Yoga and Cardiovascular Health Trial (YACHT): a UK-based randomised mechanistic study of a yoga intervention plus usual care versus usual care alone following an acute coronary event

Abstract

ObjectiveTo determine the effects of yoga practice on subclinical cardiovascular measures, risk factors and neuro-endocrine pathways in patients undergoing cardiac rehabilitation (CR) following acute coronary events.Design3-month, two-arm (yoga +usual care vs usual care alone) parallel randomised mechanistic study.SettingOne general hospital and two primary care CR centres in London. Assessments were conducted at Imperial College London.Participants80 participants, aged 35–80 years (68% men, 60% South Asian) referred to CR programmes 2012–2014.InterventionA certified yoga teacher conducted yoga classes which included exercises in stretching, breathing, healing imagery and deep relaxation. It was pre-specified that at least 18 yoga classes were attended for inclusion in analysis. Participants and partners in both groups were invited to attend weekly a 6- to 12-week local standard UK National Health Service CR programme.Main outcome measures(i) Estimated left ventricular filling pressure (E/e′), (ii) distance walked, fatigue and breathlessness in a 6 min walk test, (iii) blood pressure, heart rate and estimated peak VO2 following a 3 min step-test. Effects on the hypothalamus–pituitary–adrenal axis, autonomic function, body fat, blood lipids and glucose, stress and general health were also explored.Results25 participants in the yoga + usual care group and 35 participants in the usual care group completed the study. Following the 3-month intervention period, E/e′ was not improved by yoga (E/e′: between-group difference: yoga minus usual care:−0.40 (−1.38, 0.58). Exercise testing and secondary outcomes also showed no benefits of yoga.ConclusionsIn this small UK-based randomised mechanistic study, with 60 completing participants (of whom 25 were in the yoga + usual care group), we found no discernible improvement associated with the addition of a structured 3-month yoga intervention to usual CR care in key cardiovascular and neuroendocrine measures shown to be responsive to yoga in previous mechanistic studies.Trial registration number NCT01597960; Pre-results.

Susceptibility of Women to Cardiovascular Disease and the Prevention Potential of Mind–Body Intervention by Changes in Neural Circuits and Cardiovascular Physiology

“…In a meta-analysis of yoga interventions [ 239 ], yoga interventions significantly reduced resting SBP (17 studies, n = 1058 [ 242 , 245 , 252 , 257 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 ], while MBSR interventions did not change the resting SBP (two studies, n = 76) [ 257 , 262 ]. In a meta-analysis study of the effects of yoga on patients with coronary heart disease [ 270 ], yoga interventions of 3–6 months significantly reduced SBP compared to usual care (three studies, n = 330 [ 271 , 272 , 273 ]). In a meta–analysis study of the effectiveness of tai chi on risk factors in CVD for adults with essential hypertension [ 274 ], the tai chi intervention significantly decreased SBP (significant for all <three months, ≥three months, ≥six months) compared to the controls (15 studies, n = 772).…”

“…When comparing MBSR and non-MBSR (yoga) groups, both had a significantly reduced resting DBP [ 239 ]. In a meta-analysis study of the effects of yoga on patients with coronary heart disease [ 270 ], yoga interventions for three to six months significantly reduced DBP compared to usual care (three studies, n = 330 [ 271 , 272 , 273 ]). In a meta-analysis study investigating the effectiveness of tai chi on risk factors of CVDs [ 274 ], tai chi intervention did not change DBP in the interventions of less than three months (three studies, n = 194), but changed DBP in the interventions of more than three months (six studies, n = 620) or six months (six studies, n = 729).…”

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...…”

Development of a Yoga-Based Cardiac Rehabilitation (Yoga-CaRe) Programme for Secondary Prevention of Myocardial Infarction

“…Furthermore, some studies show that yoga can have beneficial effects on blood pressure, glucose and lipid homeostasis, body weight, and functional capacity through a range of hormonal and neuroendocrine pathways [22]. Effects of yoga practice on subclinical cardiovascular measures, risk factors, and neuroendocrine pathways following acute coronary events are investigated in a parallel mechanistic study to the main clinical trial [23].…”