Abstract
Cardiac rehabilitation (CR) after myocardial infarction is highly effective. It is unavailable in public hospitals in India due to limited resources. Our objective was to develop a scalable model of CR for India based on yoga, which could also appeal to some groups with low uptake of CR (e.g., ethnic minorities, women, and older people) globally. The intervention was developed using a structured process. A literature review and consultations with yoga experts, CR experts, and postmyocardial infarction patients were conducted to systematically identify and shortlist appropriate yoga exercises and postures, breathing exercises, meditation and relaxation practices, and lifestyle changes, which were incorporated into a conventional CR framework. The draft intervention was further refined based on the feedback from an internal stakeholder group and an external panel of international experts, before being piloted with yoga instructors and patients with myocardial infarction. A four-phase yoga-based CR (Yoga-CaRe) programme was developed for delivery by a single yoga instructor with basic training. The programme consists of a total of 13 instructor-led sessions (2 individual and 11 group) over a 3-month period. Group sessions include guided practice of yoga exercises and postures, breathing exercises, and meditation and relaxation practices, and support for the lifestyle change and coping through a moderated discussion. Patients are encouraged to self-practice daily at home and continue long-term with the help of a booklet and digital video disc (DVD). Family members/carers are encouraged to join throughout. In conclusion, a novel yoga-based CR programme has been developed, which promises to provide a scalable CR solution for India and an alternative choice for CR globally. It is currently being evaluated in a large multicentre randomised controlled trial across India.
Highlights
Secondary prevention of myocardial infarction reduces associated morbidity and mortality [1]
One approach is cardiac rehabilitation (CR), a programme of information and exercise sessions, which aims to help patients recover from myocardial infarction and reduce lifestyle risk factors for cardiovascular disease [1]
In high-income countries (HICs), CR programmes are widely available, but participation is still poor, especially among population subgroups, such as ethnic minorities, women, and older people who may find the vigorous forms of exercise and communication style of established CR programmes unappealing [3, 6, 7]
Summary
Secondary prevention of myocardial infarction reduces associated morbidity and mortality [1]. Of the seven major branches of yoga, hatha yoga is probably the most commonly recognised [13] It aims to build physical and mental strength through yoga exercises and postures, breathing exercises, meditation and relaxation practices (which reduces stress), and moderation in lifestyle [13]. The aim of this study was to systematically develop a yoga-based CR (Yoga-CaRe) programme for the secondary prevention of myocardial infarction. The intention was to develop a low-cost scalable programme that could be integrated within the existing care (with the help of a single yoga instructor with basic training) rather than requiring additional resources for activities (e.g., diagnostics) that are not part of the existing care (and would limit scalability)
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