Designing a Yoga Program for Active Seniors

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How a simple yoga practice can help alleviate symptoms of arthritis, hypertension and osteoporosis, three health conditions that typically affect seniors.

Fitness professionals are reporting a surge in the number of active seniors who are engaging in mind-body exercise programs, such as yoga. According to the 2004 IDEA Fitness Programs & Equipment Survey, 47% of the respondents said that they now offer this type of specialty programming just for seniors (Nov-Dec 2004 IDEA Fitness Manager).

What are some of the benefits and contraindications of yoga for seniors? Are there appropriate yoga breathing techniques and pose sequences for our older clients? And what can we, as fitness professionals, do to appropriately adapt our regular yoga classes to accommodate clients who suffer from three of the most common health conditions facing seniors today: arthritis, hypertension and osteoporosis?

Health Benefits of Yoga
Studies have shown that the practice of yoga--including pranayama (breath work), asana (movement) and dhyana (meditation)—offers numerous physiological and psychological health benefits for all age groups. When it comes to older yoga students, the benefits can be particularly helpful in relieving the symptoms of arthritis, hypertension and osteoporosis.

 

  • decreased blood pressure
  • increased respiratory efficiency
  • improved musculoskeletal flexibility and range of motion (ROM)
  • improved posture
  • increase in strength and resiliency
  • improved immune function
  • decrease in pain
  • improved somatic and kinesthetic awareness
  • increased steadiness
  • improved depth perception
  • improved balance
  • improved integrated functioning of body parts (Lamb 2001)


The Physiology of Aging
As we age, our bodies undergo a number of degenerative physiological changes in the skin, bones, heart, blood vessels, lungs, nerves, and other organs and tissues. Three conditions that are very common in the senior population are arthritis, hypertension and osteoporosis.

Yoga instructors working with an aging population need to become familiar with these changes and how to modify a yoga practice to address these conditions. Even if you are not teaching a class specifically for seniors, this information is valuable as more and more older adults start to participate in mainstream fitness classes.

Arthritis
Arthritis is a medical condition that affects the joints and causes pain, swelling and stiffness, especially in older adults. Although the term “arthritis” encompasses more than 100 different diseases and conditions, two of the most common types that affect the senior population are rheumatoid arthritis and osteoarthritis (Keller 2004).

Rheumatoid arthritis (RA) is a chronic inflammation of the joint lining (synovium), which leads to weakness, loss of mobility and eventual destruction and deformity of the joints. It is a chronic disease that affects sufferers for life, but also episodic in that flare-ups can occur at any time. Because RA is a systemic disease, it affects other organs in the body. RA affects 1 percent of the U.S. population, impacting the lives of some 2.1 million Americans (The Arthritis Foundation 2005).

Osteoarthritis (OA) is characterized by the breakdown of cartilage in the part of the joint that cushions the ends of bones. This causes the bones to rub directly against each other, causing pain and limiting movement. Also known as degenerative joint disease, OA usually appears after middle age and affects the hands and weight-bearing joints, such as those in the knees, hips, feet and back. OA can lead to long-term joint damage, chronic pain, loss of function and disability. Osteoarthritis affects an estimated 20.7 million Americans, especially women (The Arthritis Foundation 2005).

Studies have shown that physical activity, maintaining a healthy weight and avoiding joint injuries are all effective in reducing the risk and symptoms of arthritis and may even slow progression of the disease (Keller 2004) Yoga promotes full ROM movements, helping to restore flexibility and improve circulation to joints, which aids in healing. Yoga also facilitates the release of endorphins, which promote a sense of well being and can help alleviate pain. Finally, yoga can help end the stress/pain cycle (i.e., chronic muscle tension creates stress, stress creates pain, pain causes more muscle tension, etc.) that many arthritis sufferers experience.

