To develop and validate an Integrated Yoga Module for Tennis Players

[Find the meaning and references behind the names: Vijay Kumar, Kovacs, Fernandez, Mathews, Vijay, Low, Kumar, Main]

ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 41 To develop and validate an Integrated Yoga Module for Tennis Players Tresha Rathod 1 , Vijay Kumar PS 2 , Sahana AU 3 , Kritika Rathod 4 1,2,4 Department of Ashtanga Yoga, Lakulish Yoga University, Ahmedabad, India. 3 Department of Academics, Lakulish Yoga University, Ahmedabad, India. I NTRODUCTION Tennis is one of the world-class, competitive racket sports based on physical abilities and sport-specific technical skills. The tennis sport is characterised by intermittent exercise, combination of low-intensity and high-intensity aerobic and anaerobic capabilities of motor skills involving powerful movements such as Address for correspondence: Tresha Rathod Department of Ashtanga Yoga, Lakulish Yoga University, Ahmedabad, India. E-mail: tresha 008@gmail.com Submission Date: 08/07/2021 Accepted Date: 12/08/2021 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.6.4.7 quick starts and stops running at different speeds, acceleration, deceleration, turns, changeovers, power, strength, multidirectional agility, repetitive overhead motions and explosive muscle actions during different strokes (Kovacs, 2007; Fernandez et al., 2006). Therefore, tennis players need to acquire sportspecific physiological attributes, such as power, aerobic fitness and muscle strength to reach the optimal level of match performance (Kovacs, 2006). Hence, it is essential to identify and comprehend the required physical characteristics and physiological responses, to understand the nature of the sport is crucial for developing an effective integrated yoga module for professional tennis athletes as per the physical and psychophysiological needs of a sport. Tennis is an anaerobic sport (Fox & Mathews, 1974; Kovacs, 2007) with aerobic breaks between the rallies, making athletes to perform short bursts of high- A B S T R A C T Tennis athletes need a combination of low-intensity and high-intensity aerobic and anaerobic capabilities. Sports related fatigue, injury, stress and anxiety reduce the sports performance of a player. The main objective of any sports training should be to refrain from the onset of fatigue, stress and anxiety during competition and training. Integrated Yoga has been researched extensively. It shows that yoga helps improve psychophysiological components such as aerobic and anaerobic capacities, cardiovascular fitness, while reducing fatigue, competitive stress and anxiety. Yoga also improves relaxation and mindfulness, hence, improving performance. However, a valid yoga module is unavailable for tennis sports athletes. IYM for tennis players is developed based on ancient yogic text and previous research evidence. The yoga module was presented to 30 SMEs to evaluate and validate a total number of 82 practices included in the proposed module based on a three-point scale. The content validity has been calculated b y applying Lawshe’s formula of content validity ratio (CVR). According to Lawshe’s formula, 0.33 is the critical value of CVR required for validation with 30 SMEs. Data analysis shows that out of 82 yogic practices, 41 yogic practices showed significant content validity (p<0.05). Results show that, among the 82 practices, 41 were found to be essential (CVR ≥0.33) and 41 were found to be not essential (CVR <0.33). However, the feasibility and efficacy of the Integrated Yoga Module for tennis players need to be determined by future studies. Key words: Fatigue; Overtraining; Sports Performance; Yoga for Athletes; Yoga Training

