The Effect of Yoga on Decreasing Risk of Fall-Related Injury in Peri and Post-Menopausal
Condition: Fall Injury; Incontinence; Balance; Distorted
MeSH terms: Wounds and Injuries
Study type: Observational

Summary: 
      The primary objective of this study is to evaluate the effect of yoga on both fall risk
      factors AND capacity to successfully control landing and descent during a simulated fall
      among peri-and post- menopausal women. Older women are particularly vulnerable to sustaining
      fall-related injuries and although targeted exercises focusing on balance and strength may
      decrease the risk of falls, the ideal type of intervention to prevent injury when a fall is
      unavoidable is not known. Yoga is an increasingly popular health practice with potential
      benefits linked to improving balance, muscle strength and quality of life, but there is no
      evidence that yoga can improve the capacity to reduce the risk of fall-related injury. Such
      evidence will help to inform health promotion and fall/injury risk management for older
      adults.
    

Detailed description: 
      Falls are the leading cause of injury hospitalization for older adults in Canada. Determining
      effective and feasible community-based interventions is important to prevent the downward
      spiral of failing health, admission to long term care and even death following a serious
      fall-related injury. Women in their 50s and 60s are particularly vulnerable to sustaining
      fall-related injuries such as fractures. Our research team has identified early signs of fall
      risk in women aged 50 to 65 years. Exercise is known to decrease fall risk in
      community-dwelling older adults when components of balance, strength and agility are
      included, but the evidence is not clear on the effect of different types of exercise on
      decreasing fall-related injury risk particularly for older women at risk in their
      peri-menopausal and early post-menopausal years.

      The risk of injury from falls depends on both the severity of impact and neuromuscular
      capacity such as bone and muscle strength of the affected body part. Most falls in
      community-dwelling older women occur in a forward direction. Forward falls are typically
      combined with hand contact as a protective response to prevent head, hip or torso injury.
      Evidence from the investigators' research team suggests that women in their 60s and 70s years
      do not have the same capacity to control a safe landing and decrease force impact compared to
      women in their 20s or 30s.Older women also demonstrate diminished activation of the abdominal
      core muscles prior to an unexpected simulated fall. The impact of diminished pelvic floor
      muscle control could also be a contributing factor to fall and injury risk in peri- and
      post-menopausal women as it has been associated with decreased balance, urinary incontinence
      and fall risk.

      Yoga is a common recreational choice for peri- and post-menopausal women. Reasons could
      include a range of health improvements such as easing menopausal symptoms, improving pelvic
      floor dysfunctions such as incontinence or pelvic pain, enhancing bone loading to combat
      early osteoporosis, and improving overall quality of life. Yoga has also been associated with
      benefits to decrease fall risk; however, there is no substantive evidence that these outcomes
      result in a decrease in fall rates or a reduction in the injuries associated with falling.

      Yoga, a system of health that promotes physical, mental, emotional, social and spiritual
      well-being, may offer unique benefits to decrease both fall risk and injury risk in the event
      a fall is unavoidable. Hatha yoga includes physical poses, mindful movement, breath awareness
      and regulation practices that can address balance, flexibility, and promote upper body
      loading and whole body strength training. The additional focus on abdominal and pelvic floor
      core control and breath techniques during functional movement may also promote motor control
      important in the maintenance of balance and enhance protective responses and landing
      strategies. The positive mental health focus and meditative component of linking physical
      postures and movement to breath could also help to improve balance confidence and decrease
      fear of falls. Yoga has multiple promising benefits to decrease the risk of fall-related
      injury in older women but there remains gaps in the literature to substantiate these claims.

      The primary research questions are:

        1. What is the effect of 12 weeks of hatha yoga on fall risk factors in peri- and
           post-menopausal women? (balance, balance confidence, functional mobility, muscle
           strength, incontinence leakage, symptoms and bother) and

        2. Does 12 weeks of hatha yoga improve capacity to land and control the descent of a
           forward fall in peri- and post-menopausal women? (muscle activation, range of motion,
           reaction time, and energy absorption).

           Secondary research questions will explore:

        3. What are the perceived changes in general health, fall risk, menopausal symptoms and
           incontinence for women who participate in yoga? What are the motivators, facilitators
           and barriers for participation in a regular yoga practice?
    

Intervention name(s): Balance Flow Yoga
Intervention type(s): Other
Intervention description(s): The yoga class is based on hatha yoga which includes physical poses and mindful movement integrated with breath. Conducted in a local yoga studio for 75 minutes duration, twice per week and also open to the public. The specific yoga techniques reflect the objectives of our study and focus on addressing some of the physical, mental and emotional factors that potentially contribute to falls such as balance, balance confidence, strength, coordination, proprioception, core training strategies, and breathing techniques integrated with mindfulness practices and yoga philosophy. The practices will incorporate a combination of seated, kneeling, standing and lying postures and transitions between positions with individual modifications provided on an as-needed basis. The yoga classes will be co-designed by registered yoga teachers and taught by two trained and experienced and yoga teachers blinded to study testing measures.
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Women age 50 to 70 years of age