Community-Based Yoga to Improve Quality of Life of the Coronary Heart Disease Survivors in Developing Countries: A Systematic Review

Abstract

Background: Coronary heart disease (CHD) survivors in developing countries often face limited access to cardiac rehabilitation, leading to functional decline and impaired quality of life (QoL). Community-based yoga offers a scalable, low-cost mind–body intervention; however, its implementation models and specific physiological mechanisms require systematic synthesis. This study addresses the clinical question of whether community-based yoga serves as a feasible and effective alternative to improve quality of life and physiological regulation in these resource-limited settings.  Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Electronic databases (PubMed, Google Scholar, and Springer Nature) were searched for Randomized Controlled Trials (RCTs) published between 2015 and 2025. Studies were analyzed using the CLARIFY framework to classify intervention components (asanas, pranayama, and lifestyle) and were examined through the lenses of Polyvagal theory. Results: Three RCTs involving approximately 4,105 participants were included, met the strict study-design eligibility criteria. The review identified diverse intervention models, ranging from the scalable, community-based Yoga-CaRe program to hospital-to-home transition protocols. Compared with standard care—which often consisted only of educational leaflets—yoga interventions significantly improved Quality of Life (QoL) scores and functional capacity. Physiologically, yoga was found to reduce sympathetic overdrive, showing positive associations with improved sympathovagal balance, as evidenced by significant increases in high-frequency (HF) Heart Rate Variability (HRV) in one trial (p=0.005), though overall composite cardiovascular event rates did not differ significantly between groups. Evidence regarding formal cost-effectiveness and safety profiles remains limited. Conclusion: Community-based and transitional yoga models are evidence-based strategies that effectively enhance both the psychosocial well-being and cardiac autonomic regulation of CHD survivors. The findings provide a supportive empirical foundation for health authorities to consider integrating tiered yoga protocols into primary healthcare policies in developing countries to bridge the gap in secondary prevention services.