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Brief Review
Yoga and the heart
Rahul Mehrotra1, MD, DNB

From the 1Department of The concept of “Yoga” is currently gaining a lot of popularity worldwide owing to

Abstract
Cardiology, Medanta ‑ The its various health benefits and other advantages such as safety and ease of practice.
Medicity, Gurgaon, There is considerable evidence accumulating related to its benefits on health,
Haryana, India especially cardiovascular health. There is, however, a lot of confusion related to the
term “Yoga” in the various studies as it comprises several different practices. More
good quality studies are needed utilizing different components of “Yoga” investigating
their effects on cardiovascular disease. There is also a change in the understanding of
the role of the heart in the human body.
Received: July, 2016.
Accepted: August, 2016. Key Words: Cardiovascular health, heartfulness, meditation, spirituality, stress, Yoga

“T he heart of creatures is the foundation of life,

the prince of all, the sun of their microcosm,
on which all vegetation does depend, from whence all
vigor and strength does flow.”
‑William Harvey, M.D., 1628
All of us have heard about “Yoga” and some of us
have even practiced one or the other form of Yogic
practices at some point of time. Having originated in
India, “Yoga” has become very popular in the recent
times even in the Occident, owing to several reasons.
Ease of practice, health benefits, its ability to reduce
stress, and increased awareness about fitness coupled
with its spiritual benefits are some of the reasons
for its increasing popularity and universal appeal.
The United Nations too has declared June 21 as the
International Yoga Day to promote it worldwide.
There is, however, a lot of confusion regarding the
term “Yoga,” what it may constitute and thus, the
benefits that can be obtained. From simple physical
postures (asanas), breathing exercises (pranayamas) to
different types of meditations, and a combination of
all these are being loosely termed as “Yoga.” Actually,
“Yoga” is a Sanskrit word with the root “Yuj” which
means to join. “Yad jyute, anena, iti yogah.” Originally,
it meant the union of the individual soul (atma) with
the ultimate (paramatma). Clearly, it implies the
culmination, the apotheosis, of all the spiritual practices
aimed at arriving at this stage and is not an activity that
is performed. The Vedantists had suggested four means
of achieving this (Sadhana Chatushtaya) comprising of
Viveka (discrimination), Vairagya (detachment), Shat
Sampatti (six ways of regulating mental tendencies),
and Mumukshutva[1] to achieve this end. This approach
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required rigorous physical and mental self‑discipline
apart from enormous dedication, effort, and time to
achieve the ultimate goal. Besides, with the passage of
time, several complexities had crept up with various
interpretations and approaches. There arose Japa
Yoga, Tapa Yoga, Tantra Yoga, Mantra Yoga, Bhakti
Yoga, Gyana Yoga, Karma Yoga, Kundalini Yoga, etc.
Around 2000 years ago, Sage Patanjali removed all the
confusions and gave a simplified eight step approach to
God realization‑Ashtanga Yoga (eight‑limbed approach)
in his significant work ‑ The Yoga Sutra [Figure 1]. This
system starts with morality and ethics so as to inculcate
superior human qualities and ends with Samadhi‑being
one with the original state. It includes all the
aspects required in making of a human in achieving
perfection‑the real the goal of human life. Broadly, the
first five aspects deal with physical‑mental aspects
and are referred to as constituting Hatha Yoga, while
the other three are concerned with finer experiences
directly related to the soul and constitute Raja Yoga.[2]
With this background in mind, it is clear that the term
“Yoga” is very vast, encompassing numerous practices.
We must therefore be clear when we use the term
“Yoga” as to which component or what practice we are
referring to.
Since these practices include physical exercises, dietary
regulation, and mental discipline, it is expected that
Address for correspondence:
Dr. Rahul Mehrotra, MD, DNB,
Medanta ‑ The Medicity, Sector 38,
Gurgaon ‑ 122 001, Haryana, India.
E‑mail: drrahulm@hotmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI: 10.4103/2250-3528.192697 How to cite this article: Mehrotra R. Yoga and the heart. J Clin Prev Cardiol
2016;5:138-42.

138 © 2016 Journal of Clinical and Preventive Cardiology | Published by Wolters Kluwer ‑ Medknow

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Mehrotra: Yoga and the heart
Figure 1: The eight limb approach (Ashtanga Yoga) of Saint Patanjali. The
green boxes on the left constitute Hatha Yoga, while the blue boxes on the
right represent Raja Yoga
they result in overall improvement in health and
wellbeing. This is one of the reasons why many people
are taking up yogic practices. The scientific community
has also started investigating the health impact, if any,
of these practices by the way of performing studies and
clinical trials to evaluate the actual benefits of these
practices in ameliorating disease and promoting health.
