Impact of Yoga on cardiovascular system beyond physical training: An updated review
Abstract
Background
Cardiovascular diseases are one of the most dreaded ailments in both the developing and developed nations. Their morbidity, mortality and economic toll is unparalleled. The importance of primary prevention of these diseases, in the form of lifestyle modification remains the most favored approach to reduce the disease burden and the same has been echoed by most of the recent guidelines. Herein lies the role of yoga.
Main body
Yoga is an ancient practice dating back thousands of years, with its origin in the Harrapan and Mohenjo-Daro civilizations. It has many physical and spiritual aspects. Hatha yoga which comprises of physical movements and breathing techniques is commonly practiced nowadays. The usefulness and health benefits of yoga have recently come to the fore, and are a subject of ongoing research, even in the Western world. Yoga has been shown to be beneficial in both primary and secondary prevention of diseases, especially cardiovascular diseases, and their risk factors. Our study aims to review the physiology of yoga, the recent studies on its effect on prevention and control of cardiovascular diseases, and the clinical implications of the same.
Conclusions
Emerging evidence points to the significant positive alterations of yoga at the physiological and neurohormonal level leading to overall improvement in health. At a time when the world is focussing on the importance of lifestyle modifications and looking for ways to reduce the pill-burden and polypharmacy, yoga seems to provide a compelling solution. In our review, we bring together an amalgamated evidence surrounding yoga and discuss approaches for its incorporation in real-world setting. Most of the recent evidence surrounding yoga has been included here and our interpretation and conclusions discussed.
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6. Foy AJ, Mandrola JM. Heavy Heart: The Economic Burden of Heart Disease in the United States Now and in the Future. Prim Care. 2018 Mar;45(1):17–24.
7. Kumar V. Review of ancient history of yoga. Int J Appl Res. 2017 Mar; (5):656-8
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9. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011;4(2):49–54.
10. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med N Y N. 2010 Jan;16(1):3–12.
11. Riley K, Park C. How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry. Health Psychol Rev. 2015 Jan 3;9:1–30.
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13. Michalsen A, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit Int Med J Exp Clin Res. 2005 Dec;11(12):CR555-561.
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33. Telles S, Sharma SK, Yadav A, Singh N, Balkrishna A. A comparative controlled trial comparing the effects of yoga and walking for overweight and obese adults. Med Sci Monit Int Med J Exp Clin Res. 2014 May 31;20:894–904.
34. Sharma S, Bhardwaj S, Jangir S, Gupta B. Influence of yoga on status of lipid indices in type 2 diabetes mellitus subjects. Int J Diabetes Dev Ctries. 2020 Sep 1;40(3):410–5.
35. Shantakumari N, Sequeira S, El deeb R. Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart J. 2013 Mar;65(2):127–31.
36. Gordon L, McGrowder DA, Pena YT, Cabrera E, Lawrence-Wright M. Effect of exercise therapy on lipid parameters in patients with end-stage renal disease on hemodialysis. J Lab Physicians. 2012 Jan;4(1):17–23.
37. Reaven GM. Role of Insulin Resistance in Human Disease. Diabetes. 1988 Dec 1;37(12):1595–607.
38. Lemieux I, Després JP. Metabolic Syndrome: Past, Present and Future. Nutrients. 2020 Nov 14;12(11):3501.
39. Khan S, Agarwal R, Memon S. Comparison of Effect of Yoga versus Aerobic Exercise on Waist Circumference, Waist-Hip Ratio and Body Mass Index in Overweight and Obese Adult Individuals. Kathmandu Univ Med J. 2022;77(1):38-42
40. Jakicic JM, Davis KK, Rogers RJ, Sherman SA, Barr S, Marcin ML, et al. Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial. Obesity. 2021;29(3):512–20.
41. Unick JL, Dunsiger SI, Bock BC, Sherman SA, Braun TD, Wing RR. A preliminary investigation of yoga as an intervention approach for improving long-term weight loss: A randomized trial. PLOS ONE. 2022 Feb 4;17(2):e0263405.
