Marcia Frellick

April 29, 2016

WASHINGTON, DC — A 12-week yoga regimen significantly improved anxiety, depression, and quality-of-life scores in adults with pulmonary arterial hypertension, results from a small study suggest.

The findings are promising for patients with the progressive disease, which is characterized by dyspnea that can lead to anxiety and depression.

Yoga hasn't been assessed in this population "partly because people are afraid of exercising patients with lung disease," said lead researcher Mitesh Thakrar, MD, from the University of Calgary in Alberta, Canada.

Dr Thakrar presented the results here at the International Society for Heart and Lung Transplantation (ISHLT) 2016 Scientific Sessions.

The study of 48 patients was conducted at two Canadian pulmonary arterial hypertension clinics. Mean age was 57 years, 52% of the patients were on a combination of hypertension-specific therapies, and 31% were on oxygen. Patients were asked not to participate in other exercise programs during the study period.

The researchers found that a number of measures improved after 12 weekly 2-hour supervised sessions of Iyengar yoga.

Table. Mean Improvements After 12 Weeks of Yoga

Measure Baseline Score, Points Mean Improvement, Points P Value
Hospital Anxiety and Depression Scale
   Anxiety score 6.97 2.25 .003
   Depression score 7.81 2.78 .001
Chronic Respiratory Questionnaire
   Dyspnea score 4.58 0.56 .020
   Emotion score 4.93 0.49 .049


No Adverse Effects

"A highlight in the findings is that this therapy did not result in adverse side effects to the patient, which is promising as a supportive approach for pulmonary arterial hypertension patients," ISHLT Program Chair Andrew Fisher, PhD, said in a statement.

Most impressive is the improvement in depression scores, said Rana Awdish, MD, director of the pulmonary hypertension program at Henry Ford Hospital in Detroit, who was not involved with the study.

"Everyone knows how difficult it is to affect depression and anxiety," she told Medscape Medical News.

But the most disappointing aspect of the study is that it didn't show an improvement in 6-minute walk distance, she said. The baseline distance of 363 m (range, 71 -565 m) did not change after yoga.

"That's really our surrogate marker for how our patients are doing," Dr Awdish explained. However, 6-minute walk distance tends to decline over 12 weeks in pulmonary arterial hypertension patients, she added, so the fact it did not is positive news.

In the study cohort, 83% of the participants were white women and 96% had at least a high-school education, so further research is needed before the generalizability of the findings can be confirmed, she said.

Dr Awdish pointed out that pulmonary arterial hypertension disproportionately affects women with autoimmune disease. It makes sense that yoga would help this population because studies have shown that stress negatively affects pulmonary hypertension in autoimmune disease.

She explained that she developed one of a very few yoga programs for pulmonary hypertension patients 2 years ago at Henry Ford. It is designed for patients at any level, whether or not they use a wheelchair. Patients can take home the instructional DVD that teaches the program, which is a huge benefit to those who have transportation issues.

Yoga That Uses Props to Support People

The common Iyengar method of yoga was chosen because it relies heavily on props to support participants with limited mobility, Dr Thakrar told Medscape Medical News. Patients can practice it while on oxygen or while sitting in a chair.

"As such, we thought it would lend itself well to our pulmonary arterial hypertension patients who frequently have both dyspnea and rheumatologic complaints," he explained.

The next step is to see whether the intervention works with other chronic lung diseases. Dr Thakrar said his team is designing a study to test that.

Iyengar yoga was created by B.K.S. Iyengar, who is credited with bringing it from India to the Western world. The certified instructors in this study trained with him in India, Dr Thakrar reported.

Dr Thakrar reports receiving support from Actelion and Bayer. Some of his coauthors report receiving support from Forrest Laboratories, Gilead, Bayer, United Therapeutics, and Bellerophon. Dr Fisher has disclosed no relevant financial relationships. Dr Awdish reports that the Henry Ford Hospital receives support from Bayer, United Therapeutics, Gilead, and Actelion.

International Society for Heart and Lung Transplantation (ISHLT) 2016 Scientific Sessions: Abstract 0115. Presented April 28, 2016.


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