Effect of yoga training on inflammatory cytokines and C-reactive protein in employees of small-scale industries
Sanjay Uddhav Shete, Anita Verma, Dattatraya Devarao Kulkarni, Ranjeet Singh Bhogal
Department of Scientific Research, Kaivalyadhama, Swami Kuvalayananda Marg, Pune, Maharashtra, India
|Date of Submission||12-Jun-2017|
|Date of Acceptance||02-Jul-2017|
|Date of Web Publication||09-Aug-2017|
Department of Scientific Research, Kaivalyadhama, Swami Kuvalayananda Marg, Lonavla, Pune - 410 403, Maharashtra
Source of Support: None, Conflict of Interest: None
Objective: The present study intends to see the effect of yoga practices on lipid profile, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and high-sensitivity-C-reactive protein (hs-CRP) among apparently healthy adults exposed to occupational hazards.
Materials and Methods: In the present study, 48 participants aged 30–58 years (41.5 ± 5.2) who were exposed to occupational hazards were randomized into two groups, that is, experimental and wait-list control. All the participants were assessed for lipid profile, IL-6, TNF-α, and hs-CRP at the baseline and after completion of 3 months of yoga training intervention. The experimental group underwent yoga training intervention for 1 h for 6 days a week for 3 months, whereas control group continued with their daily activities except yoga training. Data analysis was done using statistical software SPSS Version 20.0. Data were analyzed using paired t-tests and independent t-test.
Results: The results of within group comparison revealed highly significant changes in cholesterol (P < 0.001), high-density lipoprotein (P < 0.001), low-density lipoprotein (LDL)(P < 0.01), hs-CRP (P < 0.01), IL-6 (P < 0.001), and TNF-α (P < 0.001) in experimental group. Comparison between experimental and control group revealed significant changes in cholesterol (P < 0.01), LDL (P < 0.05), IL-6 (P < 0.01), TNF-α (P < 0.01), and hs-CRP (P < 0.01).
Conclusion: A yoga-based lifestyle intervention seems to be a highly promising alternative therapy which favorably alters inflammatory markers and metabolic risk factors.
Keywords: High-sensitivity-C-reactive protein, inflammatory markers, interleukin-6, yoga
|How to cite this article:|
Shete SU, Verma A, Kulkarni DD, Bhogal RS. Effect of yoga training on inflammatory cytokines and C-reactive protein in employees of small-scale industries. J Edu Health Promot 2017;6:76
|How to cite this URL:|
Shete SU, Verma A, Kulkarni DD, Bhogal RS. Effect of yoga training on inflammatory cytokines and C-reactive protein in employees of small-scale industries. J Edu Health Promot [serial online] 2017 [cited 2018 Feb 23];6:76. Available from: http://www.jehp.net/text.asp?2017/6/1/76/212626
| Introduction|| |
Inflammation plays a major role in the defense mechanism of the body. In chronic metabolic disorders such as diabetes mellitus (DM), hypertension, obesity, insulin resistance syndrome, and coronary artery disease  inflammation becomes an important contributing factor for disease progression. Cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) plays a major role in body's inflammatory response. These are released by adipose tissues and can initiate atherogenetic process. Further, inflammatory marker such as high-sensitivity-C-reactive protein (hs-CRP), the synthesis of which is mostly under the control of IL-6, predicts the future cardiovascular events in healthy participants. This indicates that these inflammatory markers play an important role in the initiation of atherosclerosis in healthy adults. Moreover, the elevated levels of cytokines, such as IL-6, IL-18, and TNF-α, as well as hs-CRP have been found to be associated with elevated levels of body fat and BMI.,, Even the clinically normal ranges of these markers are risk factors for cardiovascular disease in both middle aged ,,,,, and older ,,,,, people. In addition, lipid abnormalities contribute significantly toward increased risk of cardiovascular disease and morbidity in patients with diabetes. It has been demonstrated in previous studies that higher levels of serum cholesterol, triglycerides, low-density lipoprotein (LDL), very low density lipoprotein (VLDL), HbA1c, high-density lipoprotein (HDL), and high body mass index (BMI) are associated significantly with coronary heart disease.,,,,Nevertheless, it is evident that the physical activity or exercise plays an important role in inflammation. Earlier studies showed that the treatments, such as weight loss and exercise, which are used to improve glucose metabolism,,, can also decrease inflammatory markers. It has been found that dietary-induced weight loss results in decrease of CRP, IL-6, and TNF-α concentration in obese women.,,, More active individuals involved in regular exercise have lower concentrations of IL-6 and CRP. Further, it has been observed that physical exercise decreases several markers of inflammation., The research findings reveal that inflammatory markers are associated with several metabolic disorders and regular physical activity can prevent the risk of developing these disorders in healthy adults.
