Atlas›Domain X · Body, movement, breath & physical›Guide 139
Guide X-139

Chair and adaptive yoga

Lakshmi Voelker, Jivana Heyman, Matthew Sanford
A 29 · L 54 · M 1723 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: three published approaches, each named where used: (1) the Lakshmi Voelker Chair Yoga method (‘Get Fit Where You Sit’), as set out in its Lakshmi Voelker Chair Yoga Teacher (LVCYT) curriculum and the Kripalu training description; (2) Accessible Yoga as framed by Jivana Heyman in Accessible Yoga: Poses and Practices for Every Body (Shambhala, 2019) and A Teacher’s Guide to Accessible Yoga (published around 2024 [uncertain: not verified]); (3) adaptive yoga for disability as taught by Matthew Sanford and Mind Body Solutions (Minnetonka, Minnesota). Where these differ, the guide says which one it follows.

What it is. Chair and adaptive yoga is a family of approaches, not a single manualised therapy. Postures, breathing, meditation and relaxation from yoga are offered seated, standing with a chair for support, in a wheelchair, at a wall, on the floor or in bed, so that people who cannot or do not want to practise on a mat can take part. Lakshmi Voelker’s method teaches each pose at several ‘Levels of Flexibility’ and in five forms (single, double, pair, weighted and wheelchair chair yoga) [source: Get Fit Where You Sit, LVCYT page; Kripalu]. Accessible Yoga treats yoga as something everyone has a right to, and aims to make its tools available so people can personalise their practice, rather than making students conform to a class [source: Penguin Random House book page; Bell 2024 review]. Sanford’s adaptive yoga grew from his own practice after a spinal cord injury at 13. He describes yoga as a way to ‘re-inhabit’ a paralysed body and to strengthen the mind–body relationship [source: Star Tribune 2009; Watkins 2024].

How change is thought to happen. The developers describe change through three things: regular practice within the body a person actually has; growing awareness of, and connection with, that body; and a supportive group. Sanford speaks of working ‘with integrity within the body you have’ and of being present rather than being ‘fixed’ [source: NCHPAD]. Accessible Yoga names a supportive community as necessary for growth [source: Bell 2024]. The physical aims are strength, flexibility, balance and confidence in movement; the psychological aims are agency, belonging and a less adversarial relationship with the body [synthesis from the sources above]. Spiritual aims and concepts such as prana or chakras belong to the yoga tradition and to these schools’ teaching. They are not presented here as physiological fact.

2. Framework

No fixed phases. None of the three approaches publishes a phased protocol with session counts. Classes are usually ongoing groups, and adaptive yoga is offered in groups and one-to-one [source: NCHPAD; Kripalu]. In research, chair yoga programmes were run for several weeks with sessions more than once a week, as reported in reviews [source: Van Pelt 2023]. This describes research, not a recommended dose. The working structure below is a [synthesis] of the published elements.

Stage A: Screening, medical clearance and consent (before the first class). Goal: identify medical, mobility and psychological risks and agree how touch, choice and stopping will work. Move on when: the client has talked with their health care provider where needed, the teacher knows the relevant precautions, and the client knows they can modify, skip or stop anything. NCCIH advises people with health conditions, older adults and pregnant people to discuss their needs with their health care provider and the yoga instructor [source: NCCIH 2024]. The LV training teaches how to ‘identify precautions and contraindications’ [source: Kripalu]. The full list it teaches is not published [uncertain: not verified].

Stage B: Setup and orientation. Goal: a safe, stable environment and familiarity with the format. This means a sturdy, armless chair (not a folding chair), optionally placed near a wall; supportive shoes with tread; lights left on during relaxation; and music quiet enough for the teacher to be heard [source: Van Pelt 2023].

Stage C: The class arc. The LV training teaches an hour-long chair class [source: Kripalu]. Published elements, arranged in a typical order [synthesis of order]:

  • arrival and settling
  • breath awareness
  • warm-up range-of-motion and large-muscle movements before stronger strength or flexibility work [source: Van Pelt 2023]
  • posture sequences seated or standing with the chair (in LV: Sun, Moon and Earth Salutations, the Warrior Sequence and the Balance Sequence) [source: LVCYT page]
  • optional hand, knee and self-massage practices (LV)
  • relaxation or meditation
  • closing

Every standing pose has a seated alternative [source: Van Pelt 2023].

Stage D: Ongoing individualisation. Goal: each person works at their own Level of Flexibility, which can differ between upper and lower body and between the right and left sides [source: LVCYT page]. Progression means moving to more demanding variations or forms (for example from single to double chair work, or adding light weights in Weighted Chair Yoga) when the person chooses, the teacher judges it safe, and there is medical clearance where needed [synthesis].

Stage E: Ending or continuation. Many people continue in community classes. The Accessible Yoga and Mind Body Solutions sources stress community and continuing practice [source: Bell 2024; Star Tribune 2009]. In therapy, endings are discussed like any other adjunct [synthesis].

