusion: Reduction of SBP, DBP, heart rate, body fat%, total cholesterol, triglycerides and
LDL after regular yogic practices is beneficial for cardiac and hypertensive patients. Therefore
yogic practices included in this study are helpful for the patients of coronary artery disease.
© 2011 Elsevier Ltd. All rights reserved.

Introduction

Indians have considerably higher prevalence of premature

Abbreviations: BMI, body mass index; SBP, systolic blood pres-
sure; DBP, diastolic blood pressure; HDL, high density lipoprotein;
LDL, low density lipoprotein.
∗ Corresponding author. Tel.: +91 9415024024.
E-mail address: drneenasrivastava@rediffmail.com
(N. Srivastava).
coronary artery disease (CAD) and mortality rates for CAD
compared with Europeans, Chinese and Malays.1—4 Mortal-
ity rates due to CAD is increasing in India and it will be 100%
increase from 1985 to 2015.5 The Indian population are more
prone to CAD at a much younger age.6,7 The CAD is affecting

0965-2299/$ — see front matter © 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctim.2011.05.001
 Author's personal copy
Effect of yogic practices on lipid profile and body fat composition in patients of coronary artery disease
Figure 1 Flow of the subjects during study.
Indians 5—10 years earlier than other communities. Coro-
nary heart disease is the leading cause of morbidity and
mortality in most industrialized societies.8 The most com-
mon cardiovascular diseases are hypertension and coronary
artery disease but the basis for most cardiovascular diseases
is atherosclerosis which is almost universally present in the
world. A study conducted in India suggests that the preva-
lence of CAD is about 10%.9
Fat is one of the nutrients that supply calories to the
body. The relation between body fat obesity usually assessed
as body mass index (weight (kg)/height (m)2 ).10 In physical
fitness, body composition is used to describe the percent-
ages of fat, bone and muscle in human body. A high level of
blood cholesterol leads to atherosclerosis and an increased
risk of heart disease. Elevated LDL cholesterol is considered
to be a major cause of CHD.11
Research objectives
To see the effect of yogic practices on body fat and lipid
profile in patients of coronary artery diseases.
Methods
Study population
Two hundred eight (208) subjects were selected from the
Department of Cardiology CSMMU UP Lucknow India. One
hundred seventy (170) subjects were eligible for the study.
123
Each subject was randomly assigned to one of the two
groups: (i) medication + yoga, (ii) medication, using a ran-
dom number generator such that equal numbers were
recruited into each group. A professional not associated with
this study generated the randomization scheme with block of
size four for up to 190 patients. These numbers were pasted
on identical opaque envelopes containing yoga and non-
yoga. The numbers were noted for group 1 (yoga) and group 2
(non yoga) and sealed in a big envelope. After randomization
patients in yoga and non-yoga groups were (n = 85). A senior
cardiologist referred all the patients after examining their
physical health and medication status. Approximately simi-
lar medications (Metoprolol/Atenolol, Aspirin, Clopidopril,
Atorvastatin/Rosuvastatin, Ramipril/Losartan/Telmisartan)
were provided to both the groups. After six months of yogic
intervention yoga (n = 80) and non-yoga (n = 74) groups com-
pleted the study protocol. Subjects who did not participate
in yogic intervention classes (>60% yogic practice classes)
were excluded from the study. Patients, who dropped the
study, also did not differ significantly in terms of age and
sex. Fasting glucose estimation was done once for exclu-
sion of diabetic patients. Before study all the subjects were
asked to maintain their routine activities and not initiate
any new physical activities for this duration.
Those patients with clinical history e.g. angina, ECG
changes of ischemic heart, treadmill positivity; history of
MI, PCI, and ≤70% narrowing in one or major coronary artery
and age limit 40—75 years were included for the study
and patients with other co-morbid conditions like malignant
hypertension, diabetes mellitus, COPD, asthma, diseases of
 Author's personal copy

