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Yoga Breathing, Meditation, and Longevity

Richard P. Browna and Patricia L. Gerbargb
Associate Professor of Clinical Psychiatry, Columbia University College of Physicians
and Surgeons, New York, New York, USA
Assistant Professor of Clinical Psychiatry, New York Medical College, Valhalla,
New York, USA

Yoga breathing is an important part of health and spiritual practices in Indo-Tibetan

traditions. Considered fundamental for the development of physical well-being, med-
itation, awareness, and enlightenment, it is both a form of meditation in itself and
a preparation for deep meditation. Yoga breathing (pranayama) can rapidly bring the
mind to the present moment and reduce stress. In this paper, we review data indicat-
ing how breath work can affect longevity mechanisms in some ways that overlap with
meditation and in other ways that are different from, but that synergistically enhance,
the effects of meditation. We also provide clinical evidence for the use of yoga breathing
in the treatment of depression, anxiety, post-traumatic stress disorder, and for victims
of mass disasters. By inducing stress resilience, breath work enables us to rapidly and
compassionately relieve many forms of suffering.

Key words: yoga; breathing; meditation; depression; post-traumatic stress; anxiety

Mindfulness of in-and-out breathing, when developed and as increased insulin resistance), oxidative dam-
pursued, brings the four frames of reference to their culmina- age by free radicals, and neural degeneration.
tion. Is there evidence that these ancient practices
Anapanasati Sutta can ameliorate stress and the process of aging?
If so, how can we understand such effects in
Peace in our world can only start with peace in our minds. Western scientific terms?
Sri Sri Ravi Shankar

Historical Context
Awareness and training of breath are fun-
When we think of aging, we worry about damental to Indo-Tibetan yoga and medi-
loss of energy, vigor, mental functions, sexual tation. While Transcendental Meditation has
capacity, independence, and the ability to deal been studied in research institutions since 1963,
with physical or emotional stress. Yoga breath- the scientific study of Tibetan Buddhist and
ing and meditation have been an integral part yoga breath practices is relatively new. In
of the spiritual practices used for thousands of the past this has been due to the protective
years by Eastern cultures to deal with these con- secrecy surrounding these techniques. There
cerns. Neuro-immuno-endocrine changes asso- have been concerns that if the practices are not
ciated with stress and aging include inflamma- taught properly, they could cause harm. More-
tion, dysregulation of energy utilization (such over, religious leaders and devotees are reluc-
tant to see treasured traditions taught piece-
meal without their spiritual and philosophical
Address for correspondence: Patricia L. Gerbarg, M.D., 86 Sherry
Lane, Kingston, NY 12401. Voice: 845-331-8881; fax: 845-331-3562.
underpinnings. Nevertheless, interest in East-
PGerbarg@aol.com ern healing and spiritual practices is growing
Longevity, Regeneration, and Optimal Health: Ann. N.Y. Acad. Sci. 1172: 5462 (2009).
doi: 10.1111/j.1749-6632.2009.04394.x  C 2009 New York Academy of Sciences.

