DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173523

Alternate nostril breathing: a systematic review of clinical trials

Shreya Ghiya

Abstract


Anulom-vilom Pranayama/ alternate nostril breathing (ANB)/Nadi-suddhi pranayama is one of the common yogic breathing techniques and involves breathing through one nostril at a time while closing the other nostril manually. This study aimed to summarize effects of independent ANB on various physiological parameters, to evaluate safety issues in clinical populations and collect published primary scientific evidence on the benefits of ANB. PubMed/Medline, Cinahl, Web of Science and Google Scholar were searched using the following terms: Alternate nostril breathing, Anulom-vilom/ anuloma-viloma pranayama, Nadi-shodhan/Nadi-shodhana pranayama. Forty-four randomized controlled trials were included in this review paper. These studies evaluated the effects of alternate nostril breathing on parameters of the autonomic nervous system, cardiopulmonary system, cognitive functioning, problem solving and motor memory retention. Of the studies, ten showed a high level of bias; twenty-nine showed a low level of bias and five showed an unknown level of bias as per Cochrane systemic review guidelines. Most of the studies included healthy subjects and age range was eight to seventy years. Alternate nostril breathing has few variations and standardization of the technique is yet to be established. This technique provides high level evidence for positive outcomes for the autonomic nervous and cardiopulmonary systems. There is also high level of evidence regarding improvement in cognitive functioning with regular practice of alternate nostril breathing. More clinical trials are required to evaluate the effects of alternate nostril breathing in clinical populations and to synthesize effective frequency and duration parameters.


Keywords


Alternate nostril breathing, Anulom-vilom pranayama, Cardio-pulmonary and autonomic function, Slow breathing exercises, Systemic review, Yoga

Full Text:

PDF

References


Bryant EF. The yoga sutras of Patanjali: A new edition, translation, and commentary: North Point Press; 2015.

Hasegawa M, Kern E, editors. The human nasal cycle. Mayo Clinic Proceedings; 1977.

Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: John Wiley and Sons; 2011.

Raghuraj P, Nagarathna R, Nagendra H, Telles S. Pranayama increases grip strength without lateralized effects; 1997.

Sivapriya D, Malani S, Thirumeni S. Effect of Nadi Shodhana Pranayama on Respiratory parameters in school students. Recent Res Sci Tech. 2010;2(11).

Naveen K, Nagendra RNH, Telles S. Yoga breathing through a particular nostril increases spatial memory scores without lateralized effects. Psychological reports. 1997;81(2):555-61.

Subramanian RK. Alternate nostril breathing at different rates and its influence on heart rate variability in non-practitioners of yoga. J Clin Diagn Res. 2016;10(1):CM01-2.

Yadav G, Mutha PK. Deep breathing practice facilitates retention of newly learned motor skills. Scientific Reports. 2016;6.

Ghiya S, Lee CM. Influence of alternate nostril breathing on heart rate variability in non-practitioners of yogic breathing. Int J Yoga. 2012;5(1):66.

Dhadse M, Fadia A. Effect of anulom vilom pranayam on auditory reaction time in Indian population aged 18-22 years. Int J Res Medical Sci. 2016;4(3):891-5.

Dhadse M, Fadia A. Effect of anulom vilom pranayam on visual reaction time in young adults of Indian population. Society Basic Appl Physiol. 2013;2:57.

Garg S, Chandla S. Effect of nadi shodhan pranayama on pulmonary functions. Int J Health Sci Res. 2016;6(4):192-6.

Kinabalu K. Immediate effect of ‘nadi-shodhana pranayama’on some selected parameters of cardiovascular, pulmonary, and higher functions of brain. Thai J Physiol Sci. 2005;18(2):10-6.

Telles S, Sharma SK, Balkrishna A. Blood pressure and heart rate variability during yoga-based alternate nostril breathing practice and breath awareness. Med Sci Monitor Basic Res. 2014;20:184.

Telles S, Singh N, Puthige R. Changes in P300 following alternate nostril yoga breathing and breath awareness. BioPsychoSocial Med. 2013;7(1):11.

