A recent study conducted at a tertiary care centre in South India examined the long-term effects of yoga therapy to see whether including it as an additional kind of care for the treatment of heart failure would be advantageous. The findings were presented at the American College of Cardiology Asia 2023 Conference, in Manila, Philippines on 29-30 September.
Let's start by understanding what heart failure is. Heart failure occurs when the heart muscle is either too frail or too stiff to effectively pump blood, leading to fluid retention, shortness of breath, and other problems. The New York Heart Association (NYHA) Functional classification method is the most widely used system for assessing the severity of a patient's symptoms. According to their physical activity restrictions, patients are divided into one of four groups according to the NYHA classification, with Class I being the least severe and Class IV being the most severe. Clinicians examine the ejection fraction to assess how effectively the heart pumps blood.
The recent study involved the participation of 75 heart failure patients who had undergone coronary intervention, revascularization, or device therapy over the previous six months to one year. To qualify for the trial, the patients had to be between 30 and 70 years old and have a left ventricular ejection fraction (LVEF) of 45 per cent. The selected patients were all less than or equivalent to NYHA Class III and had been on optimised medical therapy for at least 6 months to one year.
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For purposes of the study, the participants were divided into an interventional group of 35 participants (31 males and 4 women), and a non-interventional group of 40 participants (30 men and 10 women). The interventional group received yoga therapy as well as standard guideline-directed medical care, whereas the non-interventional group only received standard guideline-directed medical therapy. To assess the impact of yoga therapy on heart failure patients, echocardiographic parameters were examined at various follow-ups.
Participants in the yoga group were taken to the department of Yoga at the hospital and an experienced yoga therapist taught selected yoga therapy like pranayama, meditation and relaxation techniques. Each session lasted around 60 minutes and participants were supervised for one week at the training center before being asked to continue self-administered yoga at home. Those in the yoga group were advised to perform yoga at least five days a week for 12 months. At the training centre, all the participants were taught together to perform the same steps, but individual support was available.
“Yoga is a combination of mind-body techniques, which is a set of physical exercises [asana] with breathing techniques [pranayama], relaxation and meditation that can be effectively used to stimulate physical and mental well-being,” said Ajit Singh, PhD, research scientist for the Indian Council for Medical Research at Kasturba Medical College & Hospital, Manipal Academy of Heart Education in Manipal, India, and the study’s lead author. “Our patients observed improvement in systolic blood pressure and heart rate compared to patients who were on medication without yoga,” he said.
Researchers measured quality of life improvements using the World Health Organization Quality of Life questionnaire, which uses 26 questions to evaluate quality of life in four aspects: physical, psychological, social and environmental health. The participants completed the questionnaire at enrollment, as well as at 24 weeks and 48 weeks of follow-up.
According to the researchers, the study showed participants in the yoga group had improvement in endurance, strength, balance, symptom stability and quality of life. They also observed that while patients improved physically and psychologically, there was no improvement in social and environmental health.
Echocardiographic parameters did not show any significant differences between the two groups at baseline. At both the six- and 12-month follow-up, improved biventricular systolic function was seen in the interventional (yoga) group compared to the non-interventional group. The interventional group also showed substantial improvement in functional outcomes as assessed by the NHYA classification.
“This study proves that the addition of yoga therapy to standard medical management of heart failure leads to an improvement in left ventricular systolic function and quality of life in heart failure patients,” Singh said. “Hence, yoga therapy may improve physical well-being and left ventricular function among heart failure patients on guideline-directed optimal medical therapy,” he concluded.
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