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Gathright EC, Hughes JW, Sun S, Storlazzi LE, DeCosta J, Balletto BL, Carey MP, Scott-Sheldon LAJ, Salmoirago-Blotcher E. Effects of stress management interventions on heart rate variability in adults with cardiovascular disease: a systematic review and meta-analysis. J Behav Med 2024; 47:374-388. [PMID: 38478157 DOI: 10.1007/s10865-024-00468-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 04/19/2024]
Abstract
Meta-analysis was used to investigate the potential benefits of stress management interventions (SMIs) on vagally-mediated heart rate variability (HRV) in adults with cardiovascular disease. Electronic bibliographic databases were searched through August 2022. Randomized controlled trials and quasi-experimental studies assessing effects of SMIs on HRV were included. Methodological quality was assessed with a standardized checklist. A pooled effect size was calculated for vagally-mediated HRV indices (standard deviation of normal-to-normal intervals, root mean square of the successive differences, and high frequency power) using random effects models. Fourteen studies (1202 participants, Mage: 59 ± 6.25 years; 25% ± 16% women; 61% ± 22% White) were included. Ten studies (11 effects) reported short-term HRV assessment; a small between-group difference emerged for vagally-mediated HRV (d+ = .27, 95% confidence interval [CI] 0.01-0.52, k = 11). Most interventions examined biofeedback; these studies yielded a small between-group difference on vagally-mediated HRV (d+ = 0.31, 95% CI 0.09-0.53, k = 7, Q [6] = 3.82, p = .70, I2 = 11%). This is the first systematic examination of the effect of SMIs on HRV in adults with CVD. Findings suggest a small effect of SMIs on vagally-mediated HRV, with biofeedback likely driving the effect. More research is required to fully understand whether this benefit on vagally-mediated HRV applies to other SMIs.
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Affiliation(s)
- Emily C Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Shufang Sun
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Laurie E Storlazzi
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Julie DeCosta
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Brittany L Balletto
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Lori A J Scott-Sheldon
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Elena Salmoirago-Blotcher
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
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Okada K, Shimatani K. Effect of olfactory stimulation from aromatherapy on the autonomic nervous activity during aerobic exercises. Sci Rep 2024; 14:11198. [PMID: 38755393 PMCID: PMC11099183 DOI: 10.1038/s41598-024-61732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
Variations in the autonomic nervous system activity during exercise therapy in patients with cardiovascular diseases may lead to adverse events. Aromatherapy may reduce these adverse events by enhancing parasympathetic nervous activity (PNA). However, the effects of aromatherapy during exercise remain relatively unknown. This study aimed to evaluate the effect of aromatherapy on autonomic nervous activity during exercise and recovery. This randomized crossover study included 20 healthy men subjected to both aroma and placebo conditions which involved rest and moderate-intensity aerobic exercise on a cycle ergometer, followed by recovery. Blood pressure, heart rate variability indices, and SpO2 were measured during the rest, exercise, and recovery phases. Moreover, aroma preferences and emotional changes in response to the aroma were assessed. Under the placebo condition, high frequency (HF), root mean square of successive differences indices, and heart rate showed delayed recovery (P < 0.05). Furthermore, a moderate positive correlation was identified between aroma preference, pleasant emotions induced by aromatherapy, and the HF index (P < 0.05). These results indicate that aromatherapy facilitates the recovery of PNA after exercise. Furthermore, these effects were more pronounced among individuals who exhibited a stronger preference for and more positive emotions toward aromas.
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Affiliation(s)
- Katsuki Okada
- Ehime Prefectural Imabari Hospital, Imabari, Ehime, 794-0006, Japan
| | - Koji Shimatani
- Prefectural University of Hiroshima, Mihara, Hiroshima, 723-0053, Japan.
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3
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Loewenthal JV, Farkas EJ, McGough K, Tomita B, Wayne PM, Orkaby AR. The impact of yoga on aging physiology: A review. J Nutr Health Aging 2024; 28:100005. [PMID: 38388108 DOI: 10.1016/j.jnha.2023.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 02/24/2024]
Abstract
Frailty represents diminished reserve across multiple physiologic systems, accompanied by increased vulnerability to stressors and increased morbidity and mortality. With population aging, strategies to prevent and manage frailty are priorities in clinical medicine and public health. Current evidence-based approaches to frailty management are multimodal in nature. Yoga, an increasingly popular and highly adaptable mind-body practice, is multi-component, incorporating physical postures, breathing practices, meditation, and other elements, and may be a strategy for frailty management. Here, we summarize the evidence linking yoga practice to mitigation of age-related degradation across multiple physiologic systems, including cardiovascular, pulmonary, musculoskeletal, and nervous systems. We discuss putative mechanisms of action including modulation of the hypothalamic-pituitary-adrenal axis. Finally, we consider implications for clinical practice and future research.
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Affiliation(s)
- Julia V Loewenthal
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Eva J Farkas
- Tufts University School of Medicine, Boston, MA, USA
| | - Katherine McGough
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | | | - Peter M Wayne
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA; Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ariela R Orkaby
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Prabhu S, Annapoorna K, Devasia T, Paramasivam G, Nayak K, Shetty L, Singh A, Samanth J. Yoga as an adjuvant therapy in heart failure patients on optimal medical management analysed using echocardiographic parameters. Explore (NY) 2023; 19:736-742. [PMID: 36878773 DOI: 10.1016/j.explore.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/06/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Heart failure (HF) is a chronic complex disease that prevails as a prime cause of concern for healthcare sectors worldwide, with a concordant objective to improve the long-term prognosis. Analysis of the available literature is evidence that yoga therapy and basic lifestyle modifications have considerably augmented heart failure patients' quality of life and enhanced left ventricular ejection fraction and NYHA functional class. AIM Our study aims to establish the long-term outcomes of yoga therapy to validate the addition of yoga therapy as a complementary treatment in managing HF. METHODS A prospective non-randomized study was conducted at a tertiary care center including seventy-five HF patients with NYHA class III or less who underwent coronary intervention, revascularization, or device therapy within the past six months to one year and continuing guideline-directed optimal medical therapy (GDMT). Thirty-five participants were part of the Interventional Group (IG), and forty were in the Non-Interventional Group (Non-IG). The IG received yoga therapy and GDMT, while the non-IG were only under standard GDMT. Echocardiographic parameters were compared at various follow-ups up to one year to see the impact of Yoga therapy on HF patients. RESULTS A total of 75 heart failure patients, including 61 males and 14 females. The IG and non-IG had 35 subjects (31 males and 4 females) and 40 subjects (30 males and 10 females), respectively. Echocardiographic parameters were observed to compare the IG and Non-IG groups, and those did not demonstrate any significant difference between the two groups (p-value > 0.05). But, the echocardiographic parameters of the IG and non-IG from baseline to six months and one year showed a significant improvement (p-value of <0.05). The functional outcome (NYHA classes) was assessed after follow-up, and a p-value <0.05 showed a substantial improvement in the IG. CONCLUSION Yoga therapy results in better prognosis, functional outcome, and left ventricular performance in HF patients with NYHA III or less. Hence this investigation has attempted to justify its importance as adjuvant/complimentary treatment for HF patients.