Who may deliver it, training and credentials

  • Lakshmi Voelker Chair Yoga Teacher (LVCYT):
    • Online: a 30-hour certification made up of two live group sessions, one 1-to-1 video call and self-study, with a 275-page Teacher Development Manual.
    • Open to yoga practitioners, yoga teachers and health care workers. People with little or no yoga experience first complete at least 15 hours of classes with a certified teacher.
    • The page names physical, occupational, recreational, speech and movement therapists, clinical social workers and nurses among the intended trainees.
    • Offers Yoga Alliance continuing education; it is not a Yoga Alliance teacher registration.
    • [source: LVCYT page]
    • Kripalu also runs an in-person LV training that leads to a ‘certificate in Lakshmi Voelker Chair Yoga worth 25 CEUs’, with Get Fit Where You Sit: A Guide to the Lakshmi Voelker Chair Yoga Method as the course text [source: Kripalu].
  • Accessible Yoga:
    • Accessible Yoga is an organisation founded and directed by Jivana Heyman.
    • Its trainings have produced ‘Accessible Yoga Ambassadors’. Trainees who also hold a 200-hour yoga teacher training can become ‘Certified Accessible Yoga Teachers’. One residential training was listed with about 30 Yoga Alliance contact hours.
    • Training topics included adapted asana, integrated classes, sample floor, chair and bed classes, common medical conditions, ageing, adapted pranayama and meditation, empowering people with disabilities, and a trauma-informed approach.
    • [source: Yogaville 2019 listing]
    • Current formats and hours [uncertain: not verified].
  • Mind Body Solutions (Matthew Sanford):
    • Sanford began teaching adaptive yoga in 1998 and founded the Mind Body Solutions nonprofit in 2001 [source: Star Tribune 2009].
    • In 2008 he created a 3-day workshop, ‘Adapting Yoga for Disability’, for yoga teachers. It covers adapting categories of poses and individual poses, giving and receiving hands-on adjustments, and running group and one-to-one sessions [source: NCHPAD].
    • At the time that source was written, a certification was being explored; whether one exists now is [uncertain: not verified].
    • Mind Body Solutions offers free online adaptive yoga classes [source: Watkins 2024].
  • Yoga therapy: IAYT describes C-IAYT as a professional certification. Applicants must affirm they have read the IAYT Scope of Practice, which acknowledges the requirements of regulating agencies and the laws in each jurisdiction. It is not a licence [source: IAYT Intro to Scope]. In most jurisdictions yoga teaching is not government-regulated, and none of the credentials above is a licence [uncertain: jurisdiction-specific, not verified].
  • Can a psychotherapist deliver it? Yes, if they also hold yoga-teacher training plus one of the chair or adaptive trainings above. LV training explicitly admits health care professionals, including clinical social workers, though people new to yoga first need class experience [source: LVCYT page]. Without that training, the psychotherapist refers out and works alongside the teacher (see ‘The psychotherapist’s role’ below). A psychotherapist should not provide hands-on assists within psychotherapy unless their own professional code and training allow it (see 4.19).

Physical safety: screening and contraindications

  • Documented risks:
    • The most common yoga injuries are sprains and strains, and they occur more often in adults aged 65 and over [source: NCCIH 2024].
    • Serious adverse events are rare but have been reported in case series [source: a systematic review of published case reports and case series [uncertain: not verified]].
    • ‘Gentle’ or ‘basic’ mat classes can include poses that are challenging or dangerous for many older adults, and getting up from the floor is hard for people with osteoarthritis [source: Van Pelt 2023].
  • Falls safety:
    • Use a stable, armless chair, never a folding chair, and a wall where useful.
    • Wear shoes with tread.
    • Offer a seated version of every standing or balance pose.
    • Keep the lights on during relaxation.
    • [source: Van Pelt 2023]
    • Add: allow time to stand slowly after seated or relaxation work; check for dizziness before standing; keep walking aids within reach; place the chair so a person cannot fall into a hard edge [synthesis].
  • Breath: Breathing practices that involve holding the breath should be avoided in chair yoga for older adults [source: Van Pelt 2023]. Fast or forceful breathing is likewise not used with people who have panic disorder, epilepsy, psychosis or cardiovascular disease without medical advice [synthesis; condition list [uncertain: not verified]].
  • Pregnancy: Avoid poses that require lying on the back for long periods, and avoid hot yoga [source: NCCIH 2024].
  • Conditions commonly flagged for medical advice and pose modification [uncertain: not verified; ask the client’s provider]:
    • osteoporosis, where loaded or end-range spinal flexion and twisting are a concern, and before using weights (Weighted Chair Yoga)
    • glaucoma or retinal disease, with head-below-heart positions
    • uncontrolled high or low blood pressure, and orthostatic hypotension
    • recent surgery or joint replacement
    • hypermobility
    • spinal cord injury, where there is risk of autonomic dysreflexia and skin breakdown from pressure or friction on insensate areas
    • peripheral neuropathy and other reduced sensation
    • cognitive impairment that affects safety judgement
  • Not a treatment for disease: NCCIH advises never using yoga to avoid or postpone seeing a health care provider about a medical problem [source: NCCIH 2024]. Chair or adaptive yoga is not a treatment for cancer, arthritis, multiple sclerosis or any other physical disease. Health claims made by programmes (for example LV’s statements about pranayama and oxygenation, energy or pain) are the programme’s claims [source: LVCYT page], not established findings.

Evidence status and limits

  • Chair-based exercise in older adults: a 2021 systematic review and meta-analysis of 25 studies found improvements in handgrip strength, arm curl and chair-stand performance. It does not separate out chair yoga [source: Klempel et al. 2021].
  • Falls: a 2022 review of 18 trials (3 of them chair yoga) found improved balance and reduced fear of falling. It did not report fall incidence, the studies were small and heterogeneous, and the authors note that safety protocols need further work [source: SciELO 2022 falls review].
  • Specific conditions:
    • one randomised trial in lower-limb osteoarthritis (Park et al. 2017) reported greater pain reduction than health education
    • small studies report benefits in frailty, dementia (online chair yoga) and older adults with previous falls
    • no adverse events from chair yoga were reported in those studies, but most were small and few compared yoga with other exercise
    • [source: Van Pelt 2023, a secondary summary]
  • Mental health: NCCIH summarises some evidence that yoga helps anxiety linked to life situations, weaker evidence for anxiety disorders, and growing evidence for depression [source: NCCIH 2024]. Evidence specific to chair or adaptive yoga for mental health, PTSD or disability adjustment is thin [uncertain: not verified].

