A serious health issue that has plagued modern society in recent times

A serious health issue that has plagued modern society in recent times, has been the rampant rise in diabetes. Chiefly due to the incidence and prevalence of type II diabetes mellitus, it has caused a widespread epidemic worldwide.

Statistical evidence displayed in a study by Diabetes Care (Mokdad et al. 2000), showed that the intensification of diabetes, inclusive of gestational diabetes, in different parts of the United States of America (USA) has been steadily increasing from the years 1990 โ€“ 1998. Further evidence displayed in J Am Med Assoc (Mokdad et al. 2001) that continued analysing the trend of the rise in diabetes from 1999 โ€“ 2001, showed even more so that the American dream was proving too sweet to handle for many of its citizens across the state.

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It has been shown however, that a key intervention for adults suffering from cardiovascular illness, overweightness or type II diabetes mellitus, would be to participate in regular exercise. The main benefit from exercise for someone with type II diabetes mellitus, would be the lowering of the blood glucose level. Stored glycogen in muscles is used during exercise as glucose and may allow a diabetic to better control the level of homeostasis within the body due to the fact the body becomes more insulin sensitive. Yet, few engage regularly in exercise, choosing a sedentary lifestyle over one where physical exertion is clearly needed to improve health.

Yoga however, is proving to be a popular alternative. Though some studies argue that it is indeed also classified as a form of exercise, others argue that it is yoga is a holistic intervention incorporating body postures (asanas), breathing techniques (pranayamas), meditation, cleansing, nutrition, modification of attitudes and behaviour, and mental discipline (Alexander et al. 2008)

This holistic philosophy, deemed more than mere physical exercise, is a lifestyle associated to a range of other pathologies including diet, relaxation and stress management. Furthermore, it has low cardiovascular demands compared to other forms of exercise like running or swimming, as far as exercise strenuous levels are concerned. Also, it is a low impact activity, meeting the demand for obese practitioners who might have difficulty moving around efficiently and lastly, offers a different form of sporting identity.

By introducing yoga to adults suffering from diabetes, the exercise referral scheme hopes to achieve and maintain optimal blood glucose, lipid, and blood pressure levels to prevent or delay levels of chronic difficulty (Diabetes Care, 2010;33,S62-69).

Several patients suffering from type II diabetes can attain blood glucose control by following a strict diet and exercise plan, shedding excess weight, applying essential self-care behaviour and taking oral medication, although others may require supplemental insulin (US Department of Health & Human Services Center for Disease Control, 2008). Medication used to regulate type II diabetes should enhance lifestyle improvements instead of replacing them.

The aim of this research study is to introduce yoga as a form of physical exercise into the lives of adults suffering from diabetes. Often, they lead sedentary lifestyles and the purpose of making yoga known to them would be to inspire a change in their way of life and hopefully for them to continue to be physically active independently.

Protocol
Before population selection criteria is determined, a detailed clinical examination in order to ascertain the diagnosis of diabetes upon each participant is carried out. Participants selected will be thoroughly briefed prior to undergoing the study with consent given from the willing parties. It is important to note that the newly selected subjects will not be prescribed any new form of drugs for medicinal usage if they are not already on medication.

For non-experimental bias to take place, participants would return for tests after a week, so as to eliminate any consequences of dieting. The tests included consists of an oral glucose tolerance test, the gold standard for testing type II diabetes, is implemented upon participants for this study. Considering all factors of the test, participants (non-pregnant) with a blood glucose level of 200mg/dl and above during test period and with a fasting blood glucose level of beyond 126mg/dl, would be considered appropriate for the study.

Further basic tests will include anthropometry tests, serum insulin estimation, plasma cortisol, blood urea, serum creatinine, serum lipid profile, serum lactates and pyruvates. Medical assessment is carried out at intervals and tests are done regularly as per required. Modifications by way of evaluation results and changes in frequency due to investigations done as per the particular study were also carried out. It is important to note that, yogic practices were not carried out during the day that these tests were done.

Data analysis is expressed in the form of, mean +/- 1 SD, and ‘T’ test is completed between initial and ensuing values at each point in time.

According to yogic research on diabetes from India, where this study is derived after, the earliest study assessed the effect of Pranayama on blood sugar level in fifty normal individuals. It showed a significant fall in the blood sugar level soon after the practice of Pranayama (Sahay et al. 2007).

