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Abstract
The aim of this pilot study was to examine whether chair yoga was effective in reducing pain level and improving physical function and emotional well-being in a sample
of community-dwelling older adults with osteoarthritis. One-way repeated measures analysis of variance was performed to examine the effectiveness of chair yoga
at baseline, midpoint (4 weeks), and end of the intervention (8 weeks). Although

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chair yoga was effective in improving physical function and reducing stiffness in older adults with osteoarthritis, it was not effective in reducing pain level or improving

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depressive symptoms. Future research planned by this team will use rigorous study

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1. Read
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Adults
With Osteoarthritis
by Juyoung
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PhD; and
Ruth McCaffrey,
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methods, including larger samples, randomized controlled trials, and follow up for
monitoring home practice after the interventions.

steoarthritis (OA), as a
degenerative joint disease, is the most common
type of arthritis and a major cause
of pain and disability (Burkes, 2005;
Centers for Disease Control and
Prevention [CDC], 2002; Felson &
Zhang, 1998). OA affects 27 million
people in the United States, and the
incidence continues to increase, par-

1. Objective 1

Activity Objectives

2. Objective 2
1. Identify the prevalence of functional limitation associated with osteoar3. Objective
thritis3(OA) in older adults.
4. Objective
4 the components and use of yoga for treatment of OA in older adults.
2. Discuss

2012/iStockphoto.com/jamstock/Doucet

3. Describe
5. Objective
5 the methodology used in the study of chair yoga conducted by
the authors.

Author
Disclosure
Statement
4. Discuss
the themes
identified by the focus group following implementation of the chair yoga sessions.
Statement
5. Describe the limitations of the study.
Commercial
Support Statement
All authors and planners have agreed that this activity will be free of commercial
Author
Disclosure
Statement
bias. There is no commercial support
for this activity. There is no non-commercial

support
for this
activity.
Dr. Park
and
Dr. McCaffrey disclose that they have no significant financial

interests in any product or class of products discussed directly or indirectly in

this activity. This pilot study was supported by the Florida Atlantic University
mentoring grant (seed grant).

Commercial Support Statement

All authors and planners have agreed that this activity will be free of commercial
bias. There is no commercial support for this activity. There is no non-commercial
support for this activity.

12

Juyoung Park, PhD; and

Ruth McCaffrey, DNP, ARNP,
FNP-BC, GNP-BC
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ticularly with age (Arthritis Foundation, 2012; CDC, 2011; Vitiello,

Rybarczyk, Von Korff, & Stepanski, 2009). Thus, OA is a significant
problem for the aging population
(Peyron & Altman, 1992). Nearly
50% of adults 65 and older have
symptoms associated with OA, and
approximately 11% are functionally
limited due to the disease (Lawrence
et al., 1998). Symptoms associated
with OA often include morning
stiffness, joint pain, limited range of
motion, and depression (Kolasinski
et al., 2005; World Health Organization, 2003).
Older adults with unrelieved
knee pain from OA were more
likely to need assistance with bathing, dressing, and transferring than
those without knee pain, adding
to the cost of care for this group
(Nishiwaki, Michikawa, Yamada,
Eto, & Takebayashi, 2011). Knee
and hip joint replacements accounted for 35% of total arthritis-related
procedures during hospitalizations
(Mannoni et al., 2003). OA pain
often increases depression and decreases life satisfaction (Jakobsson
& Hallberg, 2002).
The purpose of managing OA is
to relieve pain and improve func-

Journal of Gerontological Nursing Vol. 38, No. 5, 2012

tion and quality of life (American

Academy of Orthopaedic Surgeons,
2003). Although pharmacological
treatments are considered to be a
typical approach to managing OA,
older adults are at high risk for adverse events or side effects associated with medications (Kolasinski et
al., 2005), which highlights the need
to identify alternatives to a solely
pharmaceutical approach to treatment of OA in older adults (Berman
et al., 2004).
Nonpharmacological approaches
have been shown to reduce pain,
improve function, and mitigate
emotional problems due to pain in
chronic pain patients (Dominick et
al., 2004). Research has shown that
many older adults with OA are
interested in nonpharmacological
pain therapies (Konvicka, Meyer,
McDavid, & Roberson, 2008). Researchers have identified the need
for evidence-based interventions to
address the broad range of biophysical and psychosocial difficulties experienced by older adults with OA
(Rizzo, 2009). Yoga is one of the
several nonpharmacological pain
therapies that address physical and
psychosocial components and have
demonstrated effectiveness in treatment of OA (Hurley & Scott, 1998;
Kolasinski, 1999).

