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Symposium: "Beyond medicines. Evidence of relaxation techniques for cardiovascular prevention and management"

Commented by Monica Tiberi, Prevention, Epidemiology and Population Science Section member

This Symposium: "Beyond medicines. Evidence of relaxation techniques for cardiovascular prevention and management" was held at EuroPrevent 2018 in Ljubljana and is commented by one of the chairpersons.

Risk Factors and Prevention

Chairpersons & Speakers


Christine Graf and Monica Tiberi


  • Jari Antero Laukkanen
  • Jean-Paul Schmid
  • Ricardo Stein
  • Kushal Madan


Mind and body

Mind and body practices have become popular for stress reduction. Stress-related pathophysiological changes, such as lowered arrhythmic threshold and increased sympathetic activation with related increases in blood pressure and heart rate, as well as pro-inflammatory and pro-coagulant responses may lead to increased risk of clinical events such as ventricular tachycardia and fibrillation, atrial fibrillation, myocardial infarction, acute coronary syndrome, stroke.

JA Laukkanen presented a randomized clinical trial showing that cardiovascular rehabilitation enhanced by stress management techniques, produced significant reductions in stress and greater improvements in medical outcomes compared with standard rehabilitation (1). 


JP Schmid reported on a recent study indicating that regular sauna bathing is associated with a lower risk of sudden cardiac death, fatal coronary heart and CVD and all causes of mortality (2). An experimental study shows that sauna exposure of 30 minutes reduces blood pressure, improves arterial compliance and the dynamics of blood flow and pressure (3).

Waon therapy developed in Japan, it’s a dry sauna with a temperature maintained at 60°C and defined as a warming of the entire body in a uniformly heated chamber (far-infrared ray) for 15 minutes, increasing the core temperature by 1.0–1.2 °C, followed by a 30-minute rest outside the sauna. It has been reported to improve the haemodynamics, cardiac function, ventricular arrhythmia, vascular endothelial function, neurohormonal factors, sympathetic nervous system function and symptoms in patients with chronic heart failure and peripheral artery disease (4).

Cardiorespiratory fitness and frequency of sauna bathing are independently associated with a reduced mortality risk, a combination of cardiovascular fitness and frequent sauna bathing may confer additional survival benefits (5). Regular sauna has positive effects on vascular physiology, morbidity, and mortality in patient with cardiac disease. The alternation between heat exposure and cold water immersion, raises concerns related to haemodynamic tolerance, a risk of arrhythmias, triggering of acute coronary syndromes or cardiac decompensation. Avoiding cold-water immersion and using a shower for cooling might be prudent in patients with a particular risk of arrhythmias.

Tai Chi

Tai Chi might have beneficial effects on reducing blood pressure, stress anxiety and depression, modifying lipid profile, increasing the quality of life. Practicing Tai Chi, deep diaphragmatic breathing is integrated into body motions to achieve a harmonious balance between body and mind and to facilitate the flow of internal energy. This aerobic exercise with mild-to-moderate intensity can effectively improve physiological and biochemical outcomes, physical function, quality of life, and depression among patients with chronic heart failure. R Stain showed that this practice was associated with an increase in VO2 peak in patients with a recent myocardial infarction (6). Further investigations are needed.


Yoga is a lifestyle explained K Madan, consisting of physical, mental emotional and spiritual well-being. A lifestyle polypill, which might decrease blood pressure, HbA1C, BMI, blood lipid, improve several components of the metabolic syndrome and be helpful on smoking cessation. Lifestyle interventions using yoga for stress management, showed a retards in the progression and increased regression of coronary atherosclerosis in patients with severe coronary artery disease (7, 8). Yoga rehabilitation group after coronary bypass surgery, showed a significantly improvement in LV ejection fraction (LVEF), blood glucose and lipids, reduction in perceived stress, anxiety and depression. In patient with heart failure improves LVEF, VO2 peak, mood and decreases inflammatory markers (9). Yoga in adjunct to pharmacological therapy has shown some benefit in treating atrial fibrillation (10). Multicentre large studies using uniform methodologies with long-term outcome are needed.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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This Symposium: "Beyond medicines. Evidence of relaxation techniques for cardiovascular prevention and management" was held at EuroPrevent 2018 in Ljubljana.

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  1. Enhancing Cardiac Rehabilitation With Stress Management Training, J Blumenthal et al, Circulation. 2016;133:1341-1350
  2. Association between sauna bathing and fatal cardiovascular and all-cause mortality events, T Laukkanen et al, JAMA Intern Med 2015; 175: 542–548
  3. Sauna exposure leads to improved arterial compliance: Findings from a non-randomised experimental study, E Lee et al, Eur J Prev Cardiol.2018, Vol. 25(2) 130–138
  4. Waon therapy: soothing warmth therapy, C Tei et al, J Cardiol 2007; 49: 301–304
  5. Joint associations of sauna bathing and cardiorespiratory fitness on cardiovascular and all-cause mortality risk: a long-term prospective cohort study, SK Kunutsor et al, Ann Med 2018 Mar;50(2):139-146
  6. Tai Chi Chuan improves functional capacity after myocardial infarction: A randomized clinical trial. RM Nery et al, Am Heart J 2015 Jun;169(6):854-60
  7. Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients-Mount Abu Open Heart Trial, SK Gupta et al, Indian Heart J. 2011; 63:461-469
  8. Retardation of coronary atherosclerosis with yoga lifestyle intervention, SC Manchanda et al, The Journal of the Association of Physicians of India 2000, 48(7):687-694
  9. A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure, BH Krishna et al, Integr Med Insights. 2014 Apr 1;9:1-6
  10. The impact of yoga on atrial fibrillation: A review of The Yoga My Heart Study, SB Deutsch et al, J Arrhythm. 2015 Dec; 31(6): 337–338