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Julia Loewenthal, MD



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Julia Loewenthal, MD; Kim Innes, MSPH, PhD; Margalit Mitzner, BS; Carol Mita, MLIS; Ariela R. Orkaby, MD, MPH

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Julia Loewenthal, MD

Research Category: Other


The Effect of Yoga on Frailty in Older Adults: A Systematic Review

Scientific Abstract

Background: Yoga, a multicomponent mind-body practice, improves multiple domains of physical and psychological health and may improve frailty in older adults.
Purpose: To evaluate the available trial evidence on the impact of yoga-based interventions on frailty in older adults.
Data Sources: Medline, Embase, and Cochrane Central, from their inception to April 27, 2022.
Study Selection: Randomized controlled trials evaluating the effect a yoga-based intervention, including at least one session of physical postures, on a validated frailty scale or single-item marker(s) of frailty in adults aged 65 years or older.
Data Extraction: Two authors independently screened articles, extracted data, and assessed quality. A third author resolved any disagreements.
Data Synthesis: Thirty-seven studies (n=2,608 participants) of moderate methodological quality (mean PEDro score 5.6) were identified in varied populations including community-dwellers, nursing home residents, and those with chronic disease. Yoga styles were primarily based on Hatha yoga and most often included the Iyengar yoga or chair-based methods. Function, gait speed, handgrip strength, balance, lower extremity strength and endurance, and multicomponent physical performance measures were the most frequently used single-item markers of frailty; no studies included a classic operational definition of frailty. Of 37 trials, 25 (67.5%) showed significant improvements in frailty after a yoga intervention.
Limitations: Heterogeneity in study design and yoga style, small sample sizes, variable study duration, limited post-intervention follow-up.
Conclusions: Yoga improves frailty in older adults and is a promising prevention and management strategy for frailty.

Lay Abstract

The world’s population is aging and frailty, a condition that makes older people vulnerable to stress, increases as people get older. Earlier research has shown that physical activity can help prevent frailty from starting and help reverse it once it is already present. Yoga is a mind-body practice that includes not only physical poses but also other elements like breathing exercises, meditation, and relaxation. Yoga has been shown to benefit the physical and psychological health as older people, but it is not known if it affects frailty. We reviewed the available research evidence to see if yoga impacts frailty in older people. We found 37 studies that included different measurements of frailty such as walking speed, grip strength, balance, function, and leg strength. Over half of studies showed significant improvements in these measurements after a yoga intervention. Studies were limited in their quality and included many different populations of older people and yoga styles. From this review, it seems that yoga improves frailty in older adults and more research should be done in this area.

Clinical Implications

There are few prevention and management strategies for frailty, a common condition in older adults with significant public health implications. This review identifies yoga as a potential strategy, though more research is needed.