Yoga and Health
In terms of health, the benefits of these yogic practices
are wholesome‑encompassing the physical, mental/
emotional, social, and spiritual. As mentioned earlier,
the loose term “Yoga” cannot be used to denote a single
type of activity. As such, the benefits also depend
on the type of activity undertaken. For example,
mere performance of physical asanas is unlikely to
yield as much reduction in emotional stress as is
expected with meditation, while asanas are likely to
have more demonstrable effects on physical health
as compared to meditation. Moreover, there are
different types of meditation such as heartfulness,
mindfulness, vipassana, and transcendental, each
utilizing different techniques, and the benefits of one
cannot be extrapolated on another. The temporal
association of the effects with each of these is also
unknown. The planning and interpretation of studies
on yogic practices thus have to take into account these
factors. Moreover, the studies aimed at demonstrating
the tangible, physical benefits which are more easily
performed than those showing the mental/emotional
benefits like stress reduction for obvious reasons. The
spiritual aspects cannot be evaluated by science at all
since it is a different domain altogether beyond matter.
In spite of these severe limitations, substantial progress
has been made to study the effects of yogic practices on
different aspects of health and new literature is being
published from around the world with different type of
yogic practices at an astonishing rate.
Journal of Clinical and Preventive Cardiology  ¦  Oct-Dec 2016  ¦  Volume 5  ¦  Issue 4
Yoga and Cardiovascular Health
Cardiovascular diseases (CVDs) are the leading killers
of our times, and coronary artery disease (CAD) is
the most important contributor to this epidemic.
CAD is considered to be a lifestyle disease since the
factors responsible for the development of CAD are
largely related to the faulty lifestyle of the individual.
Since most yogic practices involve a disciplining
of the behavior, regulation in eating and drinking
habits, and abstinence from smoking, it is expected
that the performance of some or the other of these
yogic practices would result in a change to a healthy
lifestyle in general with reduced risk of development
of CAD.
If one looks at the nine risk factors for myocardial
infarction as brought out by the INTERHEART study,
psychosocial stress emerged as a powerful risk
factor.[3] This clearly underscores the importance of
thought process influencing the metabolic factors
which ultimately result in plaque rupture. It is thus
clear that negative emotions described as “stress,”
influences the atherosclerotic plaque dynamics,
perhaps through the hypothalamus‑pituitary‑adrenal
axis. In a landmark meta‑analysis published in JAMA,
47 trials involving over 3500 participants were studied.
The authors concluded that mindfulness meditation
programs had moderate evidence of improved anxiety
and depression up to 3–6 months.[4] This points to
the significant benefit of meditation on reducing
negative emotions. The effect of positive emotions
such as calmness of mind and other states produced
in meditators has not been demonstrated as yet on
CAD, but indirect evidence points out that these may
have a protective role. In a study using Vipassana
meditation, Krygier et  al. demonstrated that after a
brief training in meditation, the self‑reported feeling of
well‑being improved and ill‑being reduced. Moreover,
there was a positive impact on measures of heart
rate variability (HRV)‑a psychophysiological index
of health.[5] It is well known that HRV is a marker of
cardiovascular (CV), as well as overall mortality. By
influencing HRV, meditation may have a favorable
impact on overall CV health and mortality. In another
meta‑analysis of 32 studies of Yoga,[6] it was shown
that the practice of different types of Yoga resulted
in a significant reduction in LDL cholesterol, systolic
blood pressure (SBP), and body mass index. Moreover,
it had a favorable impact on those who wanted to quit
smoking. The meta‑analysis concludes that the practice
of different forms of Yoga favorably impacts several
risk factors directly or indirectly influencing CAD. The
major limitation of this type of analysis is that it does
not discriminate the different type of practices and the
effects produced for a more specific information.
There have been studies on different CAD risk factors
with different type of yogic practices. Certain asanas and
pranayamas are believed to lower blood pressure (BP)
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Mehrotra: Yoga and the heart
and are routinely prescribed for this purpose. The
benefits may be by modulation of parasympathetic
tone, baroreceptor sensitivity, and by reducing stress.
