Yoga for Heart Failure: A Review and Future Research

Paula R Pullen, William S Seffens, Walter R Thompson, Paula R Pullen, William S Seffens, Walter R Thompson

Abstract

Background: Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients.

Aim: The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients.

Methods: The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies.

Conclusions: Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.

Keywords: Complementary medicine; exercise adherence; heart failure; quality of life; yoga therapy.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Measurement of metabolic consumption during a yoga posture
Figure 2
Figure 2
Yoga intervention may lower cardiovascular risk by acting through physiologic pathways of activation and stimulation. Yoga effects nerve stimulation, stress reactivity, musculoskeletal, and hormonal systems

References

    1. Hatha Yoga (n.d.) In Medical Dictionary Online. [Last accessed on 2017 Aug 12]. Available from:
    1. Iyengar BK. Light on Yoga. New York: Shocken Books; 1979.
    1. Birch BB. Power Yoga. New York: Fireside; 1995.
    1. Chu P, Gotink RA, Yeh GY, Goldie SJ, Hunink MG. The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2016;23:291–307.
    1. Tyagi A, Cohen M, Reece J, Telles S. An explorative study of metabolic responses to mental stress and yoga practices in yoga practitioners, non-yoga practitioners and individuals with metabolic syndrome. BMC Complement Altern Med. 2014;14:445.
    1. Cramer H, Lauche R, Haller H, Dobos G, Michalsen A. A systematic review of yoga for heart disease. Eur J Prev Cardiol. 2015;22:284–95.
    1. Madanmohan, Udupa K, Bhavanani AB, Krishnamurthy N, Pal GK. Modulation of cold pressor-induced stress by shavasan in normal adult volunteers. Indian J Physiol Pharmacol. 2002;46:307–12.
    1. Kristal AR, Littman AJ, Benitez D, White E. Yoga practice is associated with attenuated weight gain in healthy, middle-aged men and women. Altern Ther Health Med. 2005;11:28–33.
    1. Rioux JG, Ritenbaugh C. Narrative review of yoga intervention clinical trials including weight-related outcomes. Altern Ther Health Med. 2013;19:32–46.
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics - 2015 update: A report from the American heart association. Circulation. 2015;131:e29–322.
    1. Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP, et al. Trends in heart failure incidence and survival in a community - Based population. JAMA. 2004;292:344–50.
    1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.
    1. Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA. 2002;287:628–40.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6:e1000097.
    1. DiCarlo LJ, Sparling PB, Hinson BT, Snow TK, Roskoph LB. Cardiovascular, metabolic, and perceptual responses to hatha yoga standing poses. Med Exerc Nutr Health. 1995;4:107–12.
    1. Carroll J, Blansit A, Otto RM, Wygand JW. The metabolic requirements of Vinyasa Yoga. Med Sci Sports Exerc. 2003;35:S155.
    1. Hagins M, Moore W, Rundle A. Does practicing hatha yoga satisfy recommendations for intensity of physical activity which improves and maintains health and cardiovascular fitness? BMC Complement Altern Med. 2007;7:40.
    1. Ray US, Pathak A, Tomer OS. Hatha yoga practices: Energy expenditure, respiratory changes and intensity of exercise. Evid Based Complement Alternat Med 2011. 2011:241294.
    1. Pullen PR, Ogbesor A, Seffens W. Kinect acquisition of skeleton body positions during yoga and tai chi for exergame development. Med Sci Sports Exerc. 2015;47:162.
    1. Clay CC, Lloyd LK, Walker JL, Sharp KR, Pankey RB. The metabolic cost of hatha yoga. J Strength Cond Res. 2005;19:604–10.
    1. Niranjan M, Bhagyalakshmi K, Ganaraja, Prabha AM, Ramesh B. Effects of yoga and supervised integrated exercise on heart rate variability and blood pressure in hypertensive patients. J Chin Clin Med. 2009;4:139–43.
    1. Hagins M, States R, Selfe T, Innes K. Effectiveness of yoga for hypertension: Systematic review and meta-analysis. Evid Based Complement Alternat Med 2013. 2013:649836.
    1. Innes KE, Vincent HK, Taylor AG. Chronic stress and insulin resistance-related indices of cardiovascular disease risk, part 2: A potential role for mind-body therapies. Altern Ther Health Med. 2007;13:44–51.
    1. Benson H, Rosner BA, Marzetta BR, Klemchuk HM. Decreased blood-pressure in pharmacologically treated hypertensive patients who regularly elicited the relaxation response. Lancet. 1974;1:289–91.
