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CHICAGO -- Yoga-based cardiac rehabilitation seemed to improve clinical outcomes in patients, and may help MI patients return to normal activity, according to a researcher here.

In a multi-center randomized controlled trial, self-rated quality of life data showed improvements for the yoga-based cardiac rehab (yoga-CaRe) group from baseline to 3 months. For Enhance Standard Care (ESC) participants, there was a mean change in EQ-5D VAS score of 9.2 (95% CI 8.4-10.1), while the yoga-care participants had a mean change in EQ-5D VAS score of 10.7 (95% CI 9.9-11.5, P=0.002 for both groups), reported Dorairaj Prabhakaran MD, DM, of the Public Health Foundation of India in New Delhi at the American Heart Association (AHA) annual meeting.

Among the 1,989 ESC participants, the primary outcomes were the time to occurrence of first cardiac event, which included composite of 77 deaths, 15 nonfatal MIs, three nonfatal strokes, and 59 emergency cardiac admissions. Among the 1,970 yoga-CaRe participants, the same primary outcomes were measured along with the occurrence of first cardiac event, including 78 deaths, 13 nonfatal MIs, five nonfatal strokes, and 48 emergency cardiovascular hospitalizations, he stated.

Cardiac rehabilitation is a class I indication for patients after they have MI and has become a key aspect of cardiac care in higher-income countries, Prabhakaran noted.

But cardiac rehab, "is virtually non-existent" in low- to middle-income countries because of its high cost and need for a multidisciplinary approach. Even in high-income countries, cardiac rehab is generally only implemented 25%-35% of the time as women and older patients tend to prefer simple, gender-appropriate approaches, Prabhakaran stated.

"In India, need for developing a low-cost, culturally acceptable and effective cardiac rehabilitation -- a need that would be filled by yoga-CaRe should it prove to be efficacious," he said.

A indicated that there were no randomized controlled trials that looked at yoga outcomes related to cardiac events, death, and health-related quality of life. As a result, there is limited information on the details of the effectiveness of yoga for prevention in select coronary heart disease outcomes, highlighting the need for more research, said AHA discussant Vera Bittner, MD, MSPH, of University of Alabama at Birmingham.

"We can consider the yoga-CaRe trial a true landmark in this area of research," Bittner said.

The researchers assessed 3,959 patients (mean age 53.4). Among the ESC patients, 14.1% were female, as were 13.8% of yoga-CaRe patients.

Of the ESC patients, 62.1% underwent revascularization, 98.5% used antiplatelet therapy, 83.5% used dual antiplatelet therapy, 49.4% used ACE inhibitors/angiotensin II receptor blockers (ARB), 62.6% took beta-blockers, and 93.2% took statins.

Of the yoga-CaRe participants, 60.7% underwent revascularization, 98.5% used antiplatelet therapy, 84.3% used dual antiplatelet, 51.4% used ACE/ARB, 62.6% took beta-blockers, and 93.2% took statins.

The Yoga-CaRe intervention consisted of education on lifestyle, mediation, and breathing; yoga training session two times per week for weeks 5-7; full weekly yoga sessions for weeks 8-13; and yoga at home for weeks ≥14.

The ESC group received standard care: a brochure, delivered by clinician either individually or in group setting, and three informational sessions before hospital discharge and at weeks 5 and 12.

For intention-to-treat (ITT) analysis, the secondary outcomes at 3 months showed a change in health states EQ-5D-0.03 (95% CI-0.19-0.13. P=0.72) for the unadjusted regression coefficient, and return to pre-infarct daily activities 1.17 (95% CI 0.11-2.23, P<0.001).

For ITT analysis, other secondary outcomes at 3 months were the unadjusted odds ratio for health states (≤6) of 1.16 (95% C 1.01-1.34, P=0.04), tobacco cessation (OR 1.14, 95% CI 0.89-1.46, P=0.11), and high compliance to medication (OR 1.04, 0.91-1.19; P=0.52).

"Yoga-CaRe has the potential to be an alternative to the conventional [cardiac rehab] programs and address the unmet needs of cardiac rehabilitation for patients in low- and middle-income countries," Prabhakaran said.

Bittner highlighted the study limitations, which included the inclusion of young patients and very few women, and the low cardiovascular event rate among patients. Also, the ESC patients had less contact with the study staff than did yoga patients.

She also noted that there was no exercise intervention for the ESC group, limited compliance among the yoga participants, and there were no report on adverse events or injuries resulting from the yoga intervention.

Future research questions that should be looked at include how Yoga-CaRe fares against in-center or home-based cardiac rehab, or if the program could be incorporated into existing treatment protocols, Bittner stated.