The Effectiveness of Combined Hatha Yoga and Tandem Walking Exercise on Sleep Quality: A Preliminary Study

Nikmatur Rosidah; Annisa Salsabila Budi Ningrum; Bayu Prastowo; Nungki Marlian Yuliadarwati; Ananda Viona Ameylia; Anup Acharya; Fahmi Rizal; Dwi Agung Prasetyo

doi:10.56741/IISTR.jphs.002183

Authors

Nikmatur Rosidah
nikmaturrosidah@umm.ac.id
University of Muhammadiyah Malang https://orcid.org/0000-0001-8519-4972
Annisa Salsabila Budi Ningrum University of Muhammadiyah Malang
Bayu Prastowo Physiotherapy Department https://orcid.org/0000-0002-6249-3299
Nungki Marlian Yuliadarwati University of Muhammadiyah Malang https://orcid.org/0000-0002-5830-3915
Ananda Viona Ameylia University of Muhammadiyah Malang
Anup Acharya Gurkha Welfare Trust https://orcid.org/0009-0008-3900-9009
Fahmi Rizal University of Muhammadiyah Pekajangan Pekalongan
Dwi Agung Prasetyo Institute of Science and Health Technology Dr. Soepraoen Hospital Malang https://orcid.org/0009-0002-1559-1141

Keywords:

Aged, Exercise, Hatha Yoga, Sleep Quality, Tandem Walking

Abstract

To improve sleep quality, the use of a combination of relaxation techniques and physical fitness training has been suggested. This study aimed to assess the impact of a combined Hatha Yoga and Tandem Walking program on improving the quality of sleep in older adults in Malang, Indonesia. A one-group pre-post experimental design was used in this study. A total of 30 elderly participants participated and received a combination of Hatha yoga and tandem walking exercise for 30–45 minutes, for a total of 12 sessions. Pittsburgh sleep quality index used to measure the quality of sleep of the participants. Wilcoxon signed-rank test used for data analysis, and statistically significant set at 0.05. This study resulted in a substantial enhancement in sleep quality after 6 weeks of combined Hatha Yoga and Tandem Walking exercise, with the mean PSQI score decreasing from 9.32 ± 1.70 to 4.24 ± 0.75 and 81% of the participants experiencing good sleep quality (p = 0.001) after the intervention. The combination of Hatha Yoga and Tandem Walking is an effective and safe non-pharmacological intervention to improve sleep quality in older adults and support healthy aging. For optimal results, this intervention can be practiced regularly and incorporated into a program for senior communities.

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Author Biographies

Nikmatur Rosidah, University of Muhammadiyah Malang

is a lecturer in Physiotherapy at the University of Muhammadiyah Malang with an MSc in Physical Therapy from Mahidol University, Thailand. Work integrates teaching, research, and clinical practice, focusing on geriatric and musculoskeletal physiotherapy, particularly fall prevention, knee osteoarthritis, balance training, and promoting physical activity to enhance quality of life. Committed to integrating evidence-based practice with meaningful community impact to support healthier aging and stronger communities. (email: nikmaturrosidah@umm.ac.id).

Annisa Salsabila Budi Ningrum, University of Muhammadiyah Malang

is a graduate of the Bachelor of Physiotherapy program who is currently pursuing her professional physiotherapy education. She has a strong interest in geriatric care, particularly in improving the quality of life of the elderly. Passionate about continuous learning, she actively engages in volunteer work within elderly communities, gaining hands-on experience and contributing to their well-being. (email: annisalsabila101@gmail.com).

Bayu Prastowo, Physiotherapy Department

is a lecturer in the Physiotherapy Department at the Universitas Muhammadiyah Malang. He specializes in musculoskeletal physiotherapy, with research interests covering areas such as pain and injury, manual therapy, and physical rehabilitation. In addition to his academic and research roles, he is actively involved in promoting innovative and creative learning approaches, encouraging students to develop critical thinking and practical problem-solving skills in physiotherapy (email: bayuprastowo@umm.ac.id).

