The Effect of Yoga on Balance and Fear of Falling in Older Adults

Intensity of Hatha yoga training for older adults

The aim of this study was to assess the intensity of hatha yoga training for older adults in alignment with international physical activity recommendations. The sample included 26 participants (one male), aged 70 ± 5.7 years, with a mean BMI of 25.3 ± 3.2, recruited from a University of the Third Age. Heart rate (HR) was measured during a yoga session using the Polar Vantage V2 multisport GPS watch and the Polar H10 chest strap sensor. Results indicated that the mean HR during the most intensive phase of yoga reached 60% of participants' HRmax and 31% of the heart rate reserve (HRR). On average, participants spent 16 min (15.9 ± 14.76) in the 64-76% HRmax range and nine minutes (9.4 ± 8.67) in the 40-59% HRR range, corresponding to moderate-intensity exercise. Four participants maintained moderate intensity for 30 min based on the 64 - 76% HRmax criterion, while only one participant sustained this intensity for at least 30 min according to the 40 - 59% HRR criterion. Participants reported a perceived exertion of 12, indicating a moderate level of effort. The study highlights that hatha yoga incorporates muscle-strengthening and endurance exercises for all major muscle groups, enhancing balance, coordination, flexibility, and range of motion, making it a comprehensive physical activity option for older adults. However, the session's intensity remained predominantly below the moderate level.

Effect of yoga on balance, falls, and bone metabolism: a systematic review of randomized controlled trials in healthy individuals

This systematic review of 18 RCTs assessed the impact of yoga on balance, fall risk, fear of falling, bone mineral density (BMD), and bone turnover markers in healthy individuals. Yoga significantly improved balance but its effects on BMD were inconclusive. Standardised protocols and longer-term studies are needed.

BACKGROUND

Yoga's effects on interconnected bone health parameters viz balance, falls, fear of falling (FOF), bone mineral density (BMD), and bone turnover markers (BTMs) in healthy individuals are unclear. We critically evaluated randomized controlled trials (RCTs) that compared yoga to no intervention control (NIC) or comparators such as Tai Chi, on these parameters in healthy individuals.

METHODS

We systematically searched multiple scientific data bases using a predefined protocol. We summarized data qualitatively when there was heterogeneity in reporting. A meta-analysis of those studies comparing yoga to NIC was done. Since the included studies used different scales for the same outcomes, we used standardised mean differences (SMDs) to allow pooling. We assessed the risk of bias with the Cochrane RoB2 tool for randomized trials and graded certainty of evidence using the GRADE approach.

RESULTS

Eighteen RCTs with 1408 participants were evaluated. Fifteen explored yoga's effects on balance and/or falls or FOF, and three RCTs, its effect on BMD and BTMs. Yoga types included Hatha, Vinyasa, Ashtanga, Iyengar, Bikram, and specially designed yoga protocols. Twenty-four kinds of balance assessment tools were used in the studies. Study durations varied from 6 weeks to 14 months. Almost all the studies reported positive effects of yoga on balance compared to NIC, and non-inferiority when compared to active interventions such as Tai Chi. Meta-analysis of four RCTs comparing yoga to NIC demonstrated significant improvements in static balance with yoga (SMD = 2.36; 95% CI 1.13-3.58; P = 0.0002, I2 = 93% ⊕ ⊕ ⊝ ⊝). Yoga's effects on falls and FOF were mixed. Two studies showed a positive effect of yoga on bone formation. Yoga was found to have a positive effect on BMD in only one study. Meta-analysis of two RCTs showed no significant effect on BMD for yoga compared to NIC. The studies exhibited substantial heterogeneity in terms of yoga styles, intervention durations, and assessment methods.

CONCLUSION

In healthy adults, low certainty evidence shows that yoga has a beneficial effect on balance. Its effect on BMD remains unclear. Standardised protocols and longer-term research are necessary to facilitate more definitive conclusions on yoga's role in enhancing skeletal health and preventing falls.

Effects of different exercise types on balance function in healthy older adults and Parkinson's patients: a systematic review

Objective

This study aims to compare the effects of Tai Chi, yoga, and resistance training on balance function in healthy elderly individuals and patients with Parkinson's disease (PD). Given the well-documented benefits of these three exercise types in enhancing balance and motor function, it is crucial to assess their differential impacts.

Methods

A comprehensive search was conducted across PubMed, Web of Science, Scopus, and Cochrane Library databases through December 2023. Articles were selected based on predefined criteria, screened, and evaluated by two independent researchers who also extracted study characteristics. The risk of bias was assessed using the Cochrane risk of bias tool. The primary outcome measures were the Berg Balance Scale and the Timed Up and Go test, while the secondary measure was the Unified Parkinson's Disease Rating Scale Part III. A random effects model was employed, and heterogeneity was measured using the I 2 statistic.

Results

Of the 21 studies reviewed, 9 focused on healthy older adults and 12 targeted individuals with PD. The meta-analysis showed that Tai Chi, yoga, and resistance training significantly improved balance in patients with PD compared to control groups (p < 0.00001). Resistance training was most effective in enhancing dynamic balance in healthy older adults (p = 0.003), while Tai Chi had the most significant impact on balance improvement in PD patients (p < 0.00001). Notably, interventions conducted three to four times per week, each lasting 50-60 min and continued over 12 weeks, yielded the most substantial balance improvements.

