Summoning the Spirit of Shiva: Yoga for Fall Prevention

For people over the age of 64, falls are both the leading cause of injury-related death and the most common reason for trauma-related hospitalization. Yoga practice may seem an obvious part of any fall-prevention strategy, but up until now, little empirical proof has existed.  

Thanks to a promising collaboration between a research team, a gerontologist, a kinesiologist,  a physical therapist, and a yoga teacher eager to better serve the needs of his students, that’s changing.

In 2012, Wisconsin-based yoga teacher Paul Mross began to notice the increased incidences of falls in his aging students. Searching for empirical data on programs that were proven to reduce falls among people over 60, he was able to find studies on various movement protocols to improve balance, but none that specifically looked at protocols for decreasing falls. 

Defining Fall Prevention and Yoga’s Role

“Balance and fall prevention are two different things,” Paul points out. “You could have good balance and yet have a fall related to a drug you are taking, a vision problem, or some other cause. Data about improved balance may appear similar, but I really wanted to address falls specifically.” 

The CDC rates Wisconsin as the highest in the nation in fall-based fatality rates. At the time Paul was looking for data, Wisconsin was in the midst of a statewide initiative aimed at reducing fall-related injuries and deaths among its older residents via community- and medically-based prevention approaches.

Paul thought Yoga should be part of the solution, but he couldn’t prove it.   

“I knew there was an older adult population that needed more access to yoga and that traditional venues were not going to be as effective in preventing falls. But to tap into funding for community projects, you have to have evidence-based results,” he relates. His solution? He gathered some colleagues and endeavored to conduct his own study.

The first pilot project on the efficacy, Yoga As A Fall Prevention Strategy, was launched in 2013 and was sponsored by a local hospital. The sample size was small–19 participants completed the study–but the results were nonetheless promising. (1) 

The second project was funded via the Wisconsin Partnership Program, a branch of the University of Wisconsin in Madison that funds researchers and community initiatives. Paul served as Research Consultant. Along with a researcher friend, he set out to do two things: “First I wanted to see if we could do a safe intervention,” he states. Secondly, as I had never done a study, I just wanted to see if I could do one. The outcomes were secondary,”  

A Mindful Yoga Practice Design    

In designing the yoga intervention, Paul consulted with a gerontologist, a physical therapist, a kinesiologist, and yoga therapist, Iris Mickey. While the academic research team did all the assessments, data, and structure of the study to create a true peer-reviewed paper, Paul taught the yoga sequences.

The practices addressed some obvious elements of balance, such as the vestibular and visual systems, muscular strength, and gait enhancement. But the group also felt it was important to emphasize transitions between poses to emulate the functional activities of daily living.

“Instead of just stepping back into a high lunge, we wanted to make sure they were engaged to the point of lifting their feet off the floor and taking weight into one leg, as we often do in daily life,” Paul explains.

The practice was anchored by three key poses– High Lunge, Tree Pose, and Fierce Pose (Chair Pose)–that have been the basis for all of the subsequent studies. In addition, a great emphasis was placed on awareness of bottoms of the feet. “That was in everything we did. We kept coming back to the foundation, expansion, chin alignment, and so forth, but it always started with the feet,” Paul says. 

The current study is being conducted in 5 rural communities and has roughly 120 participants. Throughout, refinements have been done along the way. Additional teachers have also been brought in to conduct some of the classes. 

To date, all of the studies have reported positive outcomes. Data from the second study, for example, showed a decrease in fall rates by 48%. Participants showed improvements in balance, functional gate, dynamic gate, and single-leg stand time. (2) (In the third study, the team adapted the intervention to be accessible for the Deaf and hard-of-hearing community.) 

One thing that Paul understood early on was that a yoga intervention had to address more than feet and gait patterns. The goal was to enrich his students’ lives, and that meant tapping into joy. So while you could label the act of changing arms mid-stream, or challenging focus with an oppositional arm sweep and head turn, as right-brain/left-brain cognition exercises, Paul’s students just knew they were having fun and getting stronger. Sessions were punctuated with laughter and camaraderie. 

For Paul, the study was a natural evolution in his work. “My passion has always been providing safe and effective access to yoga for all individuals, no matter what their challenges,” he shares. He created a concept called, Happ:y (Healthy Accessible Products and Programs with Yoga), with the goal of providing programming in the areas of health, accessibility, and prevention using the benefits of yoga. 

“Providing access to yoga has always been my passion. I get to see communities form because of this research. If we find results that show a decrease in fall rates because of yoga … that would be an added bonus,” he relates. 

The Dance of Shiva

The Dance of Shiva practice–an homage to the Lord of the Dance–encapsulates the research goals and was included as a pinnacle pose in the first three studies. This movement-based sequence includes elements of strength, balance, and cognitive awareness, as it progresses through a series of increasingly challenging transitions to an asymmetrical balance.

Paul leads the Dance of Shiva sequence in the video below. Try it for yourself!

​To learn more about Paul’s work:  https://thehappyyogamat.com

Lynn Crimando, MA, serves as the teaching mentor for YogaUOnline’s Wellness Educator Program. She is a yoga teacher, C-IAYT Yoga Therapist, Certified Personal Trainer, board-certified Health and Wellness Coach, and a Buteyko Practitioner. She has a private practice in New York City and teaches classes throughout the city on behalf of Health Advocates for Older People. In addition, Lynn Co-Program Director of the IAYT-approved Yoga Nanda Therapist Training in Garden City, New York. To learn more about Lynn, visit her website: yogalynn.com.

Resources

(1) https://www.ncbi.nlm.nih.gov/pubmed/28434464

(2) https://www.sciencedirect.com/science/article/abs/pii/S0965229917302698