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Affiliation(s)
- Sridevi Prabhu
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K Annapoorna
- Division of Yoga, Centre for Integrative Medicine and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Lavya Shetty
- Division of Yoga, Centre for Integrative Medicine and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ajit Singh
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyothi Samanth
- Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Christa E, Srivastava P, Chandran DS, Jaryal AK, Yadav RK, Roy A, Deepak KK. Effect of Yoga Based Cardiac Rehabilitation on Blood Pressure Variability and Baroreflex Sensitivity: RCT in Patients Post MI. Appl Psychophysiol Biofeedback 2023; 48:1-15. [PMID: 36318438 DOI: 10.1007/s10484-022-09561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 02/09/2023]
Abstract
To assess the effects of 12 weeks Yoga based Cardiac Rehabilitation program on Blood Pressure Variability and Baroreflex Sensitivity in Eighty patients post myocardial infarction. Randomized controlled trial with two parallel groups. A tertiary care institution in India. The Yoga group received 13 hospital-based structured yoga sessions in adjunct to the standard care. Control Group participants received enhanced standard care involving three brief educational sessions on importance of diet and physical activity. Beat to beat arterial pressure variability and baroreflex sensitivity was determined non-invasively. Baseline measurement was done at 3 weeks post Myocardial Infarction. The measurements were repeated at 13th week and at 26th week post MI. There was no significant difference between the groups in time domain indices of SBP variability. At 26th week post MI, after normalization the Low Frequency power increased in the yoga group as compared to the decrease in the standard care group (p = 0.02). Though the High Frequency power increased in both the groups, the magnitude of increase was higher in the standard care group (p = 0.005). However, the total power increased significantly in yoga group with a concurrent decrease in standard care group (p = < 0.001). The SBP All BRS was significantly different between the groups with an increase in the yoga group and a decline in standard care group (p = 0.003) at 13th week. A short-term Yoga based cardiac rehabilitation has additive effects in improving baroreflex sensitivity and dampening blood pressure variability post myocardial infarction in patients under optimal medication.The main trial is registered in Clinical Trials Registry-India (CTRI) (Ref. No: CTRI/2012/02/002408). In addition, CTRI has also been registered for the sub-study. (Ref. No: CTRI/2017/09/009925).
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Affiliation(s)
- Edmin Christa
- Autonomic & Vascular Function Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.,Department of Manipulative Therapy, Government Yoga and Naturopathy Medical College & Hospital, Chennai, Tamil Nadu, India
| | - Prachi Srivastava
- Autonomic & Vascular Function Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dinu S Chandran
- Autonomic & Vascular Function Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Autonomic & Vascular Function Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Yadav
- Autonomic & Vascular Function Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- Autonomic & Vascular Function Laboratory, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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Ismail AMA, Abd Elfatah Abo Saif HF, El-Moatasem Mohamed AM. Effect of Jyoti-Trataka on intraocular pressure, autonomic control, and blood glucose in diabetic patients with high-tension primary open-angle glaucoma: a randomized-controlled trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:1013-1018. [PMID: 34303323 DOI: 10.1515/jcim-2021-0041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/15/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Yoga is used as a complementary therapy to control the symptomatic and complicated consequences of type 2 diabetes mellitus (T2DM) but the effect of Jyoti-Trataka yoga (gazing steadily at a 4-feet away-fixed candle flame) on the intraocular pressure (IOP), autonomic control, and fasting blood glucose (FBG) in T2DM patients with high-tension primary open-angle glaucoma (POAG) was not previously investigated. This study aimed to search the effect of Jyoti-Trataka on IOP, systolic blood pressure (SBP), respiratory rate (RR), diastolic blood pressure (DBP), FBG, and pulse rate (PR) in T2DM patients with bilateral high-tension POAG. METHODS The patients with a 52- to 67-year range and body mass index below 30 kg/m2 were randomly assigned to one of two 30-patient groups, study or control groups. Besides the administered oral hypoglycemic drugs by both groups, the study group only received one month of daily 55-min Jyoti-Trataka session. RESULTS A significant decrease (p<0.05) was identified after the comparison between the pre and post SBP, RR, DBP, FBG, IOP of both eyes, and PR in the study group while the control group exhibited no significant changes of all measures (p>0.05). In-favor-of the study group, the between-group post-treatment comparison showed a significant improvement of all measures (p<0.05). CONCLUSIONS Jyoti-Trataka is a good yogic complementary therapy that can be used to regulate autonomic functions, blood glucose, and IOP in T2DM patients with high-tension POAG.