124 A. Pal et al.

Table 1 Comparison of yoga and non yoga groups at base

Sample collection
line.
Five milliliters of peripheral fasting blood was collected,
Variables Yoga Non yoga following informed consent, from all individuals who par-
ticipated in this study before yogic intervention and again
Age (yrs) 58.9, 9.4 58.6, 10.5
fasting blood was collected after six months of yogic
BMI (kg/m2 ) 24.46, 4.2 25.19, 4.5
intervention in yoga group and with out intervention
TC1 (mg/dl) 159.9 149.9
in non yoga group. Serum was separated by centrifuge
TG1 (mg/dl) 135.7 105.8
machine (3500—4000 rotations/min) at room temperature.
Male 72 72
Total cholesterol, triglycerides, and HDL cholesterol were
Female 13 13
measured after overnight fasting (12 h after meal).
Abbreviations: BMI, body mass index; TC1, pre total cholesterol
level; TG1, pre triglycerides level.
Biochemical measurements

Serum total cholesterol was measured by the Cholesterol

nervous system, endocrinal disorders, and congenital heart
diseases, patients with known complications of CAD, A-V
block etc., on pace maker and undergone bypass surgery
were excluded from the study (Fig. 1).
Abbreviations: ECG, electro cardiogram; MI, myocardial
infarction; PCI, percutaneous coronary intervention; COPD,
chronic obstructive pulmonary disease; A-V block, atrioven-
tricular block.
Patients were registered from March 2007 to Septem-
ber 2007, who fulfilled the inclusion criteria and willing for
compliance were invited to participate in the yogic inter-
ventional prospective study. This study was approved by
the Institutional Research Ethics-Committee. After signed
informed consent by the subjects, anthropometric measure-
ments were taken.
Estimation of body fat composition
The body fat analyzer (bioelectrical impedance was
obtained using a device, Tanita — TBF — 310, Japan) was
used for assessing the BMI, fat%, fat mass, fat free mass
(FFM) and total body water (TBW).
Oxidase — Pap method, end point with lipid clearing
agent using the Transasia Bio-medicals Ltd. commercial kit,
HDL cholesterol was determined by Phosphotungstic Acid
Method, End point with Transasia Bio-medicals Ltd. commer-
cial kit, and triglyceride determination by dynamic extended
stability with lipid clearing agent Glycerol Phosphate Oxi-
dase — Trinder Method, End point, Transasia Bio-medicals
Ltd. commercial kit LDL cholesterol was calculated by
the formula of Friedewald (LDL-cholesterol = total choles-
terol − HDL cholesterol − triglyceride/5 mg/dl).
Yogic intervention
Under the guidance and supervision of yoga experts and
faculty, subjects performed yogic practices. The yogic prac-
ticed were Jal Neti (nasal cleansing) once in a week; this
is a process of cleaning the nasal passage with salt water
and is essential in allowing free breathing. Shavashana
(body awareness, 10—15 min) laying flat on back in the
supine position. Bhujangasana (5 times in 3 min) lying flat
on the stomach with the legs straight and the soles of the
feet uppermost. Shashankasana (5 times in 3 min) sitting
in Vajrasana then bending forward and placing the hand

Table 2 Comparison of difference in pre treatment and post treatment scores among yoga and non yoga groups.

