|Year : 2020 | Volume
| Issue : 2 | Page : 56-60
Yoga training enhances auditory and visual reaction time in elderly woman inmates of a hospice: A pilot randomized controlled trial
Meena Ramanathan, Ananda Balayogi Bhavanani
Centre for Yoga Therapy Education and Research, Sri Balaji Vidyapeeth, Puducherry, India
|Date of Submission||11-Aug-2020|
|Date of Acceptance||21-Oct-2020|
|Date of Web Publication||23-Dec-2020|
Ananda Balayogi Bhavanani
Centre for Yoga Therapy Education and Research, Sri Balaji Vidyapeeth, Pillayarkuppam, Puducherry - 607 402
Introduction: There is a generalized impairment of mind–body functioning due to old age, resulting in disintegration, leading to diseases, and yoga is a boon to the elderly as it has preventive, curative, as well as rehabilitative potential. Reaction time (RT) is a simple, noninvasive index of processing ability of the central nervous system.
Aim: This study planned to investigate changes in auditory RT (ART) and visual RT (VRT), respectively, before and after 12 weeks of yoga training in elderly woman inmates of a hospice in Puducherry.
Subjects and Methods: Forty woman inmates were randomized to two groups of twenty each. Group A (yoga group) received training in integrated Silver Yoga program, while Group B (wait-listed control group) did not. ART and VRT were measured before and after study period using RT apparatus. Data passed normality testing, and parametric statistical methods were applied for intra and inter-group comparisons using Student's paired and unpaired t-test, respectively. A p < 0.05 was considered to indicate significance.
Results: Baseline values were comparable between both groups. Intra-group comparison of pre-post data showed statistically significant (p < 0.001) differences in Group A, for both ART and VRT. Actual p values have been given for unpaired t-test and the intergroup comparison of ART and VRT showed significant differences (p = 0.001 and p = 0.018, respectively).
Discussion: The influence of yoga in the reduction of ART and VRT in elderly females is evident as has been reported in earlier studies and may be attributed to enhanced central processing ability resulting from improved alertness and awareness. Significant shortening in ART and VRT signifies faster reactivity and enhanced sensory motor function in the elderly.
Limitations: It is limited by smaller sample size and single center. Further multi-centric studies with larger populations can deepen understanding.
Conclusion: Yoga training can enhance RT in senior citizens, increasing their agility and alertness, which is dulled with aging. Results of this study give preliminary evidence that incorporation of yoga as part of senior's lifestyle can help in promoting health modifying age-related disorders. We suggest that yoga should be part of health-care facilities for the elderly as it can enhance quality of life and improve overall health status.
Keywords: Senior citizens, hospice, Silver Yoga, central neuronal processing, sensory motor functions, lifestyle, health-care facility
|How to cite this article:|
Ramanathan M, Bhavanani AB. Yoga training enhances auditory and visual reaction time in elderly woman inmates of a hospice: A pilot randomized controlled trial. Yoga Mimamsa 2020;52:56-60
|How to cite this URL:|
Ramanathan M, Bhavanani AB. Yoga training enhances auditory and visual reaction time in elderly woman inmates of a hospice: A pilot randomized controlled trial. Yoga Mimamsa [serial online] 2020 [cited 2021 Jun 20];52:56-60. Available from: https://www.ym-kdham.in/text.asp?2020/52/2/56/304614
| Background|| |
Mental health in the elderly is of grave concern and an earlier report on health status of elderly woman inmates in a hospice by the authors reported impaired physical and mental health due to such a life in the hospice as these women felt abandoned by their families or had no family at all (Ramanathan & Bhavanani, 2016). Health concerns in seniors are often precipitated by sedentary lifestyle and sluggish metabolism associated with weight gain. It is often seen that women generally have a higher body mass index (BMI) and prolonged reaction time (RT). As compared to men, there is a positive correlation between BMI and visual RT (VRT) and auditory RT (ART), respectively. Prolonged RT has been shown to be an indicator of impaired sensory-motor coordination that puts the elderly at an increased risk of falls and injuries (Nikam & Gadkari, 2012).
The Centre for Yoga Therapy Education and Research (CYTER) of Sri Balaji Vidyapeeth (SBV) based in Puducherry, India, has designed a “SILVER YOGA©” program for senior citizens as part of its community outreach activities. These practices are nonstrenuous and nonfatiguing and can be performed comfortably by the elderly as it has been designed keeping in mind their health status and physical limitations (Bhavanani, Ramanathan, & Trakroo, 2015).
To the best of our knowledge, very few studies have been done to establish the efficacy of Yoga on RT in elderly women. Hence, this study done as a follow up to the previous pilot study planned to evaluate ART and VRT in elderly woman inmates of a hospice before and after 12 weeks of an integrated Silver Yoga program.
| Introduction|| |
Aging is a progressive, generalized impairment of function, resulting in a loss of adaptive response to stress and in a growing risk of age-related disease (Kirkwood, 1995). It is a natural process characterized by declining physical performance, slower speed of reaction, and inadequate working of various systems with poor motor and sensory conduction.
