Safe yoga poses for heart patients

Posted by destro @destro, Feb 22 1:04pm

I am having trouble finding information on safe yoga poses for heart patients. I am recovering from a heart attack a few months ago, and would like to return to doing yoga, but am quite fearful of overdoing anything. However, everyone seems afraid of the topic (liability?). I actually have formal training as a yoga teacher, but this isn't a subject that was covered. All I can find are expensive seminars on the subject, which I am not interested in attending due to Covid concerns. It seems like this is a subject that would have a simple do's and don'ts list of yoga poses, based on where you are at in recovery. Has anyone seen this kind of information publicly available?

Hello @destro and welcome to Mayo Connect!

I see that you have had a heart attack. If you could provide a little more information that might be helpful as other members respond to your post. For example, how long ago was your heart attack? Did you need open heart surgery or was it treated with a stent? What type of heart damage do you now have?

I'm assuming that you have discussed, with your cardiologist, what type of exercise routine is OK for you. If not, please do so.

While I don't practice yoga, I've recently read about adaptive yoga. Adaptive yoga was developed for people who have disabilities where they can't get into the regular positions that yoga requires.

Here is some information about adaptive yoga from the Yoga International website, https://yogainternational.com/article/view/learning-to-listen-to-my-body-an-adaptive-yoga-journey. I would encourage you to talk with your doctor about this before beginning any exercise program.

I'm just wondering, have you had cardiac therapy already?

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@hopeful33250

Hello @destro and welcome to Mayo Connect!

I see that you have had a heart attack. If you could provide a little more information that might be helpful as other members respond to your post. For example, how long ago was your heart attack? Did you need open heart surgery or was it treated with a stent? What type of heart damage do you now have?

I'm assuming that you have discussed, with your cardiologist, what type of exercise routine is OK for you. If not, please do so.

While I don't practice yoga, I've recently read about adaptive yoga. Adaptive yoga was developed for people who have disabilities where they can't get into the regular positions that yoga requires.

Here is some information about adaptive yoga from the Yoga International website, https://yogainternational.com/article/view/learning-to-listen-to-my-body-an-adaptive-yoga-journey. I would encourage you to talk with your doctor about this before beginning any exercise program.

I'm just wondering, have you had cardiac therapy already?

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Thanks for your reply!

Four months ago, I had a STEMI heart attack. It was treated with 2 stents. I was already in great shape, great diet and habits, and everyone is truly baffled as to where this came from. And at having just turned 43, I was completely surprised and in disbelief of what was happening to me. Fortunately, my wife recognized the signs and rushed me to the hospital and treatment was completed not long after onset. The amount of damage is still unknown. My ejection fraction after the heart attack was low enough to require me to wear an external defibrillator (AKA a life vest) for now, until my next echocardiogram. But all signs are pointing to a very significant recovery.

Unfortunately, I did not complete the cardiac rehab program. I was on a waiting list, and when I finally got in, felt like I didn't belong and was taking up a space someone else needed more than I did. Additionally, rehab created far more stress in my life than it should have. Because of the defibrillator, my wife has to drive me everywhere. That means two hours, three times a week, out of both of our work days, to drive me to rehab, come home and shower, and hurry me back to the office to work. All for 25 minutes of minor exercise with minimal monitoring and no physician's oversight. Instead, I am exercising at home, on my own schedule, on my own equipment (which is better than what they had at rehab), for 60 minutes a day, and can keep a record of my vitals myself. And without any possible exposure to covid, not just from the other rehab patients and staff; they are giving vaccine shots in the lobby where rehab is, so I was having to fight my way through a crowd of people eager to get vaccinated against covid.

Unfortunately, my cardiologist has left my exercise guidance up to my rehab specialist, and neither the cardiologist or rehab has given me much specifics beyond no lifting more than 15 lbs, and stop if I'm experiencing shortness of breath or dizziness. There are a lot of different poses in yoga, with great variances in intensity. Anything from laying flat on your back to literally standing on your head. My concern is about the poses in between, which may not be obviously too intense. Is triangle pose, or similar standing and fold over at the hips poses too much? Or upper-body weight-bearing poses, such as upward dog and downward dog?

Honestly, I would love to work with a cardiologist or someone to develop such a practice for patients to use. I am seeing a lot of recommendations to do yoga both for heart health before, and following a cardiac event, but I am not seeing much guidance on safe poses. Maybe we could get the guy who does the Fitness articles in the Mayo Portal on the app to demonstrate, or take us through a couple of different levels of yoga classes based on where you are in recovery.

Also, yoga would really help with stress relief from all of these changes to my life. I was taking CBD oil before, to help with my Meneire's disease, and the CBD also relieved stress, but my cardiologist has told me not to take it any more.

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Hello, again @destro,

I am sorry to hear that getting cardiac rehab was so challenging for you. You must live in a rural area or at least a small town. Outside of contacting a cardiologist, I don't know what to offer you. I'm not sure what would be appropriate for you.

Perhaps after your next electrocardiogram, your cardiologist can give you more information on safe forms of exercise. I agree that yoga (and also Tai Chi) can be great for stress relief. You might take a look at YouTube videos for both Tai Chi and Adaptive Yoga and see what you think about both.

Will you keep in touch and report back after your next doctor's visit?

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aDestro, I too had to forgo my cardiac rehab because the pandemic hit a few days after I was released from the hospital. I have attached an article – Page 2 and 3 have some suggestions. As always please check with your doctor before you set up a yoga routine. All the best!

