Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction

Dorairaj Prabhakaran(Emory University), Ambalam M. Chandrasekaran(Centre for Chronic Disease Control), Kalpana Singh(Centre for Chronic Disease Control), Bishav Mohan(Dayanand Medical College & Hospital), Kaushik Chattopadhyay(University of London), D.S. Chadha(Command Hospital), Prakash Chand Negi(Indira Gandhi Medical College), Prabhavathi Bhat(Sri Jayadeva Institute of Cardiovascular Sciences and Research), Kanchanahalli Siddegowda Sadananda(Sri Jayadeva Institute of Cardiovascular Sciences and Research), Vamadevan S. Ajay(Centre for Chronic Disease Control), Kavita Singh(Centre for Chronic Disease Control), Pradeep A. Praveen(Centre for Chronic Disease Control), Raji Devarajan(Centre for Chronic Disease Control), Dimple Kondal(Centre for Chronic Disease Control), Divya Soni(Centre for Chronic Disease Control), Poppy Alice Carson Mallinson(London School of Hygiene & Tropical Medicine), Subhash C. Manchanda(Sir Ganga Ram Hospital), Kushal Madan(Sir Ganga Ram Hospital), Alun D. Hughes(MRC Unit for Lifelong Health and Ageing), Nishi Chathurvedi(MRC Unit for Lifelong Health and Ageing), Ian Roberts(London School of Hygiene & Tropical Medicine), Shah Ebrahim(London School of Hygiene & Tropical Medicine), Kolli S. Reddy(Public Health Foundation of India), Nikhil Tandon(All India Institute of Medical Sciences), Stuart Pocock(London School of Hygiene & Tropical Medicine), Ambuj Roy(All India Institute of Medical Sciences), Sanjay Kinra(London School of Hygiene & Tropical Medicine), Dorairaj Prabhakaran(Emory University), Sanjay Kinra(London School of Hygiene & Tropical Medicine), Nikhil Tandon(All India Institute of Medical Sciences), Subhash C. Manchanda(Sir Ganga Ram Hospital), Ajay Vamadevan S(Centre for Chronic Disease Control), Kolli Srinath Reddy(Public Health Foundation of India), Ian Roberts(London School of Hygiene & Tropical Medicine), Deepak Bhatnagar, Vivek Chaturvedi, Pablo Perel, Dorairaj Prabhakaran(Emory University), Sanjay Kinra(London School of Hygiene & Tropical Medicine), Neil Poulter, S Harikrishnan(MRC Unit for Lifelong Health and Ageing), R. M. Pandey, S Harikrishnan(MRC Unit for Lifelong Health and Ageing), Amitava Banerjee, Paramjit Gill, D.S. Chadha(Command Hospital), Ambuj Roy(All India Institute of Medical Sciences), Neil Bardoloi, Ambuj Roy(All India Institute of Medical Sciences), Subhash C. Manchanda(Sir Ganga Ram Hospital), Bishav Mohan(Dayanand Medical College & Hospital), Prakash Chand Negi(Indira Gandhi Medical College), Sanjeev Asotra, Prabhavati Bhat(Sri Jayadeva Institute of Cardiovascular Sciences and Research), Manjunath C. Nanjappa, Kanchanahalli Siddegowda Sadananda(Sri Jayadeva Institute of Cardiovascular Sciences and Research), Manya Prasad, Raghava Sarma, Kalpana Natrajan(Sir Ganga Ram Hospital), Srikumar Swaminathan, R. K. Tongia, S. Natarajan(MRC Unit for Lifelong Health and Ageing), Bhaskara Rao, Calambur Narasimhan, Jabir Abdullakutty, Srinivas Mallya, Anil Jain, Sudhir Naik, Nagraj Desai, Sunil Kumar, Shankar Patil, Satish G. Patil, D.S. Chadha(Command Hospital), Sharad Chandra(Centre for Chronic Disease Control), Nagamalesh Udigala Madappa
Journal of the American College of Cardiology
March 30, 2020
10.1016/j.jacc.2020.01.050
Cited by 102Open Access
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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 subgroups with poor uptake (e.g., women and elderly). OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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).

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