Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial

Prabhakaran, Dorairaj; Chandrasekaran, Ambalam M.; Singh, Kalpana; Bishav Mohan, Bishav; Chattopadhyay, Kaushik; Chadha, Davinder S.; Negi, Prakash C.; Bhat, Prabhavathi; Sadananda, Kanchanahalli S.; Ajay, Vamadevan S.; Singh, Kavita; Pradeep, Praveen A.; Devarajan, Raji; Kondal, Dimple; Soni, Divya; Mallinson, Poppy; Manchanda, Subhash C.; Madan, Kushal; Hughes, Alun D.; Chathurvedi, Nishi; Roberts, Ian; Ebrahim, Shah; Reddy, Kolli S.; Tandon, Nikhil; Pocock, Stuart; Roy, Ambuj; Kinra, Sanjay; Yoga-CaRe trial Investigators

Abstract

Background: Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to sub-groups with poor uptake e.g. women and elderly.

Objectives: We evaluated the effects of yoga-base cardiac rehabilitation (Yoga-CaRe) on major cardiovascular events and self-rated health in a multi-centre randomized controlled trial.

Methods: The trial was conducted in 24 medical centres across India. We recruited 3959 patients with acute myocardial infarction (AMI) with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a yoga-based cardiac rehabilitation (Yoga-CaRe) program (n = 1970) or enhanced standard care involving educational advice (n = 1989). The co-primary outcomes were a) first occurrence of major adverse cardiovascular events (MACE: composite of all-cause mortality, myocardial infarction, stroke or emergency cardiovascular hospitalization), and b) self-rated health on EuroQoL-5D-5L’s visual analogue scale at 12 weeks.

Results: MACE occurred in 131 (6.7%) patients in Yoga-CaRe group and 146 (7.4%) patients in enhanced standard care group (hazard ratio with Yoga-CaRe, 0.90; 95% confidence interval [CI] 0.71 to 1.15; P=0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in enhanced standard care group (baseline-adjusted mean difference in favour of Yoga-CaRe, 1.5 (95% CI 0.5 to 2.5); P=0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes).

Conclusions: Yoga-CaRe improved self-rated health and return to pre-infarct activities after AMI, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe maybe an option where conventional CR is unavailable or unacceptable to individuals.

• Journal Article Type: Article
• Acceptance Date: Jan 29, 2020
• Online Publication Date: Mar 30, 2020
• Publication Date: 2020-04
• Deposit Date: Feb 6, 2020
• Publicly Available Date: Mar 31, 2021
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Electronic ISSN: 1558-3597
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 75
• Issue: 13
• Pages: 1551-1561
• DOI: https://doi.org/10.1016/j.jacc.2020.01.050
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/3905319
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0735109720305301?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction; Journal Title: Journal of the American College of Cardiology; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jacc.2020.01.050; Content Type: article; Copyright: © 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.