YOGA FOR THE ELDERLY

I have always found myself more drawn to the elderly, in which has also probably led me to specialize more on the geriatrics department and found myself working in a nursing home. With the growing aging population in Singapore, more research is also looking into non-pharmacological approach in tackling the problems that comes with ageing. One common approach on the rise is Yoga, especially interested within groups of elderly who are still ambulant/ physically active who wants to make a change in their lifestyle. Because yoga recognizes that that body is not just a physical body, it incorporates the mind and spirit and raise questions of existentialism and philosophy, it has a higher draw to these group of people who recognizes that the span of their lifetime is nearing death.

 

Problems of aging

The ‘problems’ of aging (as compared to the younger self) is that, although it does not equate to developing medical conditions, they tend to be more at risk of fraility. There is lesser joint range of motion, strength and balance, which puts them at risk of falls and other secondary problems that comes with it. Some of the common conditions seen in this age group are osteoarthrisitis, Hypertension,hyperlipidemia, diabetes,  low back syndrome(mostly kyphosis), which may deter them from doing the actual asana pose properly and modifications needs to be done.

In a recent randomized controlled trial done by Osth et al (2019), showed that a 12 week yoga programme improved the health and well being, mobility, mood and cognition in physically inactive elderly age 65-85 years old.

They used the same treatment intervention (YESS-yoga empower senior study) that was previously done by Greendale et al in 2013.

 

What is the Yoga Empowers Seniors Study (YESS): Design and Asana Series?

YESS is formed by a group of people with knowledge in physical therapy, yoga, and movement science. They developed a hatha yoga asana series (included pranayama and asanas) meant for ambulatory participants of age 65 and had medically stable condition in their criteria group for 2 days/week of 1 hour session for 32 weeks. There were 2 series-series 1 progressively increase intensity to series2.

The main key points of designing the series is based on

  • Ensuring safe yet challenging pract (exclusion criteria on those whose medical conditions are not well controlled/ acute musculoskeletal injuries/awaiting for surgery)
  • Target major muscles that assist in their functional daily activities (eg reaching overheads to carry groceries, sitting to standing). Making the exercise more meaningful to the participants.
  • Asanas that improve balance
  • Asanas that increase their joint ROM.

 

Series 1 and 2 is described in detail in this website for more reference. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639444/

For Series I : Chair, Wall Plank, Tree, Warrior II, Warrior I, Downward Facing Dog, Side Stretch, Chair Twist, Cobra, Bridge and Abdominal Cultivation.

For series 2: Chair, Wall Plank, Tree, Warrior II, Crescent, One-Legged Balance, Side Stretch, Chair Twist, Recumbent Leg Stretch, Bridge and Abdominal Cultivation

 

What kind of modifications was done for the elderly?

Props and hands on tactile cues were given for exteroceptive feedback to achieve better alignment in poses. Some of the examples were:

Series 1 Series 2(more advanced compared to series 1)
·         Chair pose done with yoga block inbwetween knees and back against wall for support

·         Chair pose

 

·         Planking against the wall instead of the floor to reduce upper extremity loading

 

·         Chaturanga with feet placed further and hands more caudally     

·         Tree pose done with hand on wall for support and 1 leg just slightly lifted

·         Tree without wall and on lifted leg on other side of medial foot
·         Warrior 1 and 2 done with rear foot against wall-floor and hand on chair for support

Warrior 1 and 2 without wall and chair support

·         Downward dog done on wall to reduce demand on hamstring flexibility

·         Uthita hasta pandangusthasana modified to 1 legged balance with back against wall and blocks under feet

·         Side stretch same with wall ·         Side stretch with use of chair instead of wall. Increase trunk forwards and hip flexion.

·         Bharadvjasana twist seated on chair to reduce hip and knees flexion demand and using the chair as a lever to twist from the trunk

·         Same as series 1

Most of the other sitting and supine poses uses towels/blankets to cushion the parts of the body which has more pressure (eg hip, pelvis, knees), and modifications of lesser ranging were done.