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Affiliation(s)
- Ali Mohamed Ali Ismail
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Alaa Mohamed El-Moatasem Mohamed
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Kalra S, Miraj M, Ajmera P, Shaik RA, Seyam MK, Shawky GM, Alasiry SM, Mohamed EH, Alasiri HM, Alzhrani M, Alanazi A, Alqahtani M, Shaikh AR, Al-Otaibi ML, Saleem S, Pal S, Jain V, Ahmad F. Effects of Yogic Interventions on Patients Diagnosed With Cardiac Diseases. A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:942740. [PMID: 35990980 PMCID: PMC9386118 DOI: 10.3389/fcvm.2022.942740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Presently, evidence-based research studies on the efficacy of complimentary therapies like yoga for patients with different cardiac diseases are limited and conflicting. The objective of this study is to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on yogic interventions compared with usual care or non-pharmacological treatment in patients diagnosed with cardiac diseases. Methods We conducted an electronic search of literature published from 2006 to May 2021 through five databases. PRISMA statement was used to develop and report a systematic review and meta-analysis protocol. Sixteen RCTs were included in the systematic review and 11 RCTs were used for meta-analysis. Outcome measures were blood pressure, lipid profile, and psychosocial measures. The Cochrane collaboration tool was used to assess bias risk. Results The results show that yogic interventions resulted in significant reduction in systolic (d = 046; 95% CI.08–0.84; I2 = 81.86%) and diastolic blood pressures (d = 0.56; 95% CI.13–0.99, I2 = 84.84%). A medium statistically significant increase in HDL (d =0.67; 95% CI 0 to 1.33; I2 79.7%) and a low but significant effect on LDL (d = 0.23; 95% CI −0.08–0.54; I2 32.61%), total cholesterol (d =0.28; 95% CI −0.14–0.7; I2 63.72%), and triglycerides (d = 0.43; 95% CI −0.1–0.97; I2 76.64%) were observed. Pooled effect sizes showed a medium to low statistically significant effect on psychosocial indicators viz., QoL, stress, anxiety, and depression. Conclusion The meta-analysis found strong evidence of effectiveness of yogic interventions on lipid profile, blood pressure, and psychosocial outcomes in patients with diagnosed cardiac diseases.
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Affiliation(s)
- Sheetal Kalra
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Mohammad Miraj
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
- *Correspondence: Mohammad Miraj
| | - Puneeta Ajmera
- School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Riyaz Ahamad Shaik
- Department of Community Medicine/Public Health, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Mohamed K. Seyam
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Ghada M. Shawky
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Sharifa M. Alasiry
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Elsayed H. Mohamed
- Department of Physical Therapy, Buraydah Private Colleges, Buraydah, Saudi Arabia
| | - Hatim M. Alasiri
- Department of Internal Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
- College of Applied Medical Sciences, Al Maarefa University, Riyadh, Saudi Arabia
| | - Abdul Raheem Shaikh
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Mohammad Lafi Al-Otaibi
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Shakir Saleem
- Department of Public Health, College of Health Science, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Sajjan Pal
- Faculty of Physiotherapy, SGT University, Gurugram, India
| | | | - Fuzail Ahmad
- Department of Physiotherapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
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Bruce C, Achan V, Rathore S. Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease. Vasc Health Risk Manag 2021; 17:779-789. [PMID: 34880621 PMCID: PMC8648328 DOI: 10.2147/vhrm.s286928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Coronary artery disease carries a high morbidity and mortality worldwide, and exercise-based cardiac rehabilitation programmes play a large role in secondary prevention. Exercise-based rehabilitation programmes are expensive, and in certain subgroups uptake is poor. Yoga has been suggested to show improvements in cardiovascular health which would support its use in cardiac rehabilitation programmes. We carried out a review of current randomized controlled trials to determine if yoga-based cardiac rehabilitation leads to reduced cardiac risk factors, and improved physiological and psychological outcomes in patients with coronary artery disease compared to standard care. Six randomized controlled studies were identified after a medical database search, and meta-analysis was carried out for the different outcomes. Overall, the addition of yoga to standard care resulted in improved subjective feeling of cardiac health and quality of life. There was also a trend towards improvement in left ventricular systolic function. Improvement in cardiac risk factors, MACE and psychological health in this cohort has still to be proven, but was not inferior to standard or enhanced care, and the benefits became more pronounced at longer follow-up. Future studies with longer follow-up and larger patient numbers would aid in accurately assessing the long-term benefit of yoga-based rehabilitation.
