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Secondary Research: The benefits of the Alexander Technique (AT) for the aging population 1
Research Paper: SECONDARY RESEARCH: THE BENEFITS OF THE ALEXANDER
TECHNIQUE (AT) FOR THE AGING POPULATION
Secondary Research: The benefits of the Alexander Technique (AT) for the aging population
Deborah Bayardino George
Graduate Certificate in Gerontology
Portland State University
December 5th, 2014
Perspectives on Aging PHE 558/658
Professor Margaret Neal

PART I
INTRODUCTION
There are different mind-body practices such as acupuncture, massage, mindful
meditation, Tai Chi, Feldenkrais and Reiki among many others, that have been used as
interventions for “specific conditions or to promote overall well-being” (NCCAM, 2014, para.2).
The National Center for Complementary and Alternative Medicine (NCCAM), a division of The
U.S Department of Health and Human Services, states that “approximately 40% of Americans
use health care approaches developed outside of mainstream conventional medicine” (NCCAM,
2014, para.2).
Statistics also reveal that “the proportion of people age 60 and over is growing faster than
other age groups”, and that “There will be approximately 1.2 billion people over the age 60 in
2025 in the world” (WHO, 2002, p.6). In addition to that, it is estimated that 22% of the global
population will be aged 60 and over in 2050. This means that for the first time in human history
there will be more older people than children aged 0-14 years old (WHO, 2007, p.3). In the
United States only, the demographic growth rate in number of persons aged 65 and over from
2010 and 2030 is estimated to be 79.2%, and 78.4% in the State of Oregon (U.S Census Bureau,
2008; Metro, 2009).
It is plausible that the rapidly growing population of older adults, with their expected
biological declines of normal aging, is searching for alternatives to promote a higher quality of
life, not to substitute for the traditional medicine, but to complement it.
The Alexander Technique is a mind-body practice offered for the general public. This
paper attempts to demonstrate that the older adults could benefit from this technique.

This paper will first expose congruent ideas between the AT and some gerontological
studies. Then, it will define the Alexander Technique and its concepts. Thirdly, it will describe
and analyze the scientific findings about the AT. It will then be finalized with a discussion, a
brief personal opinion and a suggestion of an appropriate applicability of this technique.
The conceptual correlation between the AT and gerontology is based on that the mind-
body connection is as an essential medical model of care especially for older ones (Longing &
Powell, 2004, p.208). It is also based on the fact that a systemic-holistic approach is an
integrative procedure of understanding, describing and explaining the aging process” (Baltes &
Smith, 1997, p. 395).
The concept of resilience in advanced age, which is the ability to positively negotiate
with adversities (Wild, Wiles & Allen, 2013, p.138) is a common view between AT and
gerontology. It is also a common view the idea of Positive Aging which is to have the goal of
adapting and making the best of our situation, even if it means chronic illness and decline.
Instead of postponing decline, it is recognized that decline is to be expected, and so it is
compensated and adapted. It does not mean remaining healthy as long as possible but adapting to
losses when they occur (Moody, 2005).
Other key concepts found in the AT and gerontology literature are behavioral plasticity
and latent reserve. Behavioral plasticity “is a measure of potential and preparedness for dealing
with a variety of demands” (Baltes, 1990, p. 7). Rabello de Castro (2001) notes that “Human
plasticity refers to the potentiality of change itself” (p. 183).
It is also important to define some terms in advance in order to clarify future statements
that will be made in this paper.