Nungki Marlian Yuliadarwati, University of Muhammadiyah Malang

is a lecturer in the Physiotherapy Department at the University of Muhammadiyah Malang, with expertise in elderly physiotherapy and community-based health services. Her work focuses on promoting healthy aging, improving functional independence among older adults, and enhancing community wellbeing through physiotherapy education, prevention programs, and rehabilitation initiatives. She is actively involved in academic development, research, and community engagement to support evidence-based physiotherapy for diverse populations (email: nungki@umm.ac.id).

Ananda Viona Ameylia, University of Muhammadiyah Malang

is a Bachelor of Physiotherapy graduate who is currently continuing her studies in the professional physiotherapy program. She is an enthusiastic learner with a particular interest in physical activity, balance, and fall prevention in the elderly. Her focus reflects a commitment to supporting healthy aging and improving functional independence among older adults. (email: vionaameylia@gmail.com).

Anup Acharya, Gurkha Welfare Trust

is a master’s graduate and a physiotherapist currently working with the Gurkha Trust in Nepal. He specializes in geriatrics and community-based physiotherapy, with a strong focus on improving healthcare access and quality of life for older adults. Actively engaged in professional development, he contributes to research and regularly attends conferences related to physiotherapy and community-based geriatric care. (email: aanupacharya@gmail.com).

Fahmi Rizal, University of Muhammadiyah Pekajangan Pekalongan

is a lecturer in the Physiotherapy Department at University of Muhammadiyah Pekajangan Pekalongan, Indonesia. His expertise lies in public health, with a focus on healthcare service quality and patient satisfaction, particularly in hospital and medical service settings. (email: fahmirizal.physio@gmail.com )

Dwi Agung Prasetyo, Institute of Science and Health Technology Dr. Soepraoen Hospital Malang

is a lecturer in physiotherapy at Institut Teknologi Sains dan Kesehatan RS dr. Soepraoen, Malang, Indonesia. His research broadly focuses on rehabilitation science and physiotherapy, particularly in the management of osteoarthritis, exercise-based interventions, and the role of inflammation and pain modulation in musculoskeletal disorders. (email: dwi-agung-prasetyo@itsk-soepraoen.ac.id).

References

R. Sakamoto, “Aging in Southeast Asia and Japan: Challenges and opportunities,” Geriatr. Gerontol. Int., vol. 25, no. 7, pp. 837–854, Jul. 2025, doi: 10.1111/ggi.70062. DOI: https://doi.org/10.1111/ggi.70062

M. Casagrande, G. Forte, F. Favieri, and I. Corbo, “Sleep Quality and Aging: A Systematic Review on Healthy Older People, Mild Cognitive Impairment and Alzheimer’s Disease,” Int. J. Environ. Res. Public Health, vol. 19, no. 14, Jul. 2022, doi: 10.3390/ijerph19148457.

R. G. Foster, “Introduction and reflections on the comparative physiology of sleep and circadian rhythms,” J. Comp. Physiol. B, vol. 194, no. 3, pp. 225–231, Jun. 2024, doi: 10.1007/s00360-024-01567-z. DOI: https://doi.org/10.1007/s00360-024-01567-z

A. K. Patel, V. Reddy, K. R. Shumway, and J. F. Araujo, “Physiology, Sleep Stages,” StatPearls, Jan. 2024, Accessed: Mar. 23, 2026. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK526132/

T. van Hattem et al., “Targeting Sleep Physiology to Modulate Glymphatic Brain Clearance,” Physiology (Bethesda), vol. 40, no. 3, pp. 271–290, May 2025, doi: 10.1152/physiol.00019.2024. DOI: https://doi.org/10.1152/physiol.00019.2024

N. Baranwal, P. K. Yu, and N. S. Siegel, “Sleep physiology, pathophysiology, and sleep hygiene,” Prog. Cardiovasc. Dis., vol. 77, pp. 59–69, Mar. 2023, doi: 10.1016/j.pcad.2023.02.005. DOI: https://doi.org/10.1016/j.pcad.2023.02.005

