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The Impact of a Short-Term Iyengar Yoga Program on the Health and Well-
Being of Physically Inactive Older Adults

Article  in  International Journal of Yoga Therapy · September 2011

DOI: 10.17761/ijyt.21.1.e15852u665l710r1 · Source: PubMed

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 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011) 61

Research
The Impact of a Short-Term Iyengar Yoga Program on the
Health and Well-Being of Physically Inactive Older Adults
Juliane Vogler, MSc, Lily O’Hara, MPH, Jane Gregg, MHP,
Fiona Burnell, PhD
University of the Sunshine Coast, QLD, Australia

Abstract: Background: With the current challenge of rapidly aging populations, practices such as yoga may help older
adults stay physically active, healthy, and fulfilled. Methods: The impact of an 8-week Iyengar yoga program on the
holistic health and well-being of physically inactive people aged 55 years and over was assessed. Thirty-eight older
adults (mean age 73.21 ± 8.38 years; 19 intervention, 19 control) engaged in either twice-weekly yoga classes or con-
tinued their usual daily routines. Physical health measures were muscle strength, active range of motion, respiratory
function (FEV1), resting blood pressure, and immune function (salivary IgA and lysozyme). Self-perceived general,
physical, mental, spiritual, and social health and well-being were assessed with the Life’s Odyssey Questionnaire and
the SF12v2™ Health Survey. Results: Muscle strength, active range of motion, physical well-being, and aspects of
mental well-being (emotional well-being and self-care) improved significantly in the yoga group (p < .05). Median
changes in most of these variables were also significantly different from those in the control group. Conclusions:
Participation in Iyengar yoga programs by older people is beneficial for health and well-being, and greater availability
of such programs could improve quality of life.

Key words: yoga, older adults, aging, well-being, health, fitness, physical activity, mind-body therapy

Correspondence: Lily O’Hara, Health Authority Abu Dhabi, PO Box 5674, Abu Dhabi, United Arab Emirates.
Tel: +971 2 4193 251. lohara@haad.ae.

Background
As the populations in Western countries rapidly age,1
attention is being focused on practices and lifestyle changes
that allow people to live extended physically active, healthy,
and fulfilled lives. Significant physical changes occur on a
physical level as people age: muscle strength and joint flex-
ibility decrease, and the function of the endocrine, nervous,
pulmonary, cardiovascular, and immune systems declines.2-6
Vaillant’s7 Model of Aging Well offers additional indicators
of health and well-being among older adults: nondisability at
the age of 75 years, good subjective physical health, positive