Telles S, Yadav A, Kumar N, Sharma S. Blood pressure and purdue pegboard scores in individuals with hypertension after alternate nostril breathing, breath awareness, and no intervention. Med Sci Monitor. 2013;19:61-6.

Telles S, Joshi M, Somvanshi P. Yoga breathing through a particular nostril is associated with contralateral event-related potential changes. Int J Yoga. 2012;5(2):102.

Bhavanani AB, Ramanathan M, Balaji R, Pushpa D. Differential effects of uninostril and alternate nostril pranayamas on cardiovascular parameters and reaction time. Int J Yoga. 2014;7(1):60.

Telles S, Raghuraj P, Maharana S, Nagendra H. Immediate effect of three yoga breathing techniques on performance on a letter-cancellation task. Perceptual and motor skills. 2007;104(3 suppl):1289-96.

Raghuraj P, Ramakrishnan A, Nagendra H, Telles S. Effect of two selected yogic breathing techniques on heart rate variability. Indian J Physiol Pharmacol. 1998;42:467-72.

Joshi M, Telles S. Effect of four voluntary regulated yoga breathing techniques on grip strength. Perceptual and motor skills. 2009;108(3):775-81.

Raghuraj P, Telles S. Immediate effect of specific nostril manipulating yoga breathing practices on autonomic and respiratory variables. Applied Psychophysiol Biof. 2008;33(2):65-75.

Bhavanani AB. immediate effect of alternate nostril breathing on cardiovascular parameters and reaction time. Int Interdisciplinary Res J. 2014;4:297-302.

Gupta PK, Kumar M, Kumari R, Deo J. Anuloma-Viloma pranayama and anxiety and depression among the aged. J Indian Acad Applied Psychol. 2010;36(1):159-64.

Jain S, Agarwal J. Effect of alternate nostril breathing on cardiac output and systemic peripheral resistance. Int J Physiol. 2014;2(2):4-7.

Jain S. Effect of alternate nostril breathing on acute stress-induced changes in cardiovascular parameters in obese young adults. Nat J Physiol Pharma Pharmacol. 2016;6(6):515-9.

Pal G, Velkumary S. Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian J Med Res. 2004;120(2):115.

Jain S. Effect of six week training of alternate nostril breathing on cardiac output and systemic peripheral resistance in prehypertensive obese young adults. Indian J Pub Health Res Develop. 2016;7(1):1-4.

Singh S, Gaurav V, Parkash V. Effects of a 6-week nadi-shodhana pranayama training on cardio-pulmonary parameters. J Physical Edu Sport Management. 2011;2(4):44-7.

Garg R, Malhotra V, Tripathi Y, Agarawal R. Effect of left, right and alternate nostril breathing on verbal and spatial memory. J Clin Diag Res. 2016;10(2):CC01.

Sharma B, Misra R, Singh K, Sharma R. Comparative study of effect of anuloma-viloma (pranayam) and yogic asanas in premenstrual syndrome. 2013;57(4):384-9.

Dhungel K, Malhotra V, Sarkar D, Prajapati R. Effect of alternate nostril breathing exercise on cardiorespiratory functions. 2008;10(1):25-7.

Dhanvijay AD, Dhokne N, Choudhary AK. Effects of alternate nostril breathing on cardio-respiratory variable in healthy young adults. Int J Pharma Bio Sci. 2015;6(2):1352-60.

Dhanvijay AD, Bagade AH, Kumar A. Alternate nostril breathing and autonomic function in healthy young adults. J Dent Med Sci. 2015;14(3):62-5.

Goel S, Malhotra V, Goel N. Effect of nadi shodhan pranayama on cardiovascular functions. 2016;2(1):9-12.

Thakur GS, Kulkarni D, Pant G. Immediate effect of nostril breathing on memory performance. 2011 55(1): 89-93.

Mourya M, Mahajan AS, Singh NP, Jain AK. Effect of slow-and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Alternative Comp Med. 2009;15(7):711-7.

Malhotra V, Dhar U, Garg R. Anuloma viloma pranayama modifies reaction times and autonomic activity of heart: a pilot study. Int J Current Res and Rev. 2012;4(19):146.