J. P. Chaput et al., “The role of insufficient sleep and circadian misalignment in obesity,” Nat. Rev. Endocrinol., vol. 19, no. 2, pp. 82–97, Feb. 2023, doi: 10.1038/s41574-022-00747-7. DOI: https://doi.org/10.1038/s41574-022-00747-7

J. Zitser et al., “Pittsburgh Sleep Quality Index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults,” PLoS One, vol. 17, no. 6, Jun. 2022, doi: 10.1371/journal.pone.0270095. DOI: https://doi.org/10.1371/journal.pone.0270095

K. Dwitya Widi Adnyani, L. Gede Pradnyawati, and A. Eka Pratiwi, “Hubungan antara Kebiasaan Latihan Yoga terhadap Kualitas Tidur pada Komunitas Lansia Widya Werda Sentana Santi,” Aesculapius Medical Journal |, vol. 3, no. 1, Feb. 2023, doi: 10.22225/amj.3.1.2023.56-65. [Eng Trans: The relationship between Yoga exercise and Sleep Quality in the Widya Werda Sentana Santi Elderly Community] DOI: https://doi.org/10.22225/amj.3.1.2023.56-65

R. Ding, X.-Y. Liu, Y. Ding, M.-M. Leng, L.-J. Yang, and A.-H. Zhang, “Correlation analysis between sleep quality and depressive symptoms among rural elderly in China: An observational study,” World J. Psychiatry, vol. 15, no. 12, p. 112672, Dec. 2025, doi: 10.5498/wjp.v15.i12.112672. DOI: https://doi.org/10.5498/wjp.v15.i12.112672

J. He, S. H. W. Chan, R. C. K. Chung, and H. W. H. Tsang, “Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial,” J. Psychiatr. Res., vol. 180, pp. 281–290, Dec. 2024, doi: 10.1016/j.jpsychires.2024.10.025. DOI: https://doi.org/10.1016/j.jpsychires.2024.10.025

Z. Liu et al., “Repetitive Transcranial Magnetic Stimulation and Tai Chi Chuan for Older Adults With Sleep Disorders and Mild Cognitive Impairment: A Randomized Clinical Trial,” JAMA Netw. Open, vol. 8, no. 1, Jan. 2025, doi: 10.1001/jamanetworkopen.2024.54307. DOI: https://doi.org/10.1001/jamanetworkopen.2024.54307

A. J. Huang, H. E. Jenny, M. A. Chesney, M. Schembri, and L. L. Subak, “A group-based yoga therapy intervention for urinary incontinence in women: A pilot randomized trial,” Female Pelvic Med. Reconstr. Surg., vol. 20, no. 3, pp. 147–154, 2014, doi: 10.1097/SPV.0000000000000072. DOI: https://doi.org/10.1097/SPV.0000000000000072

H. Tankha et al., “Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial,” JAMA Netw. Open, vol. 7, no. 11, p. e2442339, Nov. 2024, doi: 10.1001/jamanetworkopen.2024.42339. DOI: https://doi.org/10.1001/jamanetworkopen.2024.42339

A. Chatutain, J. Pattana, T. Parinsarum, and S. Lapanantasin, “Walking meditation promotes ankle proprioception and balance performance among elderly women,” J. Bodyw. Mov. Ther., vol. 23, no. 3, pp. 652–657, Jul. 2019, doi: 10.1016/j.jbmt.2018.09.152. DOI: https://doi.org/10.1016/j.jbmt.2018.09.152

H. S. Cohen, H. Sangi-Haghpeykar, and S. P. Williams, “Prediction of Functional Limitations in Balance after Tests of Tandem Walking and Standing Balance in Older Adults,” South. Med. J., vol. 113, no. 9, pp. 423–426, Sep. 2020, doi: 10.14423/SMJ.0000000000001138. DOI: https://doi.org/10.14423/SMJ.0000000000001138

M. Casagrande, G. Forte, F. Favieri, and I. Corbo, “Sleep Quality and Aging: A Systematic Review on Healthy Older People, Mild Cognitive Impairment and Alzheimer’s Disease,” Int. J. Environ. Res. Public Health, vol. 19, no. 14, Jul. 2022, doi: 10.3390/ijerph19148457. DOI: https://doi.org/10.3390/ijerph19148457