Variables Difference in scores t value p value

Yoga Non yoga

n = 80Mean, sd n = 74Mean, sd

BMI 1.45, 1.74 0.96, 1.16 2.04 0.04*

Fat% 3.09, 3.36 1.28, 2.26 3.87 0.0002*
Fat mass 1.99, 2.70 2.68, 4.05 1.24 0.21
Fat free mass 1.51, 6.35 −0.54, 6.24 2.03 0.04*
Total body water 2.47, 3.26 2.95, 4.01 0.82 0.41
SBP 11.02, 9.46 7.05, 6.29 3.043 0.002*
DBP 8.85, 7.92 6.01, 4.98 2.63 0.009*
HR 4.17, 10.64 −2.32, 7.12 4.42 0.0001*
Total cholesterol 28.29, 30.86 5.31, 40.93 3.95 0.0001*
HDL 6.44, 4.92 2.00, 6.88 4.63 0.0001*
Triglyceride 38.04, 37.39 7.33, 34.82 5.26 0.0001*
LDL 15.10, 45.23 1.09, 39.64 2.05 0.04*
Abbreviations: *, statistically significant; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart
rate; HDL, high density lipoprotein; LDL, low density lipoprotein.
 Author's personal copy
Effect of yogic practices on lipid profile and body fat composition in patients of coronary artery disease
and foreheads rest on the floor in front of the knees. Ush-
trasana (5 times in 3 min) kneel and adjust the knees and
feet so that they are separated by the same width as the
hips. Hasthutthanasana (5 times in 3 min) inhale deeply and
slowly raising the arms above the head bending the head
slightly backward and look up at the hands. Shiddhasana
(changing the feet, 5 min) sitting with the legs straight in
front of the body. Bending the right leg and placing the sole
of the foot flat against the inner left thigh. Nadi Shodhan
Pranayama (5 times in 6—7 min) with om chanting (3 times
in 2 min) was also done. Total duration of these practices
was 35—40 min/day, five days in week till six months in the
Department of Physiology of the institute.
Statistical analysis
R-software version 2.7 (this can be freely downloaded by the
www.cran.r-project.org) was used in the statistical analy-
sis. For univariate analysis, differences12,13 in means were
analyzed by independent ‘t’ test was used. All statistical
tests were 2-tailed and a p value of <0.05 was considered
significant. Our main objective was to compare the total
cholesterol level in the two groups (yoga and non-yoga) after
the follow-up period of six months. In order to increase
the precision in estimating the association of interest, the
analysis of covariance model was used to take into account
the possible confounding effects due to age, body mass
index, pre-total cholesterol (pre-total cholesterol means the
value of cholesterol before yogic intervention at the time of
anthropometric measurement), pre-triglycerides, pre high
density lipoprotein. The partial F-test was used to test the
significance of adjusted mean scores. The test of paral-
lelism was performed before using the analysis of covariance
(ANCOVA) method of adjusting the cholesterol scores after
which we got results of post yogic intervention after six
months of yogic practices.
Results
Out of 170 patients 154 have finished the program and
completed study protocol. Table 1 summarizes demographic
characteristics of study participants. Table 2 summarizes
pre and post-intervention changes in the variables. Com-
pared to the non yoga group, the yoga group revealed a
pattern of improvements in BMI (p < 0.04), fat % (p < 0.0002),
SBP (p < 0.002), DBP (p < 0.009), heart rate (p < 0.0001), total
cholesterol (p < 0.0001), triglycerides (p < 0.0001), low den-
sity lipoprotein (p < 0.04) and fat free mass (p < 0.04), HDL
(p < 0.0001).
Adjustments for covariates
Here, the need for adjustment stems from the fact that age,
body mass index (BMI), pre treatment cholesterol level (TC1)
are the factors known to be strongly associated with post
treatment cholesterol level (TC2) and that the two groups,
as sampled, may have widely different distributions of age,
BMI, TC1 etc. The adjustment for covariate was done using
ANCOVA.
125
Table 3 Comparison of unadjusted and adjusted post total
cholesterol levels.
Types of scores Groups
Yoga Non yoga
Unadjusted mean TC2 140.53 143.97
Adjusted mean TC2 136.84 148.01
Abbreviations: TC2, post total cholesterol.
The fitted ANCOVA models for two groups are:
Yoga : ŷ = 85.25 − 0.55Age + 0.451TC1 + 0.115TG1 (1)
Non-yoga : ŷ = 85.25 − 0.55Age + 0.451TC1
+ 0.115TG1 + 11.173 (2)
The adjusted mean scores are obtained from these two
equations by taking the values of explanatory variables to
be their average values. A comparison of the adjusted mean
scores with the unadjusted means gives in Table 3.
Notice that the adjusted mean for yoga group is slightly
lower than the unadjusted mean for yoga group, whereas the
non-yoga group adjusted mean is higher than its unadjusted
counterpart. The direction of these changes accurately
