Date Presented 04/200/21
Rural-dwelling older adults experience health care disparities and limited access to physical activity programming. The purpose of this study was to examine fall-related outcomes following a 12-week yoga intervention designed for rural older adults. Significant improvements in the Canadian Occupational Performance Measure and MiniBESTest were observed, suggesting that yoga could be an appropriate and accessible strategy for addressing fall prevention and occupational performance in rural-dwelling older adults.
Primary Author and Speaker: Alicia Oestreich
Additional Authors and Speakers: Julia Bieber, Christine Auriemma, Casey Flanigan, Hannah Frolli, Maria McGloin, Meghan O'Brien, Emma Oliver, and Tara Schorr
PURPOSE: Rural-dwelling adults are at an increased risk of falls and fear of falling compared to adults living in larger cities (Cho et al., 2013). This finding is due in part to a lack of access to healthcare, specialty healthcare, and accessible exercise opportunities, all of which contribute to rural older adults often being underserved, especially with regard to fall prevention. Yoga presents a feasible and acceptable (Smith et al., 2017) intervention strategy for this population due to its ability to address balance and fear of falling (Schmid et al., 2012). A pilot test of the 8-week ‘Yoga for Seniors Program' was previously found to show improvement in self-reported falls and balance measures (Hamrick et al., 2017). The purpose of this study was to examine balance and occupational performance outcome measures following a 12-week balance focused yoga intervention for rural-dwelling older adults.
DESIGN: Participants in this experimental crossover study included individuals residing in five rural Wisconsin counties. Recruitment was conducted through local community partners. Inclusion criteria included: 1) over the age of 60; 2) no yoga in the last 6 months; 3) ability to independently ambulate for 10 minutes; and 4) score higher than 18 on the phone version of the Montreal Cognitive Assessment (MOCA).
METHOD: A previously developed 8-week yoga program focused on balance and fall prevention for older adults was adapted and expanded into a 12-week program for this study. Classes were taught by local, certified yoga instructors and were held twice a week for one hour and fifteen minutes. All instructors completed eight hours of program specific training. All classes, mats and blocks were provided free to study participants. Outcome measures included the Mini Balance Evaluation Systems Test (MiniBESTest) to examine changes in balance and the Canadian Occupational Performance Measure (COPM) to assess performance and satisfaction on self-identified occupational performance problem areas.
RESULTS: Preliminary findings from the first 49 individuals show significant improvement from baseline to post-test scores for the MiniBESTest (p < .001) with an overall mean increase of 2 points. Self-identified COPM occupational problem areas varied greatly between participants and communities. Activities related to physical activity, balance and self-care were most frequently listed. COPM Performance and Satisfaction scores for the first three self-identified occupational areas all improved significantly (all p-values < .001), suggesting a significant improvement in occupational performance. Performance scores on self-identified item 4 of the COPM were significantly different from baseline to post-test (p = .027) while differences in Satisfaction scores did not improve significantly (p = .063).
CONCLUSION: This study examined the effectiveness of a 12-week falls prevention yoga program on measures of balance and occupational performance. Improved primary outcome measures from baseline to post-test indicate that the yoga program may have succeeded in addressing balance as well as performance and satisfaction on self-selected occupational performance measures.
IMPACT STATEMENT: Yoga may provide a means to address balance and falls-related concerns as well as occupational performance of rural-dwelling older adults. The results of this study, in combination with the low implementation cost, suggest yoga as a viable means of intervention for rural older adults to address fall prevention, if the limitations due to the lack of properly trained yoga professionals can be addressed.
References
Cho, H., Seol, S. J., Yoon, D. H., Kim, M. J., Choi, B. Y., & Kim, T. (2013). Disparity in the Fear of Falling Between Urban and Rural Residents in Relation With Socio-economic Variables, Health Issues, and Functional Independency. Ann Rehabil Med, 37(6), 848-861. https://doi.org/10.5535/arm.2013.37.6.848
Hamrick, I., Mross, P., Christopher, N., & Smith, P. D. (2017). Yoga’s effect on falls in rural, older adults. Complementary therapies in medicine, 35, 57-63. https://doi.org/10.1016/j.ctim.2017.09.007
Schmid, A. A., Van Puymbroeck, M., Altenburger, P. A., Schalk, N. L., Dierks, T. A., Miller, K. K., . . . Williams, L. S. (2012). Poststroke balance improves with yoga: a pilot study. Stroke, 43(9), 2402-2407. https://doi.org/10.1161/STROKEAHA.112.658211
Smith, P. D., Mross, P., & Christopher, N. (2017). Development of a falls reduction yoga program for older adults-A pilot study. Complementary therapies in medicine, 31, 118-126. https://doi.org/10.1016/j.ctim.2017.01.007
