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UCSF Study Looks to Yoga as Possible Health Boon for Heart Failure Patients

Robert Wertz practices a leg stretch in the UCSF study on the effects of yoga on patients with heart failure.

By Robin Hindery It sounded like a bad idea: a roomful of heart failure patients doing something called the “warrior series.” But on a recent afternoon at UCSF’s Osher Center for Integrative Medicine, five men with significant cardiac damage tackled not only the warrior series, but also the “superhero poses” and a variety of other exercises with milder names such as “cat” and “table.” The men, all patients at the UCSF Cardiology Clinic, were the latest participants in a first-of-its-kind pilot study of the effects of yoga on heart rate variability in people with heart failure. The study started on Jan. 12 and has enrolled 18 men and women so far. The study consists of eight weeks of twice-weekly, hourlong yoga classes adapted to patients’ physical capabilities through the use of chairs, cushions and modified poses. For 24 hours before the first class, and again after the eight-week session ends, each participant’s heart rate is measured and recorded using a Holter monitor.

Basab Basu, left, and lead investigator Jill Howie Esquivel, RN, NP, PhD, practice a yoga pose.

The hope is that by the end of the eight weeks, participants will have experienced improved heart rate variability on a typical day, said the study’s principal investigator, Jill Howie Esquivel, RN, NP, PhD, associate clinical professor and vice chair of clinical academic programs and personnel in the UCSF Department of Physiological Nursing. Greater variability is associated with a healthier heart, she said. Heart failure affects more than 5 million people in the United States and is the leading cause of hospitalization in people older than 65, according to the American Heart Association. Heart failure occurs when the heart’s pumping power is weakened – by coronary artery disease, a heart attack, high blood pressure or various other conditions – and the heart is unable to pump sufficient oxygen and nutrients through the bloodstream. Though many heart failure patients are unable to engage in vigorous activity, regular exercise is an important part of rehabilitation and improving quality of life, Howie Esquivel said. And yoga not only improves fitness and flexibility, but also can be custom-tailored to the individual, she noted. “In our classes, people do yoga in a way that fits their body,” she said. “A lot of these patients are extremely frail and don’t have much stamina. But I’ve been amazed to see what they are still able to do with the proper modifications.”

Jill Howie Esquivel, RN, NP, PhD, associate clinical professor and vice chair of clinical academic programs and personnel in the UCSF Department of Physiological Nursing, and principal investigator of a yoga study for cardiac patients, practices a neck stretch.

In addition to the on-site classes, participants in the UCSF study are given a CD of yoga instruction so that they can practice on their own, and they are asked to keep a diary of their home practice. Though it is not yet known whether the yoga has improved participants’ heart rate variability, they have raved about the improvements in their energy level, their mood and their ability to manage life’s daily stressors, Howie Esquivel said. “It has been very heart-warming,” she said. “When people are finished with the eight weeks, they ask me, ‘Can we keep coming back to class?’” One participant, Jerry Grissom, said his heart failure and his past experience with cancer had opened him up to activities – such as yoga, tai chi and meditation – that emphasize the mind-body connection. “I’ve really noticed a difference since I started the program,” he said in mid-April, about three weeks into his eight-week yoga session. “When I leave here, I’m more energetic.”

Jerry Grissom does a side stretch as part of the pilot study on the effects of yoga.

The pilot study, funded by a grant from the UCSF Academic Senate, is the first to examine yoga’s effect on heart rate variability among heart failure patients, Howie Esquivel said. A 2008 study by University of Georgia researchers found that yoga improved exercise capacity and positively affected levels of inflammatory markers in patients with chronic heart failure. Howie Esquivel hopes to use her initial data to apply for funding from the National Institutes of Health and expand the study to multiple sites with a larger number of participants. “I hear so many patients say they want to have more options besides medications to treat their symptoms of heart failure, but so few alternative or complementary therapies for heart failure have been studied,” she said. “I’d love to see UCSF offer yoga as a permanent program for these patients.” Photos by Susan Merrell

Related Links:

UCSF School of Nursing

Osher Center for Integrative Medicine