Individually randomised controlled multi-centre trial to determine the clinical and cost effectiveness of an adapted yoga programme for older adults with multimorbidity, including an embedded process evaluation

Aim: We will address the NIHR Themed Call on Complex Health and Care Needs in Older People, with a focus on Theme 4: promoting healthy ageing/preventing ill health. We propose a randomised controlled trial in 12 sites across the UK to understand the health effects and cost effectiveness of a 12-week yoga programme adapted for older adults who have complex health needs. NIHR defines complex health needs as the presence of more than one health or social care need (impacting on health) as well as a depth of need in terms of the severity of the conditions or intensity of the needs. The definition of multimorbidity adopted is the existence of two or more chronic health disorders in one individual. The Need: One of the biggest challenges facing healthcare is the presence of complex health needs in the rapidly expanding older population. Research studies have shown that people with complex health needs are more likely to have reduced physical function, quality of life and life expectancy and increased mental health concerns. The more health problems someone has the more likely they are to consult a GP, be prescribed drugs and be admitted to hospital. Treatments associated with long-term health conditions account for 70% of NHS expenditure. Guidelines highlight that further research is needed to identify cost-effective treatments for this patient group. The proposed benefits of regular yoga practice are wide-ranging, including increased strength, flexibility, balance and quality of life, and reduced stress, anxiety and depression. Research suggests that yoga may improve physical function and quality of life in older people, but little work has been done to understand the effects of yoga in older people with complex health needs. Background: A 2016 pilot study of the British Wheel of Yoga (BWY) Gentle Years Yoga© programme was conducted with 52 older adults (average age 75). Adaptations to common yoga poses were developed so that inactive older adults with long-term conditions such as osteoarthritis, high blood pressure and dementia could safely participate in and reap the benefits of chair-based yoga. Recruitment was easy. The study showed that yoga could be a potentially useful treatment for improving mobility as well as mental and social wellbeing. It is simple, cheap, non-invasive, and can benefit several health conditions. Public Involvement: Most of the participants continued in the classes on a self-pay basis after the pilot ended, which confirmed that they found the programme to be of value. They have been actively involved in the proposed trial’s plans and they are committed to continuing their support and help with the project. Methods: The trial will recruit 586 adults aged 65 years or over who have more than one long-term condition. After initial assessments, participants will be allocated either to a group that receives usual care and a 12-week yoga programme (involving weekly group-based sessions and self-managed home practice) or a group that receives usual care only. Participants will complete questionnaires after 3, 6 and 12 months to assess their progress. This will involve assessments of quality of life and mental health. Some participants and yoga tutors will be interviewed to determine their experiences of the programme and study processes. Dissemination: The research findings will be written up in journal publications and evidence briefings, and presented at various forums and conferences.