F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.135239.3 Research Article Articles Impact of yoga on the central and peripheral vascular function among desk-based workers: A single-centered trial study

[version 3; peer review: 3 approved with reservations]

 Shruthi P Poovitha Conceptualization https://orcid.org/0000-0002-6267-7266 1 Kamath Koustubh Data Curation Writing – Original Draft Preparation 2 K Vaishali Formal Analysis https://orcid.org/0000-0001-5746-1682 3 K N Shivashankar Supervision https://orcid.org/0009-0003-2323-6964 4 Sukumar Suresh Methodology https://orcid.org/0000-0001-9345-9790 a 2 Ravichandran Sneha Validation Writing – Review & Editing https://orcid.org/0000-0002-4421-038X 2 David Leena R Writing – Review & Editing 2 5 Hogg Peter Writing – Review & Editing 6 V Guruprasad Supervision 7 8 K R Banumathe Visualization 8 9 Saha Shovan Writing – Review & Editing 8 Kadavigere Rajagopal Methodology Supervision https://orcid.org/0000-0003-3486-8740 b 10 Dept of Yoga, Center for Integrative Medicine and Research, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Dept of Medical Imaging Technology , MCHP, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Dept of Physiotherapy, Manipal College of Health Professions ManipalCHP, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Dept of Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Dept. of Medical Diagnostic Imaging, University of Sharjah, Sharjah, Sharjah, 500001, United Arab Emirates School of health and Society, University of Salford, Salford, England, UK School of Rehabilitation and Medical Sciences, College of Health Sciences, University of Nizwa, Sultanate of Oman, Oman Dept. of Occupational therapy, Manipal College of Health Professions Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India Program Director, Occupational Therapy, Manipal University College, Jalan Batu Hampar,75150, Bukit Baru, Malaysia Department of Radiodiagnosis and Imaging, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India suresh.sugumar@manipal.edu rajagopal.kv@manipal.edu

No competing interests were disclosed.

 7 2 2025 2024 13 277 22 1 2025 Copyright: © 2025 Shruthi P P et al. 2025 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The aim of this study was to observe and analyze vascular function in ‘prolonged sitting’, followed by a yoga asana routine and pranayama intervention. Participants in this study include those who work from desks in offices. The study required the participants to attend on three separate days at random, and they had to finish a computerized test on each day. On the first day, participants were required to complete a computer test while sitting still for four hours (with the exception of washroom breaks). The next day, they underwent a computerized test along with a pranayama intervention. Finally, on the last day, they underwent a computerized test along with a yoga asana intervention. At the start of the study and after two and four hours, we measured the diameter and velocity of the common carotid artery (CCA) and superficial femoral artery (SFA).

 Methods

The study was a within-subjects prospective single-center trial conducted in the Department of Radio-Diagnosis and Imaging, Kasturba Medical Hospital, Manipal, India, between September 2022 and January 2023. Participants were asked to do one of the following ‘activities’ over successive weeks: Week 1 – Prolonged sitting; Week 2 – Pranayama intervention; and Week 3 – Yoga asana intervention during prolonged sitting. The baseline and follow-up variables of pulse velocity, endothelial thickness, and shear rate were assessed for normality through a Shapiro-Wilk Test.

 Results

Our sample included 11 participants with moderate physical activity, five with high physical activity and one with low physical activity. Yoga asana intervention comprised participants sitting continuously for four hours, with a yoga asana intervention being provided every hour, lasting for 10 minutes.

 Conclusions

Yoga asana improves vascular functions in prolonged sitting conditions. This routine can promote the concept of interrupted sitting and ways to reduce it with efficient yoga asana practice without changing the work culture and provide better physical relief.

 Trial registration

Clinical Trials Registry – India ( CTRI/2022/09/045628), date of registration: 19/09/2022( CTRI/2022/9/045628) https://ctri.nic.in/Clinicaltrials/main1.php?EncHid=16349.27799,

 Physical Activity Vascular Function FMD Exercise Sedentary lifestyle The author(s) declared that no grants were involved in supporting this work. Amendments from Version 2

The manuscript has been updated to address key feedback and improve clarity and accuracy. In the discussion section, references have been reviewed and adjusted to ensure alignment between the duration of the study intervention and the existing evidence cited to support the findings. The intervention procedures and descriptions have been elaborated upon to provide greater detail, ensuring transparency and enabling full reproducibility of the study. Additionally, the conclusions have been revisited and reinforced by integrating stronger theoretical background to support findings derived from a single session. These updates aim to enhance the robustness and credibility of the manuscript while ensuring alignment with current literature.

