Lopes Carla Pinheiro, Danzmann Luiz Claudio, Umpierre Daniel, Moraes Ruy Silveira, Soares Douglas Santos, Leitão Santiago Alonso Tobar, Filho Alexandre Silva Campos, Depaoli Flávio, Guimarães Luciano Pinto, Chiappa Gaspar, Vieira Paulo José Cardoso, Ribeiro Jorge Pinto, Biolo Andreia
School of Medicine,Post-Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Ramiro Barcelos, Rio Branco, Porto Alegre, RS 90035-903, Brazil.
Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
medRxiv. 2025 Sep 5:2025.09.03.25335058. doi: 10.1101/2025.09.03.25335058.
Patients 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.
This study is a multicenter, randomized 1:1:1, outcome-blind, parallel-group, no-inferiority trial. Thirty-two patients with previous diagnosis of HFpEF (EF ≥ 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 (Pth) [19 (7-29) 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 PI, functional capacity nor in parameters of diastolic function.
In 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.
射血分数保留的心力衰竭（HFpEF）患者通常存在体力活动不耐受，且可能出现吸气肌无力（IMW）。众所周知，瑜伽对心血管和呼吸健康有显著益处。然而，瑜伽和呼吸技巧对HFpEF的影响尚未见报道。
本研究是一项多中心、随机1:1:1、结果盲法、平行组、非劣效性试验。32例年龄在45 - 75岁、既往诊断为HFpEF（射血分数≥50%）的患者被随机分组：瑜伽组（Y = 11）、呼吸技巧组（BT = 11）或对照组（C = 10），以评估为期8周的瑜伽和特定呼吸技巧的面对面训练计划对吸气肌反应、功能能力、自主神经系统的不同特征、利钠肽、舒张功能和生活质量的影响。数据采用广义估计方程模型（GEE - GZLM）进行分析。瑜伽训练使吸气肌力量（Pth）提高了44.1%[对照组为19（7 - 29），瑜伽组为2（-2至5），（p < 0.05）]。呼吸技巧增加了心率变异性（HRV）（对照组为827.6±46.7ms，呼吸技巧组为936±51.4ms，（p < 0.05））。在PI、功能能力和舒张功能参数方面均未改善。
在有或无IMW的HFpEF患者中，瑜伽训练是可行的，并能促进呼吸肌力量增加。进一步的研究应更好地探讨其对功能参数可能的益处。临床试验注册：网址：https://www.clinicaltrials.gov；NCT03028168；方案研究：Trials. 2018；7:19:405。https://doi.org/10.1186/s13063 - 018 - 2802 - 5。
