Yoga-Based Cardiac Rehab Improves Quality of Life in Heart Failure Patients

Patients with heart failure with reduced ejection fraction (HFrEF) who participate in supervised yoga-based cardiac rehabilitation show improvements in quality-of-life scores and physical function, according to results from the Yoga-CaRe study presented at the American Heart Association 2026 Scientific Sessions.

Key Clinical Takeaways:

• The yoga intervention group demonstrated an 8.1-point advantage in Minnesota Living with Heart Failure Questionnaire scores compared to standard care at three months.
• While functional capacity and emotional health improved, the study did not find a statistically significant reduction in all-cause death, stroke, or hospitalization.
• Higher adherence to home-based yoga practice—at least 255 minutes per week—was associated with a 28% lower incidence of major adverse cardiovascular events (MACE) over 24 months.

TCTMD.com reported that the Yoga-CaRe trial investigated the efficacy of a specialized, supervised exercise program for adults living with HFrEF. The study involved 3,492 patients randomized across 16 medical centers in India, with a median participant age of 57 years. The cohort included 1,737 patients in the yoga intervention arm and 1,755 in an enhanced-standard-care control group.

Yoga Sessions Improved Clinical Metrics over Three Months

The intervention group received 20 supervised sessions over three months, delivered through a combination of in-person, virtual, and at-home instruction by a board-certified yoga naturopathy physician. This regimen included written health education, guided behavior change, and goal-setting assistance. Following the initial three months, participants received follow-up sessions every three months for a total of 24 months.

At the three-month co-primary endpoint, the yoga group showed superior clinical metrics across several domains. The differences between the intervention and control groups were measured as follows:

The study also observed higher rates of tobacco cessation and improved measures of frailty within the yoga intervention group. Researchers also noted a positive impact on caregivers, who reported better quality-of-life scores and lower levels of depression compared to those managing patients in the standard-care group.

Trial Failed to Show Significant Clinical Event Differences

Despite the functional gains, the trial did not meet its second co-primary endpoint regarding hard clinical outcomes. The study analyzed the time to the first composite event, which included all-cause death, all-cause hospitalization, or stroke. Ambalam Chandrasekaran, MPh, of the Centre for Chronic Disease Control in New Delhi, India, noted that the event rate was 21% in the yoga group compared to 22.8% in the control group.

“This translated to a hazard ratio of 0.90, but this was not statistically significant, and this finding was consistent across all prespecified subgroups,” Chandrasekaran said during the presentation.

The difficulty in achieving significant reductions in mortality or hospitalization is a common hurdle in cardiac rehabilitation research. Justin A. Ezekowitz, MBBCh, of the University of Alberta, Canada, observed that while over 60 trials involving more than 8,000 patients have tested various cardiac rehabilitation elements, they generally show a non-significant reduction in all-cause mortality or heart failure hospitalizations.

Mechanisms of Improvement and Patient Engagement

Medical experts suggested that the observed benefits might stem from factors beyond the physical movements of yoga. Hani Najm, MD, vice president of the American College of Cardiology at the Cleveland Clinic, noted that the connection between yoga and quality-of-life improvements requires further clarification.

“I’m sure most of these people were not exposed to yoga before and now they’ve got a yoga instructor telling them what to do, and so it might be the indirect effect of yoga rather than the actual physical intervention, but it’s still a good thing,” Najm said.

Najm suggested that the increased frequency of contact with a care team and the novelty of the intervention might improve patient attitudes. He noted that when a treatment is framed as yoga rather than a strictly medical intervention, patients may view it as an engaging activity rather than a clinical requirement. This shift in perspective can lead to a higher willingness to be proactive in self-care.

Adherence appears to be a critical factor in translating lifestyle interventions into clinical benefits. A per-protocol analysis indicated that patients who practiced yoga at home at least five days a week, or for a minimum of 255 minutes per week, saw a cumulative incidence of major adverse cardiovascular events (MACE) that was approximately 28% lower than the standard-care group over the 24-month follow-up period.

Implications for Cardiac Rehabilitation Protocols

The Yoga-CaRe study shows that patients often struggle to engage with traditional cardiac rehabilitation. Because attendance rates for conventional programs are often low, experts suggest that diversifying rehabilitation options is essential for the HFrEF population.

Ezekowitz emphasized the need for bespoke options to maintain patient engagement, stating that providers should offer whatever methods—such as yoga, Tai Chi, or high-intensity interval training—effectively keep patients involved in their rehabilitation.

The durability of the improvements seen in the Yoga-CaRe study suggests that the skills learned during the supervised sessions may provide long-term benefits for well-being and functional capacity, even if they do not immediately alter mortality statistics.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.