Common Yoga Protocol Increases Peripheral Blood CD34+ Cells: An Open-Label Single-Arm Exploratory Trial

Figures & data

Figure 1 Participant information.

Table 1 Shows the Details of Common Yoga Protocol (CYP) Intervention

S. No.	ASANAS	Protocol
1.	Invocation/ Prayer (1 minute)	To enhance the benefits of practice.
2.	Loosening practices (5 minutes)	● Neck bending  ● Shoulder’s movement  ● Trunk movement (Katishaktivikasak)  ● Knee movement
3.	Yogasanas (Yoga postures) (1 minute per asana)	Standing postures  ● Tadasana (Palm tree pose)  ● Vrksasana (Tree posture)  ● Padahastasana (The hands and feet posture)  ● Ardhacakrasana (The half wheel posture)  ● Trikonasana (The Triangle Posture) Sitting postures  ● Bhadrasana (The firm auspicious posture)  ● Vajrasana (Thunderbolt posture)  ● Ardhaustrasana (The half camel posture)  ● Ustrasana (Camel Posture)  ● Sasakasana (The Hare posture)  ● Uttana mandukasana (Stretched up frog posture)  ● Vakrasana (The spinal twist posture) Prone postures  ● Makarasana (The Crocodile posture)  ● Bhujangasana (The Cobra posture)  ● Salabhasana (The Locust Posture) Supine postures  ● Setubandhasana (The Bridge Posture)  ● Uttanapada Asana (Raised feet posture)  ● Ardha Halasana (Half plough posture)  ● Pavanamuktasana (The Wind releasing Posture)  ● Savasana (The Dead body Posture)
4.	Kapalbhati (3–4 minutes)	Forceful exhalation by contracting the abdominal muscles (30 strokes/round)
5.	Pranayama (2 minutes each)	● Nadishodhana or Anulom Viloma Pranayama (Alternate nostril breathing)  ● Sitali pranayama  ● Bhramari pranayama
6.	Dhyana (Meditation) (5–10 minutes)	For stress free deep relaxation and silencing of mind.
7.	Sankalpa (1 minute)	Commitment to be healthy, happy, peaceful and joyful human being.
8.	Shanti path (1 minute)	Prayer for happiness, health and peace for all.

Table 2 Demographics and Anthropometric Details. Data Was Analyzed Using Paired t-Test. N = 17, **p <0.01

Demographics of the Participants
Average age (in years)	40.82 ± 10.11
Occupation	11 working professionals, 6- non professional
Ethnicity	Asian Indian
Nationality	Indian
Education	Higher secondary school or above
Primary Language	Primary Language: Hindi
	Understandable Language: English
Socio economic status	All the participants belonged to middle income salary status (Monthly income ≥Rs 45,000/-)
Co morbidity	2 had migraine
Diet (self- declared)	4 non-vegetarians, 13 vegetarians
	Pre (Mean ± SD)	Post (Mean ± SD)	p value	t value	Effect size (95% CI)
Weight (kg)	66.48 ± 7.82	65.32 ± 6.92	0.019**	2.607	0.16 (2.16 to 2.10)
BMI (kg/m^2)	26.36 ± 3.05	25.92 ± 2.82	0.017**	2.659	0.16 (0.090 to 0.80)

Figure 2 Figure showing attendance record of the participants for 3 months of intervention.

Figure 3 Enumeration of CD34+ cells before and after 1 month and after 3 months of CYP practice. (A) Scatter plot of enumeration CD34+ cells total blood cells, P1 shows total leukocyte population, P2 depicts the total CD45+ population, P3 is the CD34 population from the total CD45 population and P4 is the dim CD45+ (B) Box plot depicting quantified CD34+ cell population. **p≤0.01, Degrees of Freedom=2, Effect Size, W= 0.405.

Abbreviations: FSC, Forward Scatter; SSC, Side Scatter; PE, Phycoerythrin; FITC Fluorescein isothiocyanate.