C. Di Lorito et al., “Exercise interventions for older adults: A systematic review of meta-analyses,” J. Sport Health Sci., vol. 10, no. 1, pp. 29–47, Jan. 2021, doi: 10.1016/j.jshs.2020.06.003. DOI: https://doi.org/10.1016/j.jshs.2020.06.003

J. Guo et al., “Aging and aging-related diseases: from molecular mechanisms to interventions and treatments,” Signal Transduct. Target. Ther., vol. 7, no. 1, Dec. 2022, doi: 10.1038/s41392-022-01251-0. DOI: https://doi.org/10.1038/s41392-022-01251-0

V. Gianfredi, D. Nucci, F. Pennisi, S. Maggi, N. Veronese, and P. Soysal, “Aging, longevity, and healthy aging: the public health approach,” Aging Clin. Exp. Res., vol. 37, no. 1, Dec. 2025, doi: 10.1007/s40520-025-03021-8. DOI: https://doi.org/10.1007/s40520-025-03021-8

E. M. Crimmins, H. Shim, Y. S. Zhang, and J. K. Kim, “Differences between Men and Women in Mortality and the Health Dimensions of the Morbidity Process,” Clin. Chem., vol. 65, no. 1, pp. 135–145, Jan. 2019, doi: 10.1373/clinchem.2018.288332. DOI: https://doi.org/10.1373/clinchem.2018.288332

S. Jehan et al., “Sleep Disorders in Postmenopausal Women,” J. Sleep Disord. Ther., vol. 4, no. 5, p. 212, 2015, Accessed: Mar. 23, 2026. [Online]. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC4621258/

S. Jehan et al., “Sleep, Melatonin, and the Menopausal Transition: What Are the Links?,” Sleep Sci., vol. 10, no. 1, pp. 11–18, 2017, doi: 10.5935/1984-0063.20170003. DOI: https://doi.org/10.5935/1984-0063.20170003

A. E. Thompson, Y. Anisimowicz, B. Miedema, W. Hogg, W. P. Wodchis, and K. Aubrey-Bassler, “The influence of gender and other patient characteristics on health care-seeking behaviour: a QUALICOPC study,” BMC Fam. Pract., vol. 17, no. 1, 2016, doi: 10.1186/s12875-016-0440-0. DOI: https://doi.org/10.1186/s12875-016-0440-0

M. Dramé and L. Godaert, “The Obesity Paradox and Mortality in Older Adults: A Systematic Review,” Nutrients, vol. 15, no. 7, Apr. 2023, doi: 10.3390/nu15071780. DOI: https://doi.org/10.3390/nu15071780

D. F. Estrella-Castillo and L. Gómez-De-Regil, “Comparison of body mass index range criteria and their association with cognition, functioning and depression: a cross-sectional study in Mexican older adults,” BMC Geriatr., vol. 19, no. 1, Dec. 2019, doi: 10.1186/s12877-019-1363-0. DOI: https://doi.org/10.1186/s12877-019-1363-0

Y. Muroga et al., “Dietary characteristics of urban community-dwelling older adults with low muscle mass: the bunkyo health study: a cross-sectional study,” BMC Geriatr., vol. 24, no. 1, Dec. 2024, doi: 10.1186/s12877-024-05218-4. DOI: https://doi.org/10.1186/s12877-024-05218-4

T. Roenneberg, K. V. Allebrandt, M. Merrow, and C. Vetter, “Social jetlag and obesity,” Curr. Biol., vol. 22, no. 10, pp. 939–943, May 2012, doi: 10.1016/j.cub.2012.03.038. DOI: https://doi.org/10.1016/j.cub.2012.03.038

M. A. Albqoor and A. M. Shaheen, “Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan,” Sleep Breath., vol. 25, no. 2, pp. 1147–1154, Jun. 2021, doi: 10.1007/s11325-020-02188-w. DOI: https://doi.org/10.1007/s11325-020-02188-w

