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Primary Care Companion CNS Disord, February 2022;24(1):21m03064.  Original Research: Therapeutic Efficacy of Rhemercise: A Novel Mindfulness Technique in Patients With Opioid Use Disorder,

Deepam Kundal, MDa; Rajnish Raj, MDb; Rohit Garg, MDb; Maju Mathew Koola, MDc; Alex R. Zachariah, MDd; Stephen Daniel Paul, BAd; Michael Y. Baie; Ori David Florentin, BAf; and Sajoy P. Varghese, MDg,*
Biological Psychiatry Abstract no. 652. May 15, 2017 ‘Novel Complementary and Alternative Mindfulness Based Intervention (Rhemercise): Therapeutic Approach to Manage Substance Use Disorders and Posttraumatic Stress Disorder, Sajoy Varghese1, Sheena Varghese2, Anish Chackochan3, Maju Koola4, Sandeep Saini5, and Alex R Zachariah6, ‘Rhemercise’

“Therapeutic Efficacy of Rhemercise: A Novel Mindfulness Technique in Patients With Opioid Use Disorder” 
Accepted for Publication in September 2021, The Primary Care Companion to The Journal of Clinical Psychiatry
Authors: Deepam Kundal, Government Medical College, Patiala, India; Rajnish Raj, Government Medical College, Patiala, India; Rohit Garg, Government Medical College and Hospital, Patiala; 
Maju Koola Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ; Alex Zachariah, Stephen Paul; Michael Bai Prince of Wales Hospital and Community Health Services; 
Ori David Florentin; Sajoy P. Varghese VA Northern California Health Care System, m (University of California Davis). 

 Abstract:Relapse is a major challenge in substance use disorders, including opioid use disorder (OUD), particularly for people with comorbid medical conditions. The limited treatment modalities used to target these complex issues include medication and behavioral management. Rhemercise is a novel mindfulness technique used to prevent relapse in OUD. Rhemercise is a quantifiable and intentional slow-breathing technique that could increase subjective well-being, which helps to prevent relapse in OUD by reducing craving, negative affect, and visceral reactivity. The objective of this study was to assess the efficacy of rhemercise as an adjunctive therapy in patients with OUD undergoing detoxification. This was a hospital-based, open-label, prospective, and exploratory study that included 126 male inpatients admitted for detoxification of OUD. All the domains of the Subjective Well Being Inventory (general well-being–positive affect, confidence in coping, inadequate mental mastery) improved significantly among OUD patients who received rhemercise treatment compared to treatment as usual. Rhemercise promoted general well-being and positive affect and decreased the opioid withdrawal symptoms, thereby potentially reducing the overall risk for relapse. Future studies are warranted with rhemercise to validate these promising findings.
The Story of Rhemercise- A Novel Mindfulness Technique.
Dr Alex Zachariah shows a flag that is used while practising “kabaddi yoga” by drug addicts undergoing rehabilitation. Photo: Inderjeet Verma
 ‘Rhemercise’ was a word coined and described well in the book, “Let’s breathe Mindfully” .and subsequently mentioned in Dr. Sajoy P Varghese MD’s Abstract in ‘Biological Psychiatry’ in May 2017, summarizing the study by Sonam Tiwari and Dr. Saneep Saini.

Biological Psychiatry: Therapeutic Approach to Manage Substance Use Disorders and Posttraumatic Stress Disorder

Sajoy Varghese1 , Sheena Varghese2 , Anish Chackochan3 , Maju Koola4 , Sandeep Saini5 , and Alex Zachariah6 1 Jesse Brown VA Medical Center, 2 Department of Physical Therapy, RML Specialty Hospital, 3 3PASS Program, 4 Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, 5 College of Physiotherapy, Christian Medical College, Ludhiana, India, 6 National Institute of Health/National Institute of Aging Background:

Relapse is a core feature of substance use disorders (SUD). Intentional slower breathing or intentional respiratory rate variability" (IRRV) by the aid of Rhemercise (a new exercise manual) may be an effective therapeutic approach for well-being. IRRV can increase Heart Rate Variability (HRV) and that HRV is the biomarker of overall well-being. We hypothesize that increased HRV could decrease craving creating relapse prevention strategy. We hypothesize that IRRV increases HRV.

Fitness Assessment Chair Test (FACT) performed at the College of Physiotherapy, Christian Medical College, Ludhiana, Punjab, India. The research involved 15 physiotherapy students and interns 19-25. The progression of fitness was assessed using the FACT, over 3 weeks. The statistical F test, ANOVA, was used to compare the data and post hoc test, Tukey’s test, to compare the pairwise count. This small sample study showed significant changes in week 1, week 2, and week 3 readings. Results: F test (ANOVA) is used to compare the counts. Calculated Test statistics (F test) value 20.447 is more than the table value 3.220. So the difference is significant. Null Hypothesis is rejected there is significant change in week 1, week 2 and week 3 readings with respect to 10 seconds readings.

FACT is a form of Rhemercise that could increase physical well-being. We hypothesize that IRRV by YR can increase HRV and subsequently decrease craving for illicit drugs. IRRV could be a therapeutic approach to prevent relapses in people with SUD and PTSD. Keywords: YoHA Rhemercise, Substance Use Disorder, Posttraumatic Stress Disorder,
Intentional Respiratory Rate Variability, Heart Rate Variability.