Subscribe to RSS
Yoga as Adjunct Therapy for Chronic Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsFunding 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.
Keywordsyoga - meditation - chronic heart failure - randomized controlled trials - quality of life - peak VO2 - NT-proBNP - systematic review - meta-analysis
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.
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. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Roger VL. Epidemiology of heart failure. Circ Res 2013; 113 (06) 646-659
- 2 Sakata Y, Shimokawa H. Epidemiology of heart failure in Asia. Circ J 2013; 77 (09) 2209-2217
- 3 Khatibzadeh S, Farzadfar F, Oliver J, Ezzati M, Moran A. Worldwide risk factors for heart failure: a systematic review and pooled analysis. Int J Cardiol 2013; 168 (02) 1186-1194
- 4 Krishna BH, Pal P. G K P, et al. Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure. J Clin Diagn Res 2014; 8 (01) 14-16
- 5 Howie-Esquivel J, Lee J, Collier G, Mehling W, Fleischmann K. Yoga in heart failure patients: a pilot study. J Card Fail 2010; 16 (09) 742-749
- 6 Ostrominski JW, Vaduganathan M. Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction. Clin Cardiol 2022; 45 (Suppl. 01) S40-S51
- 7 Pullen PR, Thompson WR, Benardot D. et al. Benefits of yoga for African American heart failure patients. Med Sci Sports Exerc 2010; 42 (04) 651-657
- 8 Pullen PR, Nagamia SH, Mehta PK. et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail 2008; 14 (05) 407-413
- 9 Hägglund E, Hagerman I, Dencker K, Strömberg A. Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: a randomized controlled study. Eur J Cardiovasc Nurs 2017; 16 (05) 381-389
- 10 Cramer H, Lauche R, Haller H, Steckhan N, Michalsen A, Dobos G. Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis. Int J Cardiol 2014; 173 (02) 170-183
- 11 Cramer H, Lauche R, Haller H, Dobos G, Michalsen A. A systematic review of yoga for heart disease. Eur J Prev Cardiol 2015; 22 (03) 284-295
- 12 Li J, Gao X, Hao X. et al. Yoga for secondary prevention of coronary heart disease: a systematic review and meta-analysis. Complement Ther Med 2021; 57: 102643
- 13 Wang J, Xiong X, Liu W. Yoga for essential hypertension: a systematic review. PLoS One 2013; 8 (10) e76357
- 14 Posadzki P, Cramer H, Kuzdzal A, Lee MS, Ernst E. Yoga for hypertension: a systematic review of randomized clinical trials. Complement Ther Med 2014; 22 (03) 511-522
- 15 Tyagi A, Cohen M. Yoga and hypertension: a systematic review. Altern Ther Health Med 2014; 20 (02) 32-59
- 16 Gomes-Neto M, Rodrigues Jr ES, Silva Jr WM, Carvalho VO. Effects of yoga in patients with chronic heart failure: a meta-analysis. Arq Bras Cardiol 2014; 103 (05) 433-439
- 17 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898
- 18 Dalton JE, Bolen SD, Mascha EJ. Publication bias: the elephant in the review. Anesth Analg 2016; 123 (04) 812-813
- 19 Curiati JA, Bocchi E, Freire JO. et al. Meditation reduces sympathetic activation and improves the quality of life in elderly patients with optimally treated heart failure: a prospective randomized study. J Altern Complement Med 2005; 11 (03) 465-472
- 20 Jain AK, Subhash CM, Bhola SV, Kushal M, Ashwini M, Jitendrapal SS. Effect of yoga lifestyle in patients with heart failure: a randomized control trial. Int J Yoga 2022; 15 (01) 40-44
- 21 Krishna BH, Pal P, Pal GK. et al. Yoga improves quality of life and functional capacity in heart failure patients. Biomed Res 2014; 25 (02) 178-182
- 22 Krishna BH, Pal P, Pal G. 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
- 23 Sharma KNS, Pailoor S, Choudhary NR, Bhat P, Shrestha S. Integrated yoga practice in cardiac rehabilitation program: a randomized control trial. J Altern Complement Med 2020; 26 (10) 918-927
- 24 Aditee D, Pankaj M, Neil B, Nayereh P, Dali F. N Srivatsa U. Meditation for improved clinical outcomes in patients with implantable defibrillators for heart failure: pilot study. J Atr Fibrillation 2020; 12 (06) 2314
- 25 Jayadevappa R, Johnson JC, Bloom BS. et al. Effectiveness of transcendental meditation on functional capacity and quality of life of African Americans with congestive heart failure: a randomized control study. Ethn Dis 2007; 17 (01) 72-77