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Yoga-Based Cardiac Rehabilitation After Acute MI
Study Questions:
Can a yoga-based cardiac rehabilitation program reduce major cardiovascular events?
Methods:
The Yoga-CaRe study used a randomized controlled trial design to recruit and enroll patients with recent acute myocardial infarction across 24 medical centers in India. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). Primary outcomes included the first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization), and self-rated health on the European Quality of Life–5 Dimensions–5 Level visual analogue scale at 12 weeks. Median and minimum follow-up was 22 and 6 months, respectively.
Results:
A total of 3,959 participants were enrolled in the study, mean age 53.4 ± 10.9 years, 14% female. The majority had no prior history of coronary heart disease. Most participants had received angiography (80%) and a revascularization procedure (61%) during the index event. MACE occurred in 131 (6.7%) patients in the yoga group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe, 0.90; 95% confidence interval [CI], 0.71-1.15; p = 0.41). Self-rated health was higher in the yoga group compared to the enhanced care group. (baseline-adjusted mean difference in favor of yoga, 1.5; 95% CI, 0.5-2.5; p = 0.002). The Yoga-CaRe group had a greater return to preinfarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes).
Conclusions:
The investigators concluded that a yoga-based cardiac rehabilitation program improved self-rated health and return to preinfarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE.
Perspective:
Although there was a trend toward lower MACE in the yoga group, the difference with enhanced usual care was not significant. It is important to note that participants who received the yoga intervention reported higher quality of life and were more likely to return to preinfarct activities. This suggests that yoga may provide some benefits and may warrant further study, in particular, when combined with traditional cardiac rehabilitation.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Angiography, Cardiac Rehabilitation, Coronary Disease, Medication Adherence, Myocardial Infarction, Myocardial Revascularization, Quality of Life, Secondary Prevention, Stroke, Tobacco Use Cessation, Treatment Outcome, Yoga
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