Figure 4 Box plot of Lipid profile at baseline, after 1 month and after 3 months of CYP practice (A) Cholesterol, Degree of Freedom = 2; Effect size, W = 0.027 (p = 0.630). (B) Triglycerides, Degree of Freedom = 2, Effect size, W = 0.064, p = 0.336. (C) HDL, Degree of Freedom = 2; Effect size, W = 0.122 (p = 0.126). (D) LDL Degree of Freedom = 2; Effect size, W = 0.010 (p = 0.838). (E) VLDL Degree of Freedom = 2, Effect size, W = 0.064, p = 0.336. Data was analysed by using SPSS Friedman K related samples test, N = 17.

Abbreviations: HDL, High-Density Lipoprotein; LDL, Low-Density Lipoprotein; VLDL, Very Low-Density Lipoprotein; CYP, Common Yoga Protocol.

Table 3 Table Showing Levels of Angiogenesis Markers, ie, VEGF, Angiogenin and BDNF at Baseline, After 1 Month and After 3 Months of CYP Practice. Data Was Analyzed Using SPSS Friedman Related Sample KS Test. N = 17, **p = 0.002

	VEGF (pg/µg)			Angiogenin (pg/µg)			BDNF (ng/µg)
	Baseline	After 1 Month of CYP Practice	After 3 Months of CYP Practice	Baseline	After 1 Month of CYP Practice	After 3 Months of CYP Practice	Baseline	After 1 Month of CYP Practice	After 3 Months of CYP Practice
Median	30 x 10^−4	45 x 10^−4	39 x 10^−4	71 x 10^−5	69 x 10^−5	70 x 10^−5	14 x 10^−6	13 x 10^−6	7 x 10^−6
Minimum	3 x 10^−4	18 x 10^−4	16 x 10^−4	15 x 10^−5	30 x 10^−5	20 x 10^−5	8 x 10^−6	6 x 10^−6	4 x 10^−6
Maximum	7 x 10^−2	7 x 10^−2	6 x 10^−2	14 x 10^−3	23 x 10^−3	19 x 10^−3	12 x 10^−5	15 x 10^−5	12 x 10^−5
25th percentile	2 x 10^−3	3 x 10^−3	2 x 10^−3	39 x 10^−5	49 x 10^−5	36 x 10^−5	93 x 10^−7	80 x 10^−7	55 x 10^−7
75th percentile	20 x 10^−3	12 x 10^−3	14 x 10^−3	33 x 10^−4	32 x 10^−4	54 x 10^−4	58 x 10^−6	56 x 10^−6	40 x 10^−6
Chi square	1.412			1.529			12.933
p value	0.494			0.465			0.002**
Degree of freedom	2			2			2
Effect size (Kendall’s W)	0.042			0.045			0.431

Table 4 Table Showing Pre and Post Effects of Psychological Assessment. Data Was Analyzed Using SPSS Paired Sample t-Test. N = 17, *p < 0.05, **p <0.01

Psychological Assessment	Before Intervention (Mean ± SD)	After 3 Months of CYP Practice (Mean ± SD)	t value	Effect Size (Cohen’s d)	95% CI		Degree of Freedom	p value
					Lower	Upper
General Health Questionnaire score (GHQ-12)	10.64 ± 3.53	6.52 ± 3.12	4.07	0.98	1.97	6.259	16	0.001**
State Trait Anxiety Inventory (STAI)	29.23 ± 8.62	23.11± 3.40	3.78	0.91	2.69	9.542	16	0.002**
DST (Digit Span Test) Score (forward and backward)	16.88±5.06	16.70±4.52	0.65	0.15	−17.36	32.778	16	0.524
SLCT (Six Letter Cancellation Test)	30.82±12.26	32±13.23	0.23	0.05	−1.42	1.774	16	0.818
DSST (Digit Symbol Substitution Test) Time in seconds	241.17±87.5	233.47± 103.1	−0.49	−0.11	−6.27	3.917	16	0.631
TMT A (Trail Making Test A)	33.41±13.53	31.41±11.16	0.71	0.17	−3.93	7.932	16	0.485
TMT B (Trail Making Test B)	69.94±26.21	61.88±28.55	2.28	0.55	0.582	15.534	16	0.036*

Table 5 Table Showing Correlation Between the Change in CD34+ Cells, Lipid Parameters and Biochemical Parameters After 1 Month of CYP Practice. Data Was Analyzed Using SPSS Spearman Correlation Analysis. N = 17, *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001. the table alignment should be proper, the empty boxes can be deleted.

