Yoga-Based Cardiac Rehab Improves Quality of Life in Heart Failure Trial

A structured yoga-based cardiac rehabilitation program significantly improved quality of life and physical functioning among adults with heart failure with reduced ejection fraction (HFrEF), but did not reduce the combined risk of death, hospitalization, or stroke, according to late-breaking findings presented at the American Heart Association (AHA) Scientific Sessions 2026, held November 6-9 in Chicago, Illinois.¹˒²

In the randomized Yoga-CaRe HF trial involving 3492 adults, participants receiving yoga-based cardiac rehabilitation experienced an 8.06-point greater improvement in Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores at 3 months compared with those receiving enhanced standard care (95% CI, −8.87 to −7.24; P<.001). The yoga intervention was also associated with significantly greater improvements in 6-minute walk distance and self-reported health status.²

However, the composite clinical endpoint of all-cause mortality, all-cause hospitalization, or stroke occurred in 21.0% of participants receiving yoga-based rehabilitation compared with 22.8% receiving enhanced standard care during a median follow-up of 15 months, a difference that was not statistically significant (hazard ratio [HR], 0.90; 95% CI, 0.78-1.04; P=.15).²

The findings suggest that structured yoga-based rehabilitation may offer an accessible approach to improving quality of life and exercise capacity among individuals with HFrEF, particularly in settings where conventional cardiac rehabilitation programs are limited.

"Cardiac rehab programs are inaccessible to many, and their uptake is poor in many countries," lead investigator Dorairaj Prabhakaran, MD, executive director of the Centre for Chronic Disease Control in New Delhi, India, said in an AHA press release.¹ "Innovations are needed to reduce costs, scale up cardiac rehab and make it sustainable."

How Was Yoga-Based Cardiac Rehabilitation Evaluated?

Yoga-CaRe HF was a multicenter, prospective, randomized, open-label trial with blinded endpoint assessment conducted across 16 hospitals in India. The study evaluated whether a structured yoga-based cardiac rehabilitation program could reduce clinical events and improve quality of life, functional capacity, and health status among adults with HFrEF.¹˒²

Between April 2023 and December 2025, investigators recruited 3547 participants, of whom 55 were ineligible. The remaining 3492 participants were randomized to yoga-based cardiac rehabilitation (n=1737) or enhanced standard care (n=1755).

Participants had a median age of 57 years, and 27% were women. Approximately half had New York Heart Association (NYHA) class III symptoms, indicating marked limitations in physical activity, while nearly 40% were recruited from inpatient settings following hospitalization for heart failure.

The intervention consisted of standardized yoga practices combined with structured health education and individualized behavioral goals. Participants attended 20 supervised sessions over 3 months, followed by 1 session every 3 months through the end of follow-up.

The comparison group received enhanced standard care consisting of 3 health education sessions over 3 months, along with the same Healthy Living with Heart Failure educational booklet provided to the intervention group.

The trial had 2 co-primary endpoints: time to the first occurrence of all-cause death, all-cause hospitalization, or stroke, and change in quality of life at 3 months using the MLHFQ. Confirmatory secondary endpoints included 6-minute walk distance and health utility values measured using the EQ-5D-5L questionnaire.

How Much Did Yoga Improve Quality of Life and Physical Function?

At 3 months, participants receiving yoga-based cardiac rehabilitation experienced significantly greater improvements in quality of life compared with the enhanced standard care group.

The adjusted between-group difference in MLHFQ score change was −8.06 points (95% CI, −8.87 to −7.24; P<.001), with lower scores indicating better quality of life.²

The MLHFQ is a 21-item questionnaire assessing how heart failure affects physical, emotional, and socioeconomic aspects of daily living.

Improvements were also observed in exercise capacity. Participants in the yoga-based rehabilitation group achieved a 25.5-meter greater improvement in 6-minute walk distance compared with enhanced standard care (95% CI, 20.8-30.3; P<.001).

Similarly, health utility values derived from the EQ-5D-5L questionnaire improved significantly in the intervention group, with a between-group difference of 0.05 points (95% CI, 0.03-0.06; P<.001).