Background

Yoga is a popular alternative form

of mind-body therapy (Chukumnerd, Hatthakit, & Chuaprapaisilp,
2011) that involves a combination of
physical postures (asanas), breathing (pranayama), deep relaxation
(savasana), and meditation (Nayak
& Shankar, 2004).
The possible therapeutic benefits
of yoga have been studied for a variety of medical conditions; yoga

13

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Sidebar

Chair Yoga Program Outline

I.

II.

Breath of LifeThe Revivers (10 minutes; one breathing technique

per class)
A.

Diaphragmatic breathing

B.

Alternate nostril breathing

C.

Ujjayi breath

The Body ProperThe Antidotes (20 minutes)

A.

B.

Rotation Extension
1.

Cervical Vertebra Release

11.

Half Inversion

2.

Finger Flecks

12.

Cat

3.

Hand Wake-Up

13.

Fan Palm

4.

Mountain

14.

Sciatica Stretch

5.

Eagle

15.

Half Moon

6.

Sun Breath

16.

Dancer

7.

Stick

17.

Half and Full Gate

8.

Calf Shaper

18.

Triangle

9.

Shin Toner

19.

Warrior I

10.

Head to Knee

20.

Warrior II

Contraction
1.

III.

Cobra

Warrior in the BodyThe Rechargers (5 minutes)

As students progress, the poses below are done standing (holding chair if
necessary). Students may also continue seated.
A.

Balance
1.
2.

B.

C.

IV.

Stork
Tree

Strengthening
1.

Mountain

2.

Warrior I and II

Flexibility
1.

Half Moon

2.

Triangle

3.

Cobra

4.

Locust

5.

Table

Mind-Body ConnectionThe Transformers (10 minutes)

A.

Tense and relax

B.

Total body relaxation

C.

VisualizationA transformed you!

has been associated with improved

health outcomes in research trials, in
particular for people with hyperten-

14

sion (Patel & North, 1975), epilepsy

(Lundgren, Dahl, Yardi, & Melin,
2008), multiple sclerosis (Oken et

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al., 2004), carpal tunnel syndrome

(Garfinkel et al., 1998), cancer (Carson et al., 2007), back pain (Sherman,
Cherkin, Erro, Miglioretti, & Deyo,
2005), and depression (Shapiro et al.,
2007). Yoga is also effective in treating various forms of arthritis (Garfinkel & Schumacher, 2000), including
OA (Garfinkel, Schumacher, Husain, Levy, & Reshetar, 1994; Kolasinski et al., 2005; Krishnamurthy &
Telles, 2007) and rheumatoid arthritis
(Badsha, Chhabra, Leibman, Mofti,
& Kong, 2009; Bosch, Traustadttir, Howard, & Matt, 2009; Dash &
Telles, 2001). In particular, studies of
yoga treatment for OA (Garfinkel et
al., 1994; Kolasinski et al., 2005) and
carpal tunnel syndrome (Garfinkel
et al., 1998) have shown significant
alleviation of musculoskeletal pain
during activity. In addition to pain
reduction, yoga has been associated with significant improvement
in range of motion and function,
decreased tenderness (Garfinkel et
al., 1994), and alleviated depression
(Krishnamurthy & Telles, 2007).
A few studies have been conducted to determine the effect of yoga in
people with OA (Bukowski, Conway, Glentz, Kurland, & Galantino,
2006; Garfinkel et al., 1994; Kolasinski et al., 2005; Taibi & Vitiello,
2011), but only one (Garfinkel et al.,
1994) used a randomized controlled
trial. These studies have contributed
to the body of evidence demonstrating positive health benefits of yoga
(Ross & Thomas, 2010). A knee OA
study (Kolasinski et al., 2005) reported that an 8-week yoga program
was beneficial in reducing pain and
disability and improving physical
functioning, and a hand OA study
(Haugen, Slatkowsky-Christensen,
Lessem, & Kvien, 2009) noted improvement in finger tenderness and
finger range of motion, whereas a
study of general arthritis (Sharma,
2005) reported no improvements
as measured by responses to their
symptom self-report instrument.
The studies reported in the literature include relatively small samples

