Medicin Sportiv (2010), 23, 1417 -1422 Romanian Sports Medicine Society

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Efficacy of Sudarshan Kriya and deep breathing in reducing of the precompetitive anxiety among young athletes
Maman Paul, Neeraj Kumar, Gopal K Saini , Jaspal S Sandhu Faculty of Sports Medicine and Physiotherapy Guru Nanak Dev University, Amritsar, India

Abstract. Back ground and objectives. Deep breathing and sudarshan kriya help to decrease anxiety by improving autonomic function by changing sympathetic or parasympathetic activity. Therefore the present study design is to study and compare the effect of Deep Breathing and Sudarshan Kriya in reducing precompetitive anxiety among young volunteers male volleyball players in the age group of 19 23 yr. Methods. 45 university level male Volleyball players were randomly assigned into three groups: Group - I: Control group in which no intervention was given; Group - II: Deep Breathing group and Group - III: Sudarshan Kriya group. Deep breathing and sudarshan kriya group were practiced for one month. CAT questionnaire score filed, alpha-EEG and heart rate were measured before one month and before competition. Results. Both deep breathing and sudarshan kriya resulted in consistent pattern of precompetitive relaxation changes reflected in scores of Comprehensive Anxiety Test (CAT) Questionnaire, alpha-EEG activity and heart rate as compared to control group. Significant changes were not observed on comparing in Deep Breathing and Sudarshan Kriya groups but mean score shows that Sudarshan Kriya is more effective then deep breathing group in reducing pre competitive anxiety. Interpretation and conclusions. It can be concluded that both sudarshan kriya and deep breathing help in reduction in precompetitive anxiety levels whereas control group showed increase in the level of precompetitive anxiety. Mean score shows that Sudarshan Kriya is more effective in reducing precompetitive anxiety than deep breathing Key words: Comprehensive anxiety test, electroencephalography, athletes.

Introduction Stress and anxiety are very common in athletic environment. Anxiety results when the individual doubt their ability to cope with the situation that results in stress (1). Each individual has an optimal level of pre-performance anxiety which results in peak performances. However, if the pre-performance anxiety lies outside the area of the individualized zones of optimal functioning (IZOF), whether too high or too low, then performance will deteriorate (2, 3). Researchers have reported that over 50 of consultations among athletes at an Olympic festival were related to stress or anxiety related problems (4). Precompetitive anxiety (PCA) is a state of arousal that is unpleasant or negative and occurs during the 24 hour span prior to the competition. The worry that is associated with pre competitive anxiety is not just experienced with the mind but with the entire body.

Bodies provide numerous cues such as muscle tension, butterflies in stomach, desire to urinate and cotton mouth that suggests that individual is getting out of control. Thoughts become selffocused; self defeating and negative; therefore, it is imperative to search for an effective method for its treatment (5). Arousal can be considered to be a signal to the individual that athlete has entered a stressful state and is characterized by physiological signs. Physiological arousal can influence performance as a result of the individual's interpretation of their physiological symptoms. Once physiological arousal levels are too high there is a steep drop in performance which can only be reversed by a reduction in physiological arousal (6). Research in the field has identified the numerous strategies used by elite performers to control their anxiety: goal setting, positive thinking, cognitive restructuring,