Acknowledgments: This study was funded by the University of the Sunshine Coast, QLD, Australia. The authors ac-
knowledge Dr. Leigh Findlay for editorial assistance with the manuscript. The authors also acknowledge the support of
the management and residents at the retirement village in which the study was conducted. Thank you to the anonymous
reviewers of the paper; their comments and suggestions have strengthened it considerably.
62 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)
mental health, social support, and life satisfaction. Similarly,
the World Health Organization1 defines health (at any age) as
a state of physical, mental, and social well-being, rather than
merely the absence of disease or infirmity. This definition is
consistent with the holistic approach to health and well-being,
which focuses on the whole person. Holistic health and well-
being are now regarded as including physical, mental, social,
and spiritual dimensions by an increasing number of practi-
tioners,8,9 and Aldwin and Gilmer10 proposed that spiritual
well-being is also important in healthy aging.
The practice of yoga is traditionally considered to be ben-
eficial to holistic health and well-being.11,12 In the Iyengar yoga
tradition, developed by B.K.S. Iyengar, over 200 postures and
breathing techniques are used to align physical, emotional,
mental, and spiritual aspects of being, in order to promote
holistic health and well-being.11 According to Iyengar yoga
philosophy, changes in the physical body and health are ex-
pected in the early stages of an Iyengar yoga program.11 The
more time spent in practice, the greater the potential to influ-
ence mental, spiritual, and social well-being.
An advantage of yoga is that it can be practiced by ev-
eryone, regardless of age, illness, or infirmity.13 The recom-
mendations for yoga practice differ according to the stage of
life; adults are recommended postures to maintain physical
health, which in turn supports mental and emotional well-
being; practice for older adults focuses on breathing prac-
tices and physical strengthening to protect against fragility
and debility.12
Research on the impact of yoga on health and well-being
has primarily focused on its effects on physical and mental
health and well-being, and numerous studies have demon-
strated significant benefits.14-20 Research on the impact of yoga
in older people has shown improvements in osteoarthritis,17
age-related changes in gait,21 cognition and quality of life,22
sense of coherence,23 and depression.24 For example, a pilot
study involving an 8-week intervention with once-weekly
classes and no home practice showed a 39% decline in stiff-
ness when using Iyengar yoga to treat osteoarthritic symptoms
of the knee.17 Another study that assessed changes in gait in
the elderly after an 8-week Iyengar yoga program found im-
provements in peak hip extension, stride length, and aver-
age anterior pelvic tilt.21 Improvements in flexibility, balance,
and coordination are particularly important for older people,
as this can reduce the risk of falls. However, there is limited
research on the impact of yoga on the social or spiritual di-
mensions of health and well-being in older adults. Therefore,
the aim of this study was to assess the impact of a short-term
Iyengar yoga program on the holistic health and well-being of
physically inactive people aged 55 years and over.
Methods
Participants
Forty participants were recruited from a single retire-
ment resort in the Sunshine Coast, Queensland, Australia.
Residence at the retirement resort is completely voluntary
and is not associated with impairment or need for assisted
living. Retirement resorts are popular with older adults, as
they provide a living environment tailored to their housing,
entertainment, social, and transportation needs. Residents
who were aged 55 years or over, new to Iyengar yoga, and
physically inactive were invited to participate in the study.
Physical inactivity was defined as participating in less than
30 minutes of moderate physical activity per day.25
An invitation letter was distributed to all residents
through the resort’s internal mail system that informed them
about the project and invited them to attend an information
session about the research project. Participants could volun-
teer for the project at any time up to the start of the pre-pro-
gram testing. There was no pressure or expectation placed
on residents to volunteer for the study. The University of
the Sunshine Coast Human Research Ethics Committee ap-
proved this research, and all participants signed an informed
consent form.
Study Design and Yoga Program
Participants were randomly assigned to either a yoga
group or a wait-list control group, each with 20 participants.
The yoga intervention consisted of an 8-week Iyengar yoga
program, taught by an internationally certified Iyengar yoga
instructor. Participants attended two 90-minute group-based
yoga classes per week and were asked to engage in at least 15
to 20 minutes of home practice on 3 other days each week.
Yoga classes for the intervention (yoga) group consisted of a
maximum of 10 participants to ensure adequate individual
attention and personal safety.
The Iyengar yoga program included the yoga postures
listed in Table 1. Detailed explanations of these asanas in
the Iyengar tradition are provided elsewhere.11,12 Asanas were
gradually introduced to the participants of the yoga group
and, depending on their needs and limitations, modified
and supported with appropriate aids such as belts, blankets,
blocks, bolsters, chairs, and the walls.
Before and after class, there was opportunity for queries
and feedback. At the end of each class, general suggestions
for all aspects of home practice were given. These sugges-
tions were not individualized, nor were any written or
graphic materials provided. Participants were encouraged
to explore and practice their preferred postures and those
 YOGA FOR INACTIVE OLDER ADULTS 63

that they perceived as beneficial. Participants in the control
group were asked to continue with their usual lifestyles and
not to change their physical activity pattern or to engage
in new exercises or physical activity over the intervention
period. After the completion of the intervention period and
outcome measurement, a similar 8-week Iyengar yoga pro-
gram was provided for control group participants.
Outcome Measures
Both the yoga program and all assessments took place
at the retirement resort where the participants lived. An ex-
ercise physiologist administered all the tests to both groups
before and after the intervention. All participants completed
the tests in the same sequence before and after the inter-
vention. Each testing session took approximately one hour.
Various dimensions of holistic health and well-being were
assessed with a combination of noninvasive tests for physical
health indicators and two questionnaires to assess self-per-
ceived general, physical, mental, spiritual, and social health
and well-being: the Medical Outcomes Study Short Form
12 Health Survey Version 2 (SF-12v2™)26 and Life’s Odyssey
Questionnaire.27 The SF-12 is a widely used health-related
questionnaire and has been validated for use in an older
population.28 It assesses 8 domains of functional health sta-
tus: physical functioning; role limitations because of physi-
cal health problems; bodily pain; general health perceptions;