Conclusion

Comparative analyses demonstrate that Tai Chi, yoga, and resistance training significantly enhance balance and motor function. Specifically, resistance training markedly improves dynamic balance in healthy elderly individuals, while Tai Chi shows pronounced improvements in motor function and balance for PD patients. Optimal balance improvements are achieved by performing interventions three to four times per week, with each session lasting 50-60 min, over 12 weeks.

Systematic review registration

https://inplasy.com/, identifier INPLASY202470042.

The impact of yoga on successful aging based on the selection, optimization, and compensation model in elderly women: A quasi-experimental study

OBJECTIVE

To investigate the impact of yoga on successful aging based on the selection, optimization, and compensation model in elderly women.

DESIGN

Quasi-experimental study.

SAMPLE

Seniors' meeting points and parks and clubs for the old age pensioners of the ministry of education, ministry of healthcare, and the oil corporation in Shiraz, Iran. 68 elderly women within the age range of 60-86 years were divided into a yoga and a control group.

MEASUREMENTS

The subjects in both groups were asked to complete the selection, optimization, and compensation model questionnaire before and after the intervention. Successful aging was measured using the selection, optimization, and compensation questionnaire.

INTERVENTION

The yoga training program was implemented in 1-h sessions twice a week for eight weeks.

RESULTS

After eight weeks of yoga training, the results showed a significant difference between the pretest and posttest successful aging total scores of the yoga group (P = .005). However, the difference between the yoga and control groups' posttest mean total scores was not significant (P = .601).

CONCLUSION

Based on the results, it seems that yoga training can improve successful aging. Thus, yoga is recommended as an inexpensive and entertaining method.

Holistic frailty prevention: The promise of movement-based mind-body therapies

Aging is characterized by fundamental cellular and molecular hallmarks that result in physiologic decline of most body systems. This may culminate in frailty, a state of decreased reserve. Because frailty is a state of multisystem dysregulation, multimodal interventions may be necessary to mitigate and prevent progression rather than interventions targeting a single system. Movement-based mind-body therapies, such as tai chi and yoga, are promising multimodal strategies for frailty prevention and treatment given their inherent multicomponent nature. In this review, we summarize the links between hallmarks of aging and frailty and how tai chi and yoga may impact these hallmarks. We review trial evidence for the impact of tai chi and yoga on frailty in older populations and discuss opportunities for future research.

Yoga therapy on elderly patients with fear of fall: an open-label randomised controlled trial (YOFEAR trial)

INTRODUCTION

Fear of fall is experienced by the elderly irrespective of the presence or absence of history of fall. Falls contribute to injuries that culminate in hospitalisation that incur unwarranted medical expenses. Yoga is unique to Indian cultural practices, with a potential to enhance proprioception. It increases self-body awareness, ultimately improving the balancing capacity of older adults. Thus, the objective of this study is to compare the effect of yoga therapy in the study and control groups at 12 weeks from the baseline.

METHODS AND ANALYSIS

This study is designed as an open-label, randomised controlled trial (1:1) with a sample size of 62 elderly patients more than or equal to 60 years of age. Participation of either sex, male or female with a fear of fall will be considered. Two randomised groups of 31 participants each will receive standard therapy for their primary diseases as per the local, national or international guidelines. However, participants in the intervention arm will receive additional structured yoga therapy sessions. The primary objective of this study is to assess and compare the change in fear of fall score of participants in each group using Falls Efficacy Scale (FES) and Berg Balance Scale (BBS) at 12 weeks versus baseline. The secondary endpoint will assess the change in the quality of life of participants at 3 months compared with the baseline.Data will be gathered, entered into Microsoft Excel and further analysed by R software (V.4.3.0). Changes in FES-Intervention and BBS of two groups will be compared either by Student's t-test for parametric data or Mann-Whitney U test for non-parametric data. Statistical significance will be considered if p<0.05 at 95% confidence level.

ETHICS AND DISSEMINATION

Ethical approval for this study protocol (version 1.0, 22 April 2022) was obtained from the institute ethics committee (AIIMS/IEC/22/195).

TRIAL REGISTRATION NUMBER

CTRI/2022/06/043287.

Effects of yoga on physical and psychological health among community-dwelling older adults: A systematic review and meta-analysis

OBJECTIVES

To synthesise and critically appraise the quality of existing evidence about the effects of yoga on physical and psychological outcomes among older adults.

DESIGN

A systematic review and meta-analysis.

PARTICIPANTS

Participants aged 60 and above.

MEASUREMENTS

Nine English and two Chinese electronic bibliographic databases, including MEDLINE OvidSP, PsycINFO, AMED, EMBASE, Global Health, PubMed, Scopus, CINAHL, Cochrane Library, Hyread and WanFang databases, were searched. Randomised controlled trials (RCT) of yoga on physical and psychological outcomes among older adults were included. Meta-analysis was conducted for outcomes studied in three or more studies, otherwise narrative synthesis was performed.

RESULTS

Fifteen studies were included for review. The results of meta-analysis after sensitivity analysis showed that yoga significantly improved balance (SMD = 0.81, 95% CI: 0.48-1.14, p < .001, II2  = 59%), flexibility (SMD = 0.38, 95% CI: 0.07-0.68, p = .020, II2 34%), muscle strength (SMD = 0.49, 95% CI: 0.18-0.79, p = .002, I2 43%) and depressive symptoms (SMD = 0.50, 95% CI = 0.09-0.91, p = .01, I2 0%). There was insufficient data for meta-analysis on gait and other psychological outcomes. Narrative synthesis suggested that yoga has positive effects on reducing anxiety, but its effects on improving gait and reducing stress among older adults were inconclusive.