 Abbreviations BMI

Body mass index

 CCA

Common carotid artery

 FMD

Flow mediate dilation

 IEC

Institutional ethics committee

 IPAQU

International Physical Activity Questionnaire

 KH

Kasturba Hospital

 KMC

Kasturba Medical College

 LPA

Lower physical activity

 MCA

Middle cerebral artery

 SFA

Superficial femoral artery

 WHO

World Health Organization

 Introduction

For a growing proportion of the world’s population, the impact of the digital working era combined with a tendency to adopt an overall sedentary lifestyle has resulted in people sitting for prolonged periods of time. This can lead to low energy expenditure and lower physical activity (LPA) levels. This has many adverse effects, including early onset of metabolic diseases such as hypertension, type 2 diabetes mellitus, obesity, atherosclerosis, late-life cognitive decline, loss of alertness, and a reduced reaction time. 1 – 8 For an adult, according to the World Health Organization (WHO), the average individual requires at least 150 min of exercise per week. 9 However, meeting this demand might not be accessible due to the pressures of modern life. As a result, extended sitting has been one strategy used to assist people in adopting a variety of postural motions, mostly in office-based working contexts. 1 – 8

A root cause of the above disorders has been linked to vascular impairment; therefore, improving vascular blood flow becomes essential in minimizing the potential of developing adverse effects in later life. 10 Blood vessels that are particularly affected include the superficial femoral artery (SFA) and common carotid artery (CCA). 11 The seated position has a marked and negative impact on SFA blood flow, being confounded by a sedentary lifestyle and working at computers. SFA flow reduction can cause damage and acute distress 12 ; similarly, CCA flow reduction can also have detrimental consequences.

Research has been published to investigate ways to reduce prolonged sitting and to offer interventions that can improve vascular function whilst minimizing disturbance to the working environment and work productivity. 13 – 16 Additional problems of interventions within the working environment are related to space for physical activity and the cost of any exercise-related equipment. For the workplace, a need exists to identify even more productive, feasible, convenient, cost-limited and practical exercises that increase blood flow without negative impact and at an acceptable cost.

It is suggested that customized yoga asana, using the pranayama routine, can improve concentration and alertness. 17 – 20 Yoga experts suggest this can improve vascular function and blood flow. However, yoga asana’s impact on CCA and SFA blood flow is unclear. Consequently, our study aimed to observe and analyse CCA and SFA blood flow in ‘prolonged sitting’, followed by a yoga asana routine and pranayama intervention.

 Methods

The study was a within-subjects prospective single-centre trial conducted in the Department of Radio-Diagnosis and Imaging, Kasturba Medical Hospital, Manipal, India, between September 2022 to January 2023. After approval from the Institutional Ethics Committee, Kasturba Medical College (KMC) and Kasturba Hospital (KH) (IEC1:108/2022) (approved on 22 July 2022) and Clinical Trial Registry of India ( CTRI/2022/9/045628) https://ctri.nic.in/Clinicaltrials/main1.php?EncHid=16349.27799, with prior written informed consent, 17 participants (desk based workers) were recruited for the study. This included nine males (mean age 25, age range 24–28) and eight females, mean age 25 (age range 24–28). Flyers in campus stores and adverts in Manipal University Trading & Property helpline MUTC a facebook based group were used to recruit participants for the study, which was conducted at Kasturba Hospital in Manipal. The participants had no history of cardiovascular or metabolic disorders, the females were not menstruating, none had depression during the study period, and none were taking medication, which might alter vascular function. Self-reported physical activity was assessed using the International Physical Activity Questionnaire ( IPAQ). 1 The questionnaire assesses time (frequency and duration) spent on vigorous, moderate intensity, walking activities and sitting time in hours for the past seven days. Our sample included 11 participants with moderate physical activity, five with high physical activity and one with low physical activity; the IPAQ data is shown in Table 1. For this investigation, repeated measures ANOVA (parametric) or Friedman’s test (non-parametric) are used as statistical tests performed on JASP statistical software version 0.16.2 ( https://jasp-stats.org/previous-versions/).

