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.
Keywords:
Accidental falls; Aging; Healthy aging; Yoga
Resumo
Introdução:
Estudos têm demonstrado a importância dos hábitos saudáveis em idosos, enfatizando a atividade física ou mobilidade como categoria para uma melhor qualidade de vida nas condições orgânicas e retardo da degeneração física nesse grupo populacional. Dentre diversas atividades físicas, o yoga é conhecido como um dos exercícios indicados e utilizados de forma terapêutica, que pode reduzir o risco de quedas, sendo este um evento prevalente nessa faixa etária.
Objetivo:
Sintetizar as evidências existentes quanto aos efeitos da prática de yoga na qualidade de vida e capacidade físico-funcional que possam contribuir para a prevenção de quedas em idosos.
Métodos:
Trata-se de uma revisão sistemática, cujas buscas foram realizadas em agosto de 2020 nas bases de dados Medline/Pubmed, LILACS, SCOPUS, Web of Science e PEDro, sem restrições linguísticas ou de ano de publicação. Seguindo os critérios de elegibilidade, foram incluídos estudos do tipo ensaio clínico randomizado ou quase randomizado.
Resultados:
Foram encontrados 1190 artigos, sendo incluídos 18 para a coleta dos dados, os quais tinham como amostra uma média de 16 a 120 participantes, sendo esses idosos de 62 a 85 anos e de ambos os sexos.
Conclusão:
A prática regular de yoga promove benefícios sobre a qualidade de vida e capacidade físico-funcional de idosos que contribuem para a prevenção de quedas. No entanto as evidências ainda são limitadas e sugerem-se novos estudos para melhor elucidação da abrangência dos efeitos do yoga como recurso terapêutico.
Palavras-chave:
Acidentes por quedas; Envelhecimento; Envelhecimento saudável; Yoga
Introduction
Population aging occurs due to increased longevity, resulting from a decline in mortality and consequently a longer lifespan.11 Bueno LS, Araújo RA, Oliveira MAF. Efeitos da prática do Yoga no medo de cair e mobilidade de idosos caidores. Revisa. 2019;8(4):382-93. DOI
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Aging is a natural and unavoidable process involving several physiological and immunological changes, as well as limitations in the activities of daily living and restricted mobility and functional capacity caused by intrinsic and extrinsic factors.22 Teixeira DKS, Andrade LM, Santos JLP, Caires ES. Quedas em pessoas idosas: restrições do ambiente doméstico e perdas funcionais. Rev Bras Geriatr e Gerontol. 2019;22(3):e180229. DOI
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In addition to sedentary behavior and the presence of uncompensated chronic comorbidities, the process accelerates, directly affecting the quality of life of older adults.33 Alves AS, Baptista MR, Dantas EHM. Os efeitos da prática do yoga sobre a capacidade física e autonomia funcional em idosas. Fit Perf J. 2006;5(4):243-9. Full text link
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Studies have demonstrated the importance of healthy habits in older people, emphasizing physical activity or mobility as a strategy for better quality of life and delaying physical degeneration.44 Rodrigues BGS, Cader SA, Torres NVOB, Oliveira EM, Dantas EHM. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodyw Mov Ther. 2010;14(2):195-202. DOI
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Physical activity is indispensable to physical and mental health, primarily for older persons. World Health Organization recommendations for older people (65 years or older) include aerobic components, muscle strengthening and balance.55 World Health Organization. Global recommendations on physical activity for health. Genebra: WHO; 2010. Full text link
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Although the percentage of elderly that meet these recommendations remains low, several studies have shown the benefits of regular exercise.55 World Health Organization. Global recommendations on physical activity for health. Genebra: WHO; 2010. Full text link
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6 Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, et al. Global physical activity levels: Surveillance progress, pitfalls, and prospects. Lancet. 2012;380(9838):247-57. DOI
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-77 Camboim FEF, Nóbrega MO, Davim RMB, Camboim JCA, Nunes RMV, Oliveira SX. Benefícios da atividade física na terceira idade para a qualidade de vida. Rev Enferm UFPE. 2017;11(6):2415-22. Full text link