 

EVALUATION

Overall in the scientific research arena, there is still no exact yoga exercise prescription (frequency, intensity, time, type) for the elderly whether healthy or even those with medical conditions. The supposed gold standard of exercise prescription is ACSM (American College of Sports Medicine). In which the guidelines recommend elderly to participate in minimum 30 mins/ day of moderate intensity aerobic  , at least 3-5 days/week to total of 150mins/week and supplementing resistance, flexibility and balance exercise training.

Therefore, this YESS intervention study is useful in providing a starting framework for development of a yoga class for the elderly. However it is important to note that the 2 studies -Greendale et al (2013) and Osth et al (2019) were done on generally healthy elderly population with controlled medical conditions. It is best to get medical clearance from doctors and screening of each individual elderly is a must. Assessing their balance,joint range, strength, flexibility and physical function can give the instructor an idea of their impairments which will determine certain asanas to be more difficult to manage/needs modifications.

As yoga is not just as exercise intervention, explaining to the elderly the theory and philosophy aspect is equally important. Explanations like how the chakras can be stimulate for each pose, importance of pranayama and breath with movement can help them better understand the purpose and apply even on their daily function (eg, being more mindful and balanced with walking/standing/bending to pick things). This can translate to benefit them in the long term and may even help in preventions of falls and fraility, also reducing the reliance on pharmacological treatments.

 

 

References:

-Effects of yoga on well-being and healthy ageing: study protocol for a randomised controlled trial (FitForAge). Osth et al (2019)

-Yoga Empowers Seniors Study (YESS): Design and Asana Series. Greendale et al (2013)

 

Comparison Between Yoga and Qigong

As we know, Yoga comes from India and Qigong comes from China. Interestingly, although they originate from 2 oriental civilisations where the culture, history, and philosophies are different, we can find some similarities in the philosophy and practices of Yoga and Qigong.

The Energy System – Prana (Yoga) and Qi (Qigong)

In both Yoga and Qigong, there is a concept of “vital life force”. It is referred as “Prana” in Yoga and “Qi” in Qigong. In Yoga, there are 5 main categories of Prana: Apana Vayu, Samana Vayu, Prana Vayu, Udana Vayu and Vyana Vayu. Comparatively, the idea of “Qi” in China has been applied to Traditional Chinese Medicine, which refers to 6 common types of weather, “Feng”(Windy), “Han”(Cold), “Shu”(Hot), “Shi”(Humid), “Zao”(Dry), “Huo”(Heaty). The disturbance in the energy results in diseases.

The Storage of Energy – Chakra (Yoga) and Dantian (Qigong)

In Yoga, there are 7 Chakras in human body, which are Muladhara Chakra, Swadhisthana Chakra, Manipura Chakra, Anahata Chakra, Vishuddha Chakra, Ajna Chakra and Sahasrara Chakra. However, in Qigong, it is believed that Dantian is the only place where stores “Qi”.

The Channel of Energy – Nadi (Yoga) and JingLuo(Qigong)

In Yoga, there is an idea of “Nadis”, which are channels that energy flow through the body. There are 3 principal nadis that run from the base of spine to the head, and are the ida on the left, sushumna in the center and pingala on the right. Ida is associated with the lunar energy, it controls more mental process. Pingala is associated with solar energy which controls more vital process. Sushumna interpenetrates the cerebrospinal axis and it refers to both nostrils being open and free to the passage of air.

In Qigong, energy is channelled via JingLuo, aka meridians. There are 12 main meridians which connects between organs in the human body. There are 2 types of meridians, “Yin” and “Yang” respectively, where Yin can be mapped to “Ida” in Yoga and “Yang” is mapped to Pingala.

Conclusion

We can see the similarities and differences behind Yoga and Qigong. There is no concrete rule saying which idea is superior to the other. Today, we can see that both practices are adopted for individuals’ health and wellbeing. And one may see a trend of convergence in these two practices in the future. Adoption of whatever practice depends very much on individuals’ preferences. The ultimate idea is to achieve the balance among individuals’ mind, body and spirituality.

 

 

Ashtanga Vinyasa Practice and the 3 gunas

Guna is a Sanskrit word for quality or attribute. There are 3 gunas:

  • tamas: state of darkness, inertia, inactivity, and materiality.
  • rajas: state of energy, action, change, and movement
  • Sattva: state of harmony, balance, joy, and intelligence

While we strive towards sattva and reduce tamas and rajas, it is impossible to posses sattva only. There are elements of tamas rajas in us.

Our ashtanga practice reflect all these 3 gunas, how they exist together and how they affect the way we should live.

Tamas: When we practice on the mat, we should strive to engage the muscles required to do the pose, and not without engagement, i.e. the inertia to not do things. Do not be lazy. Set to finish what we started. But our body need rest, and hence tamas comes into play, in the form of shavasana. So Tamas is not entirely bad.

Rajas: It’s about the energy, the activeness, the movement. Our vinyasa should flow with energy, generate the heat within us. We should have the energy or the fire, find this energy when doing any task. The energy will give us the motivation to carry on. But too much of rajas is also not good. We expend our energy unnecessary and send ourself to state of inertia. Thus, there is a need to control our rajas.

Sattva: It’s about harmony, how am I feeling calm and at peace with ourself. Similarly, when practising on the mat, we should find stability within our pose, breathing normally with calmness. We should be focus. There shouldn’t be any rush. We shouldn’t be panting. It is in this state; that we realize what and why we are doing this.

Hence, all there gunas plays a role to our life and our ashtanga practice reflect these attributes. Next, we need to reflect upon ourself after practice and evaluate how to mainly the gunas within us.

 

Is Yoga a Religion?

When I first started my 200 hours Yoga Instructor course, someone told me there’s a saying from her religion that meditation could create a space for demon to invade us cause we are in an empty mind during meditation. I was confused and dissapointed that why people always create arguments whenever there is something becoming popular? I love to be free on my mind as well as my physical body, putting religion into everything is just too restricting.

Sadhguru did answered “Is Yoga a Religion?” in his speech, I’d like to share it here:

What religion you belong to has nothing to do with your ability to make use of the yogic systems, because yoga  is a technology. Technology does not make any distinction as to what you believe in and what you do not believe in. What you may believe in or not is purely a psychological process – it has got nothing to do with making use of a technology.

Yoga is Hindu just the way gravity is Christian. Just because the law of gravity was propounded by Isaac Newton, who lived in a Christian culture, does it make gravity Christian? Yoga is a technology. Anybody who is willing to make use of it can make use of it. It is ridiculous to even think that there could be a religious tinge to yoga.

The spiritual process and the technology of yoga predates all religion. Before human beings started thinking of forming religious groups to fracture humanity in a way that you can’t fix them, the idea that a human being can evolve himself came from Shiva, the Adiyogi.

I started practising because of enjoying it, it brings me peace of mind and physical improvement. With guidance of technique from Trisula Yoga I could see significant of improvement, that’s why I’m becoming more dedicated to it.

The reason of making this as one of my blogposts is simply because I hope to clarify the nature of Yoga. If your body and mind becoming more healthy after practising Yoga, just go for it; Conversely, just stop it.

Yoga as an extreme sport

More than 300 million people are getting their asana on in yoga studios, ashrams, back yards or goat farms. Far away is the era when it was strictly reserved for the higher castes of India. We found some of the craziest yoga variations for you. Will you be brave enough to try?

On 2 wheels

Yoga doesn’t only borrow the shorts from cyclists. You haven’t heard about her yet but Viola Brand is a star in her discipline: artistic cycling. She combines some yoga and dance techniques… on a bicycle. If you think you nailed your handstand, I suggest you to watch some of her tricks in this video. She brings the peacock to the next level.

 

In India, Gugulotu Lachiram Naik created his yoga style after being inspired by some bike stunts he saw on television. He combines his love for motorbikes to his love for yoga and created a very unique and extreme routine. Would you dare?

Breakdance yoga

Yoga and breakdancing are both about flexibility, balance, and focus. It is naturally that some passionate dancers and yoga practitioners merged them.

