MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Some people seem to think that all so-called alternative medicine (SCAM) is ineffective, harmful or both. And some believe that I am hell-bent to make sure that this message gets out there. I recommend that these guys read my latest book or this 2008 article (sadly now out-dated) and find those (admittedly few) SCAMs that demonstrably generate more good than harm.

The truth, as far as this blog is concerned, is that I am constantly on the lookout to review research that shows or suggests that a therapy is effective or a diagnostic technique is valid (if you see such a paper that is sound and new, please let me know). And yesterday, I have been lucky:

This paper has just been presented at the ESC Congress in Paris.

Its authors are: A Pandey (1), N Huq (1), M Chapman (1), A Fongang (1), P Poirier (2)

(1) Cambridge Cardiac Care Centre – Cambridge – Canada

(2) Université Laval, Faculté de Pharmacie – Laval – Canada

Here is the abstract in full:

Introduction: Regular physical activity may modulate the inflammatory process and be cardio-protective. Yoga is a form of exercise that may have cardiovascular benefits. The effects of yoga on global cardiovascular risk have not been adequately described. The purpose of this study is to determine whether the addition of yoga to a regular exercise regimen reduces global cardiovascular risk.
Methods: Sixty consecutive individuals with essential hypertension were recruited in a lifestyle intervention program. All individuals with known hypertensive end organ damage, known cardiovascular diseases, as well as those taking medications/supplements that affected blood pressure, blood sugar, cholesterol or vascular inflammation were excluded. Participants were randomized to either a yoga group or similar duration stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercises thrice weekly. Blood pressure, cholesterol levels and hs-CRP were measured, and Reynold’s Global Cardiovascular Risk Score was calculated at baseline and at the end of the 3-month intervention program.
Results: At screening, there were no statistically significant differences between the groups in any measured parameters or the 10-year risk of a cardiovascular event as measured by the Reynolds Risk Score. (8.2 vs. 9.0%; yoga vs. control group) After the 3-month intervention period, there was a statistically significantly greater decrease in the Reynold’s Risk Score in the yoga vs. the control group. (7.0 vs. 8.4%, p=0.003, relative reduction 13.2 vs. 6.5%, p<0.0001)
Conclusions: In patients with essential hypertension on no medications and with no known end organ damage, the practice of yoga incorporated into a 3-month exercise intervention program was associated with significant greater improvement in the Reynold’s Risk of a 10-year cardiovascular event, when compared to the control stretching group. If these results are validated in more diverse populations over a longer duration of follow up, yoga may represent an important addition to traditional cardiovascular disease prevention programs.

Yes, this study was small, too small to draw far-reaching conclusions. And no, we don’t know what precisely ‘yoga’ entailed (we need to wait for the full publication to get this information plus all the other details needed to evaluate the study properly). Yet, this is surely promising: yoga has few adverse effects, is liked by many consumers, and could potentially help millions to reduce their cardiovascular risk. What is more, there is at least some encouraging previous evidence.

But what I like most about this abstract is the fact that the authors are sufficiently cautious in their conclusions and even state ‘if these results are validated…’

SCAM-researchers, please take note!

11 Responses to Who says it’s all negative? The addition of yoga to aerobic exercise programs reduces global cardiovascular risk

  • Interesting. My fitness regime is close to the one tested here – an aerobic walk for an hour three times a week and yoga-like stretching several times a week. I say yoga-like since I do not consciously practice “yoga”. I simply make up my own stetching/relaxing exercises. I am curious to know what the differences between the control and the yoga exercises were.

    Am I wasting my time or are my homemade exercises “yoga” even though I am just doing what seems subjectively like a good thing to do to keep my muscles and joints in good condition.

    • Yoga as exercise is not “just” stretching. One can work up quite a sweat during Yoga. (I regularly do Yoga as exercise, next to other types of exercise.)
      https://en.wikipedia.org/wiki/Yoga_as_exercise
      During Yoga, the body typically gets into positions, and is stressed/stimulated in ways that it typically isn’t in daily life or with other types of exercise. For example: upside-down postures, bending backwards and twisting.
      If, and why this type of exercise would be beneficial for the cardiovascular system would be interesting to find out.

      • the problem is, we don’t know what ‘yoga’ meant in this study; yoga can mean a lot of things, including breathing techniques, meditation, life-style, nutrition, etc.