CD34 F1	ρ=1.000
Cholesterol F1	ρ=−0.087 P=0.740	ρ=1.000
Triglycerides F1	ρ=0.218 p=0.400	ρ=0.524* p=0.031	ρ=1.000
HDL F1	ρ=0.342 p=0.179	ρ=0.549 p=0.022*	ρ=0.447 p=0.072	ρ=1.000
LDL F1	ρ=−0.368 p=0.146	ρ=0.888 p≤0.001***	ρ=0.191 p=0.462	ρ=0.291 p=0.257	ρ=1.000
VLDL F1	ρ=0.200 p=0.442	ρ=0.533 p=0.028*	ρ=0.999 p≤0.001***	ρ=0.438 p=0.079	ρ=0.201 p=0.439	ρ=1.000
VEGF F1	ρ=0.262 p=0.309	ρ=0.120 p=0.646	ρ=0.196 P=0.451	ρ=0.053 p=0.841	ρ=0.050 p=0.848	ρ=0.197 p=0.448	ρ=1.000
BDNF F1	ρ=0.189 P=0.499	ρ=0.173 p=0.537	ρ=0.300 p=0.277	ρ=0.048 p=0.864	ρ=0.154 p=0.585	ρ=0.302 p=0.274	ρ=0.929 p≤0.001***	ρ=1.000
Angiogenin F1	ρ=0.257 P=0.319	ρ=0.155 p=0.554	ρ=0.324 p=0.205	ρ=0.082 p=0.754	ρ=0.070 p=0.790	ρ=0.326 p=0.201	ρ=0.917 p≤0.001***	ρ=0.896 p≤0.001***	ρ=1.000
	CD34 F1	Cholesterol F1	Triglycerides F1	HDL F1	LDL F1	VLDL F1	VEGF F1	BDNF F1	Angiogenin F1

Note: Parameters showing significant correlation is represented in bold.

Table 6 Table Showing Correlation Between the Change in CD34+ Cells, Lipid Parameters and Biochemical Parameters After 3 Months of CYP Practice. Data Was Analyzed Using SPSS Spearman Correlation Analysis. N = 17, *p ≤ 0.05, **p ≤ 0.01, ***p ≤ 0.001the table alignment is not proper.