• Tonic Postural activity: it is the characteristic of the musculature of the body of being in
continuous and low-level activity. This mode of activity is called tonic postural activity (Jove,
2014);
• Wellness: “it is an active process through which people become aware of, and make choices
toward, a more successful existence” and “it is a conscious, self-directed and evolving process
of achieving full potential (National Wellness Institute, 2014);
• Wellness Program: “it is a program in which participants are encouraged to become their best
selves, regardless of personal challenges” (International Council on Active Aging, 2014);
• Outreach Programs: Programs that make possible to a diverse range of professionals to go to
the residents’ private houses. The residents are able to receive a variety of supportive services;
• Age-in-place: “The ability to live in one’s own home and community safely, independently,
and comfortably, regardless of age, income, or ability level” (CDC, 2014).
PART II
ALEXANDER TECHNIQUE STANDARDS
The Alexander Technique has been applied to the general public worldwide for over 100
years. Teachers complete a 3-year training course, 1600 hours, with 80% devoted to hands-on
practical experience, to acquire practical competence of the AT in themselves as a basis for
teaching (Cacciatore, Gurfinkel, Horak, Cordo & Ames, 2011, p. 76). “Training courses are
overseen by the Society of the Alexander Technique (STAT, United Kingdom) and its
international affiliated societies, such as the American Society for the Alexander Technique
(AmSAT)” (Cacciatore, Horak & Henry, 2005, p. 567). The Oregon Center for the Alexander
Technique is currently located in Portland, Oregon, and there are approximately 20 teachers
located in this city.

ALEXANDER TECHNIQUE DEFINITIONS
In order to support any hypothesis of the effectiveness of the Alexander Technique (AT)
for the aging population, it seems necessary that the meaning of this technique should first be
clarified.
The researchers that have been studying ageing and the Alexander Technique state that
"Alexander Technique is a method of allowing new patterns of coordination to happen. It
employs a nonexercise approach to the improvement of the use and function of oneself“ (Dennis,
1999, p. M8). Batson & Barker (2008) present that “The Alexander Technique is a method that
purports to improve postural control through augmented perceptual and cognitive strategies
applied to task-based activities”
The study linking AT with benefits on Parkinson’s disease’s symptoms sustains that “The
Alexander Technique concerns the practical relationships between thought and the resultant
muscle activity involved in postural support and has particular relevance for the initiation of
movement. Using skilled hand contact a teacher observes and assesses changes in muscle
activity, balance and co-ordination resulting from mental (activity). In this way through
practicing mental procedures with help and advice from the teacher, pupils learn to recognize
and adopt better thinking strategies for overall control of balance and movement“ (Stalibrass,
Sissons & Chalmers, 2002, p. 696)
The British Medical Journal also has contributed to understanding the AT’s definition
expressing that "Lessons in the Alexander Technique offer an individualized approach designed
to develop lifelong skills for self-care that help people recognize, understand, and avoid poor
habits affecting postural tone and neuromuscular coordination” (Little, Lewith, Webley, Evans,
Beattie, Middleton, Barnett, Ballard, Oxford, Smith, Yardley, Hollinghurst, Sharp, 2008, p.1).

In addition to that, since 2005 the neuroscientist Timothy Cacciatore and colleagues has
been publishing a series of peer-reviewed articles in which the term ‘tonic postural activity” has
been deeply investigated and correlated with Alexander Technique teachers’ characteristics of
poise and composure. In his perspective, the Alexander Technique could be defined as “a
technique that aims to alter habitual faulty postural behavior and to increase the efficiency of
postural coordination by teaching a person to consciously assume a state of postural readiness
that, in turn, affects automatic postural coordination and ongoing muscular activity“ (Cacciatore,
Horak & Henry, 2005, p. 566).
Frederick Mathias Alexander (1869-1955), the original founder of the Alexander
Technique, defines it as follows: “My technique is based on the inhibition of undesirable,
unwanted responses to stimuli, and hence it is primarily a technique for the development of the
control of human reactions” (Alexander, 2000, p. 88). He also states that “it is a technique which
enables us to put into practice new beliefs in new ways of doing things in the process of making
changes in the habitual use of the self” ( Alexander, 2000, p.150).
The Oregon Center for the Alexander Technique endorses that “The Alexander
Technique teaches us to become aware of how we “use” or “misuse“ ourselves. It is a means for
stopping the misuse and a technique to replace habitual reactions with conscious choice”
(OCAT, 2014, para. 2)
Experienced and qualified AT teachers affirm that the AT is “an educational method in
which individuals learn about their own neuromuscular behavior patterns and learn how to
develop a conscious control of their reactions” (The Alexander Technique Studio, 2014). Its
main objective is a psychophysical re-education, teaching how the body and mind can work

