Points to consider when designing yoga programs for pre/postnatal women, seniors, children, and clients with weight and health challenges.
It wasn’t that long ago that only the most cutting-edge health clubs offered yoga classes. Now, programming schedules are rife with yoga offerings for people at all fitness levels. Even in the more conservative regions of the United States, yoga has become the number-one fitness trend, according to program directors polled for the 2002 IDEA Group Fitness Trendwatch.
This proliferation of yoga classes in fitness settings is generating interesting new formats for populations with special needs. For example, educational sessions at the 2002 International Yoga Conference Presented by IDEA® and Yoga Journal targeted overweight clients and people with back injuries. In the same vein, more yoga instructors are creating special classes for older adults, kids, pre/postnatal women, and individuals who suffer from medical conditions such as multiple sclerosis (MS), chronic fatigue, fibromyalgia and cancer. Even yoga instructors who don’t target a specific population attest to the need to modify certain poses to reduce the number of injuries and address limitations in diversified clienteles.
In the following pages, some of today’s most innovative yoga instructors share how they accommodate the needs of different populations, either in mainstream classes or in specialized programs.
Yoga’s newfound popularity has created a desire for classes that meet a wide variety of needs and abilities. Some instructors respond by offering inclusive formats that appeal to everyone, whereas others tailor their classes to one specific population.
“I think there is a place for special classes,” says Pat Albright, a Philadelphia-based instructor schooled in Iyengar yoga. “But we also need general yoga classes that integrate people with a variety of special needs and make them feel welcome and comfortable.” Albright worked with the National Multiple Sclerosis Society (NMSS) to create a yoga class specifically for people with MS, yet she also “mainstreams” special clients into traditional classes. “People with MS, heart conditions or cancer and those who are older, obese, teenaged or pregnant have been successfully integrated into my regular classes. It’s important for people to have options so they can choose the situation that best meets their needs.”
Beth Shaw, creator and founder of YogaFit® Training Systems Worldwide, based in Hermosa Beach, California, has developed specialized training programs for yoga instructors who want to target specific populations. “Our YogaFit studios offer classes for kids, seniors, pregnant women and new mothers,” she says. “We also offer classes for athletes—for example, volleyball and tennis players and surfers.” Not surprisingly, Shaw is a proponent of specialization over the one-class-fits-all concept. “It’s challenging to teach yoga to all populations,” she says. “Instructors can arm themselves by taking specialty training and being flexible and creative in their teaching.” Each specialized YogaFit class features different props and poses and unique modifications.
Lanita Varshell, owner of A Gentle Way and Joyful Movement Center in La Mesa, California, creates specialized yoga classes for people who have health challenges or are overweight or obese. Her objective is to reach out to “basically anyone who thinks he or she could never do yoga and who would probably not be able to do yoga in a more traditional class,” she explains. “So many instructors ask their students to do something they are just not capable of doing,” says Varshell. “You need to give health-challenged or overweight students permission to come out of poses earlier than other students and let them stop and rest when they need to.”
To make her specialized classes less intimidating to newcomers, Varshell insists on initial private consultations with her clients to determine each individual’s needs and abilities. “I have found that no two people are alike, even if they have the same medical condition,” she says. “For example, two people who suffer from fibromyalgia may have completely different symptoms and limitations. Some larger-sized students may be flexible, whereas others are stiff. A private consultation ensures that each person is placed in the right class for [her or his] body.” This approach also helps students feel more comfortable, Varshell says. “And they love the special attention.”
Researchers are just starting to study the therapeutic benefits of yoga in patients with different medical conditions. Scientists have reviewed or are currently studying how a regular yoga regimen may relieve the symptoms of asthma, chronic back pain, mental disorders, MS, insomnia, stress, hypertension and cardiovascular disease. Meanwhile, fitness instructors are seeing more yoga students who suffer from debilitating diseases.
