AUTHOR=Dhansoia Vipin , Majumdar Vijaya , Manjunath N. K. , Singh Gaharwar Usha , Singh Deepeshwar 

TITLE=Breathing-Focused Yoga Intervention on Respiratory Decline in Chronically Pesticide-Exposed Farmers: A Randomized Controlled Trial

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.807612

DOI=10.3389/fmed.2022.807612

ISSN=2296-858X

ABSTRACT=Background 
Occupational exposure to pesticides have been associated with lung function exacerbations; risk of fixed airway obstruction and chronic pulmonary obstructive disease. 

Methods
We undertook a parallel, two-armed randomized controlled trial with blinded outcome assessors on chronically pesticide-exposed farming population. The study was conducted at district Panipat, State Haryana located in the Northern part of India from November 2019 to August 2020. A total of 634 farmers were screened, and 135 farmers were randomized to breathing-focussed yoga intervention (BFY, n=70) and waitlist control arms (n=65). BFY was delivered weekly in 45-minute group sessions over 12 weeks followed by home-based practice. Primary outcome was changes in spiromery-based markers of pulmonary function expressed as raw values, Global Lung Initiative (GLI) percent predicted (pp), and GLI z-scoresafter 24 weeks of intervention. Secondary variables were Trail making tests (TMT A and B), Digit symbol substitution (DSST), and WHO Quality of life-BREF (WHOQOL-Bref).  Analysis was by intention-to-treat. Mediation analysis was done considering oxidative stress markers as potential mediators. 






Results
At the end of 6 months of intervention, the overall follow-up in the participants was 87.85% (n=123); 90% (n=63) in the control group, and 85.71% in the yoga group (n=60). The mean age of the study cohort (n=140) was 38.75 (SD =7.50) years. Compared with the control group, at 24 weeks post-intervention, BFY group had significantly improved status of the raw sand z scores markers of airway obstruction, after adjusting for confounders, FEV1, FVC, FEF25-75 [z score adjusted mean differences (95% CI); 1.66 (1.10-2.21), respectively.  A  fraction of FEF25-75 change (mediation percentage 23.95%) was explained by glutathione augmentation. There were also significant improvements in cognitive scores of DSST, TMT-A and TMT-B, and WHOQOL-Bref.
Conclusion
In conclusion, regular practice of BFY could improve the exacerbations in the markers of airway obstruction in chronically pesticide-exposed farmers, and cognitive variables. A significant mediating effects of glutathione augmention was also observed concerning the effect of  intervention on FEF25-75. These findings provide an important piece of beneficial evidence of the breathing-based yoga intervention that needs validation across different farming ethnicities.
Trial Registration
 Clinical Trial Registration Number: CTRI/2019/11/021989