Integrated Yoga Practice in Cardiac Rehabilitation Program: A Randomized Control Trial

Abstract

Background: Coronary artery disease (CAD) is a detrimental noncommunicable disease, which is increasing due to sedentary lifestyle and urbanization in the young population. It is further elevated with risk factors such as stress, anxiety, depression, an increase in triglycerides, dyslipidemia, hyperglycemia, hypertension, and so on, which manifests as atherosclerotic disease. Yoga-based lifestyle intervention is a noninvasive effective treatment method to control and prevent cardiac risk factors in CAD patients. Yoga has been used in India as a therapeutic method to manage hypertension and other chronic disorders and is fast gaining popularity as an effective means for the alleviation of stress, improvement of fitness, and enhancement of well-being. This study aimed to determine the feasibility of introducing the integrated approach of yoga therapy (IAYT) in a cardiac rehabilitation center in India and understand its usefulness in improving the cardiac function and managing the cardiac risk factors in acute myocardial infarction patients with left ventricular dysfunction. Methods and Design: Cardiac patients were randomized to a yoga-practicing group (n = 33) and a control group (n = 33). The yoga-practicing group was instructed to attend three supervised IAYT classes 3 days per week for 12 weeks at the hospital yoga center. The control group received standard care that included pharmacologic treatment and the instructions of the cardiologist. The outcome measures were assessed at baseline (T1 = 0) and completion (T2 = 3 months). The primary outcome measure was the left ventricular ejection fraction (LVEF). Results: There was no statistically significant difference in LVEF (U = 420.500, p value = 0.218) between the two groups. However, the yoga-practicing group showed significant reduction in depression (Cardiac Depression Scale [CDS], U = 71, p value = 0.0), anxiety (Hamilton Anxiety Rating Scale [HAM-A], U = 128, p value = 0.0), and a significant increase in quality of life (QOL) scores (Duke Activity Status Index [DASI], U = 146, p value = 0.0; and metabolic equivalents (METs), U = 136, p value = 0.0) at 3 months compared to control. Overall, the CAD patients practicing yoga showed a favorable profile compared to control individuals on CDS, HAM-A, DASI, and MET outcomes. Control and yoga practicing groups did not differ significantly in the lipid levels. Conclusion: This study indicated that the integration of yoga practice in a cardiac rehabilitation program is feasible and has no added benefit in improving the cardiac function. However, the addition of yoga to cardiac rehabilitation may be beneficial in reducing depression and anxiety and improving QOL in patients.

Effects of Exercise Therapy on Anxiety and Depression in Patients With Coronary Heart Disease: A Meta-Analysis of a Randomized Controlled Study

“…In total, 260 participants in five randomized controlled studies (16,17,(26)(27)(28) evaluated the effect of exercise therapy on anxiety in patients with coronary heart disease (Figure 4). Using evaluation methods, including GAD7, HADS-A, HAMA, and DASS-A, due to the diversity of dimensions, we used SMD to aggregate the anxiety symptom data, and the fixed-effect model was chosen because the combined results had no obvious statistical heterogeneity.…”

“…The results showed that compared with the control group, the intervention group had a significant overall effect in improving anxiety of patients with coronary heart disease. Since one of the trials did not study the target outcome of depression and could not be included in the meta-analysis, 731 participants in 10 randomized controlled studies (16,17,(20)(21)(22)(23)(24)(25)(26)(27) evaluated the effect of exercise therapy on depression in patients with coronary heart disease (Figure 5). Using evaluation methods, including HAMD, SDS, PHQ-9, BDI, CDS, HADS-D, CDS, and DASS-D, the random effects model was chosen because the combined results were highly statistically heterogeneous.…”

Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease

“… 12-month LVEF improved in yoga group ( p =0.001) in those with LVEF <53% LVEF 47% to 53% at 1 year vs 49% in control. Significant difference in weight loss in those with BMI >23 ( p =0.038) Total cholesterol p =0.61 Total triglycerides p =0.03 Total HDL p =0.003 Total LDL p =0.75 Total VLDL p =0.03 PSS p =0.12 PANAS-positive p =0.02 PANAS-negative p=0.97 HADS-Anxiety p =0.42 HADS-Depression p =0.07 Sharma et al 14 2020 India Single centre CAD – Medically managed MI with LVSD 66 (33:33) 12-week yoga-based cardiac rehab adjunct Standard care (not exercise-based) 3 months LVEF Biochemical: Total triglycerides, cholesterol, LDL, HDL QOL: DASI and MET Anxiety and depression: HAM-A CDS No difference in LVEF ( p =0.218) No difference in biochemical measures Statistically significant improvement in QOL ( p <0.001) And anxiety and depression ( p <0.001) Tillin et al 16 2019 UK Multicentre ACS 60 (25:35) Addition of at least 18 yoga classes to standard programme Control – standard UK NHS cardiac rehab programme Exercise-based CR 3 months Filling pressures (E/e’) 6MWT BP HR blood profile QOL E/e’ p =0.4 6MWT p =0.7 Resting SBP p =0.5 Resting DBP p =0.6 Resting HR p =0.8 International physical activity score p =0.8 EQ-5D health status p =1.0 EQ-5D self-rated thermometer p =0.6 PSS p =0.11 Abbreviations : ACS, acute coronary syndrome; BMI, body mass index; CABG, coronary artery bypass graft; CAD, coronary artery disease; CDS, Cardiac Depression Scale; CR, cardiac rehabilitation; DASI, Duke Activity Status Index; DBP, diastolic blood pressure; HADS, Hospital Anxiety and Depression Score; HAM-A, Hamilton Anxiety Rating Scale; LVEF, left ventricular ejection fraction; LVSD, left ventricular systolic dysfunction; MACE, major advers...…”

“… 12 One study only looked at patients post-CABG (Raghuram et al), and one study only looked at MI patients receiving medical therapy (Sharma et al), which is not reflective of current practice. 13 , 14 Control group intervention also varied between studies ranging from purely pharmacological intervention to comprehensive exercise-based programmes. There were high numbers screened out in the studies, and dropout rates varied from 40% to almost nothing (Sharma et al).…”

Yoga Effects on Anthropometric Indices and Polycystic Ovary Syndrome Symptoms in Women Undergoing Infertility Treatment: A Randomized Controlled Clinical Trial

“…Today, yoga is used as a treatment for various conditions such as hypertension, multiple sclerosis, asthma, low back pain, and arthritis, as well as pain and stress management. The results of various studies have shown that doing yoga exercises in women with polycystic ovary syndrome has led to improved insulin sensitivity and lipid indexes [ 16 – 19 ]. Furthermore, in the latest systematic review studies conducted in 2020, it was stated that although regular exercises have helped improve hormonal, metabolic, and clinical parameters among these patients, there is the need for better and more accurate studies in this regard [ 8 ].…”