Emerging Trends in Yoga-Based Interventions for Cardiovascular Disease Prevention: A Literature Review

Introduction

The global burden of cardiovascular disease (CVD) is substantial and continues to escalate, contributing significantly to both morbidity and mortality worldwide. CVD‘s remains the leading cause of death, accounting for approximately 32% of global fatalities, with an estimated 17.9 million deaths annually. Key risk factors for CVD, including hypertension, hyperlipidaemia, diabetes, obesity, and smoking, are increasingly prevalent, particularly in low- and middle-income countries, thereby exacerbating the global burden. This alarming trend underscores the urgent need for preventive strategies such as Yoga and Pranayama, which have demonstrated efficacy in enhancing psychological well-being, improving stress resilience, mood, and sleep quality, as well as promoting physical health through the improvement of strength, flexibility, and metabolic function, while reducing blood pressure and inflammation.

Yoga, derived from the Sanskrit term meaning “union” or “connection,” encompasses physical postures (Asana), breathing techniques (Pranayama), and meditation (Dhyana) aimed at achieving harmony between the body, mind, and spirit. Its goal is the liberation of the soul (Moksha) and the integration of individual consciousness with universal consciousness. In recent years, the medical community has increasingly recognized the significance of Yoga, particularly regarding its mind-body connections and potential benefits for various medical conditions. This renewed interest has prompted rigorous evaluations of Yoga’s physiological and clinical effects, especially concerning the cardiovascular system. This review highlights the growing trend of using evidence-based medicine to assess these benefits.According to Ayurveda cardiovascular diseases are considered as Hridroga as a condition of heart that cause discomfort in heart due to the vitiation of Rasa Dhathu [1].

Patanjali’s Yoga-Sutra, written around 600-400 BCE, is regarded as the cornerstone of contemporary yoga practice. It consists of 196 aphorisms that outline the 8-fold path of yoga, also known as the eight limbs of classical yoga. This era is referred to as Yoga-darshana or raja-yoga. Over time, non-classical schools led to the rise of post-classical Yoga, which introduced new branches such as Tantra, Siddha, and Hatha Yoga [2]. In the early 20th century, influential figures like Swami Vivekananda brought modern Hinduism and Yoga to the West. Subsequently, gurus like Swami Kuvalayananda and Yogendraji played key roles in popularizing the systematic practice of yoga and established research centers to further its study and dissemination. In the words of Maharshi Patanjali, “Yoga is the restraint of the process of the mind.” Yoga has been extensively studied for the beneficial effects on human health [3]. In last few decades Yoga has gained immense importance in the preventive as well as curative aspect across the world.

The main factors leading to cardiovascular disease (CVD) are chronic stress, anxiety, and depression, which contribute to various cardiovascular problems as shown in (figure.1). Stress also increases the prevalence and severity of several CVD risk factors, including hypertension, diabetes mellitus, and obesity [4] .This underscores the potential of Yoga as a valuable intervention, positioning it as an emerging trend in preventive cardiology.

Physiological effect of Yoga in preventive cardiology

A significant body of research demonstrates the beneficial neuro-humoral effects of Yoga, including lower levels of serum cortisol, catecholamines, and aldosterone. Chronic activation of these pathways is often seen in various cardiovascular diseases, such as hypertension and heart failure. Furthermore, Yoga and meditation have been found to enhance levels of melatonin, γ-amino butyric acid, and several other neurotransmitters. Importantly, reductions in stress markers like 8-hydroxydeoxyguanosine and increased endorphin levels indicate that Yoga is effective in mitigating stress in individuals [5] In addition, the regular practice of Yoga is known to attenuate oxidative stress and improve endothelial function by enhancing bioavailability of nitric oxide [6][7] .Yoga has been shown to have anti-inflammatory and insulin-sensitizing effects by increasing adiponectin levels and decreasing leptin resistance [8].Mindfulness-based meditation can reduce pro-inflammatory response gene profiles,[9][10] , and Yogic meditation appears to reverse nuclear factor- κ B-related transcription of pro-inflammatory cytokines [11] .

 Materials and Methods

This review compiles insights from various database PubMed and Google Scholar, articles related to yoga and cardiovascular health, mental stress and cardiac health, including Yoga texts like light on Yoga, contemporary research on cardiovascular diseases. An extensive review focused on the connection between Yoga and its growing significance in preventive cardiology. The inclusion criteria required studies to focus on diverse benefits of Yoga for individuals of all ages, highlighting its physical, mental, emotional, social, and spiritual advantages. It examines the multifaceted impact of Yoga across different health domains and underscores the importance of practicing Yoga in prevention of cardiovascular disease.

