DEPARTMENT OF PHYSIOTHERAPY

FACULTY OF APPLIED SCIENCES

MANAV RACHNA INTERNATIONAL
INSTITUTE OF RESEARCH AND
STUDIES
NAME: Parmeet Kaur
ROLL NO. : 14/FAS/BPT/41

GUIDE NAME: Dr. Deepti Sharma

Effect of yoga and physical activities
on flexibility and balance in elderly
 INTRODUCTION
• Aging , the process of becoming older , a process that is
genetically determined and environmentally modulated
(Harraan,D,1955 ). It is defined as a loss of "Entropy and
fractality " (Balducci , L .2007 ). Aging represents the
accumulation of changes in a human being over time ( Bowen
, Richard ,L. 2004).
• Aging results in a decrement of muscle cross - sectional area
and the volume of connective tissue .(Williams GN et al 2002).
Other physiologic attributes that can evaluated , each of which
supports behaviors necessary to perform everyday activities,
are lower and upper body flexibility and strength and aerobic
endurance and mobile agility/ dynamic balance (Roberta .E.
Rikli and C .Jessie Jones 1999).
• Among these all age -related changes , the one that contribute
the most to loss of functional autonomy are reductions in
strength , flexibility and balance
• Balance the one of the component that contributes the most in
the studies related to the older age .Balance is the ability to
maintain the bodies centre of mass (COM) within the limits of
the base of support (Shumway -cook .A et al 2007 ). It is the
complex process that regulates the maintenance of positions ,
the postural adjustments of voluntary activity , and the
response to external distrurbances (Berg , 1989 ).
• Balance is contributed by providing information about the
body's position in relation to the external environment.
• Researches shows that balance decreases with aging
(Thorbahn & Newton ,1996). There are many age - related
changes seen in elderly that affect balance. These alteration
can be seen because systems and strategies that help to
maintain the balance of younger people are become less
effective in the elderly population because of physiological
changes (Alnaqeeb MA ,1984) .Alterations in balance can also
be bought about by disuse or disease.
• Researches shows that balance decreases with aging
(Thorbahn & Newton ,1996). There are many age - related
changes seen in elderly that affect balance. These alteration
can be seen because systems and strategies that help to
maintain the balance of younger people are become less
effective in the elderly population because of physiological
changes (Alnaqeeb MA ,1984) .Alterations in balance can also
be bought about by disuse or disease.
• Muscle flexibility may decrease across the age span , which
has the potential to affect normal daily functioning. Body
flexibility is very important component for the older age
people . Upper body flexibility is known to be important for
activities such as getting dressed and reaching for objects
,while lower body flexibility is important for activities such as
maintaining normal walking patterns and for activities
involving bending and reaching.
• But as getting old , There is decriment in flexibility .As there is
increase in connective tissue in the aging muscle . It would
lead to a decrease flexibility (Alnaqeeb MA ,1984). There is a
50% loss of body flexibility after the age of 70 years (Shumway
- cook A 2007 ).
• While flexibility and balance may decrease with age , with the
potential to affect normal daily function , to affect normal
daily function and to maintain the life expentency as aging
process start people start some sort of activities , some do
normal bending exercises while some enroll in yoga .
• Yoga is a group of physical , mental and spritual practices or
discipline which originates in ancient india . It is a technique of
controlling the body and mind .
• Yoga poses stretch your muscles and increase your range of motion
with regular practice , they ‘ll improve your flexibility .Same goes
with other physical activities like simple exercises like side bending
or walking or other activities people do in parks or gym like cycling
etc.
• As till now , we understand about the two different context that is
about the yoga and walking and other physical activities . As all the
content give us the idea of their on the two major components that
is flexibility and balance but none of it gives us comparative results
in both activities .
• The present study attempts to add additional information to this
area by presenting the comparison between the relationship
between yoga performing group people and walking and other
exercises performing people effects on their flexibility and balance
. This study will show which will give better results either yoga or
walking and other exercises on the balance and flexibility on
maintainence of flexibility with aging .
• STATEMENT OF PROBLEM
• Not many studies have been attempted to discover the relation
of walking and yoga with balance and flexibility in the elderly.
So the present study aimed to determine whether yoga gives
better effects on the balance and flexibility in elderly or the
other physical activities .
• Because of the muscle stiffness and various balance and
flexibility impairment seen in elder people .These impairments
get resolve by low intensity workout . These variables are
important to demonstrate in elderly for the betterment and
increase the lifespan by preventing diseases and muscle
stiffness by doing walking and yoga .These relationships and
studies are not studied yet that describes which give better
result on flexibility and balance in elderly either yoga or other
physical activities includes breathing exercises ,stretching
exercises , walking , cycling.
• AIM
• To find out the effects of the yoga and other physical activities like
stretchings on the balance and flexibility in elderly.
• HYPOTHHESIS
• NULL HYPOTHESIS : There will be no significant relationship
between yoga and balance ,
• There will be no significant relationship between yoga and
flexibility ,
