Is a yoga-based program with potential to decrease falls perceived to be acceptable to community-dwelling people older than 60?

Objectives and importance of study: Yoga improves balance and mobility, and therefore has potential as a fall prevention strategy, yet its validity for preventing falls has not been established. The Otago Exercise Programme (OEP) and tai chi are proven to prevent falls. This study aimed to evaluate the perceptions and preferences of older people towards a yoga-based program with potential to decrease falls, to compare these perceptions to the views expressed about the OEP and tai chi, and to identify participant characteristics associated with a preference for the yoga program. STUDY TYPE: Survey. METHODS: Participants were 235 community-dwellers aged 60 years or older who were not participating or had not previously participated (within the past 10 years) in yoga-based exercise. Participants completed a self-report survey measuring demographics, physical activity level and attitude. They then viewed explanations of the yoga-based program, the OEP and tai chi. Participants completed the Attitudes to Falls-Related Interventions Scale (AFRIS) to measure program acceptability and identified their preferred program. Acceptability scores and preference were compared between the programs, and factors associated with yoga preference were identified with analysis of variance. RESULTS: The mean age of participants (69% female) was 69.4 years (standard deviation 7.4). All programs were rated as equally acceptable (p = 0.17), with AFRIS scores ranging from 28.1 to 29.4. Eighty-two people (35%) preferred yoga, 32% chose the OEP and 33% chose tai chi. Overall, people who preferred yoga were significantly younger, healthier, less fearful of falling, and perceived exercise more positively than people who preferred the OEP (p values ranged from 0.03 to <0.001). The characteristics of people who preferred yoga and those who preferred tai chi did not vary significantly. CONCLUSIONS: Yoga was perceived to be appropriate and was as popular as two validated fall prevention programs. Yoga warrants further investigation as a fall prevention strategy, particularly for 'younger' and healthier people aged 60 years or older.

A multidisciplinary intervention to prevent subsequent falls and health service use following fall-related paramedic care: a randomised controlled trial.

Background: approximately 25% of older people who fall and receive paramedic care are not subsequently transported to an emergency department (ED). These people are at high risk of future falls, unplanned healthcare use and poor health outcomes. Objective: to evaluate the impact of a fall-risk assessment and tailored fall prevention interventions among older community-dwellers not transported to ED following a fall on subsequent falls and health service use. Design, setting, participants: Randomised controlled trial involving 221 non-transported older fallers from Sydney, Australia. Intervention: the intervention targeted identified risk factors and used existing services to implement physiotherapy, occupational therapy, geriatric assessment, optometry and medication management interventions as appropriate. The control group received individualised written fall prevention advice. Measurements: primary outcome measures were rates of falls and injurious falls. Secondary outcome measures were ambulance re-attendance, ED presentation, hospitalisation and quality of life over 12 months. Analysis was by intention-to-treat and per-protocol according to self-reported adherence using negative binominal regression and multivariate analysis. Results: ITT analysis showed no significant difference between groups in subsequent falls, injurious falls and health service use. The per-protocol analyses revealed that the intervention participants who adhered to the recommended interventions had significantly lower rates of falls compared to non-adherers (IRR: 0.53 (95% CI : 0.32-0.87)). Conclusion: a multidisciplinary intervention did not prevent falls in older people who received paramedic care but were not transported to ED. However the intervention was effective in those who adhered to the recommendations. Trial registration: the trial is registered at the Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921, 13/05/2011.

A 12-week Iyengar yoga program improved balance and mobility in older community-dwelling people: a pilot randomized controlled trial.

BACKGROUND: Exercise that challenges balance can improve mobility and prevent falls in older adults. Yoga as a physical activity option for older adults is not well studied. This trial evaluated the feasibility and effect of a 12-week Iyengar yoga program on balance and mobility in older people. METHODS: We conducted a blinded, pilot randomized controlled trial with intention-to-treat analysis. Participants were 54 community dwellers (mean age 68 years, SD 7.1) not currently participating in yoga or tai chi. The intervention group (n = 27) participated in a 12-week, twice-weekly yoga program focused on standing postures and received a fall prevention education booklet. The control group (n = 27) received the education booklet only. Primary outcome was standing balance component of the short physical performance battery with addition of one-legged stance time (standing balance). Secondary outcomes were the timed sit-to-stand test, timed 4-m walk, one-legged stand with eyes closed, and Short Falls Efficacy Scale-International. Feasibility was measured by recording class attendance and adverse events. RESULTS: Fifty-two participants completed follow-up assessments. The intervention group significantly improved compared with control group on standing balance (mean difference = 1.52 seconds, 95% CI 0.10-2.96, p = .04), sit-to-stand test (mean difference = -3.43 seconds, 95% CI -5.23 to -1.64, p < .001), 4-m walk (mean difference = -0.50 seconds, 95% CI -0.72 to -0.28, p < .001), and one-legged stand with eyes closed (mean difference = 1.93 seconds, 95% CI 0.40-3.46, p = .02). Average class attendance was 20 of 24 classes (83%). No serious adverse events occurred. CONCLUSIONS: This trial demonstrates the balance and mobility-related benefits and feasibility of Iyengar yoga for older people. The fall prevention effect of Iyengar yoga warrants further investigation.