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)