CONCLUSION

The results of this review supported the beneficial effects of yoga on physical outcomes among older adults, but the heterogeneity across studies was relatively high. Evidence related to the effect on psychological outcomes was limited.

Effect of Yoga on Frailty in Older Adults : A Systematic Review

BACKGROUND

Yoga, a multicomponent mind-body practice, improves several domains of physical and psychological health and may affect frailty in older adults.

PURPOSE

To evaluate the available trial evidence on the effect of yoga-based interventions on frailty in older adults.

DATA SOURCES

MEDLINE, EMBASE, and Cochrane Central from their inception to 12 December 2022.

STUDY SELECTION

Randomized controlled trials evaluating the effect of yoga-based interventions, including at least 1 session of physical postures, on a validated frailty scale or single-item markers of frailty in adults aged 65 years or older.

DATA EXTRACTION

Two authors independently screened articles and extracted data; 1 author assessed risk of bias with review from a second author. Disagreements were resolved through consensus and as-needed input from a third author.

DATA SYNTHESIS

Thirty-three studies (n = 2384 participants) were identified in varied populations, including community dwellers, nursing home residents, and those with chronic disease. Yoga styles were primarily based on Hatha yoga and most often included Iyengar or chair-based methods. Single-item frailty markers included measures of gait speed, handgrip strength, balance, lower-extremity strength and endurance, and multicomponent physical performance measures; no studies included a validated definition of frailty. When compared with education or inactive control, there was moderate-certainty evidence that yoga improved gait speed and lower-extremity strength and endurance, low-certainty evidence for balance and multicomponent physical function measures, and very low-certainty evidence for handgrip strength.

LIMITATION

Heterogeneity in study design and yoga style, small sample sizes, and reporting deficiencies leading to concerns for selection bias.

CONCLUSION

Yoga may affect frailty markers that are associated with clinically meaningful outcomes in older adult populations but may not offer benefit over active interventions (for example, exercise).

PRIMARY FUNDING SOURCE

None. (PROSPERO: CRD42020130303).

Disentangling interventions to reduce fear of falling in community-dwelling older people: a systematic review and meta-analysis of intervention components

PURPOSE

Fear of falling (FoF) is a common and debilitating problem for older people. Most multicomponent interventions show only moderate effects. Exploring the effective components may help in the optimization of treatments for FoF.

MATERIALS AND METHODS

In a systematic review of five scientific literature databases, we identified randomized controlled trials with older community-dwelling people that included FoF as an outcome. There was no restriction on types of interventions. Two reviewers extracted information about outcomes and content of interventions. Intervention content was coded with a coding scheme of 68 intervention components. We compared all studies with a component to those without using univariate meta-regressions.

RESULTS

Sixty-six studies, reporting on 85 interventions, were included in the systematic review. In the meta-regressions (n = 49), few components were associated with intervention effects at the first available follow up after the intervention, but interventions with meditation, holistic exercises (such as Tai Chi or Pilates) or body awareness were significantly more effective than interventions without these components. Interventions with self-monitoring, balance exercises, or tailoring were less effective compared to those without these components.

CONCLUSIONS

The identified components may be important for the design and optimization of treatments to reduce FoF. Implications for rehabilitationFear of falling (FoF) is a common and debilitating issue among older people and multicomponent interventions usually show only small to moderate effects on FoF.This review and meta-analysis investigated 68 intervention components and their relation to intervention effects on FoF.Interventions with meditation, holistic exercises (such as Tai Chi), or body awareness are more effective than interventions without these components.Clinicians aiming to reduce FoF may recommend selected interventions to older people taking into account the current knowledge of intervention components.

Ditangquan exercises based on safe-landing strategies prevent falls and injury among older individuals with sarcopenia

Background

Sarcopenia is the age-related loss of skeletal muscle mass and function; it is a risk factor for falls among older individuals. Few studies have focused on training such individuals to adopt a safe-landing strategy that would protect them from fall-related injuries. Ditangquan is a traditional Chinese martial art comprising movements that conform to the principles of safe landing. This study aims to investigate the effectiveness of Ditangquan in preventing fall-related injuries among older individuals with sarcopenia.

Methods

A total of 70 participants (21 males and 49 females with sarcopenia) between 60 and 80 years of age were recruited from three local communities and randomly assigned to the Ditangquan exercise group (DG) or the control group (CG) in a 1:1 ratio. Three times a week for 24 weeks, both the DG and CG received an hour of conventional exercise and an hour of Ditangquan exercise based on safe landing. Primary outcomes were the modified falls efficacy scale (MFES), the number of falls, and fall injuries; the secondary outcome was the Timed Up & Go (TUG) test.

Results

The DG had significantly fewer falls (1 vs. 8, P = 0.028) and fall injuries (0 vs. 6, P = 0.025) than the CG. Furthermore, at the end of the study, the DG had a significantly improved MFES (mean difference: 32.17 scores; 95% CI: 21.32, 43.02; P <0.001) and TUGT (mean difference: −4.94 s; 95% CI: −7.95, −1.93; P = 0.002) as compared with the CG.

Conclusion

Ditangquan exercise based on the safe-landing strategy effectively improves the functional mobility of the elderly, reduces the occurrence of falls and injuries, and increases the individual's confidence in preventing falls.