In a systematic review of all published studies on Yoga
and hypertension, which included 48 randomized
controlled trials and a total of over 6600 patients,
it was shown that Yoga effectively lowered BP in
both normotensive and hypertensive populations.[7]
The role of meditation in reducing BP has also been
studied. Hughes et al. studied mindfulness‑based stress
reduction (MBSR), a structured protocol of mantra and
breathing‑focused meditation, in 56 male and female
patients with prehypertension. Patients randomized
to the MBSR arm exhibited a 4.8 mmHg reduction in
systolic blood pressure (SBP) and a 1.9 mmHg reduction
in diastolic BP (DBP) compared to a 0.7 mmHg
reduction in SBP and an increase in DBP in the control
group.[8] BP lowering by Yoga is a safe adjunct to diet
and exercise which is free of any toxicity apart from
being inexpensive. However, it is still not clear which
component, asanas, pranayama, or meditation, has the
maximal BP lowering effect or it is a combination of all
these that works.
Lipid lowering by statins is currently the cornerstone
of CVD risk reduction. However, the considerable
debate is raging related to the side effects of statins
on long‑term use, and the practice of yogic techniques
to lower lipid levels is a safe alternative which is
being evaluated. In a small study, Cooper and Aygen
compared 12 patients with hypercholesterolemia
who regularly practiced meditation with 11 control
participants who did not practice meditation and found
a significant 10% (P < 0.005) reduction in fasting serum
cholesterol levels in those who practiced meditation
during a 13‑month period.[9] This effect is probably
mediated through a reduction in adrenergic activity
and effect on serum cortisol due to the relaxation effect
of meditation.
Elevated cortisol level is now being considered as an
emerging risk factor for CAD. It has been shown that
it is related to raised fasting glucose, cholesterol, and
prevalent CAD independent of other risk factors. There
are several reports of reduction in serum cortisol levels
and blunting of rise in the levels in response to stress
in people who meditate.[10] This may well be one of the
mechanisms by which meditation benefits the bodily
functions.
Smoking is a major risk factor for CAD worldwide,
which is primarily related to human behavior. The
practice of meditation being directly related to bringing
about positive behavioral changes encourages healthy
lifestyle choices and avoiding risky behaviors like
smoking and substance abuse. Besides, it is a very
safe and cost‑effective means of helping people quit
smoking. In a randomized trial, brief training (for
2 weeks or 5 h total) in mindfulness meditation
resulted in as much as 60% reduction in smoking,
140 Journal of Clinical and Preventive Cardiology  ¦  Oct-Dec 2016  ¦  Volume 5  ¦  Issue 4
and it also reduced craving, a major factor why
smokers are unable to quit.[11] In a meta‑analysis of ten
studies of Yoga‑based interventions, it was concluded
that majority of interventions were able to enhance
quitting‑smoking‑rates in the study participants and
that Yoga‑based interventions held promise as smoking
cessation tools.[12]
Apart from the above‑discussed studies related to
conventional and unconventional risk factors for CAD,
there have been studies which have demonstrated
regression of established atherosclerotic plaques. In
a study involving around eighty patients of metabolic
syndrome, Yoga‑based intervention (including asanas,
pranayama, and meditation) was compared to control
group. At the end of a year, there was a significant
improvement in the parameters of metabolic syndrome
along with a reduction in carotid intima‑media
thickness in the intervention arm as compared to the
control arm.[13] In another prospective randomized
trial involving 42 patients with angiographically
proven CAD, it was shown that the intervention arm
undergoing Yoga had significantly less anginal episodes,
improved exercise capacity, greater lesion regression,
and less lesion progression compared to the control
arm at the end of 1 year.[14]
Another area where meditation, asanas, and pranayama
can be integrated in CV health is during the period
after a major CV event. Incorporation of these practices
in cardiac rehabilitation programs is likely to improve
adherence and retention rates rather than relying solely
on diet and exercise prescription based programs, where
the long‑term adherence rates have been quite poor.[15,16]
There is no straightforward mechanism which can be
used to explain all the beneficial effects of different
constituents of Yoga‑such as asanas, pranayama,
and meditation. Figure 2 summarizes few proposed
mechanisms of action of all these yogic practices based
on studies carried out so far. It is not a comprehensive
and complete list since new mechanisms are being
revealed as our understanding is improving and new
research is being undertaken.
As discussed above, there is an evolving body of
evidence demonstrating the effectiveness of Yoga‑based
interventions in various stages of CAD prevention.