[Find the meaning and references behind the names: Max, Long, Fast, Mendez, Heart, Smith, Villanueva, Min]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 42 intensity movements with intervals of rest of lowintensity activities over approximately 2-4 hours of match play (Fernandez et al., 2006; Kovacs, 2007). The higher the game intensity, the faster will be the heart beats. The studies show that the mean HR of 20 to 30- year-old trained tennis players ranges between 140- 160 beats per minute (bpm). The mean HR of players during singles and doubles tennis competitions are 94 ± 15.6 and 164 ± 15.8 bpm, respectively. These values of mean HR correspond to 70% and 80% of HRmax. During long and fast rallies HR can increase up to 190 to 200 bpm with approximately 100% of HR max , indicating an intense activity during a play (Fernandez et al., 2006; Kovacs, 2007). Smekal et al. (2001) reported peak VO 2 values close to 50 mL/kg/min during a simulated match play, representing approximately 80% of VO 2 max. LA levels increases with increase in the activity profile during game. LA levels reported to be relatively low during actual tennis match play (8 to 2.8 mmol/L). Although, during long and intense rallies, LA levels increases up to 8 mmol/L, indicating an increased participation of glycolytic processes to supply the energy need (Fernandez et al., 2008; Mendez- Villanueva et al., 2007), with increases in rate of perceived exertion (RPE) in response to increase in the match activity (longer rallies or more strokes per rally), suggesting a correlation between RPE values and variables describing the match characteristics (Mendez-Villanueva et al., 2007). The combination of excessively long periods of intensive training load and lack of appropriate recovery period can lead to an advanced fatigue state, which negatively impacts the competitive performance of the athlete, termed as ‘Overtraining Syndrome’ (OTS) (Kuipers & Keizer 1988; Lehmann et al., 1991). The work-to-rest ratios of competitive tennis athletes’ range between 1:2 and 1:5, and fatigue has been reported to reduce the tennis-hitting accuracy significantly by 81% of the ground stroke and a 30% decrease in accuracy of service, (Davey et al., 2003; Kovacs, 2006; 2007). Fatigue reduces the running movement efficacy and the quality of movement patterns (Ferrauti et al., 2001). Fatigue has a detrimental effect on muscular functioning of an athlete. Tennis matches and training induce muscle damage as players are subjected to strenuous eccentric contractions (Ellenbecker et al., 2007) Overtraining induces a long-lasting imbalance in autonomic nervous system activity (Kuipers & Keizer 1988; Lehmann et al., 1998). In overtrained athletes, this imbalance is characterized by a predominance of the parasympathetic or the sympathetic activity, depending on the type of overtraining (Kuipers & Keizer 1988; Lehmann et al., 1998). Intrinsic dysfunctions of the hypothalamic – pituitary – adrenal axis (HPA axis) response to a stress situation have been reported in OTS-affected athletes from exerciseinduced stimulation (Meeusen et al., 2013, 2010, 2004; Lehmann et al., 1993). Repetitive strain and sprain injuries (overuse injuries) are the most common type of injuries found in the tennis player (Chandler, 1998, Kovacs, 2007). Repetitive nature of the game and speed are the main cause of overuse injuries (Chandler, 1998; 1995) where 210 km/h serves are common (Kovacs, 2007). High-intensity exercise for long durations is linked with immunosuppression, higher susceptibility to infection (Smith, 2004) microtraumas and a local inflammatory reaction in the musculature triggering changes in serum markers of inflammation (Bresciani et al., 2010; Main et al., 2010). Increased levels of oxidative stress may lead to OTS, which is also related to inflammation, resulting in an impaired antioxidant defence and a lack of expected adaptations to training (Tanskanen et al., 2010). Tennis players found to be significantly tighter in sit and reach flexibility, more flexible in dominant shoulder external rotation and nondominant shoulder external rotation, with reduced range of motion (ROM) in both hamstrings than other athletes, but an even poorer ROM in their back leg, while serving (Chandler et al., 1990). Lower back pain and injury are common complaints among elite tennis players, and this correlates with poor lower back and hamstring ROM. It is extremely important to implement a hamstring lengthening (stretching) programme from

