Yoga guide
Yoga is a good way for older adults to keep moving, and chair yoga makes it possible for almost anyone. In trials of people aged 60 and over, yoga improved balance test scores, walking speed and flexibility, and UK guidance counts it toward the strength and balance activities older adults need on at least 2 days a week.
Better balance scores aren't the same as fewer falls, though. Yoga hasn't been shown to prevent falls, and one large trial found more falls with a yoga programme. It doesn't build bone either, so it works best alongside walking, strength training and balance exercise.
This guide covers balance and falls, chair yoga, how to adapt poses for osteoporosis, high blood pressure, glaucoma and joint replacements, how to choose a class and when to stop, with poses to use and a 20-minute chair yoga workout that ends standing at the chair.
UK guidelines ask adults over 65 to do activities that improve strength, balance and flexibility on at least 2 days a week. The NHS lists yoga as a muscle-strengthening activity, and the UK osteoporosis consensus names it among the balance and strength exercises to do at least twice a week.
Yoga improved balance test scores in people aged 60 and over. But in the largest falls trial, 700 people offered a year of yoga classes had more falls than those offered seated relaxation.
In the UK's Gentle Years Yoga trial, 12 weeks of chair-based classes were safe and well liked but didn't improve quality of life or reduce falls. Seated exercise doesn't train balance, so add standing poses at the chair as soon as you can.
Trials found no significant change in bone density, and the popular claim that 12 minutes a day reverses bone loss comes from a study with no comparison group.
With osteoporosis, swap deep forward folds for a flat-back hinge from the hips. With glaucoma or high blood pressure that isn't under control, skip headstands, shoulder stands and long head-down holds.
If you're frail, have moderate to severe dementia, have had a spinal fracture or fall regularly, start with a trained professional. Look for a small class with a teacher trained to work with older people.
Yoga trials in older adults mostly enrolled people aged 60 or 65 and over: the falls trial's participants averaged 67 and the UK chair yoga trial's 73.5. The UK Chief Medical Officers' guidance for older adults starts at 65.
Yoga done sitting on a chair, or standing with the chair for support, or both. In the UK trial's classes, people were mostly seated and held the chair when standing, poses were held for shorter times, and there was no lying on the back or front and no breath holding. Each 75-minute class moved from breathing and focusing to a long warm-up, then seated and standing poses, breathing and relaxation.
Trials measure balance with clinic tests, such as how long you can stand on one leg. A falls trial counts actual falls, month by month. A better test score is encouraging, but it isn't proof of fewer falls, and the reviewers of yoga's balance trials called for falls trials to find out.
The UK osteoporosis consensus advises modifying or avoiding movements that bend the spine forward for a long time, repeatedly or to the end of its range, especially with a load, "both during everyday life and exercise such as Pilates or yoga". It says this advice rests on expert agreement, because the evidence is limited, so the swaps are a precaution and yoga itself is encouraged.
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In 6 good-quality trials (307 people aged 60 and over), yoga improved balance by a small amount and mobility by a moderate amount. A review of 22 trials found a moderate improvement in balance against doing nothing, and another of 18 trials found that almost all showed better balance than no exercise, at low certainty. A 2014 review cited by the US National Center for Complementary and Integrative Health (NCCIH) found 11 of 15 studies improved at least one balance measure.
The SAGE trial is a single trial, and we read its abstract; most of its classes ran online during COVID. In 700 people aged 60 and over, those offered a year of Iyengar-based yoga classes (twice a week, focused on standing balance and leg strength) had 1.33 times as many falls as those offered seated relaxation: 0.87 against 0.64 falls per person a year. The 95% confidence interval, the range the true figure probably lies in, ran from 1.01 to 1.75. Balance confidence and activity improved, and the authors say this programme shouldn't be recommended for falls prevention in its current form.
In the UK chair yoga trial, falls didn't differ from usual care, and a review of yoga trials called the effects on falls mixed. So yoga improves balance scores, but it hasn't been shown to prevent falls.
The world falls guidelines strongly recommend exercise that challenges balance and includes functional moves such as sit-to-stands and stepping, 3 or more times a week, progressed for at least 12 weeks and continued for longer. They also recommend tai chi and strength training where possible, taught by trained professionals.
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The falls guidelines note that supervised classes such as Pilates or yoga had the largest effects on concern about falling in two reviews, and the large yoga trial improved balance confidence even though falls rose.
In 33 studies of people aged 65 and over, yoga improved walking speed and leg strength and endurance compared with education or no exercise (moderate certainty), but may not beat other exercise. Against doing nothing, lower-body flexibility, mood and sleep quality improved too.
Two reviews found better leg strength against doing nothing, and one also against other activities, but in a third, of 21 studies, the gains didn't hold up once missing small studies were allowed for. For real strength gains, add progressive strength training.
In 11 studies of Pilates or yoga (591 women aged 45 to 78), bone density didn't change significantly, and 2 yoga trials found no effect. The widely shared 12-minute study had no comparison group: of 741 volunteers, it analysed the 227 who practised more than every other day and compared their scans before and after starting, so it can't show that yoga caused any change.
In 30 trials of people with raised blood pressure, yoga lowered the top number by about 8 mmHg and the bottom number by about 5 mmHg compared with a waiting list, but the evidence was of very low quality, and the effect against other activities was smaller and less certain. An earlier review found no effect against exercise.
In US emergency departments in 2014, yoga injuries per 100,000 people doing yoga were 57.9 at 65 and over, against 11.9 at 18 to 44. Most yoga injuries are sprains and strains, and NCCIH says older adults may need to be particularly cautious and that learning yoga on your own without supervision has been linked to higher risks.
The Gentle Years Yoga trial's published abstracts report that 454 adults aged 65 and over with two or more long-term conditions, from 15 general practices in England and Wales, were offered 12 weekly 75-minute chair-based classes (7 courses face to face, 12 online) plus practice at home, or usual care. Over 12 months, quality of life didn't improve meaningfully, and anxiety, depression, loneliness and falls didn't differ.
The same abstracts report no serious related side effects, an average of 9 classes attended, and a good chance that the programme was cost-effective: about £4,546 per quality-adjusted life year (a measure combining length and quality of life), with a 79% chance of being worth it at the £20,000 threshold commonly used in the NHS. The authors called it safe and acceptable, and highly valued by some.
In 131 older adults with hip or knee arthritis who couldn't do standing exercise, chair yoga twice a week for 8 weeks eased how much pain got in the way of daily life, still 3 months later, and eased pain and fatigue during the programme, but had no effect on balance. In 33 care home residents aged 80 to 101, including people with dementia, twice-weekly chair yoga improved anxiety, depression and mood, in a small study that wasn't randomised.
Across 14 trials, seated exercise improved thinking skills a lot, and strength, mood and quality of life a little, but had "no effect on balance or mobility". Experts agreed that chair-based exercise should, where possible, be "a starting point to progress to standing programmes".
The NHS suggests a solid, stable chair without wheels, where you can sit with your feet flat and your knees at right angles, and a chair without arms, which would restrict your movement. After a hip replacement, follow your physiotherapist: the NHS advises against low chairs and chairs without arms while you recover.
Most of these are precautions agreed by experts, not trial results. Each pose's page has the details.
Balance and strength exercise, including yoga, at least twice a week, and back-strengthening exercises repeated 3 to 5 times and held for 3 to 5 seconds, at least twice a week. Modify or avoid moves that bend the spine forward for a long time, repeatedly or to the end of its range, especially with a load. Twisting should be safe if it's smooth and comfortable.
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In one series, 9 people (median age 66) developed spinal compression fractures after starting yoga poses that bent the spine forward, some of them with osteoporosis or thinning bones. Another small series described similar cases. In 89 people treated for yoga injuries at a spine clinic, 13 had compression fractures, and the poses most often involved in the injuries bent or arched the spine to extremes. These reports show it can happen, not how often.
Following the consensus, if you have osteoporosis or a higher risk of fracture:
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The consensus says yoga and Pilates "should be considered to help with posture and pain", ideally with an instructor trained to work with older people or people with osteoporosis. Get individual advice from a physiotherapist first if you can.
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Yoga helps balance, posture and confidence. For bone strength, the consensus recommends strength training and impact exercise; our osteoporosis guide has the detail.
In 10 people with glaucoma and 10 without, eye pressure rose within a minute in downward dog, a standing forward bend, plough and legs up the wall, most in downward dog, and returned to normal within 2 minutes of sitting up. Whether this harms glaucoma over time isn't known. A review of case reports advises people with glaucoma to avoid inversions, and NCCIH lists glaucoma among conditions that may need adapted poses.
Skip headstands, shoulder stands and long head-down holds while your blood pressure is uncontrolled: a precaution, not a trial finding, as our high blood pressure guide says. Keep breathing through every pose. The UK chair yoga programme avoided holding the breath, which it notes is unsuitable with high blood pressure, and held poses for shorter times.
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Feeling dizzy when you stand up is common with age. The NHS advises getting up slowly from sitting to standing, and moving slowly from lying to sitting to standing. In yoga, come up slowly from forward folds and from the floor, and pause before you walk away.
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After a hip replacement, the NHS advice while you recover includes not sitting with your legs crossed, not bending your hip more than 90 degrees (a right angle) and not bending down to touch your feet or ankles. After a knee replacement, don't sit with your legs crossed for the first 6 weeks, and don't kneel on the new knee until your doctor says you can.
Our reading: while you recover, leave out cross-legged sitting, deep forward folds, pigeon and figure-four shapes and anything that bends the hip past a right angle, and leave kneeling poses such as child's pose until you're cleared. Seated and supported standing poses at a chair are usually fine; check with your physiotherapist.
The UK guidelines for over-65s: activities to improve strength, balance and flexibility on at least 2 days a week, plus aerobic activity such as brisk walking. Yoga or chair yoga twice a week covers the first part; it doesn't replace walking.
Falls prevention needs balance-challenging exercise 3 or more times a week. Add our balance exercises routine on a third day, near a wall or a stable chair, as the NHS balance exercises suggest.
For comparison:
Our 20-minute chair yoga workout twice a week, or a gentle class, plus walking on most days. If falls are a concern, add standing balance exercise on a third day, and ask your GP about a falls assessment if you've fallen.
From the UK chair yoga trial's teachers: small classes (up to 15 in person and 12 online in the trial), an individual session before the first class, a focus on chair-based and standing poses, simple breath awareness, guidance on how a pose should feel rather than how it should look, a slower pace with time to rest, clear demonstrations and simple, repeated instructions.
The osteoporosis consensus suggests an instructor trained to work with older people or with osteoporosis, who can adapt exercises to your ability and range of movement. Yoga teacher training is mostly unregulated, the trial's process evaluation notes. In the UK, the British Wheel of Yoga is the national governing body for yoga in England and Wales; in the US, Yoga Alliance keeps a register of 200-hour teacher trainings, which is a registry, not a licence. NCCIH suggests asking about a teacher's training and experience.
Before the first class, tell the teacher about falls, fractures, osteoporosis, joint replacements, glaucoma and blood pressure, so they can suggest swaps. Choose a gentle, chair or seniors' class rather than hot, power or advanced yoga (our suggestions).
You're frail, have moderate to severe dementia, have had a spinal fracture or fall regularly: the UK guidelines say new exercise might best be supervised by a trained professional at first.
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On a solid chair with your feet flat. 5 slow breaths, 5 to 10 repetitions or the dose on each pose's page; cat-cow, breath reach, chin tuck and the twist are done seated here, though their demos show other positions. Keep the rounding in cat-cow small and smooth if you have osteoporosis.
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or box
3D demoSlow breathing (6 breaths a minute)Beginner · No equipment
3D demoBreath reachBeginner · No equipment
3D demoChin tuckBeginner · No equipment
3D demoSeated marchBeginner · A bench or box
3D demoCat-cowBeginner · No equipment
3D demoSeated overhead side bendBeginner · A bench or box
3D demoThoracic rotationBeginner · No equipment
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoChair leg extension and sweepBeginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoAlternate Nostril BreathingBeginner · No equipmentThe part that trains balance. Hold the back of a stable chair or stand near a wall, as the NHS balance exercises suggest; 3 to 5 breaths in each pose, keep the tree pose foot at the ankle at first and never press it into the knee (our starting points).
3D demoSit to stand, pushing on the thighsBeginner · A bench or box
3D demoSit to stand from a chairBeginner · A bench or box
3D demoMountain Pose (Tadasana)Beginner · No equipment
3D demoChair pose (Utkatasana)Beginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipment
3D demoTree pose (Vrksasana)Beginner · No equipment
3D demoSlow calf raiseBeginner · A wall
3D demoWall push-upBeginner · A wallBack-strengthening holds of 3 to 5 seconds, 3 to 5 times, as the osteoporosis consensus suggests; pad your knees in child's pose and skip it after a knee replacement until you're cleared. Our older adults guide covers getting up from the floor.
With osteoporosis, fold from the hips with a long back instead of rounding, and leave out plough and shoulder stand. With glaucoma or high blood pressure that isn't under control, skip headstand, shoulder stand and plough, and keep downward dog, wide-legged folds and legs up the wall brief.
3D demoSeated forward fold (Paschimottanasana)Intermediate · No equipment
3D demoHead-to-knee pose (Janu Sirsasana)Beginner · No equipment
3D demoWide-legged standing forward fold (Prasarita Padottanasana)Beginner · No equipment
3D demoSun salutation A (Surya Namaskar A)Intermediate · No equipment
3D demoBoat pose (Navasana)Intermediate · No equipment
3D demoPlow pose (Halasana)Advanced · No equipment
3D demoSupported shoulderstand (Salamba Sarvangasana)Advanced · No equipment
3D demoSupported headstand (Salamba Sirsasana)Expert · A wall
3D demoDownward-facing dog (Adho Mukha Svanasana)Beginner · No equipment
3D demoLegs up the wall (Viparita Karani)Beginner · A wallStart with the 20-minute chair yoga workout twice a week. Add the balance exercises routine on a third day if falls are a worry, and the strength sessions for muscle and bone.
A free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 20-minute chair Pilates workout for beginners and older adults: breathing, sitting tall, gentle spine and leg moves, and a standing finish at the chair.
20 minBeginner14 movesA bench or box, Something with weightA 30-minute routine for a rounded upper back in later life, built from the SHEAF trial: floor back-strengthening, posture practice and gentle mobility.
30 minBeginner13 movesA bench or box, A wallImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA 20-minute beginner yoga sequence: mountain, chair, warrior II, triangle, tree, down dog, cobra and child's pose.
20 minBeginner11 movesA stepStrength, balance and walking across the week, in line with the UK advice for over-65s.
You're frail, have moderate to severe dementia, have had a spinal fracture or fall regularly. Our older adults guide explains how to get started safely.
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For chest pain or tightness that spreads to your arms, neck or jaw or doesn't settle with rest, signs of a stroke, or a fall in which you may have hurt your head, neck, back or hip, or can't get up. Our older adults guide has the full list.
Dizzy, faint, unusually breathless, or sharp or increasing pain. Sit down until it passes, and see a GP if you keep getting dizzy or faint when you stand up.
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Sudden back pain, losing height or a newly rounded upper back can be signs of a spinal fracture: see a GP. If you've had painful spinal fractures, see a physiotherapist before starting yoga.
If you have fallen, or are worried about falling, ask your GP about a falls assessment. The NHS says strength, balance and flexibility exercise will help make you stronger and feel more confident on your feet.
With glaucoma, recent eye surgery or high blood pressure that isn't under control, skip headstands, shoulder stands and plough. After a joint replacement, follow your surgical team's limits.
Yoga improves balance test scores, but in the largest falls trial, a year of yoga classes led to more falls than seated relaxation. Balance-challenging exercise 3 times a week is what prevents falls.
Trials found no significant change in bone density, and the 12-minute study had no comparison group and analysed fewer than a third of its volunteers.
The UK consensus recommends yoga among balance and strength activities, and for posture and pain after a spinal fracture. Swap the extreme forward folds.
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Seated exercise had no effect on balance or mobility in pooled trials, and chair yoga had no effect on balance in a trial. Stand at the chair for balance.
The UK chair yoga trial's participants averaged 73, with people up to 91 taking part, and a care home study included residents up to 101. The UK guidelines say the benefits of activity in older adults outweigh the risks.
We found no evidence for this. Head-down poses raise eye pressure within a minute, and beginners are advised to avoid headstands and shoulder stands.
Yes, for most older adults. In trials of people aged 60 and over, it improved balance tests, flexibility and walking speed, and it counts toward the advice to do strength, balance and flexibility activities on at least 2 days a week. It hasn't been shown to prevent falls, so add balance exercise if falls are a worry.
Yoga done sitting on a chair, or standing with the chair for support. It suits people who find standing for long, or getting down to the floor, difficult, and it's a good way to start.
It's safe and well liked, and in smaller trials it eased arthritis pain and lifted mood. In the UK's largest trial, a 12-week chair yoga course didn't improve quality of life or reduce falls, though it was probably good value. It doesn't train balance, so add standing poses at the chair.
Not on the evidence so far. In one large trial of 700 adults aged 60 and over, a year of yoga classes led to more falls than seated relaxation, though most classes were online during COVID. To cut falls, do balance-challenging standing exercise 3 times a week, and ask about a falls assessment if you've fallen.
Yes, with changes. The UK consensus recommends yoga for balance and strength, and after a spinal fracture for posture and pain. Swap deep forward folds, plough and shoulder stand for flat-back hinges and back-strengthening poses, because case reports link extreme forward bending to spinal fractures.
It hasn't been shown to: trials found no significant change in bone density. The study claiming 12 minutes a day reverses bone loss had no comparison group. For bone, add strength and impact exercise.
Yoga may lower blood pressure a little. Skip headstands, shoulder stands and long head-down holds if your blood pressure isn't under control or you have glaucoma, because head-down poses raise eye pressure within a minute. Keep breathing, and don't hold your breath.
Usually, once your surgical team agrees. While you recover, follow the NHS precautions: after a hip replacement, no crossed legs and no bending your hip past a right angle; after a knee replacement, no kneeling until your doctor says so. Chair-based poses are a good way back.
Twice a week fits the UK advice for over-65s. Add walking on most days, and balance exercise on a third day if falls are a worry.
Look for a small, gentle or chair-based class with a teacher trained to work with older people or osteoporosis, who meets you before the first class and adapts poses. Tell them about falls, fractures, joint replacements, glaucoma or blood pressure, and start supervised if you're frail.
No. The UK chair yoga trial's participants averaged 73, and a care home study included people up to 101. Start with chair or gentle classes and build up; the benefits of activity at older ages outweigh the risks.
It's gentle, and the chair yoga trials measured pain, mood, quality of life and falls, not weight. Our yoga for weight loss guide covers what yoga can and can't do for weight.
Exercise education, not a personal prescription, and clinical review of these guides is pending. If you are pregnant, have a health condition such as glaucoma, high blood pressure or osteoporosis, or have had recent surgery, check with a doctor, midwife or physiotherapist before starting, and stop for sharp or increasing pain. Health disclaimer.
