A structured yoga-based cardiac rehabilitation programme significantly improves quality of life and physical capacity in people living with heart failure, according to a large Indian clinical trial whose results were presented at the American Heart Association's Scientific Sessions in Chicago on November 7, 2026.
The study, known as Yoga-CaRe HF, is the largest cardiac rehabilitation trial conducted anywhere in the world. It was funded by the Indian Council of Medical Research and coordinated by the Centre for Chronic Disease Control in New Delhi, under the leadership of Professor Dorairaj Prabhakaran, the centre's executive director and the president-elect of the World Heart Federation.
The trial involved nearly 3,500 people with heart failure with reduced ejection fraction, a condition in which the heart pumps out less than 40 per cent of its blood volume with each beat. The participants were recruited from 16 hospitals across India between April 2023 and December 2025, and were randomly assigned to either the yoga-based programme or enhanced standard care. A total of 3,492 adults were randomised — 1,737 to the yoga group and 1,755 to the control group.
The Yoga-CaRe programme has three major components: health education through a booklet called "Healthy Living with Heart Failure"; guided behaviour change, involving goal-setting to improve lifestyle habits and control risk factors; and a standardised set of yoga practices, including physical postures, breathing practices and meditation and relaxation, tailored to each patient's exercise capacity.
Participants in the yoga group received 20 supervised sessions over three months, followed by one maintenance session every three months until follow-up ended. The sessions were delivered by trained professionals, including board-certified yoga and naturopathy physicians, through a combination of in-person, virtual and at-home instruction.
At three months after enrolment, patients in the yoga group reported a better quality of life, measured by the Minnesota Living with Heart Failure Questionnaire, with an 8.1-point improvement compared with the control group. They also walked 25.5 metres further in the six-minute walking test, a standard measure of exercise capacity, and recorded quality-adjusted utility values 0.05 higher than the control group.
All of these differences were statistically and clinically significant, and importantly, they persisted through 24 months of follow-up.
The trial also found improvements beyond the headline measures. Participants in the yoga group showed greater improvements in frailty, higher rates of tobacco cessation and better lifestyle habits. Caregivers of patients in the yoga group reported better quality of life and less depression than those caring for patients in the standard-care group, suggesting that the benefits of the programme extended to families as well.
However, the trial did not meet its other main goal. The researchers observed a numerical reduction of around 10 per cent in clinical events — a composite of death from any cause, hospitalisation for any reason, or stroke — but the difference was not statistically significant.
Over a median follow-up of 15 months, 364 participants (21.0 per cent) in the yoga group and 401 (22.8 per cent) in the control group reached the composite endpoint, translating to a hazard ratio of 0.90. That finding was consistent across all prespecified subgroups.
The distinction between the two sets of results matters. The trial showed clearly that yoga-based rehabilitation helps people with heart failure feel better and function better in their daily lives. It did not show that the programme reduces deaths or hospital admissions, at least not within the follow-up period studied.
Presenting the findings, Ambalam Chandrasekaran of the Centre for Chronic Disease Control reported both results plainly, and independent experts commenting on the trial made the same distinction.
Hani Najm of the Cleveland Clinic, vice president of the American College of Cardiology, said the connection between yoga and the quality-of-life and functional improvements was not entirely clear-cut.
Justin Ezekowitz of the University of Alberta noted that clinical trials testing various cardiac rehabilitation elements generally point toward a small, non-significant reduction in deaths and hospitalisations, but added that improvements in quality of life and functional capacity remain consistent and highly significant, without safety concerns.
There was one encouraging signal within the clinical events data. Among patients who kept up the prescribed practice — those who practised yoga at home five days a week or for at least 255 minutes per week — the cumulative incidence of major adverse cardiac events was about 28 per cent lower than in the standard-care group over the 24-month follow-up.
That finding comes from a subgroup analysis rather than the trial's main result, so it should be treated with caution, but it suggests that the amount of practice may matter.
The trial builds on a decade of research by the Centre for Chronic Disease Control. In an earlier trial involving nearly 4,000 patients who had suffered a heart attack, the Yoga-CaRe investigators showed that their programme, delivered by trained medical professionals, was as safe as a conventional cardiac rehabilitation programme. The new trial extends the concept to a sicker population — people living with heart failure — and to a much larger group of patients.
The findings arrive at a moment when cardiac rehabilitation is gaining formal recognition in India. The country has just released its first-ever national guidelines for cardiac rehabilitation, the 2026 Standard Clinical Practice Guidelines for Cardiac Rehabilitation.
Conventional cardiac rehabilitation programmes, which typically involve supervised exercise in a hospital or clinic, are effective but remain out of reach for many patients, particularly in resource-constrained settings where facilities are scarce and travel is difficult. A yoga-based programme that can be delivered partly at home, at low cost, and in a form that is culturally familiar to Indian patients, could help close that gap.
Heart failure is a condition in which the heart cannot pump blood efficiently enough to meet the body's needs, leaving patients breathless, fatigued and limited in what they can do. For people living with the condition, the ability to walk further, breathe more easily and feel better day to day is itself a meaningful outcome, even when the risk of hospitalisation or death is unchanged.
The six-minute walking test, in which patients walk as far as they can in six minutes, is used precisely because walking distance is independently associated with better exercise capacity, fewer symptoms and reduced mortality risk in other research.
The trial's message, then, is measured rather than triumphant. Yoga-based cardiac rehabilitation is not a cure for heart failure, and it did not reduce deaths or hospital admissions in this study. But it did something that matters deeply to patients: it helped them live better with their condition, for longer, and at a cost and in a form that could realistically reach far more people than conventional programmes.
For health systems struggling to provide rehabilitation to everyone who needs it, that is a result worth taking seriously.
(Reporting based on The Tribune and TCTMD.)