Chronic pain is a Catch-22 for many older adults. More than half of community-dwelling adults over age 65, and up to 80 percent of nursing home residents, suffer from persistent pain.
Exercise can improve flexibility, strength and mobility, but many people don’t exercise because it’s painful. That leads to a downward spiral of social isolation, depression, further withdrawal and increasing disability. Only 14.8 percent of adults 65 to 74 years and 7.9 percent of adults 75 years and older met both aerobic and muscle-strengthening physical activity guidelines in 2012 according to the Centers for Disease Control and Prevention.
As this article in Pain Medicine News highlights, many older adults rely on over-the-counter and prescription medications instead to manage chronic pain. That in turn can trigger increasing dependence on pharmaceutical solutions that lead to addiction, as NPR recently reported. However, there are other options.
For many, yoga may be the answer. Current research shows that “a carefully adapted set of yoga poses may reduce low-back pain and improve function,” according to the NIH. Additional studies suggest that practicing yoga (and other types of regular exercise) are associated with improved quality of life; reduced stress; lower heart rate and blood pressure; diminished anxiety, depression, and insomnia; improved overall physical fitness, strength and flexibility.
A recent randomized pilot study tracked two groups of low-income older adults in Broward County, Fla., to see whether chair yoga can reduce pain and improve physical and psychosocial function. None of the participants were exercising before the study and all reported chronic pain from osteoarthritis. Half of the group attended chair yoga sessions (2 times aweek), while the rest received health education workshops for the period. The yoga group also was told to continue the exercises at home. Not only did this group report decreased pain and pain perception during the eight-week study, but rates of pain interference — the perception of how pain impacts ability to perform routine activities — also declined and remained lower for three months after study completion.
“Although pain is subjective it has very real consequences,” said Juyoung Park, Ph.D., the study’s co-author and an associate professor at Florida Atlantic University’s College for Design and Social Inquiry. The study did not track pain medication use, but Park said many participants anecdotally reported decreased reliance on medication.
There was also notably more socialization and less reported depression by both groups. “People liked the intervention and liked coming to class,” Park said by phone. The chair yoga program was so popular that it was offered to the education group after the formal study.
Why is yoga so effective?
Yoga helps those with osteoarthritis and other conditions stay mobile and gain other benefits, according to Steffany Moonaz, Ph.D., a yoga therapist and researcher in Baltimore, Maryland, who specializes in arthritis and chronic pain. “Yoga transcends the physical,” she explained. “It’s a mind-body connection that includes breathing, meditation and mindfulness. In addition to increasing flexibility and agility, it relieves stress, reduces depression, reduces fear of falling by improving balance, and increases self-sufficiency.” That can help decrease isolation and loneliness.
Unfortunately, doctors often don’t recommend the practice because they don’t know that much about it or what is appropriate for their patients, said Moonaz. In addition, some types of yoga actually can be detrimental for older adults. For example, “hot yoga” can take place in a moist environment that may reach over 100 degrees and also is faster moving. These factors can impact those with cardiac conditions or cause participants to push into potentially harmful positions.
Using adaptive yoga – an approach that includes meditation and ensures appropriateness for all ages and abilities – extends the principles of practice to other areas of participants’ lives, said Eve Kennedy-Spaien, an occupational therapist and clinical supervisor of the pain and work injury program at Spalding Rehabilitation Hospital in Medford, Massachusetts.
“It helps people be more aware of themselves and surroundings, and encourages them to think about terms like balance, flexibility, and tension in ways beyond just the physical,” Kennedy-Spaien said.
Any pitfalls are typically related to individuals participating in movement meditations without listening to the body and competing with the next person, according to Johanna Gaskins, D.N.P., R.N., a University of Minnesota nurse-practitioner who focuses on integrative health. “These movements are about more than the body but the breath, mind, spirit connecting and finding harmony and balance,” she said in an email interview. “It is a partnership versus a dominating practice of forcing the body.”
Kennedy-Spaien recommends that anyone interested in pursuing yoga to seek out an instructor trained in helping older adults with their particular challenges, be it arthritis, back pain or joint problems. Chair yoga programs can be helpful for alleviating balance and fear of falling concerns, Park noted. While not all exercises are performed sitting down, the chair provides additional support and builds confidence.
The meditation component of yoga can make a difference in how people manage pain, said Moonaz, who also is assistant director of academic research at Maryland University for Integrative Health and trains instructors on arthritis-related yoga techniques. “Mediation increases gray matter and reverses the chronic effects of pain on the brain. It can also decrease a person’s reliance on medication.”
While many older adults perceive pain and disability as a normal part of aging, it is a social expectation rather than a medical reality, as this American Psychologist article explains. However, with the practice of deep breathing, the body releases endorphins, our natural pain-killing hormone, Gaskins explained. Other stress hormones stop excreting and the body relaxes, rather than the unconscious mind sending messages that cause tightly held, rigid postures.
“The body and its natural ability is so awesome,” she said. “Biologics are man’s version of an attempt to create awesomeness. There is no comparison to what the body can do if allowed the opportunity.”
Yoga therapy is gaining traction as an emerging profession. It not only offers benefits for mind and body, but it may help address the opioid epidemic among older adults.
Journalists may want to check out adaptive yoga or tai chi programs for older adults in their communities, as well as other integrative approaches to managing chronic pain. The National Institute of Health’s National Center for Complementary and Integrative Health and the International Association of Yoga Therapists also are good resources.