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Cover page of the Journal of Health Sciences

 Table of Contents  
Year : 2021  |  Volume : 14  |  Issue : 1  |  Page : 103-107

Effect of yoga on pulmonary function test, thyroid-stimulating hormone estimation, hand grip strength, and quality of life in participants with thyroid dysfunction: A pre-post clinical trial

Department of Cardiovascular and Pulmonary Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission17-Jun-2020
Date of Acceptance15-Oct-2020
Date of Web Publication09-Feb-2021

Correspondence Address:
Surya Krishnanunni
94 Daffodil, Glendale CHS, Opp. Lok Hospital, Vasant Vihar, Pokhran Road 2, Thane (w), Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kleuhsj.kleuhsj_183_20

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Background: Thyroid dysfunction is the most common occurring endocrine disorder among the general population. According to projections from several readings on thyroid disease, 42 million people in India have been estimated to be suffering from diseases as a result of thyroidism. Yoga has been found valuable in numerous diseases. Yogic exercise restores body roles through the manipulation of cardiovascular, respiratory, and metabolic control mechanism. Yoga has been proven to be an effective adjunct in thyroid conditions in various studies.
Objectives: The objective of this study is to assess the effect of yoga on respiratory function, thyroid-stimulating hormone estimation, and hand grip strength as well as quality of life (QoL) in participants with clinically diagnosed thyroid dysfunction.
Methods: Twenty-five participants aged between 20 and 50 years were enrolled for the trial. Yoga sessions of four times a week for 3 weeks were given to every subject. Pulmonary function test (PFT), thyroid function, grip strength as well as QoL was measured pre as well as post intervention.
Results: Highly significant variations (P < 0.001) were noted within PFT, thyroid function, grip strength as well as QoL parameters
Conclusion: Significant effect was found within all the parameters of PFT, thyroid function, hand grip strength as well as QoL following 3 weeks of yoga training.

Keywords: Grip strength, pulmonary function test, quality of life, thyroid dysfunction, yoga

How to cite this article:
Krishnanunni S, Ganesh B R. Effect of yoga on pulmonary function test, thyroid-stimulating hormone estimation, hand grip strength, and quality of life in participants with thyroid dysfunction: A pre-post clinical trial. Indian J Health Sci Biomed Res 2021;14:103-7

How to cite this URL:
Krishnanunni S, Ganesh B R. Effect of yoga on pulmonary function test, thyroid-stimulating hormone estimation, hand grip strength, and quality of life in participants with thyroid dysfunction: A pre-post clinical trial. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Apr 16];14:103-7. Available from: https://www.ijournalhs.org/text.asp?2021/14/1/103/308953

  Introduction Top

Thyroid dysfunction is the most common occurring endocrine disorder among the general population; every so often it is perceived through preclinical stage as subclinical hypo- or hyperthyroidism owing to systematic screening programs, mainly functional in adults.[1] Thyroid is 2 inch long endocrine gland, positioned anterior to the neck below larynx/voice box with two lobes, one on each side of windpipe.[2] It weighs <1 ounce (28.34 gms), with each lobe being around 5 cm long, 3 cm wide, and 2 cm thick, and isthmus being 1.25 cm in height and width.[3] Yogas have concocted practices which not only retained healthy glands and metabolism, but also the molded part of system of enlightenment. Several participants with hypothyroidism complain of fatigue and shortness of breath on maximum exertion. Differences in forced-vital capacity (FVC) were observed, FVC as percentage of predicted FVC were noted, forced expiratory volume in 1st s (FEV1), and maximum mid-expiratory flow rate forced expiratory flow (25%–75%) attained arithmetic connotation.[4] Skeletal muscle is one of the major bull's eye organ of THs.[5] Relaxation and contraction proportions of skeletal muscle are intensely exaggerated by T3, which regulate myosin expression and vigor supplied by mitochondrial substrate oxidation.[6] Thyroid hormones have an indispensable role in the regulation of mood as well as cognition, with exceptional clinical variability that is unswervingly correlated to disease period, thyrotoxicosis severity, individual susceptibility to thyroid hormone surplus, and patient's age. Moreover, poor quality of life (QoL) interrelated with hyperthyroidism is supplementary to negative bearing on psychological, social and efficiency of work, and also produce marked variation in QoL and is concomitant with boundless changes in the physical form.[7]