The psychotherapist’s role

  • When to suggest it:
    • for older, disabled, chronically ill or deconditioned clients who are isolated, have a fearful or alienated relationship with their body, or are adjusting to illness, injury or ageing
    • for clients who want body-based practice but cannot use a mat class
    • [synthesis]
  • Choosing a teacher:
    • Look for an LVCYT, Accessible Yoga or Mind Body Solutions-trained teacher, or a C-IAYT yoga therapist with experience of the client’s condition.
    • Ask how they screen, how they handle touch and consent, whether every pose has a seated option, and whether they have trauma-informed training.
    • [synthesis drawing on Yoga International article and Van Pelt 2023]
  • Preparing clients:
    • Discuss trauma history, dissociation, body image or eating-disorder concerns, shame about disability or ageing, and any preference about touch.
    • Rehearse saying no and modifying.
    • Agree the client may share relevant information with the teacher.
    • [synthesis]
  • Integrating experiences: Invite the client to report what they noticed in their body, what they chose and what was hard, and link this to therapy goals [synthesis].
  • Recognising and passing on harms:
    • Ask about pain, falls, dizziness, distress, flashbacks, unwanted touch or pressure to perform.
    • Encourage reporting injuries to the medical provider, and boundary violations to the studio, training body or relevant authority.
    • Document.
    • [synthesis]
  • Cultural context: These approaches draw on the Bhagavad Gita, the Upanishads and the Yoga Sutras, and Heyman places yoga ethics (the yamas, especially ahimsa, non-harming) at the centre of teaching [source: Bell 2024]. Discussions of cultural appropriation and of ‘decolonising’ yoga exist in the field; their specific content here is [uncertain: not verified]. Present yoga’s Hindu and wider Indian roots respectfully, and let clients choose whether the spiritual content is included.

3. Guiding principles

  • Everyone has a right to yoga (Accessible Yoga) [source: Bell 2024]. Practical meaning: the class adapts to the person, never the reverse; no one is excluded for age, size, disability or diagnosis.
  • Each individual is a unique and equal expression of universal connectedness (Accessible Yoga, a spiritual framing attributed to the school) [source: Bell 2024]. Practical meaning: no student’s version of a pose is ‘lesser’; avoid ranking variations.
  • Service and compassion are yoga in action (Accessible Yoga) [source: Bell 2024]. Practical meaning: the teacher’s job is to serve the student’s practice, not to display skill.
  • Teaching is collaborative and creative (Accessible Yoga) [source: Bell 2024]. Practical meaning: work out variations with the student; ask what works.
  • Growth needs a supportive community (Accessible Yoga) [source: Bell 2024]. Practical meaning: build belonging; mixed-ability classes practise together.
  • Share power; consent comes first (Accessible Yoga, Part 2 topics ‘power, consent, and language’; teachers quoted by Yoga International) [source: Bell 2024; Yoga International]. Practical meaning: invite rather than command; verbal cues before any touch; touch only with explicit consent that can be withdrawn.
  • Levels of Flexibility (Lakshmi Voelker) [source: LVCYT page]. Practical meaning: every pose has several levels, and a person may use different levels for different body parts and sides.
  • Choose postures and breathing by individual need (LV) [source: Kripalu]. Practical meaning: screen first, then select; drop anything that does not suit this person.
  • Work with integrity within the body you have (Sanford, paraphrased in NCHPAD) [source: NCHPAD]. Practical meaning: the aim is connection and presence, not achieving a shape or ‘overcoming’ disability.
  • Don’t fix the student (Sanford) [source: NCHPAD]. Practical meaning: the teacher, and the therapist, help the person be present with a difficult life rather than trying to change them.
  • Mutual learning (Sanford) [source: NCHPAD]. Practical meaning: treat the disabled student as an expert on their body; explore together.
  • Keep it simple at first (Sanford) [source: NCHPAD]. Practical meaning: begin with alignment-based poses and basic breathing, then build.
  • No fear or anxiety in the session (Sanford) [source: NCHPAD]. Practical meaning: meet vulnerability with understanding; slow down or change course when fear appears.
  • Grief is part of becoming (Sanford: ‘We try to avoid grief and we shouldn’t’) [source: Watkins 2024]. Practical meaning: expect grief about lost function to surface; allow it rather than redirecting to positivity.
  • Stillness and breath can feel unsafe; offer alternatives (Accessible Yoga, Part 3) [source: Bell 2024]. Practical meaning: offer eyes-open, moving or shorter options for relaxation, breath and meditation.
  • Safety by design [source: Van Pelt 2023; NCCIH 2024]. Practical meaning: stable chairs, a seated version of every standing pose, lights on, no breath-holding, medical input where indicated.
  • Spiritual content is the tradition’s, offered by choice [synthesis; LV teaches chakras and yamas and niyamas, source: LVCYT page]. Practical meaning: name chakras and similar concepts as part of the yoga tradition; in clinical settings make them optional.

4. Intervention inventory

The published sources name these practices but do not publish step-by-step teaching scripts. The LV Teacher Development Manual and Heyman’s books contain the detail. Steps below are paraphrased from the cited sources or marked [synthesis]. Postures are described by name and purpose only. No hold times, repetitions, durations or breath-retention timings are given.

4.1 Pre-participation screening and medical clearance

  • Purpose: identify medical, mobility, sensory, cognitive and psychological risks before the first class. Use with every new participant, and again after illness, falls, surgery or medication changes [source: NCCIH 2024; Kripalu].
  • Steps:
    1. Take a brief history: diagnoses, surgeries, pain, falls in the past year, dizziness on standing, vision, sensation, continence and skin issues for wheelchair users, mobility aids, pregnancy, and medications that affect balance or blood pressure [synthesis].
    2. Ask about mental health relevant to practice: panic, trauma, dissociation, psychosis, eating disorder or body-image distress [synthesis].
    3. Where conditions are present, ask the client to talk with their health care provider about which movements to avoid or modify [source: NCCIH 2024].
    4. Record the precautions and agree an individual plan: which forms (seated only, standing with chair support, wheelchair), whether light weights are allowed, and touch preferences [synthesis].
    5. Re-screen at intervals [synthesis].
  • Example language (illustrative): ‘Before we start, I’d like to understand your body as it is today, including anything that makes standing, balance or breathing exercises tricky. Is there anything your doctor or physio has told you to avoid?’
  • Watch for: clients who minimise falls or symptoms to avoid exclusion. Watch too for cognitive impairment that limits self-report; involve a carer, with consent. It is working when the client can name their own precautions and modifications.

