Yoga guide
Gentle yoga can be a safe way to stay active with stable heart failure, and small trials suggest it may help quality of life and mood a little. But the evidence is weak, yoga isn't a treatment for heart failure, and it never replaces your medicines or cardiac rehab, which has the evidence for fewer hospital stays and a better quality of life.
This guide covers what the yoga trials found and what they didn't, cardiac rehab, how to judge effort when you get breathless, breathing slowly without holding your breath, fluid, weight and blood pressure, the poses to skip, lying down safely and the warning signs that need help. It uses our free 35-minute heart health class, which has no breath holds and a seated option at the end. Our exercise with heart failure guide covers walking, strength work and medicines.
The NHS says heart failure "does not mean your heart has stopped working or is about to stop working", and that there's no cure but treatment and lifestyle changes can help. The British Heart Foundation (BHF) says it's "not reversible with exercise". Keep taking your medicines: yoga goes alongside them.
NICE (the National Institute for Health and Care Excellence) says everyone with heart failure should be offered an exercise-based cardiac rehabilitation programme. Across 60 trials, rehab probably cut hospital admissions (15.9% of people against 23.8%) and improved quality of life. Do yoga alongside it, not instead.
About 9 small randomised trials have tested yoga in heart failure, with roughly 500 people between them (the count depends on how a review counts them), mostly at single hospitals. Some found better fitness and quality of life; the best-run recent trial, of 104 older people in Sweden, found no difference from a control group. There is no Cochrane review.
Work at a moderate effort: a bit warmer, breathing a bit more heavily, but able to hold a conversation. Warm up for about 15 minutes, cool down for 10, and don't lie down straight after exercise.
The BHF says avoid holding your breath and planks, UK rehab standards say avoid breath holding and straining, and turning upside down raised the heart's workload in healthy men. If lying flat makes you breathless, prop yourself up or relax sitting.
Skip yoga on days you feel unwell or more tired or breathless than normal. Sudden weight gain or more swelling can be fluid building up: contact your heart failure team, and see the warning signs below.
Heart failure is when your heart cannot pump blood properly. The NHS lists feeling out of breath with everyday activities or when lying down, and feeling weak, light-headed or very tired, particularly after moving. Our exercise with heart failure guide explains the types and the medicines.
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The BHF's guide says you may find it difficult to lie flat, that this is a sign of worsening heart failure to report to your doctor or nurse, and that being propped up by pillows at night can help. That's why lying poses in yoga are propped up, and why new trouble lying flat is a reason to call your team, not to push on (our reading). The BHF adds that letting your tummy expand as you breathe in can help with the panic breathlessness can cause.
Fluid can build up fast: as much as 3 kg in 1 or 2 days, the BHF says. Its guide says weight gain is usually fluid if you put on more than one to two kilograms (two to four pounds) in two days. UK rehab assessments look for more than 1.8 kg in 2 to 3 days, and European guidance has used more than 2 kg in 3 days. The numbers differ, so use the one your own team gave you.
If your doctor or nurse asks you to weigh yourself every day, do it at the same time each morning, after going to the toilet, in similar clothes.
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NICE says not to routinely restrict salt or fluid in heart failure; some people are given a fluid limit for a medical reason. If you have one, ask your team how to fit drinks around a class, and avoid hot rooms (our suggestion). NICE also advises avoiding salt substitutes that contain potassium.
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Heart failure medicines can lower blood pressure, and UK rehab standards say to avoid rapid changes in position for that reason. Come up from the floor slowly, sit for a few breaths, then stand. In one session of slow breathing, blood pressure fell a little in 81 people with heart failure; that's a short-term effect, not a treatment.
The BHF's guide names an "easy yoga class" as one relaxed activity for people with heart failure, alongside walking. The lead researcher of the first yoga trials suggests beginner hatha or Iyengar classes once you're stable, and avoiding fast flowing styles, heated rooms and breath-holding.
Most used gentle classes once or twice a week for 8 to 12 weeks: in Atlanta, twice-weekly hatha classes of about an hour with breathing, postures and relaxation, plus walking at home; in Sweden, 45 to 60 minutes twice a week, mostly seated; in India, breathing "without breath retention". The trials were small, and none tested a class like ours directly.
