Effect of Yoga-Based Cardiac Rehabilitation Program on Endothelial Function, Oxidative Stress, and Inflammatory Markers in Acute Myocardial Infarction: A Randomized Controlled Trial.

Aims: The aim of this study was to evaluate the effects of yoga-based cardiac rehabilitation (Yoga-CaRe) on the endothelial system, oxidative stress, and inflammatory markers in patients with acute myocardial infarction (MI). Methods: A sub-study was conducted in two clinical sites of the Yoga-CaRe trial (a multicenter randomized controlled trial). Participants with acute MI were randomized and allocated to either the Yoga-CaRe program (13 sessions with encouragement to home practice) or enhanced standard care (three educational sessions). Endothelial function, oxidative stress, and inflammatory biomarkers were assessed using biomarkers such as asymmetric dimethylarginine (ADMA), endothelial nitric oxide synthase (eNOS), endothelin-1 (ET-1), E-selectin, P-selectin, vascular cell adhesion molecule (VCAM), intercellular cell-adhesion molecule-1, total nitric oxide concentration (NOx), oxidized low-density lipoprotein (Oxd-LDL), superoxide dismutase, total antioxidant capacity (TAOC), tumor necrosis factor-alpha (TNFα), and C-reactive protein (CRP) at baseline and 12 weeks. Laboratory and statistical analysis were done by staff blinded to group allocation. Results: Eighty-two patients (of the 110 patients recruited) completed the study. The mean age was 53.1 ± 10.6 and 51.9 ± 10.7 years in enhanced standard care and Yoga-CaRe group, respectively. At 12 weeks, Yoga-CaRe significantly reduced ADMA, ET-1, and ICMA-1 than the enhanced standard care group. Although E-selectin and VCAM at 12 weeks were reduced in both groups, enhanced standard care had a significantly higher reduction than the Yoga-CaRe group. Among markers of oxidative stress, TAOC increased in the Yoga-CaRe group. We found no difference in eNOS, NOx, P-selectin, TNFα, CRP, and Oxd-LDL between the two groups. Conclusion: Yoga-CaRe improved the endothelial function (through a reduction in ET-1 and modulating adhesion molecules) and enhanced antioxidant capacity.

Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure.

OBJECTIVE: Arterial aging along with increased blood pressure(BP) has become the major cardiovascular(CV) risk in elderly. The aim of the study was to compare the effects of yoga program and walking-exercise on cardiac function in elderly with increased pulse pressure (PP). METHODS: An open label, parallel-group randomized controlled study design was adopted. Elderly individuals aged ≥60 years with PP≥60mmHg were recruited for the study. Yoga (study) group (n=30) was assigned for yoga training and walking (exercise) group (n=30) for walking with loosening practices for one hour in the morning for 6days in a week for 3 months. The outcome measures were cardiac time intervals derived from pulse wave analysis and ECG: resting heart rate (RHR), diastolic time(DT), ventricular ejection time(LVET), upstroke time(UT), ejection duration index (ED%), pre-ejection period (PEP), rate pressure product (RPP) and percentage of mean arterial pressure (%MAP). RESULTS: The mean within-yoga group change in RHR(bpm) was 4.41 (p=0.031), PD(ms): -50.29 (p=0.042), DT(ms): -49.04 (p=0.017), ED%: 2.107 (p=0.001), ES(mmHg/ms): 14.62 (p=0.118), ET(ms): -0.66 (p=0.903), UT(ms): -2.54 (p=0.676), PEP(ms): -1.25 (p=0.11) and %MAP: 2.08 (p=0.04). The mean within-control group change in HR (bpm) was 0.35 (p=0.887), PD (ms): 11.15(p=0.717), DT (ms): 11.3 (p=0.706), ED%: -0.101 (p=0.936), ES (mmHg/ms): 0.75 (p=0.926), ET(ms): 2.2 (p=0.721), UT(ms):4.7(p=455), PEP (ms): 2.1(p=0.11), %MAP: 0.65 (p=0.451). A significant difference between-group was found in RHR (p=0.036), PD (p=0.02), ED% (p=0.049), LVET (p=0.048), DT (p=0.02) and RPP (p=0.001). CONCLUSIONS: Yoga practice for 3 months showed a significant improvement in diastolic function with a minimal change in systolic function. Yoga is more effective than walking in improving cardiac function in elderly with high PP.

Effect of yoga on arterial stiffness in elderly subjects with increased pulse pressure: A randomized controlled study.

OBJECTIVE: We aimed to determine the effect of yoga on arterial function in elderly with increased pulse pressure (PP). DESIGN: Randomized controlled study with two parallel groups. PARTICIPANTS: Elderly subjects with PP≥60 mmHg (n=60). INTERVENTIONS: Yoga group (n=30) was assigned for yoga training and brisk-walking (BW) group (n=30) for brisk-walk with stretching exercise for 1h in the morning for 6 days in a week for 12 weeks. MAIN OUTCOME MEASURES: Arterial stiffness measures: Brachial-ankle pulse wave velocity (baPWV), Carotid-femoral pulse wave velocity (c-f PWV), aortic augmentation index (AIx@75), arterial stiffness index at brachial (bASI) and tibial arteries (aASI). Total serum nitric oxide concentration (NOx) as an index of endothelial function. Heart rate variability (HRV) measures: Low frequency and high frequency in normalized units (LFnu, HFnu) and LF/HF ratio. RESULTS: The mean between-group change (with 95% CI) in arterial stiffness: c-f PWV(m/s) [1.25(0.59-1.89); p<0.001], baPWV(m/s) [1.96(0.76-3.16), p<0.01], AIx@75 [3.07(0.24-5.89), p=0.066], aASI [8.3(4.06-12.53), p<0.001]; endothelial function index: NO(µmol/L) [-9.03(-14.57 to -3.47), p<0.001]; SBP(mmHg) [14.23(12.03-16.44), p<0.001], DBP(mmHg) [0.1(-1.95-2.15), p=0.38], PP(mmHg) [14.07(11.2-16.92), p<0.001], MAP(mmHg) [4.7(3.08-6.32), p<0.001]; and cardiac autonomic function: LF(nu) [4.81(1.54-8.08), p<0.01], HF(nu) [-4.13(-7.57 to -0.69), p<0.01], LF/HF ratio [0.84(0.3-1.37), p<0.001], indicate significant difference in effects of two intervention on arterial stiffness, endothelial function, BP and cardiac autonomic activity. There was significant change within-yoga group in vascular function, BP and autonomic function, while no significant change within-BW group was observed. CONCLUSION: Our findings suggest that yoga program offered was more effective than brisk-walk in reducing arterial stiffness along with BP in elderly individuals with increased PP. Yoga can also significantly reduce sympathetic activity and improve endothelial function with enhancement in bioavailability of NO.