    1. Wisløff U, Støylen A, Loennechen JP, Bruvold M, Rognmo Ø, Haram PM, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: A randomized study. Circulation. 2007;115:3086–94.
    1. Cook-Cottone C. Dosage as a critical variable in yoga therapy research. Int J Yoga Therap. 2013;23:11–2.
    1. Jayasinghe SR. Yoga in cardiac health (a review) Eur J Cardiovasc Prev Rehabil. 2004;11:369–75.
    1. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: A systematic review. J Am Board Fam Pract. 2005;18:491–519.
    1. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: A systematic review and meta-analysis. Depress Anxiety. 2013;30:1068–83.
    1. Halpern J, Cohen M, Kennedy G, Reece J, Cahan C, Baharav A, et al. Yoga for improving sleep quality and quality of life for older adults. Altern Ther Health Med. 2014;20:37–46.
    1. Lau C, Yu R, Woo J. Effects of a 12-week hatha yoga intervention on metabolic risk and quality of life in Hong Kong Chinese adults with and without metabolic syndrome. PLoS One. 2015;10:e0130731.
    1. McDermott KA, Rao MR, Nagarathna R, Murphy EJ, Burke A, Nagendra RH, et al. A yoga intervention for type 2 diabetes risk reduction: A pilot randomized controlled trial. BMC Complement Altern Med. 2014;14:212.
    1. Berrueta L, Muskaj I, Olenich S, Butler T, Badger GJ, Colas RA, et al. Stretching impacts inflammation resolution in connective tissue. J Cell Physiol. 2016;231:1621–7.
    1. Corey SM, Vizzard MA, Bouffard NA, Badger GJ, Langevin HM. Stretching of the back improves gait, mechanical sensitivity and connective tissue inflammation in a rodent model. PLoS One. 2012;7:e29831.
    1. Guescini M, Canonico B, Lucertini F, Maggio S, Annibalini G, Barbieri E, et al. Muscle releases alpha-sarcoglycan positive extracellular vesicles carrying miRNAs in the bloodstream. PLoS One. 2015;10:e0125094.
    1. Emanueli C, Shearn AI, Angelini GD, Sahoo S. Exosomes and exosomal miRNAs in cardiovascular protection and repair. Vascul Pharmacol. 2015;71:24–30.
    1. Sinha S, Singh SN, Monga YP, Ray US. Improvement of glutathione and total antioxidant status with yoga. J Altern Complement Med. 2007;13:1085–90.
    1. Shore R, Foster C, Pein R, Seebach E. Comparison of blood pressure lowering interventions. J Cardiopulm Rehabil. 2002;22:361–3.
    1. Murugesan R, Govindarajulu N, Bera TK. Effect of selected yogic practices on the management of hypertension. Indian J Physiol Pharmacol. 2000;44:207–10.
    1. Sivasankaran S, Pollard-Quintner S, Sachdeva R, Pugeda J, Hoq SM, Zarich SW, et al. The effect of a six-week program of yoga and meditation on brachial artery reactivity: Do psychosocial interventions affect vascular tone? Clin Cardiol. 2006;29:393–8.
    1. Santos AC, Alves MJ, Rondon MU, Barretto AC, Middlekauff HR, Negrão CE, et al. Sympathetic activation restrains endothelium-mediated muscle vasodilatation in heart failure patients. Am J Physiol Heart Circ Physiol. 2005;289:H593–9.
    1. Bernardi L, Porta C, Spicuzza L, Bellwon J, Spadacini G, Frey AW, et al. Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure. Circulation. 2002;105:143–5.
    1. Madanmohan, Bhavanani AB, Prakash ES, Kamath MG, Amudhan J. Effect of six weeks of shavasan training on spectral measures of short-term heart rate variability in young healthy volunteers. Indian J Physiol Pharmacol. 2004;48:370–3.
    1. Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and chemoreflex response to hypoxia and hypercapnia. Lancet. 2000;356:1495–6.
    1. Krishna BH, Pal P, Pal GK, Balachander J, Jayasettiaseelon E, Sreekanth Y, et al. Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure. J Clin Diagn Res. 2014;8:14–6.
    1. Krishna BH, Pal P, Pal G, Balachander J, Jayasettiaseelon E, Sreekanth Y, et al. A randomized controlled trial to study the effect of yoga therapy on cardiac function and N terminal pro BNP in heart failure. Integr Med Insights. 2014;9:1–6.
    1. Canadian Cardiovascular Society Heart Failure Management Primary Panel. Moe GW, Ezekowitz JA, O'Meara E, Howlett JG, Fremes SE, et al. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on rehabilitation and exercise and surgical coronary revascularization. Can J Cardiol. 2014;30:249–63.
    1. Flynn KE, Lin L, Moe GW, Howlett JG, Fine LJ, Spertus JA, et al. Relationships between changes in patient-reported health status and functional capacity in outpatients with heart failure. Am Heart J. 2012;163:88–94.
    1. Wenger NK. Quality of life: Can it and should it be assessed in patients with heart failure? Cardiology. 1989;76:391–8.
    1. Tyni-Lenné R, Gordon A, Sylvén C. Improved quality of life in chronic heart failure patients following local endurance training with leg muscles. J Card Fail. 1996;2:111–7.