Postural Control Adaptations in Yoga Single-Leg Support Postures: Comparison Between Practitioners and Nonpractitioners

This paper investigates whether a group of regular Yoga practitioners shows postural control differences compared with healthy controls while performing single-leg Yoga postures. Ten Yoga practitioners were compared with a control group of 10 nonpractitioners performing two single-leg support Yoga postures: Vrksasana (tree posture) and Natarajasana (dancer posture). Rambling and trembling decomposition of the center of pressure trajectories was implemented using a genetic algorithm spectral optimization that avoids using horizontal forces and was validated with bipedal posture data. Additionally, the center of mass was estimated from body kinematics using OpenSim and compared with the rambling outputs. During Natarajasana, no postural control adaptations were observed. For Vrksasana, the Yoga practitioners showed a lower center of pressure ellipse confidence interval area, center of pressure anteroposterior SD, and smaller rambling SD in the mediolateral direction, suggesting possible supraspinal feed-forward motor adaptations associated with Yoga training.

The Effect of Yoga Asana "Vrksasana (Tree Pose)" on Balance in Patients With Postmenopausal Osteoporosis: A Randomized Controlled Trial

OBJECTIVE

In this study, the effect of the add-on effect of the Tree Pose (Vrksasana) on the balance of patients with postmenopausal osteoporosis was investigated.

DESIGN

Thirty-two patients with postmenopausal osteoporosis were randomly assigned to conservative exercise group (30 mins/d for 12 wks) or Tree Pose-added exercise group (30-min conventional exercise + 2-min Tree Pose/d for 12 wks) by Microsoft Excel randomization option. The balance of the patients was evaluated with Berg Balance Scale, Timed Up and Go Test, single-leg standing test, tandem walk test, tandem stance test, and Korebalance static&dynamic balance tests at baseline, sixth week, and third month of the exercise program.

RESULTS

There was no statistically significant difference on baseline data between groups. There was a statistically significant difference between the two groups in the sixth-week measurement of single-leg stance (P < 0.05). In the Berg Balance Scale, static balance test, dynamic balance test, and tandem walk test, a statistically significant difference was found among baseline, sixth-week, and 12th week measurements in both the exercise group and the Tree Pose-added exercise group.

CONCLUSIONS

Gains in the static and dynamic balance of postmenopausal osteoporotic patients can be obtained by adding "Vrksasana" to conventional exercises.

Yoga Interventions Involving Older Adults: Integrative Review

There is growing scientific evidence that yoga interventions have positive impacts on health in community-dwelling older adults. Older adults are an exponentially growing cohort; efforts to improve their health can also contribute to community health. The objective of the current integrative review was to examine quantitative evidence concerning effectiveness of yoga interventions related to the health of community-dwelling older adults. Six studies met inclusion criteria of community-dwelling older adults, randomized controlled trial (RCT) design, and yoga intervention in the past 10 years. Hatha yoga was most frequently used; interventions were well-received with high adherence rates. Benefits from participation in yoga included improvements in psychological and physical health, such as reductions in anger, anxiety, and fear of falling, and increases in well-being, self-efficacy, improved executive and immunological function, strength, and balance. Findings reveal that additional well-designed yoga RCTs are indicated with longer intervention and follow up to assess lifespan changes. [Journal of Gerontological Nursing, 48(2), 43-52.].

Recurrent but not single report of fear of falling predicts cognitive decline in community-residing older adults

OBJECTIVES

Literature regarding the association of fear of falling (FOF), a common concern in aging, and cognition is scarce. Moreover, whether frequency of FOF endorsement influences age-related cognitive decline has not been reported. Here we determined whether FOF status (no FOF, single-report FOF, recurrent FOF), predicted decline in global cognitive function (GCF), memory, and attention/executive functions.

METHODS

Participants were community-residing older adults (n = 421; mean age = 76.29 ± 6.48; %female = 56.06). FOF was assessed bimonthly through yes/no responses to "do you have a fear of falling?" during the first year of the study. Recurrent status required two or more FOF endorsements. GCF was assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); composite scores were used to assess memory as well as attention/executive functions. Cognitive measures were administered annually for up to six years.

RESULTS

Stratification of the cohort by FOF status showed that 81 participants reported recurrent FOF, 60 participants endorsed FOF once and 280 participants reported no FOF. Linear mixed effects models revealed that compared to no FOF, recurrent FOF was associated with worse declines in GCF (estimate=-0.03, p=.006), memory (estimate=-0.04, p=.012) and attention/executive functions (estimate=-0.04, p=.006). Comparisons between single-report FOF and no FOF, however, were not significant.

CONCLUSIONS

These findings demonstrate that recurrent but not single-report FOF is a risk factor for cognitive decline in community-residing older adults.

Yoga implications for preventing accidental falls in older adults: a systematic review

Abstract Introduction: Studies have shown the importance of healthy habits in older adults, emphasizing physical activity or mobility for a better quality of life and to delay physical degeneration in this population. Yoga is one of several exercises recommended for therapeutic purposes to reduce the risk of falls, a common occurrence in this age group. Objective: To synthesize the existing evidence regarding the effects of yoga on quality of life and physical-functional capacity and its contribution to fall prevention in older people. Methods: This systematic review was conducted in August 2020 on the Medline/Pubmed, LILACS, SCOPUS, Web of Science and PEDro databases, with no restrictions for language or year of publication. In line with the eligibility criteria, randomized or quasi-randomized clinical trials were included. Results: A total of 1,190 articles were found, 18 of which were included for data collection. The average sample size was between 16 and 120 participants, consisting of older individuals of both sexes ranging in age from 62 to 85 years. Conclusion: Regular yoga practice has a beneficial effect on the quality of life and physical-functional capacity of older adults, thereby contributing to fall prevention. However, evidence is still limited and further studies are suggested to better elucidate the scope of the effects of yoga as a therapeutic resource.

