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Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: a Pilot Study Arlene A

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Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: a Pilot Study Arlene A 576 ORIGINAL ARTICLE Effect of a 12-Week Yoga Intervention on Fear of Falling and Balance in Older Adults: A Pilot Study Arlene A. Schmid, PhD, OTR, Marieke Van Puymbroeck, PhD, CTRS, David M. Koceja, PhD ABSTRACT. Schmid AA, Van Puymbroeck M, Koceja EAR OF FALLING, defined as a disabling symptom of DM. Effect of a 12-week yoga intervention on fear of falling Fimpaired mobility among frail older people, is common in and balance in older adults: a pilot study. Arch Phys Med community-dwelling older adults. It has been associated with Rehabil 2010;91:576-83. depression, functional limitations, and gait impairments.1 FoF has been identified as one of the greatest fears experienced by Objective: To determine whether fear of falling (FoF) and the elderly,2 occurring in 40% to 73% of those with and 20% balance improved after a 12-week yoga intervention among to 46% without a recent fall.2-6 At least 30% of those over the older adults. age of 65 and 50% over age 80 report a fall annually.6 Older Design: A 12-week yoga intervention single-armed pilot adults who fall often develop FoF, which in turn is considered study. a risk factor for future falls.7 The development of FoF is not, Setting: A retirement community in a medium-sized univer- however, always related to a recent fall or instability. sity town in the Midwest. Delbaere et al8 discussed the “vicious cycle” of FoF: those Participants: A convenience sample of adults (Nϭ14) over with FoF exhibit decreased activity and participation in their the age of 65 years who all endorsed an FoF. environment, leading to further decreases in strength and bal- Intervention: Each participant took part in a biweekly 12- ance, thus placing them at greater risk for falls and increased week yoga intervention. The yoga sessions included both phys- FoF. Rehabilitation therapists have identified FoF as the most common reason people do not return to premorbid activities ical postures and breathing exercises. Postures were completed 9 in sitting and standing positions. after a stroke. Development of FoF has been associated with Main Outcome Measures: We measured FoF with the worsening in performance of activities of daily living, mobility, mood, life satisfaction, and general health.10,11 Further, it has Illinois FoF Measure and balance with the Berg Balance Scale. been shown to limit participation within roles and diminish Upper- and lower-body flexibility were measured with the back social functioning, self-efficacy, and quality of life.12,13 scratch test and chair sit and reach test, respectively. Research into causes for the development of FoF is limited but Results: FoF decreased by 6%, static balance increased by has demonstrated that FoF is related not only to physical charac- 4% (Pϭ.045), and lower-body flexibility increased by 34%. teristics and falls but also to emotional and cognitive factors.14-16 Conclusions: The results indicate that yoga may be a prom- This complexity makes FoF interventions difficult to develop and ising intervention to manage FoF and improve balance, thereby assess. A review of interventions to reduce FoF indicated only 3 reducing fall risk for older adults. Rehabilitation therapists may effective interventions primarily aimed at fear; others focused on wish to explore yoga as a modality for balance and falls fall prevention.17 Exercise interventions aimed at fall prevention programming; however, future research is needed to confirm had a modest effect overall. In one of the most successful fall the use of yoga in such programming. prevention program studies, Wolf et al18 demonstrated decreased Key Words: Accidental falls; Postural balance; Rehabilita- FoF, increased core and lower extremity strength, and decreased tion; Yoga. fall rates with a modified Tai Chi program. © 2010 by the American Congress of Rehabilitation Hatha yoga (like Tai Chi), is an Eastern medicine that may Medicine have potential for improving the lives of older adults. Hatha yoga uses a combination of postures, breathing, and medita- tion. Complementary and alternative therapies, such as yoga, are theorized to be more therapeutic than traditional exercise because of the mind-body component.19-23 This is because of From the Veterans Affairs Health Services Research and Development, Center of the active engagement between the mind and the body; in yoga, Excellence on Implementing Evidence-Based Practice, and the Health Services Re- the mind is encouraged to focus specifically on what is occur- search and Development Stroke Quality Enhancement Research Initiative, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis (Schmid); the Department ring in the body and where the body is in space, increasing both of Occupational Therapy, Indiana University School of Rehabilitation Science, Indi- awareness and proprioception. Its practice has been associated anapolis (Schmid); the Indiana University Center for Aging Research, Indianapolis with increased muscle strength