The past studies have demonstrated positive effect of physical exercise on IL-6, hs-CRP, and body composition. Physical exercise significantly improves lean muscle mass, BMI, fitness, resting heart rate, systolic blood pressure, and triglycerides to produce benefits in the management of obesity in adolescents. DM and chronic inflammation are strongly related to increased cardiovascular risk. Physical exercise in patients with diabetes improves metabolic profile and exerts anti-inflammatory effects, that is, reduction in IL-6, hs-CRP, and TNF-α without weight loss. Increased serum levels of inflammatory mediators have been associated with numerous disorders such as atherosclerosis, Type II diabetes, hypertension, depression, and overall mortality, but intervention of aerobic exercise training can significantly reduce inflammatory mediators. Thus, it can be considered that the interventions that would help to reduce inflammatory markers could contribute to the prevention of various metabolic disorders and future cardiovascular events. Yogic literature and yogic research amply indicate the utility of yoga practices for achieving a holistic health. Yoga practice has substantial health benefits due to its ability to reduce inflammatory responses. More so, yoga practices can be helpful to people of all ages, even to the persons of weak psychophysiological constitution. Hence, perceiving this aspect, it has been considered that ancient Indian traditional yoga practice might be helpful in reducing inflammatory markers such as IL-6, TNF-α, and hs-CRP. However, there is dearth of research studies exploring the effect of yoga practice on inflammatory markers in industrial workers exposed to occupational hazards. Therefore, the objective of this study was to assess the effect of yoga practices on inflammatory markers and hs-CRP among apparently healthy adults exposed to occupational hazards in small-scale industries of India.
| Materials and Methods|| |
This study considered parallel group design where two groups (experimental group and wait-list control group) were formed. The participants of both the groups were randomly divided considering Fisher's random table method.
Setting and participants
This was a 3-month parallel group study conducted in apparently healthy male adults aged 30–58 years (41.5 ± 5.2) at Kaivalyadhama Yoga Institute, Lonavla. The study protocol was approved by the Institutional Research Advisory Board and Institutional Ethics Committee, Kaivalyadhama, Lonavla, Pune. The Institutional Ethical Clearance number is kdham/SRD/RAC/IEC-03/2013.
The employees from an industrial estate located at Lonavla city were briefed about the study and were invited to participate. These study participants were at high risk of occupational hazards as they worked in factories manufacturing paint, chemical, steel, etc. The participants were initially screened through telephone interviews and personal visits for major eligibility criteria. Prospective study participants were screened for major health problems along with the past medical history, physical examination, and blood pressure to exclude serious underlying medical illnesses and to ensure the safety of participants while undergoing yoga intervention. The participants were excluded due to any of the following health problems: uncontrolled hypertension, insulin-dependent diabetes, kidney failure, lung disease, smoking, alcoholism, and heart disease. The participants who practiced yoga regularly or had participated in yoga class in the past 3 months were also excluded from the study. Written informed consent was obtained from all the participants participating in this study.