together while performing all of the daily activities. It helps to detect and reduce excess tension
by promoting harmony and well-being. (Roberto Reveillau, 2014).
Lastly, Rabello declares in his paper that “coping mechanisms are said to be fundamental
at advanced age, when diverse and multiple challenges affect human lives” (Rabello de Castro,
201, p. 196). Thus, it is suggested in this paper that AT could be seen as a process of building an
individualized ‘coping mechanism’ (Rabello de Castro, 2001, p. 186).
AT CONCEPTS
The Alexander Technique is constituted of 9 fundamental concepts.
Unit of Self is the concept of understanding individuals as an integrated organism and as
an indivisible unit in which physical and mental entities are one and in correlation with each
other. In Alexander’s words, human beings are psychophysical organisms.
Use and Function is the second concept. Use means the way we use our psychophysical
organism in any activity we undertake. How we use ourselves affects the functions of our
organism.
Inhibition is a process development of consciously choose to pause between a stimulus
and a response.
Direction is a conscious motor and bodily attention information (Cacciatore, Gurfinkel,
Horak, Cordo & Ames, 2011, p. 87). It is a process development of conscious self-guiding over
the way one responds to stimuli during the activities of living.
Another definition, by Tim Cacciatore and colleagues, is that “‘direction’
describes the process of sending conscious motor commands to influence tonic muscular
activity” (Cacciatore, Horak, Henry, 2005, p. 567)

Primary Control is a dynamic relationship between the head, neck and torso that
activates the anti-gravity reflexes.
End gaining and Means Whereby is the sixth concept. End-gaining is the act of
thinking exclusively about the result to be obtained, thus reinforcing the tendency to behave in a
fixed way.
Means Whereby is the process in order to reach certain objectives, thereby it is to use
appropriate means to reach an efficient outcome. In other words, in applying the means whereby
one has a chance to break up the tendencies to behave in a fixed way (OCAT, 2014).
The Chinese ancient expression wu-wei from the Taoist philosophy could explain the
Non doing AT principle. Wu-wei means “without doing”, however “it is not an ideal of absolute
inaction; on the contrary, it is a particularly efficacious attitude since it makes all doing possible”
(Kaltenmark, 1965, p. 53). In other words, it is the allowance of things to happen accordingly
and not interfering with the natural course of it.
F.M. Alexander observed in his research that the sensory inputs that orient us on the
execution of any activity are, most of the time, inaccurate. He named this observation faulty
sensory appreciation (Reveillau, 2014).
Force of Habit is the idea that humans have a strong tendency to act physically and
mentally in the usual way over and over. In other words, Alexander observes that we are slaves
of our habitual neuromuscular patterns which are repeated throughout every moment of our lives
(Reveillau, 2014).
PART III
SCIENTIFIC FINDINGS

1. Functional Reach Improvement in Normal Older Women After Alexander Technique
Instruction, 1999
This study had a pretest and posttest design and lasted for 4 weeks. The independent
ambulatory older adults, 65+ years, were recruited from a senior facility. The 19 subjects were
divided in Group 1 and 2, having eight AT lessons, 1-hour biweekly, and Group 3 having no
interventions.
The measurements used were the Functional Reach (FR) test representing the quantitative
procedure, and a questionnaire as a qualitative procedure.
“Functional Reach testing is a clinical measure of balance, representing the maximal
distance one can reach forward beyond arm’s length while maintaining a fixed base of support in
the standing position” (Dennis, 1999, p. M8). The questionnaire inquired about their perceived
improvement on balance, leg strength, posture, overall ease of movement, general body
awareness, self-confidence in movement, enjoyment of lessons and extent of learning. The
subjects responded anonymously either “none”, “a little”, “a fair amount”, or “a lot”.’ (Dennis,
1999, p. M9)
A piece of plywood sheet, red marker, wooden yardstick, wooden ruler and data
recording were the apparatus used for the FR testing. Besides that, it was used a stable and flat
chair for the Alexander Technique ‘chair work’.
The results indicated that groups 1 and 2, after only eight 1-hour biweekly lessons on the
Alexander Technique had improved FR performances by 1.17 inches and by 1.50 inches,
respectively. The group 3 decreased by .74 inches. Another statistical analysis shows that group
1 and 2 improved by 40.8% and by 32.2%, respectively.