Posture (prop) English translation

Tadasana Mountain pose
Ardha Uttanasana Half-standing forward-bend pose
Adho Mukha Svanasana Downward-facing dog pose
Utthita Hasta Padangusthasana I & II Extended hand-to-big-toe pose I & II
Vrksasana Tree pose
Utthita Trikonasana Extended triangle pose
Virabhadrasana II Warrior pose II
Ardha Chandrasana Half-moon pose
Swastikasana Auspicious pose
Upavistha Konasana Seated wide-angle pose
Baddha Konasana Bound-angle pose
Bharadvajasana (chair) Seated twist pose
Ardha Gomukhasana Half cow-face pose
Parvatasana (chair) Daughter of the mountain pose
Namaskar/ Prstha Namaskar Salutation pose / Back salutation pose
Supta Tadasana Reclining mountain pose
Supta Padangusthasana I & II Reclining big-toe pose I & II
Viparita Karani Waterfall (legs-up-the wall) pose
Urdhva Prasarita Padasana Upward extended foot pose
Utthita Marichyasana (chair/ wall) Extended Marichi’s pose
Jathara Parivartanasana Supine bent-knee twist
Pavanamuktasana I (chair) Wind-releasing pose
Supta Baddha Konasana (big bolster) Reclining bound-angle pose
Purvottanasana II (chair) Intense stretch to the east pose II
Savasana (variations) Relaxed supine posture
Table 1. Postures in Iyengar yoga intervention. When a posture was always practiced with a prop, the prop is provided in parentheses.
64 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)
vitality (energy/fatigue); social functioning; role limitations
because of emotional problems; and general mental health
(psychological distress and psychological well-being). The
Life’s Odyssey Questionnaire, a commercially developed
self-report instrument, assesses 7 domains: physical well-
being; life, health and attitude; emotional well-being; self-
care; purpose and meaning; social connectedness; and rest,
pleasure, and play. Validation studies for the Life’s Odyssey
Questionnaire have not been published, but it has been used
in many thousands of participants over a 10-year period.27
General Health and Well-Being. General health and well-
being were assessed with the first question of the SF-12v2,
“In general, how would you rate your health?” Responses to
the question are scored on a 5-point scale from “Excellent”
to “Poor.”
Physical Health and Well-Being. Self-perceived physi-
cal health and well-being was assessed with the Physical
Component Summary of the SF-12v2™26 and the Physical
Well-Being subscale of the Life’s Odyssey Questionnaire.27
The Physical Component Summary (PCS) was computed
from the eight domains of general health status assessed by
the SF-12v2. The PCS was transformed for comparison,
with a mean score of 50 and a standard deviation of 10 in the
general U.S. population.25 The Physical Well-Being subscale
score was computed from the Life’s Odyssey questionnaire:
the scores for the 10 items in the subscale were summed
to create a subscale summary raw score; the subscale sum-
mary raw score was then transformed to a scale of 0 to 100
using the formula [(actual value – minimum possible value)
/ range] x 100.27
Physical Function. Muscle strength of major muscle
groups was assessed using manual muscle testing.29 Muscle
strength tests were conducted for the groups of muscles
responsible for hip flexion and abduction, knee extension,
shoulder flexion and abduction, and trunk rotation and ex-
tension, with possible scores from Grade 3- to Grade 5. The
scores equate to: Grade 3-, movement through the complete
test range in a gravity-eliminated position; Grade 3, move-
ment through the complete test range against gravity; Grade
3+, movement through the complete test range against grav-
ity and additional minimum resistance; Grade 4, movement
through the complete test range against gravity and addi-
tional moderate resistance; Grade 5, movement through the
complete test range against gravity and additional maximum
resistance.29 Participants’ scores for the set of strength tests
were summed and then transformed using the formula [(ac-
tual value – minimum possible value) / range] x 100. This
transformation provided a value for overall muscle strength
on a scale of 0 to 100, allowing comparison of results.
Active range of motion (aROM) was measured for the
upper extremity, hip flexion, hip extension, hip abduction,
and trunk rotation. A general scan for the range of motion
in joints of the upper extremity was undertaken by the
technique of “placing hands behind the back.”29 The tech-
nique assesses scapular, shoulder, and elbow movements in
a complex way and reveals the flexibility of the entire shoul-
der girdle. Hip flexion, hip extension, hip abduction, and
trunk rotation were measured with a universal goniometer.
In order to determine an active range of motion, the in-
dividual performs each movement unassisted, within their
personal range of ability. For measurements of hip flexion,
hip extension, and hip abduction, the neutral zero method
was used, in which the goniometer is placed lateral to the
joint. The stationary arm of the goniometer lies parallel to
the longitudinal axis of the proximal joint segment, and the
moveable arm lies, and then moves, parallel to the moving
distal segment of the joint.29,30 Trunk rotation was measured
from the top in degrees from zero position. The pivot point
of the goniometer was placed over the top of the center
of the skull and the stationary arm of the goniometer was
held in zero position, while the moveable arm was moved
with the shoulder to the side in the direction that the indi-
vidual was turning; the acromion was used as the reference
point. Participants’ measurements for the aROM for the left
and right sides of the body were summed to generate five
variables: aROM upper extremity, aROM trunk rotation,
aROM hip flexion, aROM hip abduction, and aROM hip
extension.
Physiological Measurements. Resting systolic and dia-
stolic blood pressures were measured in all participants on
the left upper arm by the auscultation method.31 The mea-
surement was taken once at the start of each testing session.
Respiratory function was assessed via forced expiratory
volume in one second (FEV1) using a Spiro II spirometer
(Medical International Research, Waukesha, WI, USA).
Three successive measurements of FEV1 were taken with
participants in the standing position. Between each mea-
surement, participants were asked to take several normal
breaths at a resting pace.31,32 Mean FEV1 was calculated from
the three measurements. Immune function was assessed
by testing for secretory IgA (SIgA) and lysozyme in saliva.
Saliva samples were collected using Salivette® cotton swabs
(Salimetrics, State College, USA). Participants were asked
not to eat or drink for one hour before the saliva collection.
For collection, participants were asked to chew the cotton
swab for at least one minute. The samples were kept cool
after collection, then centrifuged at 1000 x g for 2 minutes,
and stored at -20 ºC. The SIgA concentration was measured
 YOGA FOR INACTIVE OLDER ADULTS 65

