INTRODUCTION

Aging physiology

Sensory changes, cognitive changes, and weakness may be subtle or may be severe in the heterogeneous population of people over older age. Falls, cardiovascular disease, and difficulty with activities of daily living are common but not universal. 

Muscle Strength and Fat Changes 

Muscle mass and strength decline starting in the fourth decade of life. By age 85, approximately 20% of people meet criteria for sarcopenia (meaningful loss of muscle mass and strength) ⁽¹⁾. Muscle weakness ⁽²⁾ and rapid rate of strength decline ⁽³⁾ both predict future mortality. 

Somatic disease and multiple chronic conditions Cardiovascular Disease This category includes chronic ischemic heart disease, congestive heart failure, and arrhythmia. Ischemic heart disease may be underdiagnosed in the oldest-old ⁽⁴⁾. Normal aging includes vascular remodeling and vascular stiffness⁽⁵⁾. Atherosclerosis causes inflammation and further vascular changes⁽⁶⁾ increasing risk for cardiac events, cerebrovascular events, peripheral vascular disease, cognitive impairment, and other organ damage. Hypertension, a major contributor to atherosclerosis, is the most common chronic disease of older adults ⁽⁷⁾. Cancer is the second leading cause of death in older adults. Osteoarthritis is the second most common chronic condition ⁽⁷⁾ among American older adults and a common cause of chronic pain and disability. Diabetes rates have been increasing as populations age and become more overweight. Osteopenia is normal loss of bone density with aging. 

Physiological changes occur with aging in all organ systems. The cardiac output decreases, blood pressure increases and arteriosclerosis develops. The lungs show impaired gas exchange, a decrease in vital capacity and slower expiratory flow rates. The creatinine clearance decreases with age although the serum creatinine level remains relatively constant due to a proportionate age-related decrease in creatinine production. Functional changes, largely related to altered motility patterns, occur in the gastrointestinal system with senescence, and atrophic gastritis and altered hepatic drug metabolism are common in the elderly. Progressive elevation of blood glucose occurs with age on a multifactorial basis and osteoporosis is frequently seen due to a linear decline in bone mass after the fourth decade. The epidermis of the skin atrophies with age and due to changes in collagen and elastin the skin loses its tone and elasticity. Lean body mass declines with age and this is primarily due to loss and atrophy of muscle cells. Degenerative changes occur in many joints and this, combined with the loss of muscle mass, inhibits elderly patients’ locomotion. These changes with age have important practical implications for the clinical management of elderly patients: metabolism is altered, changes inresponse to commonly used drugs make different drug dosages necessary and there is need for rational preventive programs of diet and exercise in an effort to delay or reverse some of these changes.^[8]

MUSCULOSKELETAL PAIN

“Posture like comma looks bad, Posture is important-looks less like a comma and more like an exclamation mark.”

Musculoskeletal disorders are known as minor physical disabilities. The term is used to describe mainly muscles, joints and bones of the body. The severity of MSD can vary. Back pain and muscle spasm are mostly seen due to incorrect seating which affects the cervical spine and neck muscles causing pain

Risk factors: Risk factors for developing musculoskeletal conditions and increasing the likelihood of pain are classified into three categories Age, gender, Health and Lifestyle.

3.Yoga is a therapy that is more than 5000 years old.^[9] The word yoga means “to join or yoke together.” Yoga is seen as a therapy that brings the mind and body into harmony to improve health and the sense of well-being.^[10] Yoga therapy is based on 5 principles: proper relaxation, proper exercise, proper breathing, proper diet, and meditation.^[11] There are several types of yoga, each with a unique style.  

Yoga is a low-impact and moderate-intensity exercise characterized by its slowness, training of core muscles, flexibility, physical coordination, non-competitiveness, and ease of access; therefore, yoga is highly recommended as an exercise program for the elderly to improve their fitness ^{[12, 13, 14]}.

2.Yoga is a promising mind-body practice with four standard components: physical postures, breathing practices, relaxation, and meditative mental focus.^[15] Yoga is recommended by the Arthritis Foundation ^[16] to reduce joint pain, improve flexibility and balance, and decrease stress and tension.

Chair yoga (CY) is practiced sitting in a chair or standing while holding the chair for support ^[17]; it is well suited to older adults who cannot participate in standing yoga or exercise. ^[18,19].