U. Das and N. Kar, “Prevalence and risk factor of diabetes among the elderly people in West Bengal: evidence-based LASI 1st wave,” BMC Endocr. Disord., vol. 23, no. 1, Dec. 2023, doi: 10.1186/s12902-023-01421-3. DOI: https://doi.org/10.1186/s12902-023-01421-3

J. Leszczak, E. Czenczek-Lewandowska, M. Asif, J. Baran, A. Mazur, and J. Wyszyńska, “Risk factors and prevalence of hypertension in older adults from south-eastern Poland: an observational study,” Sci. Rep., vol. 14, no. 1, Dec. 2024, doi: 10.1038/s41598-024-52009-3. DOI: https://doi.org/10.1038/s41598-024-52009-3

E. Ji, S. Ahn, J. Y. Choi, C. H. Kim, and K. il Kim, “Effect of multimorbidity on hypertension management,” Sci. Rep., vol. 13, no. 1, Dec. 2023, doi: 10.1038/s41598-023-44813-0. DOI: https://doi.org/10.1038/s41598-023-44813-0

C. J. Lavoie, M. R. Zeidler, and J. L. Martin, “Sleep and aging,” Sleep Science and Practice 2018 2:1, vol. 2, no. 1, pp. 3-, Feb. 2018, doi: 10.1186/s41606-018-0021-3. DOI: https://doi.org/10.1186/s41606-018-0021-3

C. Alessi et al., “Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial,” J Am Geriatr Soc, vol. 64, no. 9, pp. 1830–1838, Sep. 2016, doi: 10.1111/jgs.14304. DOI: https://doi.org/10.1111/jgs.14304

C. Schmidt, P. Peigneux, and C. Cajochen, “Age-Related Changes in Sleep and Circadian Rhythms: Impact on Cognitive Performance and Underlying Neuroanatomical Networks,” Front. Neurol., vol. 3, p. 118, 2012, doi: 10.3389/fneur.2012.00118. DOI: https://doi.org/10.3389/fneur.2012.00118

N. P. Gordon, J. H. Yao, L. A. Brickner, and J. C. Lo, “Prevalence of sleep-related problems and risks in a community-dwelling older adult population: a cross-sectional survey-based study,” BMC Public Health, vol. 22, no. 1, Dec. 2022, doi: 10.1186/s12889-022-14443-8. DOI: https://doi.org/10.1186/s12889-022-14443-8

J. Taillard, C. Gronfier, S. Bioulac, P. Philip, and P. Sagaspe, “Sleep in Normal Aging, Homeostatic and Circadian Regulation and Vulnerability to Sleep Deprivation,” Brain Sci., vol. 11, no. 8, Aug. 2021, doi: 10.3390/brainsci11081003. DOI: https://doi.org/10.3390/brainsci11081003

N. L. Bragazzi et al., “The Complex Interplay Between Sleep and Healthy Aging: A Scoping Review,” Nat. Sci. Sleep, vol. 17, pp. 3085–3100, Nov. 2025, doi: 10.2147/NSS.S555177. DOI: https://doi.org/10.2147/NSS.S555177

V. R. Hariprasad et al., “Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial,” Indian J. Psychiatry, vol. 55, no. Suppl 3, p. S364, Jul. 2013, doi: 10.4103/0019-5545.116310. DOI: https://doi.org/10.4103/0019-5545.116310

M. de M. Nascimento et al., “Effects of 12 Weeks of Physical-Cognitive Dual-Task Training on Executive Functions, Depression, Sleep Quality, and Quality of Life in Older Adult Women: A Randomized Pilot Study,” Sustainability 2023, Vol. 15, vol. 15, no. 1, Dec. 2022, doi: 10.3390/su15010097. DOI: https://doi.org/10.3390/su15010097

I. Made et al., “Tandem walking exercise to improve cognitive function in the elderly,” Jurnal Keolahragaan, vol. 11, no. 2, pp. 171–179, Sep. 2023, doi: 10.21831/jk.v11i2.58001. DOI: https://doi.org/10.21831/jk.v11i2.58001

