Effect of yoga versus light exercise and its impact on quality of life among elderly – A systematic review and meta-analysis

ABSTRACT

Introduction:

Diabetes, cardiovascular diseases, metabolic syndrome, and cancer are prevalent among the elderly, significantly impacting their health-related quality of life (HRQOL). Physical activity, including yoga and light exercise, has been shown to improve various health outcomes. This meta-analysis aimed to evaluate the effect of yoga and light exercise interventions on HRQOL in older adults.

Methods:

A systematic search was conducted across PubMed, Cochrane Library, and Google Scholar databases up to March 2024. We included all published randomized controlled trials (RCTs) assessing the impact of yoga and light exercise interventions among elderly populations. Data extraction followed a standardized protocol, and statistical analyses were performed using RevMan 5 software. We calculated mean differences and odds ratios to compare intervention and control groups. A fixed-effects model was applied to assess the overall efficacy of interventions.

Results:

The findings demonstrated that yoga therapy significantly improved several dimensions of quality of life in the elderly, including cognitive function and sleep quality. Additionally, the interventions were effective in reducing psychological issues such as anxiety, depression, and stress.

Conclusion:

Our meta-analysis provides evidence supporting the beneficial role of yoga and light exercise in enhancing physical and psychological well-being among older adults.

Introduction

The natural process of ageing is linked to numerous structural and functional changes. These modifications could involve altered tissues and organs as well as poor self-regulation. Mood, physical condition, and social activity are all impacted by aging.[1,2,3] Adverse alterations occur in thought processes, perceptual sensations, and cognitive behavior. Many health issues can be resolved with regular physical activity, yet many older persons do not exercise. An increasing number of older adults are choosing to age in place while managing multiple chronic conditions. Though these conditions are often incurable, they require ongoing care management and assistance with daily activities to support independent living at home. This support system encompasses both informal caregivers and a spectrum of formal services, including rehabilitation, home nursing care, day programs, mental health services, and primary care through general practitioners.[4,5] Maintaining quality of life (QoL) represents one of the most critical outcomes when evaluating care services provided to older adults. “QoL is inherently a dynamic, multi-level and complex concept, reflecting objective, subjective, macro-societal, and micro-individual, positive and negative influences which interact together”.[6,7,8]

Yoga stands out as both a popular and scientifically supported lifestyle practice renowned for its unique ability to integrate mind, body, and soul. Since ancient times, yoga is incredibly good for one’s physical, mental, and social well-being. It is also fast increasing popularity around the globe. Regular yoga and meditation practice have been shown in prior research to substantially enhance health-related quality of life outcomes (HRQOL).[9,10] Chronic illnesses such as diabetes, cardiovascular disease, metabolic syndrome, and cancer can be effectively treated using yoga and meditation techniques. Additionally, by lowering inflammation and enhancing immune system performance, the exercise improves mental health by lowering anxiety and despair.[11,12,13] Hence, the current meta-analysis was planned to assess the effect of yoga and light exercise and their impact on quality of life among the elderly population.

Materials and Methods

The protocol for this systematic review was prospectively registered with PROSPERO (Acknowledgement number: 514331). The research adhered to PRISMA guidelines and specifications for systematic reviews and meta-analyses. Heterogeneity assessments fell within acceptable parameters, allowing for the completion of meta-analysis.

Inclusion criteria

The inclusion criteria were based on the PICOS principle and were as follows:

• Population: Elderly aged more than 60 years of age

• Intervention: Yoga (asanas, medication) and light exercise

• Control: Elderly aged more than 60 years without any co-morbidities

• Outcome: Quality of life status among the elderly

• Studies: Randomized controlled trial and its types

Exclusion criteria

Elderly with diabetes mellitus, hypertension, epilepsy, coronary heart disease, cancer patients, dialysis patients, and immuno-compromised patients.

Search strategy

Literature was obtained through electronic retrieval methods. A thorough systematic review was conducted using a combination of Medical Subject Headings, controlled vocabulary, and keywords across multiple databases, including PubMed, Google Scholar, and Cochrane Library through January 2024. All search results were imported into Rayyan online software for duplicate removal. Additionally, reference lists from primary trials were manually examined for relevant articles, which were subsequently extracted for review and analysis.

We searched PubMed, Google scholar with the following search terms: ((((“yoga”[Title/Abstract] AND ((y_10[Filter]) AND (ffrft[Filter]))) AND((y_10[Filter]) AND (ffrft[Filter])))) AND (“quality of life”[Title/Abstract] AND ((y_10[Filter]) AND (ffrft[Filter])))) AND (((“quality of life”[Title/Abstract]) OR (“wellbeing”[Title/Abstract])) OR (“healthy”[Title/Abstract]) AND ((y_10[Filter]) AND (ffrft[Filter])))) AND (((“elderly”[Title/Abstract]) OR (“oldage”[Title/Abstract])) OR (“senior citizens”[Title/Abstract]) AND ((y_10[Filter]) AND (ffrft[Filter]))) AND ((y_10[Filter]) AND (ffrft[Filter])) AND ((y_10[Filter]) AND (ffrft[Filter])).

Study selection

Search results were uploaded into Rayyan, an online systematic review management software, to facilitate study selection. A two-stage screening process was implemented: first, examining titles and abstracts, then reviewing full-text articles. All authors participated in the literature search and initial screening of titles, abstracts, and keywords. Full-text assessment was likewise conducted by all authors to identify studies meeting the established eligibility criteria. Any disagreements arising during the selection process were resolved through consensus discussions among authors. Conflicts between collaborators were moderated through joint discussion to reach unified decisions.