4.2 Setting up the space and chair

  • Purpose: prevent falls and make the class accessible [source: Van Pelt 2023].
  • Steps:
    1. Provide sturdy, armless, non-folding chairs; seats without wheels unless the person uses their own wheelchair with brakes on [source: Van Pelt 2023; wheelchair brake detail synthesis].
    2. Place chairs on a non-slip surface, with space around each. Use a wall behind or beside the chair where useful [source: Van Pelt 2023].
    3. Ask people to wear supportive shoes with tread. Mats are not needed for chair-only work [source: Van Pelt 2023].
    4. Keep the lights on for relaxation and meditation. Keep music quiet so instructions are audible [source: Van Pelt 2023].
    5. Check line of sight and hearing. Have a clear exit route, water and a phone available [synthesis].
    6. For Double Chair Yoga, give each student two chairs (see 4.5) [source: LVCYT page].
  • Example language (illustrative): ‘Have a seat towards the front of the chair, feet flat on the floor. If you’d like the wall behind you for extra security, let’s move your chair now.’
  • Watch for: chairs that slide or tip, sliding off the seat edge, and cluttered floors. It is working when no one has to reach or lean unsupported to see or hear.

4.3 Levels of Flexibility and multiple variations

  • Purpose: let each person practise every pose at a level that suits them. Levels can differ between upper and lower body and between the right and left sides. This is the core LV teaching device [source: LVCYT page; Kripalu].
  • Steps:
    1. Demonstrate or describe the pose at several levels, from the smallest movement or imagined movement up to fuller range [source: LVCYT page for levels; imagined-movement option synthesis].
    2. Invite each person to choose a level, and say that mixing levels across body parts is expected [source: LVCYT page].
    3. Present variations as equal, without hierarchy (Accessible Yoga’s equal-expression principle) [source: Bell 2024].
    4. Observe and suggest a different level if you see strain, pain or loss of balance [synthesis].
  • Example language (illustrative): ‘Here are three ways to do this. Choose the one that feels right for your arms today, and maybe a different one for your legs. Each is the whole pose.’
  • Watch for: competitive striving, comparison, or people pushing into pain. It is working when people choose different levels without apology.

4.4 Single Chair Yoga

  • Purpose: the basic LV form. Yoga poses adapted to a single chair for people who find floor yoga difficult because of ‘age, weight, disability, or inflexibility’ [source: Kripalu; LVCYT page].
  • Steps:
    1. Start seated, with feet grounded and the spine lengthened [synthesis of standard setup].
    2. Work through lengthening, strengthening, extending, expanding and balancing movements of the trunk and limbs ‘on every chair’ [source: Kripalu].
    3. Where standing is appropriate, the chair is used as support (hand on the back of the chair) [source: Van Pelt 2023].
    4. Return to sitting between standing sequences [synthesis].
  • Example language (illustrative): ‘Let your feet feel the floor and your sitting bones feel the chair. From here, let’s lengthen up through the crown of the head.’
  • Watch for: slumping, breath holding, neck strain, and dizziness on standing. It is working when movement is comfortable and the person reports more ease or confidence.

4.5 Double Chair Yoga

  • Purpose: an LV form that uses two chairs per student, giving a second surface for support or for extending a limb [source: LVCYT page]. How the second chair is used in each pose is set out in the LV manual [uncertain: not verified].
  • Steps:
    1. Set two stable chairs per person, facing each other or side by side as the pose requires [uncertain: not verified].
    2. Use the second chair for hand or leg support in stretches and standing work [synthesis].
    3. Check that both chairs are stable before any weight is placed on them [synthesis].
  • Example language (illustrative): ‘If it feels right, rest your heel on the second chair. Or keep your foot on the floor; both work.’
  • Watch for: chairs moving under load, and overstretching hamstrings or hips. It is working when the second chair adds support rather than demand.

4.6 Pair Chair Yoga (partner work)

  • Purpose: an LV form practised with a partner [source: LVCYT page]. It offers connection and mutual support. It involves touch or close proximity between participants, so consent rules apply (see 4.19) [synthesis].
  • Steps:
    1. Make partner work optional, and offer a solo version of each partner pose [synthesis].
    2. Have partners agree on contact (hands only, no contact) and on a stop signal before starting [synthesis].
    3. Teach the pose, check comfort in both partners, and close by thanking each other [synthesis].
  • Example language (illustrative): ‘This next one can be done with a partner or on your own. If you pair up, agree with your partner what contact is okay, and either of you can stop at any time.’
  • Watch for: social pressure to partner, freeze responses, and discomfort with touch, especially with trauma histories. It is working when people opt in or out freely.

4.7 Weighted Chair Yoga

  • Purpose: an LV form using light weights in chair poses, which the programme presents as building muscle and bone [source: Kripalu; LVCYT page]. This is the programme’s claim; the evidence for chair-based exercise and strength is in Section 2.
  • Steps:
    1. Use only with medical clearance where there is osteoporosis, a cardiac condition, joint replacement or uncontrolled blood pressure [synthesis].
    2. Teach the pose without weights first [synthesis].
    3. Let the person choose whether to add a light weight and which one. This guide gives no load prescriptions.
    4. Keep the breath flowing [source: Van Pelt 2023, no breath-holding].
  • Example language (illustrative): ‘If you’ve been cleared to use weights, you can pick some up for this. If not, the movement on its own is the full practice.’
  • Watch for: grip pain in arthritic hands, breath holding, and jerky movement. It is working when movement stays smooth and pain-free.