Yoga Interventions Used for the Rehabilitation of Stroke, Parkinson's Disease, and Multiple Sclerosis: A Scoping Review of Clinical Research

Objectives: The current body of literature was reviewed to compile and describe yoga interventions that have been applied in clinical research and neurologic rehabilitation settings with patients affected by stroke, Parkinson's disease (PD), and multiple sclerosis (MS). Design: Available literature on yoga therapy (YT) was mapped following a five-stage framework to identify key concepts, knowledge gaps, and evidence to inform practice. Publications were identified through Medline, CINAHL, EMBASE, and PsycINFO. Selected studies required subjects with a clinical diagnosis of stroke, PD, and MS to participate in a yoga intervention and have physical, cognitive, and/or psychosocial outcome measures assessed. Results: A total of 50 studies were included in this review. Study characteristics, patient demographics, description of the yoga intervention, reported outcome measures and the main findings were extracted from the studies. Conclusion: Implementing YT in neurorehabilitation can help health care professionals integrate a more holistic approach that addresses the fundamental physical and psychological challenges of living with a chronic and debilitating neurologic disorder. The included studies described yogic interventions consisting of group or individual therapy sessions lasting 60-75 min that were carried out one to three times per week for 8-12 consecutive weeks across all three conditions. All studies described in this scoping review used different yoga protocols confirming the lack of specific interventional parameters available for implementing yoga into the rehabilitation of individuals affected by stroke, PD, or MS.

Meta-Analysis of the Effect of Yoga Practice on Physical Fitness in the Elderly

The purpose of this study was to meta-analyze the effects of yoga intervention on physical fitness in the elderly. The following databases were systematically searched in 25 March 2021: Cochrane, PubMed and Embase. A total of 656 papers was identified through key word combinations, finally, 12 studies were included in the meta-analysis. The main conclusions are as follows. First, yoga practice showed moderately positive effects on muscle strength, balance, mobility, and lower body flexibility, but had no significant effect on cardiorespiratory endurance and upper body flexibility. Second, sub-group analysis showed that subjects in their 60s and 70s and yoga practice for 9–12 weeks had a large positive effect on physical fitness. Yoga is a multimodal activity that improves muscle strength, balance, and flexibility in the elderly, and physical activity policies should continue to promote yoga as an activity that enhances physical and mental wellbeing in this population.

Intervention Characteristics Associated With a Reduction in Fear of Falling Among Community-Dwelling Older People: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND AND OBJECTIVES

Fear of falling (FoF) is associated with decreased physical functioning and an increased fall risk. Interventions generally demonstrate moderate effects and optimized interventions are needed. Intervention characteristics, such as setting or delivery method may vary. We investigated which overarching intervention characteristics are associated with a reduction in FoF in community-dwelling older people.

RESEARCH DESIGN AND METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) in community-dwelling older people without specific diseases was performed. Associations between intervention characteristics and standardized mean differences (SMD) were determined by univariate meta-regression. Sensitivity analyses were performed.

RESULTS

Data on 62 RCTs were extracted, 50 intervention groups were included in the meta-analysis. Most intervention characteristics and intervention types were not associated with the intervention effect. Supervision by a tai chi instructor (SMD: -1.047, 95% confidence interval [CI]: -1.598; -0.496) and delivery in a community setting (SMD: -0.528, 95% CI: -0.894; -0.161) were-compared to interventions without these characteristics-associated with a greater reduction in FoF. Holistic exercise, such as Pilates or yoga (SMD: -0.823, 95% CI: -1.255; -0.392), was also associated with a greater reduction in FoF. Delivery at home (SMD: 0.384, 95% CI: 0.002; 0.766) or with written materials (SMD: 0.452, 95% CI: 0.088; 0.815) and tailoring were less effective in reducing FoF (SMD: 0.687, 95% CI: 0.364; 1.011).

DISCUSSION AND IMPLICATIONS

Holistic exercise, delivery with written materials, the setting and tailoring potentially represent characteristics to take into account when designing and improving interventions for FoF in community-dwelling older people. PROSPERO international prospective register of systematic reviews, registration ID CRD42018080483.

Experience of Elderly People Regarding the Effect of Yoga/Light Exercise on Sedentary Behavior: A Longitudinal Qualitative Study in Madhya Pradesh, India

This study is set on the background of a randomized control trial (RCT) in which intervention was carried to observe the effects of yoga/light exercise on the improvement in health and well-being among the elderly population. A longitudinal qualitative study was conducted as part of RCT interventions to explore the experience of the elderly practicing yoga/light exercise in relation to sedentary behavior in the Ujjain district of Madhya Pradesh, India. Participants of the RCT were selected for this study. Eighteen focus group discussions were conducted—six during each phase of RCT interventions (before, during, and after). The findings regarding motivating and demotivating factors in various phases of intervention were presented in three categories: experience and perception of the effects of yoga/light exercise on sedentary behavior (1) before, (2) during, and (3) after intervention. This study explores the positive effect of yoga/light exercise on sedentary behavior and subjective well-being on the elderly population. They were recognized to have undergone changes in their physical and emotional well-being by consistently practicing yoga/light exercise. The main driving factors were periodic health check-ups and the encouragement of qualified trainers without any cost. This study concludes with the notion that these interventions should be encouraged in the community to use physical exercise as a method to better control the physical and social effects of aging.