A group of twenty-five type II diabetics and five type I diabetics are to undergo yogic practice and will be monitored closely. Each yoga session will run for three quarters of an hour and all participants will undergo four types of Pranayama for half an hour followed by Shavasana for fifteen minutes. This study will be carried out for three months with two sessions weekly, amounting to a total of twenty-four yoga sessions in total.

Objective
Simply put, this study aims to lower the blood glucose level of each participant and inspire them to continue an active lifestyle by keeping physically active and mentally sound. Studies have shown that diabetics have a high percentage of affected individuals developing mild to serious levels of depression, yoga as an exercise and a way of stress management hopes to eliminate this and keep the practitioner healthy not only in body but also in mind.

From an in-depth perspective, the study targets improvements in the participant’s exercise tolerance, insulin kinetics, obesity, lipid metabolism, hypertension and overall immunity in delaying or, potentially preventing chronic diabetes.
This has been identified as novel research as, even though yoga has been practiced for centuries in Asia, it is not as widespread or popularly selected as a form of exercise in the West. Hence the selection of yoga as an alternative and less-strenuous form of physical activity for westerners that would hopefully become widely accepted and utilised.

Methods
Experimental procedure will take place in accordance to extensive and well-designed protocols on the effects of yoga as treatment for diabetes (and other forms of diseases) at Vemana Yoga Research Institute, Secunderabad.

Methodology
Based on findings done previously, yoga in this study aims to tackle diabetes and, in addition to the aforementioned objectives, hypothesises that progress in the mechanics on change in biochemical and hormonal profiles as well as a sense of discipline within the practicing individual.

However, specific exercises during yoga classes has to be selected. Hence, research on the different asanas were conducted to indicate which were the most appropriate asanas and, individually, how it affected blood glucose levels. Studies done at the Vemana Yoga Research Insstitute revealed the following:

To measure the outcome of asanas, patients were randomly allocated to groups and then performed yogic practices of that group for forty-five minutes every day followed by relaxation practices, such as Shavasana and Makrasana. Results showed that optimum control of diabetes was achieved by practising Dhanurasana, Ardhamatsayendrasana (Group D). While Halasana, Vajrasana (Group B); Bhujangasana, Naukasana (Group A) were also successful, Yogamudra and Shalabasana (Group C) exacerbated the diabetic status.

Reviewed individually, Dhanurasana was the most effective. As to why some asana techniques produced negative effects is unclear. Thus, in all subsequent studies, the incorporation of the following asanas Dhanurasana, Ardhamatsayendrasana, Bhujangasana, Naukasana, Halasana, Vajrasana and Pachimotanasana along with Pranayama would be implemented.

Participants will undergo a three-month long yoga programme, conducted twice a week with every session lasting for forty-five minutes. A selected asana, consisting of four different forms of exercises of the nature will commence for thirty minutes, the session will then conclude with relaxation exercises, either Marasana or Shavasana for a quarter of an hour, before concluding.

Besides having tests done on each participant pre and post experiment, each of them are scheduled to be monitored after the course of this study. This is to observe the long-term effects of yogic practice on diabetics and, more importantly, to serve as a reminder to them that they must carry on practicing yoga to maintain a steady level of healthiness. It is up to each individual to carry on the practice, however, they will still be monitored and have anthropometric tests done in order to examine the level of increase (or decrease) in blood glucose and other pathological levels.

Data from some patients who discontinued yogic practices for some time and then restarted showed poor control when yogic practices were missed, which confirms the “cause and effect” relationship between yogic practices and glycaemic control (Sahay et al. 2007)

In research done in previous experiments of the institute, participants who returned for a follow-up examination showed significant fall in the fasting and post-prandial blood glucose values within three months and sustained a smooth and good control of diabetes as evidence from normal glycosylated haemoglobin and blood glucose levels. A vital observation also signified that drug requirements were reduced considerably.

Similarly, research procured from the Journal of Physicians in India (Vol. 55), showed that elderly diabetics (twenty subjects, with ages greater than sixty years and average age of sixty-six years) who were followed up for a period of seven years, achieved good glycaemic control which was maintained over the duration of that period and faced no long-term difficulties in diabetes. Further studies on “Lean Diabetics”, a subset of diabetics with a BMI of less than eighteen, was monitored. Improvements in their glycaemic control with reduction in body fat content and improvement in lean body mass were observed.

These studies proved indefinitely that in different subsets of patients – obese, lean, elderly, different variations of diabetes, there was improvement in glycaemic control which persisted over long periods of time with immunity against chronic diabetic effects. Displaying evidence that monitoring of subjects in the long-term is just as important in terms of gathering data as the conduct of the experiment itself.

