Evaluating the functional impact of yoga-based cardiac rehabilitation following percutaneous coronary intervention

Background Yoga may offer a holistic, accessible and sustainable approach to cardiac rehabilitation (CR). However, randomized data evaluating its role in patients with coronary artery disease (CAD) who have undergone percutaneous coronary intervention (PCI) is limited. The aim of this trial was to evaluate the efficacy of yoga-based cardiac rehabilitation compared to standard care in patients following PCI for acute or chronic coronary syndromes. Methods Adults who had recently undergone PCI for acute or chronic coronary syndrome were randomized to a structured yoga-based CR program (n = 98) or standard care (n = 102). The primary endpoint was a change in exercise capacity (maximally tolerated exercise duration on treadmill testing using Bruce protocol) at 6 months. Key secondary endpoints included patient reported quality of life assessed via the WHO-BREF tool, patient reported physical activity level measured using the International Physical Activity Questionnaire (IPAQ), and rates of major adverse cardiovascular and cerebrovascular events (MACCE). Results 200 patients with revascularized coronary artery disease with a median age of 53 years and male preponderance (87%, 174 male patients) were randomized to yoga-based rehabilitation or standard care. There was no significant difference in maximal exercise duration on treadmill testing at 6 months in the intention- to - treat analysis (7 [5, 8.2] vs. 6.32 [5.1, 8.1] minutes, p = 0.449). At 6 months, the yoga-based CR group demonstrated significant improvements in the domains of physical health (p < 0.001), psychological health (p < 0.001), and environment (p = 0.007) (WHO-BREF quality of life questionnaire), lower anxiety (p = 0.002) and stress scores (p = 0.024) and higher self-reported physical activity levels (median METS: 1697.5 [742.5, 2631.75] vs. 500.25 [0, 1027.12], p < 0.001). The Yoga-CR compliant group (per-protocol analysis) suggested better maximal exercise duration on treadmill testing (7.01 [4.41, 8.14] vs. 7.12 [6.28, 9.05] minutes, p = 0.03) at 6 months. Conclusion Yoga-based cardiac rehabilitation following percutaneous coronary intervention improved quality of life, self-reported physical activity, and psychological outcomes at 6 months compared with standard care. Although no significant improvement in exercise capacity was observed in primary intention-to-treat analysis, the findings support yoga-based cardiac rehabilitation as a complementary strategy to conventional cardiac rehabilitation, with intervention adherence appearing to be an important determinant of functional improvement. Trial registration The trial was prospectively registered with the Clinical Trials Registry of India (CTRI/2017/07/008951).