by Dr. Ramesh I. Kapadia

“If the mind wanders, bring it back to the breath and gently replace it tenderly,,, there. Breath is Prana. Even if you did nothing during your efforts at meditation but bring your” mind back and place it again in prana, though, it went away every time you brought it back: your time spent during this effort would be very well employed.”

Dalai Lama’s guru explained quite succinctly to theauthor (at a personal meeting in 1993) why a, simple program of Shavasana and meditation is so effective. He said that the concept of separate existence is the root cause of all strifes, diseases and fear of death. The concept of separate existence is nurtured and nourished by the activities of the body and the mind. We remain so engrossed in the activities of the body and the mind that we forget that we are the spirit as well. In reality, the spirit is permanent and deathless. The body and the mind of all of us are separate manifestations of that singular spirit, In Shavasana and meditation, when we learn to quiet the body and the mind, the qualities of the spirit are experienced. The separateness and all the strifes recede in the background and oneness shines forth. Coronary heart disease and for that matter, even cancer, thrive on the background of separateness and isolation. The feeling of oneness which occurs during Shavasana and meditation heals an individual.

We have been practising with a five-point program for the patients of CHD for the last 5 years in Ahmedabad, a metropolis of India. The program consists of low-fat vegetarian diet, modest exercise like walking on the level for 30 to 40 minutes, the stretching and relaxing of various muscle-groups of the body leading to progressive deep relazation, viz. “Shavasana”, meditation, visual imagery and group discussion with an emphasis on the sharing of feeling. An experienced yoga instructor teaches Shavasana and meditation. A qualified dietition guides the participants and their spouses individually taking into account the dietary habits of the family. The presence of the founder cardiologist at each session inspires confidence in the participants. Towards the end of the program the participants share their feelings in a group discussion. In addition to the bi-weekly program, talks with visuals are held at intervals of six weeks. Nearly 2500 patients have participated so far and many more have used our books and cassettes with advantage. 150 to 200 CHD patients from all walks of life, in the age group of 30 to 70 years, both male and female in the ratio of 4 to 1, meet twice a week in the evening for one and a half hours for the program on a campus in tune with nature.

The five points of the program work in unison, each one supporting the other. While conducting the program the concepts of right diet, exercise, and the impact of comprehensive life-style changes have become clearer. Instead of emphasis on the total caloric value of the diet, only limiting fat calories and the maximum use of calories from complex carbohydrates derived from vegetarian diet, appear to be the sound basis of dietetic counseling. Complex calorie charts can be safely done away with. Modest exercise which can be performed by anyone is more beneficial than intensive exercise. Moreover, intensive exercise uses carbohydrates as fuel more than the body fat. Basal metabolic rate (BMR) decreases during intensive exercise regime which militates against weight loss. The comprehensive life-style changes which are considered impracticable have become easier through this program. Powerful motivation are the rapid improvements experienced by the participants through comprehensive changes.

The technique of “Shavasana” and meditation as practised in the program is extremely simple, easy to perform and yet effective in bringing about mental peace and fortitude. The very busy people who are fighting for time can also practise this yogic discipline for 10 to 15 minutes daily which improves the competence of the practitioner by an hour. There is hardly any excuse, hence, for not being able to spare time. In fact, the busier and more stressed the person the greater the need for practising this discipline.

“Shavasana” is a technique to relax the body which results in the relaxation of the mind. Breathing is central to all the three yogic disciplines, abdominal breathing, “Shavasana” and meditation. These discipline’s are called “Yogic” because they connect the individual to one’s larger self. They, help him to realize his inner strength, soul force and real identity. Patanjali Yogashastra intuitively observes that the control of breathing controls the restless mind which in turn controls the circulation. Normally, our breathing is involuntary and reflects the state of our mind. When our mind is not at peace, breathing is rapid and shallow. When the mind is at peace as during sleep the breathing is slow, rhythmic and abdominal. So when we consciously breathe slowly, rhythmically and abdominally, the mind automatically becomes calm. During meditation, one becomes one with breath, one with the life-force and this brings about an experience of the soul-force within oneself. The realization of the soul-force brings forth the qualities of the soul. They are love, compassion, and freedom from fear. It is easy to see that when these qualities develop, all the healthful changes occur in the body. Doctors and their trained personnel can teach these techniques in their clinics as a supportive therapy with great advantage.

