Yoga and Advanced Aging, Part 4: Teaching in Assisted Living, Skilled Nursing, and Memory Care Spaces

“It’s your birthright to live into your entire body.” Matthew Sanford

Part 4: Grounding, Rhythm, and Movement

In Part One of this series we explored the atmospheric challenges of teaching in Senior Care spaces and focused on being creative and looking for hints of connection. In Part Two we discussed the importance of creating a welcoming community that can heal and transform by encouraging students to bring their stories into the space. We also looked at a few movements we might avoid with this population. Part Three was all about breathing and the body’s brilliance in using the breath as a problem-solving mechanism. We considered shifting our cueing in order to help students develop a more subtle relationship to the breath and body. In this fourth and final installment we will explore the grounding, rhythm, and movement.

Don’t Forget the Feet

I recently had a conversation with a yoga teacher who asked me to describe what it is I do. She said, “So, you get your students into parts of the shapes?” I replied, “I would argue there are no ‘parts of the shapes;’ you are either teaching a sensation of wholeness or you aren’t.” One of the things I frequently notice when observing Chair Yoga classes is that teachers often forgo mentioning the importance of how the feet and legs relate to spinal awareness and functional movement of the body.

“Chair yoga is not yoga from the waist up. Don’t forget the feet,” is something I preach in my workshops. The fact that many students with advanced aging sit for prolonged amounts of time, use wheelchairs, or need the assistance of walkers is all the more reason to cue them to use their legs to support their spines. By cueing through the feet and legs, not only are we building strength in the lower body and core, we are also getting more of the nervous system online.

We start the movement portion of my seated chair classes “walking in place.” As we move our legs, I ask students to walk their feet all the way out in front of their bodies and bring their awareness to how out of balance they just became from the waist up. We then walk our feet underneath our chairs and explore sensations from that position. I have them find the midpoint between those two extremes and ask them to notice the support the legs provide in this position. I cue them to firmly press down through their feet and use the strength of their legs to help them sit up a little taller. From there we explore how much effort we need to expend to maintain this posture. Efficient integration of our outer bodies leads to access into subtler spaces inside ourselves.

Rhythm is Powerful

Keeping the legs active in the posture above (aka Seated Mountain Pose), I ask my students to bring their awareness to their belly. Borrowing a cue I gleaned from renowned yoga therapy teacher Doug Keller, I playfully ask students to, “Imagine you’re putting on a ‘snug pair of pants.’ They've been in the dryer just a little too long. Button up those pants and keep them buttoned as you relax your ribs and breathe.” From there we begin to sway side-to-side, slowly creating circles, and rocking forward and back. All the while, I am cueing the feet, belly, and spine.

This sequence is the glue of my teaching and is my go-to transition. Knowing that rhythm is a powerful inroad to the nervous system, and swaying is usually accessible in some form or fashion for my students, I incorporate this sequence early and often. The repetition creates body memory and an anchor that students can return to if something we just attempted was difficult or challenging. In most cases, I will lose my students if I ask them to sit still in contemplation. So, we contemplate in movement.

Slow rhythmic movements are very calming and can be used as a grounding tool in chaotic environments. I had a student fall in class recently. We were all understandably concerned and dysregulated. While nurses and staff attended to the injured student, I led the students through a rocking and tapping sequence. We held our classmate in our hearts and extended our compassion to her. The energetic shift in the room was palpable within minutes. We were able to reset and continue with class as she received the medical care and attention she needed.

Functional Movements

Another way to incorporate rhythm is to gently move the joints. Shrugging the shoulders, wiggling the fingers, swinging the legs, lifting the heels and toes, shaking the head yes and no are all familiar access points into the body. When taught with mindful intention, these movements are great opportunities to create connection by layering in the breath and/or adding detailed focus.
Here are a few examples: 1) Shake out your hands, breathe in, and sigh it out, 2) Lift your shoulders up and breathe in, lower them down and breathe out, 3) Wiggle your fingers and then touch your fingertips with your thumbs, 4) Open your hands wide, now make a fist, open your hands wide and breathe in, breathe out as you make a fist.

Movement Across the Midline

Moving across the midline is a staple of my sequencing; the midline is an imaginary line down the center of the body that divides it into left and right. This type of movement stimulates both hemispheres of the brain, but for students with a stroke history, coordinating movement across the midline can be challenging. Choosing an accessible pace and teaching with patience encourages students to problem solve.

Here’s an example: Cross your arms and take your opposite hand to your opposite leg, slide your bottom arm out and place it on top, once you start moving keep moving. You may notice that one arm is easier to move than the other, that’s okay, go as slow as you need to. Notice your breath. Breathe out and take a gentle breath in and a slow breath out.

I usually shy away from using left/right cues. Left/right discrimination is one of the things that students with age-related cognitive decline and dementia struggle with. When I do cue lefts and rights, I start a sequence on a specific side and see how the class responds. If I feel like they’re able to follow those instructions fairly well, I will keep using left and right language as a cognitive exercise. If I find the class is having a hard time, I get creative with my approach.


Let’s take a look at a few different ways you could cue a sequence that requires bilateral coordination. 1) Lift your right arm up toward the ceiling, now lift your left leg; or 2) Lift one arm up toward the ceiling, now lift your opposite leg; or 3) Let your hands rest on your legs, take one arm up toward the ceiling, now lift the leg that you’re touching.