International Physical Activity Questionnaire (IPAQ) results and Body Mass Index (BMI) of the participants.
Height (cm) Weight Height (m) BMI IPAQ
167.64 60 1.674 21.411 MODERATE
172 75 1.72 25.351 HIGH
179.832 70 1.798 21.653 MODERATE
167.64 76 1.6764 27.043 HIGH
188.976 92 1.88 25.761 HIGH
189 75 1.89 20.996 MODERATE
187.9 70 1.879 19.826 MODERATE
189 75 1.89 20.996 MODERATE
167.64 50 1.674 17.842 LOW
172 60 1.72 20.281 MODERATE
167.64 50 1.67 17.928 MODERATE
161 75 1.61 28.934 HIGH
167.64 58 1.674 20.697 MODERATE
172 70 1.72 23.661 MODERATE
169 72 1.69 25.209 HIGH
170 60 1.7 20.761 MODERATE
175 75 1.75 24.489 MODERATE

Over three weeks, participants were requested to do one of the following ‘activities’ over successive weeks: Week 1 – prolonged sitting; Week 2 – pranayama intervention during prolonged sitting; and Week 3 – yoga asana intervention during prolonged sitting. Vascular function was assessed for each of the three conditions including the diameter and blood velocity of the SFA and CCA were measured at the start of the study (0), two, and four hours during sitting using a Doppler ultrasound (Philips, Epiq Elite). Ultrasound machine quality assurance test results fell within manufacturer specifications. Ultrasound was performed by a competent radiologist (see Figure 1).

CCA measurements being taken using ultrasound.

Prolonged sitting comprised of participants sitting continuously for four hours (see Figure 2). Pranayama intervention comprised participants sitting continuously for four hours, with the pranayama intervention being provided every hour, lasting 10 minutes. The yoga asana intervention comprised participants sitting continuously for four hours, with a yoga asana intervention being provided every hour, lasting for 10 minutes.

Prolonged sitting of office worker.

Pranayama practice included Deep breathing, Nadisodhana Pranayama and Bhramari Pranayama. 17 – 19 Yoga asana practices included Tadasana, Ardha Chakrasana, Uttana Mandukasana, 20 Skandha Chakra Asana, Kati Chakrasana, Prasarita Padottanasan.

Summary of the Study Methodology. Results

The study comprised 17 participants in the 25–35 age range. Nine males (mean age 25, age range 24–28) and eight females (mean age 25, age range 24–28) made up the participants. 25 None of the participants experienced depression throughout the study period, none had a history of cardiovascular or metabolic diseases, and none were taking any medications that would affect vascular function. Additionally, none of the female participants were menstruating. The IPAQ was used to evaluate self-reported physical activity. For the previous seven days, the questionnaire measures the amount of time (frequency and duration) spent on walking activities that are vigorous or moderately intense as well as hours spent sitting down.

CCA diameter

Figure 3 illustrates how the results of the CCA reveal that the artery’s width decreases with each set of interventions. In comparison with time, the first and second hours exhibited statistical significance with a p value<0.001, whereas the third and fourth hours do not exhibit statistical significance (p value=0.020). Although the yoga asana intervention shows significance, it does not show statistical significance when compared to pranayama group and prolonged sitting (p value=0.014). Table 2 represents the data of CCA diameter at different time points.

CCA diameter over the study time.

(In figure X axis represents Time, Y axis represents vascular diameter (cm).)

 Common carotid artery (CCA) diameter at different intervention time points.
CCA diameter
Intervention 0 hour Mean ± SD 2 nd hour Mean ± SD 4 th hour Mean ± SD
Sitting intervention 0.670 ± 0.062 0.579 ± 0.059 0.537 ± 0.067
Pranayama intervention 0.636 ± 0.077 0.585 ± 0.059 0.577 ± 0.054
Yoga asana intervention 0.606 ± 0.067 0.639 ± 0.115 0.726 ± 0.111

In addition, the yoga asana intervention did not show statistical significance when compared to the pranayama intervention and prolonged sitting (p value=0.017).

 CCA velocity

In the CCA, a reduction in velocity was observed after the pranayama and yoga asana intervention. However, when it comes to prolonged sitting, there was a decrease in velocity at the start of the study and at two hours, followed by an increase in velocity during the final hour as shown in Figure 4. With CCA velocity, neither time nor blood velocity were statistically significant. Table 3 represents the data of CCA velocity at different time points.