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The data show that exercise improves functional status, increases muscle strength and postural stability, and reduces the risk of falls, a common occurrence in this age range. Accidental falls may contribute to greater functional incapacity, causing a decline in autonomy, physical performance and functional independence.77 Camboim FEF, Nóbrega MO, Davim RMB, Camboim JCA, Nunes RMV, Oliveira SX. Benefícios da atividade física na terceira idade para a qualidade de vida. Rev Enferm UFPE. 2017;11(6):2415-22. Full text link
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,88 Gasparotto LPR, Falsarella GR, Coimbra AMV. As quedas no cenário da velhice: conceitos básicos e atualidades da pesquisa em saúde. Rev Bras Geriatr e Gerontol. 2014;17(1):201-9. DOI
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In addition, functional group exercises are effective in minimizing depressive symptoms and social isolation and enhancing quality of life in older adults.99 Pinheiro HA, Cerceau VR, Pereira LC, Funghetto SS, Menezes RL. Nutritional intervention and functional exercises improve depression, loneliness and quality of life in elderly women with sarcopenia: a randomized clinical trial. Fisioter Mov. 2020;33: e003332. DOI
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Among the various physical activities, yoga is one of the most suitable and indicated for the older population due to its form of execution. Yoga is characterized as an easy-to-practice, low-impact, low-to-moderate-intensity exercise that increases independence.1010 Yao CT, Tseng CH. Effectiveness of Chair Yoga for improving the functional fitness and well-being of female community-dwelling older adults with low physical activities. Top Geriatr Rehabil. 2019;35(4):248-54. DOI
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The involvement of older adults in yoga provides a number of benefits, such as postural rehabilitation, respiratory awareness, muscle strengthening and relaxation, homeostasis, mental relaxation and emotional improvement, producing effects including the control of chronic diseases.1111 Aquini SN. O Yoga e o idoso: rumo ao alto da montanha: os efeitos da prática de yoga de acordo com a percepção de idosos [dissertação]. Florianópolis: Universidade Federal de Santa Catarina; 2010. 236 p. Full text link
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Studies show that the functional state of older people who practice yoga is 3.27 times greater than that of those who do not.1010 Yao CT, Tseng CH. Effectiveness of Chair Yoga for improving the functional fitness and well-being of female community-dwelling older adults with low physical activities. Top Geriatr Rehabil. 2019;35(4):248-54. DOI
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,1111 Aquini SN. O Yoga e o idoso: rumo ao alto da montanha: os efeitos da prática de yoga de acordo com a percepção de idosos [dissertação]. Florianópolis: Universidade Federal de Santa Catarina; 2010. 236 p. Full text link
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Significant improvements were found in muscle strength, agility, static and dynamic balance, all of which contribute to fall prevention.1212 Kertapati Y, Sahar J, Nursasi AY. The effects of chair yoga with spiritual intervention on the functional status of older adults. Enferm Clin. 2018;28(Supl 1):70-3. DOI
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Moreover, these benefits are maintained even when yoga is adapted, such as chair yoga.1212 Kertapati Y, Sahar J, Nursasi AY. The effects of chair yoga with spiritual intervention on the functional status of older adults. Enferm Clin. 2018;28(Supl 1):70-3. DOI
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Age does not impede yoga practice, as observed in a study with older women (average age = 84 years), where yoga improved physical aptitude scores, reduced stress levels and enhanced well-being.1313 Furtado GE, Uba-Chupel M, Carvalho HM, Souza NR, Ferreira JP, Teixeira AM. Effects of a chair-yoga exercises on stress hormone levels, daily life activities, falls and physical fitness in institutionalized older adults. Complement Ther Clin Pract. 2016;24:123-9. DOI
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Thus, yoga can be a therapeutic resource for this population, since it can be adapted to the individual characteristics of each person, thereby meeting their needs.
In this respect, several studies11 Bueno LS, Araújo RA, Oliveira MAF. Efeitos da prática do Yoga no medo de cair e mobilidade de idosos caidores. Revisa. 2019;8(4):382-93. DOI
DOI...
,33 Alves AS, Baptista MR, Dantas EHM. Os efeitos da prática do yoga sobre a capacidade física e autonomia funcional em idosas. Fit Perf J. 2006;5(4):243-9. Full text link
Full text link...
,1111 Aquini SN. O Yoga e o idoso: rumo ao alto da montanha: os efeitos da prática de yoga de acordo com a percepção de idosos [dissertação]. Florianópolis: Universidade Federal de Santa Catarina; 2010. 236 p. Full text link
Full text link...
