CC BY 4.0 · Avicenna J Med 2023; 13(03): 151-162
DOI: 10.1055/s-0043-1774738
Review Article

Yoga as Adjunct Therapy for Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

1   International Cooperation Section, Ministry of Ayush, Government of India, New Delhi, India
Aruchunan Mooventhan
2   Department of Research, Government Yoga and Naturopathy Medical College, Chennai, Tamil Nadu, India
L. Nivethitha
3   Department of Naturopathy, Government Yoga and Naturopathy Medical College, Chennai, Tamil Nadu, India
› Author Affiliations
Funding No funding was received for this project.


Background Chronic heart failure (CHF) is a prevalent cardiovascular condition that can significantly impact the quality of life and increase mortality risk. Yoga is a mind–body therapy that has been studied as a potential complementary treatment for CHF. However, the effectiveness of yoga in improving outcomes in patients with CHF remains uncertain.

Methods We conducted a systematic review of randomized controlled trials (RCTs) evaluating the effects of yoga on outcomes in patients with CHF. We searched the PubMed, Embase, Scopus, Cochrane Library, and IndMED databases from inception to March 2023. The outcomes of interest were left ventricular ejection fraction (LVEF), cardiac biomarkers, exercise capacity, quality of life, and cardiac function.

Results We identified 11 RCTs that met our inclusion criteria, involving a total of 552 participants. The meta-analysis showed that yoga was associated with significant improvements in peak VO2 (mean difference [MD]= 3.29; 95% Confidence Interval [CI]: 1.64 to 4.94; I2 = 0%), exercise capacity (MD=101.54; 95% CI: 6.24 to 196.83; I2 = 96%), quality of life (MD = –19.99; 95% CI: –25.76 to –14.22; I 2 = 43%), NT-proBNP (MD = –288.78; 95% CI: –492.20 to –85.37; I 2 = 94%), and 6-minute walk test (MD = 101.54; 95% CI: 6.24–196.83; I 2 = 96%), but not in the left ventricular ejection fraction (MD = 4.28; 95% CI: –1.14 to 9.70; I 2 = 93%). Subgroup analysis suggested that the effect of yoga on the quality of life is more pronounced in patients with the “New York Heart Association” (NYHA) class I and II CHF patients and in those who practiced yoga for longer durations. No serious adverse events related to yoga were reported. Most of the included studies were of “low” quality.

Conclusion Current evidence suggests that yoga may be an effective complementary and integrative therapy for improving peak VO2 exercise capacity, NT-proBNP, and quality of life in patients with CHF. However, the low-quality evidence does not render us to conclude anything beyond doubt or draw any firm clinical recommendation. Future high-quality studies are needed to explore the optimal duration and frequency of yoga practice and its effects on long-term outcomes in this population.

Author Contributions

A.D. contributed to the study design, literature search, data extraction, quality assessment, statistical analysis, interpretation, supervision, drafting and preparation of the article. M.A. contributed to the concept, study design, literature search, data extraction, quality assessment, drafting, and preparation of the article. L.N. contributed to the concept and data extraction. All the authors reviewed and approved the final version of the article.

Publication History

Article published online:
22 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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