Malhotra V, Goel N, Dhar U. Comparison of Mind control techniques: an assessment of reaction times. Bangladesh J Med Sci. 2016;15(4):596.

Kumar LR. Role of anuloma viloma pranayama in reducing stress in chronic alcoholics. Pak J Physiol. 2011;7:11-6.

Turankar A, Jain S, Patel. Effects of slow breathing exercise on cardiovascular functions, pulmonary functions and galvanic and skin resistance in healthy human volunteers-a pilot study. Indian J Med Res. 2013;137(5):916.

Dullo P, Vedi N, Gupta U. Improvement in respiratory functions after alternate nostril breathing in healthy young adults. Pak J Physiol. 2008;4(2):15-6.

Srivastava R, Jain N, Singhal A. Influence on Alternate nostril breathing on cardiorespiratory and autonomic functions in healthy young adults. Indian J Physiol Pharmacol. 2005;49(4):475.

Sinha AN, Deepak D, Gusain VS. Assessment of the effects of pranayama/alternate nostril breathing on the parasympathetic nervous system in young adults. J Clin Diagnost Res. 2013;7(5):821-3.

Kumari S, Kaur M, Kaur L. Effect of alternate nostril breathing exercise on cardiovascular functions among hypertensive patients. Int J Nurs Edu. 2015;7(3):131-4.

Mohan R, Jain S, Ramavat MR. Effect of alternate nostril breathing on cardiovascular parameters in obese young adults. Int J Physiol. 2015;3(1):108-11.

Bhardwaj A, Sharma MK, Gupta M. Endoscopic evaluation of therapeutic effects of “Anuloma-Viloma Pranayama” in Pratishyaya wsr to mucociliary clearance mechanism and Bernoulli's principle. Ayu. 2013;34(4):361.

Werntz D, Bickford R, Bloom F, Shannahoff-Khalsa D. Alternating cerebral hemispheric activity and the lateralization of autonomic nervous function. Human Neurobiol. 1982;2(1):39-43.

Shannahoff-Khalsa DS. Uniiateral forced nostril breathing: basic science, clinical trials, and selected advanced techniques. Subtle Energies and Energy. Med J Arch. 2001;12(2).

Kennedy B, Ziegler MG, Shannahoff-Khalsa DS. Alternating lateralization of plasma catecholamines and nasal patency in humans. Life Sciences. 1986;38(13):1203-14.

Keuning J. On the nasal cycle: Rijksuniversiteit te Leiden.; 1968.

Kristof M, Servit Z, Manas K. Activating effect of nasal air flow on epileptic electrographic abnormalities in the human EEG. Evidence for the reflect origin of the phenomenon. Physiol Bohemosl 1980;30(1):73-7.

Telles S, Nagarathna R, Nagendra H. Breathing through a particular nostril can alter metabolism and autonomic activities. Indian J Physiol Pharmacol. 1994;38:133.

Eccles R, Lee R. The influence of the hypothalamus on the sympathetic innervation of the nasal vasculature of the cat. Acta Oto-Laryngologica. 1981;91(1-6):127-34.

Toneatto T, Nguyen L. Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research. Canadian J Psyc. 2007;52(4):260-6.

Ott MJ, Norris RL, Bauer-Wu SM. Mindfulness meditation for oncology patients: a discussion and critical review. Int Cancer Ther. 2006;5(2):98-108.

Zgierska A, Rabago D, Chawla N. meditation for substance use disorders: a systematic review. Substance Abuse. 2009;30(4):266-94.

Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78(2):169.

Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General hospital psychiatry. 1995;17(3):192-200.

Gard T, Noggle JJ, Park CL. Potential self-regulatory mechanisms of yoga for psychological health. Frontiers in human neuroscience. 2014;8:770.

Monro R, Nagarathna R, Nagendra H. Yoga for common ailments. New York/London: Simon and Schuster Google Scholar; 1995.

Kamei T, Toriumi Y, Kimura H. Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Perceptual Motor Skills. 2000;90(3):1027-32.

Novak V, Novak P, de Champlain J. Influence of respiration on heart rate and blood pressure fluctuations. J Applied Physio. 1993;74(2):617-26.

Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. J Hyper. 2001;19(12):2221-9.