Aims: The aims of this study were to determine whether yoga and hydrotherapy training had an equal effect on the health-related quality of life in patients with heart failure and to compare the effects on exercise capacity, clinical outcomes, and symptoms of anxiety and depression between and within the two groups. Methods: The design was a randomized controlled non-inferiority study. A total of 40 patients, 30% women (meanSD age 64.98.9 years) with heart failure were randomized to an intervention of 12 weeks, either performing yoga or training with hydrotherapy for 45-60 minutes twice a week. Evaluation at baseline and after 12 weeks included self-reported health-related quality of life, a six-minute walk test, a sit-to-stand test, clinical variables, and symptoms of anxiety and depression. Results: Yoga and hydrotherapy had an equal impact on quality of life, exercise capacity, clinical outcomes, and symptoms of anxiety and depression. Within both groups, exercise capacity significantly improved (hydrotherapy p=0.02; yoga p=0.008) and symptoms of anxiety decreased (hydrotherapy p=0.03; yoga p=0.01). Patients in the yoga group significantly improved their health as rated by EQ-VAS (p=0.004) and disease-specific quality of life in the domains symptom frequency (p=0.03), self-efficacy (p=0.01), clinical summary as a combined measure of symptoms and social factors (p=0.05), and overall summary score (p=0.04). Symptoms of depression were decreased in this group (p=0.005). In the hydrotherapy group, lower limb muscle strength improved significantly (p=0.01). Conclusions: Yoga may be an alternative or complementary option to established forms of exercise training such as hydrotherapy for improvement in health-related quality of life and may decrease depressive symptoms in patients with heart failure.