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and scope, different doses of yoga,

poor statistical power, lack of randomization, unclear selection criteria, and/or short duration (Haaz &
Bartlett, 2011). They have also differed regarding frequency and duration of yoga practice, as well as yoga
styles and content of yoga sessions
(Haaz & Bartlett, 2011).
A growing body of research suggests that yoga intervention is accepted by older adults and may
reduce OA pain (Kolasinski et al.,
2005). However, limited studies
have reviewed yoga for the treatment of chronic pain in older adults
(Morone & Greco, 2007), and these
demonstrated methodological limitations, as well as lack of randomization, unclear inclusion/exclusion
criteria, and short duration (Haaz
& Bartlett, 2011). Kolasinski et al.
(2005) identified that yoga may provide a feasible treatment for previously yoga nave, obese patients
older than 50; they reported that an
8-week yoga intervention reduced
pain levels, improved physical function, and prevented disability caused
by knee OA. The study concluded
that yoga can be a feasible treatment
for people 50 and older who had not
participated in yoga previously and
can provide pain reduction and disability caused by OA. Some older
adults are unable to participate in
regular yoga classes because they
are required to stand while doing
certain yoga poses. They may feel
insecure due to decreased balance
ability and increased fear of falling
(Rejeski, Brawley, Ettinger, Morgan, & Thompson, 1997).
Chair yoga is a gentle form of
yoga that is practiced sitting in a
chair or standing and using a chair
for support. Chair yoga is appropriate for older adults with OA who
are unable to participate in regular
standing yoga or other exercise. It
is particularly safe to practice, easy
to learn, and not likely to lead to
falls. It is often used by older adults
who need the security of sitting
in a chair; it requires less physical

Table 1

Demographic Characteristics of the Participants (N = 7)

Characteristic

n (%)

Sex
Women

6 (86)

Men

1 (14)

Race
Caucasian

7 (100)

Marital status
Divorced

3 (43)

Married

2 (29)

Widowed

2 (29)
a

Current living situation

Alone

4 (57)

With spouse

2 (29)

With significant others

1 (14)

Health insuranceb
Medicare

7 (100)

Private

6 (86)

Health care choicesc

Private physicians office

7 (100)

Outpatient clinic

3 (43)

Physical therapy

2 (29)

Alternative medicine

1 (14)

Emergency department

1 (14)

Other clinic

1 (14)

Physical health
Excellent

1 (14)

Very good

2 (29)

Good

3 (43)

Fair

1 (14)

strength than a strenuous exercise,

and it can be modified to allow frail
older adults to practice individually
or in groups.
Although many older adults have
been practicing chair yoga and the
efficacy of chair yoga has been identified, no study has used chair yoga
exclusively for measuring reduction
of pain and disability and improvement in function in older adults
with OA. The chair yoga program
intervention in this study, designed

Journal of Gerontological Nursing Vol. 38, No. 5, 2012

for older adults with OA, was developed by Kristine Lee, a yoga instructor with more than 20 years of
experience. Participants came to the
yoga studio located in the University College of Nursing and received
the 45-minute sessions. The Sidebar
provides an overview of each of the
four sections of the yoga intervention. Because this intervention was
only for older adults with OA, careful attention was paid to the stress
on joints and connective tissue, as

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Table 1 (continued)

Demographic Characteristics of the Participants (N = 7)

Characteristic

n (%)

Type of diseased
Back problems

4 (57)

Broken bones

3 (43)

Cancer

3 (43)

Osteoporosis

2 (29)

Dental problems

1 (14)

Fibromyalgia

1 (14)

Headache

1 (14)

Heart disease

1 (14)

Stroke

1 (14)

Home health care

No

6 (86)

Yes

1 (14)

Mean (SD), Range

Age

77 (3.6 years), 71 to 81

Note. Percentages may not total 100 due to rounding.

a
Number and percentage total more than 7 (100%) because several participants have lived
with more than one person.
b
Number and percentage total more than 7 (100%) because several participants have had
more than one type of health insurance.
c
Number and percentage total more than 7 (100%) because several participants have had
more than one health care choice.
d
Number and percentage total more than 7 (100%) because several participants have had
more than one disease.

well as consideration of range of

motion of joints.

