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.
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.
References:
Available on request.
Dr Komal Jakhotia (PT)
Dr Apurv Shimpi (PT)
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