I have before me a report by Michel P. Stern, a physician with the University of Texas Health Science Centre in USA, which investigates the dramatic decrease in deaths from heart disease (Annals of Internal Medicine, November 1979). Over the last few years, between 1968 and 1976, the death rate decreased by 20.7%. Stern points out that this decline can most probably be attributed to changes in lifestyle, such as eating less cholesterol and animal fat and smoking fewer cigarettes, and improved medical care for heart attack victims, especially in the form of coronary care units.
Despite these improvements, heart disease still ranks as the number one killer in technological, industrialised society today. Finland has the highest mortality rate due to cardiac disorders, in the range of 1 in every 200 of its population. In America in 1905, 25% of all deaths were due to coronary heart disease (blocking of the blood vessels in the heart by fatty material) but by 1955 the number had risen to 55%. At present, 70% of all deaths in the USA are due to cardiovascular disease. Each year one million Americans have a heart attack, that is 2 every minute, and 200,000 die of it. Even in India, heart disease is the third largest killer amongst city dwelling people. According to the WHO (World Health Organisation) heart disease has caused nearly half of all deaths in 22 major countries and the Executive Board of the WHO in 1969 described the present situation in terms of blood vessel and heart disease as "the greatest epidemic mankind has faced."
Today, very little can be done to help those people suffering from coronary heart disease (which includes a spectrum ranging from mild angina pectoris, chest pain, right up to heart attack) from the medical viewpoint. There is no way to reverse the degenerative process once it has begun, via medical means alone. A more broad ranged approach is required so that not only the pain and other symptoms and causative factors in the lifestyle are removed, but also the degenerative process is stopped and eventually regeneration is induced. Yoga has a definite role to play in this regard and we have found that using simple yogic practices, demanding half an hour of one's time, pain is removed and the degenerative process halted.
In any medical regime, the heart disease patient must be rehabilitated. Light physical exercise and plenty of rest is recommended. Yet it is very difficult for heart patients to do this because they are usually highly strung, ambitious, hardworking, hard-driving individuals, and to slow down means to frustrate their basic drives and reasons for living. Many find this difficult to accept and sink into depression. Their bodies slow down but the mind keeps racing with useless and destructive thoughts. They cannot rest and may sink into a spiraling, destructive pattern which leads to progressive deterioration, augmented by fear of the disease, and a quick demise.
Clearly a better way of helping coronary heart disease patients is required. For this, simple yogic practices are ideal because they augment natural and regenerative rhythms and help to erase unnatural, disharmonious, and therefore destructive rhythms and cycles which continue to drive the individual on a downhill course.
A study by the Institute of Cardiology, Government General Hospital, Madras, has shown that certain asanas are good for heart disease and some are not, reports Medical Times (2/10/77). Dr. C. Lakshmikanthan, Chief Cardiologist, said that as some asanas can hurt heart patients, they should not be prescribed indiscriminately but rather jointly by a yogic therapist and a medical practitioner. He found that shavasana and a modified inversion pose in which the feet were kept at 45 degrees to the ground supported on pillows, improved cardiac performance and would be useful for high blood pressure and rehabilitating a patient after heart attack.
In studying vipareeta karani mudra, sarvangasana and halasana, the researchers found that these asanas increased the work of the heart and improved cardiac performance in normal people. However, they are not suitable for heart patients as in these people cardiac performance increased. They also found that smoking and normal isometric type exercises were harmful for heart patients.
Medical Times reports that "most of the cardiac patients who started practising yogasanas after the preliminary investigations felt a sense of well being, were more energetic, and slept better than before."
The asana series used at Bihar School of Yoga for the treatment of heart disease is pawanmuktasana (anti-rheumatic series). These systematic and light movements fill the doctor's prescription for light, gentle exercise designed to help a heart patient remain in a physically fit yet relaxed state. They systematically work through every muscle and joint group in the body and thereby enhance blood flow and nervous stimulation to the parts involved. They also relax the body via the central controlling mechanisms within the brain.
After pawanmuktasana, from which we omit 'dynamic spinal twist' and 'crow walking' for heart patients, shavasana is used with great benefit. On this practice is superimposed the meditative technique of yoga nidra which gives rest to the physical, emotional and mental levels, and side tracks the individual away from his worries, ambitions and obsessions, so that rest is achieved. When shavasana and abdominal breath awareness are combined, the respiration and heart rate slow and alpha wave production by the brain increases. This is, then, the ideal practice for all kinds of heart disease, ranging from mild angina to severe heart attack, and can be used with great benefit, even in the coronary care emergency ward of a hospital.
