Sleep quality, depression state, and health status of older adults after silver yoga exercises: Cluster randomized trial

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Abstract

Background

Sleep disturbances, depression, and low perception of health status are commonly seen in elderly population; however, clinicians tend to underestimate or overlook the presence of these symptoms and assume them to be a part of normal aging. Non-pharmacological methods that promote a mind–body interaction should be tested to enhance the mental health of older adults.

Objective

To test the effects of 6 months of silver yoga exercises in promoting the mental health of older adults in senior activity centers, especially their sleep quality, depression, and self-perception of health status.

Settings

Eight senior activity centers, southern Taiwan.

Participants

A sample of 139 participants was recruited, and 128 of them completed the study. Inclusion criteria: (1) community-dwelling older adults ages 60 and over, (2) no previous training in yoga, (3) able to walk without assistance, (4) cognitively alert based on the Short Portable Mental Status Questionnaire (SPMSQ) score of eight or higher, and (5) independent or mildly dependent in self-care based on a Barthel Index (BI) score of 91 or higher. The mean age of the participants was 69.20 ± 6.23 years, and the average number of chronic illness was 0.83 ± 0.90. The average BI score of the participants was 99.92 ± 0.62, and the mean SPMSQ score was 9.90 ± 0.30.

Methods

Participants were randomly assigned into either the experimental (n = 62) or the control (n = 66) group based on attendance at selected senior activity centers. A 70-min silver yoga exercise program was implemented three times per week for 6 months as the intervention for the participants in the experimental group.

Results

Most of the mental health indicators of the participants in the experimental group had significantly improved after the silver yoga interventions, and many of the indicators improved after 3 months of intervention and were maintained throughout the 6 months study. The mental health indicators of the participants in the experimental group were all better than the participants in the control group (all p < .05).

Conclusions

After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.

Introduction

Epidemiologic studies indicate that about 60% of older adults have sleep complaints most of the time (Foley et al., 1995). The three most commonly reported sleep disturbance symptoms include: difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening (Ohayon, 2002). Sleep disturbances in older adults are attributed to inactive life styles, such as repetitive daily routines, lack of physical exercise, and poor sleep practices (e.g., excessive napping, drinking, and smoking) (Foley et al., 2004) that could result in tiredness, fatigue, depression, greater anxiety, irritability, pain sensitivity, muscle tremors, immunosuppression, and lack of daytime alertness (Pandi-Perumal et al., 2002). Clinicians tend to underestimate the presence of these symptoms, especially depression, possibly because depressive symptoms may be assumed to be a part of normal aging and, therefore, are sometimes overlooked (Jackson and Baldwin, 1993). Depression is a costly and potentially disabling condition affecting substantial proportions of older adults. The prevalence of depressive symptoms in the general population is at its lowest during middle age, and then increases throughout late adulthood until reaching its highest level in adults aged 80 years and above (Mirowsky and Rose, 1992). Pharmacological treatment of sleep disorder and depression in older adults is most commonly seen in clinical practice; however, it is associated with hazardous side effects, such as tremor, anxiety, restlessness, drowsiness, dizziness, weakness, and fatigue (Manjunath and Telles, 2005). Non-pharmacological methods that promote a mind–body interaction without side effects should be tested to enhance the mental health of older adults (Lai and Good, 2006).

Yoga, a type of mind–body–spirit exercise, originated in India more than 2000 years ago (Hewitt, 1977). In its original form, yoga has a complex system of spiritual, moral, and physical directives, and the purpose of yoga practice is to attain “spiritual self-realization” (Feuerstein, 1998). Traditional yoga therapy focuses on a holistic treatment for people with various somatic or psychological dysfunctions (Feuerstein, 2000). Through the years, people practiced yoga without knowledge of its spiritual origins (Hewitt, 1977). The goals of yoga therapy are to promote health benefits and self-awareness (Feuerstein, 2000). Yoga is a meditative discipline and is a way of gaining insight into the nature of the mind and reality. The practice of yoga heals and strengthens the body, sharpens the mind, and calms the spirit (Cameron, 2002). As the body, mind, and spirit come into harmony with one another and with the infinite, the person experiences compassion, well being, and inner peace (Cameron, 2002).

