“Using technology developed for sports medicine, Salem is investigating how older adults use their muscles and joints in certain yoga postures. Although his NCCAM-funded study was small (early phase 2), it yielded findings useful for both the clinician and physical therapist.
It will also help investigators like Salem develop a program for a randomized controlled trial.
A mind-body practice with origins in Indian philosophy, yoga comes in many forms. Yet although it’s touted as a “total solution exercise” that balances flexibility and strength, there’s actually very little data on its usefulness in healthy seniors, Salem said.
|Salem hopes to see yoga incorporated into physical therapy. “You might only get 12 PT visits,” he said. “What’s the patient going to do then? We’d like to work with groups to develop safe and effective programs that people can transition into when they come out of PT.”
He focused on the type of yoga most widely practiced in the West: hatha yoga, with its gently flowing movements, breathing exercises and meditation. This ancient Eastern practice met Salem’s two Western specialties—kinesiology, the study of human movement, and biomechanics, a sub-discipline that applies principles of mechanics and engineering to analyze human motion.
“We tried to be true to yoga, which has a spiritual element, but we are just talking about the physical demands,” he said. “Before we can prescribe an intervention, we need to know the physical demands associated with it.”
None of the research volunteers had any prior exposure to yoga; all were medically screened. All were enrolled in a 32-week pre-post intervention study of two specified series of hatha yoga postures. The classes were delivered 2 days per week, 1 hour per session. The intervention consisted of two sets of postures, series I and series II, designed to be progressive (i.e., to advance in difficulty) and to train major muscle groups that are integral to conducting activities of daily living.
Then, at 16 and 32 weeks, with the help of an experienced yoga instructor, they were guided through a warm-up and each series of poses or asanas (AH-sun-as—typically named for natural elements and animals e.g., the Tree, the Cobra, the Dog) while fitted with instrumentation for motion analysis.
High-speed cameras on the room’s periphery captured movement data and sent it to a computer. There, technicians using unique modeling software created a virtual skeleton that is used to identify the forces, joint torques and muscle activations required to perform each pose.
All poses and movements were performed on force plates, which measure data during standing, stepping and so on, to quantify balance, gait and other parameters of biomechanics.
Of 22 subjects with an average age of 71 years, 20 completed the 32-week study. Highlights included:
- Muscular endurance in a step test improved 15 percent; in a heel rise (up on toes), improvement was 33 percent.
- In this group, yoga did not significantly improve balance.
- 68 percent of participants reported some type of pain following one or more of the yoga classes; shoulder pain was the most frequently reported problem. So that subjects could remain in the program, poses were modified; some modifications have distinct clinical applications.
- The study focused on static postures, but transitions are also important. The sequencing of the poses may thus be critical in reducing risk to older adults.
Salem’s vision for the future? To see yoga incorporated into physical therapy.
“You might only get 12 PT visits,” he said. “What’s the patient going to do then? We’d like to work with groups to develop safe and effective programs that people can transition into when they come out of PT.
“And why have we been slow to integrate CAM modalities into standard PT practice?” he continued. “CAM integrated with PT is not currently being reimbursed. Until we provide the evidence for that, it’s not going to be reimbursed.”
During Q&A, Stephanie Dailey of NIA asked: “Do you report any positive experiences, anecdotally?”
“We had self-report quality-of-life measures,” Salem said, “but we didn’t see any improvement. You know why? They were robust to begin with, so we had a ceiling effect. All of them reported that they loved it; there were times we had to ask people to take a day off because of soreness, but they would say, ‘No, please let me come in.’ So we would tailor the program specifically to their problem.”
Yoga is popular; a YouTube search for “yoga for beginners” yields over 3.5 million hits. But what you may find online, in DVDs or in popular magazines—slim young models, sometimes in extreme poses—may not be right for seniors.
For Salem’s safe and effective yoga prescription for older adults, the biomechanical considerations are the ones to watch.
The lecture is archived at http://videocast.nih.gov/.