42. Pramanik M, Rajkumar NCJ. Yoga as a complementary therapy for obesity prevention in childhood and adolescent obesity: A systematic review. Int J Health Sci. 2022 May 24;7669–82.
43. Ross A, Brooks A, Touchton-Leonard K, Wallen G. A Different Weight Loss Experience: A Qualitative Study Exploring the Behavioral, Physical, and Psychosocial Changes Associated with Yoga That Promote Weight Loss. Evid Based Complement Alternat Med. 2016 Aug 10;2016:e2914745.
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49. Venugopal V, Geethanjali S, Poonguzhali S, Padmavathi R, Mahadevan S, Silambanan S, et al. Effect of Yoga on Oxidative Stress in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. Curr Diabetes Rev. 2022 Feb 1;18(2):63–70.
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51. Misra P, Sharma G, Tandon N, Kant S, Sangral M, Rai SK, et al. Effect of Community-Based Structured Yoga Program on Hba1c Level among Type 2 Diabetes Mellitus Patients: An Interventional Study. Int J Yoga. 2021;14(3):222–8.
52. Raghuram N, Ram V, Majumdar V, Sk R, Singh A, Patil S, et al. Effectiveness of a Yoga-Based Lifestyle Protocol (YLP) in Preventing Diabetes in a High-Risk Indian Cohort: A Multicenter Cluster-Randomized Controlled Trial (NMB-Trial). Front Endocrinol. 2021;12:664657.
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2. Cardiovascular diseases (CVDs) [Internet]. [cited 2022 Sep 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
3. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020 Dec 22;76(25):2982–3021.
4. Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. 2018 Aug 6;18(1):975.
5. Giedrimiene D, King R. Abstract 207: Burden of Cardiovascular Disease (CVD) on Economic Cost. Comparison of Outcomes in US and Europe. Circ Cardiovasc Qual Outcomes. 2017 Mar;10(suppl_3):A207–A207.
6. Foy AJ, Mandrola JM. Heavy Heart: The Economic Burden of Heart Disease in the United States Now and in the Future. Prim Care. 2018 Mar;45(1):17–24.
7. Kumar V. Review of ancient history of yoga. Int J Appl Res. 2017 Mar; (5):656-8
8. Yoga: Its Origin, History and Development [Internet]. [cited 2022 Sep 23]. Available from: https://www.mea.gov.in/in-focus-article.htm?25096/Yoga+Its+Origin+History+and+Development
9. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011;4(2):49–54.
10. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med N Y N. 2010 Jan;16(1):3–12.
11. Riley K, Park C. How does yoga reduce stress? A systematic review of mechanisms of change and guide to future inquiry. Health Psychol Rev. 2015 Jan 3;9:1–30.
12. West J, Otte C, Geher K, Johnson J, Mohr DC. Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Ann Behav Med Publ Soc Behav Med. 2004 Oct;28(2):114–8.
13. Michalsen A, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit Int Med J Exp Clin Res. 2005 Dec;11(12):CR555-561.
14. Khatri D, Mathur KC, Gahlot S, Jain S, Agrawal RP. Effects of yoga and meditation on clinical and biochemical parameters of metabolic syndrome. Diabetes Res Clin Pract. 2007 Dec;78(3):e9-10.
15. Selvamurthy W, Sridharan K, Ray US, Tiwary RS, Hegde KS, Radhakrishan U, et al. A new physiological approach to control essential hypertension. Indian J Physiol Pharmacol. 1998 Apr;42(2):205–13.
16. Dunn KD. A review of the literature examining the physiological processes underlying the therapeutic benefits of Hatha yoga. Adv Mind Body Med. 2008;23(3):10–8.
17. Estevao C. The role of yoga in inflammatory markers. Brain Behav Immun - Health. 2022 Mar 1;20:100421.
18. Csala B, Springinsfeld C, Köteles F. The Relationship Between Yoga and Spirituality: A Systematic Review of Empirical Research. Front Psychol. 2021 Aug 1;12:695939.