[Find the meaning and references behind the names: Raju, Silva, Kaur, Pauline, Tracy, Ray, Reddy, Ramos, Bal, Tran, Jimenez]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 43 an early age so that the athlete will still be improving performance by using the low ready position, but will not be (counterproductively) increasing the chance of lower back or hamstring injury resulting from tight and inefficient hamstring or lower back ROM (Kovacs, 2006). Strength is required, in muscles and joints, for improving performance (ball velocity) and reducing injuries of joints, tendons, ligaments and so on. For optimum stroke execution, a desired grip strength, wrist strength, grip endurance and shoulder strength are required (Kibler et al., 1989). The sleep pattern of an individual may influence the pre-competitive stress and competitive achievements, and lack of sleep can negatively affect the competitive performance (Silva & Paiva, 2013). Plasma cortisol levels increase in response to intense and prolonged exercise (Kraemer et al., 2001; Bird & Tarpenning, 2004). Elevated cortisol levels are associated with depressed mood during overtraining periods (O’Connor et al., 1989). Athletes that enter overtraining levels report elevated depression symptoms (Morgan et al., 1987). The chronic presence of Interleukin 6 (IL-6) is linked with clinical depression and worse mood in endurance trained athletes (Cullen et al., 2017). Competitive stress is reported to increase cognitive anxiety and reduce self-confidence in tennis players, more in the losing player of the competition than the winner (Filaire et al., 2009; Schober, 2018). Yoga Intervention Yoga is a multifaceted, highly structured activity that improves critical aspects of athletic performance (Kogler, 1995). The physical part of yoga (hatha yoga) consists of several stretching and strength building postures which are known to improve strength and flexibility and also have effects on metabolic, physiological and psychological aspects of human being (Ramos-Jimenez et al., 2009). Improvement in body flexibility is one of the most apparent and quickly attainable effects of regular hatha yoga practice, since it is based on gradual stretching of muscle and connective tissue around bones and joint (Woodyard, 2011), static retention of yoga postures and movements of joints through the entire existing ROM (McCall, 2007). Several studies have been reported that regular yogic practice improves overall body flexibility (Ray et al., 1983; Pauline & Rintaugu, 2011), flexibility of the spine, lower back ROM, shoulder flexibility, and the hamstring muscles (Grabara, 2016; Tracy & Hart, 2013). Regular yoga training improves the flexibility and balance as well as whole body measures, may also enhance athletic performances that require these characteristics (Polsgrove et al., 2016; Iftekher et al., 2017) Yoga training practice also improves muscular strengths of leg and chest muscles (both sides), (Pauline & Rintaugu, 2011), upper body muscular endurance and increased trunk flexibility (Gruber, 2008), deadlift strength, (Tracy & Hart, 2013), agility (Bal & Kaur, 2009), muscular efficiency (Ray, 1986), muscular strength, cardio-respiratory endurance and reaction time (Vijayalakshmi & Surendiran, 2005; Nambinarayanan et al., 1992), enhance muscle torque (Buśko & Rychlik, 2006), increase in handgrip strength (Reddy, 2010), enhanced strength steadiness, balance and control (Hart and Tracy, 2008). From an athletic performance standpoint, yoga practice improves cardiovascular performance (Harinath et al., 2004), respiratory pressures, significant improvements in respiratory muscle strength and endurance (Mahadevan et al., 2008; Nambinarayanan et al., 1992; Raju et al., 1997 b), increases breathe holding capacity (Nambinarayanan et al., 1992) improves absolute and relative maximal oxygen uptake producing maximal work output (Tran et al., 2001; Raju et al., 1997 a; Ray et al., 2001 b). Yogic practice also improves physical performance in terms of aerobic performance, anaerobic performance, body composition and cardiovascular endurance (Ray et al., 2001 b), improve the cardiac recovery index (Muralidhara & Ranganathan, 1982), respiratory rate and energy expenditure (Ray et al., 2011).

[Find the meaning and references behind the names: Sharma, Bin, Chuang]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 44 There are studies that show yoga to improve strength, flexibility and ROM as part of injury rehabilitation or prevention. Decline in lower and upper extremity injuries have been observed due to yoga (McLean, 2009). Yoga can also significantly improve the chronic lower back pain, fatigue and pain (Chuang et al., 2012; Holtzman & Beggs, 2013). Integrated yoga intervention reduce inflammatory markers, lowers basal TNF- α and IL -6 levels and also reduces the amount of increase of TNF- α and IL -6 to a physical challenge of moderate to strenuous exercise and alters pro-inflammatory cytokine levels (Vijayaraghava et al., 2015), reduces the levels of interleukin (IL)- 1β, IL -8, and monocyte chemotactic protein -1 (MCP-1) (Twal et al., 2016), reduced perceived stress (Hartfiel et al., 2011), aids injury prevention, increases body awareness, recovery time (Sharma, 2015), and delay the onset of muscle soreness following strenuous activity (Boyle, 2004). The effect of yoga has also been linked to enhancements in mental health, including reduction in anxiety (Subramanya and Telles, 2009; Sarang & Telles, 2007), depression (McDermott et al., 2014; Woolery et al., 2004), improvement in stress and enhanced mood states (Granath et al., 2006; Streeter et al., 2010), enhanced the state of relaxation (Kulmatycki & Bukowska, 2007), motivation (Donohue et al., 2006) and enhanced mindfulness (Brisbon & Lowery, 2011; Shelov et al., 2009). Gamma amino butyric acid (GABA) levels showed improvement in response to yogic practice (Streeter et al., 2012), reduced sympathetic activity, decreased cortisol level and stress (Kamei et al., 2000) thus, shifting the equilibrium towards parasympathetic dominance (Selvamurthy et al., 1998), decreased anxiety (Streeter et al., 2010), increased relaxation including reduction in stress at cellular levels, reducing free radicals, improving oxidative stress, decreased anxiety and increasing EEG theta activity (Field et al., 2010) following yoga practice. An improvement in the antioxidant status is supportive in preventing many pathological processes caused by impaired antioxidant system of body (Bhattacharya et al., 2002; Martarelli et al., 2011; Sinha et al., 2007). Yoga improves cognitive and somatic anxiety in athletes (Kusuma & Bin, 2017), and improvements on almost every sleep measure (Khalsa, 2004). Integrated Yoga Module The modern game scenario, along with demanding tournament schedules, is highly stressful for the elite players to cope with edging competition and continuously battling for the top positions in the respective sport making the physical fitness to be of utmost importance. A foremost objective of tennis training should be to refrain from the onset of fatigue during competition and training (Kovacs, 2007). Finally, at competition phase, optimal performance demands a healthy body, and consolidation of not only the physiological elements but also the psychological, technical and tactical components (Smith, 2003). Despite of enough evidences on positive impact of yoga on physical, physiological and psychological parameters, little work has been done to integrate the yoga practices in the sports training programs and to investigate the effect of yoga intervention on sports performance, psychological health of athletes, reducing sports training overload fatigue, sports injury prevention and rehabilitation. The purpose of the proposed study is to develop and validate the integrated yoga module (IYM) for the tennis athletes by reviewing the ancient texts and scientific studies on sports demands and yoga. M ATERIALS AND M ETHODS Development of IYM for Tennis Players A customized protocol was developed, that comprised yoga practices supported by the classical texts and research evidence. The proposed IYM is based on the physiological needs and demands, psychological challenges and match activity profile of tennis players. The preliminary yoga module was comprised of 82 yoga practices. Flow chart (figure 1) shows the stepby-step process of design of the study.