Studies of yoga-based interventions performed on healthy populations have shown that yoga decreased depression and anxiety (Pilkington et al., 2005, Waelde and Thompson, 2004, Woolery et al., 2004), decreased stress (Anand, 1999), and improved perceived self-efficacy (Waelde and Thompson, 2004). Wood (1993) further demonstrated that a yogic stretching and breathing program had a markedly invigorating effect on perceptions of both mental and physical energy, and increased mood positively in a group of 71 adults with ages raging from 21 to 76 years. The effects of yoga on mood were examined in 113 psychiatric inpatients; results suggested that yoga was associated with improved mood, and maybe a useful way of reducing stress during inpatient psychiatric treatment (Lavey et al., 2005). Moreover, in a randomized trial on the effects of yoga intervention in 39 patients with lymphoma, the researchers found that participants in the yoga group reported significantly lower sleep disturbances, better subjective sleep quality, faster sleep latency, longer sleep duration, and less use of sleep medications during follow-up compared with participants in the wait-list control group (Cohen et al., 2004). Similar findings were found in Manjunath and Telles (2005): after 6 months of yoga practice, yoga improved different aspects of sleep in a geriatric population. The group showed a significant decrease in the time taken to fall asleep, an increase both in the total number of hours slept and in the feeling of being rested in the morning.

The silver yoga exercise program is a safe and manageable yoga program developed by Chen et al. (2007) to accommodate the reduced body flexibility experienced by many older adults. The program includes four phases: (1) warm-up (20 min): eight postures to loosen up the body structure; (2) hatha yoga (20 min): seven gentle, stretching postures to increase range of motion and progressive muscle relaxation of older adults with special consideration for their physical abilities and tolerance; (3) relaxation (10 min): three activities to rest the body; and (4) guided-imagery meditation (15 min): two imagery-guiding directions to facilitate a state of relaxation. A 5-min break is arranged between the warm-up and hatha yoga phases to accommodate the physical tolerance of older adults; the whole program takes 70 min to complete. Abdominal breathing is emphasized in each phase of the program, and the postures in the silver yoga program are considered to be less strenuous than those used in traditional yoga (Chen et al., 2007). The purpose of this study was to test the effects of a 6-month silver yoga exercise program in promoting the mental health of older adults in senior activity centers, especially sleep quality, depression, and health status. The specific research hypotheses were: (1) the participants’ sleep quality and self-report of health status would improve, and their depression state would decrease after 6 months of regular silver yoga exercises; and (2) the sleep quality and self-reported health status of participants in the experimental group would be significantly better than those participants in the control group; the depression state of participants in the experimental group would be significantly less than those participants in the control group.

Section snippets

Design

A cluster randomized trial was used. Eight senior activity centers were randomly assigned into either the silver yoga experimental group or a wait-list control group. The groups assignment used a black box drawing method, which the names of the eight senior activity centers were written on slips of paper, the slips were folded and placed into a box, and then the slips were blindly drawn. Before intervention started, all of the participants were examined on their sleep quality, depression state,

Participants’ demographic profiles

To enhance the consistency of intervention intensity across the participants, those participants with an attendance rate of 50% or less (n = 2) were screened from the study, which yield a final sample size of 128: experimental group (n = 62) and control group (n = 66). The average age for this sample of 128 older adults was 69.20 ± 6.23 years; most of them were young-older adults whose ages ranged from 60 to 75 years (107/128). The majority of them were females (93/128), married (77/128), lived with

Discussion

Results indicated that most of the mental health indicators of the participants in the experimental group had significantly improved after silver yoga interventions, and many of the indicators improved at the 3-month point in the intervention and were maintained throughout the 6 months of the study. Further, these mental health indicators of the participants in the experimental group were all better than the indicators of the participants in the control group. The improved sleep quality,

Conclusions

Results indicated positive outcomes in applying the silver yoga exercise program to a sample of healthy, community-dwelling, young-older adults. However, the applications of the program should be further examined by including other elderly populations, such as male older adults, an old-older adult population, or transitional frail or frail elders. It is recommended that the silver yoga program be incorporated as an exercise activity in senior activity centers or community-settings to promote

Conflict of interest

None declared.

Funding source

This study was funded by the National Science Council, Taiwan (NSC 95-2314-B-242-004-MY2).

Ethical approval

The study was approved by Fooyin University Internal Review Board.

Acknowledgements

Sincere appreciation is directed by our group to the National Science Council, Taiwan for funding this study (NSC 95-2314-B-242-004-MY2), to Prof. Frank Belcastro for his superlative manuscript editing, to the Social Affairs Bureau of Kaohsiung City Government and the staff of the eight senior activity centers for their support and assistance, and to the 139 wonderful older adults for their generous participation.

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