A Brief but Comprehensive Lifestyle Education Program Based on Yoga Reduces Risk Factors for Cardiovascular Disease and Diabetes Mellitus
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objectives:
The objective of the study was to study the short-term impact of a brief lifestyle intervention based on yoga on some of the biochemical indicators of risk for cardiovascular disease and diabetes mellitus.
Design:
The variables of interest were measured at the beginning (day 1) and end (day 10) of the intervention using a pre–post design.
Setting:
The study is the result of operational research carried out in our Integral Health Clinic (IHC). The IHC is an outpatient facility which conducts 8-day lifestyle modification programs based on yoga for prevention and management of chronic disease. A new course begins every alternate week of the year.
Subjects:
The study is based on data collected on 98 subjects (67 male, 31 female), ages 20–74 years, who attended one of our programs. The subjects were a heterogeneous group of patients with hypertension, coronary artery disease, diabetes mellitus, and a variety of other illnesses.
Intervention:
The intervention consisted of asanas (postures), pranayama (breathing exercises), relaxation techniques, group support, individualized advice, lectures and films on the philosophy of yoga and the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness.
Outcome measures:
The outcome measures were fasting plasma glucose and serum lipoprotein profile. These variables were determined in fasting blood samples, taken on the first and last day of the course.
Results:
Fasting plasma glucose, serum total cholesterol, low-density lipoprotein (LDL) cholesterol, very- LDL cholesterol, the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol, and total triglycerides were significantly lower, and HDL cholesterol significantly higher, on the last day of the course compared to the first day of the course. The changes were more marked in subjects with hyperglycemia or hypercholesterolemia.
Conclusions:
The observations suggest that a short lifestyle modification and stress management education program leads to favorable metabolic effects within a period of 9 days.
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Authors
Ramesh L. Bijlani
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Rama P. Vempati
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Raj K. Yadav
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Rooma Basu Ray
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Vani Gupta
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Ratna Sharma
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Nalin Mehta
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Sushil C. Mahapatra
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Journal
Journal of Alternative and Complementary Medicine
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Author's primary institution
Department of Physiology, All India Institute of Medical Sciences
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Obesity-related inflammation & cardiovascular disease: Efficacy of a yoga-based lifestyle intervention
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Obesity is a global health burden and its prevalence is increasing substantially due to changing lifestyle. Chronic adiposity is associated with metabolic imbalance leading to dyslipidaemia, diabetes, hypertension and cardiovascular diseases (CVD). Adipose tissue acts as an endocrine organ releasing several adipocytokines, and is associated with increased levels of tissue and circulating inflammatory biomolecules causing vascular inflammation and atherogenesis. Further, inflammation is also associated independently with obesity as well as CVD.
Keeping this in view, it is possible that a reduction in weight may lead to a decrease in inflammation, resulting in CVD risk reduction, and better management of patients with CVD. Lifestyle intervention has been endorsed by several health authorities in prevention and management of chronic diseases.
A yoga-based lifestyle intervention appears to be a promising option in reducing the risk for CVD as well as management of patients with CVD as it is simple to follow and cost-effective with high compliance. The efficacy of such lifestyle intervention programmes is multifaceted, and is achieved via reduction in weight, obesity-related inflammation and stress, thereby culminating into risk reduction towards several chronic diseases including CVD. In this review, the association between obesity-related inflammation and CVD, and the role of yoga-based lifestyle intervention in prevention and management of CVD are discussed.
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Authors
Kumar Sarvottam
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Raj Kumar Yadav
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Journal
Indian Journal of Medical Research
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Author's primary institution
Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objective:
To test whether rhythmic formulas such as the rosary and yoga mantras can synchronise and reinforce inherent cardiovascular rhythms and modify baroreflex sensitivity.
Design:
Comparison of effects of recitation of the Ave Maria (in Latin) or of a mantra, during spontaneous and metronome controlled breathing, on breathing rate and on spontaneous oscillations in RR interval, and on blood pressure and cerebral circulation.
Setting:
Florence and Pavia, Italy.
Participants:
23 healthy adults.
Main outcome measures:
Breathing rate, regularity of breathing, baroreflex sensitivity, frequency of cardiovascular oscillations.