,1212 Kertapati Y, Sahar J, Nursasi AY. The effects of chair yoga with spiritual intervention on the functional status of older adults. Enferm Clin. 2018;28(Supl 1):70-3. DOI
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have included yoga as a preventive therapeutic technique, demonstrating its various benefits for older people, but there is still no consensus on the issue. The aim of this study was to synthesize the existing evidence on the effects of yoga on quality of life and physical-functional capacity that may contribute to preventing falls in older adults.
Methods
This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Collaboration recommendations.1414 Moher D, Liberati A, Tetzlaff J, Altman DG. Reprint - preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89(9):873-80. PubMed
PubMed...
,1515 Higgins JPT, Altman DG. Assessing risk of bias in included studies. In: Higgins JPT, Green S, editores. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Hoboken, NJ: Wiley-Blackwell; 2008. p. 187-241. DOI
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The protocol is registered at PROSPERO (CRD42020213140).
Search strategy
The following electronic databases were used as research sources: Medical Literature Analysis and Retrieval System Online (Medline/Pubmed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), SCOPUS, Web of Science and Physiotherapy Evidence Database (PEDro), with no language or year of publication restrictions. The search was conducted in August 2020 using keywords related to “yoga” and “older adults” along with the Boolean operators AND or OR, as follows:
Medline/PubMed: ((((((Yoga[MeSH Terms]) AND (((Elderly[MeSH Terms]) OR Aged[MeSH Terms]) OR older adult)) AND ((((((((((((((physical aptitude) OR physical function) OR personal autonomy[MeSH Terms]) OR healthy aging[MeSH Terms]) OR quality of life[MeSH Terms]) OR welfare) OR well-being) OR mobility) OR functionality) OR gait[MeSH Terms]) OR postural balance[MeSH Terms]) OR accidental falls[MeSH Terms]) OR biorhythm) OR active aging).
LILACS: Ioga/yoga AND; Envelhecimento/Aging; Envelhecimento saudável/ HealthyAging.
SCOPUS: ALL ("Yoga") AND ALL ("Elderly" OR "Aged" OR "older adult") AND ALL ("physical aptitude" OR "physical function" OR "personal autonomy" OR "healthy aging" OR "quality of life" OR "welfare" OR "well-being" OR "mobility" OR "functionality" OR "gait" OR "postural balance" OR "accidental falls" OR "biorhythm" OR "active aging") AND NOT (review).
Web of Science: TS = (Yoga) AND TS = (Elderly OR Aged OR older adult) AND TS = (physical aptitude OR physical function OR personal autonomy OR healthy aging OR quality of life OR welfare OR well-being OR mobility OR functionality OR gait OR postural balance OR accidental falls OR biorhythm OR active aging).
PEDro: “Yoga” and “Elderly”.
The articles that met the eligibility criteria were included. Screening was carried out by reading the title and abstract after irrelevant and duplicate studies were excluded. Eligible articles were read in their entirety to select those included in this review. In addition, the refence lists of these articles were examined by two independent reviewers and the relevant studies therein selected for data collection. Any disagreement was resolved by discussion and consensus between them and when necessary, a third reviewer intermediated.
Eligibility criteria
The following inclusion criteria were established:
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1 - Participants: community-dwelling older adults (aged 60 years or older) of both sexes or those in long-stay institutions;
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2 - Intervention: studies that used yoga as therapy for older people compared to a control group with no exercise intervention, in usual treatment or undergoing health education;
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3 - Outcomes: studies that reported the effect of yoga on quality of life, fall prevention or physical function of older people;
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4 - Study type: randomized or semi-randomized clinical trial. Excluded were systematic reviews, literature reviews, incomplete articles, incomplete data that preclude replication, studies that used therapeutic interventions associated with yoga or those in which participants were engaged in other regular physical activities before the trial. Disagreements were discussed between the authors responsible for data collection or resolved by a third author.
Data extraction
Pairs of reviewers extracted the data independently using a standard Microsoft Office Excel 2013 form containing the following details: first author’s name and year of publication; study design; population description and sample size; control group description; intervention description; description of results and statistical comparisons between groups. Disagreements were resolved by a third reviewer. In case of missing data, the authors were contacted to acquire additional information.