    1. O'Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301:1439–50.
    1. Pullen PR, Nagamia SH, Mehta PK, Thompson WR, Benardot D, Hammoud R, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008;14:407–13.
    1. Pullen PR, Thompson WR, Benardot D, Brandon LJ, Mehta PK, Rifai L, et al. Benefits of yoga for African American heart failure patients. Med Sci Sports Exerc. 2010;42:651–7.
    1. Kubo A, Hung YY, Ritterman J. Yoga for heart failure patients: A feasibility pilot study with a multiethnic population. Int J Yoga Therap. 2011;21:77–83.
    1. Yadav A, Singh S, Singh K, Pai P. Effect of yoga regimen on lung functions including diffusion capacity in coronary artery disease patients: A randomized controlled study. Int J Yoga. 2015;8:62–7.
    1. Hassanpour Dehkordi A, Khaledi Far A. Effect of exercise training on the quality of life and echocardiography parameter of systolic function in patients with chronic heart failure: A randomized trial. Asian J Sports Med. 2015;6:e22643.
    1. Corvera-Tindel T, Doering LV, Gomez T, Dracup K. Predictors of noncompliance to exercise training in heart failure. J Cardiovasc Nurs. 2004;19:269–77.
    1. Cooper AF, Weinman J, Hankins M, Jackson G, Horne R. Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction. Heart. 2007;93:53–8.
    1. Duncan KA, Pozehl B. Staying on course: The effects of an adherence facilitation intervention on home exercise participation. Prog Cardiovasc Nurs. 2002;17:59–65.
    1. Walsh JT, Charlesworth A, Andrews R, Hawkins M, Cowley AJ. Relation of daily activity levels in patients with chronic heart failure to long-term prognosis. Am J Cardiol. 1997;79:1364–9.
    1. Evangelista LS, Dracup K, Erickson V, McCarthy WJ, Hamilton MA, Fonarow GC, et al. Validity of pedometers for measuring exercise adherence in heart failure patients. J Card Fail. 2005;11:366–71.
    1. Cowley AJ, Fullwood L, Stainer K, Hampton JR. Exercise tolerance in patients with heart failure – How should it be measured? Eur Heart J. 1991;12:50–4.
    1. Cowley AJ, Fullwood LJ, Muller AF, Stainer K, Skene AM, Hampton JR, et al. Exercise capability in heart failure: Is cardiac output important after all? Lancet. 1991;337:771–3.
    1. Pozehl BJ, Duncan K, Hertzog M, McGuire R, Norman JF, Artinian NT, et al. Study of adherence to exercise in heart failure: The HEART camp trial protocol. BMC Cardiovasc Disord. 2014;14:172.
    1. Selman L, McDermott K, Donesky D, Citron T, Howie-Esquivel J. Appropriateness and acceptability of a Tele-Yoga intervention for people with heart failure and chronic obstructive pulmonary disease: Qualitative findings from a controlled pilot study. BMC Complement Altern Med. 2015;15:21.
    1. Seffens WS, Pullen PR. Exergame development study of Kinect for yoga postures. International Association of Yoga Therapy, IYAT Symposium on Yoga Research. 2014. [Last accessed on 2017 Aug 12]. Available from:
    1. Benda NM, Eijsvogels TM, Van Dijk AP, Bellersen L, Thijssen DH, Hopman MT, et al. Altered core and skin temperature responses to endurance exercise in heart failure patients and healthy controls. Eur J Prev Cardiol. 2016;23:137–44.
    1. Pullen PR. The Benefits of Yoga Therapy for Heart Failure Patients [Dissertation]. Appendix B. Atlanta (GA): Georgia State University; 2009. [Last accessed on 2017 Aug 12]. Available from:
    1. Olex S, Newberg MD, Andrew B, Figueredo MD, Vincent M. Meditation: Should a cardiologist care? Cardiology Faculty Papers Paper 29. 2013. [Last accessed on 2017 Aug 12]. Available from: .
    1. Jevning R, Wallace RK, Beidebach M. The physiology of meditation: A review. A wakeful hypometabolic integrated response. Neurosci Biobehav Rev. 1992;16:415–24.
    1. Young JD, Taylor E. Meditation as a voluntary hypometabolic state of biological estivation. News Physiol Sci. 1998;13:149–53.
    1. Emani S, Binkley PF. Mind-body medicine in chronic heart failure: A translational science challenge. Circ Heart Fail. 2010;3:715–25.
    1. Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V, et al. The Support, Education, and Research in Chronic Heart failure study (SEARCH): A mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. Am Heart J. 2009;157:84–90.
    1. Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, et al. Stress reduction in the secondary prevention of cardiovascular disease: Randomized, controlled trial of transcendental meditation and health education in blacks. Circ Cardiovasc Qual Outcomes. 2012;5:750–8.

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