[Find the meaning and references behind the names: Master]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 45 Figure 1: Flow Chart of IYM Development Process Inclusion and Exclusion Criteria Yoga experts (SMEs) with clinical experience - who have either a doctorate (PhD) or Doctor of Medicine degree in Yoga, with a minimum of 5 years’ experience or a Master’s degree in yoga (M.Sc. Yoga) or yoga therapist, with a minimum of 7 years’ experience Doctors or Doctorates with less than 5 years of experience and yoga therapist with less than 7 years of experience were excluded Validation of the IYM by experts For validation, the developed yoga module was presented to the panel of 30 subject matter experts (SMEs), who satisfied the study criteria. These experts were requested to participate in evaluation and validate the practices in the proposed module on the basis of three-point scale as follows. (i) Not essential (ii) Useful but not essential (iii) Essential Data Extraction and Analysis The data that was collected from the SMEs, sorted in a tableau, to compute the numbers of experts deemed the item as ‘essential’ (N e ), to calculate CVR of each item to check the validity, by applying Lawshe’s Formula of CVR (Lawshe, 1975). According to Lawshe’s formula, if more than half of the panellists indicate that an item is essential, then that item has the minimum content validity and the minimum CVR value (critical value of CVR) needed for validation of content against 30 SMEs is 0.33. Hence, critical value for CVR for 82 yoga practices, to evaluate the content as “valid” is CVR value equal or above 0.33 ( ≥ 0.33). Lawshe’s formula: {?}{?}{?} = {?} {?} −( {?} {?} ) {?} {?} For the current study, N = 30 (total number of SMEs included in the study) N e = Number of experts agreeing for an item “essential” {?} 2 = 30 / 2 = 15 N critical = 20 (Minimum number of experts required to agree an item “essential”) CVR critical = 0.33 (Minimum CVR value against N=30) P value = Probability of success (p ≤ 0.05) R ESULT A structured integrated yoga module for tennis players, with 82 items (yoga practices) was taken into consideration for the validation from 30 yoga experts. CVR was calculated by applying the Lawshe’s formula. It has been found that out of 82 IYM practices selected for validation, 41 practices achieved CVR value equal or above the critical value (≥ 0.33), indicating high content validity (p ≤ 0.05) (Table 1). These practices are considered to be “essential” for tennis players. Other practices achieved CVR value below 0.33 (<0.33) (Table 2), indicating low content validity and these practices were used as complimentary poses for important postures to align the body and mind. Table 1 shows the list of ‘essential’ Yoga practices that satisfied the minimum Lawsh e’s CVR value and established as ‘Valid Integrated Yoga Module for Tennis Players’ approved by 30 Yoga experts. Table 1: Valid Integrated Yoga Module for Tennis Players with CVR value ≥ 0.33 SN Item {?} {?} CVR 1. Jogging (Slow Jogging, Forward Jogging, Backward Jogging, Side Wise Jogging) 26 0.73 Step 1 • Compilation of the Literature Step 2 • Sorting the Literature Step 3 • Development of IYM Step 4 • Validation of IYM by SMEs Step 5 • Data Extraction and Analysis Step 6 • Result Step 7 • Report Writing