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Affiliation(s)
- Charo Bruce
- Department of Cardiology, Frimley Park Hospital, Frimley, Surrey, UK
| | - Vinod Achan
- Department of Cardiology, Frimley Park Hospital, Frimley, Surrey, UK
| | - Sudhir Rathore
- Department of Cardiology, Frimley Park Hospital, Frimley, Surrey, UK
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Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021; 11:CD001800. [PMID: 34741536 PMCID: PMC8571912 DOI: 10.1002/14651858.cd001800.pub4] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
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Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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11
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Mamataz T, Uddin J, Ibn Alam S, Taylor RS, Pakosh M, Grace SL. Effects of cardiac rehabilitation in low-and middle-income countries: A systematic review and meta-analysis of randomised controlled trials. Prog Cardiovasc Dis 2021; 70:119-174. [PMID: 34271035 PMCID: PMC9187522 DOI: 10.1016/j.pcad.2021.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the effectiveness of cardiac rehabilitation (CR) in low- and middle-income countries (LMICs), given previous reviews have included scant trials from these settings and the great need there. METHODS Six electronic databases (PubMed, Medline, Embase, CINAHL, Cochrane Library, and APA PsycINFO) were searched from inception-May 2020. Randomised controlled CR (i.e., at least initial assessment and structured exercise; any setting; some Phase II) trials with any clinical outcomes (e.g., mortality and morbidity, functional capacity, risk factor control and psychosocial well-being) or cost, with usual care (UC) control or active comparison (AC), in acute coronary syndrome with or without revascularization or heart failure patients in LMICs were included. With regard to data extraction and data synthesis, two reviewers independently vetted identified citations and extracted data from included trials; Risk of bias was assessed using Cochrane's tool. Certainty of evidence was ascertained based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. A random-effects model was used to calculate weighted mean differences and 95% confidence intervals (CI). RESULTS Twenty-six trials (6380 participants; 16.9% female; median follow-up = 3 months) were included. CR meaningfully improved functional capacity (VO2peak vs UC: 5 trials; mean difference [MD] = 3.13 ml/kg/min, 95% CI = 2.61 to 3.65; I2 = 9.0%); moderate-quality evidence), systolic blood pressure (vs UC: MD = -5.29 mmHg, 95% CI = -8.12 to -2.46; I2 = 45%; low-quality evidence), low-density lipoprotein cholesterol (vs UC: MD = -16.55 mg/dl, 95% CI = -29.97 to -3.14; I2 = 74%; very low-quality evidence), body mass index (vs AC: MD = -0.84 kg/m2, 95% CI = -1.61 to -0.07; moderate-quality evidence; I2 = 0%), and quality of life (QoL; vs UC; SF-12/36 physical: MD = 6.05, 95% CI = 1.77 to 10.34; I2 = 93%, low-quality evidence; mental: MD = 5.38, 95% CI = 1.13 to 9.63; I2 = 84%; low-quality evidence), among others. There were no evidence of effects on mortality or morbidity. Qualitative analyses revealed CR was associated with lower percutaneous coronary intervention, myocardial infarction, better cardiovascular function, and biomarkers, as well as return to life roles; there were other non-significant effects. Two studies reported low cost of home-based CR. CONCLUSIONS Low to moderate-certainty evidence establishes CR as delivered in LMICs improves functional capacity, risk factor control and QoL. While more high-quality research is needed, we must augment access to CR in these settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO (CRD42020185296).