The recruitment and retention process for this study is illustrated in [Figure 1]. Out of sixty study participants, 48 participants fulfilled inclusion criteria for this study. The baseline clinical characteristics of study participants are presented in [Table 1]. The participants were randomized to one of the two groups, that is, experimental and wait-list control by employing Fisher's random number table. Initially, there were 24 study participants in each experimental and wait-list control group. However, one study participant of experimental group and two study participants of wait-list control group did not undergo pretesting of selected parameters. The participants of wait-list control group were informed that they can enroll in yoga class after the completion of 3-month study duration at no cost to ensure acceptance of the protocol. However, after the completion of 3-month yoga intervention, there were 19 and 18 participants in the experimental and wait-list control group, respectively, due to 11 dropouts. Dropouts were due to various reasons such as absenteeism, scarcity of time, lack of interest, and acute illnesses.
|Figure 1: Flow chart illustrating recruitment, enrollment, allocation, drop-outs, and data analysis of the research study|
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Yoga training was conducted by a certified yoga teacher from Kaivalyadhama Yoga Institute. The yoga training protocol was based on the principles of classical yoga. Experimental group was given selected yoga practices for 6 days a week for 3 months at the ground provided by the industrial estate at Lonavla. Each yoga session comprised 1 h of yoga training from 5.30 to 6.30 pm which included warm up, asanas, and pranayama [Table 2]. The yoga training duration was divided into three stages, that is, an adaptation stage with no maintenance time in asanas and pranayama without kumbhaka (3 weeks), a gradual advancement in yoga practice (6 weeks), and continuation stage (3 weeks). This division of yoga training program helped the participants to gradually adapt yoga practices. However, they were instructed to maintain each posture according to their comfort throughout the yoga training. As well, they were asked to practice pranayama gradually in an experiential way.
Overnight fasting venous blood sample (5 mL) was collected in Vacutainer from the antecubital vein of the arm. The collected blood samples were centrifuged at 1500 ×g for 20 min and the separated serum was stored frozen at −40°C until assayed. Serum cholesterol, triglyceride, and HDL were measured using clinical chemistry analyzer (Vector, Vchem) using enzymatic techniques, whereas LDL and VLDL were determined using Friedewald's equation. Serum IL-6, TNF-α, and hs-CRP were assessed using commercially available solid-phase sandwich ELISAs (Diaclone SAS; France and Diagnostics Biochem, Canada Inc.) on an ELISA plate reader (Bio-Rad 680, Bio-Rad PW 40, USA). The intra-assay coefficient of variation for IL-6, TNF-α, and hs-CRP was 4.2%, 3.3%, and 9.5%, whereas interassay coefficient of variation was 7.7%, 9.0%, and 9.0%, respectively.
Data analysis was done using statistical software (IBM SPSS, Statistical Package for the Social Sciences, Version 20.0). Data were analyzed using paired t-tests, independent t-test, and descriptive statistical method. The mean values ± standard deviation of pre- and post-variables are presented in [Table 3].
|Table 3: Pre- and post-test values of selected variables after 12 weeks of yoga training|
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| Results|| |
This study included 48 Indian healthy male adults aged 30–58 years (41.5 ± 5.2). No significant differences in all parameters were observed between experimental and wait-list control group at the baseline [Table 1]. Changes in lipoproteins and inflammatory markers before and after 12 weeks of yoga training are summarized in [Table 3].
The results of within group comparison revealed highly significant changes in cholesterol (P < 0.001), HDL (P < 0.001), LDL (P < 0.01), hs-CRP (P < 0.01), IL-6 (P < 0.001), and TNF-α (P < 0.001), whereas no significant improvement was observed in triglyceride (P = 0.17) and VLDL (P = 0.17) in experimental group. The results of within group comparison in wait-list control group revealed no statistically significant change in triglyceride (P = 0.23), HDL (P = 0.89), hs-CRP (P = 0.79), IL-6 (P = 0.71), and TNF-α (P = 0.15), however, significant change was observed in cholesterol (P < 0.05) and LDL (P < 0.05).