Results:
Both prayer and mantra caused striking, powerful, and synchronous increases in existing cardiovascular rhythms when recited six times a minute. Baroreflex sensitivity also increased significantly, from 9.5 (SD 4.6) to 11.5 (4.9) ms/mm Hg, P<0.05.
Conclusion:
Rhythm formulas that involve breathing at six breaths per minute induce favourable psychological and possibly physiological effects.
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Authors
Laciano Bernardi
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Peter Sleight
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Gabriele Bandinelli
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Simone Cencetti
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Lamberto Fattorini
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Johanna Wdowczyc-Sulc
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Alfonso Lagi
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Author's primary institution
Dipartimento di Medicina Interna, Unitá Ospedaliera S Maria Nuova, 50100 Florence, Italy
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Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women.
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
AIMS OF STUDY:
To study effect of yoga on the physiological, psychological well being, psychomotor parameter and modifying cardiovascular risk factors in mild to moderate hypertensive patients.
METHODS:
Twenty patients (16 males, 4 females) in the age group of 35 to 55 years with mild to moderate essential hypertension underwent yogic practices daily for one hour for three months. Biochemical, physiological and psychological parameters were studied prior and following period of three months of yoga practices, biochemical parameters included, blood glucose, lipid profile, catecholmines, MDA, Vit. C cholinesterase and urinary VMA. Psychological evaluation was done by using personal orientation inventory and subjective well being.
RESULTS:
Results showed decrease in blood pressure and drug score modifying risk factors, i.e. blood glucose, cholesterol and triglycerides decreased overall improvement in subjective well being and quality of life. There was decrease in VMA catecholamine, and decrease MDA level suggestive decrease sympathetic activity and oxidant stress.
CONCLUSION:
Yoga can play an important role in risk modification for cardiovascular diseases in mild to moderate hypertension.
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Authors
A Damodaran
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A Malathi
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N Patil
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N Shah
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Suryavanshihi
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Marathe S
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Journal
The Journal of the Association of Physicians of India
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Author's primary institution
Bhabha Atomic Research Centre, Medical Division Mumbai.
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Risk Indices Associated with the Insulin Resistance Syndrome, Cardiovascular Disease, and Possible Protection with Yoga: A Systematic Review
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objective:
To conduct a systematic review of published literature regarding the effects of yoga, a promising mind-body therapy, on specific anthropometric and physiologic indices of cardiovascular disease (CVD) risk and on related clinical endpoints.
Methods:
We performed a literature search using 4 computerized English and Indian scientific databases. The search was restricted to original studies (1970 to 2004) evaluating the effects of yoga on CVD or indices of CVD risk associated with the insulin resistance syndrome (IRS). Randomized controlled trials (RCTs), nonrandomized controlled trials, uncontrolled (pre and post) clinical trials, and cross-sectional (observational) studies were included if they met specific criteria. Data were extracted regarding study design, setting, population size and characteristics, intervention type and duration, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria.
Results:
We identified 70 eligible studies, including 1 observational study, 26 uncontrolled clinical trials, 21 nonrandomized controlled clinical trials, and 22 RCTs. Together, the reported results of these studies indicate beneficial changes overall in several IRS-related indices of CVD risk, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation, and cardiovagal function, as well as improvement in several clinical endpoints.
Conclusions:
Collectively, these studies suggest that yoga may reduce many IRS-related risk factors for CVD, may improve clinical outcomes, and may aid in the management of CVD and other IRS-related conditions. However, the methodologic and other limitations characterizing most of these studies preclude drawing firm conclusions. Additional high quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs on specific indices of CVD risk and related clinical endpoints.
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Authors
Kim E. Innes
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Cherly Bourguignon
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Ann Gill Taylor
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Author's primary institution
Center for the Study of Complementary and Alternative Therapies, The Blake Center, Suite G113, PO Box 800905, University of Virginia Health Systems, Charlottesville
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Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition.
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
In participants of a comprehensive residential three month yoga and mediation training programme living on a low fat lacto-vegetarian diet changes in cardiovascular risk factors and hormones were studied.
Substantial risk factor reduction was found. Body mass index, total serum and LDL cholesterol, fibrinogen, and blood pressure were significantly reduced especially in those with elevated levels. Urinary excretion of adrenaline, noradrenaline, dopamine, aldosterone, as well as serumtestosterone and luteinizing hormone levels were reduced, while cortisol excretion increased significantly.
