Stress is an unavoidable part of life, and while it often carries a negative connotation, it is actually a fundamental survival mechanism. When faced with a perceived threat, whether physical or emotional, the body instinctively reacts to protect itself. This automatic response is commonly known as the "fight, flight, or freeze" response. While it serves an essential function in dangerous situations, chronic activation of this response due to daily stressors can have significant consequences for mental and physical health.

The body’s response to stress is rooted in human evolution. When our ancestors encountered a predator, their nervous systems immediately prepared them to either confront the threat (fight), escape to safety (flight), or become still and unnoticed (freeze). While modern-day stressors may not include wild animals, our nervous system reacts similarly to job pressures, financial worries, or social conflicts.

According to the Cleveland Clinic, stress is the body's response to change, activating a physiological reaction that helps us adapt and protect ourselves. While short-term stress can be beneficial, prolonged exposure can lead to an overactive stress response, negatively impacting overall well-being.

The Three Stress Responses: Fight, Flight, and Freeze

1. Fight

The fight response prepares the body for direct action. When triggered, the nervous system releases adrenaline, increasing heart rate, blood pressure, and muscle tension. While this reaction once helped early humans fend off predators, today it manifests as irritability, frustration, or aggression.

For instance, the employee who has experienced too much workload may work extremely long hours just to succeed. In short term, the action may produce good results but mostly ends in burnout, anxiety, and physical illness, for example, tension headache or digestion problems.

2. Fight

The flight response triggers an intense need to remove oneself from a stressful situation. Just as our ancestors would flee from danger, modern individuals may avoid conflict, quit jobs impulsively, or detach from relationships when overwhelmed.

Flight mode is linked with restlessness and anxiety. Individuals may have a sense of needing to get up and go-pacing, changing environments constantly, or avoiding tasks that seem too overwhelming. Someone with a flight response might have the desire to change jobs constantly, relocate constantly, or become reclusive in order to avoid perceived dangers.

3. Freeze

The freeze response occurs when the nervous system perceives a threat as too overwhelming to fight or flee. Rather than taking action, individuals shut down, feeling numb, disconnected, or paralyzed by fear.

Unlike fight or flight, which involve heightened activation, freeze mode slows down physiological functions. A person experiencing freeze mode may feel physically unable to move, struggle to make decisions, or find themselves dissociating from their emotions. This can manifest in situations such as public speaking anxiety, where someone might "blank out" or feel stuck in the moment.

What Happens in the Body During A Stressful Event?

When faced with a stressor, the autonomic nervous system (ANS) activates, triggering physiological changes, including:

• Increased heart rate and breathing: The body pumps more oxygen to muscles and the brain in case action is needed.
• Muscle tension: The body prepares for movement, sometimes causing trembling or stiffness.
• Dilated pupils: Vision sharpens to detect potential threats.
• Dry mouth: Saliva production decreases as the body redirects energy to essential functions.
• Changes in skin tone: Blood flow is directed to vital organs, sometimes making the skin appear pale or flushed.

For those experiencing the freeze response, the body undergoes a different reaction, often reducing heart rate and causing physical immobility rather than heightened activation.

Strategies for Coping and Managing the Stress Response

While the stress response is necessary for survival, frequent activation due to daily stressors can take a toll on health. Recognizing your default response—whether fight, flight, or freeze—can help in developing effective coping mechanisms.

1. Moving to a Safe Space

If possible, changing your environment can help signal to your brain that the threat has passed. Stepping outside for fresh air, finding a quiet place, or distancing yourself from overwhelming stimuli can help regulate emotions.

2. Practicing Controlled Breathing

Deep, slow breathing can be used to counteract the stress response by engaging the parasympathetic nervous system, which promotes relaxation. Techniques such as diaphragmatic breathing or the 4-7-8 method (inhale for four seconds, hold for seven, exhale for eight) can be particularly effective in calming the body.

3. Engaging in Physical Activity

This helps release pent-up energy and aids in the endorphin cascade, natural boosters for our mood.

4. Seeking Social Support

Relieving oneself from stress can come in many ways, but sharing it with trusted friends, a family member, or a good therapist will sure give that psychological boost of hope. Social support is an especially effective way of cushioning people against the stressors that they are subjected to in chronic forms.

When to Seek Professional Help

While occasional stress is normal, chronic activation of the fight, flight, or freeze response can indicate underlying mental health concerns, such as anxiety disorders or post-traumatic stress disorder (PTSD). If stress is affecting daily life—leading to sleep disturbances, difficulty concentrating, or persistent feelings of fear—it may be time to consult a mental health professional.

