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Yoga-based cardiac rehabilitation offers mixed results after MI

CHICAGO – A yoga-based cardiac rehabilitation program was safe and improved quality of life after a myocardial infarction (MI) but…

CHICAGO – A yoga-based cardiac rehabilitation program was safe and improved quality of life after a myocardial infarction (MI) but failed to offer significant clinical gains in a randomized India study.

Yoga is becoming more popular all over the world and has the potential to be a cheap alternative to conventional rehabilitation programs, told the author Dorairaj Prabhakaran, MD, DM, Center for Chronic Disease Control, New Delhi, India, theheart.org | Medscape Cardiology .

“In the United States, minority people, women and elderly do not take up conventional rehabilitation because they are difficult, especially physical activity,” he said. “So we can introduce some of the milder poses, meditations and breathing exercises, which they can find more acceptable.”

The study was presented at a late science session here at the American Heart Association (AHA) 201

8 Scientific Sessions.

Surveyors at 24 centers in India randomly assigned 3959 patients within 14 days from acute MI to 14 weeks of Yoga-CaRe intervention or improved standard care with three training and printed brochures provided by nurse or cardiovascular staff.

Yoga-CaRe consisted of lifestyle training, three health-friendly exercises and breathing / mediation training and 15 yoga classes are delivered for 13 weeks by trained yoga instructors, with their own training at home for the last week. [19659002] Three quarters of the patients had a ST segment elevation MI, and almost one third had high blood pressure or diabetes or were present smokers. Their average age was 53.4 years.

There was a high standard for contemporary cardiac care in both arms, Prabhakaran noted, with nearly 60% of patients undergoing percutaneous coronary intervention, 98.5% receiving antiplatelet, 84% double treatment with the antiplatelet, 93% statins and approximately 50% angiotensin converting enzyme inhibitor / angiotensin receptor blockers.

After 42 months, 6.7% of the Yoga-CaRe group and 7.3% of the controls experienced the primary total endpoint of dead, non-fatal MI, nonfatal stroke, and acute cardiovascular hospital care. The difference failed to reach statistical significance in an intent-to-treat analysis (risk factor [HR] 0.91, 95% confidence interval [CI] 0.72-1.15).

The analysis was underpowered to detect differences because less than half the number of estimated events occurred, said Prabhakaran, who also noted that post-MI care improved in India during the study.

In one per protocol analysis of 1059 patients who completed at least 10 Yoga-CaRe sessions, the number of primary endpoint events was almost halved (HR, 0.54, 95% CI, 0.38 – 0.76, logrank P <.001).

Self-assessed quality of life, measured by the mean change in EQ-5D Visual Analog Scale score at 3 months, favored the Yoga-CaRe group significantly over controls (10.7 vs 9.2; P = .002).

Patients practicing yoga were more likely to return to daily activities ( P <.001) and to achieve up to six health states Tes ( P = .04) but were as likely to stop smoking ( P = .11) or to achieve high medical adhesion ( P .52).

Was it a fair comparator?

Invited counselor Vera Bittner, MD, University of Alabama, Birmingham, said that the yoga intervention was well-defined, but that the improved standard care effort had much fewer contacts with the study staff

“This may have affected the quality of life and also the return to previous activities , because we know from heartbeat settings that encouragement from staff can actually play a big part in these measurements, “she said. 19659016] There was also no physical activity in the control arm, which raised the question of whether the observed group differences are yoga-specific and whether similar results could be achieved with a home-run program.

Regarding the generalisability of results, Bittner said it is unclear whether they should translate into MI populations in other settings or to sick patients considering the young age of patients, low proportion of women and low cardiovascular event rates.

Adherence to the yoga intervention by only 53% increases in addition to whether the adhesion would be worse outside the clinical trial setting.

Furthermore, yoga intervention studies must compare the standard in-center or home-based cardiac rehabilitation, “concluded Bittner.

“What we missed here is a comparison with our traditional evidence-based protocols of Heartbeat vs Yoga,” past the AHA president Donna Arnett, MSPH, PhD, University of Kentucky College of Public Health, Lexington, theheart.org | Medscape Cardiology . “Seeing that comparison would be a good next step in this research.”

Heart rehabilitation is one of the best proven programs available to prevent secondary infarction for people in post-MI settings, but is very underutilized, she concluded.

“I think what we need to better understand right now is why we have so low upheaval in our population,” Arnett said. “Perhaps yoga would be less threatening to a post-MI attitude than a heartbeat with traditional methods, but we still need that comparison.”

She said, “In low and middle income countries, this might be a good solution.”

After showing the safety and feasibility of yoga in the post-MI setting, Prabhakaran said they wanted to expand intervention to heart failure. “The heart failure population is growing and a new study in India showed that 50 percent of patients were killed in five years,” he said in an interview.

Whether yoga can be a cheap alternative, rather than just an addition to standard cardiac rehabilitation, he added: “It can replace it, but it would be a hope for a country like the United States, who has many years of experience in cardiac rehabilitation.”

The trial was funded by the Indian Council for Medical Researh (India) and the Medical Research Council (UK). Prabhakaran, Arnett and Vittner reported no relevant conflicts of interest.

American Heart Association (AHA) 2018 scientific sessions. Summary 19546. Presented November 10, 2018.

Follow Patrice Wendling on Twitter: @pwendl . For more from theheart.org | Medscape Cardiology, follow us on Twitter and Facebook.

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