Yoga Group Control Group

Characteristic Median (Min-Max) Median (Min-Max)
[n = 19] [n = 19]

Age (years) 76 (66-86) 72 (56-94)

Overall Muscle Strength (%) 53.9 (34.6-71.2) 59.6 (36.5-80.8)

aROM* Upper Extremities (cm) † 28 (0-90) 20 (0-77)

aROM Trunk Rotation (0) 20 (0-42) 24 (4-80)

aROM Hip Flexion (0) 198 (128-226) 210 (158-280)

aROM Hip Abduction (0) 56 (32-80) 58 (28-100)

aROM Hip Extension (0) 11 (0-20) 16 (0-28)

FEV1‡ (L) 1.57 (0.66-2.40) 1.87 (0.78-3.74)

Systolic Blood Pressure (mm Hg) 140 (110-164) 130 (98-160)

Diastolic Blood Pressure (mm Hg) 76 (60-85) 78 (60-96)

Salivary IgA (μg/mL) 894 (182-6351) 843 (147-10130)

Salivary lysozyme (ng/mL) 1078 (194-33500) 2028 (424-5926)

Life & Health Attitudes (scale 0-100) 75.0 (55.0-100.0) 77.5 (37.5-95.0)

Social Connectedness (scale 0-100) 67.5 (35.0-95.0) 70.0 (50.0-100.0)

Emotional Well-Being (scale 0-100) 72.5 (20.0-90.0) 65.0 (40.0-80.0)

Physical Well-Being (scale 0-100) 72.5 (35.0-85.0) 65.0 (32.5-87.5)

Rest, Pleasure & Play (scale 0-100) 77.5 (55.0-95.0) 80.0 (52.5-100)

Purpose & Meaning (scale 0-100) 62.5 (37.5-95.0) 67.5 (42.5-97.5)

Self-Care (scale 0-100) 81.3 (45.0-100.0) 77.5 (45-87.5)

Physical Functioning (scale 0-100) 18.8 (0-50) § 37.5 (0-50)

Role Physical (scale 0-100) 50 (25-100) 75 (25-100)

Table 2. Baseline characteristics of participants before the yoga intervention. (continued on page 66.)
66 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)

Yoga Group Control Group

Characteristic Median (Min-Max) Median (Min-Max)
[n = 19] [n = 19]

Bodily Pain (scale 0-100) 75 (25-100) 75 (25-100)

General Health (scale 0-100) 60 (25-100) 60 (25-85)

Vitality (scale 0-100) 50 (25-75) 50 (0-100)

Social Functioning (scale 0-100) 75 (0-100) 100 (50-100)

Role Emotional (scale 0-100) 75 (25-100) 75 (50-100)

Mental Health (scale 0-100) 62.5 (50-87.5) § 75 (62.5-100)

Physical Component Summary (scale 0-100) 40.1 (20.8-63.9) 43.6 (25.8-53.8)

Mental Component Summary (scale 0-100) 49.1 (31.0-62.2) 53.4 (45.9-68.5)

* = Active range of motion; † = Sum of both sides, smaller value indicates greater flexibility; ‡ = Forced Expiratory
Volume in one second; § = significantly different from control value by Mann-Whitney test (p < 0.05).