Knee problems were once considered an issue associated with old age. However, an increasing number of Indians in their 30s are experiencing knee pain, stiffness, and cartilage damage similar to arthritis. Doctors are reporting more cases of young adults seeking treatment for knee-related issues that can affect mobility and quality of life.

Sedentary Lifestyle And Lack of Physical Activity

One of the biggest reasons behind early knee damage is a sedentary lifestyle. Many young professionals spend long hours sitting at desks, working on computers, or using mobile devices. Lack of regular movement weakens the muscles around the knees, reducing the support they provide to the joint.

At the same time, some individuals suddenly engage in intense workouts without proper conditioning. This puts excessive stress on the knees, increasing the risk of injuries and long-term wear and tear. Maintaining a balanced exercise routine with strength training and stretching can help protect knee health.

Rising Obesity And Excess Weight

India has witnessed a rise in obesity among young adults. Excess body weight places additional pressure on the knee joints, which are responsible for supporting most of the body’s weight. Even a small increase in weight can significantly increase stress on the knees during activities such as walking, climbing stairs, or running.

Over time, this extra pressure can lead to cartilage deterioration, inflammation, and chronic pain. Maintaining a healthy weight through proper nutrition and regular exercise can reduce the risk of developing arthritis-like symptoms at an early age.

Poor Posture And Nutritional Deficiencies

Poor posture while sitting, standing, or exercising can also contribute to knee problems. Improper movement patterns may cause uneven stress on the joints, leading to gradual damage. Additionally, untreated sports injuries or ligament tears can accelerate knee degeneration if not managed properly.

Nutritional deficiencies, particularly low levels of vitamin D and calcium, are another concern. These nutrients play a vital role in maintaining strong bones and joint health. Deficiencies can weaken the musculoskeletal system and make individuals more susceptible to knee-related issues.

Steps to Protect Knee Health

Preventing early knee damage requires a combination of healthy habits. Individuals should engage in regular low-impact exercises such as walking, swimming, or cycling to strengthen the muscles around the knee. Maintaining a healthy body weight can significantly reduce pressure on the joints.

It is also important to follow an ergonomic posture while working, take frequent breaks from prolonged sitting, and avoid sudden high-intensity workouts without proper preparation. A balanced diet rich in calcium, vitamin D, protein, and anti-inflammatory foods can support bone and joint health. Most importantly, persistent knee pain should not be ignored, and timely consultation with a healthcare professional can prevent minor issues from becoming serious conditions.

Conclusion

The growing incidence of arthritis-like knee damage among Indians in their 30s is a result of multiple lifestyle factors, including inactivity, obesity, poor posture, injuries, and nutritional deficiencies. While the problem is becoming more common, it is largely preventable. Regular exercise, maintaining a healthy weight, following a balanced diet, and seeking timely medical attention can help preserve knee health and reduce the risk of long-term joint damage.

Prime Minister Narendra Modi proposed the idea of a dedicated yoga day during his address to the 69th session of the UN General Assembly in 2014. On December 11, 2014, all 193 UN member states unanimously agreed to observe the International Day of Yoga on June 21.

The primary objective of the International Day of Yoga is to raise awareness about yoga as a holistic practice for mental and physical well-being. Yoga originated in India, and it has a history of more than 5000 years. Some people regard it as a fashionable fitness, but it can be beneficial in various chronic diseases, including diabetes, hypertension, and chronic kidney disease.

The Challenges Faced by Dialysis Patients

Dialysis is a life-saving treatment for stage 5 CKD patients. It has to be done 2- 3 times/week. It has been seen that these patients become physically inactive, which leads to poorer outcomes. They also have a lot of comorbidities like hypertension and diabetes, besides stress. Over the last few years, scientific studies have shown that regular exercise in patients improves outcomes. These patients are a captive audience as they spend 8-12 hours in a dialysis unit every week.

Hence, many dialysis units have incorporated exercise into the dialysis sessions. Yoga has been purported to have multiple health benefits. Over the last few years, even Western science is starting to provide some concrete clues as to how yoga works to improve health, heal aches and pains, and keep sickness at bay.

Yoga: Benefits For Heart Health

Research studies have shown that Yoga lowers blood pressure and slows the heart rate. Two studies of people with hypertension, published in the leading scientific journal The Lancet, compared the effects of Savasana (Corpse Pose) with simply lying on a couch.

