Effect of mindfulness meditation protocol in subjects with various psychometric characteristics at high altitude

Abstract Introduction Incidence of high altitude‐related sickness is increasing due to more number of people visiting the areas of high altitude which may result in life‐threatening conditions including acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), high altitude cerebral edema (HACE), and High‐altitude pulmonary hypertension (HAPH). We hypothesized that an advanced yoga regimen may be beneficial in dealing with the physiology of acclimatization. Methods Anthropometric, Biochemical, and Psychological assessments were carried out in 48 participants before and after the advance meditation program (AMP) in the experimental group. Individuals with an age range of 20–65 years with no comorbidities were included in the study. Participants were exposed to AMP for 4 days. All assessments were carried out at the baseline and after the course. Prakriti was constituted for all participants using a standard questionnaire. The study was carried out after obtaining the written informed consent as per the guidelines outlined by the Institute Ethics Committee. Results Po2 and glucose levels were found significantly reduced along with changes in the Happiness index, anxiety, and mental well‐being. However, participants with lowered Po2, after 4 days of mindfulness intervention, showed a positive outcome measured by the established scales of anxiety, happiness, and information processing. Psychometric or Prakriti wise analysis revealed that subject with “Pitta” constitution exposed to high altitude and advance meditation showed changes in more parameters than “Vatta” or “Kapha” Constitution. Conclusions Advance meditation in the high altitude zone confers biochemical and neuro‐cognitive benefits. Molecular studies may require to understand the role of hypoxic condition in improving the disease state.

notypes respond differently to diet, nutrition, medications, drugs, and environmental stimuli. Predisposition to specific diseases may require a balance between these prakritis. Rotti et al reported 80% concordance between Prakriti and software-based prediction models (Rotti et al., 2014). Altitude may affect or improve different individuals based on their prakriti constitution.
A breath-based mindfulness meditation sequence such as the Art of Living (AOL) Sudarshan Kriya Yoga (SKY) founded by Sri Sri Ravi Shankar has been shown to reduce systolic blood pressure, diastolic blood pressure and respiration rate in subjects besides development of self-awareness and harmonization of the mind with the body. This could be useful for the enhancement of human performance and happiness, necessary to rescue harsh and hypoxic conditions. Regardless of various published evidence, the mechanisms by which yogic breathing positively impacts the individual's compensatory reserves are not yet completely understood (Somwanshi, HSM, & Kolpe, 2013). Studies have reported the beneficial impact of SKY on lowering anxiety, depression, and stress as compared to controls (Chandra, Jaiswal, Singh, Jha, & Mittal, 2017;Kjellgren, Bood, Axelsson, Norlander, & Saatcioglu, 2007) but none of these studies have been systematically evaluated in harsh conditions or high altitude. In the current study, we analyzed the effect of SKY and related meditation techniques (or mindfulness meditation, herein called SKY) among individuals seeking to adapt to the hypoxic environment, caused due to abrupt ascent to high altitude, by flight, based on their Prakriti constitution.

| Recruitment and randomization of participants
A total of 48 subjects were recruited for the study.

| Inclusion and exclusion criteria
Individuals with age range of 20-65 years with no comorbidities were included in the study after obtaining their written informed consent. Subjects were exposed to SKY in order to perform the advanced level meditation. Inclusion and exclusion criteria are tabulated in Table 1. Bold represent statistically significant change after advanced meditation protocol.

| Sudarshan Kriya Yoga (SKY) and related meditation techniques protocol
up and down hand movements and is coordinated with synergetic fast breath in and out through the nostrils (Zope & Zope, 2013). It causes excitation followed by calmness. "Om" is chanted three times with very prolonged expiration and is followed by Sudarshan Kriya (Zope & Zope, 2013).

