Mind-Body Interventions for Individuals With Heart Failure: A Systematic Review of Randomized Trials

Authors: Gok Metin Zehra, Ejem Deborah, Dionne-Odom J Nicholas, Turkman Yasemin, Salvador Carolina, Pamboukian Salpy, Bakitas MarieJournal: Journal of cardiac failurePublished: March 1, 2018DOI: 10.1016/j.cardfail.2017.09.008

Strong EvidenceSystematic Reviewn=1314 participants

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The effects of mind-body interventions (MBIs) (eg, Tai Chi, yoga, meditation) for individuals with heart failure (HF) have not been systematically evaluated. We performed a systematic review of randomized controlled trials (RCTs) examining the effects of MBIs in HF. We extracted participant characteristics, MBI procedure, outcomes assessed, and main results of English-language RCTs before October 2016. We identified 24 RCTs (n = 1314 participants) of 9 MBI types: Tai Chi (n = 7), yoga (n = 4), relaxation (n = 4), meditation (n = 2), acupuncture (n = 2), biofeedback (n = 2), stress management (n = 1), Pilates (n = 1), and reflexology (n = 1). Most (n = 22, 95.8%) reported small-to-moderate improvements in quality of life (14/14 studies), exercise capacity (8/9 studies), depression (5/5 studies), anxiety and fatigue (4/4 studies), blood pressure (3/5 studies), heart rate (5/6 studies), heart rate variability (7/9 studies), and B-type natriuretic peptide (3/4 studies). Studies ranged from 4 minutes to 26 weeks and group sizes ranged from 8 to 65 patients per study arm. Although wide variability exists in the types and delivery, RCTs of MBIs have demonstrated small-to-moderate positive effects on HF patients' objective and subjective outcomes. Future research should examine the mechanisms by which different MBIs exert their effects.

Key Findings

✓A systematic review of 24 randomized controlled trials examining 9 types of mind-body interventions in heart failure patients found that 95.8% reported small-to-moderate improvements in at least one outcome measure.
✓Mind-body interventions demonstrated consistent benefits across multiple domains, with quality of life improvements reported in all 14 studies that measured it, exercise capacity improvements in 8 of 9 studies, and depression improvements in all 5 studies that assessed this outcome.
✓Tai Chi was the most frequently studied mind-body intervention with 7 randomized controlled trials, followed by yoga with 4 trials, among the 1,314 total heart failure participants included in the systematic review.

What This Means for You

While this systematic review shows promise for mind-body interventions in heart failure, reflexology was represented by only one study, so evidence specifically for reflexology remains limited—discuss with your cardiologist whether it might complement your treatment plan.

What This Means for Practitioners

This systematic review validates mind-body interventions for heart failure patients, but reflexology's evidence base is underdeveloped with only one included trial, suggesting an opportunity to conduct and publish high-quality research to strengthen the evidence for your practice.

Study Design: how this systematic review was run

Sample Size

1314 participants

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What does this study say about high blood pressure?

What did this study find?

A systematic review of 24 randomized controlled trials examining 9 types of mind-body interventions in heart failure patients found that 95.8% reported small-to-moderate improvements in at least one outcome measure. Mind-body interventions demonstrated consistent benefits across multiple domains, with quality of life improvements reported in all 14 studies that measured it, exercise capacity improvements in 8 of 9 studies, and depression improvements in all 5 studies that assessed this outcome. Tai Chi was the most frequently studied mind-body intervention with 7 randomized controlled trials, followed by yoga with 4 trials, among the 1,314 total heart failure participants included in the systematic review.

How strong is this evidence?

This is a systematic review and we rate its evidence strong. It covers 1,314 participants. It was published in Journal of cardiac failure. This study is indexed here for context; it did not test reflexology itself.