Shared files

Yoga poses for Cardiac Rehab (Yoga-poses-for-Cardiac-Rehab.pdf)

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I would like to invite Chris, @artscaping, to the conversation to get her insight on this topic.

@destro Here are also some references that might hep.
20 Yoga Asanas for a Healthy Heart: https://www.artofliving.org/yoga/health-and-wellness/20-postures-healthy-heart
"Kapalbhati, bhastrika pranayama is prohibited for people suffering from heart disease, high blood pressure or hernia. For kapalbhati, exhalation must be gentle for beginners, do not use excessive force. Shitkari pranayama is prohibited for people with low blood pressure.Jun 5, 2017".

Yoga asanas and Pranayam could be sometimes restricted in heart disease: https://timesofindia.indiatimes.com/life-style/health-fitness/every-heart-counts/yoga-asanas-and-pranayam-could-be-sometimes-restricted-in-heart-disease/articleshow/58985166.cms

@destro Did your cardiologist express why he wanted you to stop the oil?

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@amandaburnett

I would like to invite Chris, @artscaping, to the conversation to get her insight on this topic.

@destro Here are also some references that might hep.
20 Yoga Asanas for a Healthy Heart: https://www.artofliving.org/yoga/health-and-wellness/20-postures-healthy-heart
"Kapalbhati, bhastrika pranayama is prohibited for people suffering from heart disease, high blood pressure or hernia. For kapalbhati, exhalation must be gentle for beginners, do not use excessive force. Shitkari pranayama is prohibited for people with low blood pressure.Jun 5, 2017".

Yoga asanas and Pranayam could be sometimes restricted in heart disease: https://timesofindia.indiatimes.com/life-style/health-fitness/every-heart-counts/yoga-asanas-and-pranayam-could-be-sometimes-restricted-in-heart-disease/articleshow/58985166.cms

@destro Did your cardiologist express why he wanted you to stop the oil?

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@hopeful33250, @chi, @amandaburnett thank you for your helpful replies! I live about 20 minutes from the Mayo Clinic here in Jacksonville, Fl. I will stay in touch, since I'd like to leave a resolution, if I find one, and it is not offered here.

The artofliving article was interesting. The poses listed are almost the exact order of those I would cover in a normal hour-long practice. The inversion poses (such as head-stands, shoulder-stands) I have read are a strictly and obviously prohibited pose, as indicated in the timesofindia article. But the triangle pose I'm concerned about. The artofliving article describes it: "This is a heart-opening standing yoga posture, designed to promote cardiovascular exercise. The chest expands, when breathing deeply and rhythmically. It also increases stamina." Is that saying it may exert too much strain on your heart, or that it's good for rehab? Additionally, my experience with triangle pose pre-heart attack has been that I have occasional tingling in my hands or that my face is very red when I stand back upright from it. So is it just too intense for me?

As for the CBD oil, I was not given a reason why I needed to stop taking it, but it was definitely listed on my discharge papers to stop taking it. I have read that CBD can interfere with how your body metabolizes certain medications, such that there may be more or less of a medication active in your system than intended. Additionally, CBD is not FDA regulated, so there is no real way of knowing if the CBD dosage is consistent. Also, it falls into a debateably gray area, legally, so clinical research on its affects is limited at best. Couple these reasons with continuing to titrate my medications to lower my blood pressure every two weeks, and I can understand my cardiologist's concern. I'm already regularly dipping below 90 / 50 systolic / diastolic and below 45 resting bpm, so I wouldn't want to tempt any inconsistencies and risk going too low on my vitals. I've already been there with Entresto and it wasn't fun, but they switched me to losartan and I'm doing great.

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@destro

@hopeful33250, @chi, @amandaburnett thank you for your helpful replies! I live about 20 minutes from the Mayo Clinic here in Jacksonville, Fl. I will stay in touch, since I'd like to leave a resolution, if I find one, and it is not offered here.

The artofliving article was interesting. The poses listed are almost the exact order of those I would cover in a normal hour-long practice. The inversion poses (such as head-stands, shoulder-stands) I have read are a strictly and obviously prohibited pose, as indicated in the timesofindia article. But the triangle pose I'm concerned about. The artofliving article describes it: "This is a heart-opening standing yoga posture, designed to promote cardiovascular exercise. The chest expands, when breathing deeply and rhythmically. It also increases stamina." Is that saying it may exert too much strain on your heart, or that it's good for rehab? Additionally, my experience with triangle pose pre-heart attack has been that I have occasional tingling in my hands or that my face is very red when I stand back upright from it. So is it just too intense for me?

As for the CBD oil, I was not given a reason why I needed to stop taking it, but it was definitely listed on my discharge papers to stop taking it. I have read that CBD can interfere with how your body metabolizes certain medications, such that there may be more or less of a medication active in your system than intended. Additionally, CBD is not FDA regulated, so there is no real way of knowing if the CBD dosage is consistent. Also, it falls into a debateably gray area, legally, so clinical research on its affects is limited at best. Couple these reasons with continuing to titrate my medications to lower my blood pressure every two weeks, and I can understand my cardiologist's concern. I'm already regularly dipping below 90 / 50 systolic / diastolic and below 45 resting bpm, so I wouldn't want to tempt any inconsistencies and risk going too low on my vitals. I've already been there with Entresto and it wasn't fun, but they switched me to losartan and I'm doing great.

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So I met with my cardiologist again. He removed any limits I had with exercise, other than to continue avoiding shortness of breath or dizziness. He said I am doing great, and there should be no limits on yoga other than what I can't tolerate. He did say to gradually step into it, so we'll see how I do. I will follow up with my experiences, if I find any poses especially helpful or difficult.

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