Specific Aims and Research

Questions

This pilot project was an attempt

to provide preliminary evidence for
designing a larger study to determine
the effect of chair yoga on management of OA pain, stiffness, physical
function, and emotional health. The
specific aim was to determine the
effect of 8 weeks of twice-weekly
chair yoga sessions on pain, stiffness,
physical function, and depression in
older adults with OA. Two research
questions were formulated:
1. Will older adults with OA who
participate in an 8-week chair yoga
session demonstrate improvement
in pain intensity, stiffness, physical

16

function, and emotional well-being

as measured by scores on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC;
Bellamy, Buchanan, Goldsmith,
Campbell, & Stitt, 1988) and the
Center for Epidemiologic Studies
Depression Scale (CES-D; Radloff,
1977) at baseline, midpoint, and end
of intervention?
2. What benefits are reported by
older adults diagnosed with OA after participating in an 8-week chair
yoga intervention?

Method
Procedure
The study was approved by the
Universitys Institutional Review
Board. Study participants (N = 10)
were recruited. Participants in the

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chair yoga group attended 45-minute

chair yoga sessions biweekly for 8
weeks, for a total of 16 sessions. The
group was led by a certified yoga
instructor who was knowledgeable
and experienced in chair yoga sessions. Chair yoga was performed
while sitting in a chair equipped with
arms for easy access to sitting and
standing. Participants in this group
sat during the entire 45-minute yoga
session.
The WOMAC was completed by
participants before the intervention,
at midpoint (Session 8), and at the
end of the intervention (Session 16).
On completion of the yoga sessions,
participants were invited to participate in a focus group to report the
perceived effects of chair yoga. Participants received a $10 gift card after
the focus group session.
Participants
Ten participants were recruited
by placing flyers and announcements at the University Continuing Education Center and at an
independent living facility in south
Florida. Each participant met the
following inclusion criteria: (a) age
65 and older; (b) living in the community and noninstitutionalized
at the time of the study; (c) diagnosed by a health care professional
as having OA in one or more joints
(knees, hips, lower back, neck, fingers, thumb, and/or big toe); (d)
having chronic pain at least 15 days
of the month at a level of 4 on pain
scale of 1 (no pain) to 10 (excruciating pain); (e) not currently participating in yoga or other nonpharmacological pain therapies; and (f)
able to speak, read, and understand
English. Exclusion criteria were: (a)
severe cognitive impairment or (b)
inability to come to the research
site weekly.
This study was supported by
a university mentoring grant that
subsidized the cost of the yoga sessions. Participants were offered the
opportunity to continue chair yoga
sessions led by the same instructor

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after the study was conducted. The

participants voted to postpone continuation of chair yoga until they returned to Florida from their homes
in other states. Therefore, the chair
yoga program was scheduled to resume August 22, 2011, at a participant cost of $6 per session.
Data Collection
Data consisted of participants
scores on the WOMAC Index
and the CES-D at baseline, midintervention, and end of intervention, and participant responses in
the focus group session.
WOMAC. The WOMAC (Bellamy et al., 1988) consists of 24 items
in three subscales: pain (5 items),
stiffness (2 items), and physical function (17 items). Response choices are
offered on a Likert-type scale of 0
to 4. Scores for items in each of the
three subscales are summed, with
possible ranges as follows: pain = 0
to 20, stiffness = 0 to 8, and physical function = 0 to 68. Higher scores
indicate worse pain, stiffness, and
functional limitations (Bellamy et al.,
1988). Internal consistency (Cronbachs alpha coefficient = 0.86) and
test-retest reliability (Kendalls tau c
statistic = 0.68) have been reported as
moderate to excellent for pain.
CES-D. Depressive symptoms
were measured with the CES-D
(Radloff, 1977). The CES-D is used
to assess the degree of depressive
symptoms over the past week but
does not identify the diagnostic category of depressive disorder. The
CES-D consists of 20 items using a
4-point, Likert-type scale of 0 (rarely) to 3 (all of the time; 5 to 7 days).
Scores can range from 0 to 60, with a
higher score indicating a higher level of depressive symptoms. A score
greater than 16 (cut-off score) indicates significant symptomatology
in need of further assessment. High
Cronbachs alpha coefficients of
0.85 for adults without a psychiatric
diagnosis and 0.90 for adults with a
psychiatric diagnosis have been reported (Radloff, 1977). The CES-D

Table 2

Repeated Measures Analysis of Variance for the WOMAC

and CES-D at Baseline, Midpoint, and Final (N = 7)
Measure and Time Point

Mean (SD)

