Credit: Florida Atlantic University/Getty Images
A noninvasive and low-impact intervention, chair yoga is practiced sitting or standing using a chair for support.

Dementia doesn’t just involve cognitive decline, it also involves deteriorating physical function. This major cause of limitation in activities of daily living in older adults with dementia requires safe, effective, and evidence-based nonpharmacological approaches. One such approach is chair yoga. A noninvasive and low-impact intervention, chair yoga is practiced sitting or standing using a chair for support and combines flexibility, balance, strength, breathing, relaxation, and mindfulness training.

Unfortunately, barriers such as lack of transportation, living in rural areas, relying on caregivers and especially the COVID-19 pandemic has prevented many older adults with dementia from participating in group-based in-person chair yoga classes. These burdens call for an innovative way to deliver a chair yoga intervention for those who cannot travel to a community center. 

“The considerable time and cost associated with traveling to in-person yoga sessions over several weeks could be burdensome to many patients,” said Juyoung Park, Ph.D., senior author, principal investigator and a professor in the Phyllis and Harvey Sandler School of Social Work within Florida Atlantic University’s College of Social Work and Criminal Justice.

Researchers from FAU’s College of Social Work and Criminal Justice, Christine E. Lynn College of Nursing and Schmidt College of Medicine and collaborators, conducted a novel interdisciplinary study to evaluate a remotely supervised online chair yoga intervention targeted at older adults with dementia and measured clinical outcomes virtually via Zoom under the remote guidance. The study assessed the feasibility of this intervention and explored the relationship between chair yoga and clinical outcomes of pain interference, mobility, risk of falling, sleep disturbance, autonomic reactivity, and loneliness.

Results of the study, published in the journal Complimentary Therapies in Clinical Practice, showed that remotely supervised online chair yoga is a feasible approach for managing physical and psychological symptoms in socially isolated older adults with dementia based on retention (70 percent) and adherence (87.5 percent), with no injury or other adverse events.

“This finding is important, as older adults with dementia and their caregivers may be challenged in attempts to attend chair yoga programs at community facilities,” said Park, who conducted the research with her mentee and co-author Hannah Levine, a medical student at FAU. “Our telehealth-based chair yoga intervention was found to be convenient for both participants and their caregivers because it was easily accessible from home and did not require transportation or getting dressed, which reduced caregiver burden and stress.”

Participants in the pilot study took part in twice weekly 60-minute sessions for eight weeks. During the chair yoga session, the yoga interventionist was spotlighted in the Zoom screen to allow participants to see only the interventionist. This spotlighting enabled participants to focus on the yoga sessions without being distracted by other participants on the screen.

“Our study participants worked with a certified yoga interventionist and their caregivers and practiced breathing techniques and intentional practice; physical postures; and guided relaxation and visualization,” said Park.

Participants also interacted on Zoom with other participants or with the facilitator to maintain social bonds while maintaining physical distance. Psychosocial and physiological (i.e., cardiac) data were collected remotely at baseline, mid-intervention, and post-intervention.

“Remotely collected cardiac and psychosocial data can provide a more complete assessment of the effects of an intervention,” said María de los Ángeles Ortega Hernández, DNP, APRN, GNP-BC, PMHNP-BC, CDP, FAANP, FAAN, director of the FAU Louis and Anne Green Memory and Wellness Center, associate dean of clinical practice and professor, FAU Christine E. Lynn College of Nursing. “Importantly, online chair yoga classes provide a means of reducing health disparities by opening access to interventions for persons who are unable to travel to a clinic or facility.”    

The primary aim of the study was to assess the feasibility (retention, adherence, and safety) of conducting a remotely supervised, home-based, online chair intervention and completing outcome measures virtually. The secondary aim was to examine the relationship between the intervention and chronic pain, physical function, or psychological symptoms. Finally, an exploratory aim was to evaluate the ease and ability of caregivers and participants to record cardiac data remotely for offline analyses of the effect of the intervention on parasympathetic regulation and overall heart rate.

“An important feature of our technology-based intervention is that it could allow socially isolated older adults with dementia who are living at home, especially those in underserved communities where people are becoming more digitally connected, to receive remotely supervised chair yoga that provides physical, social and psychological benefits,” said Lisa Ann Kirk Wiese, Ph.D., co-author and an associate professor, FAU’s Christine E. Lynn College of Nursing.

Study co-authors are Keri Heilman, Ph.D., an assistant professor in the School of Medicine, University of North Carolina, Chapel Hill; Marlysa Sullivan and Jayshree Surage, both with the Maryland University of Integrative Health; Lillian Hung, Ph.D., an assistant professor and Canada Research Chair in Senior Care, University of British Columbia, School of Nursing; and Hyochol “Brian” Ahn, Ph.D., a professor and associate dean for research, Florida State University, College of Nursing.

“Results from our study can inform future research and practice in implementation of online chair yoga or other exercise program for promoting health and wellness in older adults with dementia living at home,” said Park.