Brown & Gerbarg: Yoga Breathing, Meditation, and Longevity 55

and their techniques are being adapted to di- tence, rapture not-of-the-flesh, serenity (calm-
verse cultures and medical settings. As more of ness of mind and body), concentration, and
the previously hidden techniques become ac- equanimity. The seven factors bring clear
cessible, they provide new areas of research that knowing and release. Thus the process of awak-
will enrich Western medicine and science. ening begins with mindfulness of breathing.3
Yoga breathing, called pranayama, is one of Paintings on the walls of the Secret Temple
the Eight Limbs of Yoga that were systematized of the Dalai Lama in Lhasa depict ancient Ti-
in Patanjalis yoga sutras (circa 200 B.C.). The betan yoga poses of trul-khor. Two forms of Ti-
life-force or prana in Sanskrit is the life-air, vi- betan trul-khor movement and breath practices
tal breath, or srong-lung in Tibetan. Life-force- are being taught in the West: Trul-khor and
energy is called chi in Chinese and ki in Japanese Yantra Yoga. The aim of these practices is to
traditions. Pranayama translates from Sanskrit clear away all unwanted obstructions, imbal-
as control of energy or expansion of en- ances (drowsiness and agitation), distractions
ergy.1 Yoga teachings are found throughout and negative emotions to enable the practi-
Buddhism. In the 7th century A.D. Ayurvedic tioner to experience the natural mind and
Medicine and Buddhism from India reached remain in the meditative state. In Tibetan the
Tibet. These traditions were further enriched word for yoga, nejor, can mean union. Nejor
by pre-Buddhist Shamanic, Chinese, and Per- can also mean original or authentic knowl-
sian influences. Yogic Science and Buddhism edge or understanding. This deeper mean-
seek to understand the nature of the mind in ing alludes to our original, never-changing con-
order to develop awareness, compassion, and dition.4 Western psychology would call this
enlightenment. Both traditions teach the same the true self. Although these practices were
basic precept, that there is a bi-directional re- believed to enhance physical and emotional
lationship between the mind and the breath, health as well as to reverse the process of ag-
such that one can affect the mind and con- ing, they were primarily used to develop med-
sciousness through manipulation of the breath. itative practices and to bring awareness of the
Breath practices are believed to eliminate tox- natural state of the mind. Trul-khor move-
ins and negative karmic airs, to clear the ments and breath practices are used when the
subtle pathways of the subtle body (the mind is unclear, unstable, or weak to stabilize
energy body), and to increase oxygenation to and clarify meditation. Exhalation with sounds
strengthen the physical body. Breathing, visu- of Ha and Phat breaks through mental obsta-
alization, mantra, and movement are used to cles while sustaining the natural state of mind.
control the forces of the mind and body to clear Yantra Yoga was originally taught in the 8th
a path to enlightenment or the realization of century A.D. in Tibet by Vairocana, a student
Buddhahood.2 of Guru Padmasambhava. According to Lama
In Thai Buddhism, the emphasis is on the Lobsang Palden Rinpoche who escaped Tibet
Mindfulness of Breathing as taught in the Ana- after the Chinese authorities closed the Tashi
panasati Sutta, part of the Tipitaka or Pali Kyil Monastery, Yantra Yoga techniques are
canon (250 B.C.), the compiled teachings of healing movements with corresponding breath
Buddha. According to the Tipitaka, the pursuit practices that put the whole body into mudras
and development of mindfulness of in-and-out to circulate and rejuvenate energy. This serves
breathing leads to the culmination of the four to purify karma, eliminate negativity, and en-
frames of reference: focus on the body, the feel- gender peace.5
ings, the mind, and mental qualities. The four Yoga philosophy considers the greatest stress
frames of reference bring the seven factors for to come from fluctuations of the mind as it
awakening: mindfulness, analysis and compre- moves toward the things it wants or away
hension of the quality of mindfulness, persis- from things it dislikes, as it runs towards future
56 Annals of the New York Academy of Sciences

worries, or becomes mired in past mistakes. that when subjects became angry their risk
Even as you read this paper or attend a lecture of further heart attacks doubled compared to
your mind is in constant motion, shifting into those who remained calm.7 In a study of 5,716
future obligations or past frustrations. When middle-aged people, those with the best self reg-
the mind is 100% in the present we experience ulatory abilities were 50 times more likely to be
the calmness, peace, and joy that minimize the alive and without chronic disease 15 years later
effects of stress. Most people agree that being than those with poor scores on measures of
in the present moment is desirable, but they self regulation.8 As the only autonomic func-
cannot find the way to get there. Yoga breath- tion easily controlled through voluntary effort,
ing rapidly quiets the fluctuations of the mind breathing serves as a portal through which im-
bringing us into the present moment.6 balances in the stress-response system can be
What do these diverse breath traditions corrected.
have in common? How might they increase For most people, the quality of life is even
longevity? What is the research evidence and more important than longevity. The quality of
what more needs to be done? ones life depends upon the quality of ones
mind. Stress, overstimulation, excess expecta-
Research Evidence tions, and mental turmoil drain our energy
and our capacity to enjoy life. Mind-body and
Western scientists and researchers have been spiritual practices offer the sense of peace,
studying Buddhist meditation, but there is very joy, and relatedness that sweeten our lives
little research on Tibetan movement and breath and the lives of those closest to us. Unfortu-
practices. However, the developing evidence on nately, many people who try to learn medita-
yoga breath techniques can be used to draw tion cannot focus their minds. Some find the
inferences and guide research on Buddhist practices difficult and austere. Most lack the
practices. patience to persist. Trying to meditate while un-
Yoga breathing can be considered a form der severe stress sometimes magnifies the sub-
of meditation. Moreover, certain breath prac- jective sense of distress. In our clinical practices,
tices prepare the mind for deeper meditation. we find that starting with breath practices gives
Both yoga breathing and meditation can acti- immediate benefits that most people can ex-
vate the parasympathetic nervous system and perience, lays the ground work for meditation,
induce altered states of consciousness. There and prepares the mind for deeper meditation.
are many patterns of breathing and specialized Many scientific studies have shown that
techniques that enhance breath practices such mind-body interventions derived from yoga (in-
as breathing deeply into the abdomen, breath- cluding breathing, meditation, physical pos-
ing against airway resistance, physical postures, tures, centering, and visualization) ameliorate
holding the breath at different parts of the stress-related mental and physical disorders in-
breath cycle, or breathing alternately through cluding asthma, high blood pressure, cardiac
both nostrils, or only one nostril. Extracting illness, elevated cholesterol, irritable bowel syn-
the common elements within this diversity and drome, cancer, insomnia, multiple sclerosis, and
studying the separate and combined effects of fibromyalgia.911 Reducing sympathetic and in-
yoga practices enriches our understanding of creasing parasympathetic nervous system tone
the impact of yoga practices on the self-repair are integral to such therapeutic action. Car-
and self-regulatory systems that may increase diac vagal (parasympathetic) tone has been
longevity, resilience, and quality of life. associated with emotional regulation and em-
Our ability to deal with stress has an impact pathic response.12,13
on how we age. A Harvard Medical School Western research confirms the Indo-
study of 1,623 heart attack survivors found Tibetan teaching that the relationship between
Brown & Gerbarg: Yoga Breathing, Meditation, and Longevity 57

