Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors

Abstract

Objective: People living with HIV infection are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV infection are high priorities. We conducted a prospective, randomized, controlled study to evaluate whether a yoga lifestyle intervention improves CVD risk factors, virological or immunological status, or quality of life (QOL) in HIV-infected adults relative to standard of care treatment in a matched control group.

Methods: Sixty HIV-infected adults with mild-moderate CVD risk were assigned to 20 weeks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were: 2-h oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4 T-cell count and plasma HIV RNA, and the Medical Outcomes Study Short Form (SF)-36 health-related QOL inventory.

Results: Resting systolic and diastolic blood pressures improved more (P=0.04) in the yoga group (-5 +/- 2 and -3 +/- 1 mmHg, respectively) than in the standard of care group (+1 +/- 2 and+2 +/- 2 mmHg, respectively). However, there was no greater reduction in body weight, fat mass or proatherogenic lipids, or improvements in glucose tolerance or overall QOL after yoga. Immune and virological status was not adversely affected.

Conclusion: Among traditional lifestyle modifications, yoga is a low-cost, simple to administer, nonpharmacological, popular behavioural intervention that can lower blood pressure in pre-hypertensive HIV-infected adults with mild-moderate CVD risk factors.

Figure 1

Flow diagram for participant screening, exclusion, randomization, and data analysis.

Figure 2

Blood glucose, plasma insulin levels, and area-under-the-curves (AUC; Mean±SE) during a 75gr 2hr-oral glucose tolerance test conducted before and after standard of care (A) or yoga lifestyle intervention (B). No baseline differences in glucose or insulin levels were noted. Glucose and insulin levels and AUC during the oGTT were not different between the 2 groups, and the trend towards a lower insulin AUC after yoga intervention was not significantly different from that in the standard of care group (p=0.46).

Figure 3

Fasting serum triglycerides, total-, HDL-, calculated LDL- and non-HDL-cholesterol levels (Mean ±SE) before and after standard of care (A) or yoga lifestyle intervention (B). Baseline triglycerides, total- and non-HDL-cholesterol levels were higher in the yoga group than in the standard of care group (§ p<0.04). After statistical adjustment for baseline differences (ANCOVA), the between group changes in triglycerides, total- and non-HDL-cholesterol levels in the yoga group were not greater than those in the standard of care (STOC) group (p>0.48).

Figure 4

Box plot representing baseline and post-intervention resting systolic (SBP) and diastolic blood pressures (DBP). The 25^th and 75^th percentiles are represented by the lower and upper border of the gray box. The dark line within the gray box represents the mean, and the lighter line the median. The whisker error bars represent the 10^th and 90^th percentiles, and any individual values outside the 10^th and 90^th percentiles are depicted by black circles. Baseline resting blood pressures were not different between the groups, but declined more in the yoga group than in the standard of care group (*p=0.04) after intervention.