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September/October 2023
Arthritis: Chair Yoga for Older Adults The benefits of yoga have been widely publicized. But, the term yoga encompasses a variety of different styles that vary in difficulty and intensity. Recommending that an older adult “do yoga” may lead them to a style that’s inappropriate for their fitness level and medical conditions, resulting in subsequent injuries and a negative perception of yoga. Even classes labeled as “basic,” “gentle,” or “appropriate for all levels” may include poses and movements that are challenging or dangerous for many older adults. These slower paced yoga classes also require being able to get down and up from a mat on the floor, sometimes multiple times during a class. Many older adults, especially those with osteoarthritis and other chronic pain or joint conditions, cannot easily transition from standing to seated floor poses without substantial effort, pain, and/or assistance. Chair yoga is a safer alternative for these and many other older adults and can be performed even by those with significant movement limitations, wheelchairs, or walkers. In chair yoga, traditional yoga poses are adapted and performed standing while using the chair for support or while seated in the chair. Meditation, relaxation, and breathing exercises traditionally performed while lying supine or seated on the floor in a cross-legged position are also performed while seated in a chair. Benefits attributed to traditional yoga, including improved flexibility, mobility, and balance, can all be achieved with a properly structured chair yoga session. Published evidence supporting the benefits of chair yoga is not as large as that for other types of yoga. However, chair-based exercise, in general, has been proven to be safe and effective in the older adult population.1-3 In fact, use of chairs for support during exercise is the foundation for the popular nationwide Silver Sneakers older adult exercise program, which includes a chair-based yoga program. In a 2022 large systematic review analyzing the benefits of chair yoga in older adults, researchers reviewed 75 studies, including 32 randomized controlled trials (RCTs), with a total of 2,964 older adults.4 Included studies compared chair yoga with control activities (education, no yoga, or continued usual nonyoga activity), other chair exercises, resistance training, Reiki, or tai chi. Participant ages ranged from 50 to older than 80 years. The reviewed studies included independent community-dwelling individuals, as well as those in nursing homes or older adult residential settings. A few reviewed studies included healthy older adults, but generally, study participants had at least one medical condition, such as osteoarthritis, osteopenia, cardiopulmonary issues, neurologic disorders, cognitive impairment, cancer, chronic pain, and/or history of falls. Chair yoga interventions included weekly sessions ranging from 15 to more than 60 minutes practiced daily (shorter sessions) or two to three times weekly, usually for eight to 12 weeks; a few studies included home-based chair yoga. In addition to physical poses, most study chair yoga also included meditation and breathing exercises. The researchers found that chair yoga positively affected psychomotor, emotional/mood, and cognitive functioning.4 Additional selected research studies published in the last 10 years demonstrating the benefits of chair yoga in the geriatric population include the following: • A 2023 systematic review of 33 RCTs with 2,384 older adults, including those in nursing homes and those with chronic disease, evaluated the effect of yoga on frailty. Chair yoga and gentle yoga with props improved gait speed, lower limb strength and endurance, and balance. However, chair yoga was not compared with other exercise.5 • In a 2022 focus group study of eight weeks of twice weekly online remotely led yoga in eight older adults with dementia and their caregivers, chair yoga improved sleep, emotional regulation, and physical functioning.6 • In a 2022 randomized study of 500 older adults in their 70s who did 30 minutes of daily chair yoga for four weeks or participated in their usual daily programs at nursing homes or older adult centers, chair yoga improved static, dynamic, and overall balance, as well as psychosocial health measures (calmness, anxiety, depression).7 • In a 2019 RCT of 31 older women with low physical activity who did twice weekly chair yoga for 12 weeks or maintained usual activities (control), chair yoga significantly improved handgrip strength, static and dynamic balance, and muscle strength.8 • A 2017 RCT involved 52 older adults with a mean age of 75 years who received a physical activity education booklet and 10 chair yoga sessions over three months or only the education booklet (control group). Participants in the yoga group showed improvements in overall physical functioning, sitting-to-standing time, and lower limb flexibility. Yoga participants also scored higher on mental well-being tests.9 • A 2017 RCT in 131 community-dwelling older adults with lower extremity osteoarthritis who participated in eight weeks of twice weekly chair yoga or health education (control group) found that chair yoga participants had significantly greater