reflects the fact that, in this sample, the distribution of
confounders such as age, pre-total cholesterol (TC1) and
pre-triglycerides (TG1) in the two intervention groups are
different (see Table 1).
Nevertheless, whether adjusted or not, the mean post-
total cholesterol for non-yoga group appears to be higher
than for yoga group. The discrepancy between the non-yoga
and yoga group is 3.44 using unadjusted mean scores and
11.17 using adjusted mean scores. Using the partial F-test,
we see that the adjusted mean score are significantly dif-
ferent (F = 5.23, p = 0.024).
Discussion
The prevalence rate of CAD is in the rural area of 4%14
and 11% in the urban area.15 In this study the effect
of yogic practices was seen on the body fat composi-
tion and lipid profile in the patients of CAD. Significant
improvement in blood pressure, heart rate and BMI was
observed and other researchers also corroborate with our
findings.16—18 In a research conducted in Connecticut, USA,
a six-week program of yoga and meditation was undertaken
to observe the brachial artery reactivity, significant reduc-
tions in blood pressure, heart rate, and BMI was observed in
the total cohort with yoga.19 It was observed that yoga prac-
tice has also significantly improved BP among people with
hypertension20 and cardiovascular disease.16 It was found
that yogic practices are useful in preventing and manag-
ing disorders related to the body systems.21 In the present
study fat% and fat free mass significantly improved after
yogic practices in yoga group. A controlled trial held in India
supports that yogic practices contribute to reduced exces-
sive body fat not only among school students but also in
obese patients.22 This study assessed the feasibility of imple-
menting a yoga program among patients of coronary artery
diseases.
 Author's personal copy
126
Physical activity to reduce one’s risk for cardiovascu-
lar disease is strongly recommended in consensus from the
Centers for Disease Control and Prevention and the Ameri-
can College of Sports Medicine Massachusetts, USA.23 Since
sustained physical exercise leads to greatest total caloric
expenditure; however CAD or other diseases may appear as
over riding factors.24 Yoga might have played role as a safety
measure. Other study also performed in Toronto, Canada,
clearly states that physically active individuals are less likely
to develop hypertension than sedentary individuals.25
We observed that level of HDL was significantly improved
after regular yogic practices in present study. A study con-
ducted on patients with angina and coronary risk factors26
have showed a positive response in lipid profile after 4—14
weeks of yogic practices. A study held in Ontario, Canada
also corroborate with our study and state that training
increases HDL cholesterol and several studies have con-
firm this belief.27 It is well known that yogic practices are
beneficial for the health. The level of cholesterol, triglyc-
eride and LDL was significantly reduced in this study after
yogic practices. Physical exercises including yogic prac-
tices along with dietary modification have been observed
to control lipid content of blood and to treat and prevent
CAD. A study was conducted in Tampere, Finland also favor
to the present study and mentioned that the practice of
yoga was associated with significant decreases in choles-
terol among subjects with cardiovascular disease.28 Another
study which was conducted in California, USA on subjects
with mild to moderate hypertension reported that yoga can
play an important role in risk modification for cardiovascular
diseases.29 The yogic practices have a favorable recondi-
tioning effect on endocrine gland secretion,30 reduction in
sympathetic tone of the autonomic nervous system as well
as in oxygen consumption and blood flow.
In the present study there were no significant changes in
most of the variables in non-yoga group. Sivsankaran et al.
have found that none of the laboratory parameters changed
significantly with yoga.19 There were no significant reduction
in Fat mass and Total Body Water in yoga group. Shenba-
gavalli also reported that body fat percentage did not show
any significant reduction due to training.31
Strengths and weaknesses of the study
Frequency of yoga practice in present study was 5 days/week
where as some other studies were restricted to only 4 days
training followed by practice at home.16—18 Many parame-
ters were studied simultaneously in present study, whereas
only lipid profile was studied in most of the studies.19,30,31
The duration of the yogic intervention was quite long (6