Albright says that, although clients with MS have different needs and abilities, the disease tends to manifest itself in similar ways. “For example, simple shoulder and leg stretches and balance work may be much more difficult [for clients afflicted with MS],” she says. “There is often numbness and tingling in the hands and feet. Weakness in the leg muscles causes locking of the knees, which makes it more difficult to walk or stand. People with MS find it particularly difficult to tolerate hot weather and must take care not to let the body get overheated.”
Albright addresses these differences by providing an array of options based on each participant’s own needs. “Some people may be able to do floor-work without too much difficulty, while others may need to use chairs. Some may need to do standing poses using a wall for support. People in wheelchairs may need assistance from the instructor to stretch their arms.” To assist clients, Albright incorporates special props and equipment into certain poses. “I use belts, blocks and chairs to ensure that people avoid straining or overstretching; blankets to help align the body properly; and sticky mats to help with balance and traction,” she says.
In addition to providing modifications and props, Albright sequences poses somewhat differently in her specialized classes than in her general yoga classes. “In the early part of class, I concentrate on the feet and hands, as these are nearly always problem areas for people with MS. Agitation may also be a problem, so I take extra care in the beginning of class to do breathing and centering work to quiet the mind.”
To augment her traditional yoga training, Albright studied with a fellow Iyengar instructor who suffers from MS, and she also consults regularly with the NMSS. “It’s a challenge to work with a population that can range from the newly diagnosed person who needs little modification to the person who is restricted to a wheelchair. You need to be able to encourage people to work to expand their limits while also [helping them] accept where their bodies are at this point in time.”
According to Varshell, clients with health challenges like chronic fatigue and fibromyalgia have unique needs best handled in a specialized class. “It is very important that [clients with these conditions] move their bodies every day, but if they try to do too much too soon, it will worsen their condition. So you really need to teach them how to relax and breathe first, then work into movement gradually,” she advises.
Like Albright, Varshell adjusts the sequence of poses to accommodate her clients’ special needs. Because people with chronic fatigue or fibromyalgia are often unable to handle the fast pace of Sun Salutations or a lengthy Savasana (deep relaxation), Varshell replaces these segments with a series of “squeeze, hold and release techniques” to prepare the body to stretch. “Many of these students are not ready for this [kind of work], and they can injure themselves by warming up improperly,” she says. She also has students perform stretches on their backs at the start of class before moving on to more active poses.
Varshell has even considered when the best time is to hold a class for health-challenged students. “People with fibromyalgia or chronic fatigue syndrome need extra sleep and sufficient time to get up and move about,” she says. “They tend to prefer a later morning class, usually from 10:00 to 11:00.”
In addition to acquiring formal training, instructors who teach yoga to clients with medical conditions need to develop empathy, says Varshell. “You don’t have to be health-challenged, but you do have to be able to convince [participants] that you understand what they are feeling. And you need to ask yourself if you really do. What would it feel like to be unable to bring your knees together or sit cross-legged? How does that affect your back, your feet and your mind?”
Elise B. Miller, MA, owner and director of the California Yoga Center in Mountain View, California, is a senior-certified Iyengar yoga teacher who works with clients with back problems, scoliosis in particular. She also presents educational sessions that teach other yoga instructors adaptations for certain yoga asanas and a series of therapeutic poses for this special population.
By modifying yoga poses and concentrating on the basics, Miller has had success teaching clients with a variety of back conditions. She advocates that instructors provide individual, “hands-on” training and back care instruction. Like others who teach clients with special needs, Miller has students use the wall during standing poses and employ props like blankets and bolsters during sitting poses. Many poses in her classes are performed lying down.
Miller advises anyone interested in working with clients who have back injuries or chronic conditions such as scoliosis to get “good therapeutic training.” She also stresses the need to be patient with this population.
After undergoing a mastectomy herself, Susan Rosen turned to yoga to hasten her postsurgery recovery. Realizing that many other breast cancer survivors could benefit from a similar therapeutic regimen, this Iyengar-trained yoga instructor—based in Del Mar, California—modified a series of 16 yoga poses specifically for this population of women. Rosen trains clients in her home and at the Kaiser Permanente Positive Choice Wellness Center in Clairemont Mesa, California.