A common symptom that accompanies diabetes is hypertension. Often encountered in diabetics, it plays a critical role in the development of both microvascular and macrovascular complications. Together with hypertension dyslipidemia, which is also equally as common. Hence it is important that this study takes into account the impact of yogic practices on these comorbidities (Bhaskaracharyulu et al. 1986).

Studies recommended that participants suffering from this ailment, proceed with the asanas, pranayama and shavasana. This was proven when twenty, non-diabetic patients with relatively elevated blood pressures had a decrease in both systolic and diastolic blood pressure after a mere three weeks of yoga sessions. Furthermore, blood pressure was maintained at ordinary levels with huge reductions in the dosage for antihypertensive drugs. Similar reductions in systolic and diastolic blood pressure, fasting and post-meal blood sugar levels was observed in patients with diabetes and hypertension. Blood pressure achieved a level of control within fifteen days and the effect was sustained even in studies up to three months (Sahay et al. 1986) These participants were devoid of cerebrovascular, cardiovascular and renal problems minus any unfavourable effects on the lipid profile.

Reduction in fasting insulin levels and normalization of insulin-glucagon ratio, together with a reduction in free fatty acid levels and decrease in insulin resistance is a largely expected outcome (Sahay et al. 1993) The effect of yoga and especially partaking in Bhujangasana and Naukasana, has shown that it plays a part in the effect on insulin receptors, as demonstrated upon investigation done on a small subset of diabetics. After a period of four weeks, there was a noteworthy increase in insulin receptors, though blood glucose levels did not yet fully normalize, indicating a reduction in insulin resistance and boost in insulin sensitivity (Madhavi et al. 1985).
Another symptom being tackled in this study is cell mediated immunity. A breakdown in cell defences against infections, cells are affected in patients with type II diabetes, especially with poor glycaemic control. The defective cell mediated immunity prompts diabetics toward various forms of illnesses. Studies however, have shown that partaking in yoga, especially the practice of Halasana and Vajrasana, display a positive effect on the lymphocyte migration test, implying improvement in the cell mediated immunity (Shambekar et al 1980).

Summary
Ultimately, yoga in all previously mentioned studies have produced a rise in lean body mass and drop in body fat percentage. Leading to overall improvement in insulin sensitivity and reduction in insulin resistance. The main irregularity in type II diabetes is undoubtedly insulin resistance and leads the line in the steady progress of general diabetes by several years. Reduction in free fatty acids in turn decreases lipotoxicity, which has been shown to have a significant effect on beta cell function. Thus, it is fair to assess that the main advantageous effect of yogic asanas on insulin kinetics and lipid metabolism, prevent beta cell exhaustion and the cause of a beta-cell secretory defect, thereby vetoing the development of type II diabetes. (Sahay et al. 1994)

All previous studies have established the practicality of yoga in the management of diabetes mellitus. Fasting and post-meal blood glucose levels are reduced considerably. Good glycaemic status is possible to be maintained for lengthy periods of time. Lowering of medication or drug requirement and frequency of serious complications like infection drastically fell.

Also, major alterations in insulin kinetics and those of counter-regulatory hormones like cortisol are noticeable. A reduction in free fatty acids implies greater insulin sensitivity and decrease in insulin resistance, with a plausible defensive effect on beta cell function. A positive effect on co-morbid conditions like hypertension and dyslipidemia has been evident. Yoga is suitable for people of all age groups and can be performed seasonally without consideration of the elements due to the low set-up requirement, moreover it is also useful for travellers and is extremely convenient.
Grant Proposal Request
With cost effectiveness on equipment at a relatively low rate. This grant proposal would look into funding for the medical coverage and date analysis required to aid the research in producing a successful outcome. Exercise equipment does not cost any money as it is provided by Surrey Sports Park, a request of $5,000 is sufficient over a six-month period. An additional three months post study due to potential tabulation of data.
Expenses include:
– Medical Equipment
– Transportation
– Health Insurance Provision
– Compensation to Participants
– Transportation fee for Participants
– Yoga Mats
– Facility Venue Booking
– Data Analysis Equipment
– Research Facility Booking
– Research Material ; Supplies
Thank you for your time and I do hope that this research on the introduction of yoga as a form of intervention, with the objective of allowing patients a different avenue in managing or controlling diabetic symptoms and also improving their quality of life, can be considered. (2498 Words)