months) in our study, many other investigators kept it for
few weeks only.16—18 Our findings are also corroborate with
the findings of other studies16—18 therefore reproducibility
becomes another very important factor in present study.
Ornish et al.34 showed short term and long term benefits of
lifestyle changes (without using cholesterol lowering drugs)
on coronary lesions and clinical manifestations of coronary
artery disease (sample size, n = 28). Manchanda et al.17 have
showed similar benefits in Indian population (sample size,
n = 21). In both these studies, numbers of subjects were
small compared to our study (170 subjects).
A. Pal et al.
In a study conducted in Mumbai, India, it was observed
that in study group average total cholesterol level fell to
184.8 mg% (p < 0.05) from the baseline level of 247.2 mg%
(p < 0.05) and LDL cholesterol level fell to 108.4 from basal
of 146.4, even without the use of statins.32 In present study
it was seen that cholesterol level fell to 140.52 mg/dl from
the baseline level of 159.99 mg/dl and LDL cholesterol level
fell to 72.97 mg/dl from baseline level of 83.78 mg/dl, but
the subjects were taking medications with yogic practices
as subjects were CAD patients so medication could not be
stopped. Another study conducted in Haridwar, India, also
reported that cholesterol level fell to 118.65 mg/dl from
baseline level of 147.00 mg/dl, in this study all the subjects
were healthy football player.33
Limitations of this study was that our study group was
taken from urban population only, keeping in mind that
urban population is more prone for heart diseases than the
rural population. Most of the variables taken in this study
were indirectly related to coronary artery disease. In this
study we did not take the effect of diet though dietary factor
plays a vital role in yogic interventional studies.
In future this study could be repeated in other popu-
lations also. Further, some other yogic practices may be
tried and compared with the present ones. More scientific
co-relations could be seen before and after yogic interven-
tions. Qualitative analysis (psychological variables) of the
subjects may be useful for discussing the variables changed
after yogic intervention. Yoga may also be responsible in cre-
ating positive changes in plasma catecholamines, cytokines
and leukotrienes levels thus benefiting the patients. Study
of such factor could be helpful in management of CAD for
clinicians and policy makers. Thus yogic intervention may be
prescribed as an adjunct to medical treatment.
Conclusion
Reduction of SBP, DBP, heart rate, and body fat%, total
cholesterol, triglycerides and LDL after regular yogic prac-
tices is beneficial for cardiac and hypertensive patients.
Therefore yogic practices included in this study are helpful
for the patients of coronary artery disease.
Conflict of interest
There is no conflict of interest of authors.
Acknowledgements
The authors wish to acknowledge the financial support of
the Department of AYUSH, Ministry of Health and Family
Welfare, Government of India.
References
1. Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S.
Coronary heart disease and its risk factors in first generation
immigrant Asian Indians to the United States of America. Indian
Heart J 1996;48:343—52.
2. Hughes K, Yeo PP, Lun KC, Sothy SP, Thai AC, Wang KW, et al.
Ischemic heart disease and its risk factors in Singapore in com-
parison with other countries. Ann Acad Med 1989;18:245—9.
 Author's personal copy
Effect of yogic practices on lipid profile and body fat composition in patients of coronary artery disease
3. Anand SS, Yusuf S, Vuksan V, Devanesen S, Teo KK, Montague
PA, et al. Differences in risk factors, atherosclerosis and cardio-
vascular disease between ethnic groups in Canada: the study
of health assessment and risk in ethnic groups (SHARE). Lancet
2000;356:279—84.
4. Balarajan R. Ethnic differences in mortality from ischemic
heart disease and cardiovascular disease in England and Wales.
BMJ 1991;302:560—4.
5. Bulato RA, Stephens PW. Preworking paper. Washington, DC:
Population Health and Nutrition Department, World Bank;
1992. p. 100.
6. Janus ED, Postiglione A, Singh RB, Lewis B. The modernization
of Asia: implications for coronary heart disease. Circulation
1996;94:2671—3.
7. McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG. Associa-
tion of early onset coronary heart disease in south Asian
men with glucose intolerance and hyperinsulnemia. Circulation
1993;87:152—61.
8. Goode GK, Miller JP, Heagerty AM. Hyperlipidemia, hyperten-