Our experience with this program corroborates the research findings of Dr. Dean Ornish and others in U.S.A. It has been observed that after attending only 10 to 12 sessions over a period of 6 weeks, a majority of the participants not only report benefit in the number of episodes of anginal pain but are also motivated to-make life-style changes, i.e. giving up smoking, alcohol and choosing low-fat vegetarian diet. Within three months their level of hostility drops remarkably.

The program is being conducted in a centrally situated, sprawling campus of a school with abundant greenery and peaceful atmosphere. The venue of the program is the prayer hall of the school with a covered roof and sides open to the green trees. We have been permitted to use this site for 2 hours twice a week for past five years without any cost. There are no stipulated fees for the program except a token payment for registration of attendance. Competent retired executives offer their services voluntarily for the program. Three books in Gujarati – vernacular language of the state – and three books in English have been published by Navajivan Publishing House, Ahmedabad, established by Mahatma Gandhi. These publications are low-priced, affordable to every section of the society. Audio and video cassettes are also priced to cover the cost. The participants of the program have not to spend the consulting fees of the medical director, cardiologist of the program prior to admission. A large majority of the participants are patients of the other consultants of the city and consult Dr. Kapadia in the clinic run by another charitable trust where just nominal fee is charged by the trust. Moreover, in this trust clinic (L.R. Cardiac Rehabilitation Center) some of the participants go through a rehabilitation program of gradually increasing exercise on a treadmill under the supervision of a competent physician. A great care is taken that the participants to the program continue with their physicians for follow-up.

The activities of the program are run under the auspices of a trust called “Universal Healing Charitable Trust”. The main aims of the trust are:

• A holistic approach accommodating all measures of drug as well as non-drug ones – conventional as well as to create mass awareness regarding coronary heart disease, and dispel unnecessary fear of the disease.
  
• To promote research and original thinking in the prevention, treatment and rehabilitation of patients with coronary disease.
  
• To simplify the treatment of coronary heart disease bearing in mind the cost effectiveness of all interventions.

All the above efforts are made with the scientific temper without prejudice to the widely accepted current methods of treatment and prevention.

We now have 24 participants who have had triple vessel disease and who would have in a normal course gone for bypass surgery, and are now rehabilitated, completely on maintenance medical therapy. They have adopted their life-style changes very willingly. In fact, they enjoy the new way of life and are full of confidence in their well-being. This has resulted in a savings of nearly Rs. 1,50,000 (approximately 5000 US dollars) per patient. The program including rehabilitation with all the guidance from the physicians, dietitians and the yoga teacher cost a meagre sum of Rs. 1,500 (approximately 50 US dollars) only.
We understand our limitations-in not having PET scan like facility for monitoring the improvement in the coronary circulation to the heart muscles or have all the investigations like 2 D echo, computerized treadmill test and lipid profiles done routinely under one roof. However, routine ECG, treadmill test, 2 D echo and lipid studios are done by participants’ physicians in the different laboratories. We maintain a regular register of attendance and try to get the forms filled up by the participants. In the summer of 1995, we analyzed the clinical records of 130 randomly selected patients and very satisfying data emerged from this study. The overall improvement in the number of anginal episodes, absence of hospital admissions during the span of 3 years and a very confident outlook on life were the striking findings. Out of twenty-five patients who were advised bypass surgery three years ago, twenty four feel so well now that they and their spouses feel that they will not require surgery at all.

We have at least 10 patients who were denied bypass surgery because of severe diffuse atherosclerosis in their coronary arteries making. CABG technically difficult to perform. We have others with ejection fraction of left ventricle reduced below 20% who were considered unfit for CABG. All these patients after being on the program for more than one year have remarkably, improved in their physical status. Their ejection fractions have gone up to 40%, they are able to lead a normal life.