NICE says the programme should start with an assessment, be offered at home, in the community or in hospital, whichever suits you, and include psychological and educational support. The NHS says everyone diagnosed should be offered it, and the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) says whatever their age.
The 2024 Cochrane review (60 trials, 8,728 people, mostly followed for about 6 months) found exercise-based rehab probably reduced hospital admissions (15.9% of people against 23.8%) and improved quality of life by an important amount, on moderate-certainty evidence. It made no clear difference to deaths in the short term. Home and centre programmes worked about equally.
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In HF-ACTION, 2,331 people with reduced ejection fraction were followed for a median of 30 months. Exercise training was safe, and deaths or hospital stays fell only a little (65% against 68%), a difference that was significant only after allowing for other factors.
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The 2026 European Society of Cardiology guideline recommends personalised exercise training for all stable patients, within rehab and over the long term, started only once you're stable on your medicines. It doesn't mention yoga.
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Small trials, mostly at one hospital, mostly in people with reduced ejection fraction and mild to moderate symptoms. Trial counts are approximate and depend on the review.
A 2023 review counted 11 trials and 552 people, but it counted one Indian group of patients three times and included three trials of meditation alone, leaving about 6 trials of yoga with postures or breathing and roughly 300 people. Its authors rated most trials low quality, and an earlier review found only 2 trials (59 people) and couldn't recommend yoga consistently. The 2023 review's journal isn't indexed in MEDLINE, the main medical database.
In Atlanta, fitness rose more with yoga than without in trials of 19 and 40 people. Pooled, three tiny trials (74 people, one of them of meditation alone) showed a gain in peak oxygen uptake of about 3.3 ml/kg/min. In Sweden, yoga and water exercise had about the same effect on quality of life and walking in 40 people.
In 104 people with heart failure in Sweden (average age 71, 42% with marked symptoms), medical yoga, exergaming and a control group were compared over a year. No statistically significant differences were found between the three groups on any outcome.
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The big rises in ejection fraction (the share of blood pumped with each beat) and falls in the heart strain marker NT-proBNP come from two Indian trials in journals outside MEDLINE, one reporting ejection fraction rising from about 39% to 53% in 12 weeks, far more than any exercise trial. A study of 85 people in the news in 2024 wasn't randomised and has no published paper, and the same team's published study of 75 people found no difference in heart scans.
In a US trial, 6 months of live online gentle yoga improved arm and leg strength and endurance tests more than education alone in 61 people, with good attendance. It was much smaller than planned and didn't measure fitness or hospital stays.
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Only one tiny trial (32 people, not yet peer reviewed) has tested yoga in heart failure with preserved ejection fraction, and it found no improvement in fitness or heart function. Exercise training in general is safe and improves fitness and quality of life in this type, European guidance says.
In 100 people with heart failure at three Boston centres, 12 weeks of tai chi improved quality of life and mood, but not walking distance or fitness, against education. It is the best-designed mind-body trial in heart failure, and the yoga trials are weaker than it.
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An umbrella review of 22 reviews says the benefits of yoga in heart failure "remain unclear", and the American Heart Association calls the evidence for complementary medicine in heart failure "limited and controversial". A Cochrane review was planned in 2016 but the protocol was withdrawn in 2017, so none exists.
No serious side effects were reported in the yoga trials, and small studies of 15 and 14 people had none at all. But many trials didn't report side effects, and they were too small to pick up rare ones.
Your rehab team's plan comes first. These are starting points.
The BHF describes moderate effort as feeling a bit warmer and breathing a bit more heavily, while still being able to talk. Don't overdo it on good days. A gentle yoga class should feel like this or easier.
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UK cardiac rehab standards start people who are less active at the low end, about 11 on the Borg scale, which runs from 6 (no effort at all) to 20 (the hardest you could manage), and build up over the weeks.
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The standards use a graduated warm-up of about 15 minutes and a cool-down of 10, with relaxation on the floor only after the cool-down. The BHF says not to lie down straight after exercise: after seated exercise, do some gentle toe tapping.
Our exercise with heart failure guide explains how beta blockers and some other heart failure medicines slow your heart, so go by how the effort feels rather than a heart rate number. Never stop or change a medicine because you've started yoga (our suggestion).
