Yoga for Cardiac Rehab Patients

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What can help mend a broken heart?

According to the American Heart Association, cardiovascular disease is the leading cause of death globally (17.3 million deaths per year) and growing. Someone dies in the United States from heart disease every 90 seconds and approximately 85.6 million Americans have some type of cardiovascular disease.1 What can help lower these numbers? The age old practice that has been around for over 5000 years—yoga.

Yoga and the Healthy Heart

Yoga practice has been associated with renewing the body and lengthening life expectancy. The word yoga is a Sanskrit word that signifies “union,” a spiritual and physical network that promotes overall health.2 Americans have long associated yoga with relaxation and flexibility, but yoga can also specifically improve heart health and prevent heart disease. Yoga can increase lung capacity, thereby improving respiratory function while decreasing blood pressure, cholesterol and heart rate. Circulation and muscle tone are also enhanced.3

In a review published in the European Journal of Preventative Cardiology, studies demonstrated that yoga helped decrease heart disease as much as conventional aerobic exercise such as brisk walking. Overall, the participants, who ranged from healthy individuals to older persons with heart disease, lost weight and reduced their blood pressure and LDL cholesterol. The particular combination of physical movement, deep breathing, concentration and relaxation that yoga offers, results in conclusive cardiovascular benefits.4

Paula Chu, a doctoral candidate at Harvard University, and her colleagues evaluated 37 randomized, controlled trials comparing yoga with no exercise and with aerobic exercise, assessing participants ranging from 12 weeks to a year. Although there were no changes noted in fasting glucose levels or hemoglobin A1C, overall systolic blood pressures decreased by an average of 5.21 mm Hg and diastolic pressures declined by 4.9 mm Hg. LDL cholesterol also diminished, on average, 12.14 mg/dl and HDL cholesterol increased by an average of 3.20 mg/dl. Heart rate was also reduced, on average, by 5 beats per minute and a 5 pound average weight loss was noted.5

More studies are warranted but the results correspond to the findings found in similar studies, such as one which analyzed Iyengar yoga, a form of Hatha yoga developed by B.K.S. Iyengar, who has worked with post myocardial infarction (MI) patients therapeutically for more than 60 years using particular postures. The study found an improvement in cardiac autonomic nervous tone among healthy Iyengar yoga practitioners.6 Even the professional basketball player, LeBron James, credits yoga with increasing his stamina in the game.7

Yoga and the Cardiac Rehab Heart

How will yoga benefit cardiac rehabilitation patients? Cardiac rehab patients present with a variety of health histories from post cardiac procedures including the span of open heart surgery to stent placements, to post MI, stable angina, and congestive heart failure (CHF). Cardiac rehab programs help the patient with goals to improve exercise habits, lipid profiles, diabetic control, blood pressure, body mass index (BMI), abdominal girth, diet, smoking cessation and stress reduction. Former president Bill Clinton, who had bypass surgery in 2004 and angioplasty in 2010, began following the Dr. Dean Ornish program which incorporates plant based low fat diet and yoga.

Chronic stress promotes plaque buildup and vascular constriction, reducing blood flow. Yoga, according to Ornish, is the “most effective stress reduction ever invented.”8 Massachusetts General Hospital points out that their cardiac patients utilize yoga for self awareness with modified poses or postures to enhance stress reduction.9

In a German study, cardiac rehab clients with the highest baseline blood pressure noted drops in blood pressure (21.2 mm Hg) with the utilization of yoga compared to other therapies.10 Another study by Dr. Satish Sivasankaran, indicated that patients who had experienced MI’s and strokes were able to recover more quickly by practicing yoga. In yet another study by the Journal of the Association of Physicians of India (JAPI), heart disease was reversed with yoga practice, decreasing total cholesterol by 23.3% with improvements noted in LDL and triglyceride levels.11

