Background. Umbrella Yoga works with adults who are disproportionately affected by health inequalities. We support communities of most need to improve quality of life, maintain wellbeing, mental health and mobility through the myriad benefits of breathwork and functional movement practice. We actively evaluate our programs and contribute to research and production of evidence-based practices. 

People with Learning Disabilities (LD) in the UK face severe health inequalities. The life expectancy of people with LD is 21 years below the general population (2018 statistics). LD adults are far more likely to suffer from mental health problems than the rest of the population. Mobility issues vary enormously; they are thought to affect around 63% of LD adults. Moreover, restricted mobility has been identified as a risk factor for mortality (Public Health England, 2018).

We think yoga can help. Many people improve their strength, range of motion, balance, and coordination through yoga. It can also help with mental health issues by reducing stress, boosting confidence and mood, and improving sleep quality. Despite all this, yoga isn’t readily available to adults with LD.

This project was a collaboration with Mencap In Kirklees, funded by the The Health and Wellbeing Innovation Centre, University of Huddersfield , offering accessible yoga sessions to adults with LD, and evaluating their impact on the group’s mental and physical capacities.

What did we do? We led 12 weekly yoga sessions in 3 Mencap day centres in Kirklees. The members were free to choose whether or not they joined in with the yoga. 45 people with an LD, aged 21 – 74, took part, of which 17 were women and 28 were men. 

The yoga sessions were adapted so everyone could participate regardless of mobility limitations and cognitive capacity. We did breathing practices and movements (or ‘asana’) and included a relaxation element at the end. Each hour-long session was different, but followed a similar framework.   We also provided each day centre with 3 sets of ‘yoga prompt cards’, with photos of the participants and the professional teachers doing yoga poses, to enable participants to do some yoga independently in between sessions.

The week before we started, and the week after we finished, we did some tests with the participants to measure:

• Mental health: anxiety symptoms
• Physical health: strength and balance
  • Hand Grip Strength
  • Leg strength and mobility – sit to stand test
  • Balance – leg stance test

We also collected feedback from participants and followed some of them more closely to examine their stories of change.  This data has been used to analyse the impact of the sessions on the participants.

 

Measuring Change

Mental Health: We used the Generalised Anxiety Scale (GAD-7) to measure self-reported anxiety symptoms. This had been adapted to be usable by adults with LD (Breen, 2017) and the participants were supported by staff members to answer the questions. There are 7 questions which ask participants to indicate on a scale of 0-4 how often they have experienced things like: trouble sleeping; feeling afraid that something terrible might happen; feeling nervous, anxious or on edge.  A high score (max 21) indicates a more anxious respondent. 

Results: About half of the participants did not complete both pre- and post-yoga assessments (either due to absence, not wanting to participate, or not understanding the questions). 22 participants who completed both the measures. The average score prior to the yoga course was 7.4, and 4.8 afterwards, representing a reduction in anxiety symptoms.*

 

Physical Health: we used the ‘Strength Balance Assessment’, developed by the ‘Get Set Goal’ wellbeing service that forms part of the Health and Wellbeing Academy at the University of Huddersfield. Health professionals including occupational therapists, physiotherapists and nurses have developed and piloted these tests with older adults at risk of falls.

Hand Grip Strength

The purpose of this assessment is to test hand strength, which can be used as an indicator of muscle weakness in the body. Muscle weakness is associated with a number of other health factors (inactivity, tendon issues, arthritis, nerve injuries, low / high body mass) [Ajay et al., 2024].

The participant is first asked ‘which hand you would write or draw with’, and then asked to squeeze a dynamometer for 10 seconds using only that hand. They would have a rest, wriggle and stretch their fingers, and then have one more go.  The hand strength (in kg) was recorded and the higher of the two attempts was used in the analyses (almost always this was the second effort). 

Results: Hand grip strength was a major problem in this group, with every single participant, bar one, scoring in the ‘weak’ range for their age group and sex.   Of the 21 participants that completed both tests, the average grip strength before starting yoga was 11.3kg, increasing to 12.7kg afterwards, representing a significant improvement in hand strength*. Only one participant (a male, aged 40) scored just within the ‘normal’ after yoga, with a 9.7kg improvement in grip strength ( 27.1kg before (‘weak’) and 36.8kg after (‘normal’).

Leg strength and mobility: Sit to Stand Test

This test was designed to test risk of frailty in the future. The participant sits on a chair with two feet on the floor, and folds their arms across their chest.  They stand up (without using their hands on the chair) and sit back down as many times as they can in 30 seconds. 