After three months, Savasana was associated with a 26-point drop in systolic blood pressure (the top number) and a 15-point drop in diastolic blood pressure (the bottom number), and the higher the initial blood pressure, the bigger the drop. A slower heart rate can benefit people with high blood pressure or heart disease, and people who've had a stroke. Yoga lowers LDL (“bad”) cholesterol and boosts HDL (“good”) cholesterol.

Yoga: Diabetes and Weight Management

In people with diabetes, yoga has been found to lower blood sugar in several ways: by lowering cortisol and adrenaline levels, encouraging weight loss, and improving sensitivity to the effects of insulin. If your blood sugar levels improve, there is a reduced risk of diabetic complications such as heart attack, kidney damage, and blindness.

Researchers have also found that people who practiced yoga for at least 30 minutes once a week for at least four years gained less weight during middle adulthood. People who were overweight actually lost weight. Overall, those who practiced yoga had a lower body mass index (BMI) compared with those who did not practice yoga. Researchers attributed this to mindfulness. Mindful eating can lead to a more positive relationship with food and eating.

Yoga also acts as a stress buster. It quells the fluctuations of the mind, according to it, slows down the mental loops of frustration, regret, anger, fear, and desire that can cause stress. And since stress is implicated in so many health problems—from migraines and insomnia to lupus, MS, eczema, high blood pressure, and heart attacks—if you learn to quiet your mind, you’ll be likely to live longer and healthier.

Yoga: Evidence For Dialysis Patients

There is a lack of good scientific data about the direct benefits of yoga in dialysis patients, but the absence of evidence does not mean evidence of absence. Some people regard it as a fashionable fitness, but it can be beneficial in various chronic diseases, including diabetes and hypertension. Diabetes and high blood pressure are among the commonest comorbidities in Dialysis patients. These patients are under great stress due to their kidney failure.

In another study, a 6-month yoga program was found to be a safe and effective measure as adjuvant therapy to conventional treatment modalities in reducing blood pressure, improving renal function, and improving QOL in these patients.

For the last 5 years, we have been celebrating World Yoga Day in our Dialysis unit and encouraging our Dialysis patients to regularly practice Yoga. Even after a kidney transplant, the better the blood pressure control, the longer the life of the transplanted kidney. Thus, there is enough indirect evidence that yoga is beneficial in patients with kidney diseases.

Yoga: Benefits for Kidney Disease Patients

However, it should be done under expert supervision. There are many other poses in yoga; you can choose those that are suitable for you under the guidance of a professional practitioner. In a word, practicing yoga can promote metabolism, blood circulation, and help discharge more metabolic wastes and toxins. It can improve endocrine functions and help repair damaged tissues.

It can strengthen physical fitness and enhance immunity. It can make the mind peaceful and ease pressure and chronic pains. They also assist in managing water retention in the body. This enables sound sleep schedules and hence better rest. A well-rested body is better able to perform functions such as regulating water in the body and stabilizing the heartbeat.

Precautions Before Practicing Yoga

Though yoga is safe, not every kidney failure patient can do all the poses. For example, if the patients have polycystic kidney disease, bending and other positions that can cause pressure on the abdomen and back should be avoided. If the patients have high blood pressure or lower back pain, leg lifts should be avoided. It is necessary to practice yoga under the guidance of a professional practitioner if you have kidney disease. Yoga asanas are known to increase relaxation.

There are many poses in yoga that are suitable for dialysis patients. Some of these could be done safely during dialysis sessions. However, special care should be taken to ensure that no arm movement on the side has an AV fistula where dialysis is taking place. For those patients who have a permacath (or permanent catheter), these restrictions are not that severe. Of these, I recommend the following, which can be done during the dialysis sessions, preferably before taking snacks and tea.

Yoga During Dialysis

1. Anulom vilom: A person needs to inhale through the left nostril and exhale through the right nostril, and then inhale through the right nostril and exhale through the left one. These alternate nostril breath exercises can promote blood circulation. All these are best done first thing in the morning

2. Kapaal Bhaarti: In this, the person exhales forcefully and then inhales passively. This is repeated a few times as per convenience, followed by a break and 3 – 5 sessions.

3. Bhastrika: In this, a person inhales deeply, followed by forceful exhalation. This is then reapted 3-5 times maximum.

4. Shavasana: In this one lies flat on the couch and is absolutely listless on the couch for a few minutes, with arms and legs lying loosely.

Yoga For Non-dialysis Days:

1. Vrikshaaasan: In this one stands straight and then places the right foot on the inner side of the left thigh, joins the hands, and raises them above the head. After a few minutes, the hands are brought down, and now the left foot is placed on the inner side of the left thigh, and the hands are joined and raised above the head.