sion, and coronary heart disease. Lancet 1995;345:362—4.
9. Chadha S, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath
N. Coronary heart disease in urban health. Indian J Med Res
1990;72:424—30.
10. WHO physical status: the use and interpretation of anthro-
pometry. Report of a WHO Expert Committee. WHO Technical
Report Series 854. Geneva: World Health Organization; 1995.
11. Expert panel on detection, evaluation, and treatment of high
blood cholesterol in adults. JAMA 2001;285:2486—97.
12. Guyatt G, et al. Measuring changes over time: assess-
ing the usefulness of evaluative instruments. J Chronic Dis
1987;40:171—7.
13. Mackenzie CR, et al. Can the sickness impact profile mea-
sure change: an example of scale measurement. J Chronic Dis
1986;39:429—38.
14. Rao GHR. Coronary artery disease in South Asians. 1st ed. New
Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2001. p.
6—28.
15. Mohan V, Deepa R, Rani SS, Premalatha G. Prevalence of coro-
nary artery disease and its relationship to lipids in a selected
population in South India. The Chennai urban population study
(CUPS No5). J Am Coll Cardiol 2001;38:682—7.
16. Mahajan AS, Reddy KS, Sachdeva U. Lipid profile of coro-
nary risk subjects following yogic lifestyle intervention. Indian
Heart J 1999;51:37—40.
17. Manchanda SC, Narang R, Reddy KS, Sachdeva U, Prabhakaran
D, Dharmanand S, et al. Retardation of coronary atheroscle-
rosis with yoga lifestyle intervention. J Assoc Physicians India
2000;48:687—94.
18. Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma
R, et al. A brief but comprehensive lifestyle education pro-
gram based on yoga reduces risk factors for cardiovascular
disease and diabetes mellitus. J Altern Complement Med
2005;11:267—74.
19. Sivasankaran S, Sachdeva S, Sachdeva R, Pugeda J, Hoq SM, Stu-
art et al. Division of Cardiovascular Medicine, Department of
127
Medicine, Bridgeport Hospital, Bridgeport, Connecticut 06610,
USA. Clinical Cardiology (Clin Cardiol) 2006;29(September
(9)):393—8.
20. Blumenthal JA, Emery CF, Madden DJ, George LK, Coleman
RE, Riddle MW, et al. Cardiovascular and behavioral effects
of aerobic exercise training in healthy older men and women.
J Gerontol 1989;44:M147—57.
21. Saraswati K, Swami. Yogic management of common diseases.
Munger: Bihar School of Yoga; 1986. p. 27.
22. Bera TK, Gore MM, Kulkarni DD, Bhogal RS, Oak JP. Yoga
Mimansa, vol. XXXIV, nos. 3 and 4. October 2002 and January
2003. p. 166—87.
23. Westcott WL, Winett RA, Anderson ES, Wojcik JR, Loud RL,
Cleggett E, et al. Effects of regular and slow-speed resis-
tance training on muscle strength. J Sports Med Phys Fitness
2001;41:154—8.
24. Arner P, Bolinder J, Engfeld P, Ostman J. Metabolism
1981;30:753—60.
25. Shephard RJ. Absolute versus relative intensity of physical
activity in a dose-response context. Med Sci Sports Exerc
2001;33:S400—18.
26. Berg A, Konig D, Diebert P, Grathwohl D, Berg A, Baumstark
MW, et al. Effect of an oat bran enriched diet on the athero-
genic lipid profile in patients with an increased coronary heart
disease risk. Ann Nutr Metab 2003;47:306—11.
27. Katzmarzyk PT, Leon AS, Rankinen T, Gagnon J, Skinner JS,
Wilmore JH, et al. Changes in blood lipids consequent to aer-
obic exercise training related to changes in body fatness and
aerobic fitness. Metabolism 2001;50:841—8.
28. Asikainen TM, Miilunpalo S, Kukkonen-Harjula K, Nenonone A,
Panasen M, Rinne M, et al. Walking trials in post menopausal
women: effect of low doses of exercise and exercise frac-
tionization on coronary risk factors. Scand J Med Sci Sports
2003;13:284—92.
29. Stefanick ML, Mackey S, Sheehan M, Ellsworth M, Haskell
WL, Wood PD. Effects of diet and exercise in men and
postmenopausal women with low levels of HDL cholesterol
and high levels of LDL cholesterol. N Engl J Med 1998;339:
12—20.
30. Copeland P. Yoga and the endocrine system. Yoga
1975;(July—August).
31. Shenbagavalli A. Yoga Mimansa, vol. XXXIV, nos. 3 and 4. Jan-
uary 2003, October 2002. p. 166—87.
32. Yogendra J, Yogendra HJ, Ambardekar S, Lele RD, Shetty
S, Dave M, et al. Beneficial effects of yoga lifestyle
on reversibility of ischaemic heart disease: caring heart
project of International Board of Yoga JAPI, vol. 52, April
2004.
33. Acharya BK, Upadhyay AK, Upadhyay RT, Kumar A. Effect of
Pranayama (voluntary regulated breathing) and Yogasana (yoga
postures) on lipid profile in normal healthy junior footballers.
Int J Yoga 2010;3(July—December (2)):70.
34. Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT,
Ports TA. Can lifestyle changes reverse coronary heart disease?
Lifestyle Heart Trial Lancet 1990;336:129—33.