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60]

Review Article

Pranayamas and Their Neurophysiological Effects

Abstract Stephany
Introduction: The millenarian breathing exercises from Yoga, commonly called Pranayamas, Campanelli,
are known to induce meditative states, reduce stress, and increase lung capacity. However, the Adriano Bretanha
physiological mechanisms by which these practices modulate the human nervous system still need
to be unveiled. Objectives: The aim of this work was to review studies describing the influence of Lopes Tort1,
breathing exercises on the brain/mind of humans. Methodology: We reviewed articles written in Bruno Lobão-Soares
English and published between 2008 and 2018. Inclusion and exclusion criteria were based on the Department of Biophysics
PRISMA recommendations to filter articles from Science Direct, PubMed, and Virtual Health Library and Pharmachology, Centre
databases. Patient/Population, Intervention, Comparison, and Outcome technique and Prospective of Biosciences, UFRN, Natal,
Rio Grande do Norte, 1Brain
Register of Systematic Reviews registration were also considered. Results: From a total of 1588
Institute, UFRN, Natal, Rio
articles, 14 attended the criteria. They were critically compared to each other and presented in a table Grande do Norte, Brazil
divided into study; country; sample size; gender; age; objective; technique; outcome. Discussion: In
general, the 14 papers highlight the impact of yogic breathing techniques on emotional and cognitive
performance. Conclusion: In‑depth studies focusing on specific aspects of the practices such as
retentions, prolonged expiration, attention on fluid respiration, and abdominal/thoracic respiration
should better elucidate the effects of Yogic Breathing Techniques (YBT).

Keywords: Brain oscillations, breathing techniques, Pranayamas, systematic review

Introduction synchronization and is correlated with sleep

disturbances and attention deficit hyperactive
Simple breathing exercises such as slow
disorder.[8,9] Some studies also suggested
and controlled breathing are known to calm
that asymmetry in nasal airflow  –  in which
the mind and are clinically used to reduce
most of the flow occurs through one of the
excessive arousal. However, the understanding
nasal passages – may be associated with
of the relationship between mind and breath
asymmetry in brain activity.[10,11] Of note,
is still incomplete.[1 ] According to the
increases in respiration rate are synchronized
Ancient Yoga Tradition, the breath and the
to amygdala activation during states of
mind are closely interconnected and their
anxiety or fear[12] and have a modulatory role
influence is bidirectional.[2] Modern science
in neuronal activity of the neocortex, directly
has just started to confirm and analyze
linking breathing to cognitive processes.[13]
this fact in more detail. Yogic breathing
In addition, one recent study highlighted that
exercises are known as Pranayamas and are
conscious breathing might promote top‑down
considered a form of meditation in itself, as
emotional regulation through the prefrontal Address for correspondence:
well as a preparation for deep meditation.
cortex network with the limbic system.[14] Ms. Stephany Campanelli,
They promote physical well‑being and Departamento de Biofísica
self‑awareness, improve lung and cognitive However, the mechanism by which yogic e Farmacologia, Centro de
capacities, reduce blood pressure, anxiety, breathing techniques (YBT) interact with Biociências, Universidade
and other psychosomatic patterns, probably the autonomic and cognitive functions of the Federal do Rio Grande do
human nervous system still needs to be better Norte, Caixa Postal 1524,
by increasing the parasympathetic tone.[3‑7] 59078‑970, Natal, RN, Brazil.
elucidated.[15] Here, we sought to review E‑mail: sce.neuroscience@
A critical study showed that nasal breathing
recent studies on this subject and discuss gmail.com
generates phase‑locked oscillations in the
their results based on previous knowledge on
local field potential activity of the piriform
neural plasticity and respiratory modulation
cortex, amygdala, and hippocampus of
of emotional and cognitive functions. Access this article online
humans.[8] Interestingly, breathing through the
Website: www.ijoy.org.in
mouth does not induce the same pattern of Methodology DOI: 10.4103/ijoy.IJOY_91_19
What kind of changes can breathing Quick Response Code:
This is an open access journal, and articles are
distributed under the terms of the Creative Commons How to cite this article: Campanelli SE, Tort AB,
Attribution‑NonCommercial‑ShareAlike 4.0 License, which Soares BL. Pranayamas and their neurophysiological
allows others to remix, tweak, and build upon the work
effects. Int J Yoga 2020;13:183-92.
non‑commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms. Submitted: 25-Nov-2019 Revised: 02-Jun-2020
For reprints contact: [email protected] Accepted: 26-Jun-2020 Published: 13-Sep-2020.