Captured in her video “Yoga and the Gentle Art of Healing: A Journey of Recovery After Breast Cancer,” the modified poses are designed to help women restore range of motion, which is often impaired after breast cancer surgery. Rosen’s tailored yoga program also aids in breaking down scar tissue after surgery and relaxes the gripping feeling that many women experience in the chest. The poses also help release mental tension and stress. Rosen says the program is especially beneficial for women who undergo radiation therapy following surgery.
To provide an array of options, Rosen adapted poses so they could be done against a wall, in a chair or on the floor, with or without simple props, both before and after surgery. She suggests that, after first getting a physician’s clearance to exercise, beginners start by performing just a few exercises and build up a practice gradually once their stamina improves.
Pre- and postnatal women are another special population being targeted by yoga instructors. “Pregnant women want to learn safe and effective ways to practice yoga poses while their bodies undergo this momentous change,” says Judith Hanson Lasater, PhD, a San Francisco-based physical therapist and yoga instructor who integrates several different populations into her classes. “They also want to learn how they can enhance the birth experience by strengthening muscles, reducing lower-back pain and improving their breathing.” The author of Relax and Renew: Restful Poses for Stressful Times (Rodmell Press 1995) and Living Your Yoga: Finding the Spiritual in Everyday Life (Rodmell Press 2000), Lasater stresses that it is important to provide modifications for pregnant women during any type of yoga class. “The most significant ones are no inversions of any kind, generally no lying on the back after the first trimester and teaching [participants] not to push stretches too aggressively.”
Andrea Feier offers specialized yoga classes for pregnant participants at two San Diego locations. Her “Pregnant Yoga” classes are based on the Svaroopa style of hatha yoga, which emphasizes poses that open the spine, starting at the tailbone. “We mostly do hip openers using the different angles of the legs to release tension in the muscles, spanning from the legs through the hips into the lower spine,” says Feier. “This helps make internal space for the baby in the abdominal cavity and allows the baby to sit back in the hips, which lessens [maternal] back strain. It also prepares the pelvis for delivery and stretches the muscles used during childbirth.” As an added bonus, Feier says, her modified poses reduce stress and anxiety.
Open to any woman out of her first trimester, Feier’s 90-minute specialized classes are restricted to no more than eight participants. As women progress in their pregnancies, props such as blankets, blocks, straps, pads and sandbags are introduced to provide extra support during certain poses.
In addition to offering specialized programs for pregnant women, YogaFit has created “Mommy and Me” yoga classes. “Women in the postpartum period require pose modifications up to 8 weeks [after childbirth],” says Krista DiMercurio, a YogaFit instructor and training coordinator in Hermosa Beach, California. “Beyond [having] their physical needs [met], these women benefit from the support network of other moms with whom they can share feelings, ideas and experiences.” Like the company’s prenatal offerings, “Mommy and Me” classes avoid contraindicated poses; however, the postpartum format is structured more like a mixed-level class for the general population, with one exception. “We encourage the moms to change their babies, breastfeed and take necessary breaks throughout class,” says DiMercurio.
Older adults can also benefit from a specialized yoga format. Rita Joseph, MEd, is a yoga instructor who specializes in the senior market in the Houston area. According to Joseph, individuals in this burgeoning market niche have diversified needs, but as a group, they do have particular needs in a yoga program. “Despite efforts to stay young and fit, the human body ages,” she says. Teaching yoga to older adults requires “more intentional honoring of their joints, acceptance of their limitations, [awareness of] balance issues and [some understanding of] various health/medical concerns that affect their abilities.”
Joseph wrote and developed a YogaFit senior yoga workshop that targets older adults at various fitness levels. “All poses are modified, and additional suggestions are noted for each pose,” says Joseph. “The timing of the class is generally slower than in [traditional] classes, and individuals move at a challenging but comfortable pace. Continuous cues for safety and self-pacing are given.” Because older adults can range from very active to physically frail, YogaFit seniors’ instructors are trained to cue at different levels simultaneously and to assess alignment and posture for safety reasons.