Made popular in New-york by Anja Poter, Breakti, as it is called, combines funky street dance moves (including arm balances called “freezes”) with yoga postures. The result is a fun and playful “breakfklow” that aims to offer something beyond the experience of a traditional class. The trend has already been noticed and adopted by some famous brands. To practice it: listen to some hip-hop music, throw on our hoodies and dig into the floor. Is Master Sree ready for some b-boy moves?

Khanda Manda Yoga

Khanda Manda Yoga is said to be one of most terrifying and difficult sadhana. It is said that the practitioner of Khanda Manda Yoga cuts off his own arms and legs with a sharp cleaver, and throws them into a roaring fire. After twelve hours these limbs reemerge from the fire and rejoin his body thus giving him a re-birth. Shirdi Sai Baba was famous to know all Yogic Practices. He was also well-versed in the six processes including Dhauti (Stomach-cleaning), and separating his limbs and joining them again.

This is not a recommended practice on our planet but maybe you’re reading this article from another yoga planet.

Pitta dosha

Pitta – Vata Dosha

After doing the Ayurveda Dosha Quiz, I found out that I was a Pitta – Vata and I need to eat a cooling diet to neutralise the fiery and intense pitta dosha. As the Pitta is the dominant dosha I should follow this diet and will do well with raw fruit and vegetables but should stay away from most spices as they are heating in nature.

My diet should consist of sweet fruit like sweet apples, figs, melons, pears, plums, grapes and mango and sweet and bitter vegetables like asparagus, leafy greens, cucumber and green beans. The grains recommended are oats (cooked), white rice, quinoa and whole wheat. All beans except lentils are allowed and dairy should be organic milk and unsalted butter. Recommended meats are the white meat from chicken and turkey.

When comparing the pitta dosha foods with the sattvic, rajasic and tamasic foods it looks very similar to the sattvic diet  with the exemption of meat. As I eat meat occasionally and then prefer chicken to red meat so I could easily follow the pitta diet with the exception of adding a little bit of rajasic foods in a daily coffee occasional beer or wine. 

Nathalie Rimmer 200hr YTT Weekend July 2020

References:

https://www.banyanbotanicals.com/info/ayurvedic-living/learning-ayurveda/understanding-your-constitution/pitta-vata/

https://www.nithyananda.org/Nithyananda-eNcyclopedia/Sattvic%20Rajasic%20Tamsic%20Food.html

 

Change

Change is the only constant in life.
I find so much truth in this particular phrase, we go through life every single day with change, sometimes it’s unnoticeable because of how subtle it may be.
As we are taught to self-reflect or as Patanjali’s Eight Limbs of Yoga calls it – Swadhyaya under the Niyamas component, you may start noticing the changes we go through daily.
It may be easier to notice physical changes as they are often more obvious like when the sky turns dark as the day ends; or when someone changes their hairstyle. Changes that are not so easily noticed may be someone’s personality, habits or thoughts.
These past few weeks have also brought on many changes. I’ve changed my sleeping pattern which went haywire due to the whole circuit breaker; my stamina has (hopefully) changed and become much better than it was before but beyond that, I feel like my whole way of thinking has changed. I’ve become more accepting of things in general as well, so I’d like to believe that I’d be able to accept change with more grace now.
I’m now a lot more conscious with my thoughts, I try to stay in the present as much. Whenever I feel like I’m having too many thoughts at once, I steady my breath and shift my focus towards it. I try to not let my thoughts consume me as I often would in the past. I’ve also slowly been learning to worry less about how others perceive me as I used to let the opinion of others take up too much of my headspace and energy.
These may be little changes but I guess it starts somewhere. I’m aware that there are many more things I need to change to become a better version of myself, and a lot more self-study to do because there’ll always be something to improve on. With the guide of Yoga, Yamas and Niyamas, I’m hopeful that whatever changes life throws at us, we’d be ready to accept and handle them better.

Inspire With Every Practice – The path to arm balances & Inversions

“Those that have tripod headstand in their practice, go ahead”, as the teacher instructed while we were holding in wide-legged forward hold. I remember tilting my head up a little while holding the pose (struggling) and saw a lady in front of my mat went upside down steadily and gracefully.