and endurance, flexibility, and (Schmid); the Department of Recreation, Park, and Tourism Studies, Indiana Univer- cardiopulmonary endurance.24,25 Yoga requires the stretching sity, Bloomington, (Van Puymbroeck); and the Department of Kinesiology, Indiana University, Bloomington (Koceja), IN. of major muscle groups to improve physical strength and Supported by the Indiana University School of Health, Physical Education, and flexibility. In a recent study of young adults (mean age, 29), Recreation Faculty Sponsored Research Program and the Department of Veterans balance improved by 228% for the experimental group, while Affairs Rehabilitation Research and Development Service (grant nos. CDA-2, D6174W). No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organi- zation with which the authors are associated. List of Abbreviations Reprint requests to Arlene A. Schmid, PhD, OTR, Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush Veterans Affairs BBS Berg Balance Scale Medical Center, HSR&D Mail Code 11H, 1481 W 10th St, Indianapolis, IN, 46202, FoF fear of falling e-mail: [email protected]. LB lower body 0003-9993/10/9104-00892$36.00/0 UB upper body doi:10.1016/j.apmr.2009.12.018 Arch Phys Med Rehabil Vol 91, April 2010 YOGA AND FEAR OF FALLING, Schmid 577 the control group did not change.26 Furthermore, mobility and and each session built on tasks introduced during prior ses- gait speed improved in breast cancer survivors after a 7-week sions. The yoga intervention was focused on balance and yoga program.27 It is possible, then, that Hatha yoga, with its postures as well as improving confidence in movement. See gentle movements, can address known fall risk factors (poor appendix 1 for further details of the intervention. balance, impaired mobility, reduced strength and flexibility) All participants were in the same yoga class, and all sessions and focus on increased awareness and proprioception, resulting were completed in a large open recreation room at the retirement in decreased FoF and improved balance in older adults. Hatha facility. Study participants were encouraged to discuss complica- yoga is considered the foundation of all other yoga practices; tions or issues with the yoga instructor to allow for appropriate therefore, we refer to Hatha yoga in this intervention simply as modifications. Most yoga postures were completed while sitting in “yoga” throughout the rest of the text. a chair or standing using the chair as a base of support. All Previous studies have demonstrated a relationship between participants were issued a yoga mat, block (common yoga prop), yoga and falls and yoga and balance26,28-30; however, none and resistance band, which were incorporated into the classes. The have focused on FoF as the variable of primary interest. Our yoga intervention protocol is accessible by contacting the authors. objective was to determine whether FoF and balance improved after the yoga intervention. Assessments The trained study research assistant and investigators (A.S., METHODS M.V.P.) completed all assessments. All assessments were com- pleted at the Indiana University School of Health, Physical Design Education, and Recreation. Through an agreement with the We completed a 12-week, single-arm pilot study of a yoga university and the retirement community, all participants re- intervention with pre and post measurements of FoF, balance, ceived free transportation to the university campus to complete and flexibility. study assessments at baseline, 6 weeks, and 12 weeks. Demographics. We collected demographics data for each Participants study participant at baseline, including age, sex, education All study participants were older adults who lived indepen- level, race, and ethnicity. dently or were employees at a retirement community in a medium-sized university town in the Midwest. The retirement Primary outcomes community has a relationship with the local university, and Fear of falling. We assessed FoF 2 ways. First, we asked residents often participate in research. Four of the participants the single yes/no question, “In general, are you worried or were employees who met inclusion criteria. We recruited afraid you might fall?” (The question was asked 3 times, each through approved flyers and a recruitment talk. One researcher time followed by “at home,” “out of the home,” or “in the (M.V.P.) went to the retirement community and talked about community.”) Only those who answered “yes” to being afraid the research, giving a yoga-focused talk about the study and the to fall in at least 1 setting were included in the study. A single accompanying expectations. question regarding FoF has been found to have high test-retest We planned to include 15 participants in this pilot study. We reliability and high concurrent validity with continuous mea- have conducted previous postural stability studies in older adults sures of FoF.32,33 in our motor control laboratory. From these studies (8-wk inter- Second, we used the Illinois FoF Measure, which has been vention studies) an effect size (Cohen’s d statistic) of .56 has been demonstrated to be a reliable and valid measure of FoF in the obtained.
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