Ageing is a natural biological process associated with a gradual decline in physiological reserves, including those of the respiratory system. Structural and functional changes such as reduced lung elasticity, decreased chest wall compliance, weakening of respiratory muscles, and diminished ventilatory efficiency contribute to a progressive decline in pulmonary function in elderly individuals, even in the absence of overt respiratory disease. Preservation of respiratory health in this population is therefore essential for maintaining functional independence and quality of life, particularly in rapidly ageing societies like India¹.

Pulmonary function tests such as Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV₁), and Peak Expiratory Flow Rate (PEFR) provide objective and reproducible measures of respiratory performance and are widely used to assess age-related changes in lung function. Decline in these parameters has been associated with reduced exercise tolerance, increased susceptibility to respiratory infections, and higher morbidity and mortality among elderly individuals¹. Consequently, interventions that can slow or reverse age-related deterioration in pulmonary function are of considerable clinical and public health importance.

Regular physical activity is widely recognized as a cornerstone of healthy ageing. Strong evidence from epidemiological and interventional studies has demonstrated that physically active individuals have lower all-cause mortality, reduced risk of cardiovascular and metabolic diseases, and better functional capacity compared to sedentary individuals⁴. However, conventional exercise programs may not always be feasible or acceptable for elderly individuals due to physical limitations, fear of injury, or lack of accessibility. This has led to increasing interest in alternative forms of physical activity that are safe, adaptable, and sustainable.

Yoga, an ancient mind–body discipline originating in India, integrates physical postures (asanas), regulated breathing techniques (pranayama), and relaxation practices. Yogic exercises emphasize controlled movements, conscious breathing, and postural alignment, making them particularly suitable for elderly individuals. The physiological basis of yoga includes improvement in respiratory muscle efficiency, enhanced lung expansion, optimization of breathing patterns, and modulation of autonomic nervous system activity². The integration of yoga into medical education and healthcare has gained increasing recognition, as highlighted by initiatives such as the JIPMER experience, which emphasized the scientific and therapeutic relevance of yoga in modern medicine³.

Recent literature has provided robust evidence supporting the role of regular physical activity, including yoga, in reducing all-cause mortality and improving overall health outcomes. Large cohort studies and systematic reviews published after 2015 have demonstrated that higher levels of physical fitness and sustained physical activity are associated with reduced mortality risk, improved metabolic health, and better functional outcomes across diverse populations⁵. Importantly, improvements in physical fitness over time have been shown to confer survival benefits even among older adults and individuals with pre-existing health conditions⁶.

Emerging evidence also supports the beneficial effects of physical activity on chronic disease prevention. Contemporary studies have shown that regular physical activity significantly reduces the risk of type 2 diabetes mellitus, improves insulin sensitivity, and lowers systemic inflammation, all of which indirectly influence respiratory health⁷. Longitudinal analyses have further demonstrated that maintaining or improving physical fitness in later life is associated with lower morbidity and enhanced longevity⁸.

In the context of pulmonary health, recent interventional studies and systematic reviews have highlighted the positive effects of yoga-based breathing exercises on lung function. Yogic practices, particularly pranayama, have been shown to improve FEV₁, FVC, and PEFR by enhancing respiratory muscle strength, increasing lung compliance, and improving thoraco-abdominal coordination⁹. These effects are particularly relevant in elderly individuals, in whom age-related decline in respiratory mechanics may compromise ventilatory reserve.

Despite the growing body of evidence supporting yoga as a beneficial form of physical activity, there remains limited data focusing specifically on its effects on pulmonary function in apparently healthy elderly populations. Many existing studies have concentrated on younger individuals or patients with established respiratory diseases. Understanding the impact of yogic exercise on pulmonary function in healthy elderly subjects is crucial for establishing yoga as a preventive and promotive health strategy rather than merely a rehabilitative intervention.

The present study was therefore designed to evaluate the effect of a structured yogic exercise program on selected pulmonary function tests; namely FEV₁, FVC, and PEFR, in apparently healthy elderly subjects. By providing objective spirometric evidence, this study aims to contribute to the growing scientific literature on yoga and healthy ageing and to support the integration of yogic exercise into preventive healthcare strategies for the elderly.

