Yoga for Healthy Aging

Manjunath N. K., Ph.D.,Professor and Head

Anvesasa Research LaboratoriesS-VYASA, Bengaluru

Aging – a natural consequence

• Predictable

• Inevitable

• Progressive

• Variable

Population

(In Millions)

% of Population Over

65

Population over 65

(Numbers in million)

2000 2030 2000 2030 2000 2030

China 1262 1483 7.0 16.0 88 237

India 1014 1437 4.6 9.0 47 129

USA 276 351 12.6 20.0 35 70

Indonesia 225 313 4.5 10.9 10 34

Brazil 173 203 5.3 13.2 9 27

Russia 146 133 12.6 20.5 18 27

Japan 127 117 17.0 28.3 22 33

Thailand 61 71 6.4 16.4 4 12

France 59 62 16.0 24.0 9 15

UK 60 61 15.7 23.5 9 14

S.Korea 47 54 7.0 19.5 3 11

Malaysia 22 35 4.1 9.4 1 3

Australia 19 23 12.4 21.1 2 5

Singapore 4 9 6.8 14.8 1 1

Table 1: Population Aging in Selected Countries

Australian trends

Source: Department of Sustainability and Environment 2004a

Demographic Trends

Three major demographic trends are apparent

1. ↓ Fertility Rates

2. Improved health care systems

3. ↑ Life Expectancy

Reference: Kalache & Keller, 2003

Healthy agingLow risk and high functional capacity

• low probability of disease and disease-related disability

• high capacity for cognitive and physical functioning

• active engagement with life including interpersonal relations

Wellness

Physical

Activity

Spiritual

Health

Social

Harmony

Healthy

Relationships

Healthy

Lifestyle

Nutrition

Mental

Health

Use of CAM in the elderly

• A survey in North America:

Most commonly used CAM interventions –

* Yoga / Meditation (64%)

* Chiropractic (61%)

* Herbal medicine (54.8%)

* Massage Therapy (35.7%)

* Acupuncture (33%)

Reasons for CAM usage

* Pain relief (54.8%)

* Improve quality of life (45.2%)

* Maintenance of health and fitness (40.5%)

Reference: Williamson et al., 2003

Use of CAM by elderly in Australia

Most commonly used CAM interventions –

* Meditation

* Chiropractic

* Herbal medicine

* Massage Therapy

Reasons for CAM usage

* Psychological wellbeing

* Improve quality of life

* Maintenance of health and fitnessReference: Zhang et al., 2007

Common health issues

• Gait and Balance

• Sleep

• Cognition (memory)

• Depression

• Arthritis

• 1041 articles in Pubmed

Gait and balance

• Major reason for falls and immobility

• Musculoskeletal system to nervous system regulate

• Aging process influences both

• Yoga has demonstrated the ability to reverse the same

• Prevention of falls will be a major contribution

Gait and Balance

• Selected Balancing postures along with loosening and strengthening exercises along with better attention and awareness through meditation improved

– Ability to get up from a chair without support

– Initiate quick walk with long steps

– Speed of walking

– Balancing

Med Sci Monit. 2007;13(12):LE19-20

Styles studied

• Integrated Yoga S-VYASA

• Iyengar Yoga

• Mindfulness

• Isha Yoga

• Relaxation response and exercise

Depression

• Socialization through group Yoga

• Dynamic Yoga for the elderly

• Keertan Yoga (Bhakthi yoga)

• Lectures on Philosophy of Yoga

• Reduced:

– Depression scores

– Improved positive approach to life

– Improved coping abilities

Journal of Gerontological Nursing, 3(2):17-23.

Styles studied

• Integrated Yoga Module S-VYASA

• Sudarshan Kriya Yoga

• Sahaja Yoga

• Mindfulness

• Keertan Yoga

Sleep• Elderly spend more time awake in the bed than

sleeping

• Both quality and quantity of sleep gets affected due to medical, psychological and aging related changes in the brain

• Yoga improved:– Time taken to fall asleep

– Number of hours slept

– Feeling of being rested in the morning

– Number of awakenings in the night

Indian Journal of Medical Research, 121: 683-690

Self rated sleep and Depression scores

References:

Manjunath & Telles, 2005; Manjunath & Telles, 2007

Arthritis in the elderly

• Older people most often have

Osteoarthritis,

Rheumatoid arthritis, or gout.

• Osteoarthritis (OA) is the most common type of arthritis in older people. OA starts when tissue, called cartilage, that pads bones in a joint begins to wear away.

