Yoga may help improve certain frailty markers in inactive older adults

Moderate-certainty evidence shows that yoga improves gait speed, lower-extremity strength, and endurance compared with education or inactive control, a systematic review of 33 studies found, although review authors noted other active interventions may work as well.

Yoga may help improve gait speed and other frailty markers in inactive older adults, a recent systematic review found.

Researchers identified 33 studies totaling 2,384 participants from various populations, including community-dwelling older adults, nursing home residents, and those with chronic disease. Included studies were randomized controlled trials that assessed the effect of yoga-based interventions, including at least one session of physical postures, on any validated measurement of frailty in adults ages 65 years and older. Yoga styles were primarily based on Hatha yoga and most often included Iyengar or chair-based methods. Results were published March 14 by Annals of Internal Medicine.

The review included 10 three-group and 23 two-group trials published in 12 countries from 2006 to 2022. Sample sizes ranged from 17 to 500 participants, and yoga interventions ranged from four to 28 weeks in duration. Only six studies included a follow-up period. No studies assessed the effect of yoga on such validated frailty measures as the Fried frailty phenotype, 5-item FRAIL, Rockwood Frailty Index, or Clinical Frailty Scale. Single-item frailty markers included measures of gait speed, handgrip strength, balance, lower-extremity strength and endurance, and multicomponent physical performance measures. When compared with education or inactive control, yoga improved gait speed and lower-extremity strength and endurance (moderate-certainty evidence), balance and multicomponent physical function measures (low-certainty evidence), and handgrip strength (very low-certainty evidence).

The most notable limitation of the review was heterogeneity in study design, population, and yoga style, the authors noted. They added that sample sizes were small, with 61% of trials including 50 or fewer participants, and that future studies should include validated definitions of frailty as outcomes.

The authors concluded that yoga may affect certain frailty markers that are associated with clinically meaningful outcomes in older adults. “However, yoga may not offer benefit over active interventions like exercise or tai chi,” they wrote. “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.”