That day was etched in my mind till date, and thoughts came flowing in such as “how long did she practice to be able to do that?” and “how does it feels like being upside down and in control”. That day marks the start of my journey to the world of arm balances and inversions.

As my practice takes me deeper into the world of yoga, I fell in love with being upside down or on my arms. It wasn’t easy, really, even as a guy. People often misunderstood that being a guy gives you the extra advantage to learn it faster than a lady by utilizing pure strength alone, but the truth is, it doesn’t. I’ve attended inversion classes with guys that were bulked from countless gym sessions and they too struggled badly trying to go into crow or headstand, till the point they tried to lift using strength itself. The shaking arms and holding of breath, as well as face turning red from frustrations, was obvious.

Yes, you may try to push through using just strength alone. When I started out trying to get into crow, I too, tried to push through using strength after being frustrated from multiple failed attempts. But at the end of the day, I exhaust myself out unnecessarily with a sore wrist and still unable to hold the pose comfortably with ease. To me, the practice taught me to be consistent and patient with myself, the control of focus and emotions play a big part in this journey.

Through my journey of progression in the world of arm balances and inversions, I’ve learned techniques and methods from others through their priceless experiences, which enables me to share it with others. Learning the pose just the start, to work up to holding the pose with ease using the least effort is another. Being in the midst of it brings a sensation that it is indescribable. For that moment, you’re focused on your breath and within a world of your own, your own kind of meditation.

I would like to end off by sharing a few ‘rules’ I’ve learned in my journey. These ‘rules’ has helped me a lot by giving me clear objectives and focus, which brings progress.

  1. Be extremely patient with yourself. It is very important to not beat yourself up when you don’t get it initially, know that this is a lifelong journey of practice and there is no end to it. 
  2. Do not compare with others. More often than not, people conveniently look past the efforts of others to reach a certain pose. It is never easy, just focus on yourself and build your own journey.
  3. Focus on quality, not quantity. You want to do a proper good attempt with effort than tiring yourself out unnecessarily over multiple lousy ones. It delivers better habits and results than mindlessly push yourself up over and over again without proper rest in between.
  4. Be ritualistic. How do you get into crow or headstand? Build your own method of executing the pose, and follow that method strictly with every attempt, improvise it as you progress. Being ritualistic in inversions and arm balance gives me the proper momentum, preparation, and ensures success in executing the pose.
  5. Recap every attempt. Learning a new pose? Had a good or bad attempt? Don’t just brush it off. Summarise your last attempt and ask questions within yourself like “How was my hand placement?”,  “Where was my focus?”, “Why was this attempt successful?” etc. 
  6. Preparation before execution. I cannot emphasize this enough. Have a proper warm-up is vital before commencing your attempts. Identify your weakness and work on them. Never rush to attempt the pose if you feel that the areas required aren’t ready.  For me, my wrist is my weakness and I spend extra time on it before attempting anything. Spending that extra time goes a long way to ensure you are able to continuously practice. Imagine injuring your wrist (which happened to me) and out of practice for weeks or months, it regresses your practice physically and emotionally.
  7. Make use of your props. Your blocks, straps, and wall are your best friend. Use them to your fullest potential. It gives you a sense of security and proper alignment to ensure good fundamentals, which trains you to be steady in any inversions or arm balances.
  8. Be kind of yourself. This falls in line with Ahimsa, one of the Yamas. You are your own doctor and your know yourself the best. Feeling fatigued? Give yourself that rest day to progress further. Getting sore hips or wrist from attempts? Take an active break for a few minutes before continuing your attempts. Sufficient rest is very important because there is so much your body can take before it breaks down. 
  9. Consistency is the key. My key belief in any practice, not just inversions and arm balances. And I don’t mean putting hours of training every day.  Just set aside an attempt or two every day and carry on with your day whether good or bad attempt. It trains your mind and body to push through that boundary and be comfortable in that position gradually, which provide results.