  Methods Top

This was a prospective, randomized, clinical trial conducted in Health Science University on participants with clinically diagnosed thyroid dysfunction, referred to KLE's Hospital, Belagavi, Karnataka, India, from March 2019 to February 2020. A single-trained investigator evaluated all participants and collected all the data to eliminate inter-investigator error. All participants will be scrutinized based on the inclusion and exclusion criteria before their enrolment into the study. The present study was approved by the Institutional Research and Ethics Committee of the KAHER Institute of Physiotherapy, Karnataka, India (Research and ethical committee, KIPT/33/03/07/19). The trial is registered under the clinical trial registry of India with trial number CTRI/2019/09/021310. Demographic data will be obtained from each subject. The purpose of the study will be explained, and a written consent will be obtained from all participants. Participants were evaluated for their demographic data along with their initial assessment of outcome measures before their intervention. Participants were informed about the aims and procedure of the study. Baseline parameters such as pulmonary function test (PFT) (spirometer recordings and vitalograpgh), thyroid-stimulating hormone (TSH) estimation, and QoL scale (short form-36 (SF-36]) were measured before and postintervention for both hyperthyroid and hypothyroid participants [Flow Chart 1]. Participants were required to practice yoga techniques daily in form of Pranayama (breathing techniques) for a period of 4 days per week for 3 weeks.

Inclusion criteria

Clinically diagnosed participants with hyperthyroidism or hypothyroidism (since 6 months), aged between 20 and 50 years, of either gender, also pregnancy-induced thyroidism were included in the study.

Exclusion criteria

Participants presenting with hypertension, chronic obstructive pulmonary diseases, any neurological disorders, complications of coronary artery disease, any organ dysfunction, or who are unable to comply with study procedure were excluded from the study.


Participants were expected to perform breathing techniques (pranayama) for a period of 30 min (consisting of Bhastrika, Bhramari, and slow breathing technique with alternate nostril deep breathing called AnulomVilom along with Ardhamatsyendrasana [half fish face pose], Trikonasana [triangle pose], and Bhujangasana [snake pose]) followed by Shavasana.


Duration of each Yogasana: Bhastrika (5 min) [Figure 1], AnulomVilom (15 min), Bhrami (5–7 times; 3–5 min)[8] Ardhamatsyendrasana (5 min) [Figure 2], Bhujangasana (5 min), Trikonasana (3–5 times; 5 min) [Figure 3].[9]
Figure 1: Subject performing Anulom Vilom (alternate nostril breathing)

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Figure 2: Subject performing Ardhamatsyendrasana (half-fish pose)

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Figure 3: Subject performing Bhujangasana (snake pose)

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  Results Top

Statistical analysis for the present trial was performed through the version 23 of Statistical Package for the Social Sciences (SPSS) IBM (Knowledge Center). Raw data were entered into the Microsoft Excel 2007, tabulated as well as subjected to the statistical analysis. All the continuous data were analyzed for the distribution by using the Kolmogorov–Smirnov test, which revealed normal distribution. Change in hence, Wilcoxon sign ranks test was applied. As per [Table 1], nominal data of the participants including data representing demographics that is age, BMI, and occupation distribution were studied using mean, standard deviation, and percentage distribution. Variables of all the outcomes were compared after 3 weeks with the baseline values. Level of significance was set at 5%; probability values of P ≤ 0.05 were taken statistically noteworthy, and probability values P ≤0.001 were taken very highly significant.
Table 1: Comparison of parameters of thyroid function test at baseline and post intervention

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As per [Table 2], QoL was measured using SF 36 questionnaire where highly significant changes were said to be distinguished within all nine parameters of SF 36 Questionnaire at baseline and post of 3 week intervention of yogasana were P < 0.001**.
Table 2: Comparison of all components of SF–36 questionnaire at baseline and post intervention

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The result showed that the mean difference of FEV1 pre as well as postintervention score was (-0.35 ± 0.31) and that of FVC the pre as well as post therapy score mean difference was (-0.32 ± 0.36), also the component of FEV1/FVC showed significant difference in the pre as well as posttherapy values with mean difference (-0.11 ± 0.18), with (P < 0.001*)

Grip strength was also said to be improved very significantly following 3 week protocol of yoga training (P ≤ 0.001**). The result showed that mean grip strength score was (21.56 ± 4.66), at baseline, whereas post intervention, it was significantly improved to (24.92 ± 3.64) at rate of (-3.36 ± 1.96) of mean difference.