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Campanelli, et al.: Pranayamas and their neurophysiological effects

exercises exert in the brain/mind of humans? This research the age of the subjects varied from 10 to 74  years
question was based on the Patient/Population, Intervention, old. Regarding their methodology, four studies used
Comparison, and Outcome technique, used to search for electroencephalography (EEG), two used functional
evidence‑based information. This study was carried out magnetic resonance imaging (fMRI), two used continuous
between August and September of 2018 and followed the transcranial Doppler (TCD), and one used tomography
PRISMA recommendations.[16] To provide transparency low‑resolution brain electromagnetic tomography. Four
and best‑quality evidence, the protocol for this systematic studies employed questionnaires.
review was registered on Prospective Register of Systematic
Vialatte et  al.[17] described Bhramari Pranayama (BhPr)
Reviews (Unique ID number: CRD42018107624).
as a vibrating, buzzing, and constant sound of bumblebees
Articles were initially collected in PubMed, Science Direct, produced while exhaling strictly through the nasal airways.
and Virtual Health Library electronic databases using the After the start of the exhalation, the EEG of all subjects
following predictors: “BREATH” OR “BREATHING” exhibited a dramatic increase in the power of high
OR “PRANAYAMA” AND “BRAIN” OR “MIND.” Data frequencies  (>15 Hz), which was not observed during
extraction, analysis, and the selection of articles were false BhPr. This increase was due to the appearance of
performed in pairs. The search strategies were customized a particular pattern of EEG activity, which they called
according to filters available in each database  [Table 1]. After “paroxysmal gamma wave” (PGW). The EEG waveform
the process of the identification of the eligible literature, studies remained stable across time, and PGW activity peaked
were systematically filtered based on inclusion and exclusion in the left middle temporal lobe, not propagating to other
criteria. Subsequently, the final papers were read in full text for brain areas during the practice. Subjectively, the subjects
a critical analysis of the content. The inclusion criterium was to reported only a feeling of peacefulness. The authors argued
select papers with at least 2 of 5 of the predictors in the text. that although displaying an epileptiform‑like waveform,
Exclusion criteria were divided into subsets: (a) Nonresearch the PGW activity measured during BhPr would not be
articles (e.g., books, reviews, editorials, commentaries, case pathological but represent nonepileptic hypersynchrony.
studies, and case reports); (b) duplicated; (c) breathing Rajesh et  al.[18] analyzed the stop‑signal reaction
exercises focused on the treatment of respiratory diseases; (d) time (SSRT), which estimates the ability to suppress motor
brain‑breathing analysis in sleep disorders or during responses, before and after two respiration techniques: deep
sleep; (e) breathing exercises combined but not compared breathing and BhPr, with the latter described in the same
to each other, or breathing exercises combined but not way as in Vialatte et al.: a humming sound produced during
compared to different techniques; and (f) only nonbreathing exhalation. Their results indicate a significant reduction in
exercises (e.g., drug administration, manipulation of air
SSRT only for BhPr, suggesting that the practice enhances
concentration and/or pressure, mechanical ventilation,
response inhibition, which means a flexible cognitive
invasive methods, and clinical protocols).
control.
Results Bhavanani et  al.[19] also studied reaction time (RT), but
From 1.588 papers screened, 277 attended the focusing on Mukh Bhastrika, described as having the
inclusion criterium for further analysis. After filtering breath actively blasted out in multiple “whooshes” with
based on exclusion criteria, 14 were selected for this forced abdominal contractions. Working with a sample
review [Figure 1]. The final articles were organized of mentally retarded children, they showed that Mukh
chronologically [Table  2] with the following information: Bhastrika produces an immediate reduction in both
study, country, sample size, gender  (♂/♀), age of visual and auditory RT, indicating improved sensorimotor
volunteers, objective, technique, and outcome. performance. Their hypothesis is that afferent inputs from
abdominal and thoracic regions probably modulate the
From the 14 papers, ten were from east countries ascending reticular activating system and thalamocortical
and four had only male volunteers. Among studies, processing, resulting in greater arousal.

