Yoga: a guide for cardiac rehabilitation patients

This leaflet is for any patients undergoing cardiac rehabilitation with an interest in yoga. Yoga practice is generally comprised of three components; breathing techniques (pranayama), physical postures (asanas) and meditation (dhyana) and can be further subdivided into many different styles with their own emphases and levels of exertion.

The benefits of yoga for cardiac patients

Research has been carried out in recent years to investigate the specific benefits of yoga for cardiac patients. These benefits include:

• Reduced psychological stress
  Research into the effects of yoga suggests that regular practice helps to regulate the body’s stress response. As a result, regular yoga practice has been associated with improved mood and better self-reported quality of life.
• Heart rate and blood pressure control
  Perhaps even more interestingly, regular yoga practice has been demonstrated to reduce inflammation which helps the arteries to fully relax. This, coupled with reduced stress levels, can help to lower the heart rate and improve blood pressure. All of these are important for reducing the risk of future cardiovascular disease.
• Reduced risk of arrhythmias
  Research into the effects of yoga has found that by regulating stress-related imbalances, it can reduce the frequency of symptomatic and non-symptomatic episodes of atrial fibrillation (AF).
• Improved strength, balance and flexibility
  The controlled movements present in these forms of exercise have been found to improve muscular strength, balance and flexibility. Improving these attributes contributes towards falls prevention in older age, reduced injury risk during exercise and helps to reverse some of the age-related decline in muscle function.

While yoga has several benefits, it is generally not intense enough to count towards the 150 minutes per week of aerobic exercise that you should be aiming for. Yoga should be thought of as an addition to the other exercises you are doing, rather than a replacement for them.

Exercise safety

You should not start exercise and should contact your GP or cardiac rehabilitation team if:

• your heartbeat feels irregular, and this is new to you
• you feel unwell, have a fever or any other temporary illness
• your heart rate is much faster or slower than is normal for you
• you have new or recurrent symptoms of breathlessness or angina
• you feel very tired/ fatigued

You should stop exercise immediately if:

• you feel lightheaded, dizzy or faint
• you feel chest pain (angina)
• your breathing becomes uncomfortable
• your heartbeat becomes irregular

Considerations

Some yoga postures and styles are more challenging than others and what’s suitable for one individual may be inappropriate for another. While the Cardiac Rehab team are on hand to offer specific advice, general guidance is as follows.

• Start with more gentle forms of yoga (sometimes referred to as Hatha or Restorative yoga) rather than more vigorous styles (such as Ashtanga, Vinyasa or Power Yoga), especially if you are a beginner.
• Avoid any challenging isometric (static) holds, breath holding or use of the Valsalva manoeuvre due to the acute effects these can have on your blood pressure.
• It is also advisable to avoid inversions (poses where your heart is above your head) as these place a greater demand on your heart where it is having to pump against gravity.
• Frequent changes in posture should also be avoided as this increases the risk of postural hypotension (a sudden drop in blood pressure from standing up too quickly). Instead, perform the standing postures together then move to the floor and perform your floor-based exercises.
• You should not practice yoga if your blood pressure is 180/100mmHg or above.
• If you are experiencing ongoing dizziness or light headedness you may want to avoid the physical postures altogether and just focus on the breathing work and meditation.

Getting started

If you are new to yoga, you may want to attend some classes with a qualified instructor who can help with your technique. Alternatively, there are many online resources to help you get started if you would prefer to practice independently, such as:

• a brief introduction to yoga and its benefits (opens in a new tab)
• a sample chair-based yoga routine (opens in a new tab)
• three powerful breathing exercises to relieve stress (opens in a new tab)
• a 35-minute bedtime meditation session, including some stretches and seated meditation (opens in a new tab)
• advice on starting Tai Chi, Yoga and Pilates (opens in a new tab)

Medication

Ensure you take all your prescribed medications as normal on the day of your session.

If you are attending a yoga class with an instructor, ensure you bring any emergency medications you may need with you (inhalers, GTN spray etc.). Also make the instructor aware of your past medical history and the medications you’re taking.

Further advice

Don’t hesitate to call the Cardiac Rehabilitation Service on 01223 216985 should you require any further advice. Good luck with your activities!

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

Privacy and dignity

Same-sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.