Assessment of methodological quality
Risk of bias was assessed using the Cochrane risk-of-bias tool.1515 Higgins JPT, Altman DG. Assessing risk of bias in included studies. In: Higgins JPT, Green S, editores. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Hoboken, NJ: Wiley-Blackwell; 2008. p. 187-241. DOI
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The following domains were evaluated: random sequence generation (selection bias); allocation concealment (selection bias); participant and personal blinding (performance bias); masking of result assessment (detection bias); incomplete data results (attrition bias); selective result reports (reporting bias); and other biases. Each of these domains contain questions related to the study design, with the responses “yes”, indicating low risk of bias; “no”, for high risk of bias; and "confused", if incomplete details were reported to adequately assess risk of bias. This process was conducted independently by two researchers and discrepancies resolved after discussion between them or by a third author. The Review Manager Software Package 5.3 (RevMan v.5.3) was used to create the figure and risk of bias graph of the studies included.
Results
The database search identified 1,187 articles, and three more in the references of the studies included, for a total of 1,190 articles. Of these, 1,129 were excluded according to the criteria of eligibility and duplication, leaving 61 eligible articles for complete reading. Eighteen of these were included in the present review, as presented in Figure 1.
Study characteristics
The characteristics of individual studies are described in Table 1. Included were studies with 16 to 20 participants of both sexes, aged between 62 and 85 years, but some involved only wome1616 Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, et al. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med. 2017;12:44-52. DOI
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or men.1717 Patil SG, Patil SS, Aithala MR, Das KK. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017;69(4):485-90. DOI
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The comorbidities exhibited by the older subjects were different and frequently included osteoarthritis,1818 Cheung C, Wyman JF, Bronas U, McCarthy T, Rudser K, Mathiason MA. Managing knee osteoarthritis with yoga or aerobic/ strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int. 2017;37(3):389-98. DOI
DOI ...
19 Cheung C, Wyman JF, Resnick B, Savik K. Yoga for managing knee osteoarthritis in older women: a pilot randomized con-trolled trial. BMC Complement Altern Med. 2014;14:160. DOI
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-2020 Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-Speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7-8):604-26. DOI
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hypertension1717 Patil SG, Patil SS, Aithala MR, Das KK. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017;69(4):485-90. DOI
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and thoracic hyperkyphosis,2121 Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-79. DOI
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as well as healthy individuals.2121 Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-79. DOI
DOI...
,2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
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TAll the studies included community-dwelling older people, except one that assessed long-stay institutions.16
The yoga intervention protocol was applied between 8 and 28 weeks. Different types were used, highlighting Hatha yoga,1818 Cheung C, Wyman JF, Bronas U, McCarthy T, Rudser K, Mathiason MA. Managing knee osteoarthritis with yoga or aerobic/ strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int. 2017;37(3):389-98. DOI
DOI ...
,1919 Cheung C, Wyman JF, Resnick B, Savik K. Yoga for managing knee osteoarthritis in older women: a pilot randomized con-trolled trial. BMC Complement Altern Med. 2014;14:160. DOI
DOI...
,2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
,2525 Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, et al. Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers. Arch Phys Med Rehabil. 2014;95(9):1620-8.e30. DOI
DOI...
Yengar yoga2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
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and Chair yoga.1616 Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, et al. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med. 2017;12:44-52. DOI
DOI...
,2020 Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-Speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7-8):604-26. DOI
DOI...
,2626 Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
DOI...
As expected, pranayama1717 Patil SG, Patil SS, Aithala MR, Das KK. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017;69(4):485-90. DOI
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,2323 Kaminsky DA, Guntupalli KK, Lippmann J, Burns SM, Brock MA, Skelly J, et al. Effect of yoga breathing (Pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: A randomized, controlled trial. J Altern Complement Med. 2017;23(9):696-704. DOI
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,2626 Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
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and dasasanas33 Alves AS, Baptista MR, Dantas EHM. Os efeitos da prática do yoga sobre a capacidade física e autonomia funcional em idosas. Fit Perf J. 2006;5(4):243-9. Full text link
Full text link...
,1717 Patil SG, Patil SS, Aithala MR, Das KK. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017;69(4):485-90. DOI
DOI...