4.8 Wheelchair Yoga

  • Purpose: an LV form, and part of Accessible Yoga’s three model students (mat, chair, wheelchair), for practitioners who stay in their wheelchair [source: LVCYT page; Bell 2024].
  • Steps:
    1. Brakes on; footplates positioned as the user prefers; ask the user how they like to be positioned. Transfers only if the person and their carers routinely do them and the teacher is trained [synthesis].
    2. Adapt poses to the trunk and upper body, and to whatever lower-body movement or awareness is available, using Levels of Flexibility [source: LVCYT page].
    3. Do not push or move the wheelchair, or the person’s limbs, without consent [synthesis].
    4. For spinal cord injury, watch skin and pressure areas and ask about autonomic dysreflexia symptoms. Stop and follow the person’s own protocol if they occur [synthesis; [uncertain: not verified]].
  • Example language (illustrative): ‘You know your body and your chair best. Show me how you like to set up, and tell me if anything I suggest doesn’t fit.’
  • Watch for: tipping when leaning, pressure injuries, and fatigue. It is working when the person directs their own adaptations.

4.9 Chair salutations: Sun, Moon and Earth

  • Purpose: flowing sequences adapted to the chair that link breath and movement through the whole body. They are named in the LV curriculum [source: LVCYT page]. The exact LV sequence of each salutation is in the LV manual [uncertain: not verified].
  • Steps:
    1. Teach the component movements separately first: arms overhead, forward fold supported on the thighs, alternate knee lifts or a single knee drawn towards the chest, gentle backbend at the chair back [synthesis description].
    2. Link them with natural breath. Never hold the breath [source: Van Pelt 2023].
    3. Offer smaller ranges (Levels of Flexibility), and keep forward folds shallow for people with osteoporosis or glaucoma [synthesis; [uncertain: not verified]].
  • Example language (illustrative): ‘As you breathe in, arms float up if they’d like to. As you breathe out, they come down. Move at your own pace, not mine.’
  • Watch for: dizziness on coming up from a fold, and shoulder pain. It is working when breath and movement feel coordinated and unhurried.

4.10 Warrior Sequence (seated or standing with chair support)

  • Purpose: strength, stability and a sense of steadiness and resolve. It is named in the LV curriculum [source: LVCYT page]. The specific LV warrior variations are not verified [uncertain: not verified].
  • Steps:
    1. Seated version: sit sideways or towards the front of the chair, extend one leg back or to the side as able, and keep the trunk upright, arms active [synthesis description].
    2. Standing version: one hand on the chair back, feet in a stance the person can control [source: Van Pelt 2023 for standing with chair support].
    3. Return to sitting before switching sides if there is fatigue [synthesis].
  • Example language (illustrative): ‘Notice the strength in your legs and your arms. You can stay seated and feel the same steadiness here.’
  • Watch for: knee pain, loss of balance, and breath holding. It is working when people report feeling strong or steady.

4.11 Balance Sequence with chair support (falls safety)

  • Purpose: balance training and confidence. It is named in the LV curriculum [source: LVCYT page]. Reviews describe improved balance and reduced fear of falling with yoga, including chair yoga, but no proven reduction in falls [source: SciELO 2022 falls review; Van Pelt 2023].
  • Steps:
    1. Always offer a seated balance option, such as lifting one foot slightly, or reaching while seated [source: Van Pelt 2023 for seated alternatives; example synthesis].
    2. Standing: both hands on the chair back first, then one hand, then fingertips, only as the person chooses. Keep the chair in front, and the wall nearby [synthesis].
    3. Keep eyes open. Look at a fixed point [synthesis].
    4. Do balance work after warm-up, not at the end when people are tired [synthesis].
  • Example language (illustrative): ‘Keep the chair right in front of you. Your hands can stay on it the whole time. That is still balance practice.’
  • Watch for: sway, grabbing, fear, and people with a recent fall or dizziness. Use seated work only for those people until medically reviewed. It is working when there is less fear of falling and more confidence moving from sitting to standing.

4.12 Pa Tuan Chin and Chinese arthritis relief hand movements

  • Purpose: the LV curriculum includes Pa Tuan Chin (Ba Duan Jin, the ‘Eight Brocades’, a traditional Chinese qigong set) and Chinese Arthritis Relief Hand Movements [source: LVCYT page]. These come from Chinese health-exercise traditions, and their qi concepts belong to those traditions. The LV adaptations are in the LV manual [uncertain: not verified].
  • Steps:
    1. Introduce the practice and name its origin [synthesis].
    2. Teach gentle, rhythmic arm, trunk and hand movements seated, matched to breath [synthesis].
    3. For hands, use gentle opening, closing and finger movements within a pain-free range [synthesis].
  • Example language (illustrative): ‘These next movements come from Chinese qigong. Let your hands open and close softly, staying within what’s comfortable for your joints.’
  • Watch for: joint flare-ups in inflammatory arthritis. Avoid presenting the practice as a cure. It is working when hand use feels easier and the person enjoys it.

4.13 Self-applied acupressure, Do-In self-massage and foot reflexology

  • Purpose: the LV curriculum includes acupressure knee-strengthening exercises, Do-In self-massage and foot reflexology [source: LVCYT page]. These are self-touch practices from East Asian traditions and from reflexology. Their meridian and reflex-zone concepts belong to those traditions; they are not established anatomy. They are not treatments for disease.
  • Steps:
    1. Offer the practice as optional [synthesis].
    2. Demonstrate self-applied gentle pressure or tapping on one’s own knees, legs, hands or feet, with the person controlling pressure throughout [synthesis description].
    3. Use a seated position that does not require bending to the floor. Bring the foot up onto the opposite knee only if the hips allow, or skip foot work [synthesis].
    4. Avoid areas with wounds, varicose veins, neuropathic insensitivity or recent surgery [synthesis].
  • Example language (illustrative): ‘If you’d like, use your own hands to give your knees some gentle pressure. You decide how firm. Skip this if touching your legs isn’t comfortable today.’
  • Watch for: distress with self-touch (trauma, body image), falls from reaching for the feet, and skin damage in diabetes or neuropathy. It is working when it is experienced as soothing and freely chosen.