19. (PDF) Framingham Risk Score and Estimated 10-Year Cardiovascular Disease Risk Reduction by a Short-Term Yoga-Based Life-Style Intervention. ResearchGate [Internet]. [cited 2022 Oct 9]; Available from: https://www.researchgate.net/publication/313817483_Framingham_Risk_Score_and_Estimated_10-Year_Cardiovascular_Disease_Risk_Reduction_by_a_Short-Term_Yoga-Based_Life-Style_Intervention
20. Antza C, Doundoulakis I, Stabouli S, Kotsis V. American, European and international hypertension guidelines: Time to shake hands? Int J Cardiol Hypertens. 2021 Mar 1;8:100075.
21. Dhungana RR, Pedisic Z, Joshi S, Khanal MK, Kalauni OP, Shakya A, et al. Effects of a health worker-led 3-month yoga intervention on blood pressure of hypertensive patients: a randomised controlled multicentre trial in the primary care setting. BMC Public Health. 2021 Mar 20;21(1):550.
22. Penrod NM, Moore JH. Antihypertensive effects of yoga in a general patient population: real-world evidence from electronic health records, a retrospective case-control study. BMC Public Health. 2022 Jan 27;22(1):186.
23. Chauhan A, Semwal DK, Mishra SP, Semwal RB. Yoga Practice Improves the Body Mass Index and Blood Pressure: A Randomized Controlled Trial. Int J Yoga. 2017;10(2):103–6.
24. Wolff M, Rogers K, Chalmers J, Sundquist K, Midlöv P. Impact of a short home-based yoga programme on blood pressure in patients with hypertension: a randomized controlled trial in primary care. J Hum Hypertens. 2016 Jan 21;30.
25. Haber D. Health Promotion to Reduce Blood Pressure Level Among Older Blacks1. The Gerontologist. 1986 Apr 1;26(2):119–21.
26. Khandekar JS, Vasavi VL, Singh VP, Samuel SR, Sudhan SG, Khandelwal B. Effect of Yoga on Blood Pressure in Prehypertension: A Systematic Review and Meta-Analysis. Sci World J. 2021 Sep 13;2021:4039364.
27. Deshpande C, Rakshani A, Nagarathna R, Ganpat T, Kurpad A, Maskar R, et al. Yoga for High-Risk Pregnancy: A Randomized Controlled Trial. Ann Med Health Sci Res. 2013;3(3):341–4.
28. Karthiga K, Pal GK, Dasari P, Nanda N, Velkumary S, Chinnakali P, et al. Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial. Sci Rep. 2022 Dec;12(1):11732.
29. Rakhshani A, Nagarathna R, Mhaskar R, Mhaskar A, Thomas A, Gunasheela S. The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: a randomized controlled trial. Prev Med. 2012 Oct;55(4):333–40.
30. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. Factors of risk in the development of coronary heart disease--six year follow-up experience. The Framingham Study. Ann Intern Med. 1961 Jul;55:33–50.
31. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J. 2020 Jan 1;41(1):111–88.
32. Nagarathna R, Kumar S, Anand A, Acharya IN, Singh AK, Patil SS, et al. Effectiveness of Yoga Lifestyle on Lipid Metabolism in a Vulnerable Population—A Community Based Multicenter Randomized Controlled Trial. Medicines. 2021 Jul;8(7):37.
33. Telles S, Sharma SK, Yadav A, Singh N, Balkrishna A. A comparative controlled trial comparing the effects of yoga and walking for overweight and obese adults. Med Sci Monit Int Med J Exp Clin Res. 2014 May 31;20:894–904.
34. Sharma S, Bhardwaj S, Jangir S, Gupta B. Influence of yoga on status of lipid indices in type 2 diabetes mellitus subjects. Int J Diabetes Dev Ctries. 2020 Sep 1;40(3):410–5.
35. Shantakumari N, Sequeira S, El deeb R. Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart J. 2013 Mar;65(2):127–31.
36. Gordon L, McGrowder DA, Pena YT, Cabrera E, Lawrence-Wright M. Effect of exercise therapy on lipid parameters in patients with end-stage renal disease on hemodialysis. J Lab Physicians. 2012 Jan;4(1):17–23.