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relaxation techniques such as diaphragmatic breathing, imagery and progressive muscle relaxation and focusing on the task at hand (7). Various studies have also shown the usefulness of deep breathing and Sudarshan Kriya yogic breathing exercise to alleviate stress and anxiety among normal individuals. Deep Breathing (Savitri Pranayam) is a slow, deep and rhythmic breathing, each cycle having a ratio of 2:1:2:1. Savitri pranayam helps to decrease heart rate, ratepressure product and double product (8). It reduces sympathetic activity and increases parasympathetic activity (9). It also reduces chemoreflex response to hypoxia and hypercapnia and increases baroreflex sensitivity (10). The mind-body interventions are beneficial in stressrelated mental and physical disorders. Sudarshan Kriya Yoga (SKY), which is a sequence of specific breathing techniques (Ujjayi, Bhastrika, AUM chant, Sudarshan Kriya and relaxation) can eliminate stress, anxiety and depression highlighted by the study of Richard et al., 2005 (11) and the antidepressant efficacy of Sudarshan Kriya in reducing anxiety in melancholia patients has been shown in the study of Janakiramaiah et al., 2000 (12). The vast literature depicts the role of deep breathing and Sudarshan Kriya in anxiety but their effect on precompetition anxiety is not fully understood. There has been conspicuous lack of studies dealing with precompetitive anxiety in sportspersons. Hence a better method of reducing precompetitive anxiety in sportspersons will be found with present study. Material and Methods 45 university level male volleyball players aged between 19-23 year were randomly assigned to three groups: Group I (n=15) - control group; Group II (n=15) - deep breathing group and Group III (n=15) = Sudarshan Kriya group. Inclusion criteria. Subject having CAT questionnaire score of 40 and above were recruited. They should not be taking any form of psychological/relaxation training other than the regular practice. Exclusion Criteria. Subjects with trauma of upper limb, lower limb disorder affecting the physical functioning of athlete, psychiatric disorder, cardio vascular disorder and subjects taking any form of medication were excluded. measure Comprehensive Anxiety Test (CAT) Questionnaire (13). Anxiety of both the covert and overt type and state and trait type is measured by this test. Reliability coefficient of test is found to be 0.83 by test retest method and 0.94 by split half method. Validity of the test is determined by computing the correlation scores of the present test and other tests like STAI (r = .82) anxiety dimension of eight state questionnaire form A (r = .74). The chosen test is particularly useful and applicable administration is 18-50 years for males and females, which covers the age limit selected for the study. Alpha-EEG activity was measured by number of alpha generated by the brain with Medicaid system Alpha-EEG Biofeedback Biotrainer EBF-5000. Heart rate was measured by using Polar heart rate monitor. Procedure. The study was approved by Institutional Medical Ethics Committee of Guru Nanak Dev University, Amritsar, India. Prior to the start of data collection, subjects were explained about the training and previous research supporting the effectiveness of deep breathing and Sudarshan Kriya in reducing anxiety. Only then the subjects who volunteered to participate in the study were recruited. A written informed consent was taken from each subject prior to training. Deep breathing group was given training by the therapist for one week followed by three weeks of follow up session monitored by therapist. Deep Breathing (Savitri pranayam) is a slow, deep and rhythmic breathing, each cycle having a ratio of 2:1:2:1 between inspiration (purak), held-in (kumbak), expiration (rechak), and held out (shunyak) phases of the respiratory cycle (8). Sudarshan Kriya group was given one week training by a certified Art of Living Foundation Yoga Teacher and the follow up training for the next three weeks was monitored by the therapist. In both the groups, training sessions given lasted for 30 minutes daily once a day for four weeks and training was conducted at Sports Psychology Lab, Department of Sports Medicine and Physiotherapy, Guru Nanak Dev University, Amritsar. The post training parameters were measured within a span of 24 hours prior to the competition. Alpha EEG was measured during a span of 24 hours before the competition whereas CAT questionnaire and heart rate measurements were done 2-3 hour prior to the competition.
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The following parameters were assessed pre (baseline) and post (before competition):
CAT score was calculated using a self-report

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Results CAT Score. Table I shows ANOVA comparison at pre-training (F = 2.626, p > 0.05) which yielded non-significant differences between the groups. ANOVA followed by Post Hoc Multiple Scheffe Range Test at post-training yielded (F = 7.237, p < 0.01) Sudarshan Kriya group to be statistically most significant in reducing precompetition anxiety followed by deep breathing group (tab.II). Intra group comparisons of all three groups (figure 1) reveal statistically significant decrease in CAT scores in Sudarshan Kriya group (t = 5.972, p< 0.01) followed by deep breathing group (t = 2.924, p< 0.05) while significant increase observed in control group (t = 3.378, p< 0.01).

Parameters CAT-score Between groups Within groups Total Between groups Within groups Total Between groups Within groups Total

Sum of squares 156.311 1250 1406.311 160.133 1287.067 1447.2 3636.4 3075533.6 3079170

Df 2 42 44 2 42 44 2 42 44

Mean square 78.156 29.762 80.067 30.644 1818.2 73226.99

F 2.626

Heart rate

2.613

Alpha-EEG

0.025

Table I. One-way ANOVA between three groups at baseline reading (*p <0 .05. **p < 0.01)

Parameters CAT-score Between groups Within groups Total Between groups Within groups Total Between groups Within groups Total

Sum of squares 937.778 2721.200 3658.978 559.224 1529.2 2088.444 1678407.511 5375581.067 7053988.578

Df 2 42 44 2 42 44 2 42 44

Mean square 468.889 64.790 279.622 36.41 839203.756 127990.025

F 7.237**

Heart rate

7.68**

Alpha-EEG

6.557**

Table II. One-way ANOVA between three groups before the competition (*p <0 .05. **p < 0.01)

Figure 1. Intra group comparisons of CAT-Score in three groups

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Figure 2. Intra group comparisons of Alpha-EEG in three groups