Table 2 (continued). Baseline characteristics of participants before the yoga intervention.

with Salivary Secretory IgA Indirect Enzyme Immunoassay
kits (Salimetrics, State College, USA), according to the man-
ufacturer’s instructions. Salivary lysozyme concentration was
measured with the Human Lysozyme EIA Kit (Biomedical
Technologies Inc., Stoughton, USA), according to the man-
ufacturer’s instructions. All samples were tested in duplicate
using a VERSAmax™ micro-plate reader (Molecular Devices,
Sunnyvale, USA) and SOFTmax PRO software (Version
3.1.2[2]). Within-sample coefficients of variation were cal-
culated and were all within acceptable limits.
Mental Health and Well-Being. Mental health and
well-being was assessed with four measures: the Mental
Component Summary (MCS) of the SF-12v2;26 and three
subscales of the Life’s Odyssey Questionnaire (Life, Health
and Attitude; Emotional Well-Being; and Self-Care).27 The
MCS was computed from the eight domains of general
health status assessed by the SF-12v2 and transformed as
described above for the PCS.26 Transformed summary scores
for each of the subscales of the Life’s Odyssey Questionnaire
were calculated via the method described above for the
Physical Health and Well-Being subscale.
Spiritual Health and Well-Being. Spiritual health and
well-being was assessed with the Purpose and Meaning sub-
scale of the Life’s Odyssey Questionnaire.27 The transformed
summary score for this subscale was also calculated via the
method described above for the Physical Health and Well-
Being subscale.
Social Health and Well-Being. Social health and well-
being was assessed with two of the Life’s Odyssey subscales:
Social Connectedness; and Rest, Pleasure, and Play.27
Transformed summary scores for each of these subscales
were calculated as above.
Statistical Analysis
Data were analyzed with SPSS Version 14.0 (SPSS Inc.,
Chicago, USA). The distribution of data for each variable at
baseline was assessed for normality using the Kolmogorov-
Smirnov test.33 Because not all the baseline data were normally
distributed, medians for each outcome measure were calculated
for both groups and all data were analyzed with non-parametric
statistical tests. The Wilcoxon signed-rank test was used within
each group to assess differences between baseline and end-of-
study medians for each variable. The median changes in each
variable over the 8-week period were calculated for the yoga
and control groups and compared using the Mann-Whitney
test.33 The level for significance was set at p < 0.05.
 YOGA FOR INACTIVE OLDER ADULTS 67

Yoga Group (n = 19) Control Group (n = 19)

Variable
Median Median Median Median
Median Median
before after in- before after in-
change change
intervention tervention intervention tervention
(Min-Max) (Min-Max)
(Min-Max) (Min-Max) (Min-Max) (Min-Max)

Overall Muscle 53.9 (34.6- 67.3* (50.0- 11.5† (0- 59.6 55.8 (38.5- -1.9 (-11.5-
Strength (%) 71.25) 76.9) 34.6) (36.5- 80.8) 75.0) 3.9)
aROM‡ Upper 28 (0-90) 14.00* (0-59) -7† (-33-0) 20 (0-77) 20 (0-46) 0 (-32-8)
Extremities (cm)§
aROM Trunk 20 (0-42) 42* (4-80) 16† (0-60) 24 (4-80) 12* (4-60) -4 (-36-10)
Rotation (0)
aROM Hip Flexion 198 (128- 212* (180- 10 (-18-72) 210 (158- 208 (178- 0 (-34-60)
(0) 226) 248) 280) 296)
aROM Hip 56 (32-80) 70* (40-92) 16† (-8-36) 58 (28-100) 56 (20-100) -2 (-36-18)
Abduction (0)
aROM Hip 11 (0-20) 20* (0-20) 4† (-4-12) 16 (0-28) 16 (0-20) 0 (-16-8)
Extension (0)
Systolic Blood 140 (110- 138 (110- -2 (-34-20) 130 (98-160) 128 (102- -2 (-42-28)
Pressure (mm Hg) 164) 160) 150)
Diastolic Blood 76 (60-85) 78 (60-94) 0 (-8-14) 78 (60-96) 78 (60-86) 0 (-20-18)
Pressure (mm Hg)
FEV1II (L) 1.57 (0.66- 1.59 (0.85- 0.11 (-0.25- 1.87 (0.78- 2.01* (0.79- 0.13 (-0.16-
2.40) 2.55) 0.50) 3.74) 3.81) 0.84)
Salivary IgA 894 (182- 1174 (283- -194 (-4177- 843 (147- 857 (75- -99 (-7511-
(μg/mL) 6351) 3022) 1852) 0130) 3324) 2481)
Salivary lysozyme 1078 1214 (575- -26 (-25978- 2028 (424- 1570 (448- 111 (-48110
(ng/mL) (194- 33500) 10926) 4440) 5926) 7816) -3771)
Physical Well-Being 62.5 (30- 72.5* (35-85) 8.75 (-10-25) 65 (32.5- 70 (22.5- 2.5 (-32.5-
82.5) 87.5) 92.5) 27.5)
Physical 40.1 (20.8- 42.5 (27.5- 0.2 (-14.6- 43.6 (25.8- 45.1 (17.4- 1.8 (-8.41-
Component 63.9) 59.2) 17.5) 53.8) 58.9) 10.66)
Summary
* = Significant difference within groups before and after intervention by Wilcoxon signed rank test (p < 0.05); † =
Significantly different from control value by Mann-Whitney test (p < 0.05); ‡ = Active range of motion; § = Sum of
both sides, smaller value indicates greater flexibility; II = Forced Expiratory Volume in one second.

