Effect of Yoga based Life Style Program (YLSP) in improving Quality of Life after Coronary Artery Bypass Graft (CABG) Surgery- A randomized Controlled Trial with 5 years follow-up

Abstract

Background: Modern medicine has given fascinating surgical and pharmacological solutions for many critical health issues. Coronary Artery Bypass Grafting (CABG) is done for Coronary Artery Disease (CAD)/ Coronary Heart Disease (CHD) to save life in double and triple vessel disease in India and Asian countries. But it cannot be a complete solution because the basic cause of the disease is not tackled. Lifestyle being the initiation of the disease, it can affect health and lead to re-occurrence of CAD and re-operation even after CABG. Lifestyle modification in a systematic plan in relation to overall health, is necessary. The most difficult task is the follow-up on life style management for prevention and progression of atherosclerosis. The aim of this study was to use yoga based lifestyle program for looking at the quality of life (QOL) after CABG. Objectives: (1) To carryout long-term follow-up in an ongoing prospective two armed randomized controlled trial (RCT) of Yoga based Life Style Program (YLSP). (2) To compare the effect of YLSP with Conventional Life Style Program (CLSP) on QOL levels at the end of 1st and 5th year after CABG. (3) To compare the effect of YLSP with CLSP on levels of stress, depression, anxiety and affect at the end of 5th year after CABG. Methodology: Three hundred patients posted for CABG at Narayana Hrudayalaya Institute of Cardiac Sciences (NHICSc), in Bengaluru, India were randomized into two groups, yoga based lifestyle program (YLSP) and conventional lifestyle program (CLSP), for a funded project between 2005 to 2007 and were followed up. QOL was measured in those patients who have completed 5 years. Inclusion criteria: Male patients posted for CABG at NHICSc in age of 35-65 years residing within 200 km around the hospital. Exclusion criteria: Females, patients posted for CABG with Ejection fraction (EF) less than 50%, those with other associated cardiac problems and other organ disorders/ diseases were excluded. Sample size: Three hundred patients posted for CABG between 2005 and 2007 were recruited for the study; 150 were allotted to Conventional Life Style Program (CLSP) and Yoga Life Style Program (YLSP) each. Intervention: YLSP group practiced integrated approach of yoga based holistic lifestyle that included diet, Äsana, präëäyäma, Meditation, emotion culture, and intellectual techniques of Jnana yoga to manage perceived stress along with the standard treatment protocol. All subjects continued the practices at home after discharge with the help of audio-visual aid and presented as an outpatient to NH annually for a follow up. The CLSP group practiced conventional post-CABG rehabilitation advice including physiotherapy exercises. Both the groups continued the standard pharmacological protocol, diet prescription and annual consultation with their cardiac surgeon. Assessments: Tools used were Echo cardiogram, Lipid profile, Complete Haemogram, blood urea Nitrogen and psychological questionnaires including: World Health Organization Quality of Life questionnaire (WHOQoL-BREF), Perceived stress scale (PSS), Hospital Anxiety Depression Score (HADS), Positive Affect Negative Affect (PANAS). Statistical analysis was done using SPSS package. Suitable tests of normalcy and to compare means between groups were used. Ethical clearance was obtained from both the committees of S-VYASA University and Narayana Hrudayalaya Institute of Cardiac Sciences (NHICSc). Registration of the trial was done with CTRI number CTRI/2008/091/000293. Results: In this ongoing follow up study, 102 and 95 at the end of 1st year and 37 and 36 at 5th year were followed up in Yoga and control groups respectively. Within group analysis using Wilcoxon’s signed ranks test on WHOQOL-BREF showed significant improvement in the YLSP group in total score (p<0.001) and on all 4 domains namely the physical health (p<0.001), psychological health (p<0.001), social relationships (p=0.038) and environmental (p<0.001) health at the end of 1st year after CABG. There was also significant difference between groups (P<0.05) in all the domains of QOL by the end of 1st year after CABG. At the end of 5th year, there was significant improvement in physical health (p=0.046), environmental (p=0.044) health domains (p<0.001) in YLSP with non-significant change in control group. Perceived stress reduced significantly in YLSP group with significant difference between groups by the end of 5th year on PSS (perceived stress scale) (p=0.011). Positive affect improved and negative affect reduced non-significantly in YLSP after 5 years of CABG whereas both positive affect and negative affect improved significantly in CLSP (p<0.05). Conclusion: Add-on Yoga based lifestyle program to the conventional rehabilitation program helps in significant improvement in all domains of quality of life with reduction in stress levels as compared to conventional rehabilitation alone at the end of 1st and 5th year after CABG in patients with triple and double vessel coronary artery disease (CAD). Keywords: CAD, CABG, Cardiac rehabilitation, YLSP, CLSP.