Figure 3. Intra group comparisions of Heart rate in three groups

Alpha-EEG activity. Table I shows ANOVA comparison at pre-training (F = 0.025, p >0.05) which yielded non-significant differences between the groups. ANOVA followed by Post Hoc Multiple Scheffe Range Test at post-training (table II) yielded (F = 6.557, p < 0.01) Sudarshan Kriya group to be statistically most significant in enhancing alpha EEG activity followed by deep breathing group. Intra group comparisons of all three groups (figure 2), reveal statistically significant increase in alpha EEG activity in Sudarshan Kriya group (t = 3.625, p< 0.01) followed by deep breathing group (t = 4.998, p< 0.01) while significant decrease observed in control group (t = 2.26, p< 0.05). Heart rate. Table I shows ANOVA comparison at pre-training (F = 2.613, p>0.05) which yielded non-significant differences between the groups. ANOVA followed by Post Hoc Multiple Scheffe Range Test at post-training (table II) yielded (F =

7.68, p < 0.01) Sudarshan Kriya group to be statistically most significant in reducing heart rate followed by deep breathing group. Intra group comparisons of all three groups (figure 3), reveal statistically significant decrease in heart rate in Sudarshan Kriya group (t = 3.324, p< 0.01) followed by deep breathing group (t = 2.128, p< 0.05) while significant increase observed in control group (t = 6.709, p< 0.01). Discussion The specific between group comparisons depicted that SKY group (16.41%) was most effective in reducing precompetitive anxiety as measured by CAT score when compared to deep breathing group (10.87%) and an increase in control group (10.35%) observed immediately before the competition. Richard et al., in 2005, stated that Sudarshan Kriya can alleviate anxiety, depression, everyday stress, post traumatic stress and stress related
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medical illness because it contributes to a state of calm alertness which includes increased parasympathetic drive, calming of stress response system, neuroendocrine release of hormones and thalamic generators (11). The significant decrease in precompetitive anxiety is also seen in deep breathing group which could be attributed to efficient gas exchange in lungs and balanced autonomic nervous system which reduces physiological correlates of anxiety (14). SKY group (26.47%) was also most effective in enhancing alpha-EEG activity followed by deep breathing group (15.06%) whereas control group showed decrease (16.18%) in alpha-EEG activity. Bhatia et al., in 2002 found that Sudarshan Kriya helps in activation and increase in alpha activity in brain (15). Increased alpha EEG leads to better coping, performance and improved decision making in the approaching competition (16). Slow breathing is also effective in enhancing alpha EEG activity, as it helps to release nitric oxide which is a major effector arm for vagal nerve stimulation to the brain. Release of nitric oxide changes autonomic responses generated by the nerve and decrease sympathetic system outflow and enhance parasympathetic system outflow. The result of the present study is further strengthened by the work of Lawrence et al., 1998 (17). The results also show that SKY group (5.27%) was most effective in reducing heart rate followed by deep breathing group (2.03%) while control group (12.53%) showed increase in heart rate measured one hour before the competition. Sakakibara et al., in1996, suggested that slow respiration decreases the cardiac parasympathetic withdrawal response to the threat and found the usefulness of slow respiration maneuver in attenuating the cardiac autonomic responses in patient with anxiety disorder (18). Heart rate, rate pressure product and double product also decrease with savitri pranayam (8). Mean score shows that sudarshan kriya is more effective in reducing precompetitive anxiety than deep breathing, as Sudarshan Kriya includes ujjayi pranayam, bhastrika pranayam, OM chanting, long kriya and rest in shavasna position with complete body scan. Ujjayi pranayam increases vagal nerve stimulation which helps to increase parasympathetic activity and decrease sympathetic activity. Bhastrika pranayam is associated with sympathetic nervous system activation and activation of brain associated areas followed by sense of calmness (11,19). OM chanting helps to increase coetaneous peripheral vascular resistance and mental alertness, even while being physiologically relaxed by reduction in heart rate (20). Long kriya relieves stress and it involves brief control form of mild hyperventilation. Hyperventilation increases excitability of the human corticospinal system and central nervous system (21). Shavasana, a yogic relaxation posture helps faster recovery by decreasing heart rate and blood pressure after exercise (22). Deep breathing (Savitri Pranayam) results into deep psychosomatic relaxation, decrease