Table 1: Scientific databases and predictors used to screen for eligible articles
Academic Strategy
databases
PubMed ((BREATHING[Title/Abstract]) OR BREATH [Title/Abstract] OR PRANAYAMA[Title/Abstract])
AND (MIND [Title/Abstract] OR BRAIN [Title/Abstract]). Filters: Full text, during the last 10 years, in humans,
written in English.
Science direct ((BREATHING[Title/Abstract]) OR BREATH [Title/Abstract] OR PRANAYAMA[Title/Abstract])
AND (MIND[Title/Abstract] OR BRAIN [Title/Abstract]). Filters: During the last 10 years, research articles only.
Virtual health library (tw:(BREATHING)) OR (tw:(BREATH)) OR (tw:(PRANAYAMA)) AND (tw:(MIND)) OR (tw:(BRAIN)). Filters:
During the last 10 years, written in English.

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Campanelli, et al.: Pranayamas and their neurophysiological effects

Figure 1: Flow diagram based on PRISMA recommendations

Ren et  al.,[20] on the other hand, analyzed how breathing the control group. Thus, the authors concluded that Sukha
meditation promotes insight. Participants were required to Pranayama is effective in alleviating the anxiety of CA
raise the hand to report every ten breaths  (M10) or every candidates and suggested its use as close as possible to the
100 breaths  (M100). Before the experimental session, they CA procedure.
were taught Susoku meditation, which requires mindful Ju and Lien[22] compared the focused‑breathing
control and focuses on their deep abdominal breathing. strategy (FBS) to the focused‑distraction strategy (FDS)
After meditation, five examples of insight problems were and found that the first is generally more effective than the
given to all three groups  (M10, M100, and rest/control). second in reducing mind wandering (MW) and intrusions
Participants were not aware that they would be given the of unwanted thoughts. They concluded that FBS allows
unsolved problems later to try to solve them again. Results users to have better control over unwanted thoughts and
showed that participants who engaged in meditation with less effort than with FDS. The performance of the
solved more previously unsolved problems compared to FBS group was independent of working memory capacities,
participants in the control condition, thereby providing which indicates that the effect of FBS does not come from
direct evidence for the role of meditation in promoting effortful top‑down control.
insight. Moreover, the M10 group had better performance
than the M100 group and they also found a significant Hasenkamp et  al.[23] noticed that during focused
negative correlation between insightful problem‑solving in attention (FA) meditation, nonadvanced practitioners
the final session and the percentage of alpha waves (known experiment a dynamic fluctuation between states such as
MW, awareness of mind wandering (AWARE), shifting
to be related to mental relaxation).
of focus back to the breath (SHIFT), and attentional focus
Mobini Bidgoli et  al.[21] described Sukha Pranayama as a on the breath (FOCUS). During the MW phase, they
conscious slow breath done regularly through the nostrils, detected activity in the posterior cingulate cortex, medial
which uses all parts of the lungs during inhalation and prefrontal cortex, posterior parietal/temporal cortex, and
exhalation. Working with a sample of patients undergoing parahippocampal gyrus (brain regions frequently associated
coronary angiography (CA), they showed that anxiety with the default mode network). The AWARE phase
levels decreased five times more in the experimental than revealed robust activations in the bilateral anterior insula

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Table 2: Selected articles published between January/2008 and August/2018