Results: 19 participants managed to complete both the pre- and post-yoga sit to stand test. The others were either absent, unwilling to participate or unable to do this due to severe mobility issues meaning they cannot stand up unassisted.

Again, this test was very challenging for most of the LD cohort, with the majority of those that were able to complete it scoring in the ‘below average’ range. These tests highlight the fact that these adults are at a higher risk of frailty and having falls as they age. 

The average score before the yoga was 9.8, and after, it was 10.6. This was an improvement which was almost large enough to be ‘statistically significant’*.

Balance: Leg Stance Test

The test was developed to give an indication of how likely a person is to be at risk of a fall. The participant is asked to stand up, put their hands on their hips, and keep their eyes open. They choose their ‘dominant’ (or ‘strongest’) leg. When they are ready, they lift the other leg off the floor, and we use a stopwatch to measure how long they can balance fo

Results: This test was very difficult for almost everyone in our group.  17 participants attempted both the pre- and post-yoga leg stance test. However, only 5 of these were able to balance for more than 3 seconds.  Due to the fairly crude stopwatch measurement tool, we did not think that times below 3 seconds were accurate enough to be a fair indication of balance. 

However, even with just 5 people in the data set, the average scores still showed a promising improvement (pre-yoga, 5.8 seconds; post-yoga 7.7 seconds). This result was drawn from a sample that is too small to be statistically useful for our analysis. 

In future we’d like to scale up our research, enabling us to draw upon a larger set of data.

Qualitative comments and feedback

After the sessions, we asked the participants about their experience. No negative feedback was received. Here are some of the responses:

“I enjoyed it.  I am not usually a yoga person.  I joined in this time, it was good.”

“I love ringing the chime and relaxing.”

“I love the whole thing.  Working on the mats and relaxation.  I find it relaxing.

“Like yoga better today, I am getting more familiar with the poses.”

 

We also asked the staff in the Mencap day centres to give their feedback and insights. One manager provided the case study of ‘S’: 

“S has been attending our day centre for many years. S has been quite happy to join in with external activities but has historically not joined in with activities when in the centre. This has been the case for some time and no end of persuasion had enticed S into joining in anything other than watching a film.

When we first started with the Yoga sessions, S started to pay attention to what was going on, he then started to mimic some of the moves and now he joins in with gusto and even asks if Yoga is on. This activity has such a massive and positive impact upon S that it is worth it just for him alone. 

Other people we support, who have not previously joined in with any exercise related activities, are now actively involved and this is down to Yoga, how it is presented and how it is made accessible to them; for both their physical and mental health needs.”

 

Evaluating Our Impact 

To summarise, our cohort of adults with LD were offered 12 weeks of accessible yoga, and at the end, they showed significant improvement in hand grip strength, and moderate improvement in anxiety symptoms and leg strength.  Our test of balance was not fit for purpose in this group.  Qualitative feedback highlighted how much the participants enjoyed the sessions, and how participating in yoga could be a gateway to participating in other activities.

The study took a participant centred research approach, supporting an empowering methodology of data capture. By working alongside LD participants and staff to understand their experience, and to monitor measurable changes – the process of learning and research has also had a positive impact within the test group.

There is a major, troubling, lack of accessible services for adults with LD. Their severe health inequalities across the board represent our failure as a society to support this group. This pilot study shows that yoga – when made accessible and inclusive – can potentially improve health outcomes on multiple levels for those with LD. What’s more, they find it enjoyable, uplifting, confidence-boosting and fun. 

What is needed now are comprehensive tests to evaluate the impact of yoga on the mental and physical health of adults with learning disabilities over extended periods. Additionally, yoga instructors and researchers need to collaborate in order to design effective yoga interventions that achieve lasting improvements.

 

* Results of statistical analyses: 

GAD – anxiety symptoms.  A paired-samples t-test indicated a marginal significance with moderate effect size: t (22) = 2.0, p = 0.06. Cohen’s D effect size: 0.4.

Hand grip strength: A paired-samples t-test indicated a statistically significant improvement and a strong effect size: t (20) = 2.89, p = 0.009. Cohen’s D effect size: 0.6.

Sit to stand test: The paired-samples t-test indicated a marginally significant improvement and a moderate effect size: t(18) = 1.79, p = 0.09. Cohen’s D effect size: 0.4.

 

Lead Researcher, and report author: Dr Ellie Firth

Editorial support from Anna Riddell-Roberts