Group yoga can improve balance in stroke survivors who no longer receive rehabilitative care, according to new research in the American Heart Association journal Stroke.

In a small pilot study, researchers tested the potential benefits of yoga among chronic stroke survivors -- those whose stroke occurred more than six months earlier.

"For people with chronic stroke, something like yoga in a group environment is cost effective and appears to improve motor function and balance," said Arlene Schmid, Ph.D., O.T.R., lead researcher and a rehabilitation research scientist at Roudebush Veterans Administration-Medical Center and Indiana University, Department of Occupational Therapy in Indianapolis, Ind.

The study's 47 participants, about three-quarters of them male veterans, were divided into three groups: twice-weekly group yoga for eight weeks; a "yoga-plus" group, which met twice weekly and had a relaxation recording to use at least three times a week; and a usual medical care group that did no rehabilitation.

The yoga classes, taught by a registered yoga therapist, included modified yoga postures, relaxation, and meditation. Classes grew more challenging each week.

Compared with patients in the usual-care group, those who completed yoga or yoga-plus significantly improved their balance.

Balance problems frequently last long after a person suffers a stroke, and are related to greater disability and a higher risk of falls, researchers said.

Furthermore, survivors in the yoga groups had improved scores for independence and quality of life and were less afraid of falling.

"For chronic stroke patients, even if they remain disabled, natural recovery and acute rehabilitation therapy typically ends after six months, or maybe a year," said Schmid, who is also an assistant professor of occupational therapy at Indiana University-Purdue University in Indianapolis and an investigator at the Regenstrief Institute.

Improvements after the six-month window can take longer to occur, she said, "but we know for a fact that the brain still can change. The problem is the healthcare system is not necessarily willing to pay for that change. The study demonstrated that with some assistance, even chronic stroke patients with significant paralysis on one side can manage to do modified yoga poses."

The oldest patient in the study was in his 90s. All participants had to be able to stand on their own at the study's outset.

Yoga may be more therapeutic than traditional exercise because the combination of postures, breathing and meditation may produce different effects than simple exercise, researchers said.

"However, stroke patients looking for such help might have a hard time finding qualified yoga therapists to work with," Schmid said. "Some occupational and physical therapists are integrating yoga into their practice, even though there's scant evidence at this point to support its effectiveness."

Researchers can draw only limited conclusions from the study because of its small number of participants and lack of diversity. The study also didn't have enough participants to uncover differences between the yoga and control groups. The scientists hope to conduct a larger study soon.

Researchers also noticed improvements in the mindset of patients about their disability. The participants talked about walking through a grocery store instead of using an assistive scooter, being able to take a shower and feeling inspired to visit friends.

"It has to do with the confidence of being more mobile," Schmid said. Although they took time to unfold, "these were very meaningful changes in life for people."

Co-authors are Marieke Van Puymbroeck, Ph.D., C.T.R.S.; Peter A. Altenburger, Ph.D., P.T.; Nancy L. Schalk, R.Y.T.; Tracy A. Dierks, Ph.D; Kristine K. Miller, P.T.; Teresa M. Damush, Ph.D.; Dawn M. Bravata, M.D.; and Linda S. Williams, M.D. Author disclosures are on the manuscript.