Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, Georgia.
Centre for Chronic Disease Control, New Delhi, India.
J Am Coll Cardiol. 2020 Apr 7;75(13):1551-1561. doi: 10.1016/j.jacc.2020.01.050.
Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly).
This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial.
The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks.
MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes).
Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408).
鉴于印度心脏康复（CR）项目短缺以及全球接受程度低，因此迫切需要寻找经济实惠的替代 CR 模式，为接受程度较低的亚组（如女性和老年人）提供选择。
本研究旨在通过多中心随机对照试验评估基于瑜伽的 CR（Yoga-CaRe）对主要心血管事件和自我评估健康的影响。
该试验在印度的 24 个医疗中心进行。这项研究招募了 3959 名急性心肌梗死患者，中位随访时间和最小随访时间分别为 22 个月和 6 个月。患者被单独随机分配到接受 Yoga-CaRe 方案（n=1970）或包括教育建议的强化标准护理（n=1989）。主要复合终点为：1）主要不良心血管事件（MACE）（全因死亡率、心肌梗死、卒中和紧急心血管住院的复合终点）的首次发生；2）12 周时欧洲生活质量-5 维度-5 级视觉模拟量表的自我评估健康状况。
Yoga-CaRe 组发生 MACE 的患者有 131 例（6.7%），强化标准护理组有 146 例（7.4%）（Yoga-CaRe 组的风险比：0.90；95%置信区间[CI]：0.71 至 1.15；p=0.41）。Yoga-CaRe 组的自我评估健康状况为 77，强化标准护理组为 75.7（Yoga-CaRe 组有利于自我评估健康状况的基线调整平均差异：1.5；95%CI：0.5 至 2.5；p=0.002）。Yoga-CaRe 组患者在急性心肌梗死后更能恢复到梗死前的活动，但两组之间在戒烟或药物依从性方面没有差异（次要结局）。
Yoga-CaRe 可改善急性心肌梗死后的自我评估健康状况和恢复到梗死前的活动，但试验缺乏统计学效力来显示 MACE 的差异。当传统的 CR 对个人不可用或不可接受时，Yoga-CaRe 可能是一种选择。（印度和英国基于瑜伽的心脏康复方案有效性研究；CTRI/2012/02/002408）
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