A. Zaccaro et al., “How Breath-Control Can Change Your Life: A Systematic Review on Psycho-Physiological Correlates of Slow Breathing,” Front. Hum. Neurosci., vol. 12, p. 409421, Sep. 2018, doi: 10.3389/fnhum.2018.00353. DOI: https://doi.org/10.3389/fnhum.2018.00353

S. Khanjani, A. Shamabadi, S. Akhondzadeh, and A. A. Malekirad, “Melatonin for Sleep Quality and Occupational Cognitive Performance in Shift Workers with Low Sleep Quality: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial,” J. Clin. Pharm. Ther., vol. 2024, 2024, doi: 10.1155/2024/8869707. DOI: https://doi.org/10.1155/2024/8869707

N. Eda, H. Ito, and T. Akama, “Beneficial Effects of Yoga Stretching on Salivary Stress Hormones and Parasympathetic Nerve Activity,” J. Sports Sci. Med., vol. 19, no. 4, p. 695, Dec. 2020, Accessed: Mar. 23, 2026. [Online]. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC7675619/

M. A. Alnawwar, M. I. Alraddadi, R. A. Algethmi, G. A. Salem, M. A. Salem, and A. A. Alharbi, “The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review,” Cureus, vol. 15, no. 8, Aug. 2023, doi: 10.7759/cureus.43595. DOI: https://doi.org/10.7759/cureus.43595

S. Prashanth, V. Nalini, K. Maheshkumar, J. Thanalakshmi, and S. Priyanka, “Effects of yoga on sleep quality among the geriatric population: Systematic review and meta-analysis,” Brain Behavior and Immunity Integrative, vol. 6, p. 100058, Apr. 2024, doi: 10.1016/j.bbii.2024.100058. DOI: https://doi.org/10.1016/j.bbii.2024.100058

N. Bandyopadhyay, T. Das, A. Biswas, and A. Koley, “Effects of Yogic Intervention on Sleep Quality of Healthy Elderly: A Systematic Review,” Univers. J. Public Health, vol. 11, no. 1, pp. 78–88, Feb. 2023, doi: 10.13189/ujph.2023.110109. DOI: https://doi.org/10.13189/ujph.2023.110109

M. A. Bankar, S. K. Chaudhari, and K. D. Chaudhari, “Impact of long-term Yoga practice on sleep quality and quality of life in the elderly,” J. Ayurveda Integr. Med., vol. 4, no. 1, pp. 28–32, 2013, doi: 10.4103/0975-9476.109548. DOI: https://doi.org/10.4103/0975-9476.109548

E. Garrote-Caparrós, M. Bellosta-Batalla, L. Moya-Albiol, and A. Cebolla, “Effectiveness of mindfulness-based interventions on psychotherapy processes: A systematic review,” Clin. Psychol. Psychother., vol. 29, no. 3, pp. 783–798, May 2022, doi: 10.1002/cpp.2676. DOI: https://doi.org/10.1002/cpp.2676

D. Kanchibhotla, S. Subramanian, and D. Singh, “Management of dysmenorrhea through yoga: A narrative review,” Frontiers in Pain Research, vol. 4, p. 1107669, Mar. 2023, doi: 10.3389/fpain.2023.1107669. DOI: https://doi.org/10.3389/fpain.2023.1107669

A. Oktaviatama, D. Mirawati, and C. Setiawan, “Pengaruh Walking Morning Exercise Terhadap Peningkatan Kualitas Tidur pada Lansia,” Jurnal Kesehatan Andalas, vol. 12, no. 2, pp. 82–86, Mar. 2023, doi: 10.25077/jka.v12i2.2233. DOI: https://doi.org/10.25077/jka.v12i2.2233

C. R. Bellenger, J. T. Fuller, R. L. Thomson, K. Davison, E. Y. Robertson, and J. D. Buckley, “Monitoring Athletic Training Status Through Autonomic Heart Rate Regulation: A Systematic Review and Meta-Analysis,” Sports Med., vol. 46, no. 10, pp. 1461–1486, Oct. 2016, doi: 10.1007/s40279-016-0484-2. DOI: https://doi.org/10.1007/s40279-016-0484-2