Recommendations for Arthritis Clients
When selecting yoga asanas, or poses, for clients with arthritis, emphasize movements that:

  • increase the space within the joints, such as the bound angle pose
  • provide both extension and flexion, such as the moving cat pose
  • strengthen surrounding ligaments and tissues, such as the tree pose (Sparrowe & Walden 2002)

Experts recommend yoga poses that encourage fluid movement and keep the joints moving. Yoga asanas can be performed statically (holding) or dynamically (moving). Many arthritis sufferers report that holding static postures is more painful than moving gently through a posture. For example, rather than holding Virabhradrasana II (Warrior II) as a static pose, try moving in and out of the pose, bending the front knee and straightening it in a gentle, rhythmic way. That gentle movement can increase the synovial fluid in the joint, lubricating it and decreasing painful friction.

Because arthritis is painful, fitness professionals need to provide cues, corrections and adjustments to let participants self-adjust the poses as needed. While it is unlikely that many students will go beyond a painful ROM, it is difficult for trainers and instructors to know the appropriate stopping point for a given participant (Christensen 1995). Additionally, allowing participants to find their ideal personal movement pattern facilitates learning, since the correct motor function automatically becomes integrated.

Late afternoon practice may be preferable for many arthritis sufferers. By late afternoon, they will typically have had time to loosen up stiff morning joints and can more fully participate in yoga practice. (Participants who anticipate pain tend to tense up as a protective mechanism, making it difficult to relax.) Encourage your students to practice at the time of day they feel best.

To keep their joints mobile and decrease further swelling, participants with arthritis should continue to practice yoga even on flare-up days. Exercising even when it is painful can heighten their sense of empowerment as they work through the pain. However, the opposite is also possible. Depending on individual temperament, attempting unsuccessfully to practice in pain can reinforce feelings of depression, inadequacy and disempowerment. If that appears to be the case, give those participants permission to take the day off, reduce the intensity of the poses or try some guided meditation or positive affirmations instead of actual movement.

Contraindications for Arthritis Clients
Although there are no specific yoga poses that are contraindicated for arthritis sufferers, vigorous practice may compromise already damaged joints. In general, these clients may want to avoid some of the more intense forms of yoga, such as ashtanga or power yoga. Yoga instructors should modify poses for arthritis clients, taking into account the individual manifestation of their condition.

Hypertension
To understand the abnormal condition called hypertension, it is helpful to review a few basic cardiovascular principles. According to the National Heart, Lung and Blood Institute, blood pressure is the force of blood against the walls of the arteries ((NHLBI 2005). Blood pressure is recorded as two numbers, with one written above or before the other. For example, a blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed verbally as “120 over 80.” In this example, the top value (120) is the systolic blood pressure, which measures the force of blood in the arteries as the heart beats, whereas the bottom value (80) is the diastolic blood pressure, which records the force of blood as the heart relaxes during
beats.

It is important to remember that blood pressure rises and falls throughout the day. However, when blood pressure stays elevated over time, it is classified as hypertension, or high blood pressure. Hypertension is dangerous because it causes the heart to work too hard, which increases the risk of heart disease and stroke.

A blood pressure level of 140/90 mmHg or above is considered hypertensive. According to the NHLBI, about two-thirds of adults over the age of 65 have hypertension. Hypertension is usually the result of lifestyle factors, such as obesity, stress, high alcohol and sodium intake, or genetics.
Last year, a national committee on high blood pressure established a new category called “prehypertension” for people whose blood pressure falls between 120/80 and 139/90 mmHg (NHLBI 2005). The bad news is that people with prehypertension are likely to advance to the hypertension range at some point in their life (Golub 2004). The good news is that hypertension can be treated with medication, diet and exercise.

Recommendations for Hypertensive Clients
Studies have shown that yoga practices that incorporate Pranyayama (breath work), guided relaxation and meditation can reduce stress, which in turn can have a favorable impact on blood pressure (Gilmore 2002). In one study, researchers compared the effect of controlled breathing to other soothing actions, such as listening to classical music or nature sounds, and then measured the time required for blood pressure to return to normal following a stressful event (Pirisi 2001). They determined that controlled breathing techniques returned both systolic and diastolic blood pressure levels to normal more quickly than any of the other methods tested.

