Yoga Heals: Heart Disease

Cardiovascular disease (also known as heart disease and coronary heart disease) is the leading cause of death worldwide for both men and women, and is an umbrella term that refers to several problems related to dysfunction of the heart. This dysfunction is often caused by plaque buildup in the walls of the arteries, or atherosclerosis, which limits blood flow to the heart and creates a risk for heart attack or stroke. Heart disease also includes congestive heart failure, irregular heartbeat (arrhythmia), and heart valve problems.

Major risk factors of heart disease include:

Additional risk factors are age, gender and race.

Fortunately, many of the risk factors of heart disease are related to lifestyle choices and can be managed to promote better health and reduce risk of disease. Yoga is a holistic practice that promotes wellness and supports other healthy habits like eating a balanced diet, reducing stress and maintaining a healthy weight.

Stress can be hard on the heart, and yoga can help people manage and respond to stress more healthfully. Stress hormones raise blood pressure and heart rate (which can strain the circulatory system), and also increase clotting factors in the blood, and even spasm in coronary arteries. In addition to the physiological effects, chronic stress is also known to increase over-eating and intra-abdominal fat, which can lead to insulin-resistance and increased blood sugar.

Another surprising benefit of yoga for those with heart disease is that it tends to reduce feelings of anger by cultivating a sense of compassion and gratitude during yoga practice that can be carried into other day-to-day activities and interactions. Learning to manage strong emotions like anger with equanimity can be instrumental to prevention of serious physical reactions to stress.

For those who have excess body fat that puts them at risk for heart disease), some styles of yoga (such as Flow and Kundalini) can raise their heart rate to the aerobic range and offer a workout. Pranayama techniques, such as ujjayi and anumloma viloma (alternate nostril breathing) have also been shown to improve cardiovascular health.

For those who have experienced heart attack, yoga can be a gentle, uplifting activity that improves health, and support the lifestyle changes that will help manage, and potentially reverse, the symptoms of heart disease.

Five Techniques for Heart Disease

Yoga practice for those with heart disease, and especially for those with high blood pressure or history of cardiac infarction (heart attack), should focus on cooling postures and breathing techniques to calm the body and center the mind. A class like Restore, with its emphasis on relaxing and resting, might be highly beneficial for students with heart disease.

Asana

Upavistha Konasana, supported

This wide-legged forward bend can be very calming if done with adequate support. Leaning onto a block, elevated bolster or even a chair can make the pose less stressful and less intense of a stretch to the back of the legs.

Setu bandhasana, supported

Supported bridge pose is a mild inversion--for students new to yoga, inversions could potentially increase blood pressure. If a student begins to feel dizzy, nauseous, or short of breath, he should come out of the posture and rest on his back with knees bent.

Supta Baddha Konasana, variation

Reclined bound angle pose is a wonderful position for opening the front of the body and creating more space for breath. To create even more opening through the chest, the student can roll a blanket and lie down with the rolled blanket running down the length of his spine. The blanket supports the spine and creates a gentle stretch for the pectoral and intercostal muscles.

Savasana, extended

Savasana, or corpse pose, is typically practiced lying flat on the back. Many variations exist, and the student is encouraged to find whatever version allows him to rest fully. Try placing a bolster or blanket under the knees and support the neck and head as needed for comfort. If shortness of breath is a concern for the student, he can try a reclining supported position with an elevated bolster behind the back and his knees supported by a bolster or rolled blanket.

To allow the full benefit of relaxation and restoration available in savasana, practice for at least fifteen minutes. Twenty minutes is even better. It takes approximately fifteen minutes for the average person's body to fully relax. Practicing savasana beyond that time allows the student to truly receive benefit from being in the relaxed state. 

Pranayama

Ujjayi pranayama practiced as a three part breath, either seated or lying down, can be a very calming and cooling breath for the yoga student. Ujjayi, a sounded breath, allows the flow of breath to be controlled so that it is smooth, regular and lengthened, and it promotes a fuller inhale and complete exhale. On his inhale, the student can focus on feeling the breath lift the upper thoracic cavity (under the clavicle), then the mid thoracic (the ribcage), then expanding the belly. On his exhale, he feels the belly draw inward first, then the ribcage, then upper chest.

Tips, Contraindications and Considerations

If a student is experiencing intermittent angina, it's best to get a doctor's approval to begin practicing yoga. Students with angina should be reminded to take care and rest if symptoms occur. If a student experiences angina for the first time during class, or if it becomes more pronounced, he should see his doctor immediately.

Sometimes a yoga teacher needs to help the student recognize, accept and honor the limits of his body. "Type A" personalities frequently experience the symptoms of heart disease, and that same tendency to push themselves throughout their lives can lead to injury or harm in any physical activity, even yoga. Especially for this group, the focus of yoga practice should be on the student's therapeutic experience--not on achievement of a certain level of proficiency, strength, flexibility or endurance.

Arm balances, full backbends and standing poses have been shown to increase blood pressure while they are held, and may not be appropriate for new students. Sun salutations also elevate blood pressure and should be practiced mindfully, with special attention to breath rate and fullness and steadiness of heart rate. 

Kapalabhati and Bhastrika pranayama exercises are contraindicated as they tend to elevate blood pressure.

Research

Dean Ornish, a leader in the research on yoga for heart health, has overseen a long-term study of the effects of a healthy lifestyle program, called the Lifestyle Heart Trial, since 1983, and his research shows reversal of heart disease after five years of following a program that consists of balanced nutrition, stress management, fitness and group support  to maintain a healthy lifestyle.

According to a recent review and analysis of over 44 studies on the benefits of yoga, researchers concluded that regular yoga practice could reduce many of the leading risk factors for heart disease and stroke. Study participants in the yoga group showed significant improvements in heart and respiration rates, systolic and diastolic blood pressure, total cholesterol, HDL, VLDL, triglycerides, and insulin resistance, as well as a significantly reduced waste circumference and waist to hip ratio (an indicator of body fat percentage).

Additional Resources:

Yoga and Heart Health - American Heart Association

It's no stretch--Yoga may benefit Heart Disease - Harvard Health Publications

Yoga is good for Your Heart, New Study Suggests - Yoga U