4.14 Breathing practices (adapted pranayama)

  • Purpose: breath awareness and calming. The LV curriculum includes pranayama, and Accessible Yoga teaches adapted pranayama [source: LVCYT page; Yogaville listing]. Prana is a concept of the yoga tradition. Claims that LV pranayama improves oxygenation, energy, pain and anxiety are the programme’s own [source: LVCYT page].
  • Steps:
    1. Begin with simply noticing the natural breath [synthesis].
    2. Then, optionally, gently lengthen the out-breath, or move the arms with the breath [synthesis].
    3. Avoid breath-holding practices [source: Van Pelt 2023]. Avoid fast, forceful breathing for people with panic, epilepsy, psychosis, cardiovascular disease, pregnancy or uncontrolled blood pressure unless a medical provider agrees [synthesis; condition list [uncertain: not verified]].
    4. Always offer an alternative to breath focus, such as feeling the feet or looking around the room. Heyman notes that breath work can feel unsafe or triggering for some students [source: Bell 2024].
  • Example language (illustrative): ‘Just notice your breath as it is. There’s nothing to change. If paying attention to breathing feels uncomfortable, you could notice your feet on the floor instead.’
  • Watch for: light-headedness, tingling, rising panic, and air hunger in respiratory disease. It is working when the person reports feeling steadier and can choose their focus.

4.15 Meditation and relaxation (including adapted shavasana)

  • Purpose: rest, integration and calming. This is part of every LV and Accessible Yoga class [source: Kripalu; Bell 2024].
  • Steps:
    1. Relax seated in the chair or wheelchair, supported (a cushion behind the back, feet supported). Lying on the floor is not necessary [source: Van Pelt 2023 on no floor work; seated setup synthesis].
    2. Keep the lights on [source: Van Pelt 2023].
    3. Offer eyes open or closed, stillness or gentle movement, and silence or guidance [source: Bell 2024, alternatives to stillness; specific options synthesis].
    4. Bring people back gradually, then have them sit upright and pause before standing [synthesis, falls safety].
  • Example language (illustrative): ‘You can close your eyes or keep them resting on a spot on the floor. If stillness doesn’t feel good, keep moving your hands gently. You’re in charge of this time.’
  • Watch for:
    • dissociation (glazed eyes, no response to voice)
    • flashbacks or intrusive memories
    • falling asleep and slumping out of the chair
    • orthostatic dizziness on rising
    • It is working when the person comes back oriented and reports rest.

4.16 Yoga philosophy content: yamas, niyamas and chakras

  • Purpose: the LV curriculum teaches the 5 Yamas and 5 Niyamas and the 7 Chakras (meanings, colours, sounds, affirmations) [source: LVCYT page]. Accessible Yoga centres ethics, especially ahimsa (non-harming), drawing on the Bhagavad Gita, Upanishads and Yoga Sutras [source: Bell 2024]. These are teachings of the yoga tradition. Chakras are a traditional energetic map, not anatomical structures.
  • Steps:
    1. In a clinical or secular setting, ask whether the group wants this content [synthesis].
    2. Present it as ‘in the yoga tradition…’ [synthesis].
    3. Link ethics such as ahimsa to how participants treat their own bodies, for example not forcing a pose [synthesis].
    4. Do not proceduralise devotional or initiatory practices [synthesis].
  • Example language (illustrative): ‘Yoga tradition talks about ahimsa, non-harming. Today we’ll practise it by not forcing anything.’
  • Watch for: religious discomfort or conflict, and clients reading chakra teaching as medical explanation. It is working when the content supports self-kindness without coercion.

4.17 Integrated (mixed-ability) classes

  • Purpose: Accessible Yoga’s model in which students on a mat, in a chair and in a wheelchair practise together, with poses adapted for each [source: Bell 2024; Yogaville listing].
  • Steps:
    1. Plan each pose in at least three versions: mat, chair, and wheelchair or bed [source: Bell 2024].
    2. Cue the shared intention of the pose, such as lengthening the spine or opening the chest, rather than one shape, so that each version is the pose [synthesis consistent with Heyman’s aim of personalising practice].
    3. Teach from a chair at times so that chair practice is visibly valued [synthesis].
    4. Build community through check-ins and shared time [source: Bell 2024, community principle; method synthesis].
  • Example language (illustrative): ‘In this pose we’re all opening the front of the chest. On the mat, in a chair or in your wheelchair, find that opening in your own way.’
  • Watch for: chair users feeling like an afterthought, and the teacher’s attention going mostly to mat students. It is working when everyone feels the class is theirs.

4.18 Choice-making and invitational language

  • Purpose: agency and safety. Accessible Yoga addresses power, consent and language in teaching [source: Bell 2024]. Teachers interviewed by Yoga International favour sharing power with students rather than having power over them [source: Yoga International].
  • Steps:
    1. Use invitations (‘you might’, ‘if you like’) rather than commands [synthesis].
    2. Offer at least two options plus the option to rest or skip [synthesis].
    3. Use inquiry (‘notice’, ‘what do you feel’) rather than telling people what they feel [synthesis].
    4. Avoid language about ‘full’ versus ‘modified’ poses, ‘good’ bodies, weight loss or fixing [synthesis consistent with Bell 2024 and NCHPAD].
    5. Explicitly normalise stopping [synthesis].
  • Example language (illustrative): ‘You might lift your arm, or simply imagine lifting it, or rest. All of these count.’
  • Watch for: people waiting for permission, and over-compliance. Choice language can also confuse some people with cognitive impairment; then offer one clear option plus ‘or rest’ [synthesis]. It is working when people make visible choices.