When working with hypertensive participants, yoga instructors should provide ample time for students to make adjustments and to get in and out of poses. Focus on simpler poses and short vinyasas, which are two or more poses linked together in flow. It is most helpful to include short rest periods in between poses, because participants whose blood pressure is above normal at rest are likely to become even more hypertensive during exercise. You should also allow adequate rest after practice, since relaxation techniques increase the parasympathetic response, which slows the body down and lowers blood pressure and respiration (Pirisi 2001).

Keep in mind, too, that static exercise tends to raise diastolic blood pressure more than dynamic exercise. Such a rise in diastolic pressure can put a strain on the heart, which must overcome that elevated pressure with every beat (Gilmore 2002). However, you can reduce this adverse effect on blood pressure by consciously designing your yoga classes to avoid the effort of stronger poses or any lengthy holding of static postures.

Contraindications for Hypertensive Clients
Inverted yoga postures, such as head stands, shoulder stands or hand stands, are a core component of many yoga practices. However, inverted postures invoke a significant rise in systolic and diastolic blood pressure levels compared to resting values. In a study of men and women with normal blood pressure, cranial blood pressure recorded when performing a headstand averaged 150/110 mmHg (Gilmore 2002). Results like this raise concerns about the possible response of a hypertensive participant when performing an inverted posture. Therefore, experts recommend that hypertensive participants avoid inverted yoga postures, even if their condition is stabilized by medication (Kraftsow 1999).

Breathing is another area of concern, especially with novices who may unconsciously hold their breath while concentrating on a new pose. The act of inhaling and exhaling causes pressure in the chest cavity to increase and decrease. Holding the breath does not allow for the natural release of this pressure, which can cause stress on the heart and circulatory system to elevate blood pressure two or three times above normal. That’s why breath retentions (pausing at the end of the inhalation or exhalation) are not recommended for hypertensive participants (Carrico 1998; Mandik 2004). Instead, remember to incorporate breathing cues into your verbal instructions. Caution your participants to avoid straining to increase the length of inhalations or exhalations and to not force the chest to expand on inhalations.

Osteoporosis
Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, which puts sufferers at increased risk of bone fragility and susceptibility to fracture. Although the wrist, spine and hips are the areas of the body most frequently affected by the condition, any bone can be at risk. Osteoporosis is a particular concern for older adults. According to the National Osteoporosis Foundation (NOF), it affects 55 percent of those over age 50 (NOF 2005). Of the 10 million Americans estimated to have osteoporosis, 80 % are women (NOF 2005).

Yoga is a weight-bearing exercise that can help stimulate bone growth in clients of all ages. By contracting the muscles around the bones, yoga poses create a force that encourages bone maintenance throughout all areas of the body (Sparrowe & Walden 2004). By strengthening the muscles supporting the joints and providing balance training, yoga can also reduce the risk of falls, a major concern for older adults.

Recommendations for Osteoporosis Clients
The first step in creating an appropriate yoga practice for participants with osteoporosis is to educate them about the ways that regular exercise can strengthen muscles and bones, improve posture and safely challenge balance (Kaspar 2004). Many people are unaware that yoga is a safe exercise option when performed carefully and with the appropriate modifications.

When designing a yoga class for osteoporosis clients, be sure to incorporate spinal extension postures, such as cobra, quadruped opposition arm and leg raises, and modified camel poses. These poses increase muscular strength around the spine, improve posture and relieve spinal compression.
Abdominal strengthening exercises that do not flex the spine are also important for participants with osteoporosis. So be sure to add poses that move the lower extremities with the spine stabilized, such as supine alternate leg lowering or a modified boat pose.

Outside of class, recommend that clients avoid high-impact activities, such as running, plyometrics and jumping, along with any props that increase the risk of falling, such as mini-trampolines and slide boards (Nelson 2000).