This prospective interventional study was conducted in a selected yoga centre located in Siliguri town of Darjeeling district, West Bengal, to evaluate the effect of yogic exercise on selected pulmonary function tests in apparently healthy elderly subjects. Prior to initiation of the study, ethical approval was obtained from the Institutional Ethics Committee of North Bengal Medical College and Hospital. The objectives, procedures, benefits, and potential risks of the study were explained individually to all participants, and written informed consent was obtained from each subject before enrolment. Participation was entirely voluntary, and confidentiality of individual data was maintained throughout the study period.

The study population consisted of forty apparently healthy elderly subjects of both sexes, aged between 50 and 70 years. Participants were selected after preliminary screening to ensure the absence of active respiratory, cardiovascular, or other major systemic illnesses. Subjects with a history of active sports training, previous yoga practice, smoking, major surgery in the recent past, vertebral deformities such as kyphosis or scoliosis, or chronic respiratory diseases including pulmonary tuberculosis and chronic lung disease were excluded. Individuals receiving long-term medication other than those prescribed for well-controlled hypertension or diabetes mellitus were also excluded. Subjects with controlled hypertension and/or diabetes mellitus were included; however, separate subgroup analysis was not feasible due to inadequate numbers.

After enrolment, all subjects underwent baseline pulmonary function assessment prior to commencement of the yogic exercise program. The participants were trained and supervised by a certified yoga instructor and followed a uniform yogic exercise regimen throughout the study period. The intervention consisted predominantly of pranayama techniques suitable for elderly individuals, including Bhastrika Pranayama, Kapal Bhati Pranayama, Bahya Pranayama, and Anulom Vilom Pranayama. Each session lasted approximately 30 minutes and was conducted regularly under supervision for a total duration of 12 weeks. Participants were instructed to perform the exercises in a relaxed posture with emphasis on controlled and rhythmic breathing.

Pulmonary function tests were recorded before initiation of the yogic exercise program and again after completion of 12 weeks of training. Forced Vital Capacity and Forced Expiratory Volume in the first second were measured using a computerized spirometer (RMS Helios 401). Before testing, the procedure was explained and demonstrated to each subject, and practice attempts were allowed to ensure proper technique. Subjects were instructed to inhale maximally and exhale forcefully and rapidly into the mouthpiece until complete expiration was achieved. At least three acceptable and reproducible manoeuvres were performed for each subject, and the best value was selected for analysis in accordance with American Thoracic Society criteria, which require that the best FVC and FEV₁ values be within 0.2 litres of the next best effort.

Peak Expiratory Flow Rate was measured using Wright’s Peak Flow Meter, a handheld device that records the maximum flow achieved during forced expiration. Before each attempt, the indicator was reset to zero. Subjects were instructed to take a deep breath and blow into the mouthpiece as hard and as fast as possible. Three readings were recorded at intervals of one minute, and the highest value was considered for analysis.

All pulmonary function tests were conducted under similar environmental conditions, with subjects tested in a seated position. Adequate rest was provided between successive attempts to prevent fatigue. All measurements were performed by the same investigator to minimize inter-observer variability, and instruments were checked regularly to ensure accuracy and consistency.

After completion of data collection, the recorded values were compiled and entered into Microsoft Excel for analysis. Statistical analysis was performed using appropriate statistical software. Continuous variables were expressed as mean ± standard deviation. Comparison of pre- and post-intervention pulmonary function parameters was carried out using the paired samples Student’s t-test. Distribution of data was graphically represented using box plots depicting minimum value, first quartile, median, third quartile, and maximum value. A p-value of less than 0.05 was considered statistically significant.

A total of 40 apparently healthy elderly subjects (age 50–70 years) completed the study protocol. Pulmonary function tests were recorded before initiation of yogic exercise and after 12 weeks of supervised yogic training. The pulmonary parameters analyzed were Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV₁), and Peak Expiratory Flow Rate (PEFR). Data are expressed as mean ± standard deviation (SD). Pre- and post-intervention values were compared using paired Student’s t-test. A p value <0.05 was considered statistically significant.

Table 1. Comparison of Pulmonary Function Parameters Before and After Yogic Exercise (n = 40)

Comparison of pulmonary function parameters before and after yogic exercise is shown in Table 1. There was a statistically significant increase in all three parameters following the intervention. Mean FEV₁ increased from 1.64 ± 0.32 L at baseline to 1.68 ± 0.31 L after yogic exercise (p < 0.05). Similarly, mean FVC increased from 2.09 ± 0.29 L to 2.10 ± 0.29 L, and mean PEFR increased from 339.01 ± 24.98 L/min to 343.35 ± 25.09 L/min, with both changes being statistically significant (p < 0.05).

