Article Text

Yoga respiratory training improves respiratory function and cardiac sympathovagal balance in elderly subjects: a randomised controlled trial
  1. Danilo F Santaella1,2,
  2. Cesar R S Devesa1,
  3. Marcos R Rojo2,
  4. Marcelo B P Amato3,
  5. Luciano F Drager4,
  6. Karina R Casali5,
  7. Nicola Montano5,
  8. Geraldo Lorenzi-Filho1
  1. 1Sleep Laboratory, Pneumology Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
  2. 2Sports Center, University of São Paulo, São Paulo, Brazil
  3. 3Experimental Laboratory, University of São Paulo Medical School, São Paulo, Brazil
  4. 4Hypertension Unit, Heart Institute (InCor), Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil
  5. 5Department of Clinical Sciences, University of Milan, Internal Medicine II, Sacco Hospital, Milan, Italy
  1. Correspondence to Geraldo Lorenzi-Filho; geraldo.lorenzi{at}


Objectives Since ageing is associated with a decline in pulmonary function, heart rate variability and spontaneous baroreflex, and recent studies suggest that yoga respiratory exercises may improve respiratory and cardiovascular function, we hypothesised that yoga respiratory training may improve respiratory function and cardiac autonomic modulation in healthy elderly subjects.

Design 76 healthy elderly subjects were enrolled in a randomised control trial in Brazil and 29 completed the study (age 68±6 years, 34% males, body mass index 25±3 kg/m2). Subjects were randomised into a 4-month training program (2 classes/week plus home exercises) of either stretching (control, n=14) or respiratory exercises (yoga, n=15). Yoga respiratory exercises (Bhastrika) consisted of rapid forced expirations followed by inspiration through the right nostril, inspiratory apnoea with generation of intrathoracic negative pressure, and expiration through the left nostril. Pulmonary function, maximum expiratory and inspiratory pressures (PEmax and PImax, respectively), heart rate variability and blood pressure variability for spontaneous baroreflex determination were determined at baseline and after 4 months.

Results Subjects in both groups had similar demographic parameters. Physiological variables did not change after 4 months in the control group. However, in the yoga group, there were significant increases in PEmax (34%, p<0.0001) and PImax (26%, p<0.0001) and a significant decrease in the low frequency component (a marker of cardiac sympathetic modulation) and low frequency/high frequency ratio (marker of sympathovagal balance) of heart rate variability (40%, p<0.001). Spontaneous baroreflex did not change, and quality of life only marginally increased in the yoga group.

Conclusion Respiratory yoga training may be beneficial for the elderly healthy population by improving respiratory function and sympathovagal balance.

Trial Registration identifier: NCT00969345; trial registry name: Effects of respiratory yoga training (Bhastrika) on heart rate variability and baroreflex, and quality of life of healthy elderly subjects.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Santaella DF, Devesa CRS, Rojo MR, et al. Yoga respiratory training improves respiratory function and cardiac sympathovagal balance in elderly subjects: a randomised controlled trial. BMJ Open 2011;1:e000085. doi:10.1136/bmjopen-2011-000085

  • Funding Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

  • Competing interests None.

  • Ethics approval The protocol was approved by the ethics committee of the University of São Paulo Medical School, São Paulo, Brazil.

  • Contributors DFS, ACRDS and MRR designed the protocol. DFS conducted the yoga and control classes, and collected and analysed the clinical data. DFS, GLF, KRC and NM drafted the article and revised it critically for important intellectual content. MBPA and LFD contributed substantially to the conception and design, acquisition of data, and analysis and interpretation of data. All authors interpreted the data, revised the article critically for important intellectual content and approved the final version.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We agree to share the published data as open access.