Effects of exergaming and yoga on exercise capacity, symptoms, functional capacity, and physical and mental health in patients with heart failure
Authors: Klompstra L , Hagglund E , Jaarsma T , Kato N , Stromberg A 
Published: July 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish National Science Council and The Swedish Heart-Lung Foundation

Background
Many people with chronic heart failure have a sedentary lifestyle. Alternative forms of physical activity might be beneficial, and should be considered, especially for patients with heart failure who are less inclined to start programs using traditional modes of exercise. Exergaming and yoga are promising interventions for improving functional capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure.

Objective
To explore effects of exergaming at home and medical yoga in a group on functional capacity, fatigue, shortness of breath, health-related quality of life, depression, and anxiety in patients with heart failure.

Methods
This is a sub-study within a larger randomized controlled trial (the HF-Wii trial) with a three-months intervention and outcomes measures at baseline, three, six, and twelve months. Study particpants were recruited from nurse-led heart failure clinics at two university hospitals in Sweden. Randomization was in a 1:1:1 ratio to either an exergame intervention, a medical yoga intervention, or an active control group. Exercise capacity was assesed using the six-minute walk test. Symptoms (shortness of breath and fatigue) were assessed with a numeric rating scale ranging from 0-10. Well-being was assessed with Cantril’s ladder of life. Health-related quality of life was examined by the Minnesota Living with Heart failure Questionnaire. Anxiety and depression were measured with the hospital anxiety and depression scale. Treatment effects in change of outcomes were tested in an analysis of mixed-effects models with repeated measures. Change in outcomes was the dependent variable. The independent fixed-effect parameters were treatment group, time, and the interaction between treatment group and time.

Results
In total, 104 patients (37% women, mean age 71±12, 48% in New York Heart Association Class II and 42% in III) were randomized to exergaming (n=35), medical yoga (n=33), or an active control group (n=36). No statistically significant differences were found between these three groups on any of the outcome measures. Exergaming improved exercise capacity, fatigue, shortness of breath, and physical health-related quality of life (all p&lt; 0.05) and medical yoga improved symptoms of fatigue and emotional health-related quality of life. The control group did not change on the exercise capacity, symptoms, health-related quality of life, or depressive or anxiety symptoms. The well-being score in patients in the control group significantly decreased at three months (p = 0.047).

Conclusions
This randomized sub-study showed that both exergaming and medical yoga had favorable effects on outcomes, with exergaming, with its higher physical intensity, having effects on physical health and with medical yoga being a mind-body intervention with effects on emotional well-being.