Pain and inflammation

Deformities

Yoga and Arthritis

• Improvement in hand grip strength in rheumatoid arthritis patients following yoga training Indian Journal of Physiology

and Pharmacology, 2001

British Journal of Rheumatology, 1994

Quality of life improved in osteoarthritis patients following yoga training

International Journal of Yoga, 2011

• Yoga program for elderly showed reduction in pain and stiffness

International Journal of Yoga therapy, 2010

• Yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health

The Journal of Rheumatology, 2015

Aging and Mental AgilityAlzheimer's and Dementia

The best gift we are bestowed with

The ability to Remember

The ability to forget

Alzheimer’s Disease

• An irreversible, progressive brain disorder

• Slowly destroys memory and thinking skills, and

• Eventually the ability to carry out the simplest tasks.

• In most people with Alzheimer’s, symptoms first appear after 65 and most common after 85

• Alzheimer’s disease is named after Dr. AloisAlzheimer In 1906

• A Psychiatrist from Germany

Prevalence

• Alzheimer's disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.

• 1 in 10 above 65 years and 1 in 2 after 85 years are known to suffer from Alzheimer’s

Dementia

• Alzheimer’s is the most common cause of dementia among older adults.

• Loss of cognitive functioning thinking,

• Remembering,

• Reasoning

• and behavioral abilities

• to such an extent that it interferes with a person’s daily life and activities.

Changes in the brain

The process

• Amyloid plaques

• Neurofibrillary tangles

• Loss of neuronal connections and cell death.

The 4 fold issue

• Aging related memory loss

• Mild cognitive impairment

• Alzheimer’s Disease

• Dementia

Even being honest may not work

Google brain

Am J Geriatr Psychiatry 17:2, February 2009

Prevention through Yoga

Smruthi

• Smruthi one of the Citta Vruthi’s

• Anubhuthavishaya Asmpramosha ha Smruthihi

• Dhyayatovishayan pumsaha……..Smruthi bramshatbuddhi nashaha……..Pranashyathe

• Vasanas and Samskaras

DHÁRANA - SINGLE THOUGHT

CANCALATA - MULTIPLE SUBJECTS

MULTIPLE

THOUGHTS

EKAGRATA - SINGLE SUBJECT

DHÁRANA

(MIND)

(INTELLECT)

(MEMORY)

MULTIPLE THOUGHTS

Yoga in Alzheimer's Disease

• Stress increases cortisol which is toxic to hippocampal

cells (normal memory function)

• A stress induced hypercortisolemia can aggravate

Alzheimer's

• Regular practice of meditation produces stress reduction

that reduces serum cortisol. Hence, provide benefit in

patients with Alzheimer's

[Ann Indian Acad Neurol. 2012;15(4): 247–54.]

Yoga in Age Related Degeneration

In Elder:

• Cortisol & adrenocorticotropic

hormone (ACTH) raised

• Brain-derived neurotropic factor

(BDNF), serotonin & dopamine

lowered

Yoga:

• Significantly reduces cortisol; ACTH

• Increases serotonin, dopamine &

BDNF

• Hence, Yoga helps in prevention of

age-related degeneration

• [Age (Dordr). 2014;36(4):9683.]

• Yoga is a promising intervention for

neurodegenerative diseases.

[Integr Med (Encinitas). 2014;13(3):33-9.]

• Long-term Sahaja Yoga

Meditation:

– Inceases overall grey matter

volume

– Regional enlargement in several

right hemispheric cortical &

subcortical brain regions

– Associated with sustained

– attention, self-control,

compassion & interoceptive

perception.

• [PLoS One. 2016;11(3):e0150757.]

• Yoga practitioners have stronger

functional connectivity within

basal ganglia cortico-thalamic

feedback loops than non-

practitioners

[Front Hum Neurosci. 2015;9:137.]

During meditation: it became

localized to the right inferior

frontal cortex/right insula and

right middle/superior temporal

cortex.

– Right inferior frontal activation

was directly associated with the

subjective depth of the mental

silence experience.

[J Altern Complement Med.

2015;21(3):175-9.]

• Yoga produces acute increases

in thalamic GABA levels &

improvements in mood and

anxiety

[J Altern Complement Med.

2010;16(11):1145-52.]

Structural changes in the brain

• Increased thickness in cortical areas related to attention as well as increased subcortical gray matter in right insula and hippocampus in long-term meditators

Neuroreport. 2005 Nov 28;16(17):1893-7.