Innovations in Geroscience to enhance mobility in older adults

Aging is the primary risk factor for functional decline; thus, understanding and preventing disability among older adults has emerged as an important public health challenge of the 21st century. The science of gerontology - or geroscience - has the practical purpose of "adding life to the years." The overall goal of geroscience is to increase healthspan, which refers to extending the portion of the lifespan in which the individual experiences enjoyment, satisfaction, and wellness. An important facet of this goal is preserving mobility, defined as the ability to move independently. Despite this clear purpose, this has proven to be a challenging endeavor as mobility and function in later life are influenced by a complex interaction of factors across multiple domains. Moreover, findings over the past decade have highlighted the complexity of walking and how targeting multiple systems, including the brain and sensory organs, as well as the environment in which a person lives, can have a dramatic effect on an older person's mobility and function. For these reasons, behavioral interventions that incorporate complex walking tasks and other activities of daily living appear to be especially helpful for improving mobility function. Other pharmaceutical interventions, such as oxytocin, and complementary and alternative interventions, such as massage therapy, may enhance physical function both through direct effects on biological mechanisms related to mobility, as well as indirectly through modulation of cognitive and socioemotional processes. Thus, the purpose of the present review is to describe evolving interventional approaches to enhance mobility and maintain healthspan in the growing population of older adults in the United States and countries throughout the world. Such interventions are likely to be greatly assisted by technological advances and the widespread adoption of virtual communications during and after the COVID-19 era.

Effects of Mind-Body Interventions Involving Meditative Movements on Quality of Life, Depressive Symptoms, Fear of Falling and Sleep Quality in Older Adults: A Systematic Review with Meta-Analysis

Background: The aim of the present systematic meta-analytical review was to quantify the effects of different mind–body interventions (MBI) involving meditative movements on relevant psychological health outcomes (i.e., quality of life (QoL), depressive symptoms, fear of falling (FoF) and sleep quality) in older adults without mental disorders. Methods: A structured literature search was conducted in five databases (Ovid, PsycINFO, PubMed, SPORTDiscus, Web of Science). Inclusion criteria were: (i) the study was a (cluster) randomized controlled trial, (ii) the subjects were aged ≥59 years without mental illnesses, (iii) an intervention arm performing MBI compared to a non-exercise control group (e.g., wait-list or usual care), (iv) psychological health outcomes related to QoL, depressive symptoms, FoF or sleep quality were assessed and (v) a PEDro score of ≥5. The interventions of the included studies were sub-grouped into Tai Chi/Qigong (TCQ) and Yoga/Pilates (YP). Statistical analyses were conducted using a random-effects inverse-variance model. Results: Thirty-seven randomized controlled trials (RCTs) (comprising 3224 participants) were included. Small to moderate-but-significant overall effect sizes favoring experimental groups (Hedges’ g: 0.25 to 0.71) compared to non-exercise control groups were observed in all outcomes (all p values ≤ 0.007), apart from one subdomain of quality of life (i.e., social functioning, p = 0.15). Interestingly, a significant larger effect on QoL and depressive symptoms with increasing training frequency was found for TCQ (p = 0.03; p = 0.004). Conclusions: MBI involving meditative movements may serve as a promising opportunity to improve psychological health domains such as QoL, depressive symptoms, FoF and sleep quality in older adults. Hence, these forms of exercise may represent potential preventive measures regarding the increase of late-life mental disorders, which need to be further confirmed by future research.

Hatha yoga training improves standing balance but not gait in Parkinson's disease

Background and purpose

Complementary therapies, such as yoga, have been proposed to address gait and balance problems in Parkinson's disease (PD). However, the effects of yoga on gait and static balance have not been studied systematically in people with PD (PWP). Here we evaluated the effects of a 12-week long Hatha yoga intervention on biomechanical parameters of gait and posture in PWP.

Methods

We employed a pilot randomized controlled trial design with two groups of mild-to-moderate PWP (immediate treatment, waitlist control; N = 10 each; Mean Hoehn and Yahr score = 2 for each group). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and gait and postural kinematics including postural sway path length, cadence, walking speed, and turning time were obtained. The immediate treatment group received a 60-min Hatha yoga training twice a week for 12 weeks, while the waitlisted control group received no training. After 12 weeks, gait and postural kinematics were assessed (post-test for treatment group and second-baseline for waitlist group). Then, the waitlist group received the same yoga training and was evaluated post-training.

Results

After Hatha yoga training, UPDRS motor scores improved with an 8-point mean decrease which is considered as a moderate clinically important change for mild-moderate PD. Sway path length during stance decreased significantly (mean reduction: -34.4%). No significant between-group differences or improvements in gait kinematics were observed.

Conclusion

This study showed that a 12-week Hatha yoga training can improve static balance in PWP. We found no evidence that it systematically improves gait performance in PWP.

