Data were analyzed using Statistical Package for the Social Sciences, version 16 (SPSS, Inc., Chicago, Illinois). Paired t tests were used to assess the following outcome variables: 4-Square Step Test, BBS, Activities-Specific Balance Scale, timed floor-to-stand, and gait speed (self-selected and fast).
Fourteen subjects began the initial yoga program with 8 subjects (all women) completing the full 8-week program. Two subjects dropped out, stating that the program was too difficult; 2 subjects dropped out because of other extensive time commitments, and 2 subjects dropped out because of medical reasons.
Subjects who completed the study did not differ significantly from subjects who dropped out of the study in age or other measures. Independent t tests revealed that control subjects did not differ significantly from the yoga group in age or measures of postural control, mobility, rising from the floor, or gait speed. However, the control subjects included 3 men and 5 women, as opposed to the research subjects who were all women (Table 1).
All subjects scored 24 or more on the MMSE and appreciated at least the 4.31 filament, bilaterally, on the plantar surface of the great toe, fifth metatarsal head, and heel. All subjects were independent in rising from the floor at the time of initial pretesting. Yoga participants attended at least 10 of the 16 classes (62% attendance). Five of the 8 yoga participants attended 12 of the 16 classes (75% attendance). No yoga participant attended 100% of classes.
This study examined the effects of yoga on postural control, mobility, and walking in community-living older adults. Yoga participants reported positive experiences with the intervention program. The results of the study support that yoga improved several measures of postural control, mobility, and walking.
Both the TUG and the ability to arise from the floor were used to measure mobility. Yoga participants scored an average of 9.38 (3.21) seconds on pretest TUG. Lusardi and Chui43 report average TUG scores for healthy older adults aged 80 to 89 years as 9.5 (3.2) seconds. Yoga participants decreased their TUG scores by an average of 0.97 seconds. This change was not statistically significance. The MDC for TUG scores has been reported as 1 to 2.49 seconds.43 Therefore, yoga participants began the study with average TUG scores and, after 8 weeks of yoga, decreased these scores by 0.97 seconds. Although not statistically significant, this does approach the MDC of 1 to 2.49 seconds. The small sample size may have prevented detection of statistical significance. A longer intervention of yoga may also continue to decrease TUG scores. As subjects continue to experience improved mobility through yoga, they may also experience a decrease in TUG scores.
Yoga participants decreased their time to rise from the floor by an average of 2.42 seconds. This change was not statistically significant. Although the test has previously been described in the literature,44–46 no data are available regarding typical time to complete the task, the MDC, or the MDIC. Knutzen et al44 found that lower extremity strength is correlated with the ability to rise from the floor. Murphy et al46 and Tinetti et al47 found that subjects with a history of a fall had difficulty rising from the floor. However, Galvao and Taaffe48 reported that a 20-week progressive resistance-training program did not improve the floor-to-stand time. Because the sample size was small, we may not have had sufficient power to evaluate whether participation in an 8-week yoga program contributes to improved ability to rise from the floor (P < .09). Strengthening of the upper and lower extremities and practice of the task during yoga may have contributed to this improvement. The ability to rise from the floor has been related to reduced injury in individuals who fall47 and is therefore an important skill to both study and train. More data are needed on this variable.
The use of complementary and alternative therapies is on the rise in the United States20,21 with up to 7.5% of the adult population participating in yoga.20 Studies examining the impact of yoga on body functions and structures have concentrated on the upper extremities,51–53 lower extremity hip extension,33 or general fitness.44 To date, no studies appear to have examined the effects of yoga on balance and risk of falling in community-dwelling older adults. The yoga program used was specifically designed for older adults at risk for a fall. Postures chosen targeted all major lower extremity muscles identified as important to prevent falls.54–58
The program was extremely well received and, at the conclusion of the study, was continued at the participating facility. Research subject 6 stated at the end of the program, “I feel a lot better since yoga, both in the house and going out.” Research subject 2 declared during the posttest, “I can do tree pose now!” Yoga may provide a safe and effective means of exercise to improve balance and posture and reduce the risk of falling in community-dwelling older adults.
This study had a number of limitations that may have impacted on results. The sample used was a sample of convenience, rather than a randomly selected sample. The sample size was small, and as a result, power to determine difference in function on posttest was likely insufficient. Replication using this study's methods, with a larger sample randomized into yoga and control groups, would be more effective in determining the impact of yoga on functional performance. Yoga sessions were limited to only 8 weeks; there is no clear evidence for determining dose, frequency, and duration for the most effective yoga program. A longer postexercise follow-up would be needed to determine whether improvement in function was stable over time. Other measures of function and gait associated with risk of falls (eg, postural sway, quality of gait, overall lower extremity strength, and sit-to-stand time) might be used. Because yoga impacts both body and mind, indicators of quality of life and/or fear of falling may show changes even when physical measures do not. Qualitative inquiry may reveal the benefits of yoga more accurately.
Subjects who participated in the study demonstrated significant improvement on the BBS and fast gait speed. Time to rise from the floor decreased, suggesting improvement in function during this task. This preliminary study suggests that yoga may be a safe and effective alternative intervention for aging adults. Replication in a larger, controlled study is warranted to clarify the efficacy of yoga in improving postural control and reducing risk of falling in community-dwelling older adults.
The authors certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on them or on any organization with which we are associated and, if applicable, we certify that all financial and material support for this research (eg, NIH or NHS grants) and work are clearly identified in the title page of the manuscript.
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balance; older adults; risk of falling; yoga