Newest Treatment for Afib: Yoga

This ancient Indian system of exercises may help prevent atrial fibrillation, lowering stroke and dementia risk.

Atrial fibrillation (Afib), which affects about 2.7 million Americans, dramatically raises the risk for stroke, is linked with mood disorders such as depression and anxiety, and increases the risk for heart failure and death. A recent study conducted by MGH researcher Jeremy Ruskin, MD, and colleagues (Annals of Internal Medicine, March 4, 2013) suggests that people with Afib are more likely to experience cognitive decline and dementia, as well.

“Afib is a serious condition with serious consequences for the brain, and any new strategy for reversing it would be very helpful,” says psychologist Ann Webster, PhD, Director of the Mind Body Program for Successful Aging at MGH’s Benson-Henry Institute for Mind Body Medicine (BHI). “The usual treatments for Afib are medication; a form of electrical or drug stimulation called cardioversion that jolts the heart back to its normal rhythm; or an invasive procedure that trims unwanted tissue from around the pulmonary veins. The recent evidence that substantial benefit may also be derived from practicing yoga—the ancient Indian system that combines physical postures with breathing exercises, concentration, and meditation—is very interesting.”

Those findings came from a small study involving 49 people with Afib who were equipped with ambulatory heart monitors to measure episodes of Afib and assigned to two sequential study phases of three months each. In the first stage, the participants engaged in regular exercise of their choice. In the second stage, they engaged in 60 minutes of supervised group yoga classes twice a week that included 15 minutes of deep breathing and meditation, and were encouraged to practice yoga at home on the other days of the week.

The effect of yoga on Afib was stunning, according to a report published in the March 2013 issue of the Journal of the American College of Cardiology. At the end of the yoga phase of the study, the number of episodes of Afib had dropped nearly 45 percent. Participants experienced a significant decrease in heart rate and systolic and diastolic blood pressure. Levels of depression and anxiety improved significantly, as did measures of quality of life, such as physical functioning, general health, vitality, and social functioning.

Multiple effects

“BHI has been using yoga with cardiac patients for 40 years now, and it has proven to be a well accepted therapy with significant benefits,” Dr. Webster says. “Although the Afib study did not describe precisely how yoga benefits individuals with Afib, there are several possible mechanisms. A relaxing session of yoga reduces levels of the stress hormone cortisol. This in turn may help calm the ‘fight or flight’ response of the sympathetic nervous system—which increases heart rate and elevates blood pressure—and strengthen the response of the parasympathetic system—which lowers the heart rate and blood pressure—thereby reducing harmful effects on the heart.

“In addition, recent research suggests that practicing yoga may help decrease the activity of neurons in the right prefrontal cortex, where negative emotions are centered, and increase the activity of neurons in the left prefrontal cortex, a center for positive mood.  These findings may explain why practicing yoga is associated with reductions in feelings of depression and anxiety. Yoga increases circulation, slows breathing, most likely reduces inflammation associated with stress, and triggers the release of brain chemicals called endorphins that reduce pain and positively affect emotions. Finally, socialization involved in the group activities of a yoga class and improvements in sleep patterns associated with yoga may also benefit mental and physical health.”

Fewer episodes ofAfib clearly translate into better brain health. Afib is associated with the formation of blood clots in the heart’s upper chambers, which then may travel through the circulatory system to the brain, block blood flow to brain tissue, and kill neurons. Over time, a series of small clots can destroy brain cells and result in a loss of brain function and possibly dementia. Larger clots can cause ischemic strokes that may cause serious brain injury, and even death.

How to begin

The benefits of yoga are increasingly well known, so finding a yoga class in your area should be relatively easy.

“All schools of yoga are related, and all are beneficial,” says Dr. Webster. “I recommend that people attend group yoga classes at least twice a week, and then practice at home for 15 to 20 minutes a day.”

For individuals who are unable to attend classes, Dr. Webster suggests taking occasional one-minute “mini-breaks” during the day to engage in deep breathing and relaxation, or learning simple yoga techniques from books, DVDs, or online tutorials.

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