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Bethune 222B, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Jamal Uddin
- Department of Cardiac Surgery, Ibrahim Cardiac Hospital & Research Institute (ICHRI), Shahbag, Dhaka, Bangladesh
| | - Sayed Ibn Alam
- Videncenter for Rehabilitering og Palliation REHPA, University of South Denmark, Nyborg, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, School of Medicine, Dentistry & Nursing, University of Glasgow, UK
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Bethune 368, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
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12
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Abstract
PURPOSE OF REVIEW To summarize recent innovations in cardiac rehabilitation and provide a view towards the future of cardiac rehabilitation as it adjusts to the pressures of a global pandemic. RECENT FINDINGS Although cardiac rehabilitation has been shown to result in a mortality benefit, research continues to enumerate the benefits of cardiac rehabilitation to patient function and quality of life in a growing range of cardiovascular diseases. In addition, new methodologies and new models of cardiac rehabilitation have emerged with the goal of increasing patient referral and participation. SUMMARY Cardiac rehabilitation continues to evolve and adapt to serve a growing and diversifying number of patients with cardiovascular disease with the goal of both decreasing mortality and improving patient function.
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13
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Murphy BM, Zaman S, Tucker K, Alvarenga M, Morrison-Jack J, Higgins R, Le Grande M, Nasis A, Jackson AC. Enhancing the appeal of cardiac rehabilitation for women: development and pilot testing of a women-only yoga cardiac rehabilitation programme. Eur J Cardiovasc Nurs 2021; 20:633-640. [PMID: 33748850 DOI: 10.1093/eurjcn/zvab008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022]
Abstract
AIMS Despite its demonstrated benefits, cardiac rehabilitation (CR) attendance, and completion is suboptimal, particularly in women. The aims of this study were (i) to develop and pilot test a women-only yoga-based CR programme (the Women's Yoga CR Programme; WYCRP); (ii) to investigate programme acceptability; and (iii) to investigate attendance and completion of the WYCRP and continuation to Phase III community-based CR. METHODS AND RESULTS Women eligible for CR at a tertiary hospital in Melbourne, Australia were recruited. Over a 6-month period in 2019, they were offered the WYCRP or usual CR. The WYCRP involved attendance at a 1-h yoga session following the usual 1-h mixed-sex education session, over a 7-week period. Participants completed pre- and post-programme questionnaires and attended focus groups to assess programme acceptability. Rates of attendance, completion, and continuation for the WYCRP were recorded and compared to those for the standard CR programme offered in 2018. In total, 27 women were eligible for the study and attended the initial CR assessment. Of those, 22 (81%) attended the WYCRP, 1 (4%) attended usual CR, and 4 (15%) did not attend CR. Ratings of programme acceptability were consistently positive; qualitative comments highlighted both physical and emotional benefits. While attendance at the WYCRP was not significantly higher than for usual CR the previous year (81% vs. 76%; P = 0.40), CR completion, and continuation were (95% vs. 56%; P = 0.02, and 72% vs. 12%; P < 0.001, respectively). CONCLUSION This pilot study has demonstrated that women-only yoga-based CR is appealing to women and can improve women's CR completion and continuation. These preliminary findings support further development of women-only and yoga-based CR options.
