More than a few patients have told me they do not like exercise. (Gulp.) Three well-known facts make this tough to hear: exercise is essential for heart health; heart disease is the number one killer of men and women; and heart disease is largely avoidable.
For many people, the word “exercise” conjures up unpleasant images of stomping madly on a mechanical contraption, or racing numbly around a track, or turning breathless laps in a pool. But does exercise have to look or feel a certain way to improve heart-health? Could other forms of movement bring similar benefits?
Yoga, for instance, looks nothing like traditional aerobic exercise. And anyone who has practiced yoga knows it brings different sensations from, say, an indoor cycling class. The ancient Indian practice combines postural exercises, breathing techniques and meditation. Previous studies on yoga suggest that it can influence how the nervous system signals the heart—in a good and calming way. Could it be, then, that yoga creates heart-healthy changes in the body?
Yoga and cardiac risk factors:
A group of researchers set out to study whether yoga can modify traditional cardiac risk factors. They did what’s called a meta-analysis, in which smaller studies are combined to answer a larger question. They found 1404 studies on yoga – 37 were direct comparisons of yoga to either no exercise, or traditional aerobic exercise.
The results of yoga versus no exercise were clear. Compared to non-exercisers, those who practiced yoga sustained significant improvement in cardiac risk factors. On average, yogis lost 2.35 kg of body weight, lowered their blood pressure by 5 mm/hg, and improved their cholesterol profiles by reducing LDL and increasing HDL.
The more remarkable findings came when the researchers looked at how yoga compared to regular aerobic exercise. Namely, there was no difference. In nine studies, yoga practice was comparable to aerobic exercise for weight loss, blood pressure and cholesterol measures.
The authors of this study concluded that yoga could be heart healthy, but they also said an important caveat about their review was that each of the studies was small and a little different in methods. (Good on them.)
One way readers can decide whether a study’s findings are plausible is to look at how it compares to other work. Is the study an outlier, or is it confirming similar findings?
The Cochrane Collaboration, an independent network of researchers, recently published a review of yoga for the prevention of heart disease. They also found that yoga led to improvements in blood pressure, HDL cholesterol and triglycerides (fats). The Cochrane researchers emphasized that the degree of improvement in physical health from yoga will vary according to how (or how much) an individual practices.
These researchers comment specifically on physical health, but the obvious thing about yoga is that it is not just about the muscles and bones. Yoga, with its emphasis on breathing and mindfulness, may also provide less tangible benefits, such as how the brain and heart deal with stress. I often advise patients that, in the practice of medicine, it’s all connected in the human body.
Yoga and atrial fibrillation:
Atrial fibrillation is a common heart rhythm disease that affects millions of Americans. It shares many of the same risk factors (high blood pressure, obesity, stress) as traditional heart disease. A recent study suggests that AF, too, is largely a preventable lifestyle-related disease. The natural question arises as to whether yoga might help with AF?
Researchers from the University of Kansas enrolled 52 patients with AF into a study of twice-weekly yoga sessions for three months. They found yoga training produced significant benefits: episodes of heart rhythm disturbances decreased, depression and anxiety measures lessened and quality of life scores improved. Yoga also lowered blood pressure and heart rate in this study.
The take home:
Evidence is mounting that yoga produces many of the same benefits as traditional exercise: Lower blood pressure, better cholesterol numbers and a smoother heart rhythm. That is a lot to like. (Imagine if it was a new pill!) Surely it is safe to say yoga practice is better than no exercise, but whether one can entirely ditch aerobic exercise in favor of yoga will have to await further studies. These early signals suggest yoga is indeed a worthy area of health research.