The Turkish version of the Modified Falls Efficacy Scale: reliability and validity from the viewpoint of balance

Background/aim

The factors associated with fall-related self-efficacy should be addressed, especially in the elderly. The Modified Falls Efficacy Scale (MFES) is a simple instrument with good scaling properties and reliability. The aim of the present study was to determine the reliability and the validity of the Turkish version of the MFES from the viewpoint of balance.

Materials and methods

In this study, 164 participants aged >65 years were included. The use of walking aids and assistive devices, history and frequency of falls in the previous year, living environment, and exercise habits were noted. Balance and risk of falling were assessed with the Berg Balance Scale (BBS). A forward-backward translation procedure was used for the Turkish version of the MFES.

Results

None of the 14 items in the MFES were modified. The Turkish version of the MFES has excellent internal consistency (Cronbach’s alpha, 0.978) and reliability (interclass correlation coefficient, 0.928–0.982), and its construct validity was supported by its ability to distinguish between the groups with respect to fall-risk factors and balance. According to the BBS scores, the high-fall-risk group had lower MFES scores than the moderate- and low-fall-risk groups (χ2 = 34.153, P = 0.001).

Conclusion

The Turkish version of the MFES is a sensitive instrument for evaluation of fall-related confidence while carrying out indoor/outdoor activities. It also predicts falls, reduced physical activity, balance and mobility problems, and restricted social participation and daily living activities.

The effects of yoga compared to active and inactive controls on physical function and health related quality of life in older adults- systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Yoga has been recommended as a muscle strengthening and balance activity in national and global physical activity guidelines. However, the evidence base establishing the effectiveness of yoga in improving physical function and health related quality of life (HRQoL) in an older adult population not recruited on the basis of any specific disease or condition, has not been systematically reviewed. The objective of this study was to synthesise existing evidence on the effects of yoga on physical function and HRQoL in older adults not characterised by any specific clinical condition.

METHODS

The following databases were systematically searched in September 2017: MEDLINE, PsycInfo, CINAHL Plus, Scopus, Web of Science, Cochrane Library, EMBASE, SPORTDiscus, AMED and ProQuest Dissertations & Theses Global. Study inclusion criteria: Older adult participants with mean age of 60 years and above, not recruited on the basis of any specific disease or condition; yoga intervention compared with inactive controls (example: wait-list control, education booklets) or active controls (example: walking, chair aerobics); physical function and HRQoL outcomes; and randomised/cluster randomised controlled trials published in English. A vote counting analysis and meta-analysis with standardised effect sizes (Hedges' g) computed using random effects models were conducted.

RESULTS

A total of 27 records from 22 RCTs were included (17 RCTs assessed physical function and 20 assessed HRQoL). The meta-analysis revealed significant effects (5% level of significance) favouring the yoga group for the following physical function outcomes compared with inactive controls: balance (effect size (ES) = 0.7), lower body flexibility (ES = 0.5), lower limb strength (ES = 0.45); compared with active controls: lower limb strength (ES = 0.49), lower body flexibility (ES = 0.28). For HRQoL, significant effects favouring yoga were found compared to inactive controls for: depression (ES = 0.64), perceived mental health (ES = 0.6), perceived physical health (ES = 0.61), sleep quality (ES = 0.65), and vitality (ES = 0.31); compared to active controls: depression (ES = 0.54).

CONCLUSION

This review is the first to compare the effects of yoga with active and inactive controls in older adults not characterised by a specific clinical condition. Results indicate that yoga interventions improve multiple physical function and HRQoL outcomes in this population compared to both control conditions. This study provides robust evidence for promoting yoga in physical activity guidelines for older adults as a multimodal activity that improves aspects of fitness like strength, balance and flexibility, as well as mental wellbeing.

TRIAL REGISTRATION

PROSPERO registration number: CRD42016038052 .

Effects of the visual-feedback-based force platform training with functional electric stimulation on the balance and prevention of falls in older adults: a randomized controlled trial

BACKGROUND

Force platform training with functional electric stimulation aimed at improving balance may be effective in fall prevention for older adults. Aim of the study is to evaluate the effects of the visual-feedback-based force platform balance training with functional electric stimulation on balance and fall prevention in older adults.

METHODS

A single-centre, unblinded, randomized controlled trial was conducted. One hundred and twenty older adults were randomly allocated to two groups: the control group (n = 60, one-leg standing balance exercise, 12 min/d) or the intervention group (n = 60, force platform training with functional electric stimulation, 12 min/d). The training was provided 15 days a month for 3 months by physical therapists. Medial-lateral and anterior-posterior maximal range of sway with eyes open and closed, the Berg Balance Scale, the Barthel Index, the Falls Efficacy scale-International were assessed at baseline and after the 3-month intervention. A fall diary was kept by each participant during the 6-month follow-up.

RESULTS

On comparing the two groups, the intervention group showed significantly decreased (p < 0.01) medial-lateral and anterior-posterior maximal range of sway with eyes open and closed. There was significantly higher improvement in the Berg Balance Scale (p < 0.05), the Barthel Index (p < 0.05) and the Falls Efficacy Scale-International (p < 0.05), along with significantly lesser number of injurious fallers (p < 0.05), number of fallers (p < 0.05), and fall rates (p < 0.05) during the 6-month follow-up in the intervention group.

CONCLUSION

This study showed that the visual feedback-based force platform training with functional electric stimulation improved balance and prevented falls in older adults.

