Heart rate variability following an integrative treatment consisting of Ayurveda, biomedicine, and yoga in patients with lymphedema
How to cite this article: Gandharva K, Sharma SK, Aggithaya MG, Narahari SR, Valliyodan SM, Telles S. Heart rate variability following an integrative treatment consisting of Ayurveda, biomedicine, and yoga in patients with lymphedema. Indian J Physiol Pharmacol 2022;66:153-4.
Lymphedema is a chronic, progressive and debilitating condition associated with persistent accumulation of protein-rich fluid in interstitial spaces leading to swelling of one or more parts of the body. Lymph drainage may be facilitated by shifting the autonomic balance toward vagal dominance. Yoga and Ayurveda are known to modulate autonomic activity. Previously, a treatment protocol integrating Ayurveda, biomedicine, and yoga was reported to be clinically useful in patients with lymphedema. With this background, the present study was intended to (i) compare the heart rate variability (HRV) of patients with lymphedema with age- and gender-matched healthy volunteers and (ii) determine the effect of an integrative treatment on the HRV in patients with lymphedema.
Eleven patients with lymphedema (group mean age ± S.D.; 46.09 ± 12.47 years; m: f = 9:2) and (ii) 11 age (group mean age ± S.D.; 46.90 ± 5.78 years) and gender- (m: f = 9:2) matched healthy adults were assessed during a 5 min recording of HRV and breath rate (MP 45, BIOPAC System, U.S.A.). The patients received a treatment protocol integrating Ayurveda, biomedicine, and yoga for 10 days. The protocol includes washing of skin of the affected limb/limbs, phanta (=herbalised infusion) soaking, manual lymph drainage, and yoga practice. The study was approved by the Ethics Committee of the Institution (approval number: YRD - 019/006). The signed consent was obtained from each participant.
The EKG data were visually inspected offline and only noise-free data were included for analysis. Frequency domain measures (i.e., the low-frequency band [0.04–0.15 Hz] and (ii) high-frequency band [0.15–0.40 Hz]) and time-domain components (i.e., mean RR interval [the mean of the intervals between adjacent QRS complexes or the instantaneous heart rate], RMSSD [the square root of the mean of the sum of the squares of differences between adjacent NN intervals], NN50 [the number of interval differences of successive normal to normal intervals >50 ms] and pNN50 [the proportion derived by dividing NN50 by the total number of NN intervals]) of HRV were extracted using Kubios HRV software. The respiration rate was determined as cycles per minute by averaging the breath rate in each 5 min state recorded at baseline and after 10 days.
The baseline data of patients with lymphedema and of normal healthy volunteers were compared using Mann–Whitney U test. The data obtained at baseline and after 10 days of integrative treatment were analysed using Wilcoxon sign rank test. RMSSD was significantly lower (P < 0.05; one-tailed) in patients with lymphedema compared to normal healthy volunteers. RMSSD reflects vagal activity. This suggests that patients with lymphedema may have lower cardiac vagal activity compared to age- and gender-matched normal healthy volunteers. Following 10 days of integrative treatment, the LF/HF ratio decreased significantly (P < 0.05; one-tailed). LF/HF ratio is an index of sympathovagal balance. Higher values of the index suggest sympathetic dominance. Hence, a decrease in LF/HF ratio after 10 days of integrative treatment suggests a shift in autonomic activity toward vagal dominance in patients with lymphedema. This may explain the clinically beneficial effects of the integrative treatment reported in the previous studies. The findings may also be extended to cases of lymphedema following oncological lymphadenectomy.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
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