According to Joseph, participants in her specialized senior yoga classes can perform poses while standing, seated or lying down or while sitting in a wheelchair. Props are used to help with poses and balance. “A bolster will support the body weight off of challenged knees and can lessen the intensity of [certain] stretches, while a chair back or seat can help older clients perform more challenging poses.” Joseph also recommends thick, cushioned mats; straps with loops; and small, firm pillows.
She advises using a “hands-on” approach when working with an older population. “It is best if instructors are comfortable teaching ‘off mat’ so they can help position, prop or verbally encourage seniors.” Joseph also encourages yoga instructors to up the fun factor for their older participants, who sometimes attend class more for the socialization they can’t find elsewhere. “Focus on the social aspects of the class as well as the fitness benefits,” she advises. “Some seniors may be coming to class just to be touched and talked to that day.”
Above all, be respectful and kind to this special group of students, says Joseph. “Too often, I hear older adults say they don’t want to be talked down to in class. This population is wise and has much to share. Honor who they are and what they are able to do individually, and encourage them toward improved health and fitness.”
In addition to working with health-challenged clients, Varshell has created a special yoga class for overweight and obese participants. This is a group that has traditionally felt uncomfortable in most yoga studios, according to Varshell. “You have to understand their mentality,” she says. “As a large woman, I can explain how a plus-sized person should feel in a pose. Most of us have a history of feeling out of place and embarrassed in gyms. For many of us, exercise became a dirty word very early in our lives. It’s a challenge to get these people to come to a yoga class initially, because they don’t think they can do it.”
Varshell says that, although yoga is a perfect exercise choice for weight-challenged individuals, most of them shy away from a modality they think is only for the superfit. “I have people come to my studio who say they were turned down by other yoga studios and told they should lose weight before practicing yoga. Yet with modifications, yoga can be done by anyone of any size. I work with 400-pound students, some of whom can’t get down on the floor or are in wheelchairs.”
To encourage larger people to try yoga, certain long-held myths need to be dispelled, says Varshell. She urges fitness and health magazines to get on the bandwagon by depicting plus-sized exercisers in the photos that accompany their yoga articles. “No one ever shows the large person doing a yoga pose,” Varshell laments. She points to a recent Time magazine cover story on yoga that showed thin models “doing poses that no weight-challenged person could possibly do.” According to Varshell, articles like this ultimately discourage larger people from enrolling in traditional yoga programs. “They need to know that there are classes they can do right now at any size,” she says.
Varshell applies many of the same pose modifications to both her health- and her weight-challenged yoga students. “With both of these populations, we have had success by teaching them how to relax and breathe first and by creating a safe and nurturing atmosphere to gain their trust and confidence,” she says. “Once [students] relax, we advance to more traditional yoga poses if their bodies are ready.”
For yoga instructors who want to reach out to the overweight population, Varshell offers this advice: “Make the classes fun and loving. As these students go through the poses, many emotions may surface, and you need to be comfortable dealing with those emotions. You must let them know that you care.”
Children are another group not commonly seen in yoga classes. But that’s about to change if Stephanie Adams gets her way. Author and creator of YogaFit Kids, Adams says yoga can help children improve posture, strength and flexibility; develop coordination and proprioception; learn to relax and focus; build self-esteem and confidence; and increase social skills. According to Adams, the program “blends mindful movement, play and yoga to create a wonderful opportunity for kids to experience the many benefits of mind-body fitness.”
Adams’s specialized yoga class integrates kids of all ages and encourages them to participate at their own levels. “Because YogaFit Kids instructors teach modifications for the poses, the children have control over how hard they challenge themselves,” she says. Her kid-friendly format augments 40 yoga poses with more than 45 games and activities that stress movement, breathing, body awareness, relaxation and team building.
“Children start by holding the poses naturally, in the way that feels best in their bodies,” says Adams, who, in addition to teaching yoga, also serves as Western training and sales manager for YogaFit Worldwide Training Systems Inc. “We emphasize feeling the pose in the body, not perfecting the pose.”