2. Tada Asaan: In this, a person stands on his toes and stretches his arms above his head, and joins his hands. In this posture, he then breathes freely and holds as long as possible.

3. Cobra pose: In this, a person lies on his belly with hands flat on the floor on each side and inhales and extends the spine forward, lifts the chest and head off the floor. One needs to make sure that the legs and feet are parallel and hold this position for several breaths. This can help put mild pressure on the kidneys and revitalize the kidney functions.

4. Camel pose: In this asana, the person kneels on the floor, extends the spine, opens the chest, and reaches for the feet. One needs to make sure that the thighs are perpendicular to the floor and the toes are tucked. This posture can help improve blood circulation as well as the body’s circulatory system.

5. Paschimottanasana: In this asana, you bend forward and try to touch your toes.

6. Surya Namaskaar: It is one of the best Yogic aasanas as it involves a combination of 11 steps. You can see details on YouTube.

7. Kati chaakra aasan: in this one lies on the floor and stretches the hands on the sides and legs kept 3 feet apart. The head is turned to one side, and the knees are in the opposite direction

Thus, yoga keeps the internal organs healthy, balances the various systems in the body, and effectively controls the stress of the body and mind. Some of the yoga asanas and pranayamas facilitate internal cleansing rituals that ensure the flushing out of toxins from the body.

The life of a woman can be called a cycle of various physical and hormonal changes occurring at particular points throughout life. From menstruation at puberty up to menopause, there will be numerous changes experienced by the female body, which can bring about consequences for her physical and psychological well-being.

Being a healthcare professional, I should mention that although medication is sometimes unavoidable, there is no point in neglecting alternative ways, including yoga.

Yoga Can Help Women

Yoga is an exercise that involves asanas, pranayamas, and meditation. There is now scientific evidence indicating that yoga aids in coping with certain conditions in women. It achieves this by positively influencing the neuroendocrine, autonomic nervous system, and stress responses.

A significant number of women are victims of menstrual conditions such as dysmenorrhea, PMS, abnormal menstrual cycle, and heavy menses during their reproductive age. The conditions may become worse due to stress, since it affects hormone levels.

Yoga reduces the amount of congestion in the pelvic area, increases blood flow, increases body flexibility, and reduces stress hormones such as cortisol. Consequently, most women have painless and psychologically stable menstruation.

Yoga Can Improve PCOS Symptoms

Moreover, yoga can prove highly helpful in the case of women who are suffering from Polycystic Ovary Syndrome (PCOS). It is the most prevalent endocrine disorder that affects women of childbearing age.

The condition has insulin resistance, obesity, irregular menstruation, and metabolic conditions as its symptoms. Thus, yoga, along with healthy living, can provide some assistance in terms of improving insulin levels, maintaining weight, reducing stress, and balancing hormones.

Yoga in Pregnancy

Yoga has many advantages during pregnancy. It will ensure good posture, decrease lower back pain, increase flexibility, improve breath control, and prepare the body for delivery. In addition, prenatal yoga helps with dealing with emotional and mental issues related to pregnancy, which will have a positive effect on the mother and her baby.

Yoga During Perimenopause And Menopause

With the onset of perimenopause and menopause, the reduction in levels of estrogen is known to cause side effects like hot flashes, insomnia, irritability, exhaustion, aches in the joints, and thinning bones. All these factors have significant impacts on both the daily life activities and the emotional state of women.

The research shows that yoga may be helpful in overcoming the symptoms of menopause through relaxation, improvement in sleep, muscle strengthening, and better handling of emotions. Breathing techniques and meditation help in lowering stress and positively influencing the mental state of patients.

Apart from the specific diseases that yoga can alleviate, it promotes self-awareness, which plays an important role in managing one’s emotions. Nowadays, women tend to have a large number of duties, such as working, taking care of children, and doing housework. Chronic stress leads to many diseases, for instance, high blood pressure, obesity, heart issues, and psychological problems.

For all phases of female development, from menstruation until menopause, the emphasis should be on not just the treatment of diseases but the maintenance of wellness. While yoga cannot replace medical care, it remains an important supplement that aids in achieving physical fitness as well as mental and spiritual well-being. Through regular yoga practice, a woman will develop her resilience and become stronger in every phase of life.

(By Dr. Ruchi Bhandari, Director- Obstetrics & Gynecology, Yatharth Hospital, Noida)