An Alternative Effective Method for Obesity Management in Females – The Modified Suryanamaskar Technique

Introduction:

Overweight and obesity are common health conditions and their prevalence is increasing globally. In developing countries, obesity & sedentary behavior coexists with under nutrition. In India, obesity is highly prevalent in women as compared to men. As the obesity epidemic spreads, there are growing concerns about efficient obesity management. Obesity comes with several causes which makes obesity management more complex. Some evidence suggests that lack of physical activity, rather than caloric intake, is a major determinant of obesity. It is the need of the moment to develop effective & comprehensive strategies which can reduce body weight & obesity related co-morbidities. The current targets should be focused on improving overall physical health rather than only reducing body weight.

Physical activity and/or exercise are commonly included as components of lifestyle interventions for weight loss. There are no specific recommendation mentioned on type & intensity of exercise.  Various studies using aerobic, resistance or combination of both types of exercises have shown to have health benefits. 

Yoga is an ancient Indian form of physical activity which may assist in achieving recommended levels of fitness. Suryanamaskar is a part of yoga. It is a set of sequential yogic postures which are called as asanas. A review by Ross et al suggests that yoga may be equally effective or better than exercise at improving a variety of health-related outcome measures like blood glucose, blood lipids & oxidative stress. Nevertheless, there is a dearth of research in the field of Suryanamaskar and also on its uses as a therapeutic exercise.

In various fitness and weight management centres, ‘aerobics’ involving high impact ballistic movements are incorporated. These forms of exercise are not suitable for obese females, especially those associated with musculoskeletal problems like knee arthritis, back pain and osteoporosis. Thus, an optimal approach is needed for management of obesity and enhancement of physical fitness parameters like cardio respiratory fitness, muscle endurance & flexibility.

Modified Chair Suryanamaskar Technique:

Suryanamaskar or Sun Salutation is the traditional exercise science done with a series of movements or asanas for fitness enhancement. But this technique seems difficult to be done by the population who has knee pain/ back pain or is obese and the protruding ‘tummy’ hinders the steps to be done in Suryanamaskar. The modified Suryanamaskar training (SN) is performed against the wall or with a chair as a modification. Although there are many literatures available on Suryanamaskar technique, no known documented evidence is available for this modified Suryanamaskar chair technique discussed in the present article and establishing the reliability of this procedure itself is an important aspect. Workers in the field of Suryanamaskar suggest that there are more than 1400 different modifications which can be possible in Suryanamaskar itself. This modified chair technique described herein, may be considered as the authors’ innovation to match the needs of the population described. This is performed at a speed of approximately 1 step/ second till the level of fatigue is ‘somewhat hard’.

The modified Suryanamaskar chair technique consists of a total of 12 steps or asanas: (Figures 1-7)

1.           Pranamasana: Stand erect with feet together. Look straight. Pull in knees, thigh muscles. Retract the shoulder girdles. Fold hands with palms pressed against each other to perform namaskar.

Figure 1: Pranamasana

2.             Hastauttanasana: Raise arms above head. Grow taller. Bend the back and stretch abdomen.

Figure 2: Hastauttanasana

3.            Hastapadasana: Bend forward. Don’t bend the knees. Go down and place your hands on the chair. Try to pull the head towards the knees.

Figure 3: Hastapadasana

4.           Ashwasanchalanasana: Take right leg back and stretch it while balancing it on the toe and keep left leg in front of your body aligned with the front legs of the chair. Keep palms straight on the chair and look upwards.

Figure 4: Ashwasanchalanasana

5.             Parvatasana: Take back the left leg as well and keep both the feet together while raising hip from the ground and balancing on all fours. (Hands on the chair & feet on the floor.)

Figure 5: Parvatasana

6.           Chaturnamaskara: Slowly come down and bring your shoulders near your hands. Knees should not touch the ground and waist and hip slightly raised above so that the body is aligned in a straight line.

Figure 6: Chaturnamaskara

7.          Bhujangasana: Arch your back. Lower waist and raise torso, make arms straight and balance. Feel bend of spine and stretch of abdomen.

Figure 7: Bhujangasana

8.             Parvatasana: Same as position 5 

9.             Ashwasanchalanasana: Same as position 4 

10.         Hastapadasana: Same as position 3 

11.         Hastauttanasana: Same as position 2 

12.         Pranamasana: Same as position 1

Discussion:

Lipids are major fuel source to the exercising muscles. Adding resistance to exercise may increase the energy expenditure leading to further fat oxidation. Suryanamaskar lowers the total body fat% by around 3.8% and the visceral fat by 9.3%. Increase in the visceral fat is associated with high risk of cardiovascular diseases & type II diabetes. Aerobic training when combined with resistance training is more effective in stimulating increase in the lean body mass with SN by around 2.2%. Increase in lean body mass caused by exercise can be associated with less reduction in total body weight. Study by Catenacci and Wyatt showed that exercise training improves body composition often independent of weight loss. Hence change in body weight is less reliable as an only outcome.