However, the long‑term impact of different types of
meditations, asanas, and pranayamas and their relative
value need to be systematically studied in a large
and diverse population for more clarity on the issue.
The major problem has been the small sample size in
studies, the heterogeneous nature of Yogic interventions
studied, short duration of follow‑up, and paucity of
quality data [Table 1].
Yoga and the Role of Heart
“The heart has its reasons which reason doesn’t know”
‑Blaise Pascal
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Mehrotra: Yoga and the heart
Figure 2: Proposed mechanisms by which the different yogic practices influence
the body based on available evidence. BMI ‑ body mass index, BMR ‑ basal
metabolic rate, GABA ‑ gamma amino butyric acid, PNS ‑ parasympathetic
nervous system, SNS ‑ sympathetic nervous system
The heart occupies a unique position in the human
system according to the scriptures. It is not just the key
organ of CV system, pumping blood to the entire body,
but is also considered to be the nucleus, the center
of the human body. All religious systems believe that
the heart is actually the seat of divinity in the human
frame. The terms such as kind hearted and soft hearted
have been used since long to describe the character
of an individual in the belief that heart was the seat
of these traits, qualities. The heart has also been
considered to have the ability to feel, communicate,
and respond. This is where science and spirituality
differed and diverged. Not any longer. New research is
focusing on roles of the heart other than mere pumping
of blood to all organs of the body.
Startling revelations by systematic experiments of heart
transplant patients have compelled a rethink of rigid
scientific beliefs. It has been shown that the character
of the recipients changed significantly, and in many
cases, the recipient recalled instances from the life of
the donor, even when they had never met the donors or
had any information about their lives.[17,18] Other studies
have looked at the ability of the heart to communicate
its feelings to the outside environment and the
relationship of the heart with other organs in the body.
This is an exciting area of research for the future which
may change the way we have been looking at the heart
and its ailments.
Summary
Although the topic of Yoga has become quite popular
in the recent times and there is a lot of excitement and
expectations related to its health benefits owing to its
universal appeal, simplicity, and almost no cost and
side effects. Caution should however be exercised in
interpreting Yogic practices and their purported health
Journal of Clinical and Preventive Cardiology  ¦  Oct-Dec 2016  ¦  Volume 5  ¦  Issue 4
Table 1: Some of the limitations of the available
scientific literature on Yoga
• Heterogenous nature of Yoga
• No uniform definition of Yoga
• Small sample size
• Single centre studies
• Short term follow-up
• Limited RCTs
• Outcome data is scant
benefits since the term “Yoga” is a very heterogeneous
term including, in various combinations, physical
exercise component‑asana, breath control‑pranayama,
and regulation of the mind‑meditation. Besides, it
should be clearly understood that the primary goal of
these practices, especially meditation, is spiritual. The
spiritual dimension is altogether beyond the scope of
science and scientific principles, which operate within
the confines of matter only. There may however result
some benefits in health as a corollary, especially CV
health, owing to the overall positive impact on the
lifestyle of the practicant. There have been studies
exploring this impact, but it is very difficult to perform
and interpret these as there is no uniformity of the
approach, the population studied, the duration of
studies performed, the duration of exposure to these
practices studied, small sample size, and the chosen
end point in these studies. The effect of meditation is
primarily mediated through the brain and autonomic
nervous system also impacting the adrenergic system
through this axis. The favorable impact has thus been
shown in stress reduction, emotional stability, HRV,
and metabolic parameters such as insulin resistance,
cholesterol, and cortisol reduction in small‑scale
studies with several limitations. Having said that,
the ideal of perfection as aimed for by some systems
of Yoga like the Sahaj Marg[19] have the potential of
promoting overall balanced lifestyle resulting in a
holistic improvement in health including physical,
mental, social, and spiritual well‑being. Moreover,
this approach is likely to be effective in improving
compliance in the patients attending various cardiac
rehabilitation programs. Prominent academic
institutions are offering the practice of meditation to
their patients as a scientific tool to reduce stress and
improve lifestyle. As an approach to holistic health, the
yogic practices have a lot to offer, and it seems their
time has come, but we as scientists must be cautious
before hailing it as the panacea, humanity has been
looking for. A lot of information needs to be collected
before this becomes a reality.
This is perhaps the best time and an opportunity to
undertake systematic research to evaluate the health
benefits of the various forms of yogic practices and give
to the world, once again a natural, holistic approach for
leading healthy, purposeful lives.
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Mehrotra: Yoga and the heart
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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