Yoga and me

The first time I went to a yoga studio, I was mainly in a search of a well-being. Quite quickly, I found out that the more I was doing yoga the more I was becoming aware of my body. Very quickly my mind followed, yoga allowed me to feel better in my body but also in my mind, it was like I was also breathing from my mind.This calm, this piece of mind yoga was giving me at that moment was exactly was I was looking for. I decided to practice yoga more regularly.

When my body was in motion, I was focusing more on the present, forgetting about my stressful life, my stressful job. My mind was completely connected to my body finding a balance as I was breathing and getting into the postures, one after the other, forgetting about the past and the future just to cease and enjoy that moment, my moment on the mat.

The more I was progressing on the mat, the less stressful I was feeling, I could really say that the level of stress I had in me dropped considerably. I was feeling so good, much more calm, more energized, yoga was helping me feel stronger in my positiveness. All the benefits that my body was getting through the physical practices were leading to some benefits on my mind and obviously yoga gave me back a better quality of life. From that moment I knew it will be a long life journey, a continuous learning and an infinite discovery and I am happy to say that I am just at the beginning of it.

Every day I am so excited to learn, to practice, to practice more, to find the beautiful strength I can have in me and to be more confident on the mat. I am not looking for perfection and I don’t want to go over my limits. I just want to take it step by step, at my pace. In my opinion, I don’t think you should force yourself, yoga can become a constraint and not to mention the risk of injury especially for those who do not have regular physical activity. The best way to do yoga for me is to always find peace and happiness when you are on your mat!

Demystifying My Beliefs

Whenever people said “yoga changed my life for the better”, I always thought that it was because of physiological benefits from physical exertion/exercise e.g. improved fitness, increased confidence, better sleep, enhanced overall mood through various factors such as release of endorphins, etc.


As a physiotherapy student, I am a firm believer of science. At university, the concept of evidence-based practice is hammered into us. If a piece of information is not supported by high-quality research, its likelihood to be true is small. Therefore, it was hard for me to believe that the “life-changing” effects of yoga could be due to anything but physiological benefits. My passion in anatomy/physiotherapy was actually one of the reasons I joined this course – to gain a better understanding of the bodily aspects of yoga. Specifically, I wanted to: 1) learn what was required of the body to perform specific asanas e.g. strength in psoas major, length in hamstring, and 2) explore the possibilities of integrating yoga practice into physiotherapy treatments through asanas.


Through this course, I am starting to develop insight on how yoga is beyond just a form of exercise – it is a way of life. The Eight Limbs of Yoga provides a guide on living happily. I especially like the yamas and niyamas of the eight limbs, which to me are great moral guides. Yoga also touches on spirituality, which I was initially sceptical about since I wrongly understood it to be associated with religion. Religious people are spiritual but spiritual people are not necessarily religious. I now see spirituality and achieving enlightenment as another way of perceiving life, which enables us to overcome life’s obstacles with greater ease.


However, delving deeper into yoga theory has not been easy, as it also means challenging my strong scientific beliefs. While some of the techniques can be supported by evidence and logic (e.g. the physiological effects of deep, slow breathing in pranayamas), there are others that I haven’t been able to find (e.g. the association of the right nostril with the sun and the left nostril with the moon). As I found that it was difficult for me to fully immerse myself into something I had doubts about, I decided to look at things in a different way.


Through my own reading (I highly recommend ‘The Power of Now’ by Eckhart Tolle and ‘The Subtle Art of Not Giving a F***’ by Mark Manson) and conversations with Sree, I learned that whatever we attach ourselves to becomes a source of suffering. And one of our biggest attachments is to our identity or life roles. Attachment to identity becomes somewhat a form of self-imprisonment as it limits me from doing or believing anything that could potentially contradict that false identity. For me, my role as a physiotherapy student and my loyalty to science and evidence was limiting me from truly absorbing what I was learning in the course.


I am also starting to accept that science does not yet know everything. After all, it wasn’t so long ago that we believed that the earth was flat or that smoking had no negative health implications. To think that we know everything is to shut our minds out to new information and the potential to learn and be better than we already are. If there is evidence supporting the benefits of certain components of yoga, who is to say that in the future, the rest of it would not potentially be proven to be true too?