Further, comparison between experimental and wait-list control group revealed significant changes in cholesterol (P < 0.01), LDL (P < 0.05), IL-6 (P < 0.01), and TNF-α (P < 0.01). Although statistically nonsignificant, a decrease was observed in triglyceride (P = 0.16), HDL (P = 0.83), VLDL (P = 0.16), and hs-CRP (P = 0.13).
| Discussion|| |
This 3-month yoga training intervention in adults of average health exposed to occupational hazards demonstrated significant improvement in inflammatory markers such as IL-6, TNF-α, and hs-CRP. Further, improvement in lipoproteins was also observed.
In the present study, the participants were employees of small-scale industries who were exposed to various occupational hazards as they worked in paint, chemical, and steel manufacturing industries.,,, The level of inflammatory markers, lipoproteins, and hs-CRP in industrial workers increases due to prolonged stress. Further, previous studies ,, showed that occupational hazards are associated with various health problems such as cardiovascular diseases,, hypertension,, respiratory disorders,, and metabolic disorders such as diabetes and obesity., According to a recent study, pro-inflammatory cytokines IL-8 and TNF-α are significantly associated with respiratory symptoms in hazardous waste workers of Karnataka.
The past research studies have demonstrated that weight loss, physical activity, and lifestyle changes can lower pro-inflammatory markers, lipoproteins, and hs-CRP levels.,, In this context, Indian traditional yoga practices were found to be beneficial in protecting an individual against inflammatory diseases by favorably altering inflammatory markers and metabolic risk factors.,
Previous research studies showed positive effects of yoga-based lifestyle modification in combating stress and reducing inflammation., In the present study, 3 months of traditional yoga practices showed significant reduction in inflammatory markers and hs-CRP, which is consistent with previous research findings.,, Yoga training intervention in the present study comprised asanas and pranayama which might have resulted in lowering stress levels, and hence caused a decrease in systemic inflammation. However, despite the apparent beneficial effects of yoga for reduction in inflammatory markers and hs-CRP, systematic and rigorous studies based on the effects of yoga on anthropometric, physiological and psychological variables in industrial workers with occupational hazards are quite meager in India. Interpretation of the current study is limited by selection bias, small sample size, lack of adjustment for baseline anthropometric characteristics, lifestyle factors, multiple intervention exposure, and methodological limitations. Furthermore, undefined age range and significant dropout rate are important limitations of the present study. Other well-established risk factors such as alcohol intake, parental history of diseases, and levels of physical activity were not included in this study.
Specifically, high quality, rigorous, and randomized controlled trials are needed to clarify and further elucidate the effects of yoga-based lifestyle intervention in industrial workers exposed to occupational hazards, especially in India and other Eastern populations that remain underrepresented in the current research study.
| Conclusion|| |
A yoga-based lifestyle intervention seems to be a highly promising alternative therapy which favorably alters inflammatory markers and metabolic risk factors. It also helps in the management of chronic diseases caused due to occupational hazards as it is cost-effective and easy to follow with good compliance. Thus, the efficacy of yoga-based lifestyle program is multifaceted and is achieved through reduction in weight, occupation-related inflammation, and stress, thereby, is helpful in reducing several associated chronic diseases.
The authors are thankful to Swami Maheshananda (Director of Research, Kaivalyadhama), Shri O. P. Tiwari (Secretary, Kaivalyadhama), and Shri Subodh Tiwari (Chief Executive Officer) for giving an opportunity to work at SRD, Kaivalyadhama.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001;286:327-34.
Navale AM, Paranjape AN. Role of inflammation in development of diabetic complications and commonly used inflammatory markers with respect to diabetic complications. Int J Pharm Pharm Sci 2013;5:1-5.
Barzilay JI, Abraham L, Heckbert SR, Cushman M, Kuller LH, Resnick HE, et al.
The relation of markers of inflammation to the development of glucose disorders in the elderly: The Cardiovascular Health Study. Diabetes 2001;50:2384-9.
Duncan BB, Schmidt MI, Pankow JS, Ballantyne CM, Couper D, Vigo A, et al.
Low-grade systemic inflammation and the development of type 2 diabetes: The atherosclerosis risk in communities study. Diabetes 2003;52:1799-805.
Rathore S, Sarkar P, Verma M, Bidwai A. Role of high sensitivity C reactive protein and interleukin-6 in cardiovascular disease. Int J Res Med Sci 2014;2:4.