4.19 Consent for touch and hands-on assistance

  • Purpose: physical help or adjustment only with explicit, ongoing consent; never sexual. Some studios use ‘Yes’ or ‘No’ consent cards so students can signal whether they accept touch, and teachers interviewed prefer verbal cues, using touch only if those fail [source: Yoga International]. The Mind Body Solutions training teaches giving and receiving hands-on adjustments as a skill [source: NCHPAD]. In disability settings, touch may also mean physical support or help with positioning.
  • Steps:
    1. Default to no touch. Use verbal and visual cues first [source: Yoga International].
    2. Agree touch preferences at intake and offer a consent card, token or signal in class [source: Yoga International; token or signal synthesis].
    3. Ask before each touch, say where and why, and touch only that area [synthesis consistent with USABP consent standards].
    4. Check during the touch. Remind the person they can stop at any moment, and stop immediately if asked or if there are signs of distress [source: USABP code on the right to refuse or end touch].
    5. Never touch genital, breast or other intimate areas. Never use sexual touch. Never touch for the teacher’s own needs [source: USABP code].
    6. Do not move paralysed or insensate limbs without consent and training, because the person cannot feel overstretch [synthesis].
    7. A psychotherapist who is also a teacher: mainstream therapy codes (for example the APA Ethics Code, BACP, UKCP) contain no explicit touch provision but prohibit sexual contact and require working within competence. Body-psychotherapy codes (USABP, EABP) regulate touch directly. Do not add hands-on assists to psychotherapy unless your professional code and training allow it; otherwise use verbal cues only, or refer to a teacher [source: touch-code summary of APA, BACP, UKCP, USABP, EABP].
  • Example language (illustrative): ‘Would it be helpful if I placed a hand on your shoulder blade to show where to lift from? You can say no, and you can tell me to stop at any time.’
  • Watch for: freezing, a polite yes that does not match the body, flinching, and holding the breath. Treat these as a no. It is working when people decline or accept freely and touch is rare and purposeful.

4.20 Adaptive yoga for disability (Sanford and Mind Body Solutions)

  • Purpose: yoga for people with paralysis and other disabilities, aimed at the mind–body connection. Sanford describes yoga as helping him ‘re-inhabit’ his body after doctors advised him to ‘forget’ his lower body [source: Watkins 2024; Star Tribune 2009].
  • Steps:
    1. Explore the student’s experience and look for common ground with your own practice; the training asks teachers to start from their own practice [source: NCHPAD].
    2. Begin simply, with alignment-based poses and basic breathing [source: NCHPAD].
    3. Adapt whole categories of poses (for example standing poses) and individual poses to the student’s body, using props, walls, chairs and trained assistance [source: NCHPAD; props and wall synthesis].
    4. Work in groups or one-to-one [source: NCHPAD].
    5. Use hands-on adjustment only with training and consent (see 4.19) [source: NCHPAD].
    6. Invite attention to sensation or awareness in all parts of the body, including areas with little or no feeling, without demanding that the person feel anything [synthesis; Sanford’s specific methods [uncertain: not verified]].
    7. Keep fear and anxiety out of the session, and meet vulnerability with understanding [source: NCHPAD].
  • Example language (illustrative): ‘We’re not trying to fix anything. Let’s see what’s here today. As we lift the arms, see if you notice anything at all, even faintly, in the legs. Nothing at all is fine too.’
  • Watch for:
    • grief, which Sanford treats as part of ‘becoming’ and which may surface strongly [source: Watkins 2024]
    • pressure on insensate skin
    • autonomic dysreflexia in spinal cord injury [uncertain: not verified]
    • fatigue in progressive conditions
    • It is working when the person describes feeling more connected to, or less at war with, their body.

4.21 Wall, floor and bed variations

  • Purpose: Accessible Yoga’s entry points beyond the chair: standing at a wall, on the floor, or lying in bed, for people who are bed-bound, hospitalised or need more support [source: Penguin Random House book page; Yogaville listing].
  • Steps:
    1. In bed, adapt to gentle limb movements, breath awareness and relaxation, with the bed and rails secured [synthesis].
    2. At a wall, use the wall for balance and for feedback on alignment [synthesis].
    3. Floor work only if the person can get down and up safely, or with trained assistance [source: Van Pelt 2023 on floor transfers; synthesis].
  • Example language (illustrative): ‘Right here in bed, see if you can gently spread your fingers wide, then let them soften.’
  • Watch for: medical lines and drains, pressure areas, and fatigue. In hospital settings, get clinical team agreement first [synthesis]. It is working when the person engages without strain.

4.22 Online or remote chair yoga

  • Purpose: reach housebound people. Small studies used remotely led online chair yoga with people with dementia and their caregivers [source: Van Pelt 2023], and Mind Body Solutions offers free online adaptive classes [source: Watkins 2024].
  • Steps:
    1. Screen as in 4.1 [synthesis].
    2. Check the home setup by video: chair, floor, lighting, camera angle [synthesis].
    3. Have a caregiver present where cognition or mobility is impaired [synthesis].
    4. Agree an emergency plan, including address and contact [synthesis].
    5. Use seated-only versions where the teacher cannot see the whole body [synthesis].
  • Example language (illustrative): ‘Before we start, could you show me your chair and the space around it? And who should I call if you needed help?’
  • Watch for: falls out of view, and technical frustration. It is working when the person attends and practises safely.