Volume of hippocampus increases

Voxel based morphometric analysis of the effects of yoga practice in healthy elderly (demonstrates significant increase in bilateral hippocampus gray matter volume after 6 months of yoga practice [indicated by the yellow circle]) Indian J Psychiatry. 2013 Jul; 55(Suppl 3): S394–S396.

Brain areas active during meditation

• Evoked Potential studies – Diencephalon

• Imaging studies –– Anterior Cingulate

– Dorso-lateral Prefrontal Cortex

– Regions of limbic systems

– Int J Psychophysiol. 2011 May;80(2):103-11

– J Altern Complement Med. 2010 Dec;16(12):1253-8

• Yoga is as effective as memory enhancement

training in improving functional connectivity

in relation to verbal memory performance in

subject with mild cognitive impairment

[J Alzheimers Dis. 2016;52(2):673-84.]

History

Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included:

• memory loss,

• language problems, and

• unpredictable behavior.

he examined her brain and found many abnormal clump and tangled bundles of fibers

The Nobel Prize in Physiology or Medicine 2009

Elizabeth H. Blackburn, Carol W. Greider Jack W. Szostak

Discovery of how chromosomes are protected by telomeres and the enzyme telomerase

Telomeres and aging

Life style modification and telomere activity

Telomerase activity is associated with complex changes in lifestyle

Cell Biology International (2011) 35, 1079–1083

Telomerase and meditation

• 30 meditators (mindfulness)

• 6 hours daily for 3 months

• ↑ Telomerase activity in retreat participants compared to controls

• ↑ Perceived Control, ↓ Neuroticism, and ↑ in both Mindfulness and Purpose in Life were greater in the retreat group (p < 0.01)

Psychoneuroendocrinology, 2011

Yoga

↑ Positive Emotions (Narasimhan L, 2011)

↓ Il-6; TNF-α (Kiecolt-Glaser, 2010)

↓ Oxidative stress (Sinha S, 2007)

↑ Adiponectin (Packard C, 2011)

Parasympathetic predominance (Nagarathna R, 2008)Maintain Telomere

Length (Li QZ, 2005) Inhibits Hypothalamus & Limbic System (Rothuizen J, 1991)

Promote Weight reduction (Jain SC, 1993)

Regulates Blood Sugar & BP (Gokal R, 2007)

• Carbohydrate intolerance, osteoporosis and high blood pressure - modified by behavioral and life style interventions such as exercise, diet, and stress reduction

• Neurobehavioral aging, including cognitive decline – Exercise, Yoga and meditation,

Reference: Schneider et al., 2002; Finch, 1987

Exercise, lifestyle management and relaxation

Yoga and Tai-chi

• A preventive health care program (Haber,

1983)

• A randomized controlled trial (Blumenthal et al., 1991)

• Heart rate variability (Bowman et al., 1997)

Few practices

4. Interventions

a. YOGA(1 hour 15 minutes/ day for 6 days/ week for 6 months)

Breathing exercises (10 min.)

Loosening exercises (5 min.)

Asanas (physical postures) (20 min.)

Pranayamas (regulated breathing) (10 min.)

Relaxation techniques (15 min.)

Meditation (15 min.) OR

Bhajans (devotional session) (15 min.)

Lectures on philosophy and practice of yoga (30 min. / month)

Joint Loosening exercises

Postures

Sun Solutation

Forward bending

Twisting

Supine stretch

Guided relaxation with imagery

• Progressive muscle relaxation

• Breath awareness and chanting

• Imagery and resolve

• Being happy

Pranic energization

• Feeling the subtle energy

• Moving it to remove blockages

• Energizing

Meditation

• Mindfulness – Being aware

• Dwelling upon positive thoughts

• Remembering enjoyable moments of life

• Being connected with family and friends

• Actively engaging in mental tasks

Integrated Yoga Module

Summary

• Yoga brings in:

• Self imposed Lifestyle modification featured by:– Physical activity

– Slow, deep breathing

– Healthy diet habits

– Relaxation

– Positive mental attitude

– Philosophy of life

You don’t stop laughing when

you grow old, you grow old

when you stop laughing

……………. George Bernard Shaw

…………Bhagavad-Gita

Life is short, live itLove is rare, grab itAnger is bad, dump itFear is awful, face itMemories are sweet, cherish it

Age gracefully

nkmsharma@gmail.com