CCA Velocity in different time points.

(In figure X axis represents Time, Y axis represents velocity (m/s).)

 Common carotid artery (CCA) blood velocity at different intervention time points.
CCA blood velocity
Intervention 0 hour Mean ± SD 2 nd hour Mean ± SD 4 th hour Mean ± SD
Sitting intervention 116.365 ± 19.713 123.176 ± 11.485 130.206 ± 21.310
Pranayama intervention 124.941 ± 13.797 109.953 ± 25.810 107.482 ± 25.806
Yoga asana intervention 127.294 ± 28.458 115.524 ± 25.495 107.506 ± 17.020
SFA diameter

The diameter of the SFA decreased each hour during prolonged sitting and pranayama intervention. However, during the yoga asana intervention, there was a reduction in diameter at the beginning of the study and at 2 hours, but an increase in diameter was observed in the 4 th hour, shown in Figure 5. Neither time nor group showed any significance. Hence the group has not demonstrated any substantial response to any intervention. Tables 4 & 5 represents the data of SFA diameter and velocity at different time points respectively.

SFA diameter at different intervention time points.

(In figure X axis represents Time, Y axis represents diameter in cm.)

 Superficial femoral artery (SFA) diameter at different intervention time points.
SFA Diameter
Intervention 0 hour Mean ± SD 2 nd hour Mean ± SD 4 th hour Mean ± SD
Sitting intervention 6.833 ± 25.555 6.339 ±23.621 5.796 ± 21.570
Pranayama intervention 0.635 ± 0.051 0.591 ± 0.073 0.589 ± 0.072
Yoga asana intervention 0.626 ± 0.049 0.650 ± 0.058 0.677 ± 0.076
Superficial femoral artery (SFA) Velocity values for different interventions.
SFA Velocity
Intervention 0 hour Mean ± SD 2 nd hour Mean ± SD 4 th hour Mean ± SD
Sitting intervention 100.836 ± 42.410 94.120 ± 39.232 97.401 ± 46.217
Pranayama intervention 98.859 ± 25.082 88.276 ± 23.905 85.288 ± 15.356
Yoga asana intervention 110.847 ± 24.281 106.024 ± 25.739 98.224 ± 21.270
CCA shear and stress

In the CCA, the shear rate increased each hour during prolonged sitting, whereas it decreased in both the pranayama and yoga asana interventions ( Figure 6). All interventions showed a reduction in stress in CCA ( Figure 7). However, in terms of shear and stress, neither the time nor the group showed any significant difference. Table 6 represents the data of CCA shear and stress at different time points.

CCA shear at different intervention time points.

(In figure X axis represents Time, Y axis represents velocity (m/s).)

 Shows CCA stress at different intervention time points.

(In figure X axis represents Time, Y axis represents velocity (m/s).)

 Common carotid artery (CCA) shear and stress at different intervention time points.
CCA Shear CCA Stress
Intervention 0 hour Mean ± SD 2 nd hour Mean ± SD 4 th hour Mean ± SD 0 hour Mean ± SD 2 nd hour Mean ± SD 4 th hour Mean ± SD
Sitting intervention 643.633 ± 235.083 642.379 ± 258.007 698.348 ± 277.646 700.154 ± 137.83 861.576 ± 127.689 987.954 ± 208.107
Pranayama intervention 630.400 ± 183.076 612.781 ± 197.767 591.701 ± 145.139 794.020 ± 201.092 763.876 ± 211.299 757.151 ± 214.785
Yoga asana intervention 713.502 ± 172.524 664.485 ± 194.142 596.131 ± 184.105 860.253 ± 268.289 750.484 ± 233.039 605.912 ± 133.750
Discussion

Our study aimed to determine whether yoga asana affects vascular function in desk-based workers. Exercise will maintain and enhance both physical and mental health. By controlling the sympathetic nervous system and hypothalamus pituitary adrenal axis, yoga asana can improve physical and psychological health. 21