• There will be no significant relationship between mild stretchings ,
walkiing and other simple activities and balance,
• There will be no significant relationship between mild stretchings ,
walkiing and other simple activities and flexibility
• ALTERNATIVE HYPOTHESIS :There will be stastical
significant relationship between yoga and balance
• There will be significant significant relationship between yoga and
flexibility
• There will be significant relationship between mild stretchings ,
walkiing and other simple activities and balance
• There will be significant relationship between mild stretchings ,
walkiing and other simple activities and flexibility
• OPERATIONAL DEFINATIONS
• YOGA: Yoga is a group of physical , mental and spiritual
practices or disciplines which originated in ancient India .It is a
discipline practice to improve the health of a person in a different
components like flexibility etc.
• FLEXIBILITY : Flexibility is the range of motion in a joint or
group of joints or the ability to move joints effectively through a
complete range of motion. Flexibility training includes stretching
exercises to lengthen the muscles and may include activities like
yoga.
• BALANCE : An even distribution of weight enabling someone or
something to remain upright and stead.
• WALKING : Walking is a popular , familiar , convenient and free
form of exercise that can be incorporated into everyday life and
sustained into old age .
• REVIEW OF LITERATURE
• Roberta E. Rikli and C. Jessie Jones conducted a study in 1999 in which
functional fitness was assessed between male & female . Study assessed
the physical parameters such as strength, aerobic endurance, flexibility
and agility/balance and body mass index. Result of this study revealed a
pattern of decline across most age groups on all variables. In this study
men scored better on strength, aerobic endurance and agility/balance;
women scored better on flexibility. The data provided information about
normal variations within and usual rates of change across age groups.
They provided a database for subsequent evaluation of individual and
group performance.
• Youlian Hong, Jing Xian Li, P D Robinson conducted a cross sectional
study in 2000 among the older Tai Chai chuan practitioners in which
balance control, flexibility, and cardiorespiratory fitness was assessed
.Study has included 28 male TCC practitioners with an average age of
67.5 years old and 13.2 years of TCC exercise experienced were
recrited to form the TCC group. While Control group included the 30
sedentary men aged 66.2 yrs old doing no exercise. this cross sectional
study concluded result that long term TCC exercise has favourable
effects on the promotion of balance control, flexibility , and
cardiovascular fitness in older adults. which gave idea that exercise
promoted the flexibility and balance components in aged group people .
• M.Brown and J.O. Holloszy conducted a study in 1991 in which
effect of low intensity exercise program on strength, flexibility ,
balance, gait and muscular endurance were determined in 60 -71
year old age group . Study included both male and female . In this
study two groups were taken . Experimental group was exercised
for 3 months , were tested at 2 time period . While control group
was not exercised but tested at 2 time period .This study revealed
that exercise subjects frequently reported improvements in
functional capacity and activities of daily living . These result
suggested that a low intensity exercise program improved strength,
balance, and flexibility in sedentary healthy older people.
• Liza Stathokostas, Robert M. D. ,LittleA. ,A. Vandervoort, and
Donald H. Paterson conducted a study in 2012 on the flexibility
abilities in older age .The purpose of study was to review the effect
of flexibility , specific training interventions & its outcome in
healthy older adults , in order databases were searched for
intervention studies , after evaluated all the article it was concluded
that flexibility may have affect on ROM outcome , but there was
less information regarding relationship between the flexibility
intervention and daily functioning .
• Hiroe Sugimoto , Shinichi Demura ,Yoshinori Nagasawa
conducted study in 2014 in which age and gender related
differences in physical functions of the elderly doing regular
exercises .This study aimed to clarify age and gender -related
differences in their physical functions. Participants included older
age group people and young elderly group people .Both male and
female were included in this study .In this study eight physical
function test were selected : grip strength , 10-m obstacle walking
time ,one -legged balance with eyes open , sit-ups , sitting trunk
flexion , 6-min walk , stepping by sitting position , and a timed up
& go (TUG) . Two way analysis of variance was used to examine
mean differences by gender and age ; young elderly group (Aged
65-74) and old elderly group (Aged above 74) . This study
concluded that physical functions of the elderly during
maintainence period were different between genders . Muscle
strength, muscle endurance, whole -body endurance, and walking
ability were superior in males whereas flexibility and agility were
superior in females. The old elderly group was inferior in all the
elements of physical function except muscle endurance .
• METHODOLOGY
• STUDY DESIGN : Comparative
• SAMPLE SIZE :A sample size is of 60 of 60yr. and above old elderly.
• SAMPLING : Sample of convenience
• SOURCE OF COLLECTION DATA : Collection will be gathered from local
people in Delhi /NCR
• INCLUSION CRITERIA :
• All the subjects taking for the study should be of age group is above 40 years .
• Study includes both male and female .
• Subjects included in the study should enroll in yoga and walking or any other
stretching exercises on the daily basis.
• EXCLUSION CRITERIA :
• All cardiac patient will be excluded
• No deformity of lower limb should be there

