Yoga for older adults with multimorbidity - Teaching insights for optimising participant safety and inclusion from the process evaluation of the Gentle Years Yoga trial

Objectives To develop a teaching exemplar for optimising the safe and accessible delivery of chair-based yoga to multimorbid older adult populations. Design A qualitative process evaluation embedded within the multi-site, randomised controlled Gentle Years Yoga trial for older adults (65+ years) with two or more long term health conditions (trial status: completed). Setting Online and face-to-face interviews were conducted with participants and yoga teachers involved in the 12-week chair-based yoga intervention. Interview data was supplemented with observations of in-person and online yoga class delivery. Participants All yoga teachers delivering the yoga intervention were invited to take part in the interviews, together with a subsample of participants receiving the yoga intervention. Participants were purposively selected to represent the trial cohort demographics of gender, age, ethnicity, index of multiple deprivation, and number and intensity of chronic health conditions. Results Twenty-five yoga participants and 11 yoga teachers took part in one (N=19) or two (N=17) interviews. Participants were aged 66-91 years (mean age 74 years), with 2-8 long term health conditions, most commonly osteoarthritis (N=15, 60%), cardiovascular disease (N=14, 56%), sensory conditions (N=9, 36%), and depression or anxiety (N=8, 32%). Yoga teachers were predominantly female (N=10, 91%), with 4-35 years yoga teaching experience across multiple yoga styles. Feedback from yoga teachers and participants was classified into six categories, generating a 21-item teaching exemplar. These covered aspects of delivery including class size and delivery formats, choosing appropriate physical content, enhancing inclusivity of personal beliefs through non-physical content, proactive teaching styles, communication tips, and ways to boost visibility. Conclusions This 21-item list adds to the current educational base of yoga for older adults. Addressing both face-to-face and online class formats, this exemplar offers pragmatic guidance for yoga teachers to enhance the safe and accessible delivery of chair-based yoga to older adults and multimorbid populations. Trial registration. ISRCTN ISRCTN13567538. Registered 18 March 2019 STRENGTHS AND LIMITATIONS OF THIS STUDY • A robust process evaluation embedded within a large scale multi-site randomised controlled trial. • Pragmatic teaching exemplar based on the perspective of stakeholders engaged in both the delivery and practice of yoga for older adults with multiple long term health conditions. • Provides guidance for both in-person and online delivery of yoga classes. • Findings are focussed on chair-based yoga delivery. KEY WORDS yoga; older adults; multimorbidity; healthy ageing; education, guidelines