Yoga could be good for heart disease

Simultaneous focus on body, breathing, and mind may be just what the doctor ordered.

Yoga, once a mystical practice performed mainly by spiritual seekers striving for inner peace, has become as American an activity as jogging and aerobics. Its newfound popularity could be a boon for people with high blood pressure, heart failure, and other forms of cardiovascular disease.

"Yoga is an excellent activity for people who haven't exercised in years or those who aren't very strong," says Dr. Suzie Bertisch, an instructor in medicine at Harvard Medical School who has studied the benefits of yoga and other mind-body techniques. A small but promising body of research suggests that yoga's combination of stretching, gentle activity, breathing, and mindfulness may have special benefits for people with cardiovascular disease.

Yoga and the heart

The word "yoga" comes from a Sanskrit term that means union. It aims to join body, mind, and the day-to-day challenges of life into a unified experience rather than keep them separate. There are different forms of yoga, from the gentle, peaceful hatha yoga to the active "power" form called ashtanga. We focus here on hatha yoga because it is a good starting point.

Hatha yoga's path to balancing the mind and the body involves three interconnected threads: physical postures called "asanas," controlled breathing, and calming the mind through relaxation and meditation. The three work together.

How could this improve cardiovascular health? Getting into the various postures during a yoga session gently exercises the muscles. Anything that works your muscles is good for your heart and blood vessels. Activity also helps muscles become more sensitive to insulin, which is important for controlling blood sugar. The deep-breathing exercises help slow the breathing rate. Taking fewer but deeper breaths each minute temporarily lowers blood pressure and calms the sympathetic nervous system, which is responsible for generating stress hormones. The postures and deep breathing offer a kind of physical meditation that focuses and clears the mind. Meditation and the mindfulness of yoga have both been shown to help people with cardiovascular disease.

Possible benefits

The words "may," "might," "can," and "could" are liberally scattered throughout this article. That's because research into the connection between yoga and cardiovascular disease is still in its scientific infancy. Several dozen studies have explored the possible benefits of yoga for people with heart disease, but these trials are mostly small or lack the scientific rigor needed to show cause and effect. This body of work suggests that yoga may

• reduce high blood pressure

• improve symptoms of heart failure

• ease palpitations

• enhance cardiac rehabilitation

• lower cardiovascular risk factors such as cholesterol levels, blood sugar, and stress hormones

• improve balance, reduce falls, ease arthritis, and improve breathing for people with chronic obstructive pulmonary disease.

Several randomized controlled trials under way should help pin down what yoga can — and can't — do for people with cardiovascular disease. Even if all of the trials provide unequivocal support for yoga, keep in mind that it won't offer magical protection against heart disease or a cure for it. Instead, yoga could be a useful method for coping with cardiovascular disease.

Trying yoga

Beginning yoga can be a challenge. Attending a general yoga class populated by fit 30-somethings who expect a good workout can be a disheartening introduction.

If you are a few gray hairs beyond 30, look for a yoga class that includes the full package — poses, breathing, and meditation — rather than one that offers just "yoga-flavored exercise," cautions Carol Krucoff, a yoga therapist at Duke Integrative Medicine and co-director of the Therapeutic Yoga for Seniors program.

People with heart disease often have other health concerns, like arthritis or osteoporosis, that limit their flexibility. A good yoga instructor creates a safe environment for his or her students and helps them modify poses to meet their abilities and limitations, according to Krucoff and her yoga partner, Kimberly Carson. Or, as one of their principles of practice for teaching yoga to seniors states, "Teach people, not poses or conditions."

Krucoff practices what she preaches. In 2008, when she needed open-heart surgery to replace a failing aortic valve and fix an aortic aneurysm, she used the meditation techniques she teaches to relax before going into surgery, as well as deep-breathing and meditation techniques right away during her recovery.

"You don't have to be a passive recipient of treatment. The breathing and relaxation aspects of yoga are something you can do for yourself when it seems like everyone is doing things to you," says Krucoff.

We have put together information on finding a teacher trained in helping older people — or those with chronic conditions — learn yoga at health.harvard.edu/yoga.