Physical function
Baseline

30.3 (8.9)

Midpoint

20.5 (3.0)

Final

14.8 (5.6)

Stiffness
Baseline

4.2 (1.5)

Midpoint

2.5 (1.8)

Final

1.8 (1.2)

Pain
Baseline

8.6 (4.2)

Midpoint

4.4 (1.9)

Final

2.8 (1.6)

Baseline

13 (1.4)

Midpoint

5 (1.4)

3 (0)

Depressive symptoms

Final

p Value

17.1

0.03

6.5

0.05

6.3

0.07

100

0.06

Note. WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index (Bellamy,
Buchanan, Goldsmith, Campbell, & Stitt, 1988), in which higher scores indicate worse pain,
stiffness, and functional limitations; CES-D = Center for Epidemiologic Studies Depression Scale
(Radloff, 1977), in which higher scores indicate a higher level of depressive symptoms.

has also been tested with community samples of older adults (Krause,
1986), as well as with populations
with arthritis (Blalock, DeVellis,
Brown, & Wallston, 1989).
Focus Group. Two researchers,
as group leaders, developed a set of
open-ended questions and a series
of probing questions to elicit the
participants experience in attending
the chair yoga sessions. The openended questions were:
l What did you experience by
participating in the 8-week
chair yoga intervention?
l Was the chair yoga program
helpful in managing OA?
The focus group session was
audiorecorded and professionally
transcribed. The transcription was
analyzed by the two authors to
identify emerging themes.

Journal of Gerontological Nursing Vol. 38, No. 5, 2012

Data Analysis
Descriptive data analysis was
performed to identify sample characteristics. To address the first research question, one-way repeated
measures of analysis of variance
(ANOVA) were performed to
compare baseline, midpoint, and
final data with the within-subjects
(time) factor to compare scores on
the pain, stiffness, physical function, and depressive symptoms
subscales. Greenhouse-Geisser adjusted degrees of freedom were used
to evaluate interaction effects when
appropriate. Significant ANOVA
interactions were examined using the Tukey procedure (Stevens,
2002) as a post-hoc test to determine which of the contrasts among
three time points were significant:
(a) baseline versus 4 weeks, (b) 4

17

weeks versus 8 weeks, and (c) baseline versus 8 weeks.

To address the second research
question, data from the focus group
discussions were analyzed using thematic analysis. The researchers were
present at the focus group session,
listened to the recordings, and read
and reread the transcript. Analysis of
the collected data proceeded using a
theme-based content analysis of the
narrative data composed of descriptions of experiences of the yoga intervention reported by the participants
in the focus group session. The two
researchers who conducted the focus
group made field notes concerning
attitudes, word emphasis, and body
language of participants. Each of the
four researchers in the study read and
reread the transcripts of the focus
group discussion, then met to discuss
individual findings and reach consensus regarding the meaning of the focus
group content and to extract themes.

Results
Sample Characteristics
The age range of participants in
this study was 71 to 81 (mean age =
77, SD = 3.6 years). Of the 10 individuals who agreed to participate, 7
(70%) completed the chair yoga sessions. Various reasons were given by
those who withdrew (e.g., I had an
extremely painful reaction to the first
session in my shoulder and neck [reported by a participant with cervical
spine stenosis, whose physician recommended she not continue in the
presence of pain], I cannot make
time for these sessions as I have a lot
of other appointments and obligations, and I have other things to
do).
Characteristics of the 7 participants who completed all sessions are
presented in Table 1. Six reported
having had chronic pain associated
with OA for more than 1 year. Three
participants reported having experienced lower back pain, and 2 reported
having experienced knee pain. In response to the question, How much
does your chronic pain affect your

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life? (0 = no effect at all to 9 = severely affects my life), 2 participants

gave a response of 5 or higher. Three
participants reported taking over-thecounter medications, such as acetaminophen (n = 2) or aspirin (n = 1).
One-Way Repeated Measures
ANOVA
Data from the 7 program completers were analyzed using a oneway repeated measures ANOVA.
To address the first research question, frequencies, means, standard
deviations, F, and significance

Chair yoga is
appropriate for older
adults with OA who are
unable to participate
in regular standing
yoga or other exercise.
It is particularly safe to
practice, easy to learn,
and not likely to lead
to falls.

