‘365 breathing’ increases parasympathetic activity, reduces IOP in patients with glaucoma
Key takeaways:
- IOP and serum cortisol were significantly lower at 6 weeks in patients who added the “365 breathing” technique to their glaucoma treatment.
- Parasympathetic activity also increased in the treatment group.
The “365 breathing” technique significantly increased parasympathetic activity and reduced IOP and serum cortisol levels after 6 weeks in patients with glaucoma, according to a study published in the Journal of Glaucoma.
“Many studies have shown a positive correlation between physiological stress and glaucoma, and that stress-related biochemical and somatic changes can have a significant contribution in the progression of glaucomatous damage,” Tanuj Dada, MD, and colleagues at All India Institute of Medical Sciences, wrote. “Patients with glaucoma have poor physiological functioning and a higher risk of anxiety and depression due to anticipated vision loss, resulting in a self-amplifying vicious cycle and reduced quality of life.”
Dada and colleagues sought to evaluate the stress-reducing efficacy of the “365 breathing” technique, in which patients with glaucoma attempt to synchronize their breathing with their heart rate over three 5-minute sessions per day.
In a randomized, controlled, interventional trial of 80 patients with early to moderate primary open-angle glaucoma at a tertiary hospital in North India, 40 patients followed the “365 breathing” technique along with pharmacological glaucoma treatment and 40 controls continued only glaucoma treatment. The researchers recorded IOP, serum cortisol, heart rate variability and heart rate response to deep breathing test at baseline and 6 weeks after intervention.
According to results, mean IOP (16.09 vs. 18.38; P = .03) and serum cortisol (13.2 vs. 14.95; P = .038) were significantly lower in the intervention group compared with the control group at the 6-week follow-up.
The intervention group also experienced a significant 11% reduction in IOP from baseline to 6 weeks (P = .0012) compared with the control group (P = .325), as well as significant reductions in resting heart rate and systolic and diastolic blood pressure.
In addition, researchers reported a significant difference between groups in the root mean square of the successive difference between RR intervals, indicating higher parasympathetic activation at 6 weeks in the intervention group.
Although there was no significant difference between groups in low frequency (LF) and high frequency (HF) domains of heart rate variability at 6 weeks, the LF:HF ratio was lower in the intervention group, representing a shift in sympathovagal balance and improvement in parasympathetic activity.
There also were significant differences in delta heart rate and expiratory/inspiratory ratio between groups at 6 weeks, further indication of higher parasympathetic reactivity in the intervention group, as well as differences in serum cortisol levels.
“Lifestyle interventions to promote positive health are an unmet need in patients with glaucoma,” Dada and colleagues wrote. “Although many patients with glaucoma suffer from anxiety/stress and have autonomic dysfunction with high sympathetic reactivity, there is no pharmacological intervention that can address this anomaly. In this regard, proper breathing can bring better health.”
Perspective
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Markers of stress such as cortisol have been found to be dysregulated in glaucoma. Stress can cause an increase in sympathetic activity and reduce parasympathetic activity. This can worsen the preexisting autonomic dysfunction in glaucoma patients. Heart rate variability, a form of autonomic dysfunction seen in patients with glaucoma, is associated with the rapid progression of disease.
Breathing techniques appear to be effective in reducing stress by influencing psychological factors, such as decreasing negative thoughts, and stimulating the parasympathetic nervous system. Increased parasympathetic activity can decrease aqueous production and increase aqueous outflow leading to decreased IOP.
Mindfulness-based stress reduction (MBSR) has been shown to reduce IOP, as well as normalize stress biomarkers and improve optic nerve perfusion, in patients with glaucoma.
A previous study by the same authors reported IOP reduction after 3 to 6 weeks of meditation/MBSR in patients with glaucoma or ocular hypertension. However, MBSR requires an hour per day, which is impractical. Conversely, “365 breathing” is a technique that requires only 15 minutes a day, performed as three 5-minute exercises.
Future studies could determine whether increasing the duration of “365 breathing” may have an even greater effect. While these lifestyle changes won’t replace medication or surgical intervention, they can be a “force multiplier.” Giving the patient some control can not only decrease stress in itself, but augment the breathing techniques’ IOP reduction potential.
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