Dr. Dean Ornish and others have documented several such patients of coronary heart disease who have improved through comprehensive life-style changes and in-depth stress management program like the Universal Healing Program.

We wish to highlight the fact that programs like the universal healing empowers the participants to make necessary life-style changes and increase their inner strength to face the vicissitudes of life. Our emphasis is on spiritual gain which automatically results in physical improvement. The spiritual gain is difficult to quantify.

One of the participants observes that now he is able to put up with his quarrelsome nagging wife. Another says he is able to cope with the irritable temperament of his boss better and is much less upset than before. Another observes that he is now less rigid in his views – he has become somewhat flexible. One executive remarks that his subordinates see a great change in his behaviour; he is more friendly and compassionate with them than before.

Some observe that they do not miss tobacco and do not crave for alcohol. They enjoy low-fat vegetarian food. Some say that they sleep without taking sleeping pills... and so on. All these participants admit of having less anginal pains than before. Their consumption of sublingual nitrates has decreased considerably.

Some of the participants of the Universal Healing program take part in cardiac rehabilitation program at L. R. (initials of the donor of the center) Cardiac Rehabilitation Center which is in operation since 1988. One cardiologist is in charge of the center. Dr. Kapadia and two other senior cardiologists of the city attend the center twice a week each. The center provides comprehensive cardiac rehabilitation with ECG monitored treadmill or bicycle ergometer exercise, dietary counselling, psycho-social counselling, patient education, and group discussion all under one roof. After explaining the pros and cons of various therapeutic modalities, if they are willing, we enroll patients of stable angina NYHA I to III, post MI patients, post CABG, post angioplasty patients having no contraindications to the treatment. The initial evaluation of every patient on entry includes the following

• Detailed history and physical examination, resting ECG.
  
• Symptom limited maximal treadmill test, with usual medicines continued.
  
• Laboratory investigations like lipid profiles, fasting and post-prandial blood sugar, haemoglobin, urea, creatinine, complete urine analysis.
  
• Assessment of risk factor score based on Framingham study.
  
• 2-D echo cardiogram and coronary aniogram wherever indicated and feasible, considering the economic condition of the patient.
  
• Assessment of psycho-social status.

Patients are given ECG monitored exercise of twenty-five minutes duration (along with 3 minutes of warming up and cooling down exercise) on alternate day on a treadmill beginning at 60% of the maximum heart rate achieved on entry TMT and gradually increasing the intensity of the exercise (by increasing the speed and/or elevation) as physical conditioning occurs. On an average the patients do 40 sessions by which time they usually acquire optimum fitness and benefit from the rehabilitation program. The exercise program is supervised by the experienced staff and cardiologists. Blood pressure and pulse rate are measured before, during and after the exercise. A graph of the patient’s performance (workload in METS, pulse rate multiplied by systolic blood pressure, i.e. a double product and conditioning index) is plotted to assess the patient’s progress. The conditioning index is measured as: Exercise workload in Mets, divided by Double product.

The conditioning index has been accepted as a reliable and quantifiable indicator of tolerance achieved. It is a valuable aid in assessing the benefit achieved by the exercise training. A sample study of 25 patients in this rehabilitation program was quite impressive. There was 228% increase in conditioning index; 59% increase in exercise performance in TMT after 40 exercise sessions; 40% decrease in coronary risk factor score and 50% decrease in medications.

The disability in most patients with coronary heart disease persists even after adequate medical and surgical management. Approximately only 10% disability is attributed to irreversible cardiac tissue pathology. The remaining 90% of the disability is due to various noncardiac, more or less reversible factors. Therefore, a rehabilitation program for the patients with coronary heart disease must be comprehensive so that it provides medical management, reduce its risk factors, reverses physiological deconditioning and provides psychological counselling.