According to the investigators, the improvements in quality of life, functional capacity, and health status observed at 3 months persisted through 24 months.²

"This study tested a yoga-based cardiac rehabilitation program incorporating health education and tailored behavior change with individual participant goals and a standardized set of physical practices of yoga," Prabhakaran said in the release.¹

"We found the Yoga-CaRe program helped improve quality of life and physical function in people living with heart failure," he continued.

Did Yoga-Based Rehabilitation Reduce Hospitalizations or Death?

Despite improvements in patient-reported outcomes and physical functioning, yoga-based rehabilitation did not significantly reduce the trial's composite clinical endpoint.

During a median follow-up of 15 months, 364 participants (21.0%) in the yoga intervention group experienced all-cause death, hospitalization, or stroke, compared with 401 (22.8%) receiving enhanced standard care (HR, 0.90; 95% CI, 0.78-1.04; P=.15).²

Although the event rate was numerically lower with yoga-based rehabilitation, the difference did not reach statistical significance.

The findings indicate that improvements in quality of life and exercise capacity did not translate into a demonstrated reduction in major clinical events during the study period.

The trial also did not establish whether individual components of the intervention, including yoga practices, health education, or behavioral goal-setting, were independently responsible for the observed improvements.

What Do the Findings Mean for Heart Failure Management in Primary Care?

The findings may be particularly relevant for primary care physicians managing patients with chronic heart failure who face barriers to participating in conventional cardiac rehabilitation programs.

Cardiac rehabilitation is a guideline-recommended component of heart failure management, but access and participation remain limited, particularly among older adults, women, underserved populations, and patients living in resource-constrained settings.

The Yoga-CaRe HF findings suggest that a structured, low-impact rehabilitation program incorporating physical activity, health education, and behavioral support may offer an alternative delivery model for improving daily functioning and quality of life.

However, the intervention should not be interpreted as a replacement for guideline-directed medical therapy or established cardiac rehabilitation services when available.

For primary care physicians, the results reinforce the importance of assessing functional limitations, discussing rehabilitation options, and addressing barriers to participation as part of comprehensive HFrEF management.

Several limitations warrant consideration. Because the trial evaluated a behavioral intervention, participants and instructors could not be blinded to treatment assignment. Additionally, the yoga group received substantially more supervised contact than the control group, potentially contributing to the differences in patient-reported outcomes.

The study was also conducted entirely in India, where the cultural acceptability of yoga and availability of conventional cardiac rehabilitation may differ from those in the United States.

Furthermore, the intervention was delivered by trained yoga and naturopathy practitioners using a standardized protocol, meaning the results may not be generalizable to unsupervised yoga or commercially available yoga classes.

The investigators noted that additional research is needed to evaluate the scalability, cost-effectiveness, and clinical impact of yoga-based rehabilitation across different healthcare systems and patient populations.

The researchers concluded that yoga-based cardiac rehabilitation improved quality of life, exercise capacity, and health status among adults with HFrEF, although it did not significantly reduce death, hospitalization, or stroke.

The findings support further investigation of structured yoga-based rehabilitation as a potentially accessible approach to addressing unmet cardiac rehabilitation needs, particularly in resource-limited settings.

References

1. American Heart Association. Yoga-based cardiac rehab improved quality of life in people living with heart failure. News release. November 7, 2026. https://newsroom.heart.org/news/yoga-based-cardiac-rehab-improved-quality-of-life-in-people-living-with-heart-failure
2. Prabhakaran D, Chandrasekaran A, Kondal D, et al. Yoga-based cardiac rehabilitation in heart failure with reduced ejection fraction. Late-Breaking Science Abstract 21982. Presented at: American Heart Association Scientific Sessions 2026; November 6-9, 2026; Chicago, IL.
3. American Heart Association. Yoga-CaRe HF: yoga-based cardiac rehabilitation in heart failure. Late-Breaking Science summary results. November 2026. https://professional.heart.org/en/-/media/PHD-Files/Meetings/Scientific-Sessions/2026/scinews/YOGA-CARE-FINAL.pdf