Two or three gentle sessions a week alongside the walking or rehab exercise your team sets. The trials used classes of 45 to 70 minutes twice a week for 8 to 12 weeks; our class is 35 minutes. On a low day, the seated warm-up and breathing alone are enough.
In 50 people with heart failure, slow, controlled breathing raised oxygen levels, and the researchers concluded that slowing your breathing "reduces dyspnoea" (breathlessness). Only 9 of 15 people allocated a month of training completed it, so it's a small, early finding.
Slow breathing with no holds suits a cool-down. Leave out breathing patterns with long breath-holds, because the BHF advises against holding your breath when you exercise.
UK rehab standards also say to avoid breath holding and straining. In healthy adults, breath retention raised blood pressure, and fast, forceful breathing (kapalbhati) raised blood pressure and heart rate.
Training the breathing muscles with a hand-held device improved walking distance and quality of life in 17 small trials (510 people). It needs the right device and settings, so ask your rehab team. The one trial of yoga breathing in heart failure didn't strengthen the breathing muscles.
About 6 breaths a minute, the rate in the slow breathing studies; the move page's dose is "At least 5 minutes, done regularly as part of your daily routine". Steps are our own.
See the movement on the 3D figure: Slow breathing (6 breaths a minute)
Seated march: 3 minutes at an easy pace; shoulder circles: 10 each way; thoracic rotation: 5 each side, seated (our yoga for heart health class). Breath reach: "5 breaths, exhale longer than inhale" (the move page's dose). With the standing poses below, this makes a warm-up of about 15 minutes.
Standing hip circles: 2 slow circles each leg, holding the wall; mountain pose: 5 slow breaths; warrior II: 3 breaths each side, short stance; tree pose: 3 to 5 breaths each side, a hand on the wall (our yoga for heart health class). Overhead side bend: "3 slow bends per side, exhale into each" (the move page's dose). Sit to stand: 8 to 10, breathing out as you stand (our heart failure exercises at home).
3D demoStanding hip CARsBeginner · A wall
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoOverhead side bendBeginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipment
3D demoTree pose (Vrksasana)Beginner · No equipment
3D demoSit to stand from a chairBeginner · A bench or boxCat-cow: 6 slow rounds, seated; seated forward bend (table slide): 8 slow reps, head no lower than your heart; chest opener: 2 holds of 20 seconds (our yoga for heart health class). Heel lifts: 10 slow (our heart failure exercises at home). Slow breathing: "At least 5 minutes, done regularly as part of your daily routine", with no holds; corpse pose: "Lie still for at least 5 minutes, up to 10, usually at the end of a session", only after the cool-down and propped up if lying flat makes you breathless, or rest sitting (the move pages' doses).
3D demoCat-cowBeginner · No equipment
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoChair chest and shoulder stretchBeginner · A bench or box
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
3D demoCorpse pose (Savasana)Beginner · No equipmentLeave out planks (the moves' own cautions say to avoid them with heart failure), long boat pose holds, headstands, shoulder stands, plough and handstands; keep downward dog brief or use your hands on a wall or chair, and leave out fast flowing sun salutations; do box and 4-7-8 breathing without the holds, or use slow breathing instead; ask your doctor before legs up the wall, as its page says. Leave out fast, forceful breathing and hot rooms too. Our suggestions, following the BHF, the UK rehab standards and the moves' cautions.
3D demoStraight-arm plank (high plank)Intermediate · No equipment
3D demoForearm plankIntermediate · No equipment
3D demoBoat pose (Navasana)Intermediate · No equipment
3D demoSupported headstand (Salamba Sirsasana)Expert · A wall
3D demoSupported shoulderstand (Salamba Sarvangasana)Advanced · No equipment
3D demoPlow pose (Halasana)Advanced · No equipment
3D demoHandstand at the wall (Adho Mukha Vrksasana, chest to wall)Advanced · A wall
3D demoDownward-facing dog (Adho Mukha Svanasana)Beginner · No equipment
3D demoSun salutation A (Surya Namaskar A)Intermediate · No equipment
3D demoBox breathingBeginner · No equipment
3D demo4-7-8 breathingBeginner · No equipment
3D demoLegs up the wall (Viparita Karani)Beginner · A wallOur 35-minute heart health class first, once your rehab assessment is done or your team agrees: a 15-minute warm-up building from sitting to standing, a seated cool-down and 8 minutes of slow breathing with no holds. Choose its seated option at the end if lying makes you breathless, and stop after the cool-down on a low day. The heart failure exercises are the session yoga goes alongside; the seated and chair yoga classes suit low-energy days; in the breathing routine, use only the slow breathing and alternate nostril breathing, without the holds.