[Find the meaning and references behind the names: Tiger]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 46 2. Forward and Backward Bending 26 0.73 3. Side Bending 27 0.8 4. Twisting 26 0.73 5. Scandasanchalan (Shoulder Movements) 23 0.53 6. Katisanchalana (Waist Movements) 23 0.53 7. Janusanchalana (Knee Movements) 23 0.53 8. Padasanchalana (Ankle Movements) 22 0.46 9. Hands Stretch Breathing 25 0.66 10. Ankle Stretch Breathing 26 0.73 11. Tiger Breathing 20 0.33 12. Straight leg Raise Breathing 22 0.46 13. Suryanamaskar 25 0.66 14. Trikonasan 23 0.53 15. Parivritta Trikonasana 29 0.93 16. Vrikshasana 23 0.53 17. Padahastasana 22 0.46 18. Ardha kati Chakrasana 20 0.33 19. Paschimottanasana 23 0.53 20. Chakrasana 23 0.53 21. Ushtrasana 22 0.46 22. Janusheerasana 21 0.4 23. Gomukhasana 22 0.46 24. Veerabhadrasana 20 0.33 25. Bhujangasana 27 0.8 26. Dhanurasana 20 0.33 27. Naukasana 20 0.33 28. Setubandhasana 22 0.46 29. Utthanpadasana 24 0.6 30. Sarvangasana 22 0.46 31. Shavasana 25 0.66 32. Nadishuddhi Pranayama 29 0.93 33 Bhastrika 22 0.46 34 Bhramari 28 0.86 35 Yoga Nidra 22 0.46 36 IRT 22 0.46 37 QRT 20 0.33 38 DRT 26 0.73 39 Kapalbhati 26 0.73 40 Trataka 27 0.8 41 Cyclic Meditation 23 0.53 Table 2: Items with CVR value below 0.33 (< 0.33) SN Item N e CVR 1. Pawanmuktasana Kriya 19 0.26 2. Greevasanchalana (Neck Movements) 18 0.2 3. Hands in & out breathing 19 0.26 4. Dog Breathing 12 - 0.2 5. Rabbit Breathing 11 - 0.26 6. Shasankasana Breathing 15 0 7. Tadasana 16 0.06 8. Tuladharasana 9 -0.4 9. Shahmrugasana 10 -0.33 10. Shuleenasana 12 -0.2 11. Bhadrasana 15 0

[Find the meaning and references behind the names: Joshi, Shaikh, Mody, Swami]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 47 12. Ardha Matsyendrasana 19 0.26 13. Marjariasana 13 -0.13 14. Matsyasana 13 -0.13 15. Markatasana 19 0.26 16. Vakrasana 16 0.06 17. Chasasana 11 - 0.26 18. Raajkapotasana 15 0 19. Pawanamuktasana 17 0.13 20. Shasankasana 15 0 21. Hanumanasana 18 0.2 22. Garudasana 19 0.26 23. Shalabhasana 16 0.06 24. Mayurasana 14 -0.06 25. Halasana 13 -0.13 26. Sarpasana 15 0 27. Bakasana 14 -0.06 28. Koormasana 10 -0.33 29. Kukkutasana 9 -0.4 30. Matsyendrasana 10 -0.33 31. Navasana 17 0.13 32. Utthana Koormasana 11 - 0.26 33. Makrasana 19 0.26 34. Ujjayi 9 -0.4 35. Shitali 14 -0.06 36. Sheetkari 14 -0.06 37. Jal Neti 15 0 38. Sutra Neti 13 -0.13 39. Vaman Dhauti 18 0.2 40. Nauli 11 - 0.26 41. Om Meditation 19 0.26 DISCUSSION In the present study, efforts have been made to develop a valid integrated yoga module for tennis players by selecting sport-specific yoga practices. However, till date there is no previous attempt has been made on validating an IYM for tennis players that can be used as cross-training. This study was conducted in two phases: (a) developing the yoga module for tennis players and (b) experts’ validation of the module for tennis players. Thirty qualified yoga experts from Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA), Bangalore and Lakulish Yoga University (LYU), Ahmedabad, who fulfilled the study criteria, participated and contributed in the current study by providing deeper insight with their expertise and experience, into the validation phase of IYM. Sports specific training regimen utilizes specific activities to improve the specific domains of physical fitness required for the physical and physiological demands of sport. In contrast, yoga is a mindfulnessbased physical activity with a holistic approach towards mind and body, which can simultaneously enhance several specific components of fitness. Although, yogic intervention involves low intensity practices within lactate threshold, physical performance improvement is possible owing to both better economy of breathing by basal metabolism and also by improvement in cardiovascular reserve. Other factors such as psycho-physiological and better relaxation may contribute to it (Ray et al., 2011). Studies on the effect of Suryanamskara reports significant improvement in flexibility, body composition, resting pulse rate, BMI, systolic and diastolic blood pressure (Anbalagan et al., 2021; Mody, 2011), hamstring tightness (Shaikh & Moharkar, 2020), hip abductor flexibility (Regmi & Joshi, 2020), upper-body and shoulder muscular strength endurance, core stability, balance, static

