Yoga for Heart Failure

I feel beautiful.  Participant feedback after an 8-week Yoga course for CHF

Almost six million people in the U.S. have congestive heart failure, and its the most common reason for those over the age of 65 to be hospitalized. Often a pattern develops of frequent hospitalizations, a revolving door in and out.

Many factors contribute to worsening function that requires a trip back to the wards. Stress, depression, and a lack of social support are associated with a worse prognosis independent of other medical or physical risk factors. The American Heart Association notes that stress reduction is one of the most important recommendations for people suffering from congestive heart failure.

Lifestyle changes like exercising, managing stress, losing excess weight, and decreasing the amount of dietary salt can drastically improve the ability to function and the quality of life of people with heart failure.

Yoga has been shown in repeated studies to decrease stress and to alleviate depression. It incorporates physical exercise as asanas and employs stress reduction techniques with breath work and meditation, all potentially helpful practices for those with congestive heart failure.

To determine the feasibility of a Yoga practice for typical heart failure patients, an 8-week pilot study was recently undertaken in northern California. The primary objective was to determine if a community-based, racially diverse Yoga program would be feasible in a low-income area where Yoga and other mind-body modalities are not readily available. The secondary objective of the study was to determine the effects of a Yoga practice on weight loss, depression, and quality of life.

Fourteen men and women took a Hatha Yoga course twice a week that lasted for eight weeks. The program was developed by a local nonprofit group in Oakland, the Niroga Institute, which promotes Yoga for individuals with specific needs. It included, among others things, versions of:

  • Trikonasana (standing side bend)
  • Setu Bandha Sarvangasana (bridge)
  • Supta Padangusthasana (reclining big toe)
  • Paschimottonasana (seated forward bend)
  • Nabhiasana (prone boat)
  • Marjariasana (cat)
  • Ardha Matsyendrasana (seated twist)
  • Viparita Karani (doing inversion, or legs-up-the-wall)
  • Savasana (corpse)
  • Pranayama, exhalation twice as long as inhalation
  • Meditation for 5 minutes in any comfortable position
  • Mindfulness practice for impulse control, enhanced self-awareness, development of fearlessness, desirelessness, detachment, and dispassion

 

In addition to the group classes, many of the participants practiced individually at home with or without a DVD provided by the Niroga Institute.

Thirteen of the 14 subjects completed the 8-week course with most of them attending at least 75% of the classes. One person joined the group for less than half the time. Given the severity of illness of the group, those are pretty good study retention numbers.

At the end, these 13 people with congestive heart failure felt better overall with their quality of life (as measured by a standardized test) improved. The effect did not reach statistical significance (p = .08), possibly because of such a small sample size. Their depression lessened (as measured by a standardized test) with the number of participants reporting moderate to severe levels decreasing from eight to four, a significant result. There was also a trend in weight reduction. The average loss was 3.5 pounds over eight weeks.

Unfortunately, this research employed no control group and relied upon self reporting for many of the indices. Its a small positive step though, in validating Yogas therapeutic potential, and it corroborates another similarly designed trial of 15 patients with CHF in which quality of life was significantly improved and an improvement of balance, endurance and strength was noted.

I believe that there is little room for doubt about the benefits of a multi-faceted Yoga lifestyle for people with heart failure. Keep in mind as well that the best way to prevent heart failure is to control risk factors and conditions that cause it coronary artery disease, high blood pressure, high cholesterol, diabetes and obesity. Yogas holistic attention to nutrition, exercise, stress reduction, and mindfulness help us to do just that.

References:

  1. Ai Kubo, Yun-Yi Hung, and Jeffrey Ritterman. Yoga for Heart Failure Patients: A Feasibility Pilot Study with a Multiethnic Population. International Journal of Yoga Therapy. 2011; 21:77-83.
  2. Howie-Esquivel J, Lee J, Collier G, Mehling W, Fleischmann K. Yoga in heart failure patients: a pilot study. Journal of Cardiac Failure. 2010;16:742-9.

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