Jang Y, Lincoff AM, Plow EF, Topol EJ. Cell adhesion molecules in coronary artery disease. J Am Coll Cardiol 1994;24:1591-601.
Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990;265:621-36.
Ridker PM. Novel risk factors and markers for coronary disease. Adv Intern Med 2000;45:391-418.
Mohamed-Ali V, Goodrick S, Rawesh A, Katz DR, Miles JM, Yudkin JS, et al.
Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo
. J Clin Endocrinol Metab 1997;82:4196-200.
Bastard JP, Jardel C, Bruckert E, Blondy P, Capeau J, Laville M, et al.
Elevated levels of interleukin 6 are reduced in serum and subcutaneous adipose tissue of obese women after weight loss. J Clin Endocrinol Metab 2000;85:3338-42.
Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999;19:972-8.
Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997;336:973-9.
Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA, Goldman S, et al.
Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1998;98:839-44.
Rost NS, Wolf PA, Kase CS, Kelly-Hayes M, Silbershatz H, Massaro JM, et al.
Plasma concentration of C-reactive protein and risk of ischemic stroke and transient ischemic attack: the Framingham study. Stroke 2001;32:2575-9.
Pradhan AD, Manson JE, Rossouw JE, Siscovick DS, Mouton CP, Rifai N, et al.
Inflammatory biomarkers, hormone replacement therapy, and incident coronary heart disease: prospective analysis from the Women's Health Initiative observational study. JAMA 2002;288:980-7.
Pai JK, Pischon T, Ma J, Manson JE, Hankinson SE, Joshipura K, et al.
Inflammatory markers and the risk of coronary heart disease in men and women. N Engl J Med 2004;351:2599-610.
Ridker PM. High-sensitivity C-reactive protein, inflammation, and cardiovascular risk: from concept to clinical practice to clinical benefit. Am Heart J 2004;148 1 Suppl:S19-26.
Tracy RP, Psaty BM, Macy E, Bovill EG, Cushman M, Cornell ES, et al.
Lifetime smoking exposure affects the association of C-reactive protein with cardiovascular disease risk factors and subclinical disease in healthy elderly subjects. Arterioscler Thromb Vasc Biol 1997;17:2167-76.
Strandberg TE, Tilvis RS. C-reactive protein, cardiovascular risk factors, and mortality in a prospective study in the elderly. Arterioscler Thromb Vasc Biol 2000;20:1057-60.
Gussekloo J, Schaap MC, Frölich M, Blauw GJ, Westendorp RG. C-reactive protein is a strong but nonspecific risk factor of fatal stroke in elderly persons. Arterioscler Thromb Vasc Biol 2000;20:1047-51.
Cesari M, Penninx BW, Newman AB, Kritchevsky SB, Nicklas BJ, Sutton-Tyrrell K, et al.
Inflammatory markers and onset of cardiovascular events: results from the Health ABC study. Circulation 2003;108:2317-22.
Tice JA, Browner W, Tracy RP, Cummings SR. The relation of C-reactive protein levels to total and cardiovascular mortality in older U.S. women. Am J Med 2003;114:199-205.
Cao JJ, Thach C, Manolio TA, Psaty BM, Kuller LH, Chaves PH, et al.
C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly: the Cardiovascular Health Study. Circulation 2003;108:166-70.
George P, Ludvik B. Lipids and diabetes. J Clin Basic Cardiol 2000;3:159-62.
Shepal AV, Shete SU. Effect of yoga on bio- markers linked with development of diabetes complications in type 2 diabetes patients: A preliminary study. Int J Recent Sci Res 2013;4:401-4.
Shete SU, Kulkarni DD, Thakur GS. Effect of yoga practices on HS-CRP in Indian railway engine drivers of metropolis. Recent Res Sci Technol 2012;4:30-3.
McEneny J, O'Kane MJ, Moles KW, McMaster C, McMaster D, Mercer C, et al.
