Effect of Vinyasa Yoga on Frailty and Anthropometric Measurements in Elderly Individuals
Condition: Geriatrics; Yoga; Complementary Therapies; Nursing Caries
MeSH terms: Frailty
Study type: Interventional

Summary: 
      During the aging process, concrete changes such as loss of function in organs and systems
      resulting from biological, physiological and psychological negativities and difficulty in
      participating in daily life activities occur. Frailty, one of the geriatric syndromes, is a
      complex condition that increases vulnerability to stressors and causes a decrease in the
      physiological reserve necessary to maintain homeostasis in most organs. When examined
      pathophysiologically, it is thought that frailty is not only evaluated as physical, but
      psychological and social fragility may also contribute to this situation.

      It is thought that physical activity that includes strength training to maintain or improve
      muscle mass throughout aging may reduce muscle loss, an important risk factor for frailty. To
      treat physical frailty, supervised exercise is recommended as an effective strategy. Yoga; It
      is a holistic practice that encourages healing through breathing, movement, strength,
      flexibility and achieving integrity of spirit, body and mind. Being a meditative practice
      distinguishes yoga from other typical forms of physical exercise, despite having similar
      metabolic intensity. Regular yoga has the potential to improve flexibility, balance and
      muscle strength in older individuals. It is also known that yoga improves cognitive function
      in the elderly, helps manage chronic conditions, reduces pain due to osteoarthritis, improves
      sleep, increases subjective well-being and health-related quality of life.

      During the healthy aging process, people may need to be guided according to their individual
      and health characteristics. By supporting this situation with appropriate nursing care,
      losses can be reduced and optimum health can be maintained. One of the biggest advantages of
      yoga applied within the scope of nursing care is that the individual's progress is ensured in
      a controlled manner by preparing a flow in line with appropriate asana selections, taking
      into account the individual's health condition. Nursing, by its nature, requires a holistic
      approach to people. Similarly, the practice of yoga is considered a practice that integrates
      not only physical health but also the mind, body and soul.

      This study was planned as a randomized controlled, double-blind and experimental study to
      evaluate the effect of vinyasa yoga on frailty and anthropometric measurements in elderly
      individuals.
    

Detailed description: 
      Epidemiological studies and evidence-based practices conducted with the increasing elderly
      population in the world suggest that active and healthy aging can be achieved by preventing
      age-related inadequacies and limitations due to changes in negative factors that occur with
      aging. Active aging is the process of enabling the individual to perform all his/her
      functions independently and maintaining and protecting his/her health in a physically,
      psychologically and socially safe environment. In addition, during this period, the person
      has the opportunity to improve himself while increasing his subjective well-being levels and
      related quality of life by focusing on his strengths rather than the losses he experiences
      due to old age.

      To date, exercise remains the interventional modality that most consistently provides benefit
      in the treatment of frailty and its core components. Exercise has physiological effects on
      almost all organ systems, especially the musculoskeletal, endocrine and immune systems. It is
      known that supervised exercise programs in healthy and pre-frail elderly individuals have
      positive effects on their participation in daily life activities while reducing physical
      fragility. Among frail older adults, exercise and maintaining self-autonomy are particularly
      important to reduce fall risk and reduce hospitalizations. It is thought that physical
      activity that includes strength training to maintain or improve muscle mass throughout aging
      may reduce muscle loss, an important risk factor for frailty. Supervised exercise is
      recommended as an effective strategy to treat physical frailty. If physical health is not
      protected, the quality of life of elderly individuals may decrease along with fragility. It
      has been observed that people who regularly participate in physical activity in older ages
      have higher levels of life satisfaction and subjective well-being than those who participate
      irregularly or intermittently. Yoga is a holistic practice that promotes healing through
      breathing, movement, strength, flexibility and achieving integrity of spirit, body and mind.
      Being a meditative practice distinguishes yoga from other typical forms of physical exercise,
      despite having similar metabolic intensity. Since Yoga aims to create the highest possible
      state of physical, mental and spiritual health, called Samadhi, many therapeutic processes
      that balance health occur in the process of achieving this goal. Yoga performed regularly has
      the potential to improve flexibility, balance and muscle strength in older individuals. It is
      also known that yoga improves cognitive function in the elderly, helps manage chronic
      conditions, reduces pain due to osteoarthritis, improves sleep, increases subjective
      well-being and health-related quality of life. It has been observed that yoga-based practices
      in the elderly also help maintain breathing and pulse rate, reduce high blood pressure and
      cortisol levels, and this helps repair stress-related autonomic regulatory reflex mechanisms.