CD34 F2

ρ=1.000

Cholesterol F2

ρ =- 0.083 P=0.750

ρ=1.000

Triglycerides F2

ρ= 0.267 P= 0.300

ρ=0.254 P=0.326

ρ= 1.000

HDL F2

ρ= −0.145 P=0.578

ρ= 0.661 P=0.004**

ρ= 0.044 P= 0.866

ρ=1.000

LDL F2

ρ= 0.065 P=0.804

ρ=0.381 P=0.132

ρ = −0.082 P= 0.754

ρ= −0.033 P= 0.899

ρ=1.000

VLDL F2

ρ= 0.245 Ρ=0.344

ρ=0.285 P=0.267

ρ= 0.997 P≤.001***

ρ= 0.074 P= 0.778

ρ= −0.065 P=0.804

ρ=1.000

VEGF F2

ρ= −0.020 P=0.940

ρ=0.150 P=0.567

ρ=0.000 P=1.000

ρ=0.547 P=0.023*

ρ= −0.163 P= 0.531

ρ= 0.005 P= 0.985

ρ=1.000

BDNF F2

ρ= −0.275 P=0.321

ρ=0.146 P=0.603

ρ = −0.089 P= 0.752

ρ=0.538 P=0.039*

ρ= −0.342 P=0.213

ρ= −0.086 P=0.761

ρ= 0.818 P≤0.001***

ρ=1.000

ANGIOGENIN F2

ρ= 0.125 P=0.633

ρ=0.197 P=0.448

ρ= 0.088 P= 0.736

ρ=0.407 P=0.105

ρ= −0.061 P= 0.815

ρ= 0.086 P= 0.743

ρ= 0.946 P≤ 0.001***

ρ= 0.725 P= 0.002**

ρ=1.000

GHQ POST

ρ= −0.359 P=0.158

ρ= −0.257 P=0.319

ρ= −0.022 P= 0.932

ρ= −0.116 P=0.656

ρ= 0.082 P= 0.754

ρ= 0.002 P= 0.992

ρ= −0.305 P= 0.234

ρ= −0.480 P= 0.070

ρ= −0.449 P= 0.070

ρ= 1.000

STAI POST

ρ= −0.118 P=0.651

ρ= −0.180 P= 0.489

ρ= −0.024 P= 0.928

ρ= −0.305 P= 0.234

ρ= 0.184 P= 0.480

ρ= −0.006 P= 0.981

ρ= −0.483 P= 0.049*

ρ= −0.585 P= 0.022*

ρ= −0.458 P= 0.064

ρ= 0.481 P= 0.051

ρ= 1.000

DSST POST

ρ= 0.104 P=0.690

ρ= 0.117 P =0.654

ρ=0.299 P=0.243

ρ= 0.260 P= 0.313

ρ= −0.038 P=0.885

ρ= 0.286 P= 0.267

ρ= 0.211 P= 0.416

ρ= 0.071 P= 0.800

ρ= 0.180 P= 0.488

ρ= 0.061 P= 0.816

ρ= −0.509* P=0.037

ρ= 1.000

DST POST

ρ= −0.290 P=0.260

ρ=0.271 P=0.292

ρ= −0.152 P= 0.561

ρ= 0.197 P= 0.449

ρ= −0.018 P=0.946

ρ= −0.123 P= 0.638

ρ= 0.144 P= 0.581

ρ= 0.382 P= 0.160

ρ= 0.100 P= 0.703

ρ= −0.258 P= 0.317

ρ= 0.089 P= 0.734

ρ= −0.711 P=0.001***

ρ= 1.000

SLCT POST

ρ= −0.243 P= 0.348

ρ= −0.172 P= 0.510

ρ= −0.278 P= 0.279

ρ= −0.478 P=0.052

ρ= 0.157 P= 0.549

ρ= −0.278 P= 0.280

ρ= −0.240 P= 0.353

ρ= 0.038 P= 0.894

ρ= −0.210 P= 0.419

ρ= −0.148 P= 0.570

ρ= 0.219 P= 0.399

ρ= −0.786 P≤0.001***

ρ= 0.678 P=0.003**

ρ= 1.000

TMT A POST

ρ= 0.244 P=0.346

ρ= 0.220 P= 0.397

ρ= 0.154 P= 0.555

ρ=0.324 P=0.205

ρ= 0.070 P= 0.791

ρ= 0.169 P= 0.516

ρ= 0.142 P= 0.588

ρ= −0.160 P= 0.569

ρ= 0.167 P= 0.521

ρ= 0.062 P= 0.814

ρ= −0.218 P= 0.401

ρ= 0.742 P= 0.001***

ρ= −0.593 P=0.012*

ρ= −0.861 P≤0.001***

ρ= 1.000

TMT B POST

ρ=0.075 P=0.775

ρ= −0.057 P= 0.827

ρ= 0.246 P= 0.341

ρ=0.255 P=0.323

ρ= −0.339 P= 0.183

ρ= 0.247 P= 0.338

ρ= 0.176 P= 0.499

ρ= 0.079 P= 0.780

ρ= 0.080 P= 0.760

ρ= 0.152 P= 0.560

ρ= −0.264 P=0.306

ρ= 0.760 P≤0.001***

ρ= −0.662 P=0.004**

ρ= −0.788 P≤0.001***

ρ= 0.735 P=0.001***

ρ=1.000

CD34 F2

Cholesterol F2

Trigly cerides F2

HDL F2

LDL F2

VLDL F2

VEGF F2

BDNF F2

ANGIO GENIN F2

GHQ POST

STAI POST

DSST POST

DST POST

SLCT POST

TMT A POST

TMT B POST

Note: Parameters showing significant correlation is represented in bold.

Figure 5 Schematic showing effects of Yoga induced through the regulation of neurogenesis and angiogenesis pathways via CD34+ cells number and Lipid metabolism.

depicts increase,

depicts decrease,

depicts the pathway.

Note: the arrows in the figure are distorted and not properly alinged