Very low density lipoprotein subfractions in Type II diabetes mellitus: alterations in composition and susceptibility to oxidation. Diabetologia 2000;43:485-93.
Loh KC, Thai AC, Lui KF, Ng WY. High prevalence of dyslipidaemia despite adequate glycaemic control in patients with diabetes. Ann Acad Med Singapore 1996;25:228-32.
O'Keefe JH, Bell DS. Postprandial hyperglycemia/hyperlipidemia (postprandial dysmetabolism) is a cardiovascular risk factor. Am J Cardiol 2007;100:899-904.
Kiecolt-Glaser JK, Christian L, Preston H, Houts CR, Malarkey WB, Emery CF, et al.
Stress, inflammation, and yoga practice. Psychosom Med 2010;72:113-21.
Goodpaster BH, Kelley DE, Wing RR, Meier A, Thaete FL. Effects of weight loss on regional fat distribution and insulin sensitivity in obesity. Diabetes 1999;48:839-47.
Janssen I, Fortier A, Hudson R, Ross R. Effects of an energy-restrictive diet with or without exercise on abdominal fat, intermuscular fat, and metabolic risk factors in obese women. Diabetes Care 2002;25:431-8.
Ryan AS, Nicklas BJ, Berman DM, Dennis KE. Dietary restriction and walking reduce fat deposition in the midthigh in obese older women. Am J Clin Nutr 2000;72:708-13.
Bastard JP, Jardel C, Bruckert E, Vidal H, Hainque B. Variations in plasma soluble tumour necrosis factor receptors after diet-induced weight loss in obesity. Diabetes Obes Metab 2000;2:323-5.
Heilbronn LK, Noakes M, Clifton PM. Energy restriction and weight loss on very-low-fat diets reduce C-reactive protein concentrations in obese, healthy women. Arterioscler Thromb Vasc Biol 2001;21:968-70.
Tchernof A, Nolan A, Sites CK, Ades PA, Poehlman ET. Weight loss reduces C-reactive protein levels in obese postmenopausal women. Circulation 2002;105:564-9.
Abramson JL, Vaccarino V. Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults. Arch Intern Med 2002;162:1286-92.
Mattusch F, Dufaux B, Heine O, Mertens I, Rost R. Reduction of the plasma concentration of C-reactive protein following nine months of endurance training. Int J Sports Med 2000;21:21-4.
Tsukui S, Kanda T, Nara M, Nishino M, Kondo T, Kobayashi I. Moderate-intensity regular exercise decreases serum tumor necrosis factor-alpha and HbA1c levels in healthy women. Int J Obes Relat Metab Disord 2000;24:1207-11.
Donges CE, Duffield R, Drinkwater EJ. Effects of resistance or aerobic exercise training on interleukin-6, C-reactive protein, and body composition. Med Sci Sports Exerc 2010;42:304-13.
Wong PC, Chia MY, Tsou IY, Wansaicheong GK, Tan B, Wang JC, et al.
Effects of a 12-week exercise training programme on aerobic fitness, body composition, blood lipids and C-reactive protein in adolescents with obesity. Ann Acad Med Singapore 2008;37:286-93.
Kadoglou NP, Iliadis F, Angelopoulou N, Perrea D, Ampatzidis G, Liapis CD, et al.
The anti-inflammatory effects of exercise training in patients with type 2 diabetes mellitus. Eur J Cardiovasc Prev Rehabil 2007;14:837-43.
Kohut ML, McCann DA, Russell DW, Konopka DN, Cunnick JE, Franke WD, et al.
Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors in older adults. Brain Behav Immun 2006;20:201-9.
Kuvalayananda S. Asanas. Lonavla: Kaivalyadhama S. M. Y. M. Samiti; 1993.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
de Oliveira HM, Dagostim GP, da Silva AM, Tavares P, da Rosa LA, de Andrade VM. Occupational risk assessment of paint industry workers. Indian J Occup Environ Med 2011;15:52-8.
Brown LM, Moradi T, Gridley G, Plato N, Dosemeci M, Fraumeni JF Jr. Exposures in the painting trades and paint manufacturing industry and risk of cancer among men and women in Sweden. J Occup Environ Med 2002;44:258-64.
