Hyperkyphosis, excessive curvature of the thoracic spine, is common. It increases with age and is associated with functional limitations and higher mortality. Hyperkyphosis has multiple precipitants, some of which are fixed (e.g., vertebral wedge fractures) and some of which are malleable (e.g., weakness). We demonstrated in a pilot Yoga intervention that women with hyperkyphosis regained height, improved their kyphosis angle, and achieved dramatic physical functional gains [Greendale 2002B]. This proposal intends to take these promising observations to the next step: to test, in a single blind, randomized controlled trial [RCT], whether a specially designed Yoga program can improve hyperkyphosis and its associated functional limitations. The RCT will block randomize (based on """"""""high"""""""" and """"""""low"""""""" baseline hyperkyphosis) 120 persons aged 60 and over with hyperkyphosis to active treatment, consisting of 6 months of 3-times-per-week Yoga classes, or to a delayed Yoga control group, which will receive 6-months of attention activities followed by Yoga. For each of the primary and secondary outcomes, 6-month change in the Yoga treatment group relative to the control group will be compared. Primary outcomes will be height, kyphometer angle, timed chair stands, functional reach, and timed 8-foot walk. Secondary outcomes will include other kyphosis measures (e.g., flexible ruler), timed physical performance, self-report functional status, quality of life, fear of falling, attitudes toward aging, and pulmonary function. At the end of the 6-month RCT, the control group will be given 6 months of Yoga. Offering delayed Yoga will make recruitment and retention feasible: in the pilot, 100% of volunteers stated that they wanted to do Yoga. A junior Yoga teacher (who assisted the senior teacher during the RCT) will lead the delayed Yoga classes under direct observation by the senior teacher. We will collect study outcomes at the end of the delayed Yoga and will compare the effects in the delayed Yoga group to those observed in the RCT Yoga group. If the effects were similar, this would suggest that the Yoga method could be implemented by other teachers (a requisite for dissemination). While the delayed Yoga is taking place, the RCT Yoga treatment group will continue in a 6-month Yoga maintenance phase. Participants will self-select into a weekly class plus home practice tape use, home tapes only, or no formal program. This phase wilt assess whether participants continue doing Yoga with less intensive supervision and the reasons underlying their selection of maintenance mode. At the end of this phase we will again measure study endpoints to assess whether participants have maintained the physical function achieved at the end of the RCT.
| Greendale, G A; Nili, N S; Huang, M-H et al. (2011) The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporos Int 22:1897-905 |
| Greendale, Gail A; Huang, Mei-Hua; Karlamangla, Arun S et al. (2009) Yoga decreases kyphosis in senior women and men with adult-onset hyperkyphosis: results of a randomized controlled trial. J Am Geriatr Soc 57:1569-79 |