In an Indian study of post coronary artery bypass grafting (CABG) patients, the yoga group with exercise versus exercises only group, showed a significant increase in left ventricular ejection fraction (LVEF) and a reduction of BMI and blood glucose. In addition, this group experienced overall emotional improvement, including lower stress, anxiety, depression and negativity.12 Another randomized controlled trial, which is in progress, is measuring the positive effects of yoga on psychological, cardiovascular and cognitive activity of Phase 2 Cardiac Rehab patients.13

It is ironic that a practice, such as yoga that has been around for thousands of years, is still in the infancy stages with respect to research on its effects on the body, particularly the heart. However, the widespread, ongoing research supports yoga practice as a “tried and true” beneficial component to the promotion of heart healthy living. What person wouldn’t like to help mend, or better yet, prevent a “broken heart”?

References

1. American Heart Association. (2015). www.heart.org

2. Burgin, T. History of Yoga. Retrieved from http://www.yogabasics.com/learn/history-of-yoga/

3. American Heart Association. Yoga and Heart Health. September 30, 2016. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/Yoga-and-Heart-Health_UCM_434966_Article.jsp#.WIpyH9IrLcs

4. Corliss, J. More than a stretch: Yoga’s benefits may extend to the heart. Harvard Health Blog. April 15, 2015. Retrieved from http://www.health.harvard.edu/blog/more-than-a-stretch-yogas-benefits-may-extend-to-the-heart-201504157868

5. Neumann, J. Yoga may benefit heart health as much as aerobics. Reuters Health News. December 26, 20154. Retrieved from http://www.reuters.com/article/us-health-yoga-cardio-trials-idUSKBN0K40Y520141226

6. Khattab, K., Khattab, A. A., Ortak, J., Richardt, G., & Bonnemeier, H.. Ivengar Yoga Increases Cardiac Parasympatheitc Nervous Modulation Among Healthy Yoga Practitioners. eCAM. December 2017. 4(4), 511-517. http://dx.doi.org/10.1093/ecam/nem087

7.  Dellecave M. Yoga and cardiac health. October 27, 2014. Retrieved from https://www.ekhartyoga.com/blog/yoga-and-cardiac-health

8. McCall, T.  A Holistic Approach to Heart Disease. Yoga Journal. June 27, 2011. Retrieved from  http://www.yogajournal.com/article/health/straight-heart/

9. Specialized yoga can reduce cardiac risk factors. Massachusetts General Hospital. February 3, 2009. Retrieved from http://www.massgeneral.org/heartcenter/news/newsarticle.aspx?id=1534

10. Wood, S. Yoga Works for BP Lowering in Cardiac Rehab…Just Don’t Call It “Yoga”.  Heartwire from Medscape. May 12, 2010. Retrieved from http://www.medscape.com/viewarticle/721720

11. Yoga for Heart Patients. Rehabilitate Your Heart. June 4, 2012. Retrieved from https://rehabilitateyourheart.wordpress.com/2012/06/04/yoga-for-heart-patients-6/.

12. Raghuram, N., Parachuri, V. R., Swarnagowri, M., Babu, S., Chaku, R., Kulkarni, R., … Nagendra, H. R. (2014, August 11). Yoga based cardiac rehabilitation after corronary artery bypass nsurgery: One-year results on LVEF, lipid profile and psychological states- A randomized controlled study. Indian Heart Journal, 66, 490-502. http://dx.doi.org/10.1016/j.ihj.2014.08.007

13. Yeung, A., Kiat, H., Denniss, A. R., Cheema, B. S., Bensoussan, A., Machliss, B., Chang, D. (2014). Randomised controlled trial of a 12 week yoga intervention on negative affective states, cardiovascular and cognitive function in post-cardiac rehabilitation patients. BMC Complementary and Alternative Medicine. October 24, 2014. 14(411). Retrieved from http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-411

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Sarahann R. Huvane, MSN-c, BSN, RN

Sarahann R. Huvane works in cardiac rehabilitation and prevention at Hackensack University Medical Center in New Jersey.

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