Perceptions and experiences of chair-based yoga by older adults with multimorbidity - a qualitative process evaluation of the Gentle Years Yoga randomised controlled trial.

Background: Yoga is increasingly practised by older adults, with growing evidence for its safety and effectiveness across a range of health conditions common to the age group. This process evaluation, embedded within a randomised controlled trial of chair-based yoga for older adults with multimorbidity, qualitatively explored participants' perceptions and experiences of the chair-based yoga programme.

Methods: One-to-one interviews and class observations were conducted with a subset of trial participants randomised to receive the 12-week chair-based yoga programme. Interview participants were selectively recruited to represent the demographic breadth of the main trial cohort; one yoga class was observed at each delivery site. Interviews were audio recorded, independently transcribed, and analysed according to longitudinal and thematic analysis.

Results: Twenty-five yoga participants were interviewed once (N = 10) or twice (N = 15), providing a 40-interview data set. Participants were aged 66-91 years (mean age 74 years), 56% female (N = 14), predominantly White British (N = 22, 88%), with 2-8 long term health conditions (mean 4.5 conditions). Four interlinked and overarching themes predominated: perceptions of healthy ageing, delineating yoga and exercise, yoga as an adaptable multifaceted health tool, and patterns of ongoing yoga practice. Participants equated acute symptom presentation, not multimorbidity, with illness, and mostly viewed their health as good. They distinguished yoga from exercise based on its integration of the breath with physical movements, which provided a mental focus unfound in other physical activities. Impact of the yoga programme ranged from minimal to transformative, dependent on meaningful biopsychosocial improvements. Accordingly, continuation of yoga beyond the trial ranged from none to full integration as a multifaceted health management tool.

Conclusions: Participant experiences of the yoga programme interlinked views on health, ageing, exercise, and sustainable health management. Yoga presented as a safe, acceptable, and adaptable option for non-pharmacological health management in older adults. Impact on biopsychosocial health was variable, and directly linked to participants' longer term yoga engagement. Education of health professionals and activity providers regarding ageist stereotypes of health and ageing, together with the evidence base for the safety and effectiveness of yoga, could support and broaden yoga's reach and engagement among both older adult and multimorbid cohorts.

Trial registration: ISRCTN ISRCTN13567538. Registered 18 March 2019.