Clients with osteoporosis often lose mobility in their hands, which negatively affects their ability to perform the activities of daily living (Aaronson 2004). Yoga mudras, or hand positions, can enhance fine motor skills by strengthening the hand muscles. Mudras can be incorporated into class during seated meditation and/or standing balance work. For variety, try adding mudras and fluid arm patterns to standing postures, such as Virabhradrasana I (warrior I); this will help clients with osteoporosis develop concentration, coordination and additional balance. Yoga mudras are also beneficial for people with arthritis.

Contraindications for Osteoporosis Clients
Clients with osteoporosis should avoid yoga poses that involve spinal flexion, which compresses the anterior part of the spine and increases the risk of fracture. Examples of poses that flex the spine include forward bending poses, such as uttanasana (standing forward bend); knees to chest; seated spine flexion; and quadruped cat and cow. It cannot be overstated that the risk of incorporating spine flexion in any yoga practice for osteoporotic clients far outweighs any desirable benefit.

In addition to not bending forward while in yoga class, clients with osteoporosis need to avoid flexing the spine during their daily activities, avoiding bending at the waist to lift objects or reaching unnecessarily. Yoga instructors should teach these participants proper lifting techniques and to move as close to an object as possible before reaching for it (Meeks 1999).

Lateral bends and twists are also contraindicated for this population, because such movements can compress the spine and increase the risk of fracture. Before including any poses that require hip abduction or adduction, check with the client’s physician, as this should be resolved on an individual basis (Bonnick 1994).

General Yoga for Seniors Guidelines
Here are some overall guidelines to consider when designing a yoga class for active seniors:

  • Incorporate Pranayama, gentle asanas and meditation in every class.
  • Teach proper spinal alignment for every pose.
  • Avoid poses that require forward spinal flexion, twists and lateral flexion (for any client with diagnosed or suspected osteoporosis).
  • Advise students to move gently through and within poses.
  • Incorporate spinal stabilization exercises in every class
  • Include yoga mudras to develop fine motor conditioning in the hands.
  • Feature poses that are comfortable and steady.
  • Encourage participants to rest whenever needed.
  • Urge students to use a chair or wall during balance exercises to reduce the risk of falls.



A Word about Hypotension and Yoga
Hypotension, or low blood pressure, can occur when a person moves his or her head to a higher position, such as when going from a sitting position to standing or when moving from a prone position to sitting up. Also referred to as orthostatic or postural hypotension, the condition is quite common in older people.
Changing head position causes a temporary reduction in cranial blood flow and therefore a temporary shortage of oxygen to the brain. This leads to light-headedness and occasionally, "blackout" episodes. In most cases, this can be prevented by simply allowing participants additional time to come up from supine or seated postures to vertical.

Sample Yoga Breathing Practice
This simple exercise can reduce stress, teach mindfulness and relieve spinal compression. It is beneficial for older clients with arthritis, hypertension and osteoporosis.

  1. Lie on your back, knees bent and feet flat on the floor. Keep knees and feet hip-width apart. (Place a yoga strap around the thighs to assist with this alignment.) Use a small pillow to support the head, placing it in such a way that the face is parallel to the floor.
  2. Place one hand on the chest and the other on the abdomen. Breathe, letting abdomen expand naturally during inhalation and contract without force during exhalation. Keep the chest as still as possible throughout the breath.
  3. Keeping the breath steady, bring the arms to the sides, slightly away from your body, with palms up. The elbows and shoulders should be at the same level. If the elbows are lower than the shoulders, place a folded towel under the elbows for support.
  4. Spend several minutes in this position, taking slow, deep, unforced breaths.
  5. When ready to come out of this position, roll onto one side, using the hand of the arm on top to push up to a seated position.

 

Vinyasa #1: Includes Forward Bending Poses

Pose/Sequence

Purpose/Benefit

Notes

Seated in easy cross leg pose

Establish neutral spinal alignment

Provide yoga blocks, blankets, or bolsters as needed to support tight joints and facilitate neutral alignment.