The responses from the questionnaire showed three most voted items. It showed a “lot of
improvement’ on extent of learning, body awareness and posture. As an example, this is one of
the comments returned on the post-instruction questionnaire: “I have been walking 1 hour daily
for 18 years. I was afraid I would have to quit because I felt like I was trying to carry a heavy
load. I learned from the AT how to stand tall and get rid of that burden. I feel in control”
(Dennis, 1999, p. M11).
The conclusion, based on the results of the study, was that the AT was mentally and
physically profitable for some older adults (Dennis, 1999, p. M11, para. 2). It also suggested that
AT lessons could be an effective intervention in some geriatric contexts. (Dennis, 1999, p. M11,
para. 4).
The author emphasizes the need for cooperation between the geriatric field and the AT
professionals for further studies. He also asserts that “certainly our aging population stands to
benefit from fuller access to this self-empowering resource” (Dennis, 1999, p. M11, para. 5).
2. Feasibility of Group Delivery of the Alexander Technique on Balance in the Community-
Dwelling Elderly: Preliminary Findings, 2008
Similarly to the study mentioned above, this quasiexperimental research was also a
pretest-posttest design and had 19 subjects. The independent 60+ years older adults, cognitively
intact and with few comorbidities, had a 2 week daily program of AT lessons.
The eligibility criteria were the ability to ambulate at least 50 feet with or without an
assistive device and with minimal assistance in transfers. On the other hand the exclusionary
criteria were cognitive, hearing and speech deficits. (Batson & Barker, 2008, p. 106).
The study used multiple types of measurements such as: TUG (The Timed Up and Go),
FAB (Fullerton advanced balance scale: Tandem Walk and Set Up and Over) and MFES

(Modified falls efficacy scale). The TUG and the FAB are well-validated measurements of
balance for aging population employed at clinical tests of balance. (Batson & Barker, 2008,
p.107) The MFES is a self-reported measurement which subjects rate themselves on fear of
falling in 10 different daily activities. Besides that, it was requested a 5-year fall history.
“All tests were administered by two licensed physical therapists with 1 and 3 years of
experience and with no knowledge of the AT” (Batson & Barker, 2008, p. 109)
The only device used was a stable and flat chair for the AT ‘chair work’ during the
lessons.
The AT teachers’ goal was to help subjects gain experiential knowledge to increase
awareness of their ‘unity of self’. It was also to understand their own maladaptive postural habits
and misdirected efforts that placed them at greater risk for falling. Finally the goal was to
develop coordination strategies to improve their sense of safety in ambulation and ease of
movement in transfers (Batson & Barker, 2008, p.110).
The subjects had valid statistical improvements on the TUG approaching a 2-second
posttest decrease and on the posttest FAB for the group as whole. In addition to that the Tandem
Walk test had statistical significance as well (Batson & Barker, 2008, p.112)
The results suggest that the brief intervention with AT lesson showed a quantitative
increase overall in movement speed (Batson & Barker, 2008, p. 113). The authors said that the
AT lessons resulted in select improvements in dynamic balance tasks by emphasizing the
following items: perceptual awareness and cognitive strategies. Finally, it is recommended that
the AT lessons should be incorporated into balance training as a self-care approach to improving
balance (Batson & Barker, 2008, p. 115, 116)

3. Randomized Controlled Trial of Alexander Technique Lessons, Exercise, and Massage for
Chronic and Recurrent Back Pain, 2008
This study had a factorial randomized trial as a design and lasted one year.
The 579 participants with chronic or recurrent low back pain were divided as follows:
144 were randomized to control group, 147 to massage, 144 to six AT lessons, 144 to 24 AT
lessons and half of each of these groups were randomized to exercise prescription. “The
inclusion criteria were current pain for three or more weeks, scoring 4 or more on the Roland
Morris disability and presentation in primary care with low back pain more than three months
previously. The exclusion criteria were previous experience of Alexander Technique, clinical
indicators of serious spinal disease, current nerve root pain, previous spinal surgery, pending
litigation, history of psychosis or major alcohol misuse and perceived inability to walk 100m”
(Little, et al., 2008, p.2).
Roland Morris disability score and number of days in pain were the measurements used
for the research.
When compared with the control group, which had little change on both measurements,
these were the results presented in the study (page 4):
• 86% reduction in days in pain and 42% reduction in Roland disability after 24 AT lessons (Fig
1), (Little, et al., 2008, p.4);
• 48% reduction in days in pain and 17% reduction in Roland disability after 6 AT lessons (Fig
1), (Little, et al., 2008, p.4);
• 0% reduction in days in pain and 17% reduction in Roland disability after prescribed exercise
(Little, et al., 2008, p.4);