levels for pain, stiffness, physical

function, and depressive symptoms by time (baseline, midpoint
[4 weeks], and final [8 weeks]) are
presented in Table 2. Higher scores
on the WOMAC indicate worse
pain, stiffness, and functional
limitations (Bellamy et al., 1988).
ANOVA showed a statistically significant difference of 15.5 points in
mean scores for physical function,

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F(1, 3) = 17.1, p = 0.03, indicating

that physical function improved
from baseline to midpoint to final.
ANOVA showed a statistically significant difference of 2.4 points in
mean scores for stiffness, F(1, 5) =
6.5, p = 0.05, decreasing from baseline to midpoint to final, indicating that stiffness was reduced after chair yoga sessions. Regarding
pain, ANOVA also showed that,
although the mean score for pain
level declined by 5.8 points from
baseline to midpoint to final, the
overall differences in mean scores
for pain were not statistically significant, F(1, 4) = 6.3, p = 0.07. In
addition, ANOVA showed that,
although the mean score for depressive symptoms declined from
baseline to midpoint to final, the
overall differences in mean scores
for depressive symptoms were not
statistically significant, F(1, 1) =
100, p = 0.06.
Tukey post-hoc comparisons were
conducted for stiffness and physical
function to determine which of the
comparisons were significant (baseline versus midpoint [4 weeks], midpoint versus final [8 weeks], baseline
versus final). For stiffness, the mean
score at baseline (3.4, SD = 2.02)
was not significantly different from
the mean score at midpoint (2.8,
SD = 1.54), p = 0.08. The mean score
at midpoint was not significantly different from the mean score at final
(2.3, SD = 1.5), p = 0.091. The mean
score at baseline was also not significantly different from the mean score
at final, p = 0.064.
For physical function, the mean
score at baseline (22, SD = 12.9) was
not significantly different from the
mean score at midpoint (18, SD =
6.51), p = 0.091. The mean score at
midpoint was significantly different from the mean score at final (13,
SD = 8.18), p = 0.05, which indicated that physical function improved
from midpoint to final. The mean
score was also significantly different (9 points) at baseline and final,
p = 0.046.

Copyright SLACK Incorporated

Focus Group Data Analysis

Analysis of the data from the focus group discussion yielded three
overall themes regarding their experience in the chair yoga intervention and their perceptions of the
major benefits of chair yoga: Pain
Reduction and Improved Mobility,
Feeling of Security, and Improvement in Sense of Well-Being.
Pain Reduction and Improved
Mobility. The first theme was that
the 8-week chair yoga sessions reduced pain associated with OA and
improved mobility. The following
quotes from the focus group session highlight this theme:
l I felt better in terms of
my ability to do more things at
home.
l It makes my body feel better and I have less pain.
l I feel its easier to bend over
to stretch to reach for something.
l I feel a difference in
my body the way I am able to
stretch.
l I feel the results of the exercise moving through my whole
body. It kind of touches every
place where I feel pain and makes
me feel better.
l It stretches my muscles and
I feel good.
l This yoga experience has
been one of generally feeling a
little more limber and having less
pain in my joints.
l Yoga helps to stretch areas
that are otherwise constricted or
too tight. The stretching increases
my blood flow.
l I was terribly frightful of
any movement, fearful of any
movement and learning that I
could do it and not, nothing happened or what I was hearing in the
joints was not breaking or splintering or lots of other things that
can happen to me. It made it easy
to do more.
Feeling of Security. The second
theme expressed by the chair yoga
focus group was a feeling of security in having the chair while prac-

keypoints
Park, J., & McCaffrey, R. (2012). Chair Yoga: Benefits for Community-Dwelling Older
Adults With Osteoarthritis. Journal of Gerontological Nursing, 38(5), 12-22.

1
2

Yoga is one of the nonpharmacological pain therapies that address

physical and psychosocial components and has demonstrated effectiveness in treatment of osteoarthritis (OA).

Although chair yoga was effective in improving physical function and reducing stiffness in older adults with OA, its effect on
reducing pain level or improving depressive symptoms was not
statistically significant.

