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Guidelines for Yoga Practitioners for COVID-19

Preamble

Yoga is a discipline based on an extremely subtle science, which focuses on bringing harmony between mind and body. It is an art and science of healthy living. Yoga leads to a perfect harmony between mind and body, man and nature, individual consciousness and universal consciousness. Yoga helps to build up psycho-physiological health, emotional harmony; and manage daily stress and its consequences. Yoga is also useful in conditions where stress is believed to play a role. Various yogic practices such as Yogasanas, Pranayama, Dhyana (meditation), cleansing and relaxation practices etc. are known help modulate the physiological response to stressors. Several randomized controlled studies have shown the efficacy of Yogic practices in management of non-communicable diseases like hypertension, Chronic Obstructive Pulmonary disease (COPD) , bronchial asthma, diabetes , sleep disorders, depression, obesity, etc. that can be comorbid conditions in patients with COVID 19. Yoga has also been shown to be useful in vulnerable population such as elderly, children. The function of the immune system is critical in the human response to infectious disease. A growing body of evidence identifies stress as a cofactor in infectious disease susceptibility and outcomes.

Studies on yoga in managing flu symptoms during an Influenza season have shown promising results. A recent randomized trial comparing meditation and exercise with wait-list control among adults aged 50 years and older found significant reductions in ARI illness during cold season with mindfulness meditation. Yoga is also known to increase mucosal immunity by increasing Salivary Beta Defensin-2 levels in elderly population Considering that they are a vulnerable group to contract such infections, yoga may be useful as a preventive measure. Yoga practices such as Kriya, Yogasana and Pranayama have been shown to reduce airway reactivity in elderly subjects with asthma and COPD. Thus, sufficient evidence exists to justify testing the hypothesis that training in Yoga /Meditation can reduce susceptibility to ARI illness. Neti kriya is useful in acute coryza and symptoms of cold.

Yoga may play significant role in the psycho-social care and rehabilitation of COVID-19 patients in quarantine and isolation. They are particularly useful in allaying their fears and anxiety.

This document provides guidelines for yoga professionals (Certified Yoga teachers/ instructors and therapists etc. ) to teach a safe set of Yoga practices based on available scientific evidences, to novices in all walks of society as a service to humanity during this pandemic of COVID -19. This is complimentary to all measures that have been adopted. Yoga based life style modules which can be used for different sections of the society in the present scenario are presented with the following objectives.

  1. To improve general immunity among the population.
  2. Prehabilitation of vulnerable populations (children, elderly and those with comorbid conditions such as diabetes and hypertension) and to those patients in isolation/quarantine with or without mild symptoms.
  3. To add-on Yoga based interventions and Meditation practices in covid-19 cases in isolation and hospitalization for psychosocial care

A Common Yoga Protocol (CYP) was developed by a team of leading Yoga Experts / Yoga Gurus that is being widely performed on International Day of Yoga (IDY) i.e. 21st June of every year. This protocol available on WHO m-app can be used by the general population to stay fit along with other hygiene and social distancing measures in this current scenario.

Yoga based lifestyle modules for health promotion in healthy population;

Yoga Based life style module to improve immune resilience in healthy population of all age groups.

Common Yoga Protocol

Forty-Five-minute module: The Common Yoga Protocol of IDY that was developed by a team of leading Yoga experts / Yoga Masters include safe practices to improve physical, mental, emotional and spiritual health of the population. Regular practice on empty stomach is recommended to improve immune resilience.

  • Twenty and ten minute modules are recommended for children, adults, Youths and the elderly population to be repeated twice a day (morning and evening).
  • Apart from CYP; Jalaneti, Sutraneti and Bhastrika Kriyas are recommended once or twice in a week and Yoga nidra for 20-30 minutes twice or thrice a week.

Yogic Diet

Follow the recommendations as per the medical advice on diet for your condition of diabetes, or heart disease etc. and add-on these concepts from yoga that promotes mental health. This includes wholesome nutritious freshly cooked traditional home cooked food with plenty of fresh vegetables and fruits (with restrictions as per your disease condition) with added traditional spices in moderate quantities, consumed at regular timings.

Abstinence from substance abuse including tobacco,alcohol and other addictive drugs

To reduce disease susceptibility in high risk population

To add-on Yoga based life style to hospitalized cases without acute respiratory distress.