37. Reaven GM. Role of Insulin Resistance in Human Disease. Diabetes. 1988 Dec 1;37(12):1595–607.
38. Lemieux I, Després JP. Metabolic Syndrome: Past, Present and Future. Nutrients. 2020 Nov 14;12(11):3501.
39. Khan S, Agarwal R, Memon S. Comparison of Effect of Yoga versus Aerobic Exercise on Waist Circumference, Waist-Hip Ratio and Body Mass Index in Overweight and Obese Adult Individuals. Kathmandu Univ Med J. 2022;77(1):38-42
40. Jakicic JM, Davis KK, Rogers RJ, Sherman SA, Barr S, Marcin ML, et al. Feasibility of Integration of Yoga in a Behavioral Weight-Loss Intervention: A Randomized Trial. Obesity. 2021;29(3):512–20.
41. Unick JL, Dunsiger SI, Bock BC, Sherman SA, Braun TD, Wing RR. A preliminary investigation of yoga as an intervention approach for improving long-term weight loss: A randomized trial. PLOS ONE. 2022 Feb 4;17(2):e0263405.
42. Pramanik M, Rajkumar NCJ. Yoga as a complementary therapy for obesity prevention in childhood and adolescent obesity: A systematic review. Int J Health Sci. 2022 May 24;7669–82.
43. Ross A, Brooks A, Touchton-Leonard K, Wallen G. A Different Weight Loss Experience: A Qualitative Study Exploring the Behavioral, Physical, and Psychosocial Changes Associated with Yoga That Promote Weight Loss. Evid Based Complement Alternat Med. 2016 Aug 10;2016:e2914745.
44. Cardiovascular Disease and Diabetes [Internet]. www.heart.org. [cited 2022 Oct 8]. Available from: https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cardiovascular-disease--diabetes
45. Ma CX, Ma XN, Guan CH, Li YD, Mauricio D, Fu SB. Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovasc Diabetol. 2022 May 14;21(1):74.
46. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. Circulation. 2014 Jun 24;129(25_suppl_2):S49–73.
47. Dal Canto E, Ceriello A, Rydén L, Ferrini M, Hansen TB, Schnell O, et al. Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications. Eur J Prev Cardiol. 2019 Dec 1;26(2_suppl):25–32.
48. Kurian J, Mohanthy S, Nanjumdaiah RM. Mechanism of action of yoga on prevention and management of type 2 diabetes mellitus: Narrative review. J Bodyw Mov Ther. 2022 Jan 1;29:134–9.
49. Venugopal V, Geethanjali S, Poonguzhali S, Padmavathi R, Mahadevan S, Silambanan S, et al. Effect of Yoga on Oxidative Stress in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. Curr Diabetes Rev. 2022 Feb 1;18(2):63–70.
50. Kaur N, Majumdar V, Nagarathna R, Malik N, Anand A, Nagendra HR. Diabetic yoga protocol improves glycemic, anthropometric and lipid levels in high risk individuals for diabetes: a randomized controlled trial from Northern India. Diabetol Metab Syndr. 2021 Dec 23;13(1):149.
51. Misra P, Sharma G, Tandon N, Kant S, Sangral M, Rai SK, et al. Effect of Community-Based Structured Yoga Program on Hba1c Level among Type 2 Diabetes Mellitus Patients: An Interventional Study. Int J Yoga. 2021;14(3):222–8.
52. Raghuram N, Ram V, Majumdar V, Sk R, Singh A, Patil S, et al. Effectiveness of a Yoga-Based Lifestyle Protocol (YLP) in Preventing Diabetes in a High-Risk Indian Cohort: A Multicenter Cluster-Randomized Controlled Trial (NMB-Trial). Front Endocrinol. 2021;12:664657.
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How to Cite
1.
Verma S, Hatwal J, Batta A. Impact of Yoga on cardiovascular system beyond physical training: An updated review. J Tehran Heart Cent. 2024;.
