Surprisingly, highly active older adults who have not experienced a recent fall may be at greater risk from this popular exercise program.
Iyengar yoga has been found to increase falls in older people by a third, according to researchers at the University of Sydney.
Shockingly, the increase was greatest among participants who were highly physically active (35 hours or more a week), had good or excellent balance or had not fallen in the previous year.
The intervention seemed to have the opposite effect for those who were less active before the study, but the reduction in falls for this group narrowly missed statistical significance.
Iyengar yoga, a popular style in Australia, incorporates props such as brick and straps to provide stability and control. Postures are also held for longer than other rapid-flow movement styles of yoga, hence why it was chosen for a USYD randomised control trial in 2019.
It was largest rigorous clinical trial investigating the effect of yoga on falls, consisting of 700 people aged 60 and over, living independently and not currently practising yoga. Three quarters of participants in both groups were under the age of 70 and 80% were female.
Despite the large body of evidence suggesting exercise can prevent falls in older people, there were no specific studies on yoga as a fall prevention strategy, Professor Anne Tiedemann, senior author and professor of physical activity and health in the Sydney School of Public Health, told media.
“We wanted to fill this gap in knowledge and carry out a study to test our idea that yoga could improve balance and therefore prevent falls – but surprisingly, our study found the opposite,” she said.
The practice of holding fixed positions rather than moving between them may be less helpful in improving balance to prevent falls, Professor Tiedemann explained.
Although the intervention group experienced more falls, they became more active, adding roughly an extra hour of planned exercise each week.
They also reported feeling more confident in their balance and met their exercise and strength goals more often after 12 months, such as improving their ability to get up from the floor or using the stairs with greater confidence.
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No significant differences were observed between groups for other secondary outcomes, including mental wellbeing, quality of life, total activity, physical function, chronic pain or sleep.
Half of participants were assigned an online instructor-led exercise program based on Iyengar yoga, a programme which specifically emphasised standing postures. The other half of participants formed the control group, who underwent a self-guided seated relaxation yoga program over the 12-month trial period. Spouses and partners were assigned to the same group to avoid contamination.
Instructors had specialised in the Iyengar style of yoga and had taught for between 12 and 29 years. They were also trained with a written protocol for the study to standardise delivery. Intervention participants attended one-hour classes twice a week and were encouraged to undertake 20-min unsupervised practice on two additional days per week using a booklet that detailed the yoga postures, although attendance of the latter was not checked.
The regimen aligned with both physical activity guidelines and fall prevention recommendations for ongoing high dose exercise that challenges balance.
Workshops for control participants were on the same schedule, but was a program considered to have minimal effect on falls, focussing on seated breathing and stretching rather than balance.
To the surprise of the researchers, there were 33% more falls in the yoga group than the relaxation group.
Despite the large increase in the number of falls for those participating in the Iyengar-yoga program, there was no difference in the amount that resulted in injury between the two groups.
There were 440 falls over the study period, a third of which resulted in injury such as cuts, sprains, fractures or head trauma. At least one fall was reported for 35% of participants, and 14% experienced an injurious fall.
Those with dementia, cognitive impairment, progressive neurological disease and other conditions which precluded exercise participation were excluded.
Researchers had initially set out to conduct in-person interventions, but covid forced the trial to run online.
The instructors often prioritised safety over introducing more challenging exercises, which could have had an impact on falls, Dr Juliana Oliviera, first author and an emerging leader in pharmacoepidemiology at the School of Population Health, told media.
“Some participants also said they found it harder to push themselves without the same level of supervision as in-person classes, which meant progress was slower and certain balance postures weren’t fully achieved,” she said.
The study did not support recommending an Iyengar yoga-based exercise program as a fall prevention intervention for people aged 60 years and older, the authors concluded.
