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Guided yoga may provide benefit for people with recurrent syncope
Professor Jayaprakash Shenthar (Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India) and colleagues report in EP Europace that guided yoga is more effective than conventional treatments for preventing syncope (fainting) in people who experience recurrent episodes. Conventional treatments include keeping hydrated, avoiding hot crowded environments, tensing the muscles, and lying down.
In their study, Shenthar et al enrolled 100 people with at least three episodes of vasovagal syncope in the previous year — none of whom were receiving treatment for syncope, and none were practising yoga at the time of enrolment. Participants were randomly allocated to the yoga or conventional treatment group.
The conventional treatment group was advised to consume six to nine grams of salt and more than three litres of water every day and perform physical counterpressure manoeuvres, such as crossing legs and tensing thigh and buttock muscles, when warning signs of syncope occurred. However, the yoga group was not given any specific advice regarding salt, fluid, or physical counterpressure manoeuvres. Instead, they attended five to seven sessions in which a certified yoga instructor showed them how to perform a 60-minute yoga module. The yoga module consisted of pranayama (breathing), asanas (postures), and dhyana (meditation). Participants were then advised to perform yoga for 60 minutes at least five days per week for the subsequent 12 months.
Participants were asked to record the number of fainting episodes during follow-up. Quality of life was assessed at baseline, three, six, and 12 months using the syncope functional status questionnaire — it asks how syncope affects daily activities such as driving, shopping, exercise, and relationships with family and friends and asks respondents to rate their fear/worry on a scale of one to eight.
The mean age of participants was 33 years, and more than half were women. Prior to the study, the average duration of syncopal episodes was 17 months, during which patients had an average of 6.4 blackouts. Compared to the conventional treatment arm, the yoga group had fewer blackouts and better quality of life scores at three, six, and 12 months. The standard treatment group reported 3.8 fainting episodes during 12 months of follow-up, while the yoga group reported 1.1 episodes.
Professor Shentha commented: “Repeated fainting gives rise to mental stress, anxiety, depression, and a constant dread of the next episode. Quality of life is negatively affected due to the unpredictability. Besides, some countries do not allow patients to drive…. “The benefits of guided yoga were apparent as early as three months after treatment initiation and were sustained at six and 12 months. Preliminary evidence suggests that the breathing and meditation aspects of yoga have a positive effect on the autonomic system while ‘asanas’ improve vascular tone — both of which could prevent gravitational pooling of blood in the lower parts of the body.”
“Our small, well-controlled, single-centre study suggests that yoga may be a useful therapeutic option for patients with vasovagal syncope. Larger multicentre studies are needed to confirm the results,” he concluded.
Fainting, or “vasovagal syncope”, is a brief loss of consciousness caused by reduced blood flow to the brain. It can be triggered by prolonged standing, fear, pain, seeing blood, and hot, humid environments. While about approximately half of the general population will have one syncopal event during their lifetime, with no serious consequences, some people will have recurrent events that require investigation. For more information about the potential causes of syncope, see the STARS conditions page.
For more information on yoga and syncope, download the STARS Mindfulness & Healthy Living with Syncope booklet.