        • Yes, I was more reacting to Leigh’s homemade exercises comment. For the study we could only assume (but shouldn’t) they may have meant Yoga exercise, since the control group was doing stretching. Looking forward to find out what the authors meant when the study comes out 🙂

      • I twist every which way I can think of and manage – twist/stretch/bending every which way. When I was young I used to do headstands. These days I just lie on my back and lever my body upright, hold for a while and then descend my legs behind my head. Maybe I am doing “yoga”, but I think of it as simply keeping my body supple.

        I am interested to know what the differences were between the control and the yoga group were. If the control was a very restricted set of exercises compared to the yoga group the result was to be expected. Within one’s personal limits, more exercise is better than little or no exercise. I don’t think too many people don’t know that.

  • Oh – labels labels labels! SCAM (So Called Alternative Medicine) is in fact practised by many MDs, GPs, qualified practitioners and others in the conventional medical world. ‘Yoga’ is not an exact science. The same body movements will have different effects on different people! Statin drugs seem to cause no side-effects on some patients, but others experience severe side-effects. Many medical experts label a group of cancer patients (for example) as requiring the same type of treatment. This is ignorance and apathy at its most extreme. Have our Doctors chosen to ignore the ‘father’ of modern medicine when he said: “FIRST, Do No Harm”.

    • This study suggests that yoga stretching exercises can be defined exactly enough to supply medical benefits that non-yoga stretching exercises do not – when combined with aerobic exercises.

      The same “treatment” appeared to worked for a group of patients. Ignorance and apathy?

    • Many medical experts label a group of cancer patients (for example) as requiring the same type of treatment.

      Well, yes, if these patients have the same type of cancer in the same stage in similar conditions(*), then prescribing the same treatment is the best choice, at least initially. Sure, there will always be exceptions, i.e. patients in this group who do not respond to this treatment – and as soon as this becomes clear, other treatment options should be explored.

      *: E.g. estrogen-receptor-positive breast tumours before stage IV, see for instance https://ww5.komen.org/BreastCancer/Table36Estrogenreceptorstatusandoverallsurvival.html

      “This is ignorance and apathy at its most extreme.”
      No. This is very often the best approach.
      But please tell us what you would propose? Identifying those aforementioned exceptions beforehand in order to give them too the best treatment from the onset is often exceedingly difficult and costly, and sometimes plain impossible. Also, extra tests may cost valuable time, causing a worse outcome in the majority for whom the ‘standard’ treatment is most appropriate after all – which would be putting the cart before the horse.

      And, of course, continuous research is carried out to refine diagnoses, e.g. genetic tests on the cancer itself, leading to ever more individualized diagnoses and treatments. So I think that your criticism is largely unwarranted.

      More in general (and on-topic), one important point of medical research is to identify (and predict!) patterns and trends in diseases and treatments, with the explicit aim to come up with treatments that work best for the largest possible group of patients – notwithstanding their individual differences. This does not mean that every patient with condition X should only receive standard treatment Y and nothing else, but it does mean that treatment Y is probably the best starting point for most patients.
      It is then up to the actual doctors to judge whether a particular patient should indeed receive treatment Y, and if so, for how long, and perhaps if treatment Y should be combined with one or more other interventions. And it is also the doctor’s responsibility to stop treatment Y in case it doesn’t do any good, and re-evaluate the patient’s diagnosis, explore other possibilities etcetera. So individualized diagnosis and treatment is already mainstream, even if not all doctors practise this to the same degree.

      In fact, I find it hugely annoying that alternative practitioners criticize regular medicine for offering only ‘one-size-fits-all’ treatments (which is clearly not the case), while doing even far worse themselves – as virtually all of their ‘treatments’ boil down to the exact same thing: Nothing.

  • I do think the quality of the studies or the risk of bias matters even if it shows significant results. And it doesn’t say that in the abstract. The Cochrane Review you posted still shows a high risk of bias. So even if there could be small benefits, we really don’t know if that is true. But encouraging as you said. Do you know what mechanisms it could be working via?

    Also, this a terrific blog and you should sign up for the Patreon at https://www.patreon.com and make some revenue. I am sure lot of people would love to donate to this blog and I cannot say this about many other sites. Just a suggestion.

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