Effects of MediYoga among patients with paroxysmal atrial fibrillation

Introduction: Patients with paroxysmal atrial fibrillation often experience impaired health-related quality of life. Standard treatment is not always sufficient and changes in life-style habits are suggested as a complement. Also, studies have suggested differences in gender where women have extended side effects of rhythm medications, more symptoms and estimate lower health-related quality of life than men. Yoga has been shown to increase health-related quality of life and decrease blood pressure, heart rate and cardiac biomarkers. The overall aim of this thesis was to study the effects of MediYoga among patients with paroxysmal atrial fibrillation. In addition, to evaluate perceptions and experiences of MediYoga as well as gender differences.

Methods and results: Paper I. This is a randomized, controlled pilot study in which 80 patients were randomized to MediYoga, n=40, or a control group, n=40 at an University Hospital, in Stockholm, Sweden. The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, EQ-5D Visual Analogue Scale), blood pressure and heart rate were collected at baseline and at the end of study. The results showed an improvement of health-related quality of life in the yoga group. Blood pressure and heart rate also decreased in the yoga group. Paper II. In this prospective randomized study at an University Hospital, Stockholm, Sweden, with stratification in gender, 132 patients, with symptomatic PAF, were randomized to yoga (n=44), relaxation (n=44) and a control group (n=44). The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Assessments as health-related quality of life questionnaires (i.e. SF-36, ASTA), blood pressure, heart rate as well as NT-proBNP were collected at baseline and at the end of the study. The results showed no differences in the ASTA and SF-36 between the groups. However, improvements were seen in health-related quality of life, SF-36, with-in the MediYoga group. Both systolic and diastolic blood pressure decreased in the MediYoga group compared to the control group but there was no difference compared to the relaxation group. There were no differences in heart rate and NT-proBNP between or with-in the groups after 12 weeks. Paper III. A study with a qualitative design was conducted using individual semistructured interviews. The study included 12 participants (7 men and 5 women) who had participated in the yoga group in Paper II. The data were analysed using qualitative content analysis with an inductive method and a manifest approach. Three categories were found in the analysis; “A time for a sense of existence and presence”, “A way of gaining well-being and increased consciousness” and “Access to a tool to gain willpower and relieve symptoms”. Paper IV. A comparative design examining gender differences among those who had performed MediYoga (women n=37, men n=34). The yoga groups had been performing MediYoga for one hour/week over a 12 weeks period. Data (i.e healthrelated quality of life [SF-36], blood pressure and heart rate) were collected at baseline and the end of the study. There were no differences between the women or men group in SF-36 at end of study, however, there was improvement with-in the women group in the subscales vitality, social function, mental health and the domain mental component summary score. In the male group, there were improvement within the subscales role-physical, bodily pain, general health, vitality, social function, role-emotion and the domain mental component summary score (SF-36). There were no differences between the groups in systolic and diastolic blood pressure as well as heart rate at the end of the study. With-in the women group differences were observed in systolic and diastolic blood pressure, however, no difference was seen in heart rate. With-in the men group improvement were seen in diastolic blood pressure but no differences were seen in systolic blood pressure or heart rate.

Conclusions: MediYoga improves health-related quality of life as well as blood pressure among patients with PAF. Also, both genders report benefits, and patients describe MediYoga as an accessible tool with which to handle emotions and symptoms. MediYoga may be a part of a self-management program, as a complementary treatment, among patients with PAF.

List of scientific papers

I. Nilsson M, Rydell Karlsson M, Medin J, Frykman V. Effects of yoga in patients with paroxysmal atrial fibrillation - a randomized controlled study. European Journal of Cardiovascular Nursing. 2017 Jan;16(1):57-63.
https://doi.org/10.1177/1474515116637734

II. Wahlström M. Rosenqvist M. Medin J, Walfridsson U, Rydell Karlsson M. MediYoga as a part of a self-management program among patients with Paroxysmal Atrial Fibrillation. [Submitted]

III. Wahlstrom M, Rydell Karlsson M, Medin J. Perceptions and experiences of MediYoga among patients with paroxysmal atrial fibrillation - an interview study. Complementary Therapies in Medicine. 2018 Dec;41:29-34.
https://doi.org/10.1016/j.ctim.2018.09.002

IV. Wahlstrom M, Medin J, Rydell Karlsson M. Differences in gender in Health-Related Quality of Life, blood pressure and heart rate among patients with paroxysmal atrial fibrillation after performing MediYoga. [Manuscript]