The client is a 66-year-old Caucasian male, 6'4", 230 lbs., who wishes to address physical limitations through yoga. His goal is become more flexible, learn to breathe properly, and be patient. He also wishes to expand his horizon and better himself. He has no experience with yoga, and thinks he would prefer gentle yoga. In the past, he took a course in TaiQi.

TCA has a PCP, has medication prescribed for high cholesterol and high blood pressure. He takes some supplements. He's had no surgeries, is current on his physical, vision, and dental exams.

The client prefers not to bend over stating that he's not flexible enough. He gets dizzy when he looks up so he avoids doing this. He is stiff in the morning and often throughout the day since he is sedentary. It is difficult for him to get down onto the floor as well as get up from it.

TCA was able to balance on his R leg for 9 seconds, and over 20 seconds on his L leg. While balancing on his R leg, he was wobbly; stable on the Left.

He stated that he has acute pain in his lower back (2-3 out of 10 on the pain scale). He tries to alleviate it by walking. He generally wakes up around 7:30am, using an alarm, and is in bed at 10pm. He gets 8 hours of uninterrupted sleep most nights. He sits 4-5 hours/day, the rest of the time he lies down. He prefers to work on his back as it relieves back tension and pain. He reports that he moves as well as he likes. He walks almost every day for 45 minutes, swims once a week for 45 minutes, and golfs every other week for 3 hours. His hobbies are music, golf, travel, history and general knowledge. His intelligence is that which he likes most about himself; and he wants us to know he's an Aquarius.

The client would benefit from learning better alignment, balance, endurance, flexibility, and gait. His L ankle internally rotates.

Breakfast consists of eggs, bacon, avocado, roll; sandwich at lunch; fish, pasta, steak, Asian food for dinner; chips at bedtime, and wine. He drinks 32 ounces of water, 16 oz of coffee, and 5 oz of wine and juice daily.

Client has not practiced relaxation, meditation or breathing techniques. He would like to learn how to do these practices and is interested in guided relaxation and meditation.

TCA is outgoing, sociable, and curious. He has no mental health concerns, nor has he received MH therapy. He experiences stress as a caregiver for one of his daughters, and there is stress in his family, his eldest daughter in particular. Both suffer from MH diagnoses. He worries about their well-being; and doesn't handle irrational behavior well. He is also currently experiencing legal stress.

TCA aspires to lead an ethical life, considers himself honest, not greedy, wishes to lead a purposeful life. He sometimes lives with purity, equanimity, discipline and introspection. He would like to learn breathing practices, concentrated awareness, practice relaxation and body scans, and meditative awareness. He aspires to live a life of meditative awareness is he can connect with his body, mind and spirit. He's not practiced meditation but would like to learn. He has no spiritual beliefs.

He believes he copes well with stress. When stressed he paces and thinks out loud. Having a positive attitude appears to help him to cope. When things get in his way, he gets nervous. His strength is his ability to solve problems.

The client has a degree in law and is self-employed as a consultant. His partner is also employed. He believes his work-life balance is very good. He doesn't work too much, enjoys his work very much, finds it somewhat stressful, and it leaves time for family.

TCA has many close friends, casual friends, work/peer relationships, and positive relationships with his immediate family. He experienced financial insecurity in the past. He considers tolerance and open-mindedness as important life values which he learned from his mother.

He has no spiritual beliefs, strong emotional ties to a cultural or community group. He's never experienced stigma, trauma.

Tripathy, Manoranjan, and Bisweswari Sahu. "Immediate effect of Nadi Shodhana pranayama on blood glucose, heart rate and blood pressure." Journal of American Science 15.5 (2019): 65-70.

I plan to use this citation from the manuscript. When practicing Nadi Suddhi, “the brain centers are stimulated to work nearer to their optimum capacity. It also induces tranquility, clarity of thought and concentration, and is recommended for those engaged in mental work. It increases vitality and lowers levels of stress and anxiety by harmonizing the pranas. It clears pranic blockages and balances ida and pingala nadis, causing sushumna nadi to flow, which leads to deep states of meditation and spiritual awakening.”

I’ll explain prana, pranic energy and the nadis to the client.

Cohen DL, Boudhar S, Bowler A, Townsend RR. Blood Pressure Effects of Yoga, Alone or in Combination With Lifestyle Measures: Results of the Lifestyle Modification and Blood Pressure Study (LIMBS). J Clin Hypertens (Greenwich). 2016 Aug;18(8):809-16. doi: 10.1111/jch.12772. Epub 2016 Jan 15. PMID: 26773737; PMCID: PMC8032101.

Both manuscripts will be shared with the client. This one concludes that there are few cardiovascular risks posed by yoga practice and no adverse events have been reported in published trials they reviewed. Regular weekly practice of yoga is a reasonable alternative, either alone or in combination with dietary and exercise measures, in the management of uncomplicated hypertension per their data.

Joshi AM, Raveendran AV, Arumugam M. Therapeutic role of yoga in hypertension. World J Methodol. 2024 Mar 20;14(1):90127. doi: 10.5662/wjm.v14.i1.90127. PMID: 38577206; PMCID: PMC10989416.

I spent time researching hypertension (blood pressure - BP) and yoga. This manuscript is recent and basic, while providing important information one needs to remember when teaching. Some poses for example stimulate the sympathetic nervous system, which may increase. Sudden changes in postures should be avoided, including standing up quickly from a supine position. A Breath should not be held during a yoga posture. A list of precautions and contradictions are listed.

Questions were answered in today's group mentoring session. My main concerns are the BP and intermittent medication usage. I was advised to ask what the barriers are to regular medication administration. I intend to start with chair and kitchen counter yoga, and will recommend aqua yoga.

• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.