Study/experience Country Sample size, Objective Technique Outcome
gender and (age)
Vialatte et al., 2009/1 Japan 8♂ (age not To obtain new insights EEG and tomography PGW were observed during
month specified) into the nature of the BhPr. This EEG activity is most
EEG during BhPr probably nonepileptic
Ren et al., China 23♂ (mean: 23.3) To determine if EEG and Watchfulness in meditation,
2011/1 day (naïve) 25♀ (mean: 23.3) breathing meditation problem‑solving rather than relaxation,
could promote insight training contributed to insight. The
percentage of alpha waves (a
brain index of mental
relaxation) was negatively
correlated with insights
Hasenkamp et al., USA 3♂ (28-66) To understand fMRI Regions associated with
2012/1 year or more 11♀ (28-66) fluctuating cognitive the DMN were activated
state (mind wandering, during mind wandering, and
awareness of mind in salience network regions
wandering, shifting of during awareness of mind
attention and sustained wandering. Elements of the
attention) executive network were active
during shifting and sustained
attention
Bhavanani et al., India 22♂ (13-16) To determine if RT measure‑ments: Mukh Bhastrika may be used as
2012/3 months or Mukh Bhastrika VRT and ART an effective means of training to
more affects central neural improve the RT in such group
processing by studying
RT
Pradhan, 2013/ India 21♂ To study the effect SLCT and DLST Both KB1 and KB5 increased
3 months (mean: 25.71) of 1 min KB1 and error scores for DLST but not
5‑min (KB5) on the for SLCT
15♀
SLCT and DLST
(mean: 24.13)
Arsenault et al., Canada 11♂ (21-42) To examine how EEG, painful Pain‑related brain activity
2013/1 day (naïve) 9♀ (21-42) breathing frequency electrical stimulation, may be reduced during
and phase affect pain plethysmograph pulse inspiration, but these changes
perception, spinal oxymeter strain‑gauge are dissociated from the spinal
nociceptive activity, belt transducer and nociceptive transmission.
and brain activity anxiety questionnaire Factors other than respiration
contribute to the analgesic
effects of relaxation and
meditation techniques
Marshall et al., USA 9♂ (31-74) To explore whether Attention, language, UNB treatment may be
2014/10 weeks 2♀ (31-74) UNB influences spatial abilities, used alongside traditional
language ability in depression, and speech ‑language therapy in
poststroke individuals, anxiety tasks before, poststroke individuals
with and without during, and after UNB
aphasia treatment
Rajesh et al., 2014/6 India 31♂ (19-31) To examine the effect SST BhPr reduced SSRT, suggesting
months-6 years of BhPr on response enhanced response inhibition,
inhibition in healthy related to a flexible cognitive
individuals control
Ju et al., Taiwan 36♂ (18-29) To compare the Automated ope‑rating FBS is more effective than FDS
2016/1 day (naïve) 46♀ (18-29) effectiveness of FBS span, concentration, in reducing mind wandering and
and FDS on working and thought thought intrusions. In ddition,
memory capacities suppression tasks in contrast to FDS, the effect
of FBS is independent of users’
mental resources

Contd...

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Table 2: Contd...
Study/experience Country Sample size, Objective Technique Outcome
gender and (age)
Doll et al., Germany 10♂ (22-31) To analyze the effects fMRI, respiration ATB decreases amygdala
2016/2 weeks 16♀ (22-31) of ATB as a basic belt transducer activation and increases
mindfulness practice and attention prefrontal integration with
on aversive emotions questionnaire the amygdala during aversive
at behavioral and brain emotions, independently of
levels effects on breathing frequency
Bidgoli et al., Iran 40♂ (48-68) To examine the effects Demographic Sukha Pranayama reduced
2016/1 day (naïve) 40♀ (48-68) of Sukha Pranayama questionnaire and the mean anxiety score in the
on anxiety of the Spielberger State experimental group
coronary angiography Anxiety Inventory
candidates
Nivethitha et al., India and 15♂ (22-32) To evaluate the Continuous TCD Bhastrika reduced end‑ diastolic
2017A/1 year Singapore effect of Bhastrika velocity and mean flow velocity
and Kumbhaka while increased pulsatility index
Pranayamas between 15 and 60 s. Kumbhaka
on cerebral had the opposite effect during
hemodynamics 30-60 s
Khng, Singapore 63♂ (10-11) To examine the effectsAnxiety and adapted Deep breathing significantly
2017/1 day (naïve) 59♀ (10-11) of deep breathing math tests, children’s reduced self‑reported feelings
on anxiety and test cognitive assessment of anxiety and improved test
performance in questionnaire and performance. There was a
children, and their distractor interference statistical trend towards greater
possible mechanisms task effectiveness in reducing state
and moderators anxiety for boys compared to
girls
Nivethitha et al., India 17♂ (20-26) To evaluate the effect Continuous TCD Various types of Pranayama
2017B/1 year 1♀ (20-26) of BhPr, KB and techniques produce different
Bahir‑Kumbhaka brain hemodynamic changes in
Pra‑ nayamas on brain healthy volunteers
hemodynamics
EEG=Electroencephalography, PGW=Paroxysmal gamma waves, BhPr=Bhramari Pranayama, fMRI=Functional magnetic resonance
imaging, DMN=Default mode network, RT=Reaction time, VRT=Visual reaction time, ART=Auditory reaction time, SLCT=Six‑letter
cancellation task, DLST=Digit‑letter substitution task, TCD=Transcranial Doppler, UNB=Unilateral nostril breathing, SST=Stop
signal task, SSRT=Stop signal RT, FBS=Focused‑breathing strategy, FDS=Focused‑distraction strategy, ATB=Attention‑to‑breath,
KB=Kapalabhati