[Find the meaning and references behind the names: Gupta, Brown, Biju]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 48 strength, agility and explosive leg power (Thander, 2021), cardiorespiratory fitness (Mody, 2011), stress and anxiety (Anbalagan et al., 2021). Loosening practices ( Shithilikarna Vyayama) and Sukshma Vyayamas helps in loosening the joints and reducing the stiffness, which consequently aid in improving mobility. Loosening exercises are intended to increase flexibility of joints and to prepare for the practice of yoga postures (Telles et al., 2007). Yogasanas strengthens all organs of the body and start functioning in a harmonious manner and the mind becomes tranquil (Villacres et al., 2014). The yoga asanas (body postures) help in improving balance, strength, overall flexibility of the body. Other supine and prone postures help in improving flexibility and strength and reducing the stiffness in the back, hip, and lower limb muscles, thereby aiding mobility. Pranayama slows down breathing rate and restores autonomic balance thereby calming the mind (Villacres et al., 2014). Pranayama reduces depression, anxiety, and post-traumatic stress disorder by inducing stress resilience and relaxation (Brown & Gerbarg, 2009). It promotes autonomic balance through mastery over the mind (Telles et al., 1994). Breathing exercises increases awareness of breathing, clears the lungs, corrects breathing pattern, and increases lung capacity (Kumar & Kumar, 2017). Practice of Yogasana, Pranayama and meditation reduces basal RR, HR, and resting HR and improves VO 2 max, cardiovascular and respiratory systems (Bhunia & Ray, 2020). Immediate effect of short-term practice (for 5 minutes) of Bhramari Pranayama reports significant reduction in systolic and diastolic BP, with a slight decrease in HR and induces parasympathetic dominance on cardiovascular system (Pramanik et al., 2009, 2010). Nadi-Shodhana Pranayama can rapidly modify cardiopulmonary responses and enhance the capacity to solve simple problems (Subbalakshmi & Saxena, 2005). Anulom-Vilom and Bhastrika Pranayama significantly improve the vital capacity and VO 2 max (Bal, 2010). A single session of cyclic meditation (CM) tranquils the mind and improves level of mindfulness, with heightened awareness of mind, body and breath, which further enhances the higher mental functions (Vinchurkar et al., 2014). CM significantly reduces salivary amylase and pulse rate with significant increase in blood oxygen level, of high school athletes, with improvements in stress levels, tension, anxiety, depression, dejection and confusion (Hiraoka & Gudapti, 2017). CM improves cognitive anxiety, somatic anxiety, and increases self-confidence among athletes (Biju Lona, 2020), enhances cognitive processing, attention cognition (Sarang & Telles, 2006; 2007), quality of sleep by increasing slow wave sleep (Patra & Telles, 2009). Trataka improves selective attention, response inhibition, cognitive flexibility, heart rate variability (HRV) and breathing rate, increase in vagal tone by a decrease in HR (Swathi et al., 2021). Kapalabhati promotes decarboxylation and oxidation, activation of sympathetic nervous system, enhances cognition, and improves overall metabolism (Swathi et al., 2021), improves cognitive performance and attention (Joshi & Telles, 2009) and decreases anxiety (Telles et al., 2019). Immediate effects of kapalabhati shows improvement in motor performance (Telles et al., 2014), finger dexterity (Telles et al., 2012), spatial and working memory tasks (Gupta et al., 2019). Sympathetic arousal (Telles et al., 2011), and metabolic activation (Telles et al., 2015), improvements in the cognitive tasks (Pradhan, 2013). Relaxation techniques help in reducing stress, anxiety, depression and improving the relaxation of the body and mind. (Parnabas et al., 2014). Like any other exercise protocol, an ideal yoga intervention consists of modes (types), frequencies, intensities, durations, and progression. Determining the appropriate mode depends upon the athlete preference. The frequency, intensity, an d duration are specific to the type of activity and should be customized according to the athlete’s ability to safely perform the activity. However, the module remains to be tested for feasibility.