      Vinyasa yoga, which is formed by combining breathing flows and exercises with a dance-like
      flow, is defined in Sanskrit as the art of asanas (postures) related to dynamic meditation of
      the mind with conscious breathing and body synchronization. It also affects many parameters,
      affecting a person's health and well-being. The harmony between respiratory mechanics and the
      musculoskeletal system holistically optimizes body functioning, maintaining serenity and
      stability as emotional and spiritual calmness of the mind is allowed. In order to maintain
      the internal balance of the body, in vinyasa yoga, asanas are created as a series of flows in
      which the breath, described as energy transition called pranayama, is circulated throughout
      the body. During Vinyasa yoga, breathing continues in its natural flow, but completing the
      breath at the beginning and end of each asana actually ensures the soft connection between
      each movement. Depending on the difficulty or depth of physical activity, breathing may
      deepen or become difficult, but the important and ideal thing is to breathe in a regular
      rhythm through the nose. This situation, combined with the rhythm of mental and intellectual
      flows, breathing and asanas, emphasizes the vinyasa aspect of yoga. It is thought that the
      physical, mental and social effects of fragility can be recycled with a modifiable vinyasa
      yoga flow for elderly individuals. Despite the increasing prevalence of frailty and its high
      impact on the elderly, the effects of this condition can be reversed and mitigated with
      interventions. The American College of Sports Medicine (ACSM) recommends at least 150 minutes
      per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity
      physical activity for the health benefits of older adults. ACSM recommends moderate to
      vigorous exercise for cardiovascular health and fitness for healthy adults. In addition, WHO
      recommends multi-component physical activities that support functional balance and strength
      exercises at medium or higher intensity, 3 or more days a week, within the weekly physical
      activities of individuals aged 65 and over, in order to prevent falls and increase functional
      capacity. Vinyasa yoga has been reported as an alternative moderate-intensity physical
      activity (50-70% MHR:maximum pulse rate) that meets ACSM criteria and may positively impact
      cardiovascular health. The metabolic cost of Hatha yoga has been stated to be 2.5 ± 0.8 MET
      (Metabolic equivalent), corresponding to 49.5 ± 12.2% MHR associated with low-intensity
      aerobic activity. However, the sequence of sun salutation postures within the typical flow
      chart of vinyasa yoga has been thought to produce a slightly higher intensity of 2.9 ± 0.77
      MET and 54.8 ± 11.8% MHR and may correspond to this when practiced for more than ten minutes
      . It was also observed that the Hatha yoga practice without Surya Namaskar/sun salutation
      resulted in approximately 2.07 ± 0.4 MET and 55.98 ± 9.19% MHR, and the sun salutation part
      corresponded to 3.74 ± 0.70 MET and 66.99 ± 9.99% MHR.

      During the healthy aging process, people may need to be guided according to their individual
      and health characteristics. By supporting this situation with appropriate nursing care,
      losses can be reduced and optimum health can be maintained. One of the biggest advantages of
      yoga applied within the scope of nursing care is that the individual's progress is ensured in
      a controlled manner by preparing a flow in line with appropriate asana selections, taking
      into account the individual's health condition. Nursing, by its nature, requires a holistic
      approach to people. Similarly, yoga practice is accepted as a practice that integrates not
      only physical health but also mind, body and soul.

      It is thought that by incorporating the Vinyasa type of yoga, one of the integrative method
      uses that has just started to participate in the active aging process, into nursing care, it
      will reduce the exposure of older individuals to risk factors and the positive effects will
      increase their level of well-being by preventing both multisystemic and multifactorial
      syndromes. Studies have shown that Vinyasa yoga has a significant effect on transforming
      negative mood states into positive ones. Physical activity has also been shown to provide
      mood, emotion and stress reduction benefits.

      No studies specifically on vinyasa yoga have been found in the field of nursing. However,
      when similar holistic practices were examined, Tai-Chi studies were found in the literature
      for individuals over the age of 60. Yoga, Tai Chi and meditation practices require focus and
      have been associated with positive changes in brain structure and function, especially in
      areas related to awareness, attention, executive functions and memory. There are
      meta-analysis studies showing that Tai-Chi practices have a positive effect on blood pressure
      by increasing exercise capacity in heart failure patients over the age of 60, and also
      increase the quality of life by reducing depression.

      Since the proposed study has not been found to investigate the effects of vinyasa yoga, which
      has flows that exercise the musculoskeletal system and also has psychosocial effects, on
      elderly individuals, it is thought that the data obtained from the research results will
      contribute to the literature in nursing care by contributing to the active aging process.
    

Intervention name(s): Yoga; Standard exercise
Intervention type(s): Other; Other
Intervention description(s): Yoga practice was standardized throughout the study to avoid the risk of intervention variability. The basic structure of each yoga session is meditation, breathing exercises (pranayama), and after a warm-up, yoga practice includes asanas (postures) for strength, balance and mobility, and finally ends with relaxation. The yoga intervention we recommend was created within the framework of the asanas that the elderly can do in the literature and by taking the expert opinion of a sports physician.; It is a type of exercise similar in intensity to vinyasa yoga. (50-70% MHR: maximum pulse rate)
Other intervention name(s): Vinyasa Yoga
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study was planned as a randomized controlled, double-blind and experimental study to evaluate the effect of vinyasa yoga on frailty and anthropometric measurements in elderly individuals.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care