,2121 Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-79. DOI
DOI...
were frequent among the different yoga modalities. With respect to sessions, most of the cases were weekly, alternating between two and three weeks.1616 Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, et al. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med. 2017;12:44-52. DOI
DOI...
,2020 Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-Speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7-8):604-26. DOI
DOI...
,2121 Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-79. DOI
DOI...
,2424 Nick N, Petramfar P, Ghodsbin F, Keshavarzi S, Jahanbin I. The effect of yoga on balance and fear of falling in older adults. PM R. 2016;8(2):145-51. DOI
DOI...
,2626 Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
DOI...
,2828 Gothe NP, Kramer AF, McAuley E. The effects of an 8-week Hatha yoga intervention on executive function in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(9):1109-16. DOI
DOI...
However, one study performed them once a day for a month.2929 Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3):S364-8. PubMed
PubMed...
The authors decided to conduct assessments before and after the intervention period and supervised at other times during this period.16,22,25,27,29
A summary of the protocols used in the studies based on the main yoga modalities is presented in Table 2.
Main results
Quality of life
Quality of life was assessed specifically using the World Health Organization Quality of Life (WHOQOL) - BREF questionnaire, in which improvement was obtained after yoga intervention.2929 Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3):S364-8. PubMed
PubMed...
The studies also observed better emotional well-being in the WHO-5,1616 Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, et al. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med. 2017;12:44-52. DOI
DOI...
mental well-being,3030 Tew GA, Howsam J, Hardy M, Bissell L. Adapted yoga to improve physical function and health-related quality of life in physically-inactive older adults: a randomised controlled pilot trial. BMC Geriatr. 2017;17(1):131. DOI
DOI...
visual, working and verbal memory,2727 Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M, et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry. 2013;55(Suppl 3):S357-63. PubMed
PubMed...
as well as reduced anxiety2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
and fear of falling.1919 Cheung C, Wyman JF, Resnick B, Savik K. Yoga for managing knee osteoarthritis in older women: a pilot randomized con-trolled trial. BMC Complement Altern Med. 2014;14:160. DOI
DOI...
Physical-functional capacity and prevention of accidental falls
Studies that applied yoga as an intervention tool exhibited improved balance, mobility, gait and postural control. Two studies assessed balance and postural control using the Berg Balance Scale (BBS), achieving favorable results.2525 Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, et al. Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers. Arch Phys Med Rehabil. 2014;95(9):1620-8.e30. DOI
DOI...
,3131 Zettergren KK, Lubeski JM, Viverito JM. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study. J Geriatr Phys Ther. 2011;34(2):88-94. DOI
DOI...
One study revealed physical performance benefits, assessed by the Short Physical Performance Battery (SPPB), Sit-To-Stand Test and the Back Scratch Test.3030 Tew GA, Howsam J, Hardy M, Bissell L. Adapted yoga to improve physical function and health-related quality of life in physically-inactive older adults: a randomised controlled pilot trial. BMC Geriatr. 2017;17(1):131. DOI
DOI...
Mobility and gait speed improved, as evaluated by the Timed Up and Go test.3131 Zettergren KK, Lubeski JM, Viverito JM. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study. J Geriatr Phys Ther. 2011;34(2):88-94. DOI
DOI...
Risk of bias
The methodology of the studies was assessed using the Cochrane risk-of-bias tool.1515 Higgins JPT, Altman DG. Assessing risk of bias in included studies. In: Higgins JPT, Green S, editores. Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Hoboken, NJ: Wiley-Blackwell; 2008. p. 187-241. DOI
DOI...
Of the 18 studies included in this review, five did not randomize correctly or describe their process33 Alves AS, Baptista MR, Dantas EHM. Os efeitos da prática do yoga sobre a capacidade física e autonomia funcional em idosas. Fit Perf J. 2006;5(4):243-9. Full text link
Full text link...
,2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
,2424 Nick N, Petramfar P, Ghodsbin F, Keshavarzi S, Jahanbin I. The effect of yoga on balance and fear of falling in older adults. PM R. 2016;8(2):145-51. DOI
DOI...
,2828 Gothe NP, Kramer AF, McAuley E. The effects of an 8-week Hatha yoga intervention on executive function in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(9):1109-16. DOI
DOI...