RT is defined as the time required for an observer to detect the presence/onset of a stimulus and initiation of appropriate voluntary motor response. It is an index of information processing ability of central nervous system (CNS) and a simple, noninvasive means of determining sensory-motor co-ordination and performance. RT is used to judge the ability of an individual to concentrate and coordinate. ART is a purposeful voluntary response time required to respond to auditory stimuli and similar response to visual stimulus is VRT (Nikam & Gadkari, 2012).
RT represents the level of neuromuscular coordination in which body through different physical, chemical, and mechanical processes decodes visual or auditory stimuli that travel via afferent pathways and reaches brain as sensory stimuli and its subsequent motor response via efferent pathways. Elderly individuals should be more careful and vigilant about injuries and falls due to increased RT as it is a direct marker of the sensory-motor coordination (Shelton & Kumar, 2010). Van den & Neely (2006) reported that fatigue due to sleep deprivation could also be a cause for elders to have slower RT.
Yoga is the best lifestyle ever designed that can play a significant role in reducing such decline. Human body has a wonderful potential for self-regulation and self-healing, and yoga boosts the curative and rehabilitative potential. These elderly-friendly yogic techniques are easy to follow, slow down aging process, improve general health and quality of life, and promote healthy aging by empowering elderly patients and also provides them an opportunity for self-improvement (Madanmohan, 2017). Yoga helps modulate autonomic functions, relieve stress, and improve psycho-physiological functions including cardio-respiratory fitness and quality of life (Madanmohan, Udupa, Bhavanani, Vijayalakshmi, & Surendiran, 2005; Innes, Bourguignon, & Taylor, 2005; Sengupta 2012).
| Subjects and Methods|| |
This 12-week pilot randomized controlled trial was done at the Hospice Convent Home for the Aged, Congregation of Saint Joseph of Cluny in Puducherry. Ethical clearance was obtained from the Institutional Human Ethics Committee of MGMCRI, Sri Balaji Vidyapeeth, Puducherry. Authorities and inmates of Hospice Convent Home for the Aged willingly volunteered and consented to take part in this study.
An orientation program was conducted for the woman inmates of the hospice to explain details of tests, purpose of study, and their role in this study to ensure proper understanding and effective cooperation. Those who were willing to participate in yoga therapy and who would be able to perform the techniques in the protocol were included in the study.
Unwilling inmates were excluded from this study. Informed consent was obtained from the women and acceptance was obtained from the authorities of the hospice. Simple randomization was done by lots method by the hospice authorities, and the forty elderly women participants were randomly divided into yoga and wait-listed control group, with twenty participants in each group [Figure 1].
Group A (yoga group) received training in integrated Silver Yoga program [Table 1] of 60 min per session, twice a week for 12 weeks; while Group B (wait-listed control group) did not receive yoga training during the study period. However, both groups participated in all routine activities of the hospice. The intervention protocol was specially designed for senior citizens, keeping in mind their health status and physical limitations.
The mean age of the women in Group A and B was 68.90 ± 7.55 and 68.20 ± 8.78 years, respectively. All parameters were measured before and after the study period of 12 weeks. Individual height was measured to the nearest mm by a wall-mounted stadiometer and weight measured with a weighing scale (Krup's scale). BMI was calculated by Quetelet's index quantified as weight (kg)/height2 (m). ART and VRT were measured using RT apparatus. RT apparatus (Anand Agencies, Pune) with a built in 4-digit chronoscope and display accuracy of 1 ms was used for the study. Simple ART was recorded for auditory beep sound stimulus and simple VRT for red light stimulus.
The women were instructed to release response key as soon as they perceived stimulus. Signals were given from the front to avoid effect of lateralized stimulus and they used dominant hand while responding to signals (Mohan, 1996; Raghuraj & Telles, 2008). All women were given adequate exposure to the equipment on two different occasions to familiarize them with procedure as RT is more consistent when women have had adequate practice (Telles, Nagaratna, & Nagendra, 1994). Ten trials were recorded and the mean of three similar observations was taken as a single value for the purpose of statistical analysis (Madanmohan, Thombre, Balakumar, Nambinarayanan, Thakur, & Krishnamurthy, 1992; Bhavanani, Ramanathan, & Harichandrakumar, 2012).
Data were assessed for normality using GraphPad InStat version 3.06 for Windows 95, (GraphPad Software, San Diego, California, USA). Parametric statistical methods were applied for intra- and inter-group comparisons using Student's paired and unpaired t-test, respectively, as all data passed normality testing by Kolmogorov–Smirnov test. p < 0.05 were accepted as indicating significant differences for pre-post and intergroup comparisons.
| Results|| |
The results are tabulated in [Table 2]. Baseline values were comparable between both yoga and control groups. After the 12 weeks of Silver Yoga, BMI showed significant reduction (p < 0.05) in Group A, due to the corresponding reduction in their weight, whereas there was an insignificant increase in Group B. Intra-group comparison of pre-post data of both ART and VRT showed statistically significant (p < 0.001) difference in Group A.
