Efficacy of 4-week yoga module on sympatho-vagal balance among healthcare workers in a tertiary care hospital: a randomized controlled trial

The concept of sympatho-vagal balance (SVB) shows how our body’s autonomic system is affected by both the sympathetic (fight or flight) and parasympathetic (rest and digest) influences, essentially indicating the balance between these two systems. The balance between these two systems is crucial for maintaining homeostasis in the body, and an imbalance can lead to various health issues including cardiovascular diseases, gastrointestinal disorders, and mental health problems. Research has extensively investigated SVB using various techniques such as heart rate variability (HRV).

The fluctuation in the time intervals between adjacent heartbeats is referred to as HRV. It is a measure of the dynamic interactions between heart and brain, influenced by the autonomic nervous system. In simpler terms, HRV provides insights into the coordination between heart and brain, influencing various aspects of the body’s functioning. HRV analysis techniques can distinguish between the activation of the parasympathetic nervous system, indicating a relaxed state that reflects good health, and the sympathetic nervous system, indicating an agitated state that, when persistently activated, leads to ill health.

Healthcare workers (HCWs) actively involved in patient care at tertiary care hospitals face significant stress and workload, which may adversely impact their overall well-being, including cardiovascular health. According to Joseph and Joseph (2016) “A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors and nurses or indirectly as aides, helpers, laboratory technicians, or even medical waste handlers”. World Health Organization (WHO) classifies healthcare workers into five broad categories: a) health professionals; b) health associate professionals; c) personal care workers in health services; d) health management and support personnel and; e) other health service providers not elsewhere classified. This classification is provided in table-1 below:

Table 1: Classification of healthcare workers according to WHO

S.no.

Classification

Occupational Group

|1.

Health professionals

Generalist medical practitioners, Nursing professionals, Paramedical practitioners, Pharmacists

|2.

Health associate professionals

Medical technicians, Nursing associate professionals, Ambulance workers, Counsellors

|3.

Personal care workers in health services

Health care assistants, First-aid attendant, Hospital orderly, Medical imaging assistant, Phlebotomist, Sterilization aide

|4.

Health management and support personnel

Health service managers, Clerical workers, Plant and machine operators and assemblers

|5.

Health service providers not elsewhere classified

Medical student intern, Hospital volunteer

 HCW’s often face substantial stressors in their professional environments, which can significantly impact their SVB. The demanding nature of healthcare duties, including long working hours, emotional strain, and exposure to high-pressure situations, can lead to chronic sympathetic activation and reduced parasympathetic tone among healthcare workers. Prolonged imbalance in sympathovagal activity has been associated with increased risk of cardiovascular disease, impaired immune function, and psychological distress, highlighting the importance of implementing strategies to support the well-being of healthcare professionals.

The dynamic interaction of SVB has frequently been associated with a variety of mind-body interventions, including yoga practices. Yoga, with its multifaceted approach encompassing physical postures, breath control, and meditation, has been suggested to influence autonomic nervous system function and, consequently, SVB. The mechanisms through which yoga influences SVB are multifaceted. Respiratory modulation, a key component of many yogic practices, is believed to play a pivotal role. Additionally, the mind-body connection fostered by yoga practices may impact the central nervous system, further influencing SVB.

Hence, the purpose of the present study is to assess the efficacy of a yoga module (consisting of asana, pranayama and relaxation & meditative practices) developed by Defence Institute of Physiology & Allied Sciences (DIPAS) [Defence Research and Development Organisation (DRDO), Ministry of Defence, Government of India] on SVB among HCWs in a tertiary care hospital. This module is henceforth referred to as DIPAS yoga module. It incorporates a comprehensive approach that combines physical postures, controlled breathing techniques, and mindfulness practices, aligning with the purpose of stress reduction. This module has been validated with content validity ratio (CVR) of 0.89 and an intra-class correlation of 0.78.