• 33% reduction in days in pain and 0% in Roland disability after massage sessions (Little, et al.,
2008, p.4);
• “6 lessons in the AT retained effectiveness at one year shows that the long term benefit of
Alexander Technique lessons is unlikely to result from non-specific placebo effects of attention
and touch” (Little, et al., 2008, p.6), but rather because AT lessons provide long term
educational element (Little, et al., 2008, p.2).
• The British Medical Journal (BMJ Video, 2008) suggested that the most cost-effectiveness
combination for the health care system is a combination of 6 AT lessons and exercise
prescription.
Fig 1:
AT LESSONS DAYS OF PAIN/MONTH
No intervention 21 days
6 AT Lessons 11 days
24 AT Lessons 3 days
The conclusion about the trial was that a series of 24 private lessons in the Alexander
Technique from certified teachers provides long term benefits for patients with chronic or
recurrent low back pain. (Little, et al., 2008, p. 1 and p.5)
It is important to notice that ”back pain is a common disorder, affecting 65–80% of the
population and is a major item in health-care expenditure, costing the United States $25 billion
annually. Back pain is common in the elderly, with a prevalence of up to 49% of the population.
Patients aged 75 and over reported back pain as the third most common complaint overall and
their most common musculoskeletal symptom. Back pain is a prevalent, significant cause of

morbidity in older patients, including depression, functional disability and decreased quality of
life” (Meng, Wang, Ngeow, Lao, Peterson, Paget, 2003, p. 1508).
Although this research described, from the British Medical Journal, involved participants
with a maximum age of 65, it is suggested by this paper that the results would most likely be
applicable to adults older than 65 due to its random samples and assignments.
4. Randomized Controlled Trial of the Alexander Technique for idiopathic Parkinson’s Disease,
2002
The design used for this trial was a randomized one with a pre and post-intervention. It
was designed to validate the results of the preliminary study, in which all average change had
been positive.
Ninety-three (93) people with clinically confirmed idiopathic Parkinson’s disease were
divided into three groups. The first group took two AT lessons per week for 12 weeks, the
second group received massage and the third group had no intervention.
The five inclusion criteria were diagnosed with idiopathic Parkinson’s disease by a
consultant neurologist, committed to keeping Parkinson’s disease medication unchanged from
before the pre-intervention test to after the post-intervention test, able to climb 20 stairs, able to
lie on the floor and get up alone (with help from furniture), and reasonable short-term memory.
On the other hand, the four exclusion criteria were taking medications for another serious
neurological illness, being hospitalized for depression in last 10 years, receiving a non-
pharmacological therapy in the last six months and receiving individual Alexander Technique
lessons in last 10 years. (Stallibrass, Sissons & Chalmers, 2002, p. 696)
The main measurements used were the Self-assessment Parkinson’s Disease Disability
Scale (SPDDS) at best and worst times of day, the Beck Depression Inventory (BDI), the