[Find the meaning and references behind the names: Pir, Jensen, Peer, Manas, Pandey, Paz, Verma, Good]

Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 49 Strength of the Study The module was developed systematically on the grounds of scientific literature reviews and various classical yogic texts. The yoga module is consisting of multidimensional yogic elements, such as Sukshma- Vyayama, Shithilikarana Vyayama, Shat-Kriya, Asanas, Pranayama, Dharana and Dhyana and relaxation practices. Hence, the yoga module is integrative in nature rather than just focusing on any particular limb of yoga. Experts selected for the validation process were from different schools of yoga, some having been exposed to multiple schools of yoga, ensuring that the module was not confined to any one school of yoga. This type of study is useful to create awareness about yoga for athletes, sport psychology and sports related activity. For research of sports related studies, the results of this study would provide a substantial base for conducting future trials. Limitations of the Study It’s a first attempt to develop a validated yoga module for tennis players, and yogic practices, duration of practices, frequency and the order has to be tested by a randomized control trial (RCT) to prove its efficacy. All the practices do not have research proven background. Further study to investigate the feasibility of the IYM is needed. Hence, once this protocol goes for RCT can become a curtain raiser for future. CONCLUSION A comprehensive IYM for tennis players has been developed, consists of 82 practices was validated by 30 yoga experts. It is found that, among the 82 practices, 41 found to be essential (CVR ≥0.33) and 41 found to be not essential (CVR <0.33). Based on the findings from this study, the IYM for tennis players suggests good content validity. This present IYM is a valid module for tennis athletes. However, the feasibility and efficacy of the IYM must be determined by future studies. A CKNOWLEDGEMENTS Authors acknowledge Lakulish Yoga University (LYU), Ahmedabad for granting permission to carry out this work. The author is grateful to all the experts from Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University and LYU for participating in the study, and for providing their valuable suggestions and time to validate the module. REFERENCES 1 Anbalagan, P., Mahasuran, A., & Atheeskumar, P. (2021). Effects of suryanamaskar practice and resistance training programme on selected physical health and mental health components among college level men handball players. Bharathiar National Journal of Physical Education and Exercise Science (ISSN: 0976-3678) e-ISSN Applied (International Peer-Reviewed Journal) , 12 (1), 50-55. 2 Bal, B. S. (2010). Effect of anulom vilom and bhastrika pranayama on the vital capacity and maximal ventilatory volume. Journal of Physical Education and Sport Management , 1 (1), 11-15. https://doi.org/10.5897/JPESM.9000009 3 Bal, B. S., & Kaur, P. J. (2009). Effects of selected asanas in hatha yoga on agility and flexibility level. J Sport Health Res , 1 (2), 75-87. 4 Bhattacharya, S., Pandey, U. S., & Verma, N. S. (2002). Improvement in oxidative status with yogic breathing in young healthy males. Indian journal of physiology and pharmacology , 46 (3), 349 – 354. 5 Biju Lona, K. (2020). A study on effect of yoga and cyclic meditation on selected psychological variables among major games and martial arts. 6 Bird, S. P., & Tarpenning, K. M. (2004). Influence of circadian time structure on acute hormonal responses to a single bout of heavy-resistance exercise in weight-trained men. Chronobiology international , 21 (1), 131-146. https://doi.org/10.1081/CBI-120027987 7 Boyle, C. A., Sayers, S. P., Jensen, B. E., Headley, S. A., & Manos, T. M. (2004). The effects of yoga training and a single bout of yoga on delayed onset muscle soreness in the lower extremity. Journal of Strength and Conditioning Research , 18 (4), 723-729. https://doi.org/10.1519/14723.1 8 Bresciani, G., Cuevas, M. J., Garatachea, N., Molinero, O., Almar, M., De Paz, J. A., ... & González-Gallego, J. (2010). Monitoring biological and psychological measures throughout an entire season in male handball players. European Journal of Sport Science , 10 (6), 377-384. https://doi.org/10.1080/17461391003699070

[Find the meaning and references behind the names: Williams, Pal, Gopinath, Thomas, Soares, Donald, Hernandez, Edward, Rivas, Omkar, Nancy, Garcia, Junior, Prasad, Diego]

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[Find the meaning and references behind the names: Gopalakrishnan, Tum, Prakash, Bakhtiar, Balakrishnan, Rao, Rahaman, Murphy, Nagendra, Clarke]

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[Find the meaning and references behind the names: Surya, Nepal, Abdullah, Singh, Ramana, Rehab, Murthy, Venkata, Mahamood, Asia, Pace, Torres, Thakur, Med, Mishra, Munoz]

