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Other Comments:
This is a very interesting opinion by Dr Gupta, and worthy of a more extensive treatise with additional references to support the proposed ideas. The writing style utilized, both in terms of orthography (with in-sentence capitalization) and use of colloquial phrases, such as the "rhythm of life", the "catastrophic torpedo" of "erratic lungs" etc distracts from an otherwise excellent point.
Systemic vascular resistance (viz afterload) is highly dependent on the skeletal muscle vascular resistance that is in turn a function of the resistance vessel calibre, controlled by the vessel smooth muscle (SM) tone. At rest this tone is dependent on inherent SM contractility and sympathetic nerve tone. Particularly at the onset of exercise, skeletal muscle vascular resistance is primarily regulated by local vascular control mechanisms. One of these mechanisms, the myogenic control mechanism, first described by Bayliss in 1902 is likely the most important underlying mechanism to the effect proposed in this article.
The premise of myogenic vascular tone regulation is that elevation in transmural pressure induces vascular SM contraction, whereas reduction in transmural pressure leads to relaxation of SM and a reduction in vascular resistance. The steady state degree of myogenic tone can be influenced by the transmural pressure at rest that is directly affected by the degree of skeletal muscle tone. Maintaining low "whole body muscle tension", including the use of relaxation exercises/yoga would ensure a high transmural vascular gradient at rest, permitting a potential for larger decrease in transmural gradient, and consequent arterioral dilatation at times of exertion. This in turn leads to a favorable reduction in afterload, and providing a physiological basis for the benefits observed with such interventions.
The proposed opinion is certainly interesting and I would welcome a more extensive and referenced discussion with corroborating propositions of underlying physiological mechanisms such as suggested above.
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Competing interests:
Western medicine afficionado
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References:
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Experience and credentials in the specific area of science:
Limited experience in relaxation method physiology.
- How to cite: Kakouros N .Great idea for an article[Review of the article 'Pre-Load and After-Load: Rhythm of Life, More so in Stiff Hearts ' by Gupta D].WebmedCentral 2012;3(1):WMCRW001363
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Again as a practicing clinician this topic interests me. I am intriqgued by the authors intelectual approach.