  Discussion Top

The present clinical trial intended at comparing the effects of various yogasanas or pranayama (breathing practices) on pulmonary function parameters (FEV1, FVC and FEV1/FVC), thyroid function estimation (T3, T4, and TSH), grip strength, and QoL in participants with thyroid dysfunction (inclusive of both hyperthyroidism and hypothyroidism).

Parameters of PFT (FEV1 and FVC) were very significantly enhanced post 3 weeks of yoga or pranayama intervention, (P < 0.001**), third parameter of PFT (FEV1/FVC), however, showed significant changes postintervention (P < 0.05*)

Similar study was steered by Madanmohan et al. who aimed at assessing changes in school children on pulmonary function following yogasana. Thereby, trial determined that 6 months of yoga intervention showed very significant improvement on pulmonary function values of FEV1 as well as FVC, which remains concomitant with the present trial.[10]

Other group of investigators directed a research work for the comparison of effects of spirometry among 21 patients with hypothyroidism, with TSH value > 10 mIU/L to 21 healthy controls. It was instituted that T4 levels in hypothyroid participants were positively correlated to FVC as well as FEV1 and ratio of FEV1/FVC, while TSH was noted to be negatively correlated to all the parameters of PFT.[11]

Parameters of thyroid function were noticed to be significantly amended post 3 week intervention of yoga training. T3 as well as TSH component showed very highly significant changes, (P < 0.001**), T4 component exhibited significant changes (P < 0.05)

Qualitative research was initiated by Banerjee, to find out the effect of yoga intervention on hypothyroidism linked with obesity among women in the urban areas leading sedentary lifestyles. A total of 150 obese women with a history of hypothyroidism aged between 30 and 50 years located in the eastern parts of West Bengal were enrolled for the study from June 17 to January 18. Intervention was performed in two phases, first 4 months with western medical management using 25–100 mcg levothyroxine (as per the prescription of physician/endocrinologist) as well as weight loss diet by referred dietitian, comprising of 4 month duration. Second 4 months phase was performed with yoga practice for average 45 min/day preferably in early morning in continuation with same weight loss diet plan (of phase 1). Four months phase was conducted based on two visits at every 2-month interval, so total four visits. In conclusion, diet in unification with yoga intervention lead to in noteworthy improvement within participants at no cost. Furthermore, yoga intervention was considered safest choice in this trial as it was considered beneficial not only for physical health but also mental well-being, with little or no side-effects as in comparison to intake of western medicines.[12]

Grip strength was said to be upgraded very significantly following 3 week protocol of yoga training (P = 0.001**). Postintervention hand grip strength was shown to have significant effect.

Thyroid dysfunction is considered to be linked closely with weakness of skeletal muscle. Trial was directed to find the association of serum thyroid hormone levels to grip strength. Cross-sectional analysis was conducted at Geriatric Department of Zhongshan Hospital in elderly males as per the standards of Asian Working Group for Sarcopenia. Grip was measured, with low value defined as HG <26 kg. The prevalence of low hand grip was found to be 48.5%, which was considered a major number. It was, therefore, established that, ineuthyroid subjects, higher serum values indicate lower strength while narrow serum range of thyroid should be considered in the protection of skeletal muscle.[13]

QoL was measured using SF-36 questionnaire where highly significant changes were said to be distinguished within all nine parameters of SF-36 Questionnaire at baseline and post of 3 week intervention of yogasana were P < 0.001**.