in sympathetic activity and increase in parasympathetic activity by reduction in blood pressure and heart rate. Decrease in oxygen consumption also occurs during the savitri pranayam. From the present study, it can be concluded that both Sudarshan Kriya and deep breathing helps in reducing precompetitive anxiety levels whereas in control group an increase in the level was observed. Sudarshan kriya was insignificantly better in reducing precompetitive anxiety as compared to deep breathing among volleyball players. Nonetheless, the present study has certain limitations. The future research should focus on a longer treatment duration as well as follow-up. One avenue of additional investigation may be to assess whether serial application of deep breathing and Sudarshan Kriya training has any substantial effect on reducing precompetitive anxiety in different group games, individual games and athletes playing at different levels. Acknowledgement We would like to thank Mr. Raman Aggarwal, Art of Living Certified Teacher for giving Sudarshan Kriya training to the subjects.
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Hanin, Y L (1986). State Trait anxiety research on sports in the USSR. In C. D. Spielberger & R. Diaz (Eds.), Cross-Cultural Anxiety (Vol. 3), Hemisphere, Washington, D.C., 45-64. 4. Murphy S M (1988). The on-site provision of sport psychology services at the 1987 U.S. Olympic Festival. The Sport Psychologist, 2, 337-351. 5. Sahni S P (2005). Psychology and its application in Sports. New Delhi: DVS Publications. 6. Hardy L, Jones G, Gould D (1996). Understanding Psychological Preparation for Sport: Theory and Practice of Elite Performers. Wiley, Chichester. 7. Gould D, Ecklund RC, Jackson SA (1993). Coping strategies used by U.S. Olympic Wrestlers. Research Quarterly for Exercise and Sport, 64, 83-93. 8. Madanmohan Udupa K, Bhavanani AB, Vijayalakshmi P, Surendiran A (2005). Effect of slow and fast pranayama on reaction time and cardiorespiratory variables. Indian journal of Physiol and Pharmacol, 49 (3), 313-318. 9. Velkumary S, Pal GK, Madanmohan. (2004). Effect of short term practice of breathing exercise on Autonomic function in normal human volunteers, Indian journal Med Res, 120, 115-121. 10. Bernardi L, Gabutti A, Spicuzza, Porta C (2001). Slow breathing reduces Chemoreflex response to hypoxia and hypercapnia and increase Baroreflex sensitivity. Journal of Hyperten, 19, 2221-9. 11. Richard PB, Gerbarg PL (2005). Sudarshan Kriya Yogic Breathing in the treatment of Stress, Anxiety, and Depression: part II clinical applications and guidelines. The Journal of Alternative and Complementary Medicine, 11(4), 711-717. 12. Janakiramaiah N, Gangadhar BN, Murthy NV, Harish MG, Subbakrishna DK, Vedamurthachar A (2000). Antidepressant efficiacy of Sudarshan Kriya yoga in Melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. Journal of Affective Disorder, 57, 255-259. 3. 13. Sharma H, Bhardwaj R L, Bhargava M (1992). Manual for comprehensive anxiety test. Agra: MAPAN, India. 14. Norris F, Murrell S A (1988). Prior experience as a moderator of disaster impact on anxiety symptoms in older adults. American journal of community psychology, 16, 665-683. 15. Bhatia M, Kumar A, Pandev R M, Kochupilli V (2002). Electrophysiologic evaluation of Sudarshan Kriya: an EEG, Baer, P300 study. Science of Breath International Symposium on Sudarshan Kriya, Pranayam & Consciousness. New Delhi, India: All India Institute of Medical Sciences, 2002. 16. Kerr G, Leith L (1993). Stress management and athletic performance. The Sport Psychologist, 7(3), 221 - 231. 17. Lawrence AJ, Castillo-Melendez M ,McLean KJ et al. (1998). The distribution of nitric oxide synthase-, adenosine deaminase- and neuropeptide Y- immunoreactivity through the entire rat nucleus tractus solitarius: Effect of unilateral nodose ganglionectomy. J Chem Neuronat. 15(1):27-40. 18. Sakakibara M, Hayano J (1996). Effect of slow respiration on cardiac parasympathetic response to threat. Psychosomatic Medicine, 58, 32-37. 19. Telles S, Desiraju T (1992). Heart rate alterations in different types of pranayamas. Indian J Physiol Pharmacol, 36(4): 287-8. 20. Telles S, Nagarathna R, Nagendra HR (1995). Autonomic changes during OM meditation. Indian J Physiol Pharmacol, 39(4):418-420. 21. Seyal M, Brendan M, Blondell G. (1998). Increase excitability of the human corticospinal system with hyperventilation. Electroencephalography and clinical neurophysiology, 109, 263-267. 22. Bera TK, Gore M.M, Oak JP (1998). Recovery from stress in two different postures and in shavasna A yogic relaxation posture. Indian J Physiol Pharmacol, 42(4):473-478.

Corresponding author Maman Paul Faculty of Sports Medicine and Physiotherapy Guru Nanak Dev University, Amritsar, Punjab, India E-mail: mamanpaul8@gmail.com Received: May 2010 Accepted: September 2010

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