Chair yoga is the term generally used to describe a gentle form of yoga that is practiced sitting in a chair or standing and using a chair for support.^[18] Chair yoga is most often used with elderly persons who require the security of sitting in the chair while they complete the stretching, breathing, and bending exercises that comprise yoga postures.^[18]

Physical activity and regular exercise have been shown to improve balance, prevent falls, and maintain physical function in older individuals.^[20] Physical and social activity has been found to have emotional benefits, such as decreased fear of falling, increased confidence and independence in leaving their residence and partaking in more overall activity.^[21] Given the benefits resulting from daily exercise in older adults, it is crucial to find safe and effective forms of activity.  ^[21]

Chair yoga is a gentle form of yoga that is practiced sitting in a chair or standing and using a chair for support. Chair yoga is appropriate for older adults with OA who are unable to participate in regular standing yoga or other exercise. It is particularly safe to practice, easy to learn, and not likely to lead to falls. It is often used by older adults who need the security of sitting in a chair; it requires less physical strength than a strenuous exercise, and it can be modified to allow frail older adults to practice individually or in groups.

NEED FOR THE STUDY:

Physical fitness is important for all human beings, irrespective of their age. It not only reduces risk of health problems such as obesity, cardio vascular disease and cancer. But also promotes social wellbeing as well as mental health among geriatric population. 

Physical fitness is also body related components of human body. The physical fitness level should be improved in geriatric population to reduce prevalence of obesity and its related problems. Evaluation of fitness test can be utilized to increase the effectiveness of fitness activities in geriatric population that has been incorporated into the physical education program over a period of time.

There are very few studies conducted on chair yoga and there effects on an older adult patients. Among them, some studies confirm the positive effect in patient with flexibility and musculoskeletal pain. The purpose of this study is to evaluate the relationship between the chair yoga and the musculoskeletal pain and flexibility in older adults.

To see awareness of chair yoga in older adults.

RESEARCH QUESTION

Is there any effectiveness of chair yoga on physical fitness parameters in older adults? 

 AIM AND OBJECTIVES

AIM:

To find the effectiveness of chair yoga on physical fitness parameters in older adults.

OBJECTIVES:

To find the effectiveness of chair yoga on flexibility in older adults.

To find the effectiveness of chair yoga on lower limb strength in older adults.

To find the effectiveness of chair yoga on upper limb strength in older adults.

To find the effectiveness of chair yoga on musculoskeletal pain older adults.

To find the effectiveness of chair yoga on cardiovascular endurance in older adults.

HYPOTHESES

Null Hypothesis (H0):

There will not be any significant the effectiveness of chair yoga on physical fitness parameters in older adults.

Alternative Hypothesis (H1):  

There will be significant the effectiveness of chair yoga on physical fitness parameters in older adults.

MATERIAL AND METHODOLOGY

Source of DATA:  Pravara Rural Hospital Loni.

Study setting:  The study will be conducted at department of Community Physiotherapy, Dr. A.P.J Abdul Kalam college of physiotherapy, Loni.

Study Duration: 2 years

Method of collection of data: Data will be collected by the primary investigator.

Type of Data: Quantitative data

Study Design:  RCT experimental study

Sample size: 54

Sampling Method: Simple random sampling

Materials and Equipment’s to be used: 

Consent form

Data collection sheet

Chair 

Stop watch

Pulse oximeter

BP apparatus

Cones 

Measuring tape.

ELIGIBLITY CRITERIA:

Inclusion criteria: 

Þ   Participants with musculoskeletal pain

Þ   Aged 60 years and above.  

Þ   Males and females.

Þ   Pain rating 3-5 VAS

Þ   Consent form

Exclusion criteria:

Participants excluded will be:

Þ   Participants who are not willing to participate in study

Þ   Any recent surgical history.

Þ   Any Autoimmune disease, systemic illness, rheumatic conditions, inflammatory joint disease, tumor, and unhealed fracture and any other spine pathologies)

Þ   Any neurological condition. 

Þ   Psychologically unstable patients. 

OUTCOME MEASURES

Senior fitness test 

The following tests are part of the Senior Fitness Test Protocol, and are designed to test the functional fitness of seniors: 

A. Chair Stand Test — tests lower body strength

Arm Curl Test — tests upper body strength

Chair Sit and Reach Test — lower body flexibility test

Back Scratch Test — upper body flexibility test

8-Foot Up and Go Test — agility test

2-minute step test

PROCEDURE

Protocol is prepared and ethical clearance will be obtained from the IEC.

The Participants will be selected based on the eligibility criteria.

Informed consent will be obtained from the participants and demographic data will be recorded.

Participants will be randomly allocated to 2 groups that is experimental group (n=27) and control group (n=27). Prior assessment of the participants will be done.

Experimental group will be administered with Warm up, chair yoga, cool down along with conventional physiotherapy that and control group will be administered with conventional treatment i.e, Warm up, balance, stretching, cool down.

All the instructions will be given verbally, provided demonstration and guided through a single practice trial of chair yoga.