• VARIABLES :
• Balance
• flexibility
• yoga
• Breathing exercises or stretchings
• PROCEDURES
• Subjects will be include depending on including and exclusion criteria. People of age
group above 60 years both male and females are assigned into 2 groups .In group A
sample size will be 30 and inclusion criteria is of older people doing walking on their
daily basis while in group B sample size will be 30 and inclusion criteria will be of older
people doing yoga on their daily basis. In this study we assess flexibility and balance
parameters in which flexibility will be assessed by various flexibility test such as :
• SIT AND REACH TEST
• Equipment required: sit and reach box (or alternatively a ruler can be used, and a step
or box).
• Procedure: This test involves sitting on the floor with legs stretched out straight ahead.
Shoes should be removed. The soles of the feet are placed flat against the box. Both
knees should be locked and pressed flat to the floor - the tester may assist by holding
them down. With the palms facing downwards, and the hands on top of each other or
side by side, the subject reaches forward along the measuring line as far as possible.
Ensure that the hands remain at the same level, not one reaching further forward than
the other. After some practice reaches, the subject reaches out and holds that position
for at one-two seconds while the distance is recorded. Make sure there are no jerky
movements.
• FORWARD BENDING TEST :
• Procedure : The patient takes off his/her t-shirt so that the spine is visible. The patient
needs to bend forward, starting at the waist until the back comes in the horizontal
plane, with the feet together, arms hanging and the knees in extension. The palms are
hold together. The examiner stands at the back of the patient and looks along the
horizontal plane of the spine, searching for abnormalities of the spinal curve, like
increased or decreased lordosis/ kyphosis, and an asymmetry of the trunk
• BALANCE that is our other parameter will be as assesed by following
test :
• BERG BALANCE SCALE : The Berg Balance Scale (BBS) was
developed to measure balance among older people with impairment in
balance function by assessing the performance of functional tasks. It is a
14-item scale designed to measure balance of the older adult in a clinical
setting.
• Equipment needed: Ruler, two standard chairs (one with arm rests, one
without), footstool or step, stopwatch or wristwatch, 15 ft walkway
• Completion: Time: 15-20 minutes
• Scoring: A five-point scale, ranging from 0-4. “0” indicates the lowest
level of function and “4” the highest level of function.
• Total Score = 56
• Interpretation: 41-56 = low fall risk
• 21-40 = medium fall risk
• 0 –20 = high fall risk
• A change of 8 points is required to reveal a genuine change in function
between 2 assessments.
 CONSENT FORM
TITLE :- EFFECT OF YOGA AND PHYSICAL ACTIVITY ON FLEXIBILITY AND BALANCE IN
ELDERLY
Invitation to participate
You are requested to take part in the study being carried out for accomplishment of a program for
Bachelor in Physiotherapy in Manav Rachna International Institute of Research and Studies.
Introduction
The research or study is being undertaken to study the Effect Of Yoga And Physical Activities On
Flexibility And Balance In Elderly
About the procedure
You will undergo the procedure involving measuring your flexibility and balance.
FLEXIBILITY
Your Flexibility is measured by two methods :
SIT AND REACH TEST in which you sit on the floor with legs stretched out straight ahead.Your Shoes
should be removed. The soles of the feet are placed flat against the box. Both knees should be locked and
pressed flat to the floor then you have to hold them down. With the palms facing downwards, and the
hands on top of each other or side by side, you will reach forward along the measuring line as far as
possible. Ensure that the hands remain at the same level, not one reaching further forward than the other.
After some practice reaches, you have to hold that position for at one-two seconds while the distance is
recorded.
FORWARD BENDING TEST in which you stand on the wooden box with legs straight and feet together. Your
shoes should be removed. You will bend forward as down as possible . you have to hold for one - two
seconds while the distance is recorded.