Table 3. Outcome measure scores for physical health and well-being within and between intervention (yoga) and control groups.
68 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)
Results
Between-Groups Baseline Comparison
Forty eligible people registered to participate in the re-
search project. One participant from the yoga group with-
drew after week 3 of the intervention, because the program
did not meet her expectations, and one participant from the
control group withdrew due to illness during the testing pe-
riod after the intervention; an attrition rate of 5% for each
group. Data were collected at baseline and after the study
period from 38 participants (32 women and 6 men). Sex
distribution was evenly spread across the yoga and control
groups, with 16 women and 3 men in each group. Individual
participants in the yoga group attended between 10 and 16
classes (average 14 classes). Home practice varied from never
to daily (average 3 times per week).
While the yoga and control groups were similar at base-
line for most characteristics (Table 2), the yoga group scored
significantly lower on two of the domains of the SF12 v2,
Physical Functioning (p = 0.01) and Mental Health (p =
0.001; Table 2).
Comparison of Outcome Scores Within and
Between Groups
There was no significant change in General Health and
Well-Being in either the yoga group (p = 0.31) or the control
group (p = 0.60) at the end of the 8-week period, as measured
by the single test item. There was, however, a significant im-
provement in the Physical Well-Being subscale of the Life’s
Odyssey Questionnaire in the yoga group (p = .003, Table 3).
No significant changes in the Physical Component Summary
of the SF-12v2 occurred within either of the groups.
There were significant changes in a number of the mea-
sures of physical function within the yoga group (Table 2):
median overall muscle strength increased by 12% in the yoga
group (p = 0.001), but did not change significantly in the
control group; median active range of motion for the upper
extremities (p = 0.001) and hip flexion (p = 0.008) both
improved in the yoga group, but remained unchanged in
the control group; median active range of motion for trunk
rotation improved significantly in the yoga group (p = .001)
and decreased significantly in the control group (p = .01);
significant positive changes in median hip abduction (p =
.001) and hip extension (p = .003) were observed within the
yoga group. In addition, the median changes in all of these
variables were significantly different between the groups, ex-
cept for the median change in hip flexion.
There were no significant changes in systolic or diastolic
blood pressure for either the yoga or control groups (Table 3).
There was a statistically significant improvement of 0.13 L
in the median FEV1 within the control group (p = .014),
but not within the yoga group. The difference in the me-
dian change between the groups was not significant (Table
3). There were also no significant changes in salivary IgA or
lysozyme levels for either the yoga or control groups.
A significant improvement in Emotional Well-Being (p
= .04) and Self-Care (p = .001) occurred in the yoga group
(Table 4), but the median change was not significantly dif-
ferent from the control group for either of these outcome
measures. There were no significant changes in any of the
other mental, spiritual, or social health and well-being out-
come measures (Table 4).
Discussion
The results of this study suggest that participation in
a short-term Iyengar yoga program by physically inactive
people aged 55 years and over may result in improvements
in health and well-being. Significant improvements in phys-
ical health and well-being were evident in overall muscle
strength and active range of motion in the upper extremi-
ties, trunk, and hip. For beginners, the performance of yoga
postures often results in an increase in flexibility, particularly
when a poor physiological range of motion preexists.11
These findings are consistent with other research using
Iyengar yoga interventions that demonstrated improvements
to musculoskeletal health.17,21 Participants in the yoga group
in this study had significant improvement in trunk rota-
tion, which may be associated with enhanced spinal joint
movement, a factor that has been described as fundamental
to intervertebral disc nutrition during the aging process.34
In contrast, participants in the control group significantly
deteriorated in trunk rotation over the 8 weeks, raising con-
cern that deterioration in flexibility can occur rapidly in the
absence of physical activity.
The short-term yoga program did not result in signifi-
cant changes to resting blood pressure, a similar finding to a
recent 10-week study of Hatha yoga and muscle relaxation
classes.18 In contrast, long-term studies of yoga programs
have demonstrated significant improvements in blood pres-
sure. For example, a study of a stress-reduction program that
included relaxation, meditation, and gentle yoga14 showed
a decline in mean systolic blood pressure of participants at
12 months, compared to initial measurements. More time
and practice may be required to influence this physiological
outcome. Similarly, the yoga program also had no impact
on lung function as measured by FEV1. This finding is con-
sistent with that of Sabina and colleagues,35 who found no
effects from a 4-week Iyengar yoga program in participants
 YOGA FOR INACTIVE OLDER ADULTS 69