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Authors
Schmidt T
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Wijga A
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Von Zur Mühlen A
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Brabant G
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Wagner TO
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Journal
Acta Physiologica Scandinavica
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Author's primary institution
Department of Epidemiology & Social Medicine, Hannover Medical University, Germany
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Effect of yoga on cardiovascular system in subjects above 40 years
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
This study was conducted to examine the effect of yoga on cardiovascular function in subjects above 40 yrs of age. Pulse rate, systolic and diastolic blood pressure and Valsalva ratio were studied in 50 control subjects (not doing any type of physical exercise) and 50 study subjects who had been practicing yoga for 5 years.
From the study it was observed that significant reduction in the pulse rate occurs in subjects practicing yoga (P<0.001). The difference in the mean values of systolic and diastolic blood pressure between study group and control group was also statistically significant (P<0.01 and P<0.001 respectively). The systolic and diastolic blood pressure showed significant positive correlation with age in the study group (r1 systolic = 0.631 and r1 diastolic = 0.610) as well as in the control group (r2 systolic = 0.981 and r2 diastolic = 0.864). The significance of difference between correlation coefficient of both the groups was also tested with the use of Z transformation and the difference was significant (Zsystolic = 4.041 and Zdiastolic = 2.901). Valsalva ratio was also found to be significantly higher inyoga practitioners than in controls (P<0.001).
Our results indicate that yoga reduces the age related deterioration in cardiovascular functions.
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Authors
JYOTSANA R. BHARSHANKAR
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RAJAY N. BHARSHANKAR
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VIJAYKUMAR N. DESHPANDE
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SHOBA B. KAORE
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Journal
Indian Journal of Physiology and Pharmacology
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Author's primary institution
Department of Physiology, Govt. Medical College, Nagpur – 440 003
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Does practicing hatha yoga satisfy recommendations for intensity of physical activity which improves and maintains health and cardiovascular fitness?
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Background:
Little is known about the metabolic and heart rate responses to a typical hatha yoga session. The purposes of this study were 1) to determine whether a typical yoga practice using various postures meets the current recommendations for levels of physical activity required to improve and maintain health and cardiovascular fitness; 2) to determine the reliability of metabolic costs of yoga across sessions; 3) to compare the metabolic costs of yoga practice to those of treadmill walking.
Methods:
In this observational study, 20 intermediate-to-advanced level yoga practitioners, age 31.4 ± 8.3 years, performed an exercise routine inside a human respiratory chamber (indirect calorimeter) while wearing heart rate monitors. The exercise routine consisted of 30 minutes of sitting, 56 minutes of beginner-level hatha yoga administered by video, and 10 minutes of treadmill walking at 3.2 and 4.8 kph each. Measures were mean oxygen consumption (VO2), heart rate (HR), percentage predicted maximal heart rate (%MHR), metabolic equivalents (METs), and energy expenditure (kcal). Seven subjects repeated the protocol so that measurement reliability could be established.
Results:
Mean values across the entire yoga session for VO2, HR, %MHR, METs, and energy/min were 0.6 L/kg/min; 93.2 beats/min; 49.4%; 2.5; and 3.2 kcal/min; respectively. Results of the ICCs (2,1) for mean values across the entire yoga session for kcal, METs, and %MHR were 0.979 and 0.973, and 0.865, respectively.
Conclusion:
Metabolic costs of yoga averaged across the entire session represent low levels of physical activity, are similar to walking on a treadmill at 3.2 kph, and do not meet recommendations for levels of physical activity for improving or maintaining health or cardiovascular fitness. Yoga practice incorporating sun salutation postures exceeding the minimum bout of 10 minutes may contribute some portion of sufficiently intense physical activity to improve cardio-respiratory fitness in unfit or sedentary individuals. The measurement of energy expenditure across yoga sessions is highly reliable.
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Authors
Marshall Hagins
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Wendy Moore
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Andrew Rundle
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Journal
BMC Complementary & Alternative Medicine
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Author's primary institution
Mailman School of Public Health, Columbia University, 622 W. 168th St. New York, NY 10032, USA
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Mindfulness Meditation, Anxiety Reduction, and Heart Disease: A Pilot Study
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Heart disease is the leading cause of death among Americans each year, yet the misperception still exists that cardiovascular disease is not a serious health problem for women. Evidence indicates that anxiety contributes to the development of heart disease. The primary purpose of this study was to assess the effectiveness of Kabat-Zinn's mindfulness-based stress reduction program to reduce anxiety in women with heart disease. Anxiety, emotional control, coping styles, and health locus of control were compared in a treatment and control group of women with heart disease.
