Development and evaluation of a yoga-based cardiac rehabilitation programme (Yoga-CaRe) for secondary prevention of myocardial infarction

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Cardiac rehabilitation (CR) programmes aim to reduce the risk of death or illness following a heart attack; in order to help the patient regain their health and ability to participate in normal day-to-day activities. CR programmes attempt to do this by improving the physical fitness of the patient, reducing stress levels and encouraging long-term lifestyle changes (such as quitting smoking, reducing alcohol consumption and eating a healthy diet). There is strong scientific evidence from developed countries, such as the UK, to show that CR programmes are effective in doing this.In developed countries, CR programmes are usually delivered as a combination of exercise and educational sessions, run by large multi-disciplinary teams including nurses, occupational therapists, doctors, psychologists, pharmacists, dieticians and counsellors. However, in developing countries such as India this is often regarded as an unaffordable luxury; as a result CR programmes are virtually non-existent.The practice of yoga, a traditional Indian mind-body discipline has similar short term objectives to a CR programme (improved physical fitness, stress reduction and lifestyle change) and a similar method of delivery (combined exercise-education sessions). However, instead of a large multi-disciplinary team only one individual is needed: the yoga teacher. A yoga-based CR programme is therefore likely to be more cost-effective to deliver on a large-scale in the Indian setting. It is also likely to be more culturally appropriate. We suggest that the development of a yoga-based CR programme will have greater acceptability both in India and also amongst particular groups in the UK (such as Asian Indian ethnic groups, women and the elderly) who currently have a low rate of uptake of traditional CR programmes.This project will combine two complementary studies: (i) a large randomised controlled trial in India to evaluate the effectiveness of a specially designed yoga-based CR programme compared to standard care; (ii) a smaller in-depth study of the underlying physiological mechanisms, carried out in the UK using high-tech exercise laboratory facilities. We will also investigate the cost effectiveness of the yoga-based CR package compared to current standard care; such information will be of great use to policymakers in scaling up the intervention if found to be effective.The large trial in India will randomise 4000 heart attack patients from 16 hospitals in India to receive either a specially designed yoga-based CR package or to receive standard care. Patients will be followed up for one year and we will compare the number of deaths, health-related quality of life and subsequent heart attacks and strokes in the two groups. In the UK patients already get CR. We will randomise 80 patients to get yoga classes in addition to their standard CR, or to just to receive standard care and carry out detailed physiological and metabolic tests, this component will allow us to understand how yoga may have beneficial effects on heart health.If found to work, the new CR programme will on implementation lead to considerable savings in lives, quality of life and economic productivity in both countries. A second outcome of this research programme will be a markedly improved scientific knowledge base on the processes underlying the health benefits of yoga, about which little is currently known.