breathing and emotion is reciprocal.14 Emo- parasympathetic, activity through numerous

tional states can affect respiratory rate, depth, mechanisms, including slow breath rate, con-
and pattern. On the other hand, voluntarily traction of the laryngeal musculature, inspira-
changing the pattern of breath can account tion against airway resistance, prolonged ex-
for at least 40% of the variance in feelings piration against airway resistance and breath
of anger, fear, joy, and sadness.15 Breathing is holds. Slow breathing with prolonged expira-
controlled by both voluntary and involuntary tion was shown to reduce psychological and
mechanisms with complex feedback involving physiological arousal in an anxiety provoking
autonomic networks, brain stem nuclei, limbic situation in a randomized study of 70 college
system, cortex, and the neuroendocrine system. students.22
The voluntary control of breath can modulate While simple slow breathing increases
autonomic nervous system functions including parasympathetic activity, Ujjayi breathing am-
cardiac vagal tone as measured by heart plifies these effects through vagal afferent
rate variability,1,16 vigilance and attention,17 inputs to the brain and improves heart rate
chemoreceptor and baroreflex sensitivity,18,19 variability (HRV).23 Numerous disorders are
as well as the level of central nervous system associated with impairment of HRV and res-
excitation.20 piratory sinus arrhythmia (RSA).24 Low RSA
A yoga breath program called Sudarshan is found in depressed, timid, or fearful infants.
Kriya Yoga (SKY) has been taught to over Low HRV and low RSA have been associated
6 million people in 150 countries by the Art of with anxiety, panic disorder, depression, irri-
Living Foundation (a non-profit service orga- table bowel syndrome, early Alzheimers, and
nization). The reproducible sequence of SKY obesity.25,26
breath practices has been found to alleviate The second breath practice in the SKY
stress, anxiety, and depression in clinical prac- program is Bhastrika (bellows breath), a high
tice and in research studies. Evidence suggests frequency, forceful technique similar to Kapal-
that SKY acts via mechanisms that are funda- abati. High frequency breathing induces au-
mental to increased longevity. tonomic sympathetic activation and CNS ex-
The effects of SKY breath practices that citation.27 The third component of the SKY
have been observed physiologically and clini- program, the om chant, improves vagal tone,
cally cannot be attributed simply to either hy- decreases sympathetic activation, and increases
perventilation or increased oxygenation. Read- mental alertness in the setting of physiologic
ers interested in a detailed discussion of the relaxation.28
neurophysiology and clinical effects of the SKY The fourth SKY component is Sudarshan
program on stress and psychiatric disorders are Kriya (SK), a cyclical breath form, believed to
referred to our previous reviews.20,21 Here we harmonize the nervous system. The translation
will briefly mention some plausible mechanisms of Sudarshan Kriya is clear vision through
for the action of breath practices, the benefits purifying action. This embodies the Indo-
for longevity, and some of the evidence for clin- Tibetan principal that the purification of the
ical efficacy. subtle and physical bodies through breath prac-
The SKY program has four breath com- tices leads to mental clarity, awareness, and
ponents: three-stage slow resistance breath- wisdom. In our clinical experience, this highly
ing, bellows breath, chanting om, and advanced breath practice often evokes deep in-
Sudarshan Kriya (cyclical breathing). Slow re- sight, resolution of emotional conflict, and a
sistance breathing, known as Ujjayi in San- subjective sense of new found mental clarity. It
skrit, means victorious breath (sometimes called also has a strong impact on stress reduction in
ocean breath). Previous research indicates clinical conditions such as post-traumatic stress
that Ujjayi breathing increases vagal, that is disorder, anxiety, and depression.
58 Annals of the New York Academy of Sciences

