Yoga as secondary prevention and cardiac rehabilitation in myocardial infarction

Funding Acknowledgements Type of funding sources: None. Introduction The prevalence of coronary artery disease is racing at a fast pace. The risk factors of myocardial infarction are old age, male sex, previous MI , diabetes, hypercholesterolemia, hypertension, unhealthy diet , smoking , physical inactivity and psychosocial stress. Interventional and pharmacological approaches are accessible these days for reduction of mortality and morbidity in myocardial infarction. Yoga as a compliment is inexpensive and devoid of side effects which has been shown to reduce body weight, blood pressure, cholesterol, blood sugar & improve physical and mental well being due to relative parasympathetic excess. Many studies performed earlier had small sample size and duration. Therefore, yoga is affordable and can be recommended along with conventional treatment to prevent and improve the outcome in MI cases. Purpose 1. To study the effect of yoga on risk factors following myocardial infarction. 2. To study the effect of yoga on Beck's Depression Inventory score. Methods Our study that comprised of 300 patients were randomized into test group (n=150) who were subjected to conventional treatment and yoga and control group (n=150) subjected to conventional treatment only. The study included patients diagnosed as myocardial infarction above 18 years with their consent to participate. Patients with hemodynamic instability, heart failure, pregnancy, prior yoga practice, arrhythmia ,cardiac pacemaker, autonomic neuropathy and musculoskeletal disease were excluded. Initially, assessment of clinical & biochemical parameters and routine investigations were performed. Beck's depression score was calculated. Yoga was started on 4th day after MI (test group) and there were sessions of 10 minutes of pranayam , 15 minutes of shavasan and 15 minutes of transcendental meditation. The patients were followed after 24 weeks for assessment of clinical & biochemical parameters. Carotid doppler & depression score was evaluated. The primary outcome included change in risk factors from baseline to the end of study period and secondary outcome was change in Beck's Depression score. Results After 24 weeks of intervention, a significant improvement was noted among yoga group in comparison to control group for BMI (p=0.04), heart rate (p=0.01), systolic & diastolic blood pressure (p<0.05), fasting & post prandial blood sugar (p<0.05), HbA1c (p=0.03), Beck's depression score (p=0.001) and lipid profile (p<0.05).In contrast, no improvement was seen for carotid intima media thickness. Conclusion On the basis of the study, it was concluded that conventional therapy with yoga has a positive impact on risk factors of MI and psychosocial stress. Therefore, yoga can be recommended to reduce morbidity and mortality after MI. Large trials with more number of cases and long term follow up are needed so that yoga as an intervention, can be added for secondary prevention and rehabilitation in myocardial infarction cases.