As these subjects are hospitalized and they remain in bed without respiratory distress, the meditative practices without breath awareness practiced repeatedly is recommended. Practice of deep relaxation of the body, slowing down of the breathing rate and calming down of the mind using any of the practices from any school of Yoga for twenty minutes repeated once every 3-4 hours during the day time using audio instructions is recommended. Some examples include: mindfulness meditation, transcendental meditation, yoganidra, progressive relaxation, quick relaxation, deep relaxation etc.

Yoga Practices for prevention, rehabilitation and to increase immunity.

S.No Yoga Practices Do's Dont's Benefits
1. ShodhanaKriya (Yogic cleansing practices) Jalaneti, Sutra Net Use lukewarm water for cleansing. Jalneti must be followed by kapalabhati to remove all water from nasal passage. Neti, is advised to practice weekly once or twice. Should avoid in case of epistaxis, middle ear infection, and recent ENT surgery. Neti helps in cleansing sinuses, beneficial in allergic conditions and reduces upper airway reactivity
2. Yogic SūkṣmaVyāyāmas / shithilikaranavyayamas/ Pawanamuktasana series (Joint movements): Neck movements Shoulder rotation Trunk movement Knee movement Ankle rotation Move the joints as far as possible. Do it slowly with breath awareness Do not over strain. Avoid this practice in case of severe joint pain and illness. Joint movements help to increase blood circulation and reduce stiffness which enhance joint flexibility. Helps to facilitate asana practices.
3.

Yogasana:

Standing, Sitting, Prone & Supine lying

Do it with breath awareness.

Cardiac patients shall do with care as advised by Yoga experts.

Asanas that involve chest expansion preferred

Simplified version/s shall be followed be beginners and elderly population

Please avoid this practice in case of cardiac disorders, abdominal hernia,inflammation, ulcers, recent abdominal surgery & vertigo. Hypertensive patients should bend with care. Do not try to bend beyond the limits and do not overdo the lateral stretch. Ushtrasana, UtthanaMandukasana, Tadasana, Trikonasana, Vakrasana, Bhujangasana, Sarala Matsyasanaetc. practices improves chest expansion and cardiopulmonary functions. 
4. Kapalabhati 40-60 strokes per minute

Hypertensive, cardiac problems, patients with respiratory distress,slipped disc patients should not do it.

Better to practice it early in the morning on an empty stomach

Improves pulmonary functions and reduces secretions. Very useful preparatory practice for pranayama practice Helps to cleanse frontal sinuses.
5. Breathing & Pranayama: Sectional breathing Nadishodhana Ujjayi Bhramari Breath should be slow, steady and controlled. It should not be forced or restricted in anyway. Initially start the practice with few repetitions and gradually increase the number of repetitions. If possible, maintain the ratio of 1:2 for inhalation and exhalation In case of any cardiac disorders start with few repetitions and gradually increase the number of repetitions. Don’t practice retention or hold at initial stage.

Nadishodhan pranayama reduces the sympathetic activity and stimulate vagal (parasympathetic) activity and decreases stress and anxiety.

Ujjayi increase the oxygen saturation in body. Bhramari pranayama similar to humming may increase Nasal Nitric Oxide (NO), which mayimprove blood flow to the ciliary epithelium and has antiinflammatory action , - (19,20).

6. Yoga Nidra (Pratyaahara) Follow mentally with awareness as per the instructions given during practices. Keep the eyes closed during the practice and avoid body movements.

Don’t open the eyes until asked.

Don’t sleep Don’t ask any questions during the practice even if any questions arise in the mind.

Gradually increase the duration of the practice

Reduction in sympathetic arousal and reduced emotional distress and improves quality of sleep. Rejuvenate the body and helps to keep the mind calm
7. Meditative practices Breath awareness, Dharana&Dhyana)

For beginners, soothing music may be played in the background during meditation or to observe the breath.

Practice it as long as you can.

Don’t open your eyes Don’t shake your body.

Don’t be judgemental with thoughts

Meditation helps to reduces anxiety and stress by reduce the cortisol level and enhance the alpha brain wave.

Makes the body stable and calm the mind Balance the functions of neuroendocrine system thereby enhance the immune system.

Source : Ministry of AYUSH



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