Review of literature

Benefits of Yoga in different domain

Effect on Physical factors: Yoga interventions improve strength and balance, lowering the risk of falls and injuries among the elderly. They also contribute to increased flexibility, muscle strength, and endurance [12] .

Effect on Metabolism: The metabolic effects of Yoga have been extensively researched in terms of glycemic control. Findings indicate that regular asana practice can enhance glucose tolerance and insulin sensitivity [13] , potentially serving as a substitute for medication in managing type 2 diabetes [14] , a major risk factor for cardiovascular disease.

Effect on Circulatory system: The circulatory health outcomes involve lowering blood pressure, enhancing arterial function, restoring baroreceptor sensitivity, and improving endothelial function [15] .

Effect on Behavioural /social factors: Regular Yoga practice enhances sleep quality and positively affects mood, contributing to better psychological well-being. Additionally, reducing social isolation and promoting networks that encourage physical activity and self-care can improve pain management and foster healthier responses to stress, both physically and psychologically.

Effect on Inflammatory markers: Yoga reduces inflammatory markers, including pro-inflammatory cytokines like IL-6, interleukin-2, and C-reactive protein, by stimulating the vagus nerve. This stimulation helps lower heart rate and blood pressure, improving stress responses and promoting heart health, thereby preventing heart diseases.

Effect on Psychology and cognition: Practicing Yoga enhances feelings of satisfaction, self-confidence, and self-control, which are associated with reduced perceived stress and improved well-being [16]  .

2.2 Physiological effect of pranayama in preventive cardiology

Pranayama is a form of Yogic breathing that literally means “extension of Prana/life.” This practice helps modify cardiovascular risk factors. Engaging in pranayama regularly can lead to a reduction in heart rate variability, which reflects a decrease in sympathetic nervous system activity. It also results in an increase in vagal tone. Incorporating pranayama into the routines of patients on antihypertensive medications leads to a significant reduction in both systolic (from 148 ± 8.09 to 127 ± 12.10 mmHg) and diastolic blood pressure [17] . Inhibitory signals arise from the stretching of lung tissue, which helps synchronize neural elements. This process modulates the nervous system and reduces metabolic activity [18] .Pranayama encompasses various breathing techniques that yield different outcomes. The practice of Sāvitrī Prāṇāyāma, characterized by slow, rhythmic, and deep breathing, is linked to a reduction in heart rate, rate pressure product (RPP), and double product. Conversely, Bhastrikā Prāṇāyāma, which involves rapid and deep breathing, results in an increase in these measurements [19]. By regular practice of Yoga and pranayama it enhance the immune system and hence prevent the risk factors leading to CVD.

Yoga for children, adults and old aged regarding preventive cardiology

Yoga for children

The likelihood of developing-hypertension and other cardiovascular disorders increases with a higher body mass index (BMI) and weight gain in childhood, which are typically connected to a poor diet.

Benefits of yoga practice in childhood

• Research indicates that mind-body practices, including cognitive therapy, mindful awareness, and Yoga, effectively lower cortisol levels, thereby improving mood and overall well-being.
• Yoga postures and breathing techniques can enhance muscle strength and flexibility, while also increasing circulation, oxygen uptake, and hormonal function [12].
• Regular practice may enhance parasympathetic nervous system activity, stabilizing the autonomic nervous system and improving resilience to stress [20].

Yoga for adults

Middle-aged individuals (typically ages 45-64) face several key risks for cardiovascular disease (CVD). Following are the risk factors observed:

• Hypertension: High blood pressure is a major risk factor that can lead to heart disease and stroke.
• High Cholesterol: Elevated levels of LDL (bad cholesterol) can lead to plaque buildup in arteries.
• Diabetes: Diabetes increases the risk of CVD due to its effects on blood vessels and nerves.

• Obesity: Excess weight contributes to hypertension, high cholesterol, and diabetes.
• Sedentary Lifestyle: Lack of physical activity increases the risk of several health issues, including CVD.
• Smoking: Tobacco use is a significant risk factor for heart disease.
• Unhealthy Diet: Diets high in saturated fats, trans fats, and sodium can contribute to heart disease.
• Family History: A family history of heart disease can increase individual risk.
• Stress: Chronic stress can lead to poor lifestyle choices and can negatively impact heart health.
• Age: The risk of CVD increases with age, even in middle age.