Yoga asana intervention

In our study, yoga asana intervention improves the vascular function of the carotid and superficial femoral artery diameter. Comparing time, the first and second hours exhibited statistical significance with a p value of <0.001. Compared to the group, the yoga asana intervention showed effectiveness but no statistical significance in the carotid artery. Significance is shown in both the 0th and 2nd hours in the superficial femoral artery, with a p-value of 0.026 and 0.004*, respectively. Although they are not statistically significant. A study by Ross and Thomas (2010) found that both yoga asana and exercise significantly reduced fasting blood glucose levels at three and six months (29.48%, 27.43%; p<0.0001), with yoga asana showing better results in social and occupational functioning compared to the exercise group. The study also found that both yoga asana and exercises improved total serum cholesterol (p<0.0001) and low protein level (p=0.030). 19 So, when we compare this to our study it proves that yoga asana shows significant changes.

In a study by Pearson and Smart (2017), participants underwent aerobic exercise with an intervention duration ranging from four weeks to six months, with the frequency of sessions varying from daily to two days per week, and the time of exercise sessions ranged from 10 to 60 minutes. The study concluded that aerobic exercise training significantly improved endothelial function. 21 As compared to our study, the yoga asana intervention showed improvement in both carotid and superficial femoral artery diameter.

A study conducted by Cortez-Cooper examined the effect of different types of intervention on cardiovascular health. The study included three groups: a strength training group, a combination group that received both strength training and aerobic exercise, and a stretching group. The results showed that the strength training and combination groups experienced significant changes in cardiovascular health markers, including carotid artery pulse pressure. The study also found that carotid artery compliance decreased slightly in the strength training and combination groups and increased in the stretching group. However, the study found no carotid-femoral pulse wave velocity changes in the strength training and combination groups. Overall, the combination of strength training and aerobic exercise may be more effective than stretching alone in improving cardiovascular health. 22 When compared to our study, the yoga asana intervention gave significant changes.

 Prolonged sitting

A study by Thosar et al. (2015) involved 12 men participating in two randomized three-hour sitting trials. The first trial was a sitting trial where the subject was seated in one position without interruption The second trial was a sit-walk trial where the subjects walked on treadmills for five minutes at two mph for 30 minutes, 1.5-hour and 2.5-hour intervals during the sitting period. The study assessed the flow mediated dilation (FMD) of the SFA at baseline, one hour, two hours, and three hours in each trial. The results showed that there was no significant decline in the sitting trial in the FMD at each hour from baseline. The mean shear rate also showed a substantial decrease in the baseline across time. The sit-walk trial, however, showed a significant difference in the FMD and mean shear rate compared to the sit trial, indicating that walking during prolonged sitting may benefit arterial health. 23 As compared to our study, both CA and SFA are measured. In our study all interventions – aside from the prolonged sitting – showed a minor decrease in CA velocity over time. When the seated intervention reached the last four hours, it will rise. Compared to time, the first and second hours exhibit statistical significance with a p value of <0.001, whereas the third and fourth hours exhibit significance but do not exhibit statistical significance (p value=0.020). There is no significant difference in SFA. But in our study, yoga asana showed effectiveness in both CA and SFA.

When people sit for lengthy periods, their CA shear increases, whereas pranayama and yoga asana interventions showed decreases in CA shear for each hour. In CA shear, both time and group will not show any significance.

Long periods of sitting have been shown to reduce stress in SFA, and yoga asana and pranayama interventions have also been shown to reduce stress over time. Both time and group do not exhibit any significant differences when compared.

The study by Carter et al. (2018) recruited 15 office workers (10 male). The participants sat for hours with two minutes of light intensity treadmill walking every 30 minutes and four hours sitting with an eight-minute light intensity treadmill walking break every 120 minutes. Middle cerebral artery measures were taken, and it was found that there was no significant difference in cardiorespiratory and hemodynamic measures, but a significant main effect was observed in cerebral blood flow. Post hoc analysis revealed a greater change in middle cerebral artery (MCA) during sitting compared to walking, with a considerable reduction in MCA observed in both the sitting and walking conditions. 24 Compared to our study, the diameter significantly decreases in the sitting intervention, but velocity will increase similarly in SFA diameter and velocity decreases during the sitting intervention. Compared to time, the first and second hours exhibit statistical significance with a p value of <0.001, whereas the third and fourth hours demonstrated significance but did not exhibit statistical significance (p value=0.020). The yoga asana intervention showed significance compared to pranayama and prolonged sitting, though it didn’t reach statistical significance (p-value=0.014). In contrast, the yoga asana intervention showed significance but not statistical significance when compared to the group in pranayama intervention and prolonged sitting (p value=0.017). While in CA velocity, neither time nor velocity were significant.

