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

心脏康复规划旨在降低心脏病发作后死亡或患病的风险；为了帮助病人恢复健康和参与正常日常活动的能力。CR方案试图通过改善病人的身体素质、减轻压力水平和鼓励长期生活方式的改变（如戒烟、减少饮酒和健康饮食）来做到这一点。来自英国等发达国家的有力科学证据表明，企业责任项目在这方面是有效的。在发达国家，CR项目通常结合锻炼和教育课程，由包括护士、职业治疗师、医生、心理学家、药剂师、营养师和咨询师在内的大型多学科团队管理。然而，在印度等发展中国家，这往往被视为负担不起的奢侈品；因此，企业社会责任项目几乎不存在。瑜伽是一种传统的印度身心训练，其短期目标与CR项目相似（提高身体素质、减轻压力和改变生活方式），其传授方法也相似（结合运动教育课程）。然而，不需要一个庞大的多学科团队，只需要一个人：瑜伽老师。因此，在印度大规模实施以瑜伽为基础的企业社会责任项目可能更具成本效益。它也可能更符合文化。我们建议，以瑜伽为基础的CR计划的发展将在印度和英国的特定群体（如亚洲印度民族，妇女和老年人）中获得更大的接受度，这些群体目前对传统CR计划的接受率较低。该项目将结合两项互补研究：(i)在印度进行一项大型随机对照试验，以评估与标准治疗相比，专门设计的基于瑜伽的CR计划的有效性；（ii）在英国使用高科技运动实验室设备进行的对潜在生理机制的小型深入研究。我们还将调查以瑜伽为基础的CR方案与当前标准治疗的成本效益；如果发现有效，这些信息将对政策制定者在扩大干预方面大有用处。在印度进行的这项大型试验将从印度16家医院随机抽取4000名心脏病患者，让他们接受专门设计的基于瑜伽的CR治疗方案，或者接受标准治疗。患者将被随访一年，我们将比较两组的死亡人数、健康相关的生活质量以及随后的心脏病发作和中风。在英国，患者已经接受了CR。我们将随机选择80名患者，让他们在标准CR之外接受瑜伽课程，或者只是接受标准护理，并进行详细的生理和代谢测试，这一组成部分将使我们了解瑜伽如何对心脏健康有益。如果能够发挥作用，新的CR计划在实施后将大大节省两国的生命、生活质量和经济生产力。这项研究计划的第二个成果将是显著改善瑜伽对健康益处的潜在过程的科学知识基础，目前对此知之甚少。

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.