Yoga confers some benefits for frailty

For older adults, yoga improved lower extremity strength and gait speed, but it did not appear to offer more benefits for frailty markers than other forms of exercise, according to a study published in Annals of Internal Medicine.

“Frailty, a geriatric syndrome of decreased functioning across several physiologic systems, is accompanied by increased vulnerability to stressors and increased morbidity and mortality,” Julia Loewenthal, MD, a geriatrician at Brigham and Women’s Hospital and an instructor at Harvard Medical School, and colleagues wrote. “Up to 50% of adults aged 80 years or older are estimated to be frail. Frailty prevention and management are high-priority areas in public health and clinical practice.”

The researchers wrote that, as a multicomponent mind-body practice that improves various domains of physical and psychological health, yoga might prevent frailty. They conducted a systematic review to evaluate the available evidence on how yoga-based interventions affect frailty in older adults.

Loewenthal and colleagues assessed 33 studies with 2,384 participants in various populations, including community dwellers, nursing home residents and those who have chronic diseases. The yoga styles most often included Iyengar or chair-based methods and were primarily based on Hatha yoga, which incorporates posture, breathing and meditation.

The single-item frailty markers were:

• balance;
• handgrip strength;
• lower-extremity strength and endurance;
• measures of gait speed; and
• multicomponent physical performance measures.

“We included frailty markers that are related to clinically meaningful outcomes, although these are only intermediate measures,” the researchers wrote.

Loewenthal and colleagues found that yoga might impact frailty markers linked to “clinically meaningful outcomes in older adult populations,” but may not be better than active interventions like exercise — findings that align with previous research, they wrote.

More specifically, compared with education or inactive control, there was moderate-certainty evidence that yoga improved gait speed along with lower-extremity strength and endurance.

“Trials that evaluated the effect of Iyengar yoga, frequently offered for older adults because of customizability, had more clinically meaningful improvements in gait speed,” Loewenthal and colleagues wrote. “However, given the heterogeneity of yoga interventions included in this review, it was not possible to further differentiate the effects of different elements.”

There was also low-certainty evidence for multicomponent physical function measures and balance and very low-certainty evidence for handgrip strength.

“On the basis of this review, yoga does not seem to offer benefit for frailty markers over active controls like exercise or tai chi,” the researchers wrote.

They added that, though the included frailty markers are objective measures and linked to clinically meaningful outcomes in older adults, future research “should include validated definitions of frailty as outcomes.”

“Although there was no clear advantage for a particular style of yoga, clinicians may consider recommending Iyengar-based styles, with a home practice, that can be customized for older adult populations,” they wrote. “This work adds to growing literature that yoga plays a role in healthy aging and frailty prevention.”