Role of Meditation in Prevention of Cardiovascular Diseases: An Analytical Study in Hyper-Reactors of Cold Pressor Test

Living a happy and healthy life on all planes is possible through the unified practice of yoga, pranayama’s, exercise, and meditation (dhyana) especially when performed consciously and with awareness. Such mindful meditation when performed on regular basis it helps to relieve stress from body and mind. Hence we undertook the present study to observe the effects of regular Meditation on the hyper reactors of cold pressure test (CPT) to find out their future outcomes in improving the modernized stressful life. After getting ethical approval to the study subjects willing to participate in the study were selected and after performing cold pressor test (CPT) 383 hyper reactors were considered for the guided meditation sessions for 3 month. The sessions were conducted for 10 min both in morning and evening. After completing the session successfully it was observed that nearly 241 (62.83%) previous hyper reactors were turned into hypo reactors. Hence we conclude thatnon pharmacological method like meditation should be encouraged to enhance significant improvements in cardiovascularparameters like systolic and diastolic BP in population having high risk of cardiovascular disease.


Introduction
Modern man is the victim of stress and stress related disorders which threaten to disrupt his life totally.Being holistic in its approach, yoga offers the best way out of this 'whirlpool of stresses'.Living a happy and healthy life on all planes is possible through the unified practice of yoga, pranayama's, exercise, and meditation (dhyana) especially when performed consciously and with awareness. 1ditation and exercisehelp us to develop strength, flexibility, will power, good health, and stability.Meditation helpsus to control our emotions & stabilize the mind which are linked to breathing.Rhythmic breathing is ideal for controlling stress and overcoming emotional cold stress are likely to develop cardiac disorders later on in any phase of life.These hyper-reactive subjects should be properly dealt with to lower the incidence of such disorders. 5nce we undertook the present study to observe the effects of regular Meditation on the hyper reactors of cold pressure test (CPT) to find out their future outcomes in improving the modernized stressful life.

Material and Method
The present study was carried out in Department of Physiology Gandhi Medical College, Bhopal.(M.P.) in collaboration with Brahmakumari center for yoga and Meditation, Bhopal.A sample size of 383 participants was calculated using SampSize online stats calculator with prevalence of hypertension in Bhopal city to 53.3%, 6 confidence interval of 95% and precision to be 5 %. 7 Young adults from Bhopal city aging 18-30 years participated in the study.After taking institutional ethics approval written and informed consent was taken from the participants.Then baseline parameters like Height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), systemic blood pressure (BP) and heart rate (HR) was taken.For measuring BP traditional mercury sphygmomanometer was used and BP was recorded by both palpation and auscultation method by a two different investigators to reduce chance of errors.
Then cold pressor test was performed on the participants (details of which given below) and the hyper-reactors of CPT were separated for further study.On the selected hyper-reactors we trained them to perform mindful meditation for 10 minutes daily in morning session from 6 a. m. to 7 a. m. and in evening session from 6.30 p. m. to 7.30 p. m.The scientific training for mindful meditation was given by trained professional trainers at Brahmakumari center for Raj yoga and Meditation, Bhopal.
This training we implemented for a minimum of three months before taking the second session of recording SBP, DBP, BP and HR.The cold pressor test we performed was as follows: Cold Pressor Test 8 : The reactivity of all the subjects to cold stress was studied by the cold pressor test of Hines & Brown.The technique is as follows: The subject is allowed to rest in supine position in a quiet room with maintained temperature from 27 to 30 degree centigrade for 20-30 minutes.Readings of blood pressure were taken until basal level had been approximated.
With the subject still supine, and with the cuff of the sphygmomanometer on one arm, the opposite hand is immersed in ice water (2-4 0 C), to a point just above the wrist.With the hand still in water, readings of the blood pressure were taken at the end of 60 seconds.The hand is removed from ice water soon as the readings had been made and then the readings were taken every two minutes until the blood pressure returned to its previous basal level.Subject were allowed to remove their hands any point time if they feel unbearable pain as per convenience.
On the basis of observations, the subjects were divided into two groups depending on their responses to cold stress: Hyper-reactors: Those subjects in whom the systolic blood pressure raised more than 20 mm Hg and/ or diastolic blood pressure raised more than 15 mm Hg.

Hypo-reactors:
Those subjects in whom the systolic blood pressure didn't exceed 20 mm Hg and /or diastolic blood pressure more than 15 mmHg.
In present study we considered hyper-reactors only as they are supposed to be the victims of hypertension and mortal cardiac vascular diseases in future affecting the disability adjusted life years (DALY).
Each subject underwent a detailed history and clinical examination with the following inclusion and exclusion criteria.
2. Subjects not doing any type of physical exercise.