Montano D. Chemical and biological work-related risks across occupations in Europe: a review. J Occup Med Toxicol 2014;9:28.
Sorahan T, Cooke MA. Cancer mortality in a cohort of United Kingdom steel foundry workers: 1946-85. Br J Ind Med 1989;46:74-81.
Sirivarasai J, Wananukul W, Kaojarern S, Chanprasertyothin S, Thongmung N, Ratanachaiwong W, et al.
Association between inflammatory marker, environmental lead exposure, and glutathione S-transferase gene. Biomed Res Int 2013;2013:474963.
Kumar A, Shrivastava SM, Jain NK, Patel P. Identification of occupational diseases, health risk, hazard and injuries among the workers engaged in thermal power plant. Int J Res Eng Technol 2015;4:149-56.
Dhami MS, Vermon H. Occupational hazards at the work place. J Can Chiropr Assoc1985;29:141-4.
Ray MR, Roychoudhury S, Mukherjee G, Roy S, Lahiri T. Respiratory and general health impairments of workers employed in a municipal solid waste disposal at an open landfill site in Delhi. Int J Hyg Environ Health 2005;208:255-62.
Vrijkotte TG, van Doornen LJ, de Geus EJ. Work stress and metabolic and hemostatic risk factors. Psychosom Med 1999;61:796-805.
Ajani UA, Ford ES, Mokdad AH. Prevalence of high C-reactive protein in persons with serum lipid concentrations within recommended values. Clin Chem 2004;50:1618-22.
Vrijkotte TG, van Doornen LJ, de Geus EJ. Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension 2000;35:880-6.
Light KC, Turner JR, Hinderliter AL. Job strain and ambulatory work blood pressure in healthy young men and women. Hypertension 1992;20:214-8.
Kalahasthi R, Pradyuonna A, Narendran P, Raghavendra Rao RH. Evaluation of the relationship between pro-inflammatory cyto-kines and health hazards in workers Involved in hazardous Waste Sites at Karnataka, India. J Res Health Sci 2010;10:7-14.
Heldal KK, Halstensen AS, Thorn J, Eduard W, Halstensen TS. Airway inflammation in waste handlers exposed to bioaerosols assessed by induced sputum. Eur Respir J 2003;21:641-5.
Dixit PN, Kishan K, Ramaswamy C, Raghavendra Babu YP, Ashoka HG, Vinodini NA, et al
. Relative role of obesity and occupational hazards on autonomic modulation. Int J Biomed Res 2012;3:109-13.
Schulte PA, Wagner GR, Ostry A, Blanciforti LA, Cutlip RG, Krajnak KM, et al.
Work, obesity, and occupational safety and health. Am J Public Health 2007;97:428-36.
Heilbronn LK, Noakes M, Clifton PM. Energy restriction and weight loss on very-low fat diets reduce C-reactive protein concentrations in obese, healthy women. Arterioscler Thromb Vasc Biol 2001;21:881-3.
Hopps E, Canino B, Caimi G. Effects of exercise on inflammation markers in type 2 diabetic subjects. Acta Diabetol 2011;48:183-9.
Vijayaraghava A, Doreswamy V, Narasipur OS, Kunnavil R, Srinivasamurthy N. Effect of yoga practice on levels of inflammatory markers after moderate and strenuous exercise. J Clin Diagn Res 2015;9:CC08-12.
Sarvottam K, Yadav RK. Obesity-related inflammation & cardiovascular disease: efficacy of a yoga-based lifestyle intervention. Indian J Med Res 2014;139:822-34.
] [Full text]
Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, et al.
Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail 2008;14:407-13.
Madanmohan D, Thombre P, Balakumar B, Nambinarayanan TK, Thakur S, Krishnanmurthy N, et al
. Effects of yogic training on reaction time, respiratory endurance and muscle strength. Indian J Physiol Pharmacol 1993;37:350-2.
[Table 1], [Table 2], [Table 3]