• Users Online: 200
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 20  |  Issue : 2  |  Page : 153-156

Yoga module for heart disease


Department of Yoga and Management Studies, Swami Vivekananda Yoga Anusandhana Samsthana University (Prashanti Kutiram), Bengaluru, Karnataka, India

Date of Web Publication2-Sep-2015

Correspondence Address:
Tikhe Sham Ganpat
Swami Vivekananda Yoga Anusandhana Samsthana University (Prashanti Kutiram), 19, Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bengaluru - 560 019, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9903.164241

Rights and Permissions
  Abstract 

Background: Heart disease (HD) is the major cause of early morbidity and mortality in most developed countries. Secondary prevention aims to prevent repeat cardiac events and death in people with established HD. Lifestyle modifications play an important role in secondary prevention. Yoga has been regarded as a kind of physical activity as well as stress management strategy. Growing evidence suggests the beneficial effects of yoga on various ailments. The aim was to develop a validated Integrated Yoga Module (IYM) for HD. Materials and Methods: The content validity of IYM for HD was assessed by a panel of 40 yoga experts. The IYM protocol was developed in the form of a tailor-made yoga practices that were supported by classical texts and research evidence. Each item in the questionnaire was discussed and rated as (i) not essential, (ii) useful, but not essential, (iii) essential and the content validity ratio (CVR) was calculated using the formula developed by Lawshe. Results: The data analysis showed that out of 39 IYM practices, 32 indicated significant content validity (cut off value 0.29 as calculated by applying Lawshe's formula for CVR). Conclusion: The IYM for HD suggests good validation for managing HD. Clinical trials are needed before any recommendation can be made.

Keywords: Content validity, heart disease, yoga


How to cite this article:
Isha S, Deshpande S, Ganpat TS, Nagendra HR. Yoga module for heart disease. J Mahatma Gandhi Inst Med Sci 2015;20:153-6

How to cite this URL:
Isha S, Deshpande S, Ganpat TS, Nagendra HR. Yoga module for heart disease. J Mahatma Gandhi Inst Med Sci [serial online] 2015 [cited 2019 Jul 16];20:153-6. Available from: http://www.jmgims.co.in/text.asp?2015/20/2/153/164241


  Introduction Top


Patients with heart disease (HD) such as congestive heart failure (CHF) have clinically significant depression at a rate 2- to 3-times higher than those of the general population, and depression creates barriers to successful CHF treatment (may be more frequent adverse clinical events and hospitalizations, twice the risk of mortality). [1] Patients with coronary artery disease (CAD) (coronary heart disease [CHD]) who suffer a myocardial infarction or undergo coronary artery bypass grafting often develop depression (16-20%), [2],[3],[4],[5] and those with depression and CAD have a diminished quality of life, an increased rate of cardiac-related morbidity, and premature mortality. [6] The CAD is thought to be the cause of CHF in nearly 65% of patients. [7] Moreover, CHD is the major cause of early morbidity and mortality in most developed countries. Secondary prevention aims to prevent repeat cardiac events and death in people with established CHD. Lifestyle modifications play an important role in secondary prevention. Yoga has been regarded as a kind of physical activity as well as stress management strategy. [8] A significant positive effect was observed in the form of reduction in body mass index, waist circumference, systolic and diastolic blood pressure, and heart rate (P < 0.05) when yoga therapy was used as an adjunct in patients with CAD. [9] It was reported that 12-week yoga therapy significantly improved the parasympathetic activity and decreased the sympathetic activity in heart failure patients. [10] A systematic review and meta-analysis on effects of yoga on HD revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors with weak recommendations of ancillary use of yoga for patients with CHD, heart failure, and cardiac dysrhythmia. [11],[12] However, the strong recommendations for using yoga in HD suggested in many of previous studies were not confirmed with well-designed and validated yoga module. The objective of this study was to develop a validated Integrated Yoga Module (IYM) for HD.


  Materials and Methods Top


Different yoga experts talk about different ways for the treatment of HD in general. At the same time text books available from schools of yoga also contemplate on few pose that can be exclusively advocated for HD. Therefore, to develop an overall protocol for HD, we have followed the following steps.