Yoga Group (n = 19) Control Group (n = 19)

Variable
Median Median Median Median
Median Median
before after in- before after in-
change change
intervention tervention intervention tervention
(Min-Max) (Min-Max)
(Min-Max) (Min-Max) (Min-Max) (Min-Max)
Life & Health 75 (62.5- 77.5 (37.5- 87.5 (52.5-
75 (55-100) 2.5 (-20-20) 5 (-15-22.5)
Attitudes 100) 95) 95)

Social 7.5 (-22.5- 2.5 (-22.5-

67.5 (35-95) 70 (50-92.5) 70 (50-100) 75 (57.5-95)
Connectedness 20) 30)

Emotional Well- 77.5 * (42.5- 65 (32.5-

72.5 (20-90) 5 (-30-35) 65 (40-80) -2.5 (-25-45)
Being 87.5) 100)

Rest, Pleasure & 80 (52.5- 750 (37.5-

77.5 (55-95) 77.5 (60-95) 5 (-22.5-25) 0 (-22.5-25)
Play 100) 100)

62.5 (37.5- 75 (42.5- 5 (-12.5- 67.5 (42.5- 72.5 (37.5-

Purpose & Meaning 0 (-17.5-20)
95) 100) 42.5) 97.5) 97.5)

81.3 (45- 92.5 * (50- 77.5 (45-

Self-Care 5 (-5-32.5) 76.3 (50-95) 0 (-20-20)
100) 100) 87.5)

Mental Component 49.1 (31- 53.7 (41.7- 1.3 (-12.7- 53.4 (45.9- 54.8 (34.8- 0.5 (-18.9-
Summary 62.2) 65.6) 20.3) 68.5) 63.8) 10.1)

* = Significant difference within group before and after intervention by Wilcoxon signed rank test (p < 0.05)