reductions in pain, as well as improved gait speed and fatigue.10 • A 2012 safety and feasibility study in 16 older adults with a median age of 88 years and history of previous falls found that eight weeks of twice weekly chair yoga significantly reduced fear of falling and improved sitting-to-standing ability.11 No adverse events related to chair yoga were reported in the studies. Although most published studies are small (fewer than 100 participants) and do not compare yoga with other exercise types, results suggest chair yoga is a safe exercise for older adults with movement limitations, dementia, and osteoarthritis that can provide benefits related to muscle strengthening, balance, and mental health. Chair yoga can also help boost weekly exercise activities for older adults who may not be able to perform other more vigorous exercises. In addition to recommending at least 150 minutes weekly of moderate intensity activity (eg, brisk walking), physical activity guidelines for older adults also recommend at least two sessions per week of muscle-strengthening activities, as well as balance exercises. Standing yoga pose sequences that include warrior pose variations, squatting poses, and balance poses on one leg, using a chair for support when needed, can help older adults meet part of recommended weekly exercise guidelines for strength and balance. Additionally, group chair yoga classes can provide opportunities for socialization for older adults. For geriatric professionals who want to incorporate chair yoga into patient care or recommend chair yoga to patients/clients, guidance for a safe and effective chair yoga class for older adults includes the following: • A stable and sturdy chair with no arms should be used. Chair yoga classes at gyms, community and senior centers, and health facilities generally use stackable metal upholstered chairs with rubber tips (available at https://hes-ssequip.tivityhealth.com/productag/36/chair). A dining room chair can be used for chair yoga at home. Folding chairs and other unstable chairs should not be used. • Chairs can be positioned next to a wall for participants who require additional support during standing poses. • While participants in traditional yoga classes are barefoot, participants in chair yoga should wear supportive shoes with treads. • Yoga mats are not required because participants do not sit or lay on the floor. However, a yoga mat can be used under a chair or for a participant to stand on to prevent slipping. • Lighting should be sufficient for all participants to see the instructor, their chair, and other participants. Lights should not be turned off for final relaxation or meditation. • If music is used, the volume should be low enough that the instructor’s voice can be heard clearly by all participants. • Range-of-motion and large-muscle movements should be included in a warm-up prior to poses held for strength or flexibility. • Pose modifications should be given for participants with movement limitations. All standing poses should have a seated chair alternative pose if class includes participants who have standing difficulties or are in a wheelchair. • Breathing exercises that involve holding the breath should be avoided. Flexibility and balance are often neglected when regular exercise is recommended for older adults. And chair yoga may be perceived as “not a workout” by health care professionals and older adults. Research supports recommending at least one or two weekly sessions of chair yoga for older adults, especially those who may have difficulties with other types of exercise. — Jennifer Van Pelt, MA, is a health care researcher and certified fitness instructor with more than 20 years of training and experience in older adult exercise, located in the Lancaster, Pennsylvania, area. References 2. Cordes T, Schoene D, Kemmler W, Wollesen B. Chair-based exercise interventions for nursing home residents: a systematic review. J Am Med Dir Assoc. 2021;22(4):733-740. 3. Efendi F, Tonapa SI, Has EMM, Ho KHM. Effects of chair-based resistance band exercise on physical functioning, sleep quality, and depression of older adults in long-term care facilities: systematic review and meta-analysis. Int J Nurs Sci. 2022;10(1):72-81. 4. Veneri D, Gannotti M. Take a seat for yoga with seniors: a scoping review. OBM Geriatrics. 2022;6(2):197. 5. Loewenthal J, Innes KE, Mitzner M, Mita C, Orkaby AR. Effect of yoga on frailty in older adults : a systematic review. Ann Intern Med. 2023;176(4):524-535. 6. Park J, Hung L, Randhawa P, et al. 'Now I can bend and meet people virtually in my home': the experience of a remotely supervised online chair yoga intervention and visual socialisation among older adults with dementia. Int J Older People Nurs. 2023;18(1):e12513. 7. Krejčí M, Hill M, Kajzar J, Tichý M, Hošek V. Yoga exercise intervention improves balance control and prevents falls in seniors aged 65. Zdr Varst. 2022;61(2):85-92. 8. 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):248-254. 9. 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. 10. 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):592-597. 11. Galantino ML, Green L, Decesari JA, et al. Safety and feasibility of modified chair-yoga on functional outcome among elderly at risk for falls. Int J Yoga. 2012;5(2):146-150. |
