Iyengar yoga and falls prevention: new evidence from the SAGE Trial
- Institute for Musculoskeletal Health
- Sep 25
- 4 min read
Falls are one of the greatest health risks for older adults. In Australia, 17 older people die as a direct result of falls every day and more than 400 older people aged 65+ are admitted to hospital due to a fall daily - that's about 1 person every 4 minutes!
Exercise targeting balance and strength is proven to reduce this risk. Yoga is becoming increasingly popular among older adults and has long been thought to offer benefits for balance and mobility, but until now its direct impact on falls hadn’t been rigorously tested.
A landmark study published today in The Lancet Healthy Longevity challenges assumptions about yoga and falls. The Successful Ageing (SAGE) Trial is the largest trial to date examining yoga and falls prevention.
What did the study involve?
Participants were randomly allocated to one of two groups:
Iyengar yoga-based exercise programme (intervention group)
- 40-week, twice-weekly supervised classes, or
Self-paced seated relaxation yoga programme (control group)
- 2 x 1hr workshops to learn stretching and breathing exercises, continued yoga was completed unsupervised at own discretion.
Iyengar yoga was selected as it is often seen as more accessible for older adults with its emphasis on holding poses for longer periods, along with the use of supportive props like blocks and chairs, offers greater stability and control. This makes it quite different from faster-paced styles, such as Vinyasa, which involve more continuous flow between movements. A previous study conducted by the team in 2013 also found a 12-week Iyengar yoga programme significantly improved balance and mobility in older adults aged 59-87 years.
The study was originally designed for in-person classes in Sydney. However, when COVID-19 restrictions and lockdowns hit, the programme quickly shifted to online delivery via Zoom. This unexpected change not only kept the trial on track but also expanded its reach, allowing older adults from across New South Wales, not just Sydney, to take part.
“We wanted to fill this gap in knowledge and carry out a study to test our idea that yoga could improve balance and therefore prevent falls – but surprisingly, our study found the opposite,” Professor Anne Tiedemann
What did the study find?
The trial involved 700 Australians aged 60 and older. At baseline, 25% of participants self-reported their balance to be fair/poor, and 33% had fallen in the past year.
Contrary to expectations, participants in the Iyengar yoga group had a higher rate of falls over the 12-month study period compared to the control group (0.87 vs 0.64 falls per person per year; incidence rate ratio 1.33 [95% CI 1.01-1.75; p=0.044])). Importantly, there was no difference in serious or injurious falls between the groups.
What does this mean?
The key message is not that yoga is “bad” for older adults. In fact, many intervention group participants enjoyed the program and reported positive outcomes:
Increased planned physical activity
Greater balance confidence
Better achievement of mobility-related goals
However, this Iyengar yoga-based programme should not be recommended as a fall prevention intervention in its current form, since overall it was associated with more falls.
“Although Iyengar yoga may not be a good form of exercise to prevent falls, especially if taught online, it can have other positive health benefits. Older people who want to try yoga should speak to their doctor to get advice about how to stay safe while exercising,” Dr Juliana Oliviera.
If people felt more balanced, why did falls increase?
Several factors may explain the unexpected results. First, participants reported greater balance confidence and mobility goal achievement, which may have encouraged them to be more active and take part in a wider range of activities and at greater intensity, potentially exposing them to higher fall-risk situations.
While participants might have felt more confident and motivated to be active, they may have lacked the increased physical capacity needed to prevent or recover from falls.
Second, the programme’s online delivery during COVID-19 meant less direct supervision. Some participants put in less effort due to reduced supervision compared to an in-person class, and instructors noted slower progress, particularly with some balance postures.
Third, SAGE was grounded in Iyengar style yoga, which focuses on static postures. This contrasts with proven fall prevention programmes that emphasise dynamic balance, functional activities, and fall prevention education.
Finally, the control group may have gained more benefit than expected. Although designed as a “minimal impact” group, the seated yoga and stretching may have improved balance and strength, narrowing the gap between the two groups.
Together, these factors may help explain why Iyengar yoga did not reduce falls in this trial, despite its positive effects on confidence, activity, and wellbeing.
“The results demonstrate the complexity of preventing falls in older age, which occur due to a combination of the individual’s physiology, their concentration and care, the activity they are undertaking and their environment,” Professor Anne Tiedemann
Where to next?
The findings highlight the importance of rigorous testing, even for widely accepted practices like yoga. More research is needed to explore whether different styles of yoga, modified programmes, or in-person delivery could support falls prevention while still providing the physical and mental health benefits yoga is known for.
For now, while yoga remains an excellent option for physical activity and wellbeing, exercise programmes that specifically target balance and strength remain the gold standard for reducing falls risk in older adults.
Oliveira JS, et al. (2025). The effect of an Iyengar yoga-based exercise programme versus a seated yoga relaxation programme on falls in people aged 60 years and older (SAGE): a pragmatic, two-arm, parallel randomised controlled trial. The Lancet Healthy Longevity. DOI: 10.1016/j.lanhl.2025.100749
Written by Courtney West, Prof Anne Tiedemann and Dr Juliana Oliveira.