The heart works on an activity to rest ratio of 1 to 2, its contraction phase being only that of its relaxation phase. It therefore works 8 hours a day and rests for 16. To augment this natural rhythm the yogic practice of nadi shodhana is ideal. In this practice the ratio of inhalation to exhalation is made 1 to 2. Inhalation, the active phase of respiration, corresponds to the active stage of heart contraction and exhalation corresponds to the phase when the heart rests.
The ratio between respiration and pulse should be in the range of 4 heart beats for every 1 breath. Proper timing indicates good health. Dr. Hildebrandt of the University of Marburg has found that cardiac patients often have a speeded up cycle, so that the ratio of heart to breath is 6 to 1. Many people with heart disease undergo spa therapy in which they follow a rigid schedule of sleep, meals, and immersion in natural spring waters, based on the classical theory that disharmony of a sick body is restored to harmony by a regular lifestyle schedule. Based on this Dr. Hildebrandt has found that many cardiac patients are restored to a 4 to 1 cycle after this treatment.
Nadi shodhana is another therapy which helps the heart cycle to regain its natural and original place in the cycles of the body and helps the heart to rest and relax by superimposing on its rhythm a relaxed and slow breathing cycle. The heart rate slows and its work is lessened, sympathetic activity is reduced and the heart and the rest of the body are given a chance to recuperate.
Aaron Friedell of Minneapolis, USA, reported in Minnesota Medicine (August, 1948) the use of a breathing technique he calls 'automatic attentive breathing', similar to nadi shodhana, which he used on his coronary heart disease patients with great success. In 1924 one patient reported to him that he could stop his severe attacks of angina by diverting his attention to the singing of a bird in a nearby tree, or by pretending that he was listening, provided he promptly stopped whatever he was doing at the time and turned his attention to his breathing, at the same time endeavouring to keep himself fully at ease and relaxed. The breathing technique consisted of slow diaphragmatic inhalation, a pause, slow exhalation and another pause. This technique is very similar to the respiration used in ajapa japa meditation. Friedell himself devised alternate nostril breathing as a means to improve diaphragmatic breathing. He then taught the technique to several patients and it gradually became automatic with them. They would not give it up since it helped them to gain relief in times of stress.
Friedell quotes several cases in which 'automatic attentive breathing' replaced all drug therapy and helped the individuals to live normal, pain-free lives. Some patients were pain-free for 18 years after starting and one reported that he had 'forgotten whether he has a heart or not', so successful was his therapy. Some took up full working duties, though restricting their activities as a precautionary measure and using the breathing technique for a few moments several times per day.
Friedell attributes the success of this breathing technique to the fact that slow abdominal breathing is a healthier physiological state, especially for its massaging effect on the heart and better blood perfusion of blood vessels in the chest, as well as for better oxygenation of tissues. It reduces sympathetic and enhances the relaxing effects of the parasympathetic nervous system on the muscles around the blood vessels, for example, of the heart.
The ideal program for a person suffering from mild coronary heart disease in the form of angina pectoris is pawanmuktasana, nadi shodhana, brahmari, sheetali, sheetkari, ajapa japa and yoga nidra.
In terms of heart attacks, shavasana and yoga nidra are the ideal methods to allay fear and pain, and to divert the patient's anxious mind from his condition in the critical first few days after the attack has occurred (in the emergency ward). Though heart attack patients used to spend 4 to 6 weeks in hospital, recent moves for earlier rehabilitation have been made in an attempt to positively influence the patient's mental state and to encourage a speedy return to normal activity. After 3 to 4 days of shavasana the patient can start nadi shodhana and by the end of one week pawanmuktasana can be instituted under expert guidance. By 2 to 3 weeks the patient should be ready to go home and to continue his practices there. Combined with sensible lifestyle habits these practices would definitely have a beneficial effect in terms of decreasing the mortality rate from coronary disease even more than was reported by Stern. A multifaceted approach is more likely to be successful. This also applies at the preventative level where more strenuous asanas and pranayama can be used to decrease sympathetic nervous system activity, cholesterol, and thereby shield the individual from the chance of contracting heart disease in the first place.