BALANCE

Your Balance is measured by Berg balance scale test which consist 14 tasks like Sitting to standing ,
Standing unsupported , Sitting unsupported , Standing to sitting , Transfers , Standing with eyes closed
,Standing with feet together , Reaching forward with outstretched arm, Retrieving object from floor
,Turning to look behind , Turning 360 degrees , Placing alternate foot on stool , Standing with one foot in
front, Standing on one foot etc . you must maintain your balance while attempting the tasks.
Benefit of participation
The study will benefit the old age person as the increase in flexibility and balance can rule out an increased
effect of physical activity on fitness of elderly.
Risk of participation
The study will not harm the subjects.
Right to withdrawal
You has the right to draw out from the study/research program at any point of time whenever you want.
Confidentiality
All the information’s regarding the subjects would be kept private and shared between me and my research
guide Dr. Deepti Sharma will not be shared with any person who is not a part of the study. We also request
you to let us use the data and photograph for presentation and publication purpose.
Declaration
I,……………………… willingly agree to engage in this study. I have been informed and acquainted to my
satisfaction about the process, risk and benefits of the study. I reserve my right to draw out from the
program at any point of time. I understand that the participation is voluntary and refusal to participate will
have no penalty, loss or benefits to whichever I am entitled. I understand that no compensation is being
offered or is available for my participation and I have the contact address of Parmeet Kaur , if I required
for any further clarification.

………………………….
Signature
Mobile No ……………
Contact Address:-
Parmeet Kaur
Mobile No: 8750209343
E-mail Id: parokaur143@gmail.com
Faculty of Applied Science
Manav Rachna International Institute Research and Studies
DATA COLLECTION CHART

NAME-

AGE-

GENDER-

ACTIVITY FLEXIBILITY BALANCE

SIT &REACH FORWARD BENDING BERG BALANCE

SCORE
 Group A

Age Flexibility Test Berg Balance Scale

Sit and Reach Test Forward Bending Test

S.No. Name (years) (centimeter) (centimeter) (Total Score)

1 Surajpal 58 5 6 56

2 Sanjay Bhatia 50 -3.1 -2.5 46

3 Mahinder singh 53 0.2 0 49

4 Yoginder kaushik 43 5.3 4.5 54

5 Pushpa 57 0.3 0 44

6 R.S. Bhatia 51 0.3 0 49

7 Ajit madan 48 -4.1 0 49

8 Apsara 50 0.5 0 48

9 A.P. Ahuja 62 -13.1 -14 49

10 Atamprakash 64 2.3 3.5 42

11 S. Ratnakar 71 -8.3 -6.5 42

12 Madanlal mehndiratta 64 0.5 2.1 49

13 Gridhar bhatia 62 -1.1 0 42

14 R.S. Bhatia 69 -6.8 -5 46

15 Chamma 44 1 0.5 46

16 Mohan singh bhatia 64 -2 -1.5 48

17 Pritam singh bhatia 45 0.5 0 44

18 Gurucharan Singh Bhatia 45 1.2 1.7 54

19 Ranjeet Singh Bhtaia 48 2.3 2.5 56

20 Subash chandra 68 -3.5 -3 55

 Group B

Age Flexibility Test Berg Balance Scale

Sit and Reach Test Forward Bending Test

S.No. Name (years) (centimeter) (centimeter) (Total Score)

1 R.D Sharma 67 11.6 13 42

2 Sunil Anand 59 1.4 9 48

3 Sharawan yadav 63 12.9 13 52

4 Dheeraj bhatia 44 10.8 9.5 56

5 Omprakash 62 12 9.9 47

6 Rameshwar Sharma 61 18.1 15 47

7 Subodh sharma 48 21.6 20.2 56

8 Shivchran 59 21.1 23 53

9 Girjya pradesh 61 9.2 9 50

10 Vijya singh 55 14.9 14.1 51

11 shatrupal sehni 47 0.5 9 45

12 Yograj bhatia 63 8.2 10.5 52

13 Sudesh kumar bhatia 71 13.6 16 41

14 Akhilesh 48 1 0.8 38

15 Malka Rani 67 5.1 5.5 31

16 Dhhan singh 60 13.2 16.1 39

17 Madan lal 64 16.6 16 55

18 Sarla Ahuja 60 17.5 20 38

19 Sunita 46 -8.3 5.5 53

20 Rajkamal 40 14.8 16 56