• Evaluation on exit from the program
• For each patient, a graph is plotted of exercise sessions with respect to Double Product, workload in METS and Conditioning Index.
• A follow-up exercise tolerance test using the exercise protocol on entry is carried out to evaluate the improvement achieved.
• Lipid and blood sugar levels are re-estimated.
• Risk factor score including the body weight is reassessed.

According to the maximum workload and the conditioning effect achieved, each patient is advised to carry out a home exercise prescription to maintain the conditioning effect. A monthly exercise follow up and 6-monthly exercise tolerance test are advised.
L. R. Cardiac Rehabilitation Center has so far enrolled 1320 heart patients for rehabilitation and has done 14,400 patient hours of medically supervised ECG monitored exercise.

In summer of 1995 we complied data of 113 patients (refer to detailed data) at random to study the feedback of the program. What emerged from this data was quite astonishing. In almost all the participants the fear of death vanished and all had become very compassionate, friendly and cooperative in every sphere of life. All, those who were advised CABG or angioplasty are now convinced that they do not need any such interventions. Their attending physician and their families are also happily about their clinical progress. They am able to control minor episodes of angina with abdominal breathing and overcome sleeplessness with “Shavasana” and meditation. Some observe that visualization after meditation helps them to increase their capacity to work without angina. Quite heartening information has emerged from the observations of the participants’ spouses. All of them observe that there is no special diet for their spouses and their families have adopted a new way of eating which they enjoy without any feeling of deprivation. They do not have the fear of the disease anymore. They are confident that their husbands will continue to do well and would not lag behind in their pursuits. Their husbands have become less irascible. The situations which used to irritate them before do not upset them any longer.

The most crucial part in the management of CHD is to lessen fear and apprehension. In the course of 35 years of practice, results of the conventional treatment coupled with fearless reassurance have been rewarding. In this context, Dalai Lama’s observations made during his meeting with the visiting American cardiologist of Harvard who had gone to Dharamsala to study the benefits of meditation are pertinent. The quintessence of Tibetan medicine, according to the Lama, consists of three conditions vital to the curing of any disease.

a) The doctor’s faith in himself to cure the patient
b) The patient’s faith in his doctor that he will cure him
c) The doctor’s karma – his skill and its application with love

It is important to note that Dalai Lama stresses that faith of the doctor in himself that he will be able to cure the patient as the foremost of the above three vital conditions. The oriental yogic method of healing is now established. A chain of heart reversal program centers exist in U.S.A., Canada, Australia and India.

There is little room for controversy regarding the usefulness of this approach to complement the conventional one. This approach is so vindicated that not making it a part of the conventional treatment would mean incomplete management of CHD. No less an authority than Dr. Larry Dossey, Co-Chairman, Alternative Medicine National Institute of Health Bethesda, Maryland, U. S. A., in his introductory remarks to the books on UHP has this to say:

“India, where Yoga was birthed, is now rediscovering its power to reintegrate mind, body and spirit, and to “change the flesh” in the process. This does not mean, of course, that we should abandon the conventional science, for it, too, is a powerful tool to change the body; and the beauty of UBP is that it honors both body and spirit, yoga and conventional science. The Universal Healing approach to treating heart disease is inherently nonviolent and gentle by nature. This noninvasive, nonsurgical approach has been proved not only to stop the advance of heart disease but actually reverse it.

“In my opinion, it shall lead to a form of medicine more glorious than any previously known to the human race. India should be honoured that its spiritual heritage is being illuminated in this program; and the West should be grateful that this wisdom is being shared with us.”

The frontiers of medicine are advancing. Consciousness and the spiritual inner strength of the healer, i.e. the physician and the healed are acquiring crucial importance. Scientific evidence of such a comprehensive approach is mounting. It is difficult to turn a blind eye to this development which has transformed medicine in the last decade of this century. Let us pay heed to it.

Dr. Ramesh Kapadia is an eminent cardiologist and the author of “Primer of Universal Healing” and Heart Disease: Science & Spirituality”