Safe & Effective Yoga Prescription for Older Adults: Biomechanical Considerations

描述(由申请人提供)：美国卫生与公众服务部和国家娱乐与公园协会都推荐瑜伽作为老年人的一种全方位运动形式，能够提供心血管健身、肌肉力量和骨骼健康的抵抗力训练，以及运动功能范围和放松的灵活性...尽管这些戏剧性的声明表明瑜伽在各种生理和心理系统中都有改善功能，但对老年人的身体需求、项目有效性和整体安全性了解很少。我们的临床试验经验表明，如果没有适当的循证处方，参加瑜伽对老年人可能是无效的，甚至是有害的。因此，该应用程序提出了一项干预发展研究(IDS)，它将使用生物力学调查(高速摄像机、力量平台和肌肉骨骼建模)来量化老年人对瑜伽表演的身体需求。此外，入侵检测系统将使用体能测试、肌肉性能测试、灵活性和平衡性评估以及自我报告来量化为非卧床老年人提供的为期32周的瑜伽计划的有效性和安全性。瑜伽课程分为入门阶段和高级阶段，每个阶段为期16周。参与者(N=24岁，年龄65-90岁)将向具有与老年人合作的专业瑜伽教练学习相关的瑜伽姿势(体式)。为了量化计划的剂量(身体需求)，参与者将在每个阶段的开始和结束时进行体位练习，同时进行生物力学分析。在每个阶段结束时，将进行体能、平衡和生活质量的后续评估，以确定该计划的效果。结果指标将包括与瑜伽相关的身体需求的生物力学指标(关节活动范围、反作用力和力矩)、肌肉和功能表现的指标(楼梯攀登、椅子站立、步态、力量、静态和动态平衡)、坚持性和安全性。来自入侵检测系统的数据将被用于开发基于证据的瑜伽处方，我们假设与非基于证据的瑜伽项目相比，这些处方将与较少的肌肉骨骼副作用相关。我们还假设，根据证据为老年人量身定做瑜伽将提高坚持性和有效性。从该入侵检测系统开发的程序将在扩展的第二阶段随机对照试验中进行测试。与公共卫生相关。瑜伽目前被推荐用于恢复和保护老年人的力量、灵活性、平衡性和体能；然而，我们的临床试验经验表明，如果没有适当的循证处方，参加瑜伽对老年人可能无效，甚至是有害的。为了解决这种循证知识的缺乏，拟议的入侵检测系统将：1)量化为独立活动老年人设计的32周瑜伽计划的身体需求；2)表征这些需求与参与者身体特征之间的关系；3)检查该计划的依从性、有效性和安全性；以及4)表征报告的不良事件、基线参与者特征和瑜伽身体需求之间的关系。

DESCRIPTION (provided by applicant): The U.S. Department of Health & Human Services and the National Recreation & Park Association both recommend Yoga as a form of total-solution exercise for older adults, capable of providing cardiovascular fitness, resistance training for muscle strength & bone health, and flexibility for functional range of motion as well as relaxation... Despite these dramatic claims of improved function across a variety of physiological & psychological systems/little is understood regarding the physical demands, program efficacy, and overall safety of Yoga for older adults. Our clinical trial experiences suggest that without proper evidenced-based prescription, Yoga participation can be ineffective or even injurious for elders. Thus, this application proposes an intervention development study (IDS) that will use biomechanical investigation (high-speed cameras, force platforms and musculoskeletal modeling) to quantify the physical demands of Yoga performance by older adults. In addition, the IDS will use physical-performance testing, muscle-performance testing, flexibility & balance assessments, and self-reports/to quantify the efficacy and safety of a 32-week Yoga program for ambulatory seniors. The Yoga program is divided into introductory and advanced phases/each lasting 16 weeks. The participants (N=24; 65-90 years of age) will learn the associated Yoga poses (asanas) from Yoga instructors with expertise working with seniors. In order to quantify the dosage (physical demands) of the program, the participants will perform the asanas at the beginning and termination of each phase/while instrumented for biomechanical analysis. Follow-up physical performance, balance, and quality of life, assessments will be conducted at the end of each phase in order to determine the efficacy of the program. Outcome measures will include biomechanical indices of the physical demands associated with Yoga (joint range-of-motion, reaction forces, & moments), measures of muscular & functional performance (stair climb, chair stand, gait, strength, static & dynamic balance), adherence, and safety. Data from the IDS will be used to develop evidenced-based Yoga prescriptions, which we postulate will be associated with fewer musculoskeletal side effects compared to non-evidence based Yoga programs. We also postulate that evidenced-based tailoring of Yoga for seniors will enhance adherence and efficacy. The programs developed from this IDS will be tested in an expanded, Phase II, Randomized Controlled Trial. PUBLIC HEALTH RELEVANCE. Yoga is currently being recommended to restore and preserve strength, flexibility, balance, & physical capacity in older adults; however, our clinical trial experiences suggest that without proper evidenced-based prescription, Yoga participation can be ineffective or even injurious for seniors. To address this lack of evidence-based knowledge, the proposed IDS will: 1) quantify the physical demands of a 32-wk Yoga program designed for independent ambulatory seniors; 2) characterize the relations between these demands and participant physical characteristics; 3) examine the adherence, efficacy, & safety of the program; and 4) characterize the relations among reported adverse events, baseline participant characteristics, and Yoga physical demands.