“The Impact of Yoga on Cardiovascular Endurance: A Systematic Review”

Abstract

ABSTRACT:

Background. Cardiovascular diseases are the primary cause of death worldwide and are associated with modifiable lifestyle risk factors, such as physical inactivity and autonomic dysfunction. Yoga is a multimodal mind–body exercise combining posture (asana), breath regulation (pranayama) and meditation, and is a practice that has been attracting sustained interest because it is low cost, accessible and low- to moderate-intensity exercise that could have beneficial effects on cardiovascular endurance.

Objective. To conduct a systematic synthesis of the peer-reviewed evidence (2015-2026, and prior landmark studies where appropriate) of the impact of yoga on the markers of cardiovascular endurance (maximal oxygen uptake (VO₂max), resting heart rate, blood pressure, heart rate variability, walking/exercise capacity) in healthy adults and clinical populations.

Methods. We used a systematic narrative synthesis approach after PRISMA 2020 (Page et al., 2021) framework. Using the Boolean operators, PubMed, Scopus, Web of Science, EMBASE, Cochrane Library, and Google Scholar were searched for articles that included both yoga and cardiovascular endurance, VO₂max, blood pressure, HRV, and six-minute walk test. Only randomised controlled trials, controlled trials and meta analyses in adult patients were included. The methodological quality of included primary studies was evaluated with Joanna Briggs Institute Critical Appraisal Checklist for RCTs and the Cochrane Risk of Bias tool.

Results. Twenty-four primary trials and eight meta-analyses were included in the analysis. In population studies, Yoga was found to be associated with modest improvements in VO₂max (peak VO₂ mean difference +1.7 mL/kg/min) in CAD patients (Neto et al., 2024), reductions in SBP (−3.2 mmHg to −8.17 mmHg) and DBP (−2.42 mmHg to −6.14 mmHg) (21368461) et al., 2025; Hagins et al., 2013; Neto et al., 2024), increased vagally mediated HRV (Cohen & Tyagi, 2016; Giridharan et al., 2024; Khattab et al., 2007), and decreased RHR (~−4.4 bpm compared to no-treatment controls) (21368461) et al., 2025; Hagins et al., 2013; Neto et al., 2024). Improvements in aerobic capacity were more consistent with trials that included dynamic components (Sun salutations, Iyengar, Hatha flows and protocols of ≥8 weeks).

Healthy adults and people with chronic obstructive pulmonary disease benefited from improved functional walking capacity, with varying effect sizes.

Conclusion. Yoga is a safe, feasible, and effective complementary approach for improving cardiovascular endurance in a range of populations, and has been shown to have positive effects on VO₂max, BP, RHR, HRV, and walking capacity. The best evidence is found in BP and HRV modulation, and VO₂max the protocols must be long enough, intense enough, and frequent enough (along with dynamic flows). Standardised protocols and high quality, adequately powered trials are still research priorities. This report contains the following keywords: yoga, cardiovascular endurance, VO₂max, blood pressure, heart rate variability, six-minute walk test, PRISMA, systematic review