Specially designed guided meditations by Sri Sri Ravi Shankar:
Guided meditation techniques which vastly emphasized on the cleansing of chakras and upliftment of energy to higher chakras.
3. Practice of silence, practical wisdom, spiritual music, and selfless services was incorporated in the remaining part of the protocol for the duration of 4 days ( Table 2).

| Anthropometric assessment
The anthropometric assessment included the measurement of an

| Assessment spO2 and BP
Oxygen saturation (sPO2) of the participants was measured using Pulse Oximeter to determine the percentage of hemoglobin in the blood saturated with oxygen. Blood Pressure of the participants was measured using Digital Blood Pressure Monitor to obtain the systolic and diastolic components.

| Biochemical assessment
About 5 ml of blood from each participant was drawn for the biochemical assessment. Biochemical assessment of cholesterol, triglycerides, HDL, LDL, and VLDL was carried out by a certified diagnostic laboratory using standard diagnostic procedures acceptable for public utility. Bold represent statistically significant change after advanced meditation protocol.

| Tridosha assessment
The prakriti (Tridosha) analysis was done by the scoring of the standard questionnaire filled by the participants. There are separate sets of questions to determine Vatta, Pitta, and Kapha dominated subjects.

| Neurocognitive and psychological assessment
Neuropsychological tests were administered to assess the attention, memory, verbal fluency, executive functioning, and information processing speed.

| Six Letter Cancelation Test (SLCT)
This test was used to measure attention, concentration, and visual scanning abilities and visual-spatial dysfunctions of the participants. SLCT consists of 22 rows *14 columns of randomly arranged alphabets. Six target letters were supposed to be identified among the randomly distributed alphabets in the stipulated timeframe of 90 s (Pradhan, 2013).

| Baseline characteristics of meditators
A total of 48 participants were recruited in the current study.
Two participants were excluded due to the non-availability of blood samples. Analysis was carried out in 46 remaining participants. The Mean (SD) age of the participants was 45.87 (10.15).
There were 25 males and 21 females in the study. Anthropometric Bold represent statistically significant change after advanced meditation protocol. assessments were carried out at the baseline and after the intervention. The baseline characteristics of the subjects are compiled in Table 3.

| Effect of SKY-meditation
The comparison of baseline partial oxygen pressure after the SKYmeditation regimen revealed a significant increase of Po2 (Figure 1).
There was a significant enhancement in glucose and reduction in triglycerides and VLDL levels. The estimates of remaining variables have been tabulated (

| Effect of change in Po2 level of meditators
The participants who showed increased Po2 after the SKY were selected in order to analyze the changes in anthropometric, biochemical, lipid profile and psychological indices. Significant enhancement in the levels of Glucose and reduced anxiety were obtained. The Table   below shows the changes after SKY. Similarly, subjects with reduced Po2 were determined and the data showed changes in the Glucose and LDL levels as shown in Figure 2. Psychological variables including anxiety and happiness index showed marked changes (Tables 5   and 6).

| Effect of Prakriti Changes in biochemical parameters of meditators
Prakriti may contribute to the early acclimatization, subjects with  Bold represent statistically significant change after advanced meditation protocol. a marked reduction in cholesterol but no psychological variables showed significant changes (Tables 7-9).

| D ISCUSS I ON
Acclimatization at high altitude requires a synergistic effect of various body systems based on individual genetic, epigenetic, and Psychometric (Prakriti) constitution (Brown & Rupert, 2014). The understanding of the varying effects of high altitude sickness in different individuals is limited. Moreover, current treatment modalities works symptomatically along with side effects which may be prevented by yoga-based interventions. Hence, our study provides an introduction to the effect of SKY-based advance meditation at high altitude.
Interesting results were obtained when genetic variants were studied in the Sherpa communities in which EPAS1 Single Nucleotide variations (rs13419896, rs4953354 and rs4953388) were reported to be contributory (Hanaoka et al., 2012). These SNPs provide biochemical protection against oxidative damage in high altitude conditions (Horscroft et al., 2017)

ACK N OWLED G M ENTS
We acknowledge the efforts of participants and volunteers for their support.

CO N FLI C T O F I NTE R E S T
The authors declare that they have no competing interests. Bold represent statistically significant change after advanced meditation protocol.

E TH I C A L A PPROVA L
The study was approved by the Institutional ethics committee of SSIAR, Bangalore (vide SSIAR/IEC/05) as well as PGIMER, Chandigarh (PGI/IEC/2019/000643). All participants provided consent for the participation under the guidelines of IECs.

DATA AVA I L A B I L I T Y S TAT E M E N T
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.