Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction
Authors: Dorairaj Prabhakaran, Ambalam M. Chandrasekaran, Kalpana Singh, Bishav Mohan, Kaushik Chattopadhyay, Davinder S. Chadha, Prakash C. Negi, Prabhavathi Bhat, Kanchanahalli S. Sadananda, Vamadevan S. Ajay, Kavita Singh, Pradeep A. Praveen, Raji Devarajan, Dimple Kondal, Divya Soni, Poppy Mallinson, Subhash C. Manchanda, Kushal Madan, Alun D. Hughes, Nishi Chathurvedi, Ian Roberts, Shah Ebrahim, Kolli S. Reddy, Nikhil Tandon, Stuart Pocock, Ambuj Roy, Sanjay Kinra, Dorairaj Prabhakaran, Sanjay Kinra, Nikhil Tandon, Subhash Chand Manchanda, Ajay Vamadevan S, Kolli Srinath Reddy, Ian Roberts, Deepak Bhatnagar, Vivek Chaturvedi, Pablo Perel, Dorairaj Prabhakaran, Sanjay Kinra, Neil Poulter, S. Harikrishnan, Ravindra M. Pandey, S. Harikrishnan, Amitava Banerjee, Paramjit Gill, Davinder Singh Chadha, Ambuj Roy, Neil Bardoloi, Ambuj Roy, Subhash Chand Manchanda, Bishav Mohan, Prakash Chand Negi, Sanjeev Asotra, Prabhavati Bhat, Manjunath C. Nanjappa, Kanchanahalli S. Sadananda, M.R. Prasad, Raghava Sarma, K.U. Natrajan, Srikumar Swaminathan, Ravindra K. Tongia, S. Natarajan, Bhaskara Rao, Calambur Narasimhan, Jabir Abdullakutty, Srinivas Mallya, Anil R. Jain, Sudhir R. Naik, Nagraj Desai, Sunil Kumar, Shankar Patil, Satish Patil, Davinder Singh Chadha, Sharad Chandra, Nagamalesh U. Madappa
Journal: Journal of the American College of Cardiology (2020)

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 subgroups with poor uptake (e.g., women and elderly).This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial.The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks.MACE occurred in 131 (6.7%) patients in the Yoga-CaRe 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 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor 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).Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408).