Exclusion Criteria:
I. Subjects who were taking other physical activity like gym, athletics etc.
II. Subjects who were smokers, alcoholic, with respiratory disorders, jaundice, diabetes or any other disease related with cardiorespiratory system.
The main rules and regulations pertaining to meditation are balance of common sense with regard to inner and outer thinking and living.We followed the following general rules • Breathing: subjects were made aware of nostrils throughout the technique.While inhaling the nostrils should dilate or expand outwards and while exhaling, they should relax back to their normal position.
• Time of Practice: we chose early morning timings from 6 a. m. to 7 a. m. as the best time to practice Meditation when the body is fresh and the mind has very few impressions.Another good time that we considered was just after sunset in evening time as 6.30 p. m. to 7.30 p. m.
• Place of practice: Preferred place of practice was quiet, clean and pleasant room with good ventilation but without drought.Practice in drought or wind, in air-condition, in direct sun-light was avoided.
• Sitting Position: Subjects were instructed to sit in a comfortable, sustainable meditation posture so as to enable the efficient breathing and body steadiness during the practice.
• Bathing: Instructions were given to take a bath or shower before commencing the practice or at least wash the hands, face and feet.Bath for at least half an hour was avoided after the practice to allow the body temp to normalize.
• No Smoking: all the subjects were given strict instructions to not to smoke tobacco or cannabis.

Method of Meditation:
The following are a few easy tips to remember while practicing Meditation: it in a comfortable posture with an erect spine, preferably in a specific yoga posture such as the-padmasana or the Lotus posture.
• Energize the breath through pranayama.
• Hold visualization for a few minutes to clear the sensory field and focus the mind internally.This may relate to peaceful colors, geometric designs (yantra), natural images or that of a deity or guru.
• Repeat an affirmation or prayer to increase positive thought power.
• Repeat a mantra such as 'Aum'or 'M' to still the mind.
• Silently observe the mind and let it empty itself out.
• Depending on one's natural temperament, it would help to try and establish contact with either Godor a Higher Consciousness through the natural movement of one's heart.
Such training was implemented over the hyperreactors which we selected from a total population of 689 people visiting the Brahmakumari ashram out of which 383 hyper reactors willing to join the study were selected.

Results
Overall 689 Meditators were visiting the Mediation center out which 260 subjects were either hypo reactors or showing less fluctuationsin BP than required to label them as hyper reactors.46 subjects though were found hyper reactors denied to participate in the study.Hence a total of 383 subjects who were hyper reactors were considered for the study.
In the present study after performing the CP; hyper reactors were selected for the study and their demographic data was recorded which is tabulated in Table .1 as: As the hyper reactors were showing no statistical significance (p >0.05) amongst gender distribution, height, weight and age hence the parameters recorded in these before and after the meditation were comparable.
After performing the CPT basal values of blood pressure were recorded in the hyper-reactors.It has demarcated that out of total 383 hyper-reactors nearly 244 were systolic hyper actors and 105 subjects were diastolic hyper reactors while 64 subjects were both systolic as well as diastolic hyper reactors.Mean values of their rise in BP are illustrated in Table .2. K. N. Udupa (1975) found significant decrease in systolic BP after 3 months of meditation.He found initial fall in systolic BP alike results were observed in the present study. 14e reduction in cold stress to systolic BP after 3 months of meditation session could be attributed to the reduction in sympathetic activity and increase in parasympathetic activity in cardiovascular tree due to increased vagal tone. 15,16  autonomic nervous system plays a majorrole in conveying adaptation of human bodyto environmental changes, by restrainingthe sensory, visceral, motor and neuro-endocrinefunctions.Also autonomic nervous system isone of the most important mediators to affect cold stress effects which may be responsiblefor the conversion of hyper reactors to hypo reactors supporting observation in present study. 17

Conclusion
In the present study Hyper-reactivity to cold pressor test decreased after 3 months of meditation.Initially there were 383 hyper-reactors to cold pressor test and the number of hyper-reactors decreased to nearly 37% after 3 months meditation, so there is approximately 63% reduction in hyper-reactivity.Hence we conclude thatnon pharmacological method like meditation should beencouraged to enhance significant improvements in cardiovascularparameters like systolic and diastolic BP.These results would justify theincorporation of meditation as part of our life style inprevention of hyper-reactivity to stress relateddisorders.Hence we can say that in a rigid societymeditation alone will bring quantum of solace from stressand hence they are now essentials forendeavouring life.
Funding: No funding's or sponsorship was availed for present study.