Post-intervention analyses provide initial support for beneficial effects of this program.
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Authors
Anna M Tacon
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Jacalyn McComb
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Yvonne Caldera
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Patrick Randolph
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Journal
Family & Community Health:
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Author's primary institution
The Department of Health, Exercise, and Sport Sciences, Texas Tech University, USA.
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Beneficial Effects of Yoga Lifestyle on Reversibility of Ischaemic Heart Disease : Caring Heart Project of International Board of Yoga
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objectives:
Yoga based lifestyle modifications have been earlier shown to be beneficial in coronary artery disease in a small number of patients. We evaluated the role of lifestyle modification based on Yoga techniques, stress management and dietary modifications in retardation of coronary artery disease.
Methods:
This prospective, controlled, open trial included angiographically proven coronary artery disease patients (71 patients in study group and 42 patients in control group). They were assessed clinically, by biochemical parameters, stress myocardial perfusion and function studies and coronary angiography and on psychological parameters. The study group patients were given a family based Yoga Programme which included, control of risk factors, dietary modifications and stress management for a period of one year. The patients were assessed at baseline, at frequent intervals and at the end of one year.
Results:
At the end of one year of yoga training, statistical significant changes (P<0.05) were found in serum total cholesterol (reduction by 23.3% in study group patients as compared to 4.4% in controls); serum LDL cholesterol (reduction of 26% in study group patients as compared to 2.6% in the control group), regression of disease (43.7% of study group patients v/s 31% control group on MPI and 70.4% of study group v/s 28% of control group on angiography) arrest of progression (46.5% study group v/s 33.3% control group on MPI) and progression (9.9% of study group vs 35.7% of controls on MPI, 29.6% of study group v/s 60.0% of controls on angiography). At the end of the study improvement in anxiety scores was concordant with the improvement seen in the MPI. No untoward effects of the therapy were observed.
Conclusion:
Yoga based lifestyle modifications help in regression of coronary lesions and in improving myocardial perfusion. This is translated into clinical benefits and symptomatic improvement.
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Authors
J Yogendra
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Hansaji J Yogendra
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S Ambardekar
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R D Lele
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S Shetty
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M Dave
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Naaznin Husein
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Author's primary institution
The Yoga Institute, Santacruz, Mumbai
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Yoga for secondary prevention of coronary heart disease
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Background
Coronary heart disease (CHD) is the major cause of early morbidity and mortality in most developed countries. Secondary prevention aims to prevent repeat cardiac events and death in people with established CHD. Lifestyle modifications play an important role in secondary prevention. Yoga has been regarded as a kind of physical activity as well as stress management strategy. Growing evidence suggests the beneficial effects of yoga on various ailments.
Objectives
To determine the effectiveness of yoga for secondary prevention of mortality, morbidity, and health related quality of life of patients with CHD.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (2012, Issue 1), MEDLINE (1948 to January 2012), EMBASE (1980 to January 2012), ISI Web of Science for conference proceedings (1970 to January 2012), China Journal Net (CJN) (1994 to March 2012), WanFang Data (1990 to March 2012), and HKInChiP (from 1980). Ongoing studies were identified in the metaRegister of Controlled Trials (April 2012) and the World Health Organization (WHO) International Clinical Trials Registry Platform (April 2012). No language restrictions were applied.
Selection criteria
We included randomized controlled trials (RCTs) investigating the influence of yoga practice on CHD outcomes. We included studies that had at least a six months follow-up period. Men and women (aged 18 years and above) with a diagnosis of acute or chronic CHD were included. We included studies with one group practicing a type of yoga compared to the control group receiving either no intervention or interventions other than yoga.
Data collection and analysis
Two authors independently selected studies according to the pre-specified inclusion criteria. Disagreements were resolved by consensus or discussion with a third author.
Main results
We found no eligible RCTs that met the inclusion criteria of the review and thus we were unable to perform a meta-analysis.
Author's conclusion
The effectiveness of yoga for secondary prevention in CHD remains uncertain. Large RCTs of high quality are needed.