,3131 Zettergren KK, Lubeski JM, Viverito JM. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study. J Geriatr Phys Ther. 2011;34(2):88-94. DOI
DOI...
and many did not use allocation concealment, participant or outcome assessment blinding.1717 Patil SG, Patil SS, Aithala MR, Das KK. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017;69(4):485-90. DOI
DOI...
,2121 Greendale GA, Huang MH, Karlamangla AS, Seeger L, Crawford S. Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: Results of a randomized controlled trial. J Am Geriatr Soc. 2009;57(9):1569-79. DOI
DOI...
22 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
23 Kaminsky DA, Guntupalli KK, Lippmann J, Burns SM, Brock MA, Skelly J, et al. Effect of yoga breathing (Pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: A randomized, controlled trial. J Altern Complement Med. 2017;23(9):696-704. DOI
DOI...
24 Nick N, Petramfar P, Ghodsbin F, Keshavarzi S, Jahanbin I. The effect of yoga on balance and fear of falling in older adults. PM R. 2016;8(2):145-51. DOI
DOI...
-2525 Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, et al. Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers. Arch Phys Med Rehabil. 2014;95(9):1620-8.e30. DOI
DOI...
,2727 Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M, et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry. 2013;55(Suppl 3):S357-63. PubMed
PubMed...
28 Gothe NP, Kramer AF, McAuley E. The effects of an 8-week Hatha yoga intervention on executive function in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(9):1109-16. DOI
DOI...
29 Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3):S364-8. PubMed
PubMed...
30 Tew GA, Howsam J, Hardy M, Bissell L. Adapted yoga to improve physical function and health-related quality of life in physically-inactive older adults: a randomised controlled pilot trial. BMC Geriatr. 2017;17(1):131. DOI
DOI...
31 Zettergren KK, Lubeski JM, Viverito JM. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study. J Geriatr Phys Ther. 2011;34(2):88-94. DOI
DOI...
-3232 Santaella DF, Devesa CRS, Rojo MR, Amato MBP, Drager LF, Casali KR, et al. Yoga respiratory training improves respiratory function and cardiac sympathovagal balance in elderly subjects: a randomised controlled trial. BMJ Open. 2011;1(1):e000085. DOI
DOI...
Incomplete results or selective outcome reporting and other biases were not found in any of the studies included. These data are presented in Figure 2, which shows a synthesis of individual articles, and Figure 3, a risk of bias graph that demonstrates the risk of bias of the studies included in percentage.
Summary of the risk of bias of the studies included, according to the authors’ judgements of each risk of bias item for each article included.
Risk of bias graph: analysis of the authors’ judgements on each risk of bias item, presented as percentages in all the studies included.
Discussion
The present systematic review showed the benefits of yoga for older adults. The studies demonstrated improvement in quality of life, analyzed via emotional well-being, reduced anxiety and a decline in stress. In addition, benefits for physicofunctional capacity and consequent fall prevention were related to decreased muscle fatigue and pain, enhanced gait performance, balance, attention, executive and psychomotor function.
When older adults have a sedentary lifestyle, yoga provides them with a daily activity and an excellent hobby. Older people feel more active and independent with daily yoga practice, given that it is a way to improve focus, quality of life, sleep quality, executive and psychomotor function.2727 Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M, et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry. 2013;55(Suppl 3):S357-63. PubMed
PubMed...
,2929 Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3):S364-8. PubMed
PubMed...
Among institutionalized older adults, yoga twice or three times a week improved emotional well-being, since individuals who live in long-stay institutions are more socially inactive and debilitated than their community-dwelling counterparts.1616 Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, et al. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med. 2017;12:44-52. DOI
DOI...
,3333 Fluetti MT, Fhon JRS, Oliveira AP, Chiquito LMO, Marques S. The frailty syndrome in institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2018;21(1):60-9. DOI
DOI...
Intervention, therefore, has numerous physical and psychological benefits.
Studies reveal that holistic practices such as yoga, and concomitantly meditation, contribute to enhancing perceived psychological well-being and quality of life, as observed in the present review.1616 Marques M, Chupel MU, Furtado GE, Minuzzi LG, Rosado F, Pedrosa F, et al. Influence of chair-based yoga on salivary anti-microbial proteins, functional fitness, perceived stress and well-being in older women: A pilot randomized controlled trial. Eur J Integr Med. 2017;12:44-52. DOI
DOI...