Attitudes to Self Scale and an open-ended questionnaire. The SPDDS is a self-reported
questionnaire containing a list of actions in which participants rated how easy or difficult it was
to perform the task. The BDI, also a questionnaire, asked the subjects how they felt about 21
items by selecting the statement that best described their feelings. The Attitudes to Self Scale is
an adapted version of the body concept questionnaire. It consists of opposite words (ex.
tense/relaxed) in which the participants identify and rate them, ranging from the most positive to
the most negative. These questionnaires have been shown to be internally consistent and valid.
(Stallibrass, Sissons & Chalmers, 2002, p 698).
The results pre-intervention to post-intervention showed that the Alexander Technique
group had a statistically significant improvement, compared with the no additional intervention
group, on both SPDDS at best and on the SPDDS at worst. The Alexander Technique group,
compared with the no additional intervention group, had a statistically significant result of
feeling better according to the BDI’s post-intervention test. The Attitudes to Self Scale at the six-
month follow-up indicated the AT group felt significantly better (Stallibrass, Sissons &
Chalmers, 2002, p. 700).
In addition to that, the participants answered open-ended questions. The answers
mentioned improvements in specific actions after experiencing the AT lessons. Fourteen
participants mentioned improvements on walking, 11 on speech, 89 mentioned general physical
benefits, 17 mentioned improvements in posture or balance, 9 greater energy or less tired, 8
reduced tremor, 8 reduced rigidity and 10 mentioned reduced stress, panic and greater
composure in dealing with the emotional impact of progressive disability (Stallibrass, Sissons &
Chalmers, 2002, p. 700).

The authors mentioned that one of the benefits from AT lessons was the decrease in
medication change. “Unexpected evidence of the clinical importance of the benefits was the
apparent impact on the incidence of medication change. The incidence of changes made by
participants in order to improve symptoms or reduce adverse side-effects was strikingly lower in
the AT group compared with both the two other groups.” (Stallibrass, Sissons & Chalmers, 2002,
p. 706)
When comparing AT group and massage group, the results of six-month follow up
showed that the massage group had no continued improvement and, in the other hand, the AT
had continued improvement. This result discarded that touch and attention alone are the lead to
sustained benefits and reinforced that beneficial effects of the AT on the management of
disability must be due to the continued application of learnt skills. (Stallibrass, Sissons &
Chalmers, 2002, p. 705, p. 706) Once again, follow-up tests have confirmed the long lasting
effects provide by the educational facet of the Alexander Technique.
The final message is that the AT “it is likely to benefit most moderately mobile,
nondemented people with Parkinson’s disease who are interested in a technique for self-help”
(Stallibrass, Sissons & Chalmers, 2002, p. 707).
It could be a concern that all the measurements used for this study were questionnaires
and no other quantitative procedure was used.
Despite this fact, it might be relevant to know that Parkinson’s disease affects 1 million
older Americans (Pan, Stutzbach, Reichwein, Lee & Dahodwala, 2014, p.340). Moreover,
Collier, Kannan and Kordomer (2011) stated that ageing is the greatest risk factor for the
development of Parkinson’s disease and that there is consistent evidence across geographic,

cultural and ethnic boundaries associating increased incidence of Parkinson’s disease diagnosis
with advancing age.
5. Neuromechanical interference of posture on movement: evidence from Alexander Technique
teachers rising from a chair. Cacciatore, T. W., Mian, O. S., Peters, A., Day, B. L. (2014).
6. Increased dynamic regulation of postural tone through Alexander Technique training.
Cacciatore, T.W., Gurfinkel, V.S., Horak, F.B., Cordo, P.J., Ames, K.E. (2011)
7. Prolonged weight-shift and altered spinal coordination during sit-to-stand in practitioners of
the Alexander Technique. Cacciatore, T.W., Gurfinkel, V.S., Horak, F.B., Day, L.B. (2011).
8. Improvement in Automatic Postural Coordination Following Alexander Technique Lessons in
a Person with Low Back Pain (LBP). Cacciatore, T.W., Horak, F.B., Henry, M. (2005).
The 4 articles above represent the chronological correlation between the AT and the
‘improvement on automatic postural coordination‘ by Tim Cacciatore and colleagues (2011).
First, it will be presented a brief explanation about the underlying goals of the studies.
The general goals of the studies have been to understand physiologically the mechanisms of
tonic postural activity. It has been to answer questions such as how does the brain control a
normal postural tone? How does abnormal tone in patients with Parkinson’s disease affect their
functional performance? How can we improve tone with treatment? (Jove, 2014). Could the
Alexander Technique be used as an intervention to improve tone?
The first research to be described is the 2005 study (number 8). It was a case
report which initiated a remarkable pioneering discussion about the correlations between
Alexander Technique lessons and improvement on automatic postural coordination, and, in turn,
the reduction of LBP.