Benefits of Yoga practices in adults

• Yoga promotes vagal stimulation and enhances parasympathetic activation [20].
• It improves heart rate variability and baroreflex sensitivity, aiding in blood pressure regulation [15].
• The practice is associated with a better metabolic and psychological profile, including increased insulin sensitivity and improved glucose tolerance [13], [14].

Yoga for geriatrics

Yoga has a holistic approach towards life, which helps an individual to improve in all spheres of existence. Yoga does so without manipulating the natural laws of rejuvenation and healing.

Benefits of yoga practices in old age

• Yoga improves the psychological well-being and shows a lowering effect in systolic blood pressure [21]
• Regular practice of Anuloma-Viloma Pranayama (alternate nostril breathing) can significantly benefit mental health by reducing anxiety and depression, especially in senior citizens which is a major cause for CVD [22] .
• Pre- and post-assessment revealed a highly significant reduction in systolic blood pressure, along with a significant decrease in diastolic blood pressure. Heart rate also declined significantly, indicating that yoga interventions may significantly enhance health outcomes in the aging population by reducing morbidity and mortality associated with cardiovascular disease [23] .

Discussion

Extensive research underscores Yoga’s profound benefits on cardiovascular health, impacting various physiological and psychological domains. Yoga improves physical factors such as strength, balance, and flexibility, which are crucial for preventing falls and injuries in the elderly. It also enhances metabolic health by improving glucose tolerance and insulin sensitivity, potentially reducing the need for medication in managing type 2 diabetes, a significant cardiovascular risk factor. Yoga’s positive effects extend to the circulatory system, where it reduces blood pressure, enhances arterial and endothelial function, and lowers inflammation. Through vagal nerve stimulation, Yoga reduces pro-inflammatory cytokines and improves heart rate variability, further supporting cardiovascular health. Behaviorally, Yoga promotes better sleep quality, mood, and stress resilience, while reducing social isolation and encouraging physical activity and self-care. These changes improve physical ,psychological and behavioral well-being (Table.1). Psychologically, Yoga boosts self-confidence, satisfaction, and emotional regulation, contributing to reduced stress and enhanced mental health. Pranayama, or Yogic breathing, modulates cardiovascular risk factors by improving heart rate variability and reducing blood pressure, showing significant benefits for hypertensive patients. Yoga’s benefits are evident across all age groups. In children, it lowers cortisol levels and enhances muscle strength, flexibility, and resilience to stress. For adults, Yoga addresses cardiovascular risk factors such as hypertension, high cholesterol, and obesity, improving metabolic and psychological health. In the elderly, Yoga enhances psychological well-being, lowers blood pressure, and reduces heart rate, significantly improving cardiovascular health and reducing morbidity and mortality. This review highlights the benefits of Yoga for cardiovascular health; however, there is a lack of robust evidence from studies such as randomized controlled trials or longitudinal research to definitively support these claims. There is considerable potential for future research in this area, which could provide substantial evidence and further establish Yoga as a valuable adjunct to conventional medical treatments in preventive cardiology.

Table.1 Outcomes categorized by domains such as physiological, psychological, and behavioral.

Conclusion

In conclusion, the integration of Yoga and Pranayama into preventive cardiology offers significant benefits in cardiovascular diseases. The practice of Yoga not only enhances physical health by improving strength, flexibility, and cardiovascular function but also contributes to mental well-being by reducing stress, anxiety, and depression. This holistic approach is beneficial for all age groups especially in elderly populations, where cardiovascular disease risks are heightened. This Research highlights that specific pranayama techniques can effectively lower blood pressure and improve heart rate variability, further underscoring Yoga’s role in mitigating cardiovascular risks. Future studies should focus on specific Yoga postures recommended for prevention of various CVD’s and effort should be taken to standardized yoga protocol for various types of heart diseases. This will help to validate yoga’s role in reducing blood pressure, improving heart rate variability, reducing inflammation and improving endothelial function which further promotes cardiovascular well-being. As awareness of these benefits grows, Yoga is increasingly recognized as a valuable complement to traditional medical interventions, emphasizing the importance of a comprehensive approach to health that includes physical, mental, and emotional well-being. By fostering a balanced lifestyle through Yoga, individuals can enhance their overall health and reduce the burden of cardiovascular disease, paving the way for improved quality of life.

Acknowledgements: The authors are thankful to National Institute of Ayurveda for giving the platform to carry out the basic research.

Financial Support & Sponsership: Nil

Conflicts of Interest: Nil

Ethical Compliance: This review did not involve human or animal subjects, and all sources used were publicly available and properly cited.

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