With benefits to body and mind, doctors now say yoga may help people wanting to change their lifestyle to prevent heart diseases and even those who have had a heart attack. Like other forms of exercise, yoga not only improves strength, muscle tone and balance but, with practices like pranayama and meditation, it can help the body relax, bring down the blood pressure and promoting mental wellbeing, according to Dr Ambuj Roy, professor of cardiology at the All India Institute of Medical Sciences, New Delhi.

A 2020 randomised control trial by several heart specialists in India and the UK, including Dr Roy, attempted to study the impact of yoga in rehabilitating those who had suffered a heart attack.

While the study with nearly 4,000 participants from 24 centres in India could not demonstrate that yoga significantly reduced major cardiovascular events afterwards — 6.7 per cent of those who did yoga suffered another cardiovascular event afterwards as compared to 7.4 per cent receiving standard care — it showed that yoga could be at least as effective in the absence of proper rehabilitation facilities. It was also shown to improve the quality of life of the participants.

Dr Roy said, “If we look at the penetration of cardiac rehabilitation in the country, it is not very high. This is because it is very resource-intensive, both in terms of trained people and machines needed. Usually, cardiac rehabilitation facilities will have machines like treadmills and cycles where patients can gradually increase their activities under careful monitoring. But, with these facilities not available in most places, yoga that can be done and monitored by a trained person at a healthcare facility can help people get back to their normal life.” He said now study participants are being followed over a longer period to see the extent of the impact of yoga on heart functioning.

How yoga is an effective intervention

Dr Dorairaj Prabhakaran, director of the Centre for Chronic Disease Control in Delhi, who was also part of the study, said that the team is looking at studying the impact of yoga in 3,600 heart failure patients.

“When we talk of yoga, it is not just the poses. Yoga includes meditation and pranayama that have an impact on heart health. The practice promotes a yogic lifestyle with regular exercise, no smoking, no drinking, and a healthy satvik diet. All of these translate into lifestyle interventions for a healthy heart,” he said.

First, practising yoga can affect the pituitary gland, reducing the production of stress hormones like cortisol that can help keep blood pressure in check. Second, it can help regulate the autonomic nervous system that controls involuntary actions like heart rate, blood pressure and respiration.

Dr Prabhakaran explained, “There are two types of responses of the autonomic nervous system — the parasympathetic system, which regulates all these responses during a normal rest stage, and a sympathetic system that controls these responses during a fight or flight situation. While the fight or flight responses were very important when man was under threat from predators, the mechanism tends to over-react in modern day scenarios thinking of harmless activities as dangerous. Practices like yoga can help convert some of these sympathetic responses to parasympathetic ones, which are good for the heart because a fight or flight response leads to the heart beating faster.”

He said yoga keeps renin levels in check. Renin is an enzyme that controls the blood pressure and maintains healthy levels of sodium and potassium and hence is good for the kidneys.

Yoga reduces inflammation in the body, which is a major driver of heart attack. “I recommend that people practise yoga along with brisk walking in their day to day lives to maintain a healthy heart,” he added.

Easy routines to follow

Breath exercises collectively known as pranayama have their benefits but which ones should heart patients practise? Says yoga expert Kamini Bobde, “If doing pranayama after a heart diagnosis, then do avoid Anulom Vilom, or alternate nostril breathing, and Kumbhak or breath retention. The recommended pranayama practices are Ujjayi, which is a diaphragmatic breath and Bhramari, where you breathe in while blocking your ears and make a humming sound before expelling the air through your nose. The sound helps you focus better.”

After a couple of months of these simple practices, a heart patient, said Bobde, can do Shashank asana or the rabbit pose asana. “Sit with your hands resting on your knees. Relax the body, inhale deeply, straighten your arms over your head, then, with exhalation, drop your body forward from the waist so that the hips remain resting on your heels while keeping your arms straight and finally resting on the floor in front. In the final position, your forehead will be resting on the floor with arms stretched out. Remain in the rabbit pose for as long as it is comfortable or for a minimum of five rounds of gentle inhalation and exhalation. Finally, with inhalation sit back with hands over the head and then finally lower it on your knees. Makrasana involves a gentle backward bending practice, which improves lung functioning, thereby affecting the heart and strengthening the lower back. Then there is the Naukasana that allows a good stretch. Follow these up with Shavasana. As for the composite benefit and heart-protective practice of Suryanamaskar, it is better for preventive purposes and maintaining heart health,” she says.

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