and dorsal part of the anterior cingulate cortex (brain regions attention, DLST involves mental flexibility  (since it
associated with conflict monitoring and self‑regulation). requires reflective consideration when substituting digits
During the SHIFT phase, significant activation was for letters), which is not present in SLCT (since it only
observed in the lateral prefrontal cortex (dorsal and requires a simple reaction to seeing the selected letters).
ventral) and lateral inferior parietal cortex, with more Surprisingly, the study found more errors in DLST after
robust activation in the right hemisphere (related to the either KB1 or KB5, while performance in SLCT was not
executive network). Moreover, in the FOCUS phase, there affected. The author concluded that KB does not improve
was a cluster in the dorsolateral prefrontal region and motor skills and may interfere with the reflection period
a lack of activation in parietal elements of the executive present in DLST.
network  (both findings were reminiscent from the SHIFT
Arsenault et  al.[25] hypothesized that slow breathing
phase).
would produce analgesic effects on shock pain,
Pradhan[24] defined Kapalabhati (KB) as active exhalation especially at the end of inspiration, due to the
by a rapid contraction of the abdominal muscles with activation of descending inhibitory pathways by
passive inhalation. Participants were divided into two respiration‑sensitive parasympathetic processes.
groups depending on the length of the KB session  (KB1: However, the amplitude of the nociceptive flexor
1  min and KB5: 5  min) and subjected to the six‑letter reflex (RIII‑reflex) was greater during inspiration
cancellation task (SLCT) and the digit letter substitution compared with expiration. They suggested that this
task (DLST) test. Of note, even though these two are breathing hypoalgesia may be due to central processes
usually considered equivalent for measuring sustained independent of descending modulation.

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Marshall et  al.[26] hypothesized that right unilateral nostril cerebral hemodynamic parameters were observed during
breathing (UNB) would improve attention and language normal breathing nor during BhPr.
as well as decrease anxiety and depression in poststroke
patients. These individuals are at an increased risk for Discussion
depression, especially those with language impairment due In this systematic review, all 14 selected studies highlight
to aphasia. Participants were asked to close the left nostril the behavioral and neurophysiological changes after
and breath with the right nostril, extending the exhalation the practice of YBT. Marshall et  al.[26] indicate that
to twice longer than inhalation  (ratio 1:2). Improvements Surya Bedhana pranayama would improve language in
in several metrics of anxiety and language were observed individuals with aphasia. Of note, most people have the left
after a 4‑week guided breathing practice; however, many of hemisphere responsible for language. From a neuroscientific
these improvements did not remain significant after the full perspective, the nostrils have a cross‑wised interaction with
course of the 10‑week breathing program, which required the brain hemispheres[31‑33] and Surya Bedhana means to
an extra 6 weeks of independent practice by the patients. breathe in through the right nostril and breath out through
The authors concluded that UNB may be a low‑cost the left nostril (with or without Kumbhaka or air retention).
prospective complementary technique and may need a more However, in this research, they combined a breathing
extended period of guidance before independent practice technique called Rechaka, when exhalation and inhalation
for poststroke patients to continue improving affective or have a proportion of 2:1, respectively, which is known to
linguistic abilities. calm the mind (in fact, they noticed reduced anxiety and
depression among participants). These results are consistent