A gentle 35-minute yoga class for heart conditions: a 15-minute warm-up that builds slowly, short standing poses, a seated cool-down, breathing with no holds and rest.
35 minBeginner18 movesBench or box, wallA 40-minute heart failure workout you can do seated or standing: a long, gentle warm-up, cardio mixed with light strength, and a slow cool-down.
40 minBeginner13 movesBench or box, wallA 15-minute chair yoga routine done entirely sitting: slow breathing, neck, shoulder and wrist stretches, seated twists and side bends, and a calm finish.
15 minBeginner16 movesBench or boxA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesBench or box, something with weightA 45-minute home session built like a UK cardiac rehab class: a 15-minute warm-up, 20 minutes of cardio mixed with light strength, and a 10-minute cool-down.
45 minBeginner14 movesWall, bench or boxA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, wallA walking plan gives structure towards 150 minutes a week once your team agrees. Build up more slowly than the plan if you need to.
These are the warning signs from our exercise with heart failure, yoga for heart health and blood clot guides, word for word. This is general information, not a diagnosis. A&E means accident and emergency; in the US, call 911 for 999.
Call 999 (911 in the US) if:
Don't drive yourself to A&E. Sit and rest on the floor with your knees bent and your back supported. Take a 300 mg aspirin if you have one and aren't allergic to aspirin, and use your GTN if you have angina. If someone stops responding and stops breathing, start CPR (cardiopulmonary resuscitation).
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Call 999 or go to A&E if palpitations don't go away, or come with chest pain, shortness of breath, feeling faint or fainting. With a fast or irregular heartbeat, the NHS also lists sweating, feeling or being sick, dizziness, a severe headache, weakness or numbness on one side, blurred vision, and confusion or difficulty speaking as reasons to call 999. If palpitations have stopped, ask for an urgent GP appointment or call NHS 111.
Call 999 if someone has fainted while exercising, or while lying down. After any other faint, see a GP.
Call 999, or have someone drive you to A&E (don't drive yourself), if:
Our suggestion: with heart failure, swelling in both ankles is more often fluid (see the signs of fluid below), but pain and swelling in one leg needs checking the same day.
Ask for an urgent GP appointment or get help from NHS 111 if:
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Tell your heart failure team if you notice any of these. On those days, don't exercise (our suggestion, following the BHF's advice not to exercise when you're unwell or more breathless than normal).
Stop if you get palpitations (your heart pounding or skipping a beat), extreme shortness of breath or light-headedness, and stop if you run out of energy. The BHF says stop immediately and contact your GP if you feel unwell, very short of breath, or get chest pain, dizziness or palpitations while exercising. Call 999 for the signs above.
Stop if you get chest pain, palpitations, dizziness or light-headedness. If it doesn't go away quickly with rest, or with your GTN if you use it, get urgent medical advice. With heart failure, also stop for extreme shortness of breath, and don't start a session on a day you feel unwell or more tired or breathless than normal.
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With heart failure, avoid "lifting heavy weights", "holding your breath" and "using your whole body as a weight, such as press-ups or planks". Don't exercise on days you're unwell or more tired or breathless than normal. Prop yourself up for lying poses if lying flat makes you breathless, and ask your doctor before legs up the wall (our suggestions, the second from the move's caution).
Come out of any pose and sit down if you feel dizzy or light-headed, and get medical advice before you train again. Keep breathing in every pose, get up slowly from the floor, leave a hot room if you feel dizzy, sick or get a headache, and keep your GTN by your mat. Tell your teacher about your heart condition (our suggestions).
You can say no to any hands-on adjustment, and a teacher registered with Yoga Alliance must get your explicit consent each time.