,2020 Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-Speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7-8):604-26. DOI
DOI...
,2626 Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
DOI...
,2727 Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M, et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry. 2013;55(Suppl 3):S357-63. PubMed
PubMed...
,2929 Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3):S364-8. PubMed
PubMed...
AlIn addition to the repercussions for physical and mental wellness related to emotional and self-care aspects, yoga had a positive influence on mood states, including depression, stress and fatigue, resulting in more vigor and less irritability in older adults.2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
In addition, given that stress influences health maintenance and quality of life, physical activity and yoga are effective at improving cognitive status and emotional balance, reducing psychophysical apathy and the physical and emotional symptoms of stress, as well as increasing assertiveness, and affectivity and self-control of anxiety.33 Alves AS, Baptista MR, Dantas EHM. Os efeitos da prática do yoga sobre a capacidade física e autonomia funcional em idosas. Fit Perf J. 2006;5(4):243-9. Full text link
Full text link...
As an ancient technique disseminated around the world, yoga is based on performing harmonic conscious body movements in order to maintain proprioceptive and respiratory control in the individual, and shows great potential in contributing to several physiological systems, such as the visual,2727 Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M, et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry. 2013;55(Suppl 3):S357-63. PubMed
PubMed...
in addition to enabling an increase or stabilization of physical function, reducing falls and the fear of falling in older persons. Yoga contributes to recovering musculoskeletal disorders that interfere in the independence of older adults,3434 Tüzün S, Aktas I, Akarirmak Ü, Sipahi S, Tüzün F. Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis. Eur J Phys Rehabil Med. 2010;46(1):69-72. Full text link
Full text link...
and improves muscle fatigue,2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
musculoskeletal pain,1919 Cheung C, Wyman JF, Resnick B, Savik K. Yoga for managing knee osteoarthritis in older women: a pilot randomized con-trolled trial. BMC Complement Altern Med. 2014;14:160. DOI
DOI...
,2020 Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-Speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7-8):604-26. DOI
DOI...
,2626 Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
DOI...
and static and dynamic balance.2020 Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-Speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7-8):604-26. DOI
DOI...
,2626 Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
DOI...
Yoga enhances postural balance by increasing flexibility, strength, hip range of motion and stride length, in addition to decreasing anterior pelvic tilt, variables that are important in postural control and its reflexes.11 Bueno LS, Araújo RA, Oliveira MAF. Efeitos da prática do Yoga no medo de cair e mobilidade de idosos caidores. Revisa. 2019;8(4):382-93. DOI
DOI...
The osteomyoarticular outcomes obtained corroborated the reduced fear of falling observed in two studies.1818 Cheung C, Wyman JF, Bronas U, McCarthy T, Rudser K, Mathiason MA. Managing knee osteoarthritis with yoga or aerobic/ strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int. 2017;37(3):389-98. DOI
DOI ...
,2525 Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, et al. Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers. Arch Phys Med Rehabil. 2014;95(9):1620-8.e30. DOI
DOI...
When practiced regularly, the resulting benefits of this intervention help decrease immobilization and isolation, leading older adults to a feeling of personal fulfillment.
Yoga clearly has a direct and indirect positive influence on the quality of life of older persons in terms of psychological and physical health, given that it is capable of maintaining and increasing mobility and resistance at different moments, contributing to the functional autonomy of these individuals during their activities of daily living.1010 Yao CT, Tseng CH. Effectiveness of Chair Yoga for improving the functional fitness and well-being of female community-dwelling older adults with low physical activities. Top Geriatr Rehabil. 2019;35(4):248-54. DOI
DOI...
,1313 Furtado GE, Uba-Chupel M, Carvalho HM, Souza NR, Ferreira JP, Teixeira AM. Effects of a chair-yoga exercises on stress hormone levels, daily life activities, falls and physical fitness in institutionalized older adults. Complement Ther Clin Pract. 2016;24:123-9. DOI
DOI...
,2222 Flegal KE, Kishiyama S, Zajdel D, Haas M, Oken BS. Adherence to yoga and exercise interventions in a 6-month clinical trial. BMC Complement Altern Med. 2007;7:37. DOI
DOI...
,2828 Gothe NP, Kramer AF, McAuley E. The effects of an 8-week Hatha yoga intervention on executive function in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(9):1109-16. DOI
DOI...