Doll et  al.[27] investigated the neural mechanisms of
with others suggesting that alternation of nasal airflow
attention to breath (ATB) in emotion regulation. Their
through the nostrils modulates contralateral activation of
results provide evidence that, independently of the effects
brain hemispheres and that prolonged expiration compared
on breathing frequency, ATB decreases amygdala activation
to inspiration may increase parasympathetic activity.[34‑36]
while increasing the integration between the amygdala and
prefrontal cortex during aversive emotions. In particular, Literature has shown that theta oscillation in the
an increase in emotion‑related functional connectivity was frontal cortex correlates to mindfulness meditation and
found between the right amygdala and the left prefrontal parasympathetic dominance.[37,38] Vialatte et  al.[17] found a
and cingulate areas during ATB. significant decrease of theta activity during BhPr, although,
in their discussion, they claimed that it was increased. They
Khng,[28] working with a sample of children, suggested also found a hypersynchronous activity in the high gamma
that taking deep breaths before a test can help reduce range in the left medial temporal lobe after the practice
feelings of anxiety and enhance (math) performance. Deep of BhPr, which was defined as high‑frequency biphasic
breathing can become a self‑regulatory tool to be applied ripples. A previous study reported that ripples in the medial
at a child’s disposal to bring about a better state‑of‑mind temporal lobe are associated with neuroplasticity and human
and performance in anxiety‑inducing test‑like situations. memory consolidation,[39] but this is a polemic topic. While
The results also showed that deep breathing may be more some authors claim that fast oscillations could predispose
helpful for boys than girls and that this technique can be meditators to seizures and that gamma oscillation is related
quickly learned (<10 min) and effectively used by children. to default mode network in frontal areas,[40,41] others show
Nivethitha et  al.[29] defined Antar‑Kumbhaka Pranayama that long‑term practice of meditation bilaterally induces
as breath retention after inhalation and argued that high‑amplitude gamma synchrony in EEG recordings over
this technique increases carbon dioxide (CO2) levels the parieto‑temporal and midfrontal cortical areas.[42,43]
and consequently leads to vasodilatation and increased In humans, the intracortical theta  (4–8 Hz) oscillation is
cerebral blood flow  (CBF). On the contrary, Bhastrika associated with attention modulation and verbal and spatial
Pranayama, described as forceful inhalation and memory tasks.[44,45]
exhalation, would increase heart rate and blood pressure Rajesh et  al.[18] showed that BhPr may enhance response
reducing CO2 levels, producing vasoconstriction, and inhibition, suggesting flexible cognitive control. Bhavanani
reducing CBF in the intracranial arteries. Consistent with et  al.[19] also found an immediate reduction in visual and
this scenario, the authors showed that these pranayamas auditory RTs, but for Mukh Bhastrika. They hypothesize
produce opposite effects in cerebral hemodynamics when that afferent inputs from abdominal and thoracic regions
analyzed through continuous TCD. Months later, the same modulate the ascending reticular activating system and
group[30] analyzed BhPr, KB, and Bahir‑Kumbhaka (breath thalamocortical processing, resulting in greater arousal.
retention after exhalation) also using TCD. They found However, they claimed that this technique is similar to
that the practices of KB and Bahir‑Kumbhaka produced KB because of an active and strong expiration and that
opposite cerebrovascular hemodynamic changes: the KB has been previously shown to increase mental activity.
first increased sympathetic activity, whereas the second, However, this is also debatable since Pradhan[24] noted
parasympathetic activity. No significant changes in the that both 1  min or 5  min of KB practice did not improve