Your heart failure nurse or team first, then your GP or rehab team. The BHF Heart Helpline (0808 802 1234, Monday to Friday, 9am to 5pm) answers questions, and the NHS links to the heart failure charity Pumping Marvellous for more information.
With glaucoma, or high blood pressure that isn't under control, skip headstands, shoulder stands and long head-down holds. With osteoporosis, swap deep forward folds for a flat-back hinge from the hips, and twist smoothly. In pregnancy, our yoga in pregnancy guide covers the changes. NCCIH advises beginners to avoid headstands, shoulder stands, the lotus position and forceful breathing.
The NHS advises getting advice from a healthcare professional first if you have a health problem, an injury or symptoms, or have recently had a heart attack or an operation.
Heart failure can't be cured and isn't reversible with exercise, the BHF says. Yoga hasn't been shown to cut hospital stays or help people live longer, and an umbrella review calls its benefits unclear.
The big rises in pumping strength come from small trials with results too large to believe. The trial with the best design found no difference between groups, and the study in the news wasn't randomised and hasn't been published in full.
The BHF says people with heart failure were once told to rest, but keeping active is now known to help symptoms and quality of life. Across 60 trials, rehab cut hospital admissions.
NICE offers rehab to everyone with heart failure, and it has the evidence from 60 trials. Yoga has a handful of small ones. Do yoga alongside rehab.
No study shows it. UK rehab standards say to avoid breath holding, the BHF says avoid holding your breath, and breath retention raised blood pressure in healthy adults.
No trial supports it. Turning upside down raised the heart's workload in healthy men, and the Atlanta yoga trials avoided upside-down poses apart from legs up the wall, which needs your doctor's agreement.
Trials included people with mild to marked symptoms, using chairs and seated poses. Breathlessness on a given day is a reason to do less or skip it; new breathlessness lying down is a reason to call your team.
It can be a gentle way to stay active alongside cardiac rehab, and small trials suggest it may help quality of life and mood a little. The evidence is weak, though: only a handful of small trials, and the best-run recent one found no difference from a control group. Yoga doesn't treat heart failure or replace your medicines or rehab.
For most people with stable heart failure who've been assessed, gentle yoga is reasonable: no serious side effects were reported in the trials, though many didn't report them well. Avoid breath holds, planks and hot rooms, and skip it on days you're unwell or more breathless than normal.
Seated warm-ups, standing poses near a wall or chair (mountain, a small side bend, short-stance warrior II, tree with a hand on the wall), sit-to-stands, a seated cool-down and slow breathing with no holds. Our 35-minute heart health class puts them together, with a seated option at the end.
Planks and press-ups, long holds, headstands, shoulder stands and plough, breath holds and fast, forceful breathing, and hot or fast-flowing classes. Ask your doctor before legs up the wall, and prop yourself up for lying poses if lying flat makes you breathless.
Congestive heart failure is an older name for heart failure with fluid building up, and the same advice applies. Gentle yoga can sit alongside rehab and your medicines, but check your weight and symptoms first, and skip it on days you're more breathless or swollen than usual.
No. NICE says everyone with heart failure should be offered exercise-based cardiac rehab, which cut hospital admissions and improved quality of life across 60 trials. Ask your GP, cardiologist or heart failure nurse to refer you, and do yoga alongside it.
You should be able to talk: the BHF describes moderate effort as feeling a bit warmer and breathing a bit more heavily while still able to hold a conversation. UK rehab standards start at a low effort and build up slowly.
Slow breathing at about 6 breaths a minute eased breathlessness and raised oxygen levels a little in a small study where only 9 people completed the training. Breathe slowly with no holds. Breathing muscle trainers are a separate treatment to ask your rehab team about.
It hasn't been shown to. The studies reporting big rises were small, with results too large to be believable, and better studies found no change in heart scans.
Not that day. Sudden weight gain or more swelling can mean fluid is building up: contact your heart failure team, or ask for an urgent GP appointment or call NHS 111 if you've suddenly gained weight.
Only after a proper cool-down, and propped up on cushions if lying flat makes you breathless, or rest sitting instead. The BHF says not to lie down straight after exercise.
Yes, it's a good way to start, especially if you get breathless or tired quickly. The trials used seated poses and chairs for support, and their lead researcher suggests seated poses for people who find getting up and down from the floor hard.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