Pranayama: breathing

Promote internal focus, calm the mind, slow breathing, warm the body

Use props described above. Can incorporate positive affirmations and stress reduction guidelines.

Seated spine extension and flexion

Prepare joints for deeper work to follow; develop kinesthetic awareness of the movements of the spine

Can include raising and lowering of arms, teaching coordination of shoulder girdle.

Seated hip internal and external rotation

Rhythmic movement of the hip through full range of motion

Place hands behind back to support spinal alignment and assist balance.

Reclining big toe pose

Increase hamstring flexibility, joint mobility and back decompression

Use a strap around the foot to assist. Keep the move dynamic by gently moving the leg back and forth in the hip socket.

Quadruped, cat and cow poses

Full range of motion for the spine, weight bearing for the shoulder and wrists.

Reinforce stabilization of the shoulder girdle while performing the movement. Place folded towel under knees for cushioning.

Downward facing dog pose

Stretch back; strengthen upper body; release spine

Distribute weight evenly over whole hand, lift tailbone, while engaging the abdominals. Use chair or table top to facilitate the pose.

Mountain pose

Reinforce standing neutral posture, indicate imbalances

Align from the mat up, keep shoulders relaxed. Can be performed against a wall to teach alignment and support balance.

Warrior I pose

Strengthen back extensors and legs; challenge balance

Align hip bones to face forward. Lift back heel to facilitate alignment and challenge balance. Add shoulder squeeze to strengthen muscles between shoulder blades and stretch chest and anterior shoulders. Can be performed with chair or stability ball for support.

Bridge pose

Open shoulders; strengthen legs

Keep feet and knees hip width apart. Use yoga strap above knees, as needed.

Corpse pose

Decompress spine; support relaxation

Let your legs roll open from the hips. Let your arms roll open from the shoulders, palms facing up. Support your back if needed by placing a blanket under your knees.

 


Vinyasa #2:

Pose/Sequence

Purpose/Benefit

Notes

Corpse pose

Begin breath work; decompress spine

Teach breathing technique, allow time for inward focus. Support with pillows or bolsters as needed.

Supine shoulder press

Strengthen shoulder girdle; stretch front of shoulders

Coordinate movement with breathing. Support arms with towel folded under elbows, if needed.

Supine shoulder stretch

Strengthen shoulder girdle; stretch latismus dorsi

Keep entire hand on the floor, with the abdominals engaged. Use opposite hand to support arm, keeping elbow up and close to head.

Rib lift

Strengthen back extensors; stretch anterior muscles

Combine with shoulder press for more advanced variation. Very weak students can use bolster for support.

Supine bridging

Strengthen core muscles; stretch quads

Vary by lifting heels, adding leg raises, or moving bridge. Place yoga block between thighs, or use yoga strap.

Alternate prone hip extension

Strengthen hip extensors and lower back

Add opposite arm raise for variation. Can be done standing against wall for support.

Cobra pose

Stretch anterior muscles; relieve compression of thoracic vertebra

Move carefully through range of motion.

Mountain pose

Reinforce standing neutral posture; indicate imbalances

The foundation point for standing balance work. Can be done against the wall to teach alignment and support balance.

Tree pose

Challenge balance; build stability of the ankle, knee and hip joints

Reinforce neutral alignment, use chair or wall for support if needed.

Warrior II pose

Strengthen legs; open chest, extend back

Can use chair for support if needed.

Mountain pose with reverse Namaste

Open front of shoulders; strengthen between shoulder blades and spinal extensors; stretch wrists

If wrists are too tight, simply clasp hands behind back and retract shoulders, or use yoga strap.

Legs up the wall pose

Decompress spine; improve circulation; assist relaxation

Restorative posture. Use blankets or bolsters as needed.

