Yoga for Bone Health
By Susan Czyzo (Bachelor of Physical Education and Health, Master of Science in Physical Therapy)
When was the last time you saw your parent or grandparent grab an exercise mat and head out the door yelling, “off to yoga class”? Believe it or not, the practice of yoga amongst older adults to build or maintain fitness is growing. Declining bone mass and its potential complications continues to be a main health concern in older adults and an important safety concern with exercise. Is yoga an effective yet safe option for maximizing bone health?
First, a few Boney Facts
- Peak bone mass is reached between the ages of 25 and 30 in most people.
- After approximately 40 years of age, we start to lose bone density as the remodeling process slows, about 0.5% per year.
- Women undergo rapid bone loss through the first few years of menopause, as estrogen levels drop.
Balance
Adequate balance is crucial to the prevention of falls and hence the protection of our ageing bones. From single leg balance poses to double leg standing poses to core strengthening to postural awareness, there are several ways that yoga can positively impact our balance. One RCT compared tai-chi, yoga and general balance training over 12 weeks in older individuals with a history of falling. Yoga was found to be as effective as tai-chi, a popular form of exercise amongst older adults, and standard balance training for improving postural stability, a key component of balance. An RCT by Zettergren et al. (2005) also provides support for the effectiveness of yoga (60 min per week for 4 weeks) in producing changes in balance, as shown by significant improvements in scores on the Tinetti Balance Scale.
Strength
Yoga has been shown to be just as effective as stretching - strengthening in improving balance (single leg balance and 4 square step test), strength (chair stand test and arm curl test), flexibility (back scratch and sit and reach) and mobility. Gothe and McAuley (2016) made this conclusion after comparing a progressive beginner yoga program (8 weeks x 3 sessions per week) led by certified instructors with a stretching - strengthening program led by certified personal trainers. These findings support yoga as an alternate form of exercise for achieving important fitness and functional goals.
Falls and Fear of Falling
Many factors influence our risk of falling. Muscle weakness, previous falls, deconditioning and fear of falling are just a few examples. One recent RCT evaluated the effect of an 8 week yoga intervention (2 days per week) on fear of falling in adults 60-74 years of age. A significant decrease in fear of falling was reported in the yoga group compared to a no intervention control group, as measured by the Modified Falls Efficacy Scale. An additional RCT, comparing tai chi and yoga, found yoga to be superior to tai chi in decreasing the incidence of falls. Saravanakumar and Higgins (2014) compared a bi-weekly, 8 week, 80 min yoga program to a regular exercise routine and found that yoga participants reported being less fearful of falling.
Bone density?
Last but furthest from least, preliminary research has emerged with evidence that yoga can positively impact bone mineral density. A pilot study examined the effect of 10 minute daily yoga routine (10 postures) in subjects with decreased bone density (osteopenia/osteoporosis) over a 2 year period. The results showed a promising trend of improved spinal and hip T-scores. Further study is warranted to improve on the drawbacks hampering this study’s findings, such as the low number of participants and self-selection.
Safety First
Yoga instructors, as well as Pilates instructors, have tremendous opportunity to help their class participants increase muscular strength, improve balance, decrease fear of falling and alter mood on a daily basis. These benefits, of course, only occur if a class is safely geared to its participants. Instructors, as well as those practitioners who recommend yoga or Pilates to their clients, must be aware of important safety considerations surrounding osteopenia/osteoporosis and adapt their classes or recommendations accordingly.
The National Osteoporosis Foundation (USA) presents the following guidelines:
In Yoga: avoid rounding poses, deep twists, deep hip stretches (e.g. pigeon pose), warrior 1 and overpressure from teachers.
In Pilates: avoid rounded spine abdominal work, loaded spinal flexion, deep twists and pressure on the ribcage (e.g., rocking).
Therapeutic Yoga Level 1
Designed for allied health professionals, on this course, you will explore mindfulness and a holistic approach to treatment, learn to design clinically relevant yoga programs and relate scientific evidence to therapeutic yoga.
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Sydney 12-13 Nov 2016
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References
American Academy of Orthopaedic Surgeons. (2012). Healthy bones at every age. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00127
Gothe, N. P., & McAuley, E. (2016). Yoga is as good as stretching-strengthening exercises in improving functional fitness outcomes: results from a randomized controlled trial. Journal of Gerontology: Biological Sciences Medical Sciences, 71(3), 406–411 doi: 10.1093/gerona/glv127
Lu, Y. H., Rosner, B., Chang, G., & Fishman, L. M. (2016). Twelve-minute daily yoga regimen reverses osteoporotic bone loss. Topics in Geriatric Rehabilitation, 32(2), 81-87. doi: 10.1097/TGR.0000000000000085
National Osteoporosis Foundation. (2016). So you want to do Yoga and you have osteoporosis? Retrieved from https://cdn.nof.org/wp-content/uploads/2016/05/Safe-Yoga-NOF-Flyer-2016.pdf
National Osteoporosis Foundation. (2016). So you want to do Pilates and you have osteoporosis? Retrieved from https://cdn.nof.org/wp-content/uploads/2016/06/Safe-Pilates_NOF-Flyer_BETZ.pdf
Ni, M., Mooney, K., Richards, L., Balachandran, A., Sun, M., Harriell, K. et al. (2014). Comparative impacts of tai-chi, balance training, and a specially designed yoga program on balance in older adults. Archives of Physical Medicine and Rehabilitation 95(9), 1620-28.
Nick, N., Petramfar, P., Ghodsbin, F., Keshavarzi, S., & Jahanbin, I. (2016). The effect of yoga on balance and fear of falling in older adults. Physical Medicine and Rehabilitation, 8(2), 145-151. doi: 10.1016/j.pmrj.2015.06.442
Saravanakumar, P., Higgins, I. J., Van Der Riet, P. J., Marquez, J., & Sibbritt, D. (2014).The influence of tai-chi and yoga on balance and falls in a residential care setting: a randomized control trial. Contemporary Nurse 48(1), 5231-55. doi: 10.5172/conu.2014.5231
Zettergren, K. K., Moriarty, E., & Zabel, A. (2005). The effectiveness of therapeutic yoga on community dwelling older adults with and without balance deficits. Journal of Neurologic Physical Therapy 29(4), 216. doi: 10.1016/j.apmr.2014.04.022