Table 4. Outcome measure scores for mental, spiritual, and social health and well-being within and between intervention (yoga)
and control groups.
with mild to moderate asthma. Although performing the
postures facilitates breathing, in the Iyengar yoga tradition,
most breathing techniques are introduced at a later stage.
Therefore, further long-term studies are suggested to inves-
tigate the possible effect of Iyengar yoga on FEV1 or other
respiratory functions once advanced breathing techniques
have been appropriately introduced.
In addition, there were no significant effects of the yoga
program on immune function in this study. High variability
was observed in salivary lysozyme and SIgA measurements,
which may have been partly due to the confounding factor
of concomitant medications taken by the participants. Many
participants were on multiple medications, which may have
influenced their mucosal immunity. Also, a few participants
in the yoga group had minor surgery during the program.
Stress and daily events may influence IgA concentration and
secretion rate, in addition to high individual variability in
these measures.5
Participants in the yoga program also showed a signifi-
cant improvement in self-perceived physical health and well-
being, consistent with the improvements evident in many of
the objective measures of physical function. However, this
improvement was not consistent with results of the Physical
Component Summary of the SF12v2, which did not show
an improvement in the yoga group. This inconsistency may
be due to the fact that the reference group used for the stan-
dardization of the SF12v2 consisted of North American
adults, and older Australians may differ significantly from
70 INTERNATIONAL JOURNAL OF YOGA THERAPY – No. 21 (2011)
this standard population. In this study, the Life’s Odyssey
Questionnaire appeared more sensitive than the SF12v2 to
detect changes in physical health and well-being. Participant
comments about the physical health benefits they were expe-
riencing during the yoga program included improvements in
body awareness, balance and walking, posture, body shape,
and ability to undertake daily activities.
Participation in the Iyengar yoga program resulted in
improvements in two of the measures used to assess mental
health and well-being: the Emotional Well-Being and Self-
Care subscales of the Life’s Odyssey Questionnaire. This is
consistent with the findings of a study on the impact of yoga
on depression in older people.24 The improvement in self-
care could be due to the participants in the Iyengar yoga
program being encouraged to explore and reflect during and
after the classes on whether and how they experienced any
effect of the yoga practice on their well-being. The effects of
restorative postures were explained, and participants were
encouraged to incorporate postures that they perceived as
beneficial into their daily lives. Thus, the improvement in
self-care might reflect an empowering effect of the yoga
program on the participants. Participant comments about
the mental health benefits of the yoga program included
improvements in emotional well-being, cognitive function,
capacity to relax, and enjoyment.
The short-term nature of the study may account for the
lack of effects on spiritual health and well-being measures. In
contrast, a longer-term study reported a significant strength-
ening of seniors’ sense of coherence after a 14-week yoga
program.23 Both of these results are consistent with Iyengar
yoga philosophy, in which the practice is believed to have
progressive effects on practitioners, starting with the physi-
cal body and only gradually affecting the deeper mental and
then spiritual levels.11 A few participants commented about
the spiritual health benefits of the yoga program, including
an increased sense of calm and peace.
Strengths, Limitations, and Future Directions
The study had a number of strengths. The absence of ex-
clusion criteria meant the program was open to a broad range
of people residing in the retirement resort. The measures
used to assess physical, mental, spiritual, and social health
and well-being allowed exploration of effects across a range
of health indicators. The extremely low attrition rate (5%)
indicates that the program met participants’ needs and expec-
tations. Participant comments reflected the range of benefits
experienced and addressed physical, mental, spiritual, and
social aspects of health and well-being. For example, one par-
ticipant made the following comment at the end of the yoga
program: “I feel a return of inner peace and quiet; I believe I
am thinking clearly, can hold a pen, walk without staggering
and a walking stick; now at the end of my road, I am content
and at peace with my life, both as it was and is now.”
In terms of limitations, the study was conducted in a
retirement resort and therefore the results should not be
generalized to the population of older people as a whole. It
was beyond the scope of this study to determine if the resort
residents were more or less healthy or frail than older people
generally. A larger sample size would have increased the
power of the statistical analyses and reduced the potential for
Type II errors. For example, Physical Well-Being and Self-
Care scores showed significant differences within the yoga
group, but the median change between groups fell outside
the (0.05) significance level. A larger sample size may have
resulted in these changes reaching significance. Results from
the questionnaires may have been inflated because statistical
analyses did not protect against the potential for error that
can arise when two instruments measure similar constructs.
Participants in the control group were not asked to record
their physical activity during the intervention period. As a
result, it is not known if their activity levels changed, and if
so, how this may have influenced their results. The 8-week
program was successful in producing changes in some mea-
sures of physical and mental health and well-being; however,
a longer yoga program may have produced further changes
in mental, spiritual, and social health and well-being, as is
suggested by Iyengar yoga philosophy. Further research is re-
quired to determine the long-term effects and sustainability
of such a program in older people.
The study assessed yoga versus no activity and did not
include a second control group of a non-yoga exercise pro-
gram or a social interaction program. Exercise has an impact
on older adult well-being,36 so it is not clear how much of
the impact of this study is truly from the Iyengar yoga pro-
gram in particular, and how much is from exercise. Likewise,
social interaction has a positive impact on older adult health
outcomes,37 and, again, it is unknown what contribution the
social interaction in the Iyengar yoga program made to the
health and well-being outcomes recorded. However, life in
the retirement resort is very sociable, with many opportuni-
ties for social interaction between residents. This may be one
reason why there was no significant change in social connect-
edness in either yoga or control group, suggesting that the
health improvements in the yoga group were not related to
the social interaction experienced in the group. In addition,
almost all of the participant comments referred to benefits
that are likely to have resulted from the yoga program itself,
rather than exercise in general or social interaction.
 YOGA FOR INACTIVE OLDER ADULTS
Conclusion
While this was a relatively small study, the results sug-
gest that an 8-week Iyengar yoga program has a significant
positive effect on some aspects of the health and well-being
of physically inactive older people. Iyengar yoga practice
resulted in improvements in overall muscle strength and
in flexibility and in self-perceived physical and emotional
well-being. Larger, longer-term studies to assess the effects
of Iyengar yoga on holistic health in older people are war-
ranted. Both this and previous studies have shown that
Iyengar yoga improves various aspects of holistic health and
well-being in older people, and making such programs read-
ily available to this population could be very beneficial.
This research contributes to the body of knowledge
about the potential of yoga to positively influence the ho-
listic health of older people, which is important in Western
countries where populations are rapidly aging. Further re-
search to inform the development of yoga programs specifi-
cally for the growing senior population would be of benefit
to the broader yoga community.
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