Effect of Vinyasa Yoga on Frailty and Anthropometric Measurements in Elderly Individuals

Epidemiological studies and evidence-based practices conducted with the increasing elderly population in the world suggest that active and healthy aging can be achieved by preventing age-related inadequacies and limitations due to changes in negative factors that occur with aging. Active aging is the process of enabling the individual to perform all his/her functions independently and maintaining and protecting his/her health in a physically, psychologically and socially safe environment. In addition, during this period, the person has the opportunity to improve himself while increasing his subjective well-being levels and related quality of life by focusing on his strengths rather than the losses he experiences due to old age.

To date, exercise remains the interventional modality that most consistently provides benefit in the treatment of frailty and its core components. Exercise has physiological effects on almost all organ systems, especially the musculoskeletal, endocrine and immune systems. It is known that supervised exercise programs in healthy and pre-frail elderly individuals have positive effects on their participation in daily life activities while reducing physical fragility. Among frail older adults, exercise and maintaining self-autonomy are particularly important to reduce fall risk and reduce hospitalizations. It is thought that physical activity that includes strength training to maintain or improve muscle mass throughout aging may reduce muscle loss, an important risk factor for frailty. Supervised exercise is recommended as an effective strategy to treat physical frailty. If physical health is not protected, the quality of life of elderly individuals may decrease along with fragility. It has been observed that people who regularly participate in physical activity in older ages have higher levels of life satisfaction and subjective well-being than those who participate irregularly or intermittently. Yoga is a holistic practice that promotes healing through breathing, movement, strength, flexibility and achieving integrity of spirit, body and mind. Being a meditative practice distinguishes yoga from other typical forms of physical exercise, despite having similar metabolic intensity. Since Yoga aims to create the highest possible state of physical, mental and spiritual health, called Samadhi, many therapeutic processes that balance health occur in the process of achieving this goal. Yoga performed regularly has the potential to improve flexibility, balance and muscle strength in older individuals. It is also known that yoga improves cognitive function in the elderly, helps manage chronic conditions, reduces pain due to osteoarthritis, improves sleep, increases subjective well-being and health-related quality of life. It has been observed that yoga-based practices in the elderly also help maintain breathing and pulse rate, reduce high blood pressure and cortisol levels, and this helps repair stress-related autonomic regulatory reflex mechanisms.

Vinyasa yoga, which is formed by combining breathing flows and exercises with a dance-like flow, is defined in Sanskrit as the art of asanas (postures) related to dynamic meditation of the mind with conscious breathing and body synchronization. It also affects many parameters, affecting a person's health and well-being. The harmony between respiratory mechanics and the musculoskeletal system holistically optimizes body functioning, maintaining serenity and stability as emotional and spiritual calmness of the mind is allowed. In order to maintain the internal balance of the body, in vinyasa yoga, asanas are created as a series of flows in which the breath, described as energy transition called pranayama, is circulated throughout the body. During Vinyasa yoga, breathing continues in its natural flow, but completing the breath at the beginning and end of each asana actually ensures the soft connection between each movement. Depending on the difficulty or depth of physical activity, breathing may deepen or become difficult, but the important and ideal thing is to breathe in a regular rhythm through the nose. This situation, combined with the rhythm of mental and intellectual flows, breathing and asanas, emphasizes the vinyasa aspect of yoga. It is thought that the physical, mental and social effects of fragility can be recycled with a modifiable vinyasa yoga flow for elderly individuals. Despite the increasing prevalence of frailty and its high impact on the elderly, the effects of this condition can be reversed and mitigated with interventions. The American College of Sports Medicine (ACSM) recommends at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity for the health benefits of older adults. ACSM recommends moderate to vigorous exercise for cardiovascular health and fitness for healthy adults. In addition, WHO recommends multi-component physical activities that support functional balance and strength exercises at medium or higher intensity, 3 or more days a week, within the weekly physical activities of individuals aged 65 and over, in order to prevent falls and increase functional capacity. Vinyasa yoga has been reported as an alternative moderate-intensity physical activity (50-70% MHR:maximum pulse rate) that meets ACSM criteria and may positively impact cardiovascular health. The metabolic cost of Hatha yoga has been stated to be 2.5 ± 0.8 MET (Metabolic equivalent), corresponding to 49.5 ± 12.2% MHR associated with low-intensity aerobic activity. However, the sequence of sun salutation postures within the typical flow chart of vinyasa yoga has been thought to produce a slightly higher intensity of 2.9 ± 0.77 MET and 54.8 ± 11.8% MHR and may correspond to this when practiced for more than ten minutes . It was also observed that the Hatha yoga practice without Surya Namaskar/sun salutation resulted in approximately 2.07 ± 0.4 MET and 55.98 ± 9.19% MHR, and the sun salutation part corresponded to 3.74 ± 0.70 MET and 66.99 ± 9.99% MHR.

During the healthy aging process, people may need to be guided according to their individual and health characteristics. By supporting this situation with appropriate nursing care, losses can be reduced and optimum health can be maintained. One of the biggest advantages of yoga applied within the scope of nursing care is that the individual's progress is ensured in a controlled manner by preparing a flow in line with appropriate asana selections, taking into account the individual's health condition. Nursing, by its nature, requires a holistic approach to people. Similarly, yoga practice is accepted as a practice that integrates not only physical health but also mind, body and soul.

It is thought that by incorporating the Vinyasa type of yoga, one of the integrative method uses that has just started to participate in the active aging process, into nursing care, it will reduce the exposure of older individuals to risk factors and the positive effects will increase their level of well-being by preventing both multisystemic and multifactorial syndromes. Studies have shown that Vinyasa yoga has a significant effect on transforming negative mood states into positive ones. Physical activity has also been shown to provide mood, emotion and stress reduction benefits.

No studies specifically on vinyasa yoga have been found in the field of nursing. However, when similar holistic practices were examined, Tai-Chi studies were found in the literature for individuals over the age of 60. Yoga, Tai Chi and meditation practices require focus and have been associated with positive changes in brain structure and function, especially in areas related to awareness, attention, executive functions and memory. There are meta-analysis studies showing that Tai-Chi practices have a positive effect on blood pressure by increasing exercise capacity in heart failure patients over the age of 60, and also increase the quality of life by reducing depression.

Since the proposed study has not been found to investigate the effects of vinyasa yoga, which has flows that exercise the musculoskeletal system and also has psychosocial effects, on elderly individuals, it is thought that the data obtained from the research results will contribute to the literature in nursing care by contributing to the active aging process.