Yoga helps heart failure patients live better, says all-India study

While it may not reduce the number of deaths and hospitalisations, yoga can significantly improve the quality of life of heart failure patients, according to a large, multi-centre study from India whose findings were recently reported at the American Heart Association’s Scientific Sessions.

The findings are significant considering that hardly any hospital in India has the highly specialised cardiac rehabilitation centres that can constantly monitor such patients. The yoga-based programme was developed to provide an affordable and accessible cardio-management alternative. The study was funded by the Indian Council of Medical Research (ICMR) and institutions from the UK and US.

What’s more, the group had previously demonstrated that yoga was also effective for the rehabilitation of people who had suffered a heart attack. “The current study has demonstrated that yoga can be used as an alternative to the traditional, highly monitored Western rehabilitation practices. Previously, we had done a similar trial for survivors of heart attack and found that yoga helped people return to their usual activities early,” said Dr Ambuj Roy, one of the authors of the study and professor of cardiology at the All India Institute of Medical Science (AIIMS, Delhi).

What is heart failure?

Heart failure is a condition in which the heart cannot keep up with its workload. It does not mean the heart has completely stopped working. Instead, it means the heart muscle has become too weak or too stiff to pump blood as efficiently as it should.

What were the findings?

The study is based on the data of nearly 3,500 people living with heart failure receiving treatment at 16 centres across India. They had a reduced ejection fraction, meaning that the heart pumps out only 40% or less of the blood with each beat. All of the participants also had limitations to physical activity — any activity that caused fatigue, heart palpitation or shortness of breath.

Half of the participants were randomly selected for the structured yoga programme while the others were provided “enhanced standard care” — three health and education sessions and the same advice booklet that the other group received. At three months, those following the yoga-based cardiac rehab witness significant improvement in their quality of life. There was also more improvement in the physical functions of those in the yoga group. When a six minute walk test was conducted — a simple test of how much a person can walk in six minutes which represents their aerobic capacity and functional endurance — those in the yoga group were able to walk on average 25.5 metres farther than the other group.

The researchers, however, found that the intervention did not significantly reduce the risk of death, hospitalisation or stroke — which stood at 21% for the intervention group and 22.8% for the control group.

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“We looked at two main outcomes: one, whether it led to reduction in deaths and hospitalisations and two, whether it improved the quality of life. When it comes to deaths and hospitalisation, although it was 10% lower in the intervention group, it was not statistically significant. However, when it came to quality of life, we saw the scores reduce by 8 points (lower scores indicate better quality of life) — a reduction of just 5 points is considered to be significant,” said Prof Dorairaj Prabhakaran, one of the authors of the study and executive director of Centre for Chronic Disease Control.

On measurable impacts, he said, “While you and I could probably walk 500 metres in six minutes — and 300 is considered to be normal — these were very sick patients and they could only walk around 200 metres. This improved to 225 metres in the intervention group showing that they were returning slowly to their normal activity level. We also saw an improvement in their scores for frailty.”

Why is the study significant?

One, the sheer number of people living with heart failure — nearly eight to ten million people live with the condition, with 1.8 million cases being diagnosed each year. Prof Prabhakaran explained that they are typically 10 years younger — most younger than 65 years — than their Western counterparts in high income countries.

Dr Roy added that only about 5% to 10% of the healthcare facilities in India even have a specialised cardiac rehabilitation centre, making treatment costly and inaccessible for many. Prof Dorairaj added: “Cardiac rehab programs are inaccessible to many, and their uptake is poor in many countries. Innovations are needed to reduce costs, scale up cardiac rehab and make it sustainable.”

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What does the intervention entail?

The structured yoga programme contained three components — health education through a booklet that was given to both the groups, guided behaviour change through goal setting to modify lifestyle risk factors, and a standardised set of yoga practice. The patient training consisted of 20 sessions, both in-person and online, over three months. Patients were advised to practise yoga at home for 50–55 minutes daily. “The check-ins by the practitioner helped ensure compliance,” said Dr Roy.

Prof SC Manchanda, also an author of the study, consultant cardiologist at Sir Ganga Ram Hospital, New Delhi, and former head of cardiology at AIIMS said that yoga is “polypill” — a complete lifestyle that can improve the overall quality of life of cardiac patients. He said that the yoga-based intervention not only improved the quality of life, the study found that it also improved compliance with lifestyle changes. “We found that the intervention group was better at following their diet and quitting smoking and drinking. They were also less depressed,” he said.