In sedentary adults, there is decline in muscle tissue by 4 to 6 lbs per decade and muscle efficiency also reduces.  This often leads to a drop in the resting metabolic rate and an increase in body fat. Even 2-3% increase in resting metabolic rate can have the effect of reversing age-related weight and fat gain. Aerobic exercise improves metabolic functions, especially enzymes in the muscles whereas, resistance training improves muscle protein synthesis and hence muscle mass. Aerobic exercise training also helps to maintain or slows down the loss of bone mass whereas resistance training improves bone mass. The modified SN technique may help to improvise this as well. Regular exercise is also associated with changes in muscle morphology and metabolism that correspond to a marked decrease in metabolic risk and increased life expectancy.

The body mechanisms to regulate water content are compromised with increasing age which are further exacerbated with hormonal changes in menopause, medical conditions like hypertension and use of certain medications e.g. diuretics. Body water percentage is an imperative marker of ageing wherein SN training raises the body water % by almost 5.1%.

Physical inactivity coupled with obesity increases the risk of cardiovascular and other obesity related diseases. When assessing the impact of obesity on health status, Cardio Respiratory Function (CRF) evaluation is fundamental part. Large observational studies recommend that CRF is inversely related to morbidity & mortality in obesity.  So, improvement in CRF may be more essential than changes in body weight or BMI in reducing the risk factors for obesity co-morbidities. This CRF is best designated by maximal aerobic capacity i.e. VO₂ max. It reflects the oxygen delivery to the exercising muscles by the cardiovascular & respiratory system. CRF depends on maximal cardiac output and the ability of skeletal muscle to extract oxygen. Hence it enhances the ability to exercise for prolonged duration. VO₂ max based on the Shuttle Walk Run Test performance shows a remarkable improvement with SN by almost 14.1%.

There are tall claims in weight management, but may not offer management of factors like endurance and flexibility which are impaired in obese people in such weight management programs. Increase in mitochondrial size and number and mitochondrial enzymes is mediated by the repetitive contractile activity of the muscle. Also these adaptations are very specific to the type of muscle fibres recruited. Increase in muscle endurance would be because of the metabolic adaptations occurring with training are lower blood lactate levels which delays the development of fatigue and increased fat oxidation. SN improves the upper limb muscle endurance markedly by 51.2% and lower limb muscle endurance by 24.5%. In SN there is repetitive upper limb loading with body weight in specific aasanas like Ashwanasanchalanasana, Chaturnamaskara & Bhujangasana activates various upper limb muscles to maintain the posture in that particular aasana.

Flexibility is the ability to move the joint through its complete Range of Motion. Insufficient ROM increases the risk of injury to the adjacent muscles and joints. Reduced flexibility may be because of various reasons like desk-bound lifestyle, physical inactivity or deposition of fat around the joints restricting complete ROM. Alterations in flexibility can lead to various bio-mechanical changes in joints and altered postures. Hence, flexibility is needed to perform daily activities with ease. Although the modified SN, unlike the traditional SN, does not permit complete movement of the trunk in asanas like the hastapadasan and bhujangasan, it is still an extremely important tool in enhancement of flexibility by almost 12.5%. The different postures in suryanamaskar demands movement till the end ROM which would be the reason of the noteworthy change with SN training.

Thus, employing exercise leads to measurable improvements in overall health status. This improvement is as a result of improvement in metabolic status, more efficient musculoskeletal and the cardiorespiratory system that can lead to a parallel increase in lean tissue and reduction in fat mass. It appears that as long as the increase in energy expenditure is sufficient, low to moderate-intensity endurance exercise is likely to generate beneficial metabolic effects similar to high-intensity exercise.

Clinical Implication:

Any form of exercise is beneficial for fitness enhancement and can be implemented for obesity management. Also, there are different types of benefits by different forms of exercise and no one method is considered superior to other. A normal fitness program requires exercise prescription of approximately 45 – 60 min. But the modified SN training regimes requires a lesser time. Thus we strongly recommend using the modified chair Suryanamaskar technique as a better method for Obesity management, with an added advantage of not requiring any instruments as in circuit training or treadmill in Gyms and also requires less space unlike walking. Hence, SN provides economic & time factor advantages and provides complete provision of fitness enhancement.

Conclusion:

Suryanamaskar training is an effective tool in weight management and improvisation of physical fitness parameters in over weight and obese females, especially in improving Cardio- respiratory fitness, upper limb muscle endurance and body flexibility.

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References:

Available on request.

Dr Komal Jakhotia (PT)

Dr Apurv Shimpi (PT)