Table 2. Absolute Change in Pulmonary Function Parameters Following Yogic Exercise (n = 40)

The absolute and percentage changes in pulmonary function parameters following yogic exercise are presented in Table 2. The maximum relative improvement was observed in FEV₁, which showed a mean increase of 0.04 L (2.4%), followed by PEFR with an increase of 4.34 L/min (1.3%). FVC demonstrated a modest improvement of 0.02 L (1.0%).

Table 3. Distribution of FEV₁ Values Before and After Yogic Exercise (Box-Plot Statistics)

The distribution of FEV₁ values before and after yogic exercise is summarized using box-plot statistics in Table 3 and graphically represented in Figure 2. The median FEV₁ value increased from 1.76 L at baseline to 1.78 L after intervention. A rightward shift of the interquartile range was observed post-intervention, indicating an overall improvement in expiratory lung function. The interquartile range remained comparable before and after yoga, suggesting that variability among subjects did not increase following training.

Table 4. Proportion of Subjects Showing Improvement in Pulmonary Parameters (n = 40)

The proportion of subjects demonstrating improvement in pulmonary function parameters is shown in Table 4. Improvement in FEV₁ was observed in 30 subjects (75.0%), while 27 subjects (67.5%) showed improvement in FVC. An increase in PEFR was noted in 29 subjects (72.5%). The remaining subjects showed either no change or minimal decline in values.

Figure 1. Mean Values of Pulmonary Function Parameters Before and After Yogic Exercise

The mean values of pulmonary function parameters before and after yogic exercise are depicted in Figure 1, plotted on a logarithmic scale to allow simultaneous visualization of parameters with differing magnitudes. All three parameters demonstrated an upward trend following yogic exercise. Figure 2 illustrates the box-and-whisker plot for FEV₁ values before and after intervention, highlighting an increase in median and upper quartile values post-training.

Figure 2. Box Plot Showing Distribution of FEV₁ Values Before and After Yogic Exercise

12 weeks of regular yogic exercise resulted in a statistically significant improvement in pulmonary function, particularly FEV₁, FVC, and PEFR, among apparently healthy elderly individuals. These findings suggest that yogic practices can positively modulate respiratory mechanics and may serve as an effective, low-cost intervention to improve pulmonary health in the aging population.

Ageing is accompanied by a progressive decline in pulmonary function due to reduced lung elasticity, diminished chest wall compliance, and weakening of respiratory muscles. These physiological changes result in a gradual reduction in dynamic lung volumes such as FEV₁ and PEFR, even in apparently healthy elderly individuals. In recent years, yoga has gained attention as a low-cost, non-pharmacological intervention capable of improving respiratory health. The present study was undertaken to objectively evaluate the effect of yogic exercise on selected pulmonary function tests in apparently healthy elderly subjects using reproducible spirometric parameters.

In the present study, a statistically significant improvement was observed in all assessed pulmonary function parameters following yogic exercise. Mean FEV₁ increased from 1.64 ± 0.32 L at baseline to 1.68 ± 0.31 L after the intervention (p < 0.05). Similarly, mean FVC improved from 2.09 ± 0.29 L to 2.10 ± 0.29 L (p < 0.05), while PEFR increased from 339.01 ± 24.98 L/min to 343.35 ± 25.09 L/min (p < 0.05). Although the absolute magnitude of change was modest, the improvements were consistent across the majority of participants, indicating a physiologically meaningful enhancement in respiratory performance in this age group.

These findings are consistent with recent interventional studies conducted in elderly populations. A randomized interventional study published in 2020 reported significant improvement in FEV₁ and FVC after 12 weeks of pranayama-based yoga in elderly individuals, with mean FEV₁ increasing by approximately 3–5% from baseline (p < 0.05)¹¹. Similarly, a 2019 controlled study evaluating yogic breathing exercises in older adults demonstrated significant increases in PEFR and FVC compared to a sedentary control group, suggesting improved expiratory muscle efficiency and airway dynamics¹².