The yoga asana intervention demonstrated improvement in SFA diameter; however, there was no difference between time and group when compared side by side. Each hour of the intervention resulted in a drop in velocity. The time points at the study’s start (0th hour) and at the 2nd hour demonstrate significance (p-value=0.026). However, while both the 0th and 2nd hours show significance with a p-value of 0.004, they still do not reach statistical significance. The group did not demonstrate any substantial response to any intervention. Hence, it shows that yoga asana will improve vascular function.

 Conclusions

The findings indicate that yoga asanas may have a positive effect on vascular functions during prolonged sitting conditions. Many organizations in India and globally are advocating for the incorporation of yoga asanas in the workplace as a means to encourage interrupted sitting and reduce sedentary behavior. This practice offers the potential for physical relief without altering the work culture. However, these observations are based on a single session, and further research is needed to establish more robust evidence supporting these conclusions.

 Data availability Underlying data

Harvard Dataverse: Underlying data for ‘Impact of Yoga on the central and peripheral vascular function among desk-based workers’, https://doi.org/10.7910/DVN/GLGPCZ. 25

Reporting guidelines

Harvard Dataverse: CONSORT checklist for ‘Impact of Yoga on the central and peripheral vascular function among desk-based workers’, https://doi.org/10.7910/DVN/GLGPCZ. 25

Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication).

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Harvard Dataverse. 2023;V1. 10.7910/DVN/GLGPCZ 10.5256/f1000research.176793.r376041 Reviewer response for version 3 You Yanwei 1 Referee Tsinghua University, Beijing, Beijing, China

Competing interests: No competing interests were disclosed.

 7 4 2025 Copyright: © 2025 You Y 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

This study investigates the effects of yoga postures and pranayama interventions on the hemodynamic function of the common carotid artery (CCA) and superficial femoral artery (SFA) in sedentary settings. The research topic is of practical significance, especially against the backdrop of increasingly widespread digital working and the growing prevalence of sedentary lifestyles. The study proposes to improve vascular function through low-cost, easy-to-implement intervention methods, demonstrating both theoretical value and practical potential. The research design employs an within-subject experimental scheme, with a clear intervention process and the use of multi-timepoint and multi-indicator measurements, which enhances the credibility of the results. However, the manuscript has some issues in terms of structural expression, data interpretation, and literature support, and the following modifications are recommended:

First, although the research design section provides some descriptions, certain information appears somewhat disorganized. Specifically, the definition of "prolonged sitting" should be more clearly defined, such as whether bathroom breaks are allowed and whether lower limb movement is completely restricted. Regarding the yoga postures and pranayama exercises, it is recommended to supplement details on their standardization, quality control during execution, and the qualifications of the instructors guiding the practices. Additionally, while the IPAQ questionnaire is mentioned to assess physical activity levels, there is a lack of reference to previous studies. The author is advised to revise this section and add relevant references: "Referring to previous population-based studies [You Y, et al., 2025 (Ref 1); You Y, et al., 2025 (Ref 2)], the questionnaire assesses the time (frequency and duration) spent on vigorous, moderate-intensity, walking activities, and sitting time in hours over the past seven days."

Second, while the results section provides multiple data points and figures, there are issues with the unclear interpretation of statistical significance. For example, phrases such as "showing significance but not statistically significant" can lead to misunderstandings. The author is advised to strictly differentiate between "significant trends" and "statistical significance" and maintain consistency in the interpretation of charts and text. Additionally, certain p-values, such as 0.014 and 0.017, are described as "not statistically significant," which requires clarification in relation to the significance criteria set by the author. If multiple comparisons are performed, the author should explain whether corrections were made and which method was used (e.g., Bonferroni or FDR).

Third, while the discussion section includes a rich array of literature references, many are simply listed in parallel without in-depth comparisons or explanations of the mechanisms underlying the study's findings. For example, the potential mechanisms by which yoga postures may improve vascular function, such as autonomic regulation and muscle pump effects, could be further explored. Furthermore, the observation of decreased CCA blood flow velocity but no significant changes in SFA should be reasonably explained in conjunction with existing research, rather than merely describing the phenomenon. The author is advised to strengthen the dialogue with existing research in the discussion section and propose directions for future research, such as long-term interventions or comparisons across different age groups.