|Table 2: Effect of 12 weeks of yoga training on auditory reaction time and visual reaction time in forty elderly women before and after the study period|
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Actual p values have been given for unpaired t-test, and the inter group comparison of ART and VRT showed significant differences (p = 0.001) and (p = 0.018) between the groups.
| Discussion|| |
The influence of yoga is unmistakably clear from this study, which provides evidence of significant shortening in ART and VRT in elderly after 12 weeks of yoga training, which is in agreement with previous studies (Nikam & Gadkari, 2012; Bhavanani et al., 2012; Ramanathan, & Bhavanani 2014; Ramanathan, Eswari, Bhavanani, Prathima, & Sanguida, 2019; Bhavanani, Ramanathan, Balaji, & Pushpa, 2013; Malathi, & Parulkar, 1989; Bhavanani, Ramanathan, Balaji & Pushpa, 2014).
Dormant lifestyle and slow metabolism due to which there is weight gain is the main cause of health-related concern in senior citizens. Elderly women seem to have higher BMI and prolonged RT than men, which has been attributed to fluid and salt retention due to female sex hormones affecting their sensory-motor co-ordination coupled with decrease in the processing capability of CNS. Older individuals should be more careful and vigilant about the injuries and falls due to increased RT as it is an index of the sensory-motor coordination (Das, Gandhi, & Mondal, 1997). Yoga addresses these problems by offering the best solution to bring about positive changes in the elderly. A healthy reduction in weight and BMI has been observed in the elderly women after 12 weeks of yoga training, resulting in an enhanced processing ability of the CNS and a similar trend had been observed by Nikam & Gadkari (2012).
The use of yoga and other therapeutic modalities is becoming increasingly popular, especially among senior citizens, for aging-related chronic conditions. Yoga practice involves physical postures with stretching, balancing, and strengthening and also includes a component of breathing and all the practices are done mindfully, resulting in many different benefits (Tiedemann, O'Rourke, Sesto, & Sherrington, 2013). Yoga has the potential to enhance cognitive function in older adults (Park, & Reuter-Lorenz, 2009). Moderate muscular tension and isometric contraction enhance brain functioning, resulting in faster rate of information processing and improved concentration leading to reduction in RT (Etnyre & Kinugasa, 2002). Relaxation response evoked regulates brain areas related to emotions, motivation, and memory (Biswas, 2010).Decreased sympathetic activation and improved parasympathetic tone, promotes body–mind equilibrium and enhances emotional self-regulation (Streeter, Gerbarg, Saper, Ciraulo, & Brown, 2012).
Among the risk factors in senior citizens to the prediction of falls, results showed that RT contributed significantly. Prolonged RT is an indicator of increased risk of falling (Lajoie, & Gallagher, 2004). Shortening of RT signifies alert the state of mind attributed to enhanced central processing ability resulting from better sense of perception, sensitivity, alertness, and awareness occurring due to yoga practices. Dedicated practice of yoga results in a calm state of mind with an enhanced ability to process information and respond appropriately than an agitated one (Bhavanani, Ramanathan, Dayanidy, Madanmohan, & Renuka, 2017). Lazar et al., (2005). Reported increased thickness in a subset of cortical regions associated with somato-sensory, auditory, visual, and interoceptive processing (which is the sensory information or awareness responsible for the emotional regulation and self-identity) with regular practice of meditation. We have earlier reported that “Silver Yoga” harmonizes and rejuvenates body, mind, and emotions, thereby improving overall neuromuscular and physiological functioning in elderly. It harmonizes cardio-respiratory function, helps rejuvenate body and mind, and facilitates inherent healing mechanisms in elderly (Bhavanani, 2015).
The smaller sample size could have caused some nonsignificant results with large effect sizes. All participants were inmates of a hospice at Puducherry. Whether similar effect can be obtained on other cohorts of different cultures and backgrounds remains unknown. Further long-term and molecular-level studies are needed to validate the present findings.
| Conclusion and Recommendations|| |
The present study provides evidence that 12-week training in Silver Yoga can shorten ART and VRT in elderly women. Yoga training enhances central processing ability that may be utilized to promote agility, attentiveness, self awareness, balance, and coordination in old age. Silver Yoga program is a simple nonpharmacological intervention that has great potential in bringing about positive changes in the elderly. Considering these positive changes, it is recommended that yoga should be an integral part of health-care facilities for the elderly, as it can enhance quality of life by improving their overall health status in the sunset years of their life.
The authors thank the management and administrators of Sri Balaji Vidyapeeth for setting up CYTER thus, enabling yoga to reach all sections of society in a scientific and holistic manner. We offer our gratitude to Mrs. Pushpa, G Sarulatha, Sangeetha M, Dr. Alagarasan, Imma Sivaraj, and Dr. Visalakshi for their valuable assistance during data collection. Sincere gratitude is also offered to inmates and authorities of Hospice of Saint Cluny, Puducherry, for their wholehearted and generous co-operation.
Financial support and sponsorship
Though the present work didn't receive any special funding, Sri Balaji Vidyapeeth funds the CYTER and all of its activities in yoga therapy, education and research.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]