Step 1 (compilation of literary research on HD): Exhaustive literary search from the Vedas, text books and research paper/thesis available in yoga was done for HD, zooming into HD and it was combined with modern scientific view on HD.

Step 2 (sorting of literary research on HD): The compiled literature has been put together in a tabular form to get a common and unique features described in each text. Then, the studies done on different practices and published in the journal as a scientific background were extracted. This gave a scientific back up to the literary search.

Step 3 (preparing treatment protocol based on literary research on HD): A minute wise treatment protocol is developed in the form of tailor made practice that is supported by classical texts and research evidence.

Step 4 (validation by experts): This complete module was presented for validation in front of yoga experts with clinical experience (≥5 years). These experts were requested to participate for evaluating the content validity for the proposed instrument on a three point scale:

  1. Not essential,
  2. Useful, but not essential,
  3. Essential.


An expert panel including 40 health educationists, environmental health specialists, cardiac electro physiologist, heart failure specialists, thoracic and cardiovascular surgery specialists and cardiologists with ≥5 years of yoga therapy experience examined the content validity. In this study, experts with yoga therapy and clinical experience (≥5 years) were considered as yoga expert. The experts selected for the present study (both males and females) were all Indians with age ranging from 45 to 72 years and following different yoga traditions like Kaivalyadham Yoga, Satyananda Yoga, Sivananda Yoga, Vivekananda Yoga and Iyengar Yoga. The expert panel was asked to comment on the necessity and relevance of the items in order to calculate the content validity ratio (CVR) and the content validity index (CVI), respectively.

Following the experts' assessments, the CVR for a total scale was computed. According to Lawshe, if more than half of the panelists indicate that an item is essential, then that item has the least content validity. [13] Here, the CVR for the scale ≥0.29 was considered satisfactory. The CVI was estimated by experts' ratings of items relevancy, simplicity, and clarity on a 4-point Likert scale. The CVI of each statement was calculated and recommended values of ≥0.80 were considered acceptable. [14],[15]

Statistical analysis

The cut-off value of 0.29 was calculated by applying Lawshe's formula for CVR. According to Lawshe formula, we have CVR = (Ne - N/2)/N/2, where CVR, Ne = total number of essentials for each practice, N = total number of panelists. The Microsoft Office Excel 2007 was used for analysis.


  Results Top


The data analysis showed that out of 39 IYM practices, 32 indicated significant content validity [Table 1], [Table 2] and [Table 3]. This result was based on the frequency, length, intensity of the program, teacher qualification, and setting that were rated and made blinded for its validity.
Table 1: Selected IYM practices (breathing practices) by yoga experts with their CVR

Click here to view
Table 2: Selected IYM practices (postures) by yoga experts with their CVR

Click here to view
Table 3: Selected IYM practices (Pranayama and meditation) by yoga experts with their CVR

Click here to view



  Discussion Top


There is growing evidence that yoga may offer a safe and cost-effective intervention for HD. However, systematic, standardized and validated yoga program in populations with HD is needed to confirm and further elucidate the effects of yoga. [16],[17] Findings from the present study indicate that IYM for HD is appealing to yoga experts. The HD educators may be able to support maintenance by discussing specific strategies with individuals who express interest in yoga practice. [18] An ideal yoga module like any other exercise prescription may consist of mode (type), frequency, intensity, duration, and progression. Determining the appropriate mode depends upon patient preference and safety issues regarding the state of HD or other conditions. Frequency, intensity, and duration are specific to the type of activity and should be tailored to the patient's abilities to perform the activity safely. [19],[20],[21],[22]


  Conclusion Top


Based on the findings from the present study, the IYM for HD suggests good validation for managing HD. Clinical trials are needed before any recommendation can be made.