4.23 Integrating chair and adaptive yoga into psychotherapy

  • Purpose: use the experience in therapy [synthesis throughout this item].
  • Steps:
    1. Agree goals with the client (for example connection with the body, social contact, coping with illness or ageing).
    2. Before they start, explore expectations, fears and body-related shame.
    3. After classes, invite reflection on what they noticed in their body, what choices they made, what was hard, and what emotions came up, including grief.
    4. Link this to therapy themes such as self-compassion, autonomy and acceptance of a changed body.
    5. If the therapist is also the trained teacher, keep roles clear. Decide in advance whether yoga happens inside or outside sessions, and document consent.
  • Example language (illustrative): ‘What did you notice in your body during class this week? Was there a moment you chose to do something differently?’
  • Watch for:
    • performance pressure transferred into therapy
    • self-criticism about ability
    • avoidance of class
    • emergence of trauma material
    • It is working when body experience becomes usable material in therapy and the client’s relationship with their body softens.

5. Handling problems

The published sources give little problem-handling guidance. Most of what follows is [synthesis] unless a source is tagged.

  • Fear of falling or refusal to stand:
    • Keep the person seated. Seated work is the full practice, and every standing pose has a seated alternative [source: Van Pelt 2023].
    • Explore the fear in therapy, including previous falls.
    • Build gradually: standing with both hands on the chair, near a wall, only when the person chooses [synthesis].
  • A fall, near-fall or dizziness in class:
    • Stop the class for that person. Do not lift them unless trained.
    • Follow the venue’s first-aid procedure, and inform the person’s carer or health provider.
    • Re-screen before they return (4.1).
    • The therapist explores the shock, and any loss of confidence, afterwards [synthesis].
  • Pain or injury after class:
    • Advise them to see their health care provider [source: NCCIH 2024].
    • Review which pose and level was involved. Reduce range or switch to seated work.
    • Report it to the teacher.
    • Sprains and strains are the most common yoga injuries, and they are more frequent over 65 [source: NCCIH 2024].
  • Overwhelm, panic, dissociation or flashbacks:
    • Stop breath or stillness practices.
    • Switch to orienting: eyes open, look around the room, feel the feet and the chair, move the hands [synthesis consistent with Bell 2024 on alternatives to stillness and breath].
    • Offer a choice to step out with support.
    • Afterwards, review triggers (for example closed eyes, a particular pose, a voice, touch) and adapt.
    • Persistent dissociation or trauma responses call for trauma-focused therapy alongside the yoga, or before it [synthesis].
  • Grief about lost function: Expect it, especially in acquired disability and ageing. Sanford frames grief as ‘how we become’ [source: Watkins 2024]. Give space in therapy rather than reassurance, and screen for depression and suicidality per standard practice [synthesis].
  • Shame, comparison and body-image distress:
    • Name that variations are equal [source: Bell 2024].
    • Avoid weight, appearance or ‘fixing’ language.
    • For eating-disorder histories, choose teachers who do not frame yoga as weight control, and monitor for compulsive exercise.
    • [synthesis]
  • Unwanted touch or a boundary violation:
    • Validate the client’s experience.
    • Help them decide on action: tell the teacher, studio or training body, or the relevant authority if criminal. Document.
    • Support the client to stop attending if they wish.
    • Never minimise. Sexual touch is never acceptable [source: USABP code].
    • Abuse by teachers in some yoga communities has been reported; the details are [uncertain: not verified].
  • Non-adherence or dropping out:
    • Explore barriers: transport, cost, pain, fatigue, embarrassment, inaccessible venues.
    • Consider online classes, including free Mind Body Solutions online classes [source: Watkins 2024], or practising with a carer.
    • Avoid turning yoga into a compliance issue.
    • [synthesis]
  • The client stuck or ‘not feeling anything’:
    • Reframe: the aim is presence and connection, not a particular sensation [source: NCHPAD, Sanford’s ‘not fixing’].
    • Try a different level, form or teacher.
    • [synthesis]
  • Perfectionism or over-effort: Encourage a smaller range. Link to the ahimsa (non-harming) teaching if the client values it [source: Bell 2024]. Explore the striving in therapy [synthesis].
  • Religious or cultural discomfort: Offer a secular framing that omits chanting, chakras and philosophy, or a teacher who works that way. For clients from yoga’s home traditions, respect their own understanding [synthesis].
  • Cognitive impairment or dementia:
    • Simplify choices, use demonstration and repetition, and involve carers.
    • Keep sessions familiar.
    • Small studies used remotely led chair yoga with people with dementia and caregivers [source: Van Pelt 2023].
  • Rupture between client and teacher, or therapist and teacher:
    • Clarify roles. With consent, share relevant information (precautions, trauma considerations) without over-disclosing.
    • If the teacher dismisses safety concerns, help the client find another teacher.
    • [synthesis]
  • Therapist-as-teacher dual role:
    • Discuss in supervision. Keep clear boundaries between yoga sessions and therapy sessions.
    • Avoid touch unless your code and training permit it.
    • Under EABP guidance, when a client receives similar services from another professional, consider the implications and discuss them with the client [source: touch-code summary, EABP 2020].
    • [synthesis otherwise]
  • Medical deterioration: New chest pain, breathlessness, neurological symptoms, autonomic dysreflexia signs or severe pain mean stop and seek medical help. Yoga is never a substitute for medical care [source: NCCIH 2024; symptom list synthesis].

Sources

Web sources:

Professional codes (touch, sexual contact, competence, referral):

Books cited:

  • Heyman, J. (2019). Accessible Yoga: Poses and Practices for Every Body. Shambhala.
  • Heyman, J. (around 2024 [uncertain: not verified]). A Teacher’s Guide to Accessible Yoga: Best Practices for Sharing Yoga with Every Body. Publisher [uncertain: not verified].
  • Voelker, L. Get Fit Where You Sit: A Guide to the Lakshmi Voelker Chair Yoga Method (year and publisher [uncertain: not verified]).
  • Sanford, M. (2006). Waking: A Memoir of Trauma and Transcendence. Rodale (paperback 2008).
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