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Campanelli, et al.: Pranayamas and their neurophysiological effects

motor skills after two tasks assessing sustained attention. control condition. This result indicates that the practice of
In addition, they found that KB may negatively interfere this technique could promote insights. In addition, there
with the reflection ability of participants. In this context, was a significant negative correlation between insightful
on the Internet Mukh Bhastrika has been more linked to problem solving and the percentage of alpha waves (known
Bhastrika (active inhalation and active exhalation) than to to be related to mental relaxation).
KB/Kapalbhati (passive inhalation and active exhalation),
Arsenault et  al.[25] hypothesized that this type of breathing
which highlights the lack of consensus about the definition
technique would produce analgesic effects on shock pain,
of these techniques.
especially at the end of inspiration, due to the activation
In parallel, Nivethitha et  al.[29,30] showed that of parasympathetic processes. However, the amplitude of
Bahir‑Kumbhaka‑or the pause after expiration‑changes nociceptive flexion reflex was higher during inspiration than
the cerebrovascular hemodynamic by increasing expiration, suggesting that the breathing hypoalgesia may
parasympathetic activity, in contrast to KB, which be due to cerebral processes independent of descending
increased sympathetic activity. Antar‑Kumbhaka‑or air modulation. This apparent contradiction may perhaps be
retention after inspiration‑may produces hypercapnia better analyzed in the light of a possible increase in body
(high CO2 levels) and leads to vasodilatation and increased awareness during the performance of the technique, which
CBF. On the contrary, Bhastrika Pranayama‑described may cause better responsiveness to nociceptive stimulus
as forceful inhalation and exhalation‑reduces CBF and but not necessarily a greater painful sensation (explaining
increases the heart rate and blood pressure reducing CO2 the higher amplitude). Khng,[28] in turn, studied the benefits
levels  (hypocapnia). A  relevant question is a difference of taking deep abdominal breaths before a test with groups
between KB and Bhastrika with regard to cerebrovascular of children. They found that the practice can help to reduce
hemodynamics and EEG signal, since both may stimulate anxiety and enhance math performance. Curiously, deep
sympathetic activity. This is an interesting phenomenon breathing was effective for students prone to autonomic
since meditation and YBT are usually related to reactions during tests/examinations, but not for those who
parasympathetic dominance.[46‑48] were not.
Hence how could these two techniques promote Three papers dealt with paying attention to the breath rather
meditation? A supposition would be that Bhastrika or KB than controlling its rhythm. This may be considered either
combined to Kumbhaka (retention), may potentialize the an initial or advanced step in the Pranayama pathway. It
effect of retention through the increase of cortical control is an initial step if the practitioner wants to observe the
over breathing centers in the brainstem. These two types qualities of his/her breath  (regularity, flow, time), and an
of Kumbhaka may lead to a better neuronal adaptation to advanced step if he/she uses it to meditate with a part of the
abnormal situations since sublethal hypoxic or ischemic body as an anchor (e.g., Nasagre or the space between the
events can improve the tolerance for subsequent injury nostril). In the case of Ju  et al.,[22] they called it FBS and
caused by hypoxia or ischemia, what is called, respectively, discovered that nonadvanced practitioners had better control
hypoxic and ischemic preconditioning.[49] over unwanted thoughts and with less effort than the group
However, neuroplasticity in the pre‑Bötzinger complex with FDS, which means paying attention to one’s flow of
induced by peripheral chemoreceptor activation following thoughts. Doll et  al.[27] found that ATB decreases amygdala
hypoxia may contribute to the development of sympathetic activation and increases prefrontal functional connectivity
overactivity and hypertension.[50] This gives rise to an open with the amygdala during aversive emotions. Their results
question: Could conscious air retention produce hypoxia suggest the amygdala‑prefrontal cortex integration as a
that stimulates the parasympathetic activity, whereas potential neural pathway of emotion regulation.
involuntary hypoxia would stimulate the sympathetic Finally, Hasenkamp et  al.[23] noticed that during FA on the
nervous system? Moreover, could a prolonged practice of breath, nonadvanced practitioners experiment a dynamic
conscious air retention make the practitioner less reactive fluctuation among brain states defined as MW, AWARE,
to involuntary hypoxia? shifting of focus back to the breath (SHIFT) and attentional
Four reviewed papers did not explicitly call the techniques focus on the breath (FOCUS). They further showed
“Pranayamas,” but they were included since their particular patterns of activated brain regions in each state.
description of deep and slow breathing can be considered Consistent with these, other studies also show differences
Sukha Pranayama. Mobini Bidgoli et  al.[21] showed that of brain activity during different mental states such as MW
“a conscious slow and deep breathing” done regularly and breathing‑focused meditation using fMRI, highlighting
through nostrils could reduce anxiety in patients before that meditation training associates with distinct patterns
a CA procedure. Similarly, Ren et  al.[20] noticed that of the default mode network[51] and with an increase in
participants who controlled and focused on deep abdominal the activity of the medial prefrontal cortex and anterior
breathing (called by the author Susoku meditation) resolved cingulate cortex in meditators, brain areas known to be
more unsolved problems compared to participants in the relevant for attention and emotion regulation.[52]

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Campanelli, et al.: Pranayamas and their neurophysiological effects

