Experts pointed out that the study lacked the kind of formalized exercise prescription typical of rehab programs in the US, but remained enthusiastic.
CHICAGO, IL—A yoga-based rehabilitation program following acute MI, called Yoga-CaRe, is as safe as a conventional program and feasible in an Indian population, according to new randomized data.
For the trial, the researchers randomized 3,959 acute MI patients from 24 Indian centers to 14 weeks of either Yoga-CaRe—which involved 13 sessions on lifestyle, meditation and breathing exercises, and yoga postures—or enhanced standard care consisting of three educational sessions and printed leaflets delivered by a nurse or other member of the cardiac care team. The yoga postures used in the study group were specifically chosen so as not to increase the participants' heart rates to dangerous levels, Prabhakaran specified.
In the intention-to-treat (ITT) analysis, patients who received Yoga-CaRe had numerically fewer primary endpoint events (death, nonfatal MI, nonfatal stroke, or emergency cardiovascular hospitalization) than controls at 42-month follow-up, but the difference was not significant.
However, in the per-protocol analysis—with completers defined as the 1,059 participants who attended at least 10 Yoga-CaRe sessions—Yoga-CaRe resulted in almost half as many primary endpoint events at 42 months (HR 0.54; 95% CI 0.38-0.76).
The secondary endpoint of self-rated quality of life, as measured by mean change in the EQ-5D VAS score, was higher for patients in the Yoga-CaRe group than controls at 3 months (10.7 vs 9.2; P = 0.002). Yoga-CaRe was also associated with a greater rate of patient return to preinfarct daily activities (P < 0.001) and achieving no more than six health states (P = 0.04) by 3 months.
"Yoga-CaRe has the potential to be an alternative to the conventional cardiac rehabilitation programs and address the unmet needs of cardiac rehabilitation for patients in low- and middle-income countries," Prabhakaran concluded.
Transport to the session was the biggest barrier for participants to complete Yoga-CaRe, he said but noted that this is typical of any cardiac rehab program.
Now that this protocol has been proven safe, Prabhakaran said he would like to see it investigated following other conditions like heart failure. "Heart failure is growing, and in India it is said that 50% of people die by 5 years," he said. "Initially we didn't look at heart failure because we were worried about the safety of yoga in this group. Now that we are demonstrating that it is safe and feasible, we will extend it to heart failure." Yoga might also be useful for cancer rehabilitation and avoidance of injury in elderly patients, he added.
Exercise physiologist Paula Seffens, PhD (University of North Georgia, Gainesville), also noted the lack of a physical exercise component in the control group arm, telling TCTMD that "this was not a head-to-head comparison." Future studies should employ a better-matched design, so that if there was any improvement seen in the yoga arm over traditional exercise "we would know that they were getting equal amounts of exercise [and] then it's something beyond just exercise that's at work here," she commented.
With regard to "the population that is already utilizing yoga as an exercise strategy, this is great news for them because now you have something, which is better than nothing, which supports [their] exercise strategy, and actually [for] the practitioners who did not believe in yoga, now they have something to go by," Parwani continued.
Prabhakaran D. Effectiveness of a yoga-based cardiac rehabilitation (Yoga-CaRe) program: a multi-centre randomised controlled trial of patients with acute myocardial infarction from India. Presented at: AHA 2018. November 10, 2018. Chicago, IL.
Prabhakaran, Seffens, and Parwani report no relevant conflicts of interest.
The study was funded by the Indian Council for Medical Research (India) and Medical Research Council (UK).
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