NIHR Signal Yoga-based exercise can improve well-being for older people
Published on 26 June 2018
Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility.
Yoga includes stretches, poses, breathing routines and meditation. This review focused on the physical exercise/activity components. Most of the 12 included trials took place in Western countries and classes were all run by qualified yoga instructors as in the UK. Class attendance was high for eight weeks or more (50 to 96%). However, women outnumbered men by three to one, implying that yoga classes may need adapting to appeal to older men.
Yoga classes are widely available and could offer an accessible way to improve older people’s activity levels and well-being. The research was moderate to high quality, but it cannot yet show exactly how much yoga or which kind works best for particular groups of people. However, the good news is that these approaches seem effective.
- Complementary and alternative therapies, Older people, Physical therapy
Why was this study needed?
In the UK, nearly 12 million people are aged 65 or older, and projections show the proportion of the population in this age group will steadily increase over the next three decades. Maintaining physical fitness is important as it can prevent illnesses that start in later life and may increase mental well-being. These benefits could reduce strains on the healthcare system.
Yoga can be enjoyed at any age, and estimates show up to half a million people participate in yoga in the UK, through classes or home practice. As a minimum, the practice of yoga only requires a mat, though props (such as blocks, straps or blankets) can be used to support the poses.
Findings from several previous trials have shown beneficial effects of yoga on older people’s physical health. However, evidence was lacking on the effects of yoga on their general quality of life or mental well-being and the researchers aimed to address this evidence gap.
What did this study do?
This systematic review compared the effects of different types of yoga-based exercise with not doing yoga or waiting list controls. It included 12 trials, involving a total of 752 participants with different health conditions. Yoga programmes lasted from 8 to 26 weeks. The mean age of the participants in trials ranged from 60 to 75 years, and the majority (74%) were female. Studies were excluded where the yoga involved meditation and breathing exercises alone.
The main outcomes were standard measures of health-related quality of life. This concept includes social, physical, mental and emotional functioning and impact on overall health. The review also assessed mental wellbeing, which includes both feeling good and functioning well.
The trials were mostly recent, and the majority were carried out in Western countries (Germany, US and Australia), so the findings are probably applicable to the UK. The quality of the included studies was moderate to high, though because the studies assessed the effects of an exercise-based intervention, blinding of therapists or patients was not possible.
What did it find?
- Based on pooled measures, yoga participants showed a moderately improved health-related quality of life when compared with control groups who did not do yoga (standardised mean difference [SMD] 0.51, 95% confidence interval [CI] 0.25 to 0.76).
- Yoga participants had a small but significant improvement in mental well-being when compared with control groups (SMD 0.38, 95% CI 0.15 to 0.62). Adverse side effects of yoga were infrequent and, where noted, generally mild, such as knee pain or muscle soreness. Seven out of 11 studies which looked at adverse effects reported that there were none.
- Included studies used several yoga styles, taught for various lengths of time to people with a range of health conditions. There was moderate variation between studies in the estimates of the effects of yoga intervention on both outcomes. There were too few trials to analyse the impact of different programmes or for groups of people with particular characteristics, such as living in care homes or having heart disease.
What does current guidance say on this issue?
There is currently no guidance on yoga for older people. However, in 2011 NHS Choices issued guidance (based on Department of Health advice) relating to physical activity for older adults (65+ years). It advises older adults to be active daily, and do at least 150 minutes of moderate intensity activity per week, such as cycling or walking. The guidance also advises older adults to improve muscle strength and avoid excessive sitting.
2008 NICE public health guidance recommends physical activity as a way of improving mental wellbeing in over 65s especially those group activities that meet people’s preferences.
What are the implications?
Health professionals may suggest yoga as a safe exercise option for older adults, to promote healthy ageing. Yoga is one form of physical activity that could help older people to meet NICE public health guideline recommendations.
We don’t know exactly how much yoga, of what type, works for which people. However, the fact that different styles of yoga seem to work for a range of older people offers the potential for tailoring the type, duration and intensity of yoga practice to individual capabilities and preferences. Representation of men is much lower than for women, so availability of classes for men may be a consideration when suggesting yoga as an exercise option for older people.
Citation and Funding
Tulloch A, Bombell H, Dean C, Tiedemann A. Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials. Age Ageing. 2018;47(4):537-44.
A Tiedemann is supported by a Research Fellowship from the National Health and Medical Research Council of Australia (APP1110768).
NHS website. Physical activity guidelines for older adults (65+ years): factsheet 5. London: Department of Health; 2011.
NHS website. A guide to yoga. London: Department of Health and Social Care; updated 2018.
NICE. Mental wellbeing in over 65s: occupational therapy and physical activity interventions. PH16. London: National Institute for Health and Care Excellence; 2008.
ONS. Overview of the UK population: July 2017. London: Office for National Statistics; 2017.
Most people know regular exercise is good for you, but perceive it to be a painful and boring experience. We, therefore, need to find physical activities that are well tolerated and effective to be integrated into clinical care. Yoga may well fit the bill.
Although it is unclear how yoga works. For example, is it because of the psychosocial benefits of a group environment or the yoga exercise itself? However, the evidence base is growing.
Further evidence on the dose-response and mechanisms may help in understanding how yoga can be used as exercise based medicine in Western society.
Mark Hamer, Professor of Exercise as Medicine, Loughborough University
Yoga is an ancient form of mind-body exercise whose main components include postures and breathing.