A total of 15 articles were retrieved and through Rayyan title and abstract screening, nine articles were included and six were excluded. Further, on full text article screening, eight articles were included for data extraction and six were excluded.

Data extraction and management

The first and second authors independently extracted relevant study characteristics related to outcome measures from included studies. Data extraction followed a predetermined checklist capturing the first author’s last name, publication year, total sample size, study design, setting, duration, study groups, and interventions such as yoga and light exercise. The collected data were exported to Review Manager (RevMan_5.3, Copenhagen: The Nordic Cochrane Center, the Cochrane Collaboration, 2014).[14,15] Data entry accuracy was verified by the third and fourth authors (DA, SS) through comparison of data presented in the review against the original reports.

Outcome measure for the study

The study aimed to evaluate the effect of yoga and light exercise on quality of life among elderly populations in Indian settings.

Quality assessment

Risk of bias in selected articles was assessed using the Joanna Briggs Institute approach.

Statistical analysis

For quantitative meta-analysis, binomial data were analyzed using RevMan_5.3. Due to heterogeneity across studies, a logistic-normal random-effect model was employed. The 95% confidence interval (CI) was calculated for both study-specific and overall pooled prevalence. Heterogeneity was assessed using I² statistics, with significant heterogeneity defined as P < 0.05 or I² > 50%. Subgroup analysis was conducted to evaluate heterogeneity and potential confounding factors. Both study-specific and pooled estimates were visually represented through forest plots for combined and subgroup analyses.

Results

Study selection and characteristics

The initial database search yielded 220 studies. After duplicate removal, 55 studies underwent screening, with 5 ultimately meeting inclusion criteria for quantitative analysis. The study selection process is illustrated in Figure 1, following PRISMA guidelines.

Figure 1.

PRISMA flow diagram of the study selection process

Participant characteristics and intervention criteria (Yoga versus light exercise)

The five included studies comprised 189 participants in the yoga intervention group and 188 participants in the light exercise control group, all receiving therapy aimed at improving quality of life.[16,17,18,19,20] Participants ranged from 60 to 75 years of age across all cohorts. Yoga therapy demonstrated benefits in addressing age-related health concerns including insomnia, constipation, depression, stress, and anxiety.

Methodological quality assessment

All five studies included in the final review were single-blinded randomized controlled trials comparing yoga therapy to light exercise. These studies were published between 2013 and 2021 and focused on elderly populations at elevated risk for cognitive impairment and dementia.

Intervention effectiveness

Meta-analysis of the five eligible comparative studies evaluating yoga therapy versus light exercise for quality of life improvement in adults aged 60 years and older revealed a significant overall intervention effect (odds ratio = 0.80, 95% CI 0.50-1.10, P = 0.87), as depicted in Figure 2. The significant Q statistic (P < 0.001) indicated substantial heterogeneity among studies (I²=98%).

Figure 2.

The size of the square box is proportional to the weight that each study contributes in the meta-analysis. The overall estimate and confidence interval are marked by a diamond

Findings of the review

Among the five studies, the risk of bias (selection, attrition, and reporting) was identified as low [Figure 3]. Study done by Shree Ganesh et al.[16] showed odds of (0.04 with 95% CI 0.35-0.27), similarly study by Hariprasad et al.,[17] Patel et al.[21] showed odds of 0.80 and 1.03 with 95% CI 0.50-1.10 and 1.18-0.88, respectively. In a few of our studies, tools like the Pittsburgh Sleep Quality Index (PSQI) and Constipation Quality of Life (PAC-QOL) were used to assess the quality of well-being.

Figure 3.

Risk of bias by JBI approach for randomized controlled trial

Discussion

Our randomized controlled trial examined yoga therapy’s impact on quality of life among elderly individuals (60-75 years). Approximately two-thirds of participants reported sleep disturbances, depression, anxiety, and stress, though memory problem prevalence showed no statistically significant difference between study groups. Despite an adequate overall sample size, baseline parameter comparison revealed imperfect randomization between the yoga and light exercise control groups. Consequently, six-month analyses of age group differences incorporated education years and baseline measurements as covariates.

Yoga group participants demonstrated significant improvements from baseline parameters at the six-month assessment. Conversely, the control group exhibited significant performance decline during the same period.

These findings suggest yoga-based interventions positively affect cognitive function in elderly populations. While numerous studies have documented the benefits of various physical activities and cognitive stimulation on elderly cognitive function,[22,23,24] yoga-based interventions, which incorporate both elements, remain understudied in this context. Our results indicate greater cognitive benefits from yoga therapy compared to light exercise management among elderly participants. This aligns with research showing enhanced cognitive performance in long-term Vihangam Yoga meditators versus age- and education-matched controls.[25] However, Oken et al.[26] previously found no differential effects between yoga and exercise on cognition in cognitively healthy elderly individuals.

These results support incorporating yoga as a lifestyle approach for cognitive and psychological benefits in elderly populations. While our model cannot position yoga as an exercise alternative, the behavioral benefits observed warrant further investigation of biological correlates in future research.

Conclusion

Our meta-analysis currently generates evidence that yoga therapy provides improvement in quality of life among elderly population. Their physical, mental, and spiritual health showed significant advantage after the intervention, which can be assessed through their sleep quality and other practical compliance.

Declaration of patient consent

Patient’s consent is not required as there are no patients in this study.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The author(s) confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Funding Statement

Nil.