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Affiliation(s)
- Barbara M Murphy
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia.,Department of Psychology, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Zaman
- MonashHeart, Monash Health, Clayton, VIC, Australia.,Monash Cardiovascular Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kim Tucker
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Marlies Alvarenga
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Jenni Morrison-Jack
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Ihana Yoga Centre, St Kilda, VIC, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia.,Centre on Behavioural Health, University of Hong Kong, Pok Fu Lam, Hong Kong
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14
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Prabhakaran D, Chandrasekaran AM, Singh K, Mohan B, Chattopadhyay K, Chadha DS, Negi PC, Bhat P, Sadananda KS, Ajay VS, Singh K, Praveen PA, Devarajan R, Kondal D, Soni D, Mallinson P, Manchanda SC, Madan K, Hughes AD, Chathurvedi N, Roberts I, Ebrahim S, Reddy KS, Tandon N, Pocock S, Roy A, Kinra S. Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial. J Am Coll Cardiol 2020; 75:1551-1561. [PMID: 32241371 PMCID: PMC7132532 DOI: 10.1016/j.jacc.2020.01.050] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
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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Affiliation(s)
- Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | | | - Kalpana Singh
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Kaushik Chattopadhyay
- London School of Hygiene and Tropical Medicine, London, United Kingdom; The University of Nottingham, Nottingham, United Kingdom
| | | | | | - Prabhavathi Bhat
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | | | - Vamadevan S Ajay
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Pradeep A Praveen
- Centre for Chronic Disease Control, New Delhi, India; All India Institute of Medical Sciences, New Delhi, India
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - Divya Soni
- Centre for Chronic Disease Control, New Delhi, India
| | - Poppy Mallinson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Nishi Chathurvedi
- MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Ian Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ambuj Roy
- All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Zhao M, Guan L, Wang Y. The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies. Front Neurol 2020; 10:1411. [PMID: 32038467 PMCID: PMC6987371 DOI: 10.3389/fneur.2019.01411] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022] Open
Abstract
Acute ischemic stroke, especially minor stroke, and transient ischemic attack have high risks of recurrence and exacerbation into severe ischemic strokes. It remains challenging to perform risk stratification and screen high-risk groups for initiation of early treatment in these patients. Moreover, with the growing population of patients with chronic small vessel disease, the mechanisms and clinical implications require further investigation. Traditional tools such as the ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) have only moderate predictive value in patients with transient ischemic attack or minor stroke. By contrast, measurement of changes in heart rate variability (HRV) is an important and novel tool for risk stratification and outcome prediction in patients with cardiovascular diseases, as it reflects the overall level of autonomic nervous system dysfunction. Thus, abnormal HRV may be useful for prognosis and improve stratification of stroke patients with diverse risks. HRV may also partially explain autonomic nervous dysfunction and other manifestations during the process of chronic cerebral small vessel disease. In summary, measurement of HRV may contribute to early initiation of interventions in acute or chronic stroke patients using novel treatments involving rebalancing of autonomic nervous system function.
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Affiliation(s)
- Mengxi Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling Guan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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16
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Xing Y, Yang SD, Wang MM, Feng YS, Dong F, Zhang F. The Beneficial Role of Exercise Training for Myocardial Infarction Treatment in Elderly. Front Physiol 2020; 11:270. [PMID: 32390856 PMCID: PMC7194188 DOI: 10.3389/fphys.2020.00270] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022] Open
Abstract
Worldwide, elderly people have a higher prevalence of myocardial infarction (MI), which is associated with body function aging and a sedentary lifestyle. In addition to medication, exercise training is a well-established supplementary method to prevent and treat cardiovascular diseases (CVDs). Substantial evidence has shown the value of different intensity exercise programs in the prevention and treatment of MI, and exercise rehabilitation programs are also applicable to elderly patients with MI. Although exercise rehabilitation programs could significantly improve function, quality of life (QoL), and lower mortality and morbidity for people with MI, such programs are underused because their mechanisms are not accurately elucidated. To promote the application of exercise therapy for MI, this review summarizes the benefits and mechanisms of exercise rehabilitation for post-MI patients and provides rationalized proposals for outpatient cardiac rehabilitation.
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Affiliation(s)
- Ying Xing
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Si-Dong Yang
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Man-Man Wang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Shuo Feng
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fang Dong
- Department of Clinical Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Provincial Orthopedic Biomechanics Key Laboratory, The Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Feng Zhang,
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