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FIT Insights

Yoga-Based Cardiac Rehabilitation:

A Solution to Close the Global Health Gap

A simple form of exercise believed to have originated more than 5,000 years ago may hold promise as an alternative to conventional cardiac rehabilitation programs and a way to address the unmet needs of cardiac rehabilitation for patients in low- and middle-income countries. That’s the conclusion of a recent article in Circulation1 that details findings from the Yoga-CaRe trial presented Nov. 10, 2018 at AHA Scientific Sessions 2018 in Chicago, Ill.

The importance of preventative and cardiac rehabilitation programs is clear, given that cardiovascular disease now accounts for nearly 30 percent of deaths in low- and middle-income countries each year, and it is accompanied by a significant economic burden associated with morbidity and disability. In the last decade, there has been an emphasis on cardiac rehabilitation, which is a Class I indication in patients who have had myocardial infarction (MI), and is offered as part of the routine cardiac management in high-income countries.2 The New Delhi experience has much to teach us about the incorporation of community practices and the need to improve access to care for patients in low- and middle-income countries.

Prabhakaran D., MD, DM, et al., looked at 3959 patients from 24 cardiac centers across India, who were recruited after acute MI and were randomized to the Yoga-CaRe program. This is the largest trial to date looking at cardiac rehabilitation and the health benefits of yoga. The investigators found that, in patients with acute MI, yoga-based cardiac rehabilitation was safe, feasible and improved quality of life.

The program included 24 centers in India. The intervention consisted of 13 in-hospital sessions supervised by an instructor with encouragement to practice regularly at home – or enhanced standard care with three educational sessions.

The primary outcome of major adverse cardiovascular event and quality of life at 12 weeks was not different between the two groups. There were numerically fewer outcomes in the Yoga-CaRe group, but the difference was not statistically significant. The investigators highlighted that there was inadequate power to detect the planned difference due to lower event rate than estimated. However, improvement in the self-rated quality of life was significantly greater in the Yoga-CaRe group.


The conclusion of the study was that Yoga-CaRe has the potential to be an alternative to the conventional cardiac rehabilitation programs and addresses the unmet needs of cardiac rehabilitation for patients in low- and middle-income countries.

There are many variants of yoga practice currently, but three consistent elements: physical posture, breath regulation and meditation. These elements are also part of the foundation of cardiac rehabilitation. There are potential central and neuroendocrine pathways that are positively affected by the yoga practice. Yoga is increasingly popular and accessible; it can be tailored to different individuals who tend to vary greatly in their mind-set and physical capacities. There’s considerable need for a cardiac rehab program so seemingly practical. Even in high-income countries, utilization of cardiac rehab is 25-35%, and there is poor adherence among the elderly and females.

Adaptation is a public health priority at the global and local levels. We should harness field experience and innovation with an emphasis on problem-solving to address prevalent health problems. Knowledge must be leveraged effectively to bridge the know-do gap and achieve better health outcomes.

The debate needs to move from the question of what constitutes evidence to problem-solving in policy and practice. Finding unique practices acclimated with the culture and practice of a place may be key to successful delivery of health programs that address the challenges of time, resources, and patient compliance. This research showcases a feasible, practical solution. Validation of local resources to provide better outcomes is the gift that the authors have provided to medical knowledge.

To reduce the impact of cardiovascular disease, we must carefully assess the needs of the target population, the state of current efforts, the available capacity and infrastructure, and the political will to support action. When we find practical, effective solutions, we should leverage them. This trial reveals the therapeutic benefits of easily accessible yoga, and its impact in India may be used as an example for similar societies worldwide as well as in high-income societies where yoga is, or could become, a mainstream trend.


Estefania Oliveros, MD

Dr. Estefania Oliveros specializes in cardiovascular disease at Rush University Medical Center in Chicago, Illinois. She volunteers extensively for the AHA FIT and ACC WIC programs.


  1. Kuehn, BM. Large trial finds yoga boosts quality of life and return to activity and adds to emerging evidence for rehabilitation alternatives. Circulation 2019. Mar 11; 139:1451–1453.
  2. Thomas RJ, Balady G, Banka G, Beckie TM, Chiu J, Gokak S, Ho PM, Keteyian SJ, King M, Lui K, Pack Q, Sanderson BK, Wang TY. 2018 ACC/AHA clinical performance and quality measures for cardiac rehabilitation: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol. 2018. Apr 24;71(16):1814-1837.