|Year : 2015 | Volume
| Issue : 2 | Page : 153-156
Yoga module for heart disease
Shukla Isha, Sudheer Deshpande, Tikhe Sham Ganpat, Hongasandra Ramarao Nagendra
Department of Yoga and Management Studies, Swami Vivekananda Yoga Anusandhana Samsthana University (Prashanti Kutiram), Bengaluru, Karnataka, India
|Date of Web Publication||2-Sep-2015|
Tikhe Sham Ganpat
Swami Vivekananda Yoga Anusandhana Samsthana University (Prashanti Kutiram), 19, Eknath Bhavan, Gavipuram Circle, Kempegowda Nagar, Bengaluru - 560 019, Karnataka
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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).  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%), ,,, and those with depression and CAD have a diminished quality of life, an increased rate of cardiac-related morbidity, and premature mortality.  The CAD is thought to be the cause of CHF in nearly 65% of patients.  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.  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.  It was reported that 12-week yoga therapy significantly improved the parasympathetic activity and decreased the sympathetic activity in heart failure patients.  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. , 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|| |
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:
- Not essential,
- Useful, but not 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.  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. ,
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|| |
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|
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|Table 2: Selected IYM practices (postures) by yoga experts with their CVR|
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|Table 3: Selected IYM practices (Pranayama and meditation) by yoga experts with their CVR|
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| Discussion|| |
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. , 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.  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. ,,,
| Conclusion|| |
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.
Authors acknowledge Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) University for granting permission to carry out this work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]