Yoga And Breathing Training In Patients With Heart Failure And Preserved Ejection Fraction: A Randomized Clinical Trial

BACKGROUNDPatients with heart failure with preserved ejection fraction (HFpEF) usually have physical effort intolerance, and may present inspiratory muscle weakness (IMW). Yoga is known to have significant benefits on cardiovascular and respiratory health. However, the effects of yoga and breathing techniques on HFpEF have not been reported. METHODS AND RESULTSThis study is a multicenter, randomized 1:1:1, outcome-blind, parallel-group, no-inferiority trial. Thirty-two patients with previous diagnosis of HFpEF (EF [&ge;] 50%) 45-75 years old, were randomized and allocated into groups: yoga group (Y = 11), breathing techniques (BT = 11) or the control group (C = 10) to evaluate the effects of an in-person program of 8-week of yoga and specific breathing techniques on inspiratory muscle responses, functional capacity, distinct features of the autonomic nervous system, natriuretic peptides, diastolic function, and quality of life. Data were analyzed using the Generalized Estimates equation model (GEE- GZLM). Yoga training resulted in 44.1% improvement in inspiratory muscle strength (Pthmax) [19 (7-29) vs 2(-2 to 5) in control group, (p < 0.05). Breathing techniques increase heart rate variability (HRV) (827.6 {+/-} 46.7ms vs 936 {+/-} 51.4 ms, in control group,( p < 0.05). There was neither improvement in PImax, functional capacity nor in parameters of diastolic function. CONCLUSIONSIn patients withHFpEF with and without IMW, yoga training was feasible and promoted increased respiratory muscle strength. Further studies should better address possible benefits on functional parameters. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; NCT03028168; Protocol study: Trials. 2018;7:19:405. https://doi.org/10.1186/s13063-018-2802-5