Literature supports the practice of yoga on the regular basis to control the side effects of thyroid dysfunction inclusive of stress, fear, insomnia, tiredness, anger as well as apprehensive mental capacity. Yoga has been considered as better method of complementary approach to disease management in comparison to western medical management, to scrutinize through contradictory reports to discriminate, also as best approach plan for optimal health outcomes. Yogic practices are, however, noted to produce positive changes in discharge of hormones.[14]

Priya et al. directed a trial to effect on blood pressure as well as QoL in objectify through yoga subjects with hypertension. Eighty-three adults, aged between 20 and 80 years with diagnosed hypertension. Yoga classes with an instructor, as well as yoga classes at home were directed over a duration of 12 weeks, also self-related QoL questionnaires were obtained from every subject. Noteworthy changes were observed in blood pressure as well as QoL of enrolled participants following yoga practice in group with yoga performed at home on regular terms. However, reason for no significant changes in yoga performed at classes were not notified.[15]

  Conclusion Top

The present study concluded that all parameters of PFT, thyroid function, hand grip strength, and QoL showed significant improvement following 3 weeks of intervention of yoga. Thus, it can be suggested that yoga has beneficial effects which can be used an alternative method, which is easy to perform, safe to adopt as well as plays an integral part in one's daily life in alleviating diseases and promoting health with no side effects compared to Western medicine.


The authors would like to extend our thanks toward staff and participants for their valuable advice that helped us carry out the trial at of KAHER Institute of Physiotherapy, Belagavi.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Veltri F, Rocha FO, Willems D, Praet JP, Grabczan L, Kleynen P, et al. Prevalence of thyroid dysfunction and autoimmunity in the older population and implications of age-specific reference ranges. Clin Chim Acta 2017;465:34-9.  Back to cited text no. 1
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2016. Niddk.nih.gov. Retrieved 2 July 2016. Available from: http://www.nidd?k.nih.gov. [Accessed on 2020 Jan 27].  Back to cited text no. 2
Standring S, Borley NR, et al., editors. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th ed.. London: Churchill Livingstone; 2008.  Back to cited text no. 3
Chaitanya PS, Suresh V, Mohan A, Sachan A. Respiratory dysfunction in hypothyroidism. J Clin Sci Res 2019;8:89.  Back to cited text no. 4
Lebon V, Dufour S, Petersen KF, Ren J, Jucker BM, Slezak LA, et al. Effect of triiodothyronine on mitochondrial energy coupling in human skeletal muscle. J Clin Invest 2001;108:733-7.  Back to cited text no. 5
Bloise FF, Cordeiro A, Ortiga-Carvalho TM. Role of thyroid hormone in skeletal muscle physiology. J Endocrinol 2018;236:R57-68.  Back to cited text no. 6
Riguetto CM, Neto AM, Tambascia MA, Zantut-Wittmann DE. The relationship between quality of life, cognition, and thyroid status in Graves' disease. Endocrine 2019;63:87-93.  Back to cited text no. 7
Swami G, Singh S, Singh KP, Gupta M. Effect of yoga on pulmonary function tests of hypothyroid patients. Indian J Physiol Pharmacol 2010;54:51-6.  Back to cited text no. 8
Mandanmohan, Jatiya L, Udupa K, Bhavanani AB. Effect of yoga training on handgrip, respiratory pressures and pulmonary function. Indian J Physiol Pharmacol 2003;47:387-92.  Back to cited text no. 9
Bhavanani AB. Effect of yoga training on handgrip, respiratory pressures and pulmonary function. Indian J Physiol Pharmacol 2003;47:387-92.  Back to cited text no. 10
Roel S, Punyabati O, Prasad L, Salam R, Ningshen K, Shimray AJ, et al. Assessment of functional lung impairment in hypothyroidism. IOSRJ Dent Med Sci 2014;13:4-7.  Back to cited text no. 11
Banerjee S. Study on yoga intervention along with diet on hypothyroidism associated with obesity among sedentary working women in West Bengal. Int J Yoga and Allied Sci 2019;1:2278-5159.  Back to cited text no. 12
Chen L, Hu Y. The correlation between serum thyroid hormone levels and hand grip among elderly male Chinese inpatients. Aging Male 2019:1-6.  Back to cited text no. 13
Mahowald S. Therapeutic effects of Yoga on Thyroid Disorders; 2019.  Back to cited text no. 14
Priya JV, Kanniammal C, Mahendra J, Valli G. Impact of yoga on blood pressure and quality of life in patients with hypertension. Int J Pharmaceut Clin Res 2017;9:413-6.  Back to cited text no. 15


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


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