Yoga May Augment Medical Therapy in Heart Failure

LISBON, Portugal — The addition of a year-long customized yoga therapy intervention to guideline-directed medical therapy (GDMT) appears to significantly improve heart failure measures associated with long-term prognosis, findings from an Indian study suggested.

The research, presented at the Heart Failure Association of the European Society of Cardiology (HFA-ESC) 2024 congress on May 12, involved 105 patients assigned to yoga plus GDMT or GDMT alone and demonstrated that there was a large shift in the New York Heart Association (NYHA) functional class from baseline to the 52-week follow-up.

“Yoga therapy has a beneficial impact on heart failure patients on optimal medical management,” said study presenter Ajit Singh, MD, Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India, and the study “demonstrated an overall improvement in left ventricle dimensions and function.”

However, because patients were followed every day and almost a quarter had dropped out by 6 months, the study was “a challenge,” he noted. Nevertheless, the addition of yoga to GDMT could be a “game changer if we try for longer duration.”

For yoga therapy to be considered in clinical practice, a randomized study is required, said session cochair Dana Dawson, MD, PhD, professor of cardiovascular medicine and lead of the Cardiology and Cardiovascular Research Unit, University of Aberdeen, Aberdeen, Scotland.

Patients in the current analysis, however, were not randomly allocated to treatment group, which resulted in baseline discrepancies that made the groups “incomparable,” Dawson explained.

Still, the study showed that yoga is feasible in this patient group and that, even just comparing baseline and follow-up outcomes in the yoga group, there were some significant results.

“It is effective in implementing a change,” she said, “and whether that change is clinically effective needs to be tested in a clinic in a randomized study.”

Why Yoga May Be Particularly Effective

Yoga may be different from other exercise and lifestyle interventions because it is “also about meditation and meeting with your own self,” which corresponds to a form of cognitive behavioral therapy, albeit “conducted in singular manner,” she added.

“It’s not going to be everyone’s cup of tea, and not everyone is going to be inclined to do it,” but it could be suitable in countries where yoga is more commonly practiced as a behavioral, as opposed to lifestyle, intervention, said Dawson.

Heart failure is a “complex chronic disease” that is a “prime cause of concern for healthcare sectors worldwide,” not least in India, where there is a “very high prevalence” of the disease, Singh noted.

Evidence from the literature indicates that yoga and other lifestyle modifications can improve the quality of life of patients with heart failure, alongside measures such as left ventricular ejection fraction (LVEF) and NYHA functional class, he said. However, the researchers did not find any study that looked at yoga therapy as an adjunct to standard-of-care treatment.

How Yoga Was Applied

They recruited patients aged 30-70 years with persistent heart failure symptoms, an LVEF of

Patients were assigned in a nonrandomized fashion to GDMT with or without a customized yoga program. Eight forms of pranayama breath work, meditation, and relaxation techniques were taught to patients in the yoga group by experienced hospital faculty.

They were supervised for 1 week and then advised to continue self-administered yoga at home once a week for 45 minutes. After each home session, an instructor followed up with each study participant to monitor progress.

All participants were assessed with echocardiography and other measures, including physical activities, to determine NYHA functional status at baseline, 6 months, and 1 year.

Of the 110 patients recruited, 25 had dropped out by 6 months. Of the remaining 85 patients included in the analysis, 40 were assigned to the yoga group. The average age was 49 years, and 70 (82%) of the participants were men. The lack of women in the study is a “major drawback,” Singh noted.

Women did not want to participate, he explained, “because they were afraid to get the follow-up,” saying, “We will not be able to follow this yoga therapy for 1 year.”

After 52 weeks, patients in the yoga group had significantly greater reductions from baseline in systolic and diastolic blood pressure, heart rate, and body mass index than those in the GDMT-alone group (P

Patients in the yoga group also experienced significantly greater improvements in ejection fraction, increasing from an average of 41.5% to 44.4% over the course of the study. In contrast, ejection fraction decreased from 42.3% to 41.6% in the GDMT-alone group (P

Crucially, there was a marked improvement in the NYHA class in the yoga group.

With yoga, the proportion of patients with class I heart failure increased from 12% to 47% over the 52 weeks of the study, whereas the proportion with class II heart failure decreased from 57% to 30%, and the proportion with class III heart failure decreased from 30% to 12% (P

No funding was declared. No relevant financial relationships were declared.