To better situate the various YBT used in these 14 studies, practice of YBT. Through the increase of respiration
it is also important to discuss the origins of pranayama control, attentional circuits could be recruited and
definitions in classical yogic traditions. Some of the stimulated to maintain self‑centered focus[57] as observed,
selected papers had not explicitly considered or defined for example, in hyperactivity disorder patients.[58] According
their techniques as Pranayamas. However, judging by to a recent study in humans, the phase of natural breathing
their description, they fit perfectly as traditional pranayama can be employed to promote oscillatory synchrony
practices. This is an issue when trying to unify all these and to optimize information processing in brain areas
practices from different yoga lineages for a scientific involved with goal‑directed behaviors.[8] In rodents,
purpose. So how can one classify a breathing technique researchers characterized respiration‑entrained oscillations
as a Pranayama? In this context, it is justifiable to look with origin in the olfactory bulb that also occur in the
at the classical approaches and definitions on the subject. hippocampus and frontal lobe, being thus implicated in
In the millenary text Yoga Sutras of Patãnjali, there is widespread communication in the brain.[59] This influence
a specific state that explains the spiritual purpose of of olfactory bulb reflects delta, theta, and beta‑range band
Pranayama practice: “Mastery in pranayama removes oscillations that are associated with attention, memory,
the veil that covers the lamp of intelligence and heralds and goal‑directed behaviors, thus possibly allowing the
the dawn of wisdom.”[53] For Patãnjali, there are four coupling between sensory and memory networks.[60,61]
aspects to be considered in breathing: Inhalation  (Puraka), Another recent paper described a specific neuronal type in
exhalation (Rechaka), the retention of air (Kumbhaka), and the pre‑Bötzinger complex  (pre‑BötC) regulating calm and
prana itself, which means primary energy or vital energy. arousal behaviors in rodents. The inactivation or ablation of
Prana has different names in other cultures, such as “Ki” those neurons left breathing intact but promoted an increase
in Japan and “Chi” in China, and is through the practice in calm behaviors and a decrease in arousal.[1] In addition,
of this pranayama that the practitioner (Sadhaka) can some researchers have found that the prolonged practice of
prepare his/her mind to truly meditate. Additionally, these pranayama (4 weeks) also modulates the activity of brain
four aspects can be regulated by space (where to focus regions involved in emotional processing, such as the
the breath on your body [e.g., diaphragm or nostrils]), amygdala, anterior cingulate, anterior insula, and prefrontal
time (the balance between inhalation and exhalation) and cortex.[6] Besides, through fMRI, it was possible to detect
count (the length of inhalation and exhalation). in these volunteers a reduction of connectivity between
Patãnjali does not name any breathing technique; he the anterior insula and lateral portions of the prefrontal
only explains the state of Pranayama and its aspects. In cortex, which is a network associated with anxiety.[6] In
contrast, the Hatha Yoga Pradipika, written by Svātmārāma this context, we argue that the sustained practice of YBT
enumerates names eight types: Surya Bhedana Kumbhaka, could promote neuroplasticity mechanisms underlying
Ujjayi Kumbhaka, Siktari Kumbhaka, Sitali Kumbhaka, these findings. That is, specific neurons from pre‑BötC
Bhastrika Kumbhaka, Bhramari Kumbhaka, Murccha could be affected by the voluntary control of respiration
Kumbhaka, and Plavini Kumbhaka, highlighting the during YBT, thus stimulating less the locus coeruleus and
importance of air retention. The late Swami Kuvalayananda reducing anxiety‑related states. In addition, considering
includes KB, one of the ShatKarmas or the six classical the prolongation of the respiratory cycle or the increase
cleansers in this list and B. K. S Iyengar claims that Murccha in nasal airflow during these practices, we argue that the
and Plavini are no longer in vogue. From the perspective olfactory bulb could exert a modulatory influence on the
of the Himalayan Lineage of Samaya Srividya Tradition, frontal lobe and limbic structures during YBT, resulting in
Nadi Shodhana (alternate nostril breathing) is considered a long‑term plasticity changes.
Pranayama and Kumbhaka, an advanced technique.[53‑56] Future studies should employ high‑quality methodologies to
In this scenario, it is challenging to have a consensus on accurately analyze the mechanisms involved in Pranayamas/
YBT practices. These include a detailed description of the
how to name and to practice Pranayama since the different
effect of single techniques since many studies combine
lineages of Yoga teach the techniques in distinct ways
them with each other or with asanas (postures). In this
and for different purposes. We suggest that all forms of
sense, the problem of mixed approaches is that we cannot
techniques may be included as long as a clear and detailed
understand in detail the neuroplasticity impacts of each
description is provided, and hence, one can understand
specific technique to apply them in modern‑day life or a
the physiology behind the technique. Complementarily,
clinical context. Finally, the underlying neural mechanisms
since the word pranayama can be either a mental state
could be better characterized by focusing on studying the
and a technique to achieve this state, we suggest that in
behavioral and structural changes   promoted by intensive
scientific texts, the term YBT should be favored instead of
training schedules. This can be accomplished with the aid
the traditional word Pranayama.
of technologies such as fMRI for neuroplasticity analysis,
In general, neuroplasticity could be involved in respiratory plethysmography combined with EEG to
physiological and behavioral alterations related to the understand the relationship between brain oscillations

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Campanelli, et al.: Pranayamas and their neurophysiological effects

and breathing patterns in real‑time, electrocardiogram 10. Kahana‑Zweig  R, Geva‑Sagiv  M, Weissbrod  A, Secundo  L,
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This research was supported by INCT 2014: Translational 17. Vialatte  FB, Bakardjian  H, Prasad  R, Cichocki  A. EEG
Medicine (nº 14/50891-1) and CNPq grants nº paroxysmal gamma waves during Bhramari Pranayama: A  yoga
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task. Int J Yoga 2014;7:138‑41.
There are no conflicts of interest.
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