Acknowledgment

Authors acknowledge Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University for granting permission to carry out this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rustad JK, Stern TA, Hebert KA, Musselman DL. Diagnosis and treatment of depression in patients with congestive heart failure: A review of the literature. Prim Care Companion CNS Disord 2013:15.  Back to cited text no. 1
    
2.
Frasure-Smith N, Lespérance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA 1993;270:1819-25.  Back to cited text no. 2
    
3.
Schleifer SJ, Macari-Hinson MM, Coyle DA, Slater WR, Kahn M, Gorlin R, et al. The nature and course of depression following myocardial infarction. Arch Intern Med 1989;149:1785-9.  Back to cited text no. 3
    
4.
Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 2006;21:30-8.  Back to cited text no. 4
    
5.
Connerney I, Shapiro PA, McLaughlin JS, Bagiella E, Sloan RP. Relation between depression after coronary artery bypass surgery and 12-month outcome: A prospective study. Lancet 2001;358:1766-71.  Back to cited text no. 5
    
6.
Celano CM, Huffman JC. Depression and cardiac disease: A review. Cardiol Rev 2011;19:130-42.  Back to cited text no. 6
    
7.
Gheorghiade M, Sopko G, De Luca L, Velazquez EJ, Parker JD, Binkley PF, et al. Navigating the crossroads of coronary artery disease and heart failure. Circulation 2006;114:1202-13.  Back to cited text no. 7
    
8.
Lau HL, Kwong JS, Yeung F, Chau PH, Woo J. Yoga for secondary prevention of coronary heart disease. Cochrane Database Syst Rev 2012;12:CD009506.  Back to cited text no. 8
    
9.
Pal A, Srivastava N, Narain VS, Agrawal GG, Rani M. Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: A randomized controlled trial. East Mediterr Health J 2013;19:452-8.  Back to cited text no. 9
    
10.
Krishna BH, Pal P, G K P, J B, E J, Y S, et al. Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure. J Clin Diagn Res 2014;8:14-6.  Back to cited text no. 10
    
11.
Cramer H, Lauche R, Haller H, Dobos G, Michalsen A. A systematic review of yoga for heart disease. Eur J Prev Cardiol 2014.  Back to cited text no. 11
    
12.
Cramer H, Lauche R, Haller H, Steckhan N, Michalsen A, Dobos G. Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis. Int J Cardiol 2014;173:170-83.  Back to cited text no. 12
    
13.
Lawshe CH, Nagle BF. A note on the combination of ratings on the basis of reliability. Psychol Bull 1952;49:270-3.  Back to cited text no. 13
    
14.
Kasmel A, Tanggaard P. Evaluation of changes in individual community-related empowerment in community health promotion interventions in Estonia. Int J Environ Res Public Health 2011;8:1772-91.  Back to cited text no. 14
    
15.
Araban M, Tavafian SS, Motesaddi Zarandi S, Hidarnia AR, Gohari MR, Prochaska JM, et al. Introducing a new measure for assessing self-efficacy in response to air pollution hazards for pregnant women. J Environ Health Sci Eng 2013;11:16.  Back to cited text no. 15
    
16.
Yoga could be good for heart disease. Simultaneous focus on body, breathing, and mind may be just what the doctor ordered. Harv Heart Lett 2010;21:5.  Back to cited text no. 16
    
17.
Kubo A, Hung YY, Ritterman J. Yoga for heart failure patients: A feasibility pilot study with a multiethnic population. Int J Yoga Therap 2011:77-83.  Back to cited text no. 17
    
18.
Yogendra J, Yogendra HJ, Ambardekar S, Lele RD, Shetty S, Dave M, et al. Beneficial effects of yoga lifestyle on reversibility of ischaemic heart disease: Caring heart project of International Board of Yoga. J Assoc Physicians India 2004;52:283-9.  Back to cited text no. 18
    
19.
Manchanda SC, Narang R. Yoga and coronary artery disease. Indian Heart J 1998;50:227-8.  Back to cited text no. 19
    
20.
Telles S, Naveen KV. Yoga for rehabilitation: An overview. Indian J Med Sci 1997;51:123-7.  Back to cited text no. 20
[PUBMED]  Medknow Journal  
21.
Schmidt T, Wijga A, Von Zur Mühlen A, Brabant G, Wagner TO. Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition. Acta Physiol Scand Suppl 1997;640:158-62.  Back to cited text no. 21
    
22.
Lakshmikanthan C, Alagesan R, Thanikachalam S, Ramamurthi B, Elangovan D, Viswanathan TR, et al. Long term effects of yoga on hypertension and/or coronary artery disease. J Assoc Physicians India 1979;27:1055-8.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed1150    
    Printed10    
    Emailed0    
    PDF Downloaded141    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]