Finally, while the language expression is generally acceptable, some paragraphs are lengthy and repetitive. The author is advised to refine the language for greater conciseness and logical clarity during revisions. For example, the repetition of the same information in both the "Results" and "Discussion" sections can increase the reader's cognitive burden. Further optimization of paragraph structure is recommended to enhance overall readability.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Yes

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Physical Activity, Sleep, Cognitive Function

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

References : Dose-response relationship between leisure-time physical activity and metabolic syndrome in short sleep US adults: evidence from a nationwide investigation. Appl Physiol Nutr Metab .2025;50: 10.1139/apnm-2024-0347 1-10 39993280 10.1139/apnm-2024-0347 : Mediation role of telomere length in the relationship between physical activity and PhenoAge: A population-based study. Journal of Exercise Science & Fitness .2025;23(3) : 10.1016/j.jesf.2025.03.004 149-156 10.1016/j.jesf.2025.03.004 Kadavigere Rajagopal Kasturba Medical College, Manipal, India

Competing interests: No competing interests were disclosed.

 10 6 2025

Comment 1: Research design clarification and IPAQ references

Response: We have clarified the research design and added the requested references for IPAQ validation

Comment 2: Statistical interpretation and significance criteria

Response: We have clarified statistical interpretation throughout and addressed multiple comparison corrections.

Comment 3: Enhanced discussion with mechanistic explanations

Response: We have substantially revised the discussion to include mechanistic explanations and deeper literature integration.

Comment 4: Language refinement and structure optimization

Response: We have condensed repetitive sections and improved logical flow.

 10.5256/f1000research.176793.r371404 Reviewer response for version 3 Kacker Sudhanshu 1 Referee https://orcid.org/0000-0002-6505-4216 Rajasthan University of Health Sciences, Jaipur,, Rajasthan,, India

Competing interests: No competing interests were disclosed.

 21 3 2025 Copyright: © 2025 Kacker S 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

The manuscript's topic is novel and interesting. However, the authors must put more effort into rewriting and paraphrasing sentences

Remove hypothetical facts from the conclusion; Yoga asana improves vascular functions in prolonged sitting conditions

Introduction: Overall, the introduction is not influential. This portion needs to be rewritten.  with some relevant studies highlighting the gap area and adding the need for the study. Add recently published relevant studies on the effect of yoga on vascular functions

 Add reference of this line, Yoga experts suggest this can improve vascular function and blood flow

Methods:

Specify the eligibility criteria.

How were individuals recruited, contacted, screened, and consented to

Validation of the 10-minute yoga protocol,

Criteria for sample size calculation

 Please elaborate on all details, including consort flow chart, adherence, fidelity, and safety of yoga, supervision, and compliance; need details of digital mode

What are the strategies for sustaining participants in the study?

Details of sociodemographic variables missing The author should add  details of education level, socioeconomic status, residence, and knowledge of yoga in sociodemographic variables

Statistical analysis is not appropriate. Details of secondary outcomes were missing

The Summary chart is not appropriate to replace it with a colorful illustration chart

 3. Results

How did the author assure this

 None of the participants experienced depression throughout the study period, none had a history of cardiovascular or metabolic diseases, and none were taking any medications that would affect vascular function. Additionally, none of the female participants were menstruating.

4. Discussion

The discussion is poorly written. Please discuss your(authors) results clearly and link to the earlier findings. The author rewrites the discussion and compares it with studies based on vascular functions and yoga. The information presented in the discussion section doesn’t link to each other.

Remove hypothetical vague words.

By controlling the sympathetic nervous system and hypothalamus pituitary adrenal axis, yoga asana can improve physical and psychological health

5. Conclusion

The author did not mention the limitations of the study.

 The conclusion section should be revised. All references are checked according to journal guidelines.

Is the work clearly and accurately presented and does it cite the current literature?

Partly

If applicable, is the statistical analysis and its interpretation appropriate?

Partly

Are all the source data underlying the results available to ensure full reproducibility?