The focus group discussion yielded three overall themes regarding participants experience in the chair yoga intervention and
their perceptions of its major benefits: Pain Reduction and Improved Mobility, Feeling of Security, and Improvement in Sense
of Well-Being.

ticing yoga. The following quotes

from the focus group session demonstrate this theme:
l I think that in regular yoga
you are getting up from the floor
and down and so forth and I think
that is more difficult when you
have any back or any other issues
to just get yourself up from a position.
l This type of yoga with the
chair is better for anyone who is
afraid to attempt regular yoga.
l That is a big thing as you
get older and as you have more
problems with getting off the floor
by yourself.
l In regular yoga, getting up
and down from the floor or standing for a long time is difficult for
me, but when you have the chair, it
is better.
l I dont think I could do the
yoga unless I had something beside me to help me. The chair yoga
offers security for me.
l I think the chair yoga offers
security but I also think its the
way to exercise if you are not able
to get up and down from lying
down on the floor.
l The chair yoga is a good
stretching and bending exercise.
When you do standing yoga, you
sometimes get wobbly and you

Journal of Gerontological Nursing Vol. 38, No. 5, 2012

dont have the security of the chair

to hold on to.
Improvement in Sense of WellBeing. The third theme expressed
by the chair yoga focus group was
an improved sense of well-being after the yoga intervention. The following quotes illustrate this theme:
l I learned how to relax,
which I didnt really know before.
I learned how it makes your body
feel better.
l The yoga helps you with
sleeping and limberness and relaxation and well-being; those are
very important aspects of life.
l There is no question that
these sessions have improved my
sense of well-being, my psychological, my sociological, all of
them.
l Nothing in my situation has
changed but my attitude toward
my life has changed for the better.
I am more calm.
l At home I do some of the
breathing exercise. It helps me to
feel calmer and more relaxed.
l Coming to the class is very
important to me because it helps
me to be all right, to feel like
things in my life are not so bad.
l I feel good about the fact
that I am doing this for myself.
The breathing exercises have made

19

a great difference for me. As I

become more conscious of the
breathing, it helps me to relax and
even sleep better at night.

Discussion

This pilot study examined the effect of chair yoga on reducing pain
and stiffness and improving physical
function and depressive symptoms
in older adults with OA. Compared
with their health status prior to taking
the chair yoga sessions, the participants had statistically significant improvement in physical function and
stiffness, as measured by the WOMAC Physical Function and Stiffness
subscales, which were congruent
with results reported in other studies
(Chen et al., 2008, 2010; Garfinkel et
al., 1994; Kolasinski et al., 2005). In
the studies by Chen et al. (2008, 2010),
results showed that physical fitness in
older adults in the Silver Yoga group
had improved significantly by the end
of the intervention.
Consistent with previous studies
(Taibi & Vitiello, 2011), this trial demonstrated that the chair yoga sessions
did not produce significant improvement in pain level or depressive symptoms. However, these findings were
not congruent with those from other
studies (Garfinkel et al., 1994; Williams et al., 2005). Williams et al. noted
that significant reductions in pain and
disability scores were found for people
who completed the yoga classes relative to the educational control group.
In the study, 60 adults with chronic
low back pain were randomized to
weekly yoga classes (90 minutes per
week) for 16 weeks or an educational
group. Because the 7 participants in the
current study attended yoga sessions
only twice per week for 45 minutes
per session, it is plausible that the lack
of significant pain reduction could be
due to a suboptimal dose of the yoga
intervention (Haaz & Bartlett, 2011)
and the small sample.
The researchers provided participants with a DVD to practice chair
yoga at home since it has been determined that home practice for long-

20

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Earn 2.1 Contact Hours

term effectiveness of chair yoga after

the intervention is convenient and
affordable, without the need for expensive equipment or access to specific facilities (Haaz & Bartlett, 2011).
However, only 1 of the 7 participants
had a DVD player, and she was not
willing to practice on her own. Such
issues could be a barrier to home practice of chair yoga by older adults with
OA. A chair yoga manual developed
by Kristine Lee (who has taught yoga
since 1997), which includes a picture
for each yoga position, will be used in

The results suggest that

a supervised 8-week
session of chair yoga
can be beneficial in
improving physical
function and reducing
stiffness in symptomatic
OA patients.