 

 

Additional Resources
The Arthritis Foundation: www.arthritis.org
National Heart, Lung, and Blood Institute: www.nhlbi.nih.gov
National Osteoporosis Foundation: www.nof.org


Leigh Crews is a Licensed Corporate Wellcoach and the owner of Think-GPS!™ Outdoor Adventures and Dynalife Inc., which develops educational programs for clients like Reebok, Heavyhands and CardioSport. She is certified by ACE, AFAA, ACSM, and White Lotus Foundation and is a Yoga Alliance Registered Yoga Teacher.

References:

  • Aaronson, N. 2004. Hand wellness for older adults. Functional U, 2(7).
  • The Arthritis Foundation. 2005. Statistics on prevalence of arthritis in America; retrieved 2/1/05 from www.arthritis.org/condition/DiseaseCenter.
  • Bonnick, S. 1994. The Osteoporosis Handbook. Lanham, MD: Taylor Trade Publishing.
  • Carrico, M. 1998. Contraindications of yoga. IDEA Health & Fitness Source, Nov./Dec., p.34.
  • Christensen, A. 1995. The Easy Does It Yoga Trainer’s Guide. Dubuque: Kendall/Hunt.
  • Gannon, S. & Life, D. 2002. Jivamukti Yoga, Practices for Liberating Body and Soul. New York, Ballantine/Random House.
  • Gilmore, R. 2002. The effects of yoga asanas on blood pressure. International Journal of Yoga Therapy, 12 45.
  • Golub, C. 2004. Prehypertension calls for lifestyle changes now to avoid meds later. Environmental Nutrition, 27 (11).
  • Kasper, M. 2004. Exercise training and bone density in postmenopausal osteopenic women. ACSM’s Certified News, 14(3).
  • Keller, J. 2004. Media morsels. IDEA Health & Fitness Journal, October, 22.
  • Kraftsow, A. 1999. Yoga For Wellness. New York: Penguin.
  • Lamb, T. 2001. Health benefits of yoga. International Association of Yoga Therapists, (Dec. 26, 2004). http://www.iayt.org/site/publications/articles/hlthbenefits.php?scdid=s68609190e9382a795c0ef8d448c7ab7018851132&
  • Mandik, Y. V. 2004. Yoga and high blood pressure. YogaPoint (Dec. 26, 2004) http://www.yogapoint.com/info/newsletter1.htm
  • Meeks, S. 1999. Walk Tall! An Exercise Program for the Prevention & Treatment of Osteoporosis. Gainesville, FL: Triad.
  • Metcalfe, L., et al. 2001. Postmenopausal women and exercise for the prevention of osteoporosis. ACSM’s Health & Fitness Journal, (May/June), p.6.
  • Mueller, D. 2002. Yoga therapy. ACSM’s Health & Fitness Journal. (Jan./Feb), p.18.
  • National Heart, Lung, and Blood Institute (NHLBI). 2005. Your Guide to Lowering Blood Pressure. Retrieved 1/26/05 from www.nhlbi.nih.gov/hbp/whathbp/htm.
  • Nelson, M. E. 2002. Strong Women, Strong Bones. New York: The Berkeley Publishing Group.
  • National Osteoporosis Foundation (NOF). 2005. Fast facts about osteoporosis. Retrieved 1/27/05 from www.nof.org/osteoporosis/diseasefacts.htm.
  • Pirisi A. 2001. Take a deep breath. Yoga Journal. Jan-Feb.
  • Sparrowe, L. 2002. The Woman’s Book of Yoga & Health. Boston: Shambhala.
  • Sparrowe, L. 2004. Yoga for Healthy Bones. Boston: Shambhala.
  • Stiles, M. 2000. Structural Yoga Therapy, Adapting to the Individual.York Beach, ME: Samuel Weiser, Inc..
  • Stiles, M. 2002. Yoga Sutras of Patanjali. Boston: Red Wheel, Weiser LLC.
  • Taylor, M. & Meeks, S. 2002. Osteoporosis and asana practice. Yoga Studies Newsletter, (Sep./Dec) http://www.iayt.org.

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