“The client was a 49 year old woman with a 25 year history of a daily left-sided
idiopathic lumbrosacral back pain” (Cacciatore et al., 2005, p. 565). She was tested monthly for
4 months before AT lessons and for 3 months after. The postural coordination was measured
through a computer-controlled, movable, hydraulic platform. In addition to that, pain was
evaluated by a self-rate from 0 representing ‘no pain’ to 10, ‘maximal pain’. After 20 weekly
AT lessons over a 6 month period, each 45 minutes length, the asymmetries on her lumbar
curvature had decreased, her balance ability improved for both legs and her pain decreased
substantially, from daily pain to 2 days of pain within a month. The Visual Analog Scale for Pain
(VAS) indicated an approximately 77% of decrease in pain. Moreover, the author states that
were substantially improvements in the abnormalities in the client’s postural coordination
following AT Lessons (Cacciatore et al., 2005, p.575).
He concluded that all the improvements were consistent with the assumption that deficits
in postural coordination associated with LBP, in particular deficits in automatic postural
coordination, can be changed through interventions like the Alexander Technique (Cacciatore et
al., 2005, p.575).
The sixth study implies that dynamic modulation of postural tone can be enhanced
through long-term training in AT. In addition to that, it suggests that the AT could constitute an
important direction for therapeutic intervention. (Cacciatore et al., 2011, p. 74-75) The authors
define postural tone as the ongoing subconscious muscular activity. They continue explaining
that postural tone is highly sensitive to the individual’s state (Cacciatore et al., 2011, p. 75).
This research has taken place at the Neurological Sciences Institute at the Oregon Health
& Science University. There, a group of scientist has developed, in 2011, a device, called
Twister, to study the regulation of tonic muscle activity during active postural maintenance.

Six years after the case report (8) until this research (6) the discussion correlating AT
with improvement on automatic postural coordination had evolved even further.
There were 37 subjects with maximal age of 60. Fourteen were AT teachers and fifteen
healthy control participants.
The study examined some items that reflect dynamic tonic modulation such as peak-to-
peak torque, cycle-to-cycle variability and phase-advance. The results showed that the mean
maximal peak-to-peak resistance of AT teachers was approximately half that of the matched
control subjects. In addition, the AT teachers had greater cycle-to-cycle variation compared with
the control group. Both outcomes were statistically significant. Consequently, it was suggested
that postural tone can be altered through training within an individual over a period of months to
years.
Based on the suggestion that dynamic modulation of postural tone is enhanced in AT
teachers, the article opens up a new discussion proposing that changes in tone after AT lessons
could be related to neural plasticity. Furthermore, the study proposed that the concept of
direction (conscious motor and bodily attention), used during AT lessons, is essential to produce
the desired adaptability of muscle tension (Cacciatore et al., 2011, p. 87).
The other research (number 7) happened in the same year of 2011. The scientists were
more specific, choosing the sit-to-stand (STS) activity to compare the coordination between AT
teachers and control subjects. It is important to mention that the sit-to-stand activity is one of the
most used activities during an AT lesson.
A total of 29 participants were part of the study, 15 AT teacher and 14 control subjects.
The data was collected through a kinematic system in which markers were placed along some

parts of the body to get the information necessary to be processed and compared. Movement
phases, monotonicity of weight-shift and spinal angles were the data analyzed.
After gathering and analyzing the data the article states that “AT teachers had altered STS
phases, weigh-shift and spinal coordination, suggesting they employ a novel strategy for this
task” (Cacciatore et al., 2011, p. 4). This “STS strategy could help impaired populations rise
from a chair, such as the elderly or those with Parkinson’s disease” (Cacciatore et al., 2011, p. 5).
The most recent publication (number 5) was about the neuromechanical interference of
posture on movement. This time, the authors observed the act of sitting and standing in specific
circumstances such as rising from a chair at a very slow speed.
They compared 10 AT teachers with 10 healthy untrained (HU) adults. It was found that