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Authors
Joey SW Kwong, Hoi Lam Caren Lau, Fai Yeung, Pui Hing Chau, Jean Woo
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Author's primary institution
Chinese Evidence-Based Medicine Center, Chengdu, Sichuan, China
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Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Background
The aim of this review was to systematically assess and meta-analyze the effects of yoga on modifiable biological cardiovascular disease risk factors in the general population and in high-risk disease groups.
Methods
MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through August 2013 for randomized controlled trials (RCTs) on yoga for predefined cardiovascular risk factors in healthy participants, non-diabetic participants with high risk for cardiovascular disease, or participants with type 2 diabetes mellitus. Risk of bias was assessed using the Cochrane risk of bias tool.
Results
Forty-four RCTs with a total of 3168 participants were included. Risk of bias was high or unclear for most RCTs. Relative to usual care or no intervention, yoga improved systolic (mean difference (MD) = − 5.85 mm Hg; 95% confidence interval (CI) = − 8.81, − 2.89) and diastolic blood pressure (MD = − 4.12 mm Hg; 95%CI = − 6.55, − 1.69), heart rate (MD = − 6.59 bpm; 95%CI = − 12.89, − 0.28), respiratory rate (MD = − 0.93 breaths/min; 95%CI = − 1.70, − 0.15), waist circumference (MD = − 1.95 cm; 95%CI = − 3.01, − 0.89), waist/hip ratio (MD = − 0.02; 95%CI = − 0.03, − 0.00), total cholesterol (MD = − 13.09 mg/dl; 95%CI = − 19.60, − 6.59), HDL (MD = 2.94 mg/dl; 95%CI = 0.57, 5.31), VLDL (MD = − 5.70 mg/dl; 95%CI = − 7.36, − 4.03), triglycerides (MD = − 20.97 mg/dl; 95%CI = − 28.61, − 13.32), HbA1c (MD = − 0.45%; 95%CI = − 0.87, − 0.02), and insulin resistance (MD = − 0.19; 95%CI = − 0.30, − 0.08). Relative to exercise, yoga improved HDL (MD = 3.70 mg/dl; 95%CI = 1.14, 6.26).
Conclusions
This meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease.
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Authors
Holger Cramer, Romy Lauche, Heidemarie Haller, Nico Steckhan, Andreas Michalsen, Gustav Dobos
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Author's primary institution
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Introduction
Currently, several studies have assessed the effect of yoga training on the management of chronic obstructive pulmonary disease (COPD), but these studies involved a wide variation of sample and convey inconclusive results. Hence, the present study was performed a systematic review and meta-analysis to investigate the efficacy of yoga training in COPD patients.
Methods
PubMed, EMBASE, the Cochrane Library, Google Scholar, and ClinicalTrials.gov databases were searched for relevant studies. The primary outcomes were forced expiratory volume in one second (FEV1), FEV1% predicted (% pred). Secondary outcomes included 6-min walking distance (6 MWD), arterial oxygen tension (PaO2), and arterial carbon dioxide tension (PaCO2). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed with the I2 test.
Results
Five randomized controlled trials (RCTs) involving 233 patients fulfilled the inclusion criteria. Yoga training significantly improved FEV1 (WMD: 123.57 mL, 95% CI: 4.12-243, P=0.04), FEV1% pred (WMD: 3.90%, 95% CI: 2.27-5.54, P<0.00001), and 6 MWD (WMD: 38.84 m, 95% CI: 15.52-62.16, P=0.001). However, yoga training had no significant effects on PaO2 (WMD: 1.29 mmHg, 95% CI: –1.21-3.78, P=0.31) and PaCO2 (WMD: –0.76 mmHg, 95% CI: –2.06-0.53, P=0.25).
Conclusions
The current limited evidence suggested that yoga training has a positive effect on improving lung function and exercise capacity and could be used as an adjunct pulmonary rehabilitation program in COPD patients. However, further studies are needed to substantiate our preliminary findings and to investigate the long-term effects of yoga training.
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Authors
Xun Chao Liu, Lei Pan, Qing Hu, Wei-Ping Dong, Jun-Hong Yan, Liang Dong
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Journal
Journal of Thoracic Disease
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Author's primary institution
Department of Respiratory Medicine, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
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A systematic review of yoga for heart disease
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Background:
This systematic review of randomized controlled trials (RCTs) aimed to evaluate the quality of evidence and the strength of recommendation for yoga as an ancillary intervention for heart disease.