However, the benefits of this exercise modality is not only limited to these areas. One study confirmed that practicing yoga for three months significantly improves diastolic function, thereby strengthening cardiac capacity.1717 Patil SG, Patil SS, Aithala MR, Das KK. Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017;69(4):485-90. DOI
DOI...
In another article, yoga intervention improved working memory (task execution), demonstrating that outcomes such as these also influence the overall well-being of older people.2828 Gothe NP, Kramer AF, McAuley E. The effects of an 8-week Hatha yoga intervention on executive function in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(9):1109-16. DOI
DOI...
However, more studies are needed on this issue, since some approaches limit the results obtained. In the present review, the studies included were heterogeneous, from the discrepancy among the intervention protocols to the outcome assessment methods. For this reason, a descriptive synthesis was conducted, since statistical data analysis was not possible. The studies do not describe how long the effects of yoga lasted, that is, the long-term benefits remain unknown. The cost-effectiveness and yoga safety protocols adopted in the studies also require further elucidation. In addition, there is a need to know the repercussions of yoga for older adults living in long-stay institutions (LSIs), since the studies included in this review involve primarily community-dwelling individuals, considering the limited evidence regarding the benefits for this population.
The evidence quality of the studies was moderate. Some articles did not conduct proper randomization and blinding, which may have influenced the accuracy of their results. Some did not describe the randomization process, which might have caused selection bias. Moreover, information bias may also be present in studies that did not blind participants. On the other hand, this could be explained by the form of yoga intervention, which hinders blinding, given that specific body activities are used that preclude effectively forming a placebo group, which is a further limitation of the studies. Nevertheless, the present review demonstrated that yoga improves quality of life and physical function, thereby contributing to preventing falls in older adults.
Conclusion
As such, the regular practice of different yoga modalities produces significant benefits for the older population, indicating an improvement in quality of life and physical-functional capacity, favoring fall prevention. However, the evidence remains limited and we suggest new studies on older persons living in long-stay institutions and that the long-term effects of yoga intervention be monitored to better understand its benefits as a therapeutic resource.
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» DOI -
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» DOI -
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» DOI -
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» DOI -
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» DOI -
26Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592-7. DOI
» DOI -
27Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M, et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry. 2013;55(Suppl 3):S357-63. PubMed
» PubMed -
28Gothe NP, Kramer AF, McAuley E. The effects of an 8-week Hatha yoga intervention on executive function in older adults. J Gerontol A Biol Sci Med Sci. 2014;69(9):1109-16. DOI
» DOI -
29Hariprasad VR, Sivakumar PT, Koparde V, Varambally S, Thirthalli J, Varghese M, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. Indian J Psychiatry. 2013;55(Suppl 3):S364-8. PubMed
» PubMed -
30Tew GA, Howsam J, Hardy M, Bissell L. Adapted yoga to improve physical function and health-related quality of life in physically-inactive older adults: a randomised controlled pilot trial. BMC Geriatr. 2017;17(1):131. DOI
» DOI -
31Zettergren KK, Lubeski JM, Viverito JM. Effects of a yoga program on postural control, mobility, and gait speed in community-living older adults: a pilot study. J Geriatr Phys Ther. 2011;34(2):88-94. DOI
» DOI -
32Santaella DF, Devesa CRS, Rojo MR, Amato MBP, Drager LF, Casali KR, et al. Yoga respiratory training improves respiratory function and cardiac sympathovagal balance in elderly subjects: a randomised controlled trial. BMJ Open. 2011;1(1):e000085. DOI
» DOI -
33Fluetti MT, Fhon JRS, Oliveira AP, Chiquito LMO, Marques S. The frailty syndrome in institutionalized elderly persons. Rev Bras Geriatr Gerontol. 2018;21(1):60-9. DOI
» DOI -
34Tüzün S, Aktas I, Akarirmak Ü, Sipahi S, Tüzün F. Yoga might be an alternative training for the quality of life and balance in postmenopausal osteoporosis. Eur J Phys Rehabil Med. 2010;46(1):69-72. Full text link
» Full text link
Edited by
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Publication Dates
-
Publication in this collection
25 Mar 2022 -
Date of issue
2022
History
-
Received
18 Dec 2020 -
Reviewed
09 Nov 2021 -
Accepted
09 Nov 2021