The sequence we just explored in the last paragraph requires students to move in multiple planes at once, i.e., across the midline and in the upper and lower body. You may have noticed that I cued movement in the upper body first, then the lower body. This allows the students find precision on one side before they cross the midline and add on. My pace is usually slow and deliberate. I might eventually layer in the breath or ask them to lift the legs and arms at the same time once they have settled in to the sequence. If students are having a difficult time managing a task, let them move without expectation of outcome. Sometimes things work, sometimes they don’t. Non-attachment and going with the flow are necessary when working with this population.

I thank you for reading this series, and encourage you to connect with your students, find your unique voice, and get creative as you share yoga with this population. Things that may not look like “yoga” can be incorporated into your classes when practiced in the spirit of unity and connection. Feel free to reach out to me at carey@careysimsyoga.com if you have any questions and I hope to see you again soon on the Accessible Yoga Blog.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

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Yoga and Advanced Aging, Part 3: Reconsidering the Breath

Part Three: Reconsidering the Breath

Many of us have discovered that connecting with our breath is where the rubber meets the road in our practice. But some of the breath techniques we find effective in the general population may not always apply to adaptive and senior students. In this article we will rethink how we cue the breath and explore the challenges our students may be facing when we ask them to breathe in certain ways.

How many times have we been encouraged to take a deep breath in a yoga class? Probably more than we can count. But for some students with advanced aging, a “deep” breath can feel invasive and even violent. I often kid that handing out a cough drop or a cup of water counts as an assist in my classes because breath work inevitably ignites a coughing spell.

I have found that replacing the word “deep” with “gentle” allows for a full inhale, but invites softness into the breathing experience. Students are less likely to overexert, grip, and become tense. Example: “Take a gentle breath in and a slow breath out.”

I also give students the freedom to breathe from their nose and/or mouth. Usually most students inhale through the nose and exhale through the mouth, but not always. As teachers, we must constantly ask what we are trying to achieve with a particular cue or technique and allow ourselves to be creative in achieving that goal. Connection to the breath is what matters to me; I don’t get dogmatic about methods.

When teaching movement, consider the breath as a layer of experience. Matthew Sanford has a saying, “Prana follows consciousness more than it follows breath.” This is one of the cornerstones of my teaching. I come from a vinyasa background and this was initially hard to wrap my head around, but once I stopped leading with breath, I began to tangibly see the results in my students’ ability to connect with their bodies. Why would this be?


Students with advanced aging and/or dementia often struggle with left/right discrimination and moving in two directions at once. Managing these types of movements and coordinating breath at the same time is extremely challenging and often causes frustration. I know that linking breath with movement is powerful, but my solution is to explore movement first and layer in the breath after we have connected with the body.


A simple change in my cueing order creates the necessary rhythm, connection, and space for the breath to benefit rather than impede my students. For example, “Lift your arms up toward the ceiling and lower them back down by your sides. Do this a few times and notice how that feels. Now we are going to move with our breath. Breathe in and lift your arms up and breathe out and lower your arms down.” I don’t want my students to feel like they are doing something wrong and become frustrated. If that happens, they may quit participating or decide not to come to yoga the next time. I am not their Physical Therapist or Occupational Therapist— I want them to feel good during our time together.

Another way to teach breath awareness is by exploring function. When we understand the utility of a technique or pattern, we can shift our relationship to it both as teachers and practitioners. Take holding the breath for example. This is natural reaction to being over stimulated. It’s like the brain knows we need to hit pause and regroup for a second or two. The next time you are focusing really hard on a new or complicated task, observe your breathing. If you find that you are holding your breath, don’t admonish yourself; instead be amazed at your body’s brilliance at problem solving.


When I work with my senior students on a new sequence, I often ask them to check in and notice if they are holding their breath. We usually laugh and smile at this recognition. I tell them it’s okay, explain why it’s happening, and ask them to let their body catch up to the posture or movement. From there we breathe out slowly. We simply need to create space for the breath to sort itself out and trust that our bodies know what to do once we get out of the way.

As we just explored, holding the breath is a brilliant stabilizing mechanism for the mind, but I’ve witnessed many times that the body also intuitively supports the spine through breath suspension or retention. Think of an instance where you picked up something a little too heavy and grunted or held your breath for a second. Your body intuitively knew it needed stability and used a pause in the breath to create it. Understanding this function helps me appreciate why some students are breathing the way they are. For many of my students, a movement like lifting the arms overhead is strong. These students often instinctively hold the breath as a means to recruit strength. Recognizing this, I will work with what is naturally happening and layer in a slow exhalation as we lower the arms.

Elongating the breath has a similar stabilizing function to breath retention, but introduces the sensation of ease inside of effort. I may refine the last example further by asking students not to drop their chest as they lower their arms. As we continue we might focus on decelerating the downward momentum of our limbs as we exhale. Example: “Lift your arms up toward the ceiling, keep your chest lifted and slowly lower the arms down as you exhale.”

A friend of mine said something beautifully powerful to me recently. “Carey you are helping your students connect with their bodies before they leave them.” I never really thought of it that way, but it’s true. Many, if not most, of my students’ bodies are steadily declining. I have lost a lot of students over the past few years. This is all the more reason to let our time together become a place of playful exploration. My students don’t need to be concerned about getting things “right,” especially their breathing. Imperfections are welcome. 

This article is part of a series exploring the practical application of yoga in Assisted Living, Skilled Nursing, and Memory Care spaces. Carey shares some of the challenges he has encountered teaching in these environments and offer practical techniques that he has found useful in sharing yoga with this population.

This post was edited by Patrice Priya Wagner, co-editor of Accessible Yoga blog and member of the Board of Directors.

Click here to view the original post on the Accessible Yoga Blog