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解决方案运动，能够提供心血管健康，肌肉力量和骨骼健康的阻力训练，以及功能性运动范围的灵活性以及放松。 尽管这些戏剧性的声明改善了各种生理和心理系统的功能，但人们对瑜伽对老年人的身体需求，计划功效和整体安全性知之甚少。我们的临床试验经验表明，如果没有适当的循证处方，瑜伽参与可能是无效的，甚至对老年人有害。因此，本申请提出了一项干预开发研究（IDS），该研究将使用生物力学研究（高速摄像机、测力平台和肌肉骨骼建模）来量化老年人瑜伽表演的身体需求。此外，IDS将使用身体性能测试，肌肉性能测试，灵活性和平衡评估，以及自我报告/来量化32周瑜伽计划的有效性和安全性。瑜伽课程分为入门和高级阶段，每个阶段持续16周。参与者（N=24; 65-90岁）将从瑜伽教练那里学习相关的瑜伽姿势（体式），这些瑜伽教练具有与老年人合作的专业知识。为了量化该计划的剂量（身体需求），参与者将在每个阶段的开始和结束时进行体式/同时进行生物力学分析。在每个阶段结束时，将进行随访体能、平衡和生活质量评估，以确定该计划的有效性。结果指标将包括与瑜伽相关的身体需求的生物力学指标（关节运动范围、反作用力和力矩）、肌肉和功能性能指标（爬楼梯、椅子站立、步态、力量、静态和动态平衡）、坚持性和安全性。来自IDS的数据将用于开发循证瑜伽处方，我们假设与非循证瑜伽计划相比，这将与更少的肌肉骨骼副作用相关。我们还假设，以证据为基础的老年人瑜伽量身定制将提高坚持和功效。从这个IDS开发的程序将在扩展的II期随机对照试验中进行测试。公共卫生相关性。瑜伽目前被推荐用于恢复和保持老年人的力量，灵活性，平衡和体能;然而，我们的临床试验经验表明，如果没有适当的循证处方，瑜伽参与可能对老年人无效甚至有害。为了解决这种缺乏循证知识的问题，拟议的IDS将：1）量化为独立走动的老年人设计的32周瑜伽计划的身体需求; 2）描述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）描述报告的不良事件、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.