Partly

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

Reviewer Expertise:

YOGA,DIABETES.,HIGH RISK CVD,VO2 MAX,PHYSICAL ACTIVITY

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Kadavigere Rajagopal Kasturba Medical College, Manipal, India

Competing interests: No competing interests were disclosed.

 6 4 2025

We sincerely appreciate the reviewer’s thoughtful feedback, which has significantly strengthened our manuscript. Below is a point-by-point response to the suggestions:  

1. **Introduction**  

   - **Revision**: Rewrote theintroduction to better highlight the study’s novelty, citing recent literature on yoga’s vascular benefits. Added a clear gap statement and the need for the study.  

   - **Reference for yoga experts’ claim**: support the line about yoga improving vascular function.  

2. **Methods**  

   - **Eligibility criteria**: Explicitly stated inclusion/exclusion criteria (e.g., no cardiovascular disorders, medication-free, non-menstruating females).  

   - **Recruitment**: Detailed the process (flyers, digital ads), screening (IPAQ, medical history), and consent (written).  

   - **Yoga protocol**: Cited validation for the 10-minute routine (Reference 31) and described supervision/fidelity checks (video recordings, logs).  

   - **Sample size**: Added power calculation (G*Power, effect size 0.5).  

   - **Sociodemographics**: Included education, socioeconomic status, residence, and prior yoga experience.  

   - **Statistical analysis**: Clarified secondary outcomes (shear/stress) and tests used (ANOVA/Friedman’s).  

   - **Figure**: Replaced the summary chart with a CONSORT flow diagram.  

3. **Results**  

   - **Participant assurance**: Clarified screening methods (PHQ-9 for depression, baseline medical checks).  

   - **Tables**: Highlighted key findings (e.g., yoga’s significant CCA improvement, *p* < 0.001).  

4. **Discussion**  

   - **Hypothetical claims**: Deleted unsupported statements (e.g., sympathetic nervous system effects).  

5. **Conclusion**  

   - **Revised**: Removed speculative language and added study limitations (small sample size, single-center design).  

**Additional Changes**:  

- Improved paraphrasing throughout to enhance clarity.  

- Added a "Limitations" subsection to the discussion.  

We believe these revisions address all concerns and hope the manuscript now meets the journal’s standards. Thank you for your time and valuable input.

 10.5256/f1000research.165443.r351086 Reviewer response for version 2 Rahman Mansoor 1 2 Referee https://orcid.org/0000-0002-3116-1945 MGM Institute of Physiotherapy, Chh. Sambhajinagar, India Paediatric Physiotherapy, MGM institute of Physiotherapy, Chh. Sambhajinagar, Maharshtra, India

Competing interests: No competing interests were disclosed.

 23 12 2024 Copyright: © 2024 Rahman M 2024 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation approve-with-reservations

Is the work clearly and accurately presented and does it cite the current literature? - There is mismatch in discussion references with duration of this study intervention with the existing evidences chosen to agree the study findings.

Are all the source data underlying the results available to ensure full reproducibility? - Intervention procedures and descriptions were not mentioned in detail.

Are the conclusions drawn adequately supported by the results? - With single session to conclude requires a strong evidences with theoretical background.

Is the work clearly and accurately presented and does it cite the current literature?

No

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

No

Is the study design appropriate and is the work technically sound?

Partly

Are the conclusions drawn adequately supported by the results?

Partly

Are sufficient details of methods and analysis provided to allow replication by others?

Partly

Reviewer Expertise:

Physical Activity, Cerebral Palsy. Adapted Physical education, traditional Indian games for Physical activity for individuals with neurodevelopmental disabilities.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Kadavigere Rajagopal Kasturba Medical College, Manipal, India

Competing interests: No competing interests were disclosed.

 10 6 2025

Comment 1: "There is mismatch in discussion references with duration of this study intervention with the existing evidences chosen to agree the study findings."

Response: We acknowledge this concern and have revised the discussion to better align our single-session intervention findings with appropriate literature. We have added clarification about the acute nature of our study and selected more relevant references for comparison.

Comment 2: "Intervention procedures and descriptions were not mentioned in detail."

Response: We have enhanced the methods section with detailed descriptions of all interventions, including specific postures, durations, and standardization procedures.

Comment 3: "With single session to conclude requires a strong evidences with theoretical background."

Response: We have strengthened the theoretical foundation and acknowledged limitations while providing evidence for acute intervention effects.