Physical-Performance Outcomes and Biomechanical Correlates from the 32-Week Yoga Empowers Seniors Study

Background. Yoga Empowers Seniors Study (YESS) quantified physical demands associated with yoga performance using biomechanical methods. This study evaluated the efficacy of the program on physical function outcomes. Methods. Twenty community-dwelling older adults aged 70.7 ± 3.8 years attended biweekly 60-minute Hatha yoga classes for 32 weeks. Four domains of the physical measurements including (1) functional performance, (2) flexibility, (3) muscle strength, and (4) balance were taken at the baseline, 16-week and 32-week time points. Repeated-measures ANOVA omnibus tests and Tukey's post hoc tests were employed to examine the differences in each outcome variable across the 3 time points. Results. Improved timed chair stands (p < 0.01), 8-foot up and go (p < 0.05), 2-min step test (p < 0.05), and vertical reach (p = 0.05) performance were evident. Isometric knee flexor strength (p < 0.05) and repetitions of the heel rise test (p < 0.001) also increased following the 32-week intervention. Both flexibility and balance performance remained unchanged. Conclusions. Significant improvements in physical function and muscle-specific lower-extremity strength occur with the regular practice of a modified Hatha yoga program designed for seniors. These adaptations corresponded with the previously reported biomechanical demands of the poses.

Yoga-Related Injuries in the United States From 2001 to 2014

BACKGROUND

Yoga has become more popular among people in the United States and has been touted by both yoga participants as well as some physicians and researchers for its health benefits. While the health benefits have been studied, the frequency of injury among yoga participants has not been well documented.

PURPOSE

Injury incidence, rates, and types associated with yoga in the United States have not been quantified. This study estimates US yoga-associated injury incidence and characterizes injury type over a 13-year period.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Data from the National Electronic Injury Surveillance System (NEISS) from 2001 to 2014 were used to estimate the incidence and type of yoga-associated injuries. The number and age distribution of yoga participants was estimated using data from National Health Statistics Reports. These national population estimates were applied to the NEISS data to determine injury rates overall and stratified according to age categories.

RESULTS

There were 29,590 yoga-related injuries seen in hospital emergency departments from 2001 to 2014. The trunk (46.6%) was the most frequent region injured, and sprain/strain (45.0%) accounted for the majority of diagnoses. The injury rate increased overall from 2001 to 2014, and it was greatest for those aged 65 years and older (57.9/100,000) compared with those aged 18 to 44 years (11.9/100,000) and 45 to 64 years (17.7/100,000) in 2014.

CONCLUSION

Participants aged 65 years and older have a greater rate of injury from practicing yoga when compared with other age groups. Most injuries sustained were to the trunk and involved a sprain/strain. While there are many health benefits to practicing yoga, participants and those wishing to become participants should confer with a physician prior to engaging in physical activity and practice only under the guidance of certified instructors.

Yoga research review

This paper is a review of empirical studies, review and meta-analysis publications on yoga from the last few years. The review includes demographics/prevalence of yoga as a practice, bibliometric analyses of the yoga publications and the use of yoga for physical fitness and cognitive function. Most of the studies reviewed here involve yoga effects on psychiatric and medical conditions. These include pregnancy, prenatal and postpartum depression; stress, PTSD, anxiety, and obesity; cardiovascular conditions including hypertension; pain syndromes including arthritis, headaches and low back pain; autoimmune conditions including asthma, type II diabetes and multiple sclerosis; immune conditions including HIV and breast cancer; and aging problems including balance, osteoporosis and Parkinson's. The methods and results of those studies are briefly summarized along with their limitations and suggestions for future research. Basically yoga has been more effective than control and waitlist control conditions, although not always more effective than treatment comparison groups such as other forms of exercise. More randomized controlled studies are needed in which yoga is compared to active exercise groups. Having established the physical and mental health benefits of yoga makes it ethically questionable to assign participants to inactive control groups. Shorter sessions should be investigated for cost-effectiveness and for daily practice. Multiple physical and physiological measures need to be added to the self-report research protocols and potential underlying mechanisms need to be further explored. In the interim, the studies reviewed here highlight the therapeutic effects of yoga, a practice that could come to be called yoga therapy.

Factors Associated with Fear of Falling among Community-Dwelling Older Adults in the Shih-Pai Study in Taiwan

Background

Fear of falling is an important risk indicator for adverse health related outcomes in older adults. However, factors associated with fear of falling among community-dwelling older adults are not well-explored.

Objectives

To explore the quality of life and associated factors in fear of falling among older people in the Shih-Pai area in Taiwan.

Methods

This community-based survey recruited three thousand eight hundred and twenty-four older adults aged ≥ 65 years. The measurements included a structured questionnaire, including quality of life by using Short-Form 36, and information of fear of falling, fall history, demographics, medical conditions, insomnia, sleep quality, depression and subjective health through face-to-face interviews.

Results

A total of 53.4% of participants reported a fear of falling. The rate of fear of falling was higher in female subjects. Subjects with fear of falling had lower Short Form-36 scores both for men and women. Falls in the previous year, older age, insomnia, depression and worse subjective health were correlates of fear of falling for both sexes. Male-specific associations with fear of falling were the accessibility of medical help in an emergency, diabetes mellitus and stroke. In parallel, cardiovascular diseases were a female-specific correlate for fear of falling.

Conclusions

Fear of falling is prevalent among community-dwelling older adults. It is seems that there are gender differences in fear of falling with respect to the prevalence and associated factors in older adults. Gender differences should be considered when planning prevention and intervention strategies for fear of falling among older people.