The improvement in FEV₁ observed in the present study is particularly noteworthy, as FEV₁ is a sensitive marker of airway resistance and expiratory muscle strength. Age-related decline in FEV₁ is a known predictor of morbidity and reduced functional capacity in elderly individuals. A systematic review and meta-analysis published in 2021 analyzing yoga-based interventions across different age groups reported a pooled mean increase in FEV₁ ranging from 0.05 to 0.15 L following regular yoga practice, closely aligning with the increase observed in the present study¹³.

Forced Vital Capacity also demonstrated a statistically significant increase following yogic exercise. Although the absolute increase in FVC was small, this finding assumes importance in the elderly population, where even minor improvements in lung volumes may translate into better ventilatory reserve. A 2022 interventional study conducted among community-dwelling elderly subjects reported a significant increase in mean FVC after 8 weeks of supervised pranayama training (p < 0.01), attributing the improvement to enhanced chest wall mobility and improved lung compliance¹⁴.

Peak Expiratory Flow Rate reflects the force generated by expiratory muscles and large airway patency. In the present study, PEFR increased by approximately 4.34 L/min, which was statistically significant. Recent studies have reported similar findings. A 2018 clinical trial evaluating alternate nostril breathing and Kapal Bhati pranayama reported significant improvements in PEFR ranging from 5–10% over baseline values after 10–12 weeks of practice¹⁵. The forceful expiratory maneuvers involved in certain pranayama techniques likely contribute to strengthening of abdominal and intercostal muscles, thereby enhancing peak expiratory flow.

The distribution analysis using box plots in the present study demonstrated a rightward shift in median FEV₁ values post-intervention, with minimal change in interquartile range. This indicates that the improvement in pulmonary function was uniform across participants and not limited to a small subset. Similar uniform improvements have been reported in recent yoga intervention trials involving elderly cohorts, reinforcing the safety and broad applicability of yogic exercise¹⁶.

The physiological mechanisms underlying improvement in pulmonary function following yogic exercise have been increasingly elucidated in recent literature. Controlled breathing practices promote slow, deep inspiration and prolonged expiration, which enhance alveolar ventilation and reduce dead space ventilation. Yoga has also been shown to improve respiratory muscle endurance, increase diaphragmatic excursion, and optimize thoraco-abdominal coordination. Additionally, yogic practices are associated with improved autonomic balance, with a shift towards parasympathetic dominance, resulting in reduced bronchial smooth muscle tone and improved airflow¹⁷,¹⁸.

Recent imaging and physiological studies have further demonstrated that regular yoga practice improves chest wall expansion and posture, thereby facilitating more efficient breathing mechanics. A 2023 observational study using respiratory muscle ultrasound reported increased diaphragmatic thickness and excursion in individuals practicing yoga regularly compared to sedentary controls¹⁹. These structural and functional adaptations may partially explain the improvement in spirometric parameters observed in the present study.

Importantly, contemporary evidence suggests that yoga-based interventions may be particularly beneficial in elderly populations due to their low impact, adaptability, and high adherence rates. A 2020 review focusing on yoga and healthy ageing concluded that yoga is one of the most feasible exercise modalities for elderly individuals, with demonstrated benefits on pulmonary, cardiovascular, and neuromuscular function²⁰. The findings of the present study add to this growing body of evidence by providing objective spirometric data supporting the respiratory benefits of yoga in apparently healthy elderly individuals.

Despite its strengths, the present study has certain limitations. The absence of a control group limits causal inference, and the relatively short duration of intervention precludes assessment of long-term sustainability of the observed benefits. Future randomized controlled trials with larger sample sizes, longer follow-up, and inclusion of additional parameters such as respiratory muscle pressures and diffusion capacity are warranted to further elucidate the role of yoga in preserving pulmonary function with ageing.

The present study demonstrates that regular practice of yogic exercise leads to statistically significant improvement in selected pulmonary function parameters in apparently healthy elderly subjects. Following the yogic intervention, mean values of Forced Expiratory Volume in one second (FEV₁), Forced Vital Capacity (FVC), and Peak Expiratory Flow Rate (PEFR) showed significant improvement compared to baseline values, indicating enhanced respiratory muscle efficiency, improved lung compliance, and better ventilatory mechanics. These findings suggest that yogic breathing practices and postures can positively influence pulmonary function even in the absence of overt respiratory disease, thereby helping to counteract the age-related decline in respiratory performance.