Methods:
Medline/PubMed, Scopus, the Cochrane Library, and IndMED were searched up to October 2013. Main outcome measures were mortality, nonfatal cardiac events, exercise capacity, health-related quality of life, and modifiable cardiac risk factors. Risk of bias, quality of evidence, and the strength of the recommendation for or against yoga were assessed according to the Cochrane Collaboration and GRADE recommendations.
Results:
Seven RCTs with 624 patients comparing yoga to usual care were included. For coronary heart disease (four RCTs), there was very low evidence for no effect on mortality, for a reduced number of angina episodes, and for increased exercise capacity, and low evidence for reduced modifiable cardiac risk factors. For heart failure (two RCTs), there was very low evidence for no effect on mortality, and low evidence for increased exercise capacity, and for no effect on health-related quality of life. For cardiac dysrhythmias treated with implantable cardioverter-defibrillator (one RCT), there was very low evidence for no effect on mortality, and for improved quality, and low evidence for effects on nonfatal device-treated ventricular events. Three RCTs reported safety data and reported that no adverse events occurred.
Conclusions:
Based on the results of this review, weak recommendations can be made for the ancillary use of yoga for patients with coronary heart disease, heart failure, and cardiac dysrhythmia at this point.
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Authors
Holger Cramer, Romy Lauche, Heidermarie Haller, Gustav Dobos, Andreas Michalsen
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Journal
European Journal of Preventive Cardiology
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Author's primary institution
Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Yoga for the primary prevention of cardiovascular disease
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Background
A sedentary lifestyle and stress are major risk factors for cardiovascular disease (CVD). Since yoga involves exercise and is thought to help in stress reduction it may be an effective strategy in the primary prevention of CVD.
Objectives
To determine the effect of any type of yoga on the primary prevention of CVD.
Search methods
We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11) in The Cochrane Library; MEDLINE (Ovid) (1946 to November Week 3 2013); EMBASE Classic + EMBASE (Ovid) (1947 to 2013 Week 48); Web of Science (Thomson Reuters) (1970 to 4 December 2013); Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database and Health Economics Evaluations Database (Issue 4 of 4, 2013) in The Cochrane Library. We also searched a number of Asian databases and the Allied and Complementary Medicine Database (AMED) (inception to December 2012). We searched trial registers and reference lists of reviews and articles, and approached experts in the field. We applied no language restrictions.
Selection criteria
Randomised controlled trials lasting at least three months involving healthy adults or those at high risk of CVD. Trials examined any type of yoga and the comparison group was no intervention or minimal intervention. Outcomes of interest were clinical CVD events and major CVD risk factors. We did not include any trials that involved multifactorial lifestyle interventions or weight loss.
Data collection and analysis
Two authors independently selected trials for inclusion, extracted data and assessed the risk of bias.
Main results
We identified 11 trials (800 participants) and two ongoing studies. Style and duration of yoga differed between trials. Half of the participants recruited to the studies were at high risk of CVD. Most of studies were at risk of performance bias, with inadequate details reported in many of them to judge the risk of selection bias.
No study reported cardiovascular mortality, all-cause mortality or non-fatal events, and most studies were small and short-term. There was substantial heterogeneity between studies making it impossible to combine studies statistically for systolic blood pressure and total cholesterol. Yoga was found to produce reductions in diastolic blood pressure (mean difference (MD) -2.90 mmHg, 95% confidence interval (CI) -4.52 to -1.28), which was stable on sensitivity analysis, triglycerides (MD -0.27 mmol/l, 95% CI -0.44 to -0.11) and high-density lipoprotein (HDL) cholesterol (MD 0.08 mmol/l, 95% CI 0.02 to 0.14). However, the contributing studies were small, short-term and at unclear or high risk of bias. There was no clear evidence of a difference between groups for low-density lipoprotein (LDL) cholesterol (MD -0.09 mmol/l, 95% CI -0.48 to 0.30), although there was moderate statistical heterogeneity. Adverse events, occurrence of type 2 diabetes and costs were not reported in any of the included studies. Quality of life was measured in three trials but the results were inconclusive.
Authors' conclusions
The limited evidence comes from small, short-term, low-quality studies. There is some evidence that yoga has favourable effects on diastolic blood pressure, HDL cholesterol and triglycerides, and uncertain effects on LDL cholesterol. These results should be considered as exploratory and interpreted with caution.
