BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) usually have physical effort intolerance, and may present inspiratory muscle weakness (IMW). Yoga is known to have significant benefits on cardiovascular and respiratory health. However, the effects of yoga and breathing techniques on HFpEF have not been reported. METHODS AND RESULTS: This study is a multicenter, randomized 1:1:1, outcome-blind, parallel-group, no-inferiority trial. Thirty-two patients with previous diagnosis of HFpEF (EF ≥ 50%) 45-75 years old, were randomized and allocated into groups: yoga group (Y = 11), breathing techniques (BT = 11) or the control group (C = 10) to evaluate the effects of an in-person program of 8-week of yoga and specific breathing techniques on inspiratory muscle responses, functional capacity, distinct features of the autonomic nervous system, natriuretic peptides, diastolic function, and quality of life. Data were analyzed using the Generalized Estimates equation model (GEE- GZLM). Yoga training resulted in 44.1% improvement in inspiratory muscle strength (Pthmax) [19 (7-29) vs 2(-2 to 5) in control group, (p < 0.05). Breathing techniques increase heart rate variability (HRV) (827.6 ± 46.7ms vs 936 ± 51.4 ms, in control group,( p < 0.05). There was neither improvement in PImax, functional capacity nor in parameters of diastolic function. CONCLUSIONS: In patients withHFpEF with and without IMW, yoga training was feasible and promoted increased respiratory muscle strength. Further studies should better address possible benefits on functional parameters.

The authors have declared no competing interest.

NCT03028168

https://doi.org/10.1186/s13063-018-2802-5

This study is funded by the FIPE/HCPA (Research and Education Funds from the Hospital de Clínicas de Porto Alegre). The referred grant number is 11?0069.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

All stages of the study were approved by the ethics committee of the Porto Alegre Clinical Hospital and the Lutheran University of Brazil.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes