Since dementia relates to an elders’ quality of life, it is important for people to keep cognitive functions healthy. This study aims to develop a mindfulness yoga program and investigate its effects on cognitive functions for elders measured via the Stroop test. The participants were community dwelling elders. They received a mindfulness yoga program approximately once a week, for a total of three months. They performed the Stroop test, in which there were four tasks on Stroop interference and reverse-Stroop interference used to measure cognitive functions pre and post program, and gave comments for the program. The correct response number and interference ratio were measured. The correct response number was significantly increased in each task between pre and post program: Task 1 (p<0.001), Task 2 (p<0.001), Task 3(p<0.01), and Task 4 (p<0.05). There was no significant difference between pre and post program in the interference ratio; this might be caused by visual impairment due to aging. The comments of participants were mostly positive and they showed intent to continue. These results suggest that this mindfulness yoga for elders improved cognitive functions, and that the mindfulness yoga program for elders may be useful.

Mindfulness yoga program, Cognition, Stroop test

Ando M, Kukihara H, Tanaka C (2018) Development of a Mindfulness Yoga Program and Effects on Cognitive Functions for the Community Dwelling Elderly. Ann Nurs Pract 5(3): 1100

Recently the number of elders has been increasing and the number of elders with dementia is also increasing. Dementia is a serious problem for peoples’ quality of life and for their family members. Thus it is important for them to live, keeping cognitive functions healthy.

In cognitive functions, inhibition is one of the most important functions. Inhibition is needed when people inhibit outside information in order to focus on something, and inhibition function decreases when aging [1]. The Stroop test is one of the tests used to measure inhibition function.

Sugimoto [2] showed that the performance of correct responses measured by the Stroop test of a not-well mental health group was lower than those of a healthy group. Ando et al. shows relationships between vigor during various moods and executive function measured via the Stroop test [3]. These studies show relations between cognitive functions and mood. There are studies in which sports [4] or light exercises [5] improve cognitive functions of adults. Byunk, Hyodo, Suwabe, et al. [5], showed that light exercises such as yoga or Tai Chi contribute to inhibit interference measured via the Stroop test, that is, light exercise improved cognitive functions for young adults. Although there is a previous study for relation effects of exercise and cognitive performance of elders [6], there are few studies about effects of mindfulness on cognitive function of elders measured by the Stroop test.

Mindfulness is a type of mental, psychological, or physical care and it includes light exercise. Kabat-Zin [7] developed the Mindfulness-Based Stress Reduction (MBSR) program, which is based on the principle of mindfulness, defined as momentto-moment, present-centered, purposive non-judgmental awareness. Mindfulness practices decrease anxiety, depression, and stress [8]. Hofmann, Sawyer, Witt, et al. [9], showed the effects of Mindfulness-Based Therapy on anxiety and depression through meta-analysis. Also mindfulness based art therapy was effective on depression, sense of coherence, and spirituality of cancer patients [10]. These studies showed effects of mindfulness on depression, anxiety, or spirituality, however, it was not tested if it is effective on cognitive functions. Mindfulness yoga is including yoga exercises a long side mindfulness. We hypothesized that mindfulness yoga may be effective on cognitive functions for elders. Then we develop a mindfulness yoga program for elders and examined the effects on cognition.

 Participants

Elderly from 65- to 80 years old who were community dwelling were recruited with flyers and twenty-five people were registered. They were mostly retired from work positions. The exclusion criteria were elderly with serious mental illnesses or dementia. Some were absent from the program, and 16 (male: 2, female: 14) participated. Since they had physical symptoms like knee pain, most of participants had not regular or continuous exercise. The backgrounds of participants were shown in Table 1.

Table 1: Background of participants

This study was held in a university. Although they had some physical or mental problems, since the university had convenient transportation they might have had an easier time participating.

Scales

Cognitive function: We used the Stoop test II [11] [12], which included four tasks listed from Task 1 to Task 4. It can measure the Stroop interference ratio (inhibition of words to respond to color), the reverse Stroop interference ratio (inhibition of color to respond to words), and the correct response number. The total time was approximately 15 minutes.

We made a mindfulness yoga program for elders. The yoga therapist had many experiences of yoga for elders. The yoga therapist and the researchers with nurse certification talked about suitable program. The program included mindfulness yoga which is a combination of mindfulness and yoga movements such as breathing, light movements, and meditation (Table 2).

Table 2: Mindfulness yoga program for elderly people

The mindfulness yoga program for the elders was conducted once a week for a total of three months. Participants came to a room at the university. The therapist was a certified yoga therapy specialist. Each session was approximately 60 minutes. The received the Stroop test pre intervention, post one month, and post month.

Ethical consideration

This study was approved from the ethical committee in the authors’ colleges and from the facility for elders.

A paired t-test was conducted on the correct number between pre and post three month (Figure 1). The number of Task 1 increased from 44.4 to 54.0 (p<0.001), that of Task 2 increased from 40.1 to 45.6 (p<0.001), that of Task 3 increased from 34.4 to 37.8, p<0.01), and Task 4 increased from 30 to33.4 (p<0.05). These results show that cognitive functions were improved through the mindfulness yoga program.

On inhibition, the paired t-test was conducted on the ratio of Stroop- and reverse Stroop tests. The ratio of the Stroop test decreased from 0.15 to 0.14 after three weeks, and that of the reverse Stroop test increased from 0.80 to 0.15, however there was no significant difference between the pre and post three weeks tests. Participants’ comments were shown in Table 3.

Table 3: Comments of participants for this program.

In the commnets, participants experinced physical good change or new recognitions, and they felt good feelings and show intent to continue.

The correct response number was significantly increased in each task. This shows improvement of cognitive functions for the elders. It suggests the efficacy of mindfulness yoga not only for psychological distress like anxiety or depression but also for cognitive functions. The reason of the increasing correct response numbers may be that their attention ability to focus on a task may be improved through the meditation and yoga of the program. Voss, et al. [13], showed that individuals with a higher working memory capacity were able to focus on a current task longer. Thus the elder’s attention ability lead to a longer working memory capacity, and they could focus on their work much more. Factor of mindfulness in our program mindfulness yoga may support a previous study in which mindfulness on older adults with mild cognitive impairment [14]. We need to investigate the effect of mindfulness or mindfulness yoga on cognition of elders much more.

There was no statistical difference between pre and post intervention in the Stroop and the reverse Stroop ratio. This means that inhibition ability was not improved for the elders in this study. A previous study [5] showed improvement of the Stroop interference for young people through light exercises. The reason for this difference might be influenced by continuing exercise time or a participants’ age. Moreover, this Stroop test required visual sheets of paper. Participants might have vision impairments. Limitation of the Stroop test due to vision impairment caused by a visual disorder such as cataracts might influence these results. We need to examine vision disorders before the investigation.

In the comments of participants, they recognized physical changes in their muscles or spine and postures. They also felt a good mood and had a good time. Moreover they had communication with each other. These factor might contribute to improve cognitive function.

From the change in correct responses and positive comments, we think that this mindfulness yoga program is useful for elders even if they have some physical or mental problems.

In nursing, nurses may promote cognitive functions of elders from the view point of health promotion. When nurses conduct mindfulness yoga, they need to learn professional yoga skills.

As a limitation, the number of participants was small and we need to include more people in the future research.

*There are no declared conflicts of interest.

*This study is supported by the KAKEN C (16K12230). 

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