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Authors
Lousie Hartley, Mariana Dyakova, Jennifer Holmes, Aileen Clarke, Myeong Soo Lee, Edzard Ernst, Karen Rees
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Author's primary institution
Warwick Medical School, University of Warwick, Division of Health Sciences, Coventry, Warwickshire, UK
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Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Background
Blacks have disproportionately high rates of cardiovascular disease. Psychosocial stress may contribute to this disparity. Previous trials on stress reduction with the Transcendental Meditation (TM) program have reported improvements in cardiovascular disease risk factors, surrogate end points, and mortality in blacks and other populations.
Methods and Results
This was a randomized, controlled trial of 201 black men and women with coronary heart disease who were randomized to the TM program or health education. The primary end point was the composite of all-cause mortality, myocardial infarction, or stroke. Secondary end points included the composite of cardiovascular mortality, revascularizations, and cardiovascular hospitalizations; blood pressure; psychosocial stress factors; and lifestyle behaviors. During an average follow-up of 5.4 years, there was a 48% risk reduction in the primary end point in the TM group (hazard ratio, 0.52; 95% confidence interval, 0.29–0.92; P=0.025). The TM group also showed a 24% risk reduction in the secondary end point (hazard ratio, 0.76; 95% confidence interval, 0.51–0.1.13; P=0.17). There were reductions of 4.9 mmHg in systolic blood pressure (95% confidence interval −8.3 to –1.5 mmHg; P=0.01) and anger expression (P<0.05 for all scales). Adherence was associated with survival.
Conclusions
A selected mind–body intervention, the TM program, significantly reduced risk for mortality, myocardial infarction, and stroke in coronary heart disease patients. These changes were associated with lower blood pressure and psychosocial stress factors. Therefore, this practice may be clinically useful in the secondary prevention of cardiovascular disease.
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Authors
Robert H. Schneider, Clarence E. Grim, Maxwell V. Rainforth, Theodore Kotchen, Sanford I. Nidich, Caroyln Gaylord-King, John W. Salerno, Jane Morley Kotchen, Charles N. Alexander
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Journal
Circulation: Cardiovascular Quality and Outcomes
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Author's primary institution
Institute for Natural Medicine and Prevention, Maharishi University of Management, Fairfield, IA
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Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: a systematic review and meta-analysis of randomised controlled trials
Practice
- Yoga
- Meditation
- Mindfulness
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Abstract
Objective
To determine the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) on psychological and physical outcomes for people with vascular disease.
Design
Systematic review and meta-analysis of randomised controlled trials.
Data sources
AMED, CINAHL, EMBASE, British Nursing Index, Medline, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews, Central, Social Sciences Citation Index, Social Policy and Practice, and HMIC from inception to January 2013.
Review methods
Articles were screened for inclusion independently by two reviewers. Data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Random-effects meta-analyses were performed.
Results
Nine articles (from eight original randomised controlled trials) met eligibility criteria and were included in the final review. In total, 578 participants were enrolled across the trials, with participants presenting with prehypertension/hypertension (n = 3 trials), type 1 or 2 diabetes (n = 2), heart disease (n = 2) and stroke (n = 1). Meta-analyses, using standardised mean differences, showed evidence of reductions in stress (−0.36; 95% CI −0.67 to −0.09; p = 0.01), depression (−0.35; 95% CI −0.53 to −0.16; p = 0.003) and anxiety (−0.50; 95% CI −0.70 to −0.29; p < 0.001). Effects on physical outcomes (blood pressure, albuminuria, stress hormones) were mixed.
Conclusion
Whilst populations with vascular disease appear to derive a range of psychological benefits from MBSR/MBCT intervention, the effects on physical parameters of disease are not yet established. More robust studies, with longer term follow-up, are required to ascertain full effectiveness of such intervention.
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Authors
Rebecca A. Abbott, Rebecca Whear, Lauren R. Rodgers, Alison Bethel, Jo Thompson Coon, Willem Kuyken, Ken Stein, Chris Dickens
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Journal
Journal of Psychosomatic Research
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Author's primary institution
University of Exeter Medical School, Exeter EX2 4SG, United Kingdom
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Heart disease
Lizzie Reumont by KarenYeomans.com