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[Find the meaning and references behind the names: Raghavendra, Souza, Tomer, Kala]

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Tresha Rathod et al. To develop and validate an Integrated Yoga Module for Tennis Players ISSN: 2456-3110 ORIGINAL ARTICLE July-Aug 2021 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2021 | Vol. 6 | Issue 4 54 autonomic activities. Indian Journal of Physiology and Pharmacology , 38 , 133-133. 101 Telles, S., Naveen, K. V., & Dash, M. (2007). Yoga reduces symptoms of distress in tsunami survivors in the Andaman Islands. Evidence-based complementary and alternative medicine , 4 (4), 503-509. https://doi.org/10.1093/ecam/nem 069 102 Telles, S., Sharma, S. K., Yadav, A., Singh, N., & Balkrishna, A. (2014). Immediate changes in muscle strength and motor speed following yoga breathing. Indian J Physiol Pharmacol , 58 (1), 22-9. 103 Telles, S., Singh, N., & Balkrishna, A. (2011). Heart rate variability changes during high frequency yoga breathingand breath awareness. BioPsychoSocial Medicine , 5 (1), 1-7. 104 Telles, S., Singh, N., & Balkrishna, A. (2012). Finger dexterity and visual discrimination following two yoga breathing practices. International Journal of Yoga , 5 (1), 37. https://dx.doi.org/10.4103%2 F 0973-6131.91710 105 Telles, S., Singh, N., & Balkrishna, A. (2015). Metabolic and ventilatory changes during and after high-frequency yoga breathing. Medical science monitor basic research , 21 , 161. https://dx.doi.org/10.12659%2 FMSMBR.894945 106 Thander, A. (2021). Comparative Effects of Suryanamaskar and Dynamic Stretching on Cricket Specific Motor Performance in Fast Bowling. https://doi.org/10.6084/m 9.figshare.JETIR 2105028 107 Tracy, B. L., & Hart, C. E. (2013). Bikram yoga training and physical fitness in healthy young adults. The Journal of Strength & Conditioning Research , 27 (3), 822-830. https://doi.org/10.1519/jsc.0 b 013 e 31825 c 340 f 108 Tran, M. D., Holly, R. G., Lashbrook, J., & Amsterdam, E. A. (2001). Effects of Hatha yoga practice on the health‐related aspects of physical fitness. Preventive cardiology , 4 (4), 165- 170. https://doi.org/10.1111/j.1520-037 x.2001.00542.x 109 Twal, W. O., Wahlquist, A. E., & Balasubramanian, S. (2016). Yogic breathing when compared to attention control reduces the levels of pro-inflammatory biomarkers in saliva: a pilot randomized controlled trial. BMC complementary and alternative medicine , 16 , 294. https://doi.org/10.1186/s 12906-016-1286-7 110 Vijayalakshmi, P., & Surendiran, A. (2005). Effect of slow and fast pranayams on reaction time and cardiorespiratory variables. Indian J Physiol Pharmacol , 49 (3), 313-318. 111 Vijayaraghava, A., Doreswamy, V., Narasipur, O. S., Kunnavil, R., & Srinivasamurthy, N. (2015). Effect of yoga practice on levels of inflammatory markers after moderate and strenuous exercise. Journal of clinical and diagnostic research: JCDR , 9 (6), CC 08. https://dx.doi.org/10.7860%2 FJCDR%2 F 2015%2 F 12851.6021 112 Villacres, M. D. C., Jagannathan, A., Nagarathna, R., & Ramakrsihna, J. (2014). Decoding the integrated approach to yoga therapy: Qualitative evidence based conceptual framework. International journal of yoga , 7 (1), 22. https://dx.doi.org/10.4103%2 F 0973-6131.123475 113 Vinchurkar, S. A., Deepeshwar, S., Visweswaraiah, N. K., & Nagendra, H. R. (2014). Immediate effects of cyclic meditation on state mindfulness in normal healthy volunteers: A controlled study. Indian Journal of Positive Psychology , 5 (4), 400-403. 114 Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International journal of yoga , 4 (2), 49. https://dx.doi.org/10.4103%2 F 0973-6131.85485 115 Woolery, A., Myers, H., Stemliebm, B., & Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies in Health & Medicine , 10 (2). ******************************* How to cite this article: Tresha Rathod, Vijay Kumar PS, Sahana AU, Kritika Rathod. To develop and validate an Integrated Yoga Module for Tennis Players. J Ayurveda Integr Med Sci 2021;4:41-54. http://dx.doi.org/10.21760/jaims.6.4.7 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2021 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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