a large-scale study. For those who are

not willing to practice chair yoga on
their own, it is recommended to practice with other people who have OA
instead of home practice.
The chair yoga program for this
pilot study was designed to provide
preliminary data for developing an innovative and evidence-based program
for older adults who are unable to attempt more strenuous exercise due to
pain, balance, physical function, or
simply fear of falling. This study determined the feasibility and safety of

cne

practicing chair yoga by older adults

with OA. Four participants stated
that when they had pain, they sat and
did some postures remembered from
the program, which they anticipated
would reduce pain levels. One participant reported shoulder and neck pain
as an adverse effect of participating in
chair yoga sessions and left the study
during the second session. The results
suggest that a supervised 8-week session of chair yoga can be beneficial in
improving physical function and reducing stiffness in symptomatic OA
patients.
The participants in the focus group
described chair yoga as a self-healing
modality. The focus group participants also reported improvement in
breathing, blood circulation, stress,
and sleep after 16 sessions of chair
yoga. While the WOMAC results did
not indicate a statistically significant
reduction in pain levels, the benefits
of chair yoga that were most frequently reported in the focus group
discussion were reduced pain associated with OA and improved mobility, a feeling of security in having a
chair, and an improved sense of wellbeing. The findings from the focus
group session provide promising preliminary support for the physical and
psychological benefits of chair yoga
in older adults with OA.
The findings from this pilot study
suggest that chair yoga practice may
improve physical function and, when
tailored to older adults with OA, may
offer a cost-effective method to prevent or reduce age-related changes.

Limitations

The small sample is recognized as

a study limitation, in that the results
lacked power to adequately evaluate
the magnitude of the effect of chair
yoga on OA. The small sample was
likely the cause of the failure to
demonstrate significant differences
in pain level and depressive symptoms. The lack of a formal manual
for chair yoga; differences in chair
yoga instructions and yoga instructor; variation in styles, doses, and

Copyright SLACK Incorporated

format (Haaz & Bartlett, 2011); and

lack of consistency in the design of
the intervention may limit generalizability of the findings.

Conclusion and
Implications

Compared with other studies

of yoga for OA, the current study
had a relatively high dropout rate
(30%). However, this percentage is
misleading due to the small sample.
One participant withdrew from
the study after the first session (I
had an extremely painful reaction
to the first session in my shoulder
and neck), which may lead the researchers to review and revise yoga
poses to consider the needs of older
adults with severe back pain. With
the exception of this participant,
the dropout rate was not related to
adverse events from participating in
the chair yoga; the major reason for
dropping out was inability to attend
sessions due to time constraints.
Future studies should use rigorous study methodologies, including larger samples, and randomized
controlled trials. Specific plans for
the next step in this research include (a) sample size increased to
90 participants to increase power
and measure differences withinand between-subject groups, (b)
randomized selection of sites from
local agencies, and (c) sufficient follow up (e.g., 3 months, 6 months)
of monitored home practice, which
can be effective for long-term effectiveness in managing OA. Future
studies should be conducted with
a variety of populations, based on
medical conditions and participant
characteristics. For example, few
studies have addressed patterns of
ethnic disparity in the efficacy of
yoga, and research is needed to understand perceptions and knowledge about practice of chair yoga by
older adults across ethnicities.
Older adults with OA can benefit from participation in chair yoga
by incorporating yoga practice into
a comprehensive pain management

plan. The overall recommendation

of this pilot study is that more research about chair yoga be conducted for older adults with OA.
Gerontological nurses could use
a holistic approach for pain management that includes therapies considered complementary-alternative
medicine (CAM) with the traditional medical treatments. Chair yoga
may be a valuable CAM therapy for
nurses to introduce to patients with
OA who are unable to attend standing yoga or other exercise programs
due to pain, weakness, or fear of
falling. More important, gerontological nurses should have sufficient
follow up to determine whether a
patient with OA can obtain benefits
from a chair yoga program.
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ABOUT THE AUTHORS

Dr. Park is Assistant Professor,

School of Social Work, and Dr. McCaffrey is Professor, College of Nursing, Florida Atlantic University, Boca
Raton, Florida.
The authors disclose that they have
no significant financial interests in any
product or class of products discussed
directly or indirectly in this activity.
This pilot study was supported by the
Florida Atlantic University mentoring
grant (seed grant).
Address correspondence to Juyoung
Park, PhD, Assistant Professor, School
of Social Work, Florida Atlantic University, 777 Glades Road, Boca Raton,
FL 33431; e-mail: jpark14@fau.edu.
Received: April 30, 2011
Accepted: December 16, 2011
Posted: April 25, 2012
doi:10.3928/00989134-20120410-01

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Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.