The participants will be given exercise regimen and administered to perform for 40-45 mins per day for 4 days in a week for 8 weeks.

The pain and disability are measured with Visual Analogue Scale and, senior fitness test, 6 minute walk test.

Statistical analysis will be done and result will be calculated.

 Group A: Experimental group.

INTERVENTION: 

GROUP B

CONVENTIONAL TREATMENT:

Group B: Control group

Will receive conventional treatment. 

REFERENCES

1. Dodds RM, Granic A, Davies K, Kirkwood TB, Jagger C, Sayer AA. Prevalence and incidence of sarcopenia in the very old: findings from the Newcastle 85+ study. J Cachexia Sarcopenia Muscle (2017) 8:229–37. doi:10.1002/jcsm.12157.

2..  Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, et al. Strength, but not muscle mass, is associated with mor- tality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci (2006) 61:72–7. doi:10.1093/gerona/61.1.72

3.  Xue QL, Beamer BA, Chaves PH, Guralnik JM, Fried LP. Heterogeneity in rate of decline in grip, hip, and knee strength and the risk of all-cause mortality: the women’s health and aging study II. J Am Geriatr Soc (2010) 58:2076–84. doi:10.1111/j.1532-5415.2010.03154.x .

4.  Collerton J, Davies K, Jagger C, Kingston A, Bond J, Eccles MP, et al. Health and disease in 85 year olds: baseline findings from the Newcastle 85+ cohort study. BMJ (2009) 339:b4904. doi:10.1136/bmj.b4904

5. Wang JC, Bennett M. Aging and atherosclerosis mechanisms, functional consequences, and potential therapeutics for cellular senescence. Circ Res (2012) 111:245–59. doi:10.1161/CIRCRESAHA.111.261388

6. Alexander RW. Hypertension and the pathogenesis of atherosclerosis. Hypertension (1995) 25:155–61. doi:10.1161/01.HYP.25.2.155

7.  Federal Interagency Forum on Aging-related Statistics. Older Americans 2016: Key Indicators of Well-Being. (2016). Available from: https://agingstats.gov/ docs/LatestReport/Older-Americans-2016-Key-Indicators-of-WellBeing.pdf

8. Gerry r. Boss, md, and j. Edwin seegmiller, md, la jolla, california age related physiological changes and their clinical significance.

9. Gregory PJ, Sperry M, Wilson AF .Dietary supplements for osteoarthritis. Am Fam Physician. 2008;77:177-184.

10. . Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depres- sion: the research evidence. J Affect Disord. 2005;89(1-3):13-24.

11. ABC of Yoga. Information about yoga. http://www.abc-of-yoga.com/. Accessed April 12, 2011.

12. Goldring S.Needs and opportunities in the assessment and treatment of osteoarthritis of the hip and knee: the view of a rheumatologist. J Bone Joint Surg. 2009;91(1):4-6.

13. Williams K, Abildso C, Steinberg L, et al. Evaluation of the effectiveness and efficacy of lyengar yoga therapy on chronic low back pain. Spine. 2009;34(19):2066-2076.

14. Chen K, Fan J, Wang H, Wu S, Li H. Silver yoga exercises improved physical fitness of transitional frail elders. Nurs Res. 2010;59(5):364- 370.

15. Taibi DM, Vitiello MV. A pilot study of gentle yoga for sleep disturbance in women with osteoarthritis. Sleep Med. 2011; 12(5):512–517. [PubMed: 21489869]

16.  Arthritis Foundation. Yoga benefits for arthritis (online). Available at http://www.arthritistoday.org/ what-you-can-do/staying-active/activity-types/index.php.

17. Jerard P. Chair yoga and the mobility of seniors (online). [Accessed January 10, 2016] Available at http://ezinearticles.com/?Chair-Yoga-and-the-Mobility-of-Seniors&id=195911.

18. Park J, McCaffrey R, Newman D, et al. The effect of Sit ‘N’ Fit Chair Yoga among community- dwelling older adults with osteoarthritis. Holistic Nurs Pract. 2014; 28:247–256. 

19. Park J, McCaffrey R. Benefits of participating in chair yoga for community-dwelling older adults with osteoarthritis. J Gerontol Nurs. 2012; 38(5):12–24. 

20. Lord SR, Castell S, Corcoran J, Dayhew J, Matters B, Shan A, et al. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: A randomized, controlled trial. J Am Geriatr Soc 2003;51:1685-92. 

21. Kim S, Lockhart T, Roberto K. The effects of 8-week balance training or weight training: For the elderly on fear of falling measures and social activity levels. Qual Ageing 2009;10:37-48.