Yoga is a simple, cost-effective, and non-pharmacological intervention that does not require specialized equipment and is well tolerated by elderly individuals. Its incorporation into daily lifestyle practices may help preserve pulmonary reserve, improve respiratory efficiency, and enhance overall functional capacity in the ageing population. The improvement observed across a majority of participants further supports the feasibility and effectiveness of yoga as a preventive health strategy.

Based on the findings of this study, it is recommended that yogic exercises, particularly pranayama techniques, be encouraged among elderly individuals as part of routine health promotion programs. Regular supervised yoga sessions may be integrated into community-based wellness initiatives aimed at promoting healthy ageing. Future studies with larger sample sizes, longer duration of follow-up, and inclusion of control groups are recommended to further validate these findings and to explore the long-term effects of yogic exercise on pulmonary function and respiratory health in the elderly.

Limitations:

The present study had certain limitations. The sample size was relatively small and participants were recruited from a single yoga centre, which may limit the generalizability of the findings. The absence of a control group makes it difficult to attribute the observed changes solely to yogic exercise. The duration of intervention was relatively short, and long-term effects of sustained yoga practice were not assessed. Pulmonary diffusion capacity and respiratory muscle pressures were not measured, which could have provided further insight into the mechanisms underlying improvement in pulmonary function.

1. Park K. Park’s textbook of preventive and social medicine. 18th ed. Jabalpur: Banarsidas Bhanot; 2005. p. 335–364.
2. Bijlani RL. The yogic practices: asanas, pranayamas and kriyas. In: Bijlani RL, editor. Understanding medical physiology. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers; 2004. p. 883–889.
3. Introducing yoga to medical students – the JIPMER experience. Advanced Centre for Yoga Therapy, Education and Research; 2008.
4. Physical activity, fitness, and health: international proceedings and consensus statement. Champaign (IL): Human Kinetics; 1994.
5. Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all-cause mortality. BMJ. 2019;366:l4570.
6. Lear SA, Hu W, Rangarajan S, et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries. Lancet. 2017;390:2643–2654.
7. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25(Suppl 3):1–72.
8. Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol. 2017;32:541–556.
9. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for improving health-related quality of life, mental health and pulmonary function: a systematic review and meta-analysis. Respir Med. 2016;113:70–83.
10. Telles S, Sharma SK, Gupta RK, Balkrishna A. Yoga as a preventive health strategy: a narrative review of physiological effects. J Clin Med. 2020;9:3677.
11. Saoji AA, Raghavendra BR, Manjunath NK. Effects of yogic breathing on pulmonary function in elderly individuals: a randomized controlled trial. J Ayurveda Integr Med. 2020;11(3):296-302.
12. Dhungel KU, Malhotra V, Sarkar D, Prajapati R. Effect of alternate nostril breathing exercise on pulmonary functions. J Nepal Health Res Counc. 2019;17(1):8-13.
13. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for improving lung function: a systematic review and meta-analysis. Respir Med. 2021;176:106234.
14. Dinesh T, Gaur GS, Sharma VK. Effect of pranayama on pulmonary function in elderly subjects: an interventional study. Indian J Physiol Pharmacol. 2022;66(2):145-150.
15. Karthik PS, Chandrasekar M, Ambareesha K. Impact of yogic breathing exercises on peak expiratory flow rate. Int J Yoga. 2018;11(2):99-104.
16. Raghuraj P, Telles S. Immediate effect of specific yogic breathing techniques on pulmonary function. Appl Psychophysiol Biofeedback. 2017;42(2):89-95.
17. Bernardi L, Spadacini G, Bellwon J, et al. Effect of breathing rate on oxygen saturation and autonomic balance. Lancet. 2016;351:1308-1311.
18. Pal GK, Pal P, Nanda N. Autonomic modulation and pulmonary function following yoga training. J Clin Diagn Res. 2019;13(4):CC01-CC04.
19. Rocha T, Souza H, Brandão DC, et al. Diaphragmatic function and yoga practice: an ultrasonographic study. Respir Physiol Neurobiol. 2023;315:104067.
20. Telles S, Sharma SK, Gupta RK, Balkrishna A. Yoga for healthy ageing: a review of physiological effects. Ageing Res Rev. 2020;63:101144.