A significant increase in -1 and -2 ac- ten uses awareness of breath as an entry point)
tivity in the left frontal, midline, and occip- including yoga, Zen Buddhist, Kundalini, and
ital regions was noted on EEGs of 19 regu- QiGong.3339
lar SKY practitioners at rest when compared Our hypothesis is that yoga breathing pro-
with 15 healthy age-matched controls.29 An- vides a neurophysiological work-out that
other study of EEGs in 12 volunteers dur- leads to greater flexibility and plasticity in the
ing Sudarshan Kriya followed by meditation nervous system. Experienced SKY practition-
showed heightened alertness in all participants ers achieved a remarkable degree of synchrony
as indicated by increased spectral power of and coherence on EEG. Hankey39 noted that
-rhythm in the middle band (1010.5 cps) increased EEG coherence has been associ-
in O 1 and O 2 montages (P < 0.005). Sig- ated with experiences of pure consciousness
nificant inter-hemispherical asymmetry disap- and greater brain processing capacity. Expe-
peared with highest -activity at the end of SK rienced Tibetan Buddhist meditators showed
in the centrencephalic mediobasal structures greater coherence and synchrony in gamma
and occipital cortex (P < 0.05), suggesting im- frequencies (2543 Hz) during the contem-
proved inter-hemispheric communication and plative practice of Compassion.40 High am-
integrative function (P < 0.05).30 plitude synchronous alpha and theta waves,
We are currently analyzing neurophysio- most pronounced in advanced practitioners,
logical data (EEG, EKG, HRV, respirometry, but also found in novices during post-SK rest
galvanic skin response, and temperature) on resembled those found in studies of long-term
beginning and experienced SKY breath practi- adepts from other traditions.41 Greater syn-
tioners.31 Preliminary findings suggest that Su- chrony has been associated with improved inte-
darshan Kriya (SK) breathing temporarily dis- grative brain functioning and problem-solving.
rupts the routine patterns (EEG) of the nervous These studies are of interest not only for
system, taking it through a range of activity, the optimization of brain function, but also for
leading to increasingly synchronized rhythms their potential anti-aging effect. Finding prac-
followed by a period of reorganization into a tices that alter brain function, neuroplasticity,
state similar to deep meditation or a dream- and even the volume of brain tissue42 raises the
like reverie. During SK the EEGs showed in- possibility that specific mental practices could
creasingly coherent and synchronous alpha (8 be found to preserve brain tissue and slow the
10 Hz), more pronounced posteriorly and then process of brain aging.
spreading over the whole brain cortex. These In yogic terms, Ujjayi quiets the mind. It may
observations are similar to studies of long-term also stabilize the cortex through an increase of
Transcendental MeditationTM practitioners in gamma-aminobutyric acid (GABA), a testable
whom alpha waves spread forward from the hypothesis. This could protect the brain from
occipital lobes and dominated the entire cor- possible adverse effects (e.g., seizures) from the
tex.32 During the rest period that followed SK, faster forms of breathing which may induce
the alpha waves showed even more regular- high amplitude synchronous brain waves. High
ization and slowing as they merged into theta frequency breathing activates the sympathetic
frequencies (68 Hz) while retaining the con- branch of the autonomic nervous system and
figuration of alpha waves. These synchronous probably prepares the brain for increased rapid
waves showed high amplitudes (3060 micro- information processing. SK cyclical breath-
volts) with the highest amplitudes occurring in ing may disrupt rigid patterns of communi-
the most advanced practitioners (45 years ex- cation and function within neural networks,
perience). Such findings are consistent with pre- the legacy of accumulated stress, for example,
vious studies of aniconic meditation (a state of unresolved emotional conflicts or trauma-
mental quiescence or transcendence that of- related emotional schemas.43,44 Cyclical
Brown & Gerbarg: Yoga Breathing, Meditation, and Longevity 59

breathing increases heart rate variability and of breath practices on lipid profile, antioxidant
synchronizes different areas of the brain to systems, and indicators of stress.
communicate more effectively. Yogic tradition The aim of yoga, according to ancient Vedic
describes this as harmonizing the layers of texts, was to cut the seed of sorrow before it
the being. Although some people have in- sprouts. This is true not only for the individual
tense physical or emotional experiences asso- enhancing his or her personal development, vi-
ciated with stress release during SKY, it usu- tal energy, stress resilience, and longevity, but
ally leads to deep relaxation, a sense of peace also for the compassionate relief of suffering
and joy, and other spiritual experiences. The throughout our world community. SKY breath
breath forms that precede SKY seem to pre- practices have been used to relieve suffering
pare the mind to tolerate and benefit from such among masses of civilians and military person-
experiences. nel in the wake of natural and man-made disas-
Brain-derived neurotrophic factor (BDNF) ters such as floods, earthquakes, wars, and ter-
is involved in neurogenesis, neuronal repair, rorist attacks.52 In a wait-list controlled study of
and neuroplasticity. Interventions that increase 180 village survivors of the 2004 Asian Tsunami
BDNF, such as exercise and antidepressant who had been living for nine months in refugee
treatment, may help preserve brain function.45 camps in Nagapattinam, a short program
Conversely, stress and depression suppress neu- of Sudarshan Kriya breath techniques dra-
rogenesis through processes that probably in- matically reduced symptoms of post-traumatic
volve BDNF.46 In Phase I of an ongoing study, stress disorder (PTSD) and depression on stan-
SKY practice increased serum levels of BDNF dardized measures, PTSD Checklist-Civilian
in a group of normal individuals.47 If repli- (PCL-C) and Beck Depression Inventory (BDI)
cated in larger studies, this data would support in four days and the benefits were sus-
the theory that SKY breathing enhances neu- tained at 6-week, 3-month, and 6-month
rogenesis and neuroplasticity, processes that are follow-ups.53
essential for maintenance of brain functions as In a series of four small open studies of dis-
we age, recovery from trauma, emotional adap- abled Australian veterans of the Vietnam War
tation, and learning. with PTSD, Iyengar Yoga improved symptoms
Preliminary data from several small stud- of depression, but the addition of pranayama
ies suggests additional pro-longevity effects of (particularly Ujjayi) and meditation signifi-
SKY practice: improved lipid profile48 ; en- cantly reduced symptoms of PTSD, includ-
hanced immune system function49 ; and in- ing anxiety, insomnia, and rage.54 A subse-
creased antioxidant defense enzymes, glu- quent wait-list controlled study of the SKY
tathione (GSH) and superoxide dismutase Program for 30 disabled Australian Vietnam
(SOD), and reduced serum lactate (stress in- veterans found that Iyengar Yoga (postures) sig-
dicator).50 Moreover, in a 30-day controlled nificantly reduced scores for depression on the
study of 190 menopausal women, 40 were given Center for Epidemiological Studies-Depression
an 8 mg estradion patch (hormone replace- Test (CES-D). However, SKY was significantly
ment therapy HRT), 40 received 500 mg vi- more effective in relieving symptoms of PTSD
tamin E/day, and 60 were given SKY only. on standardized measures, including the Clin-
Significantly greater decreases in serum mal- ician Administered PTSD Scale (CAPS) and
onic dialdehyde (MDA) (a marker of membrane the self-administered PTSD ChecklistMilitary
lipid peroxidation) and significantly greater in- (PCL-M).55
creases in GSH-px and erythrocyte SOD oc- We have found that patients with PTSD from
curred in the women given SKY than in those sexual abuse benefit when SKY breathing is
given either HRT or vitamin E.51 Further stud- combined with traditional psychiatric and psy-
ies are needed to confirm the positive effects chological therapies.56,57
60 Annals of the New York Academy of Sciences

Three studies, two open and one controlled, baby becomes immortal.62 Research on breath
found SKY to be effective in treating depres- practices from many traditions will yield new
sion and dysthymia.58 In the controlled study insights for neurophysiology, longevity, and the
of 45 hospitalized patients with severe depres- clinical treatment of stress-related physical and
sion, SKY was equivalent to treatment with emotional disorders.
150 mg/day of imipramine (tricyclic antide- Senescence is feared when it is associated
pressant). Electroconvulsive Therapy (ECT) with helplessness, dependency, and loss of the
was only slightly more effective than SKY or quality of life. Further research may confirm
imipramine.59 that it is possible to enhance our well being
and longevity by learning early in life to cul-
tivate and sustain the vital qualities of youth,
The Circle of Knowledge: Future as Lao Tzu suggests, by cultivating the tender-
Directions from the Past ness of the babe, learned most easily through
The application of modern methodologies
to study Indo-Tibetan practices raises many Conflicts of Interest
tantalizing questions. For example, what is the
relationship of the massive increase in EEG The authors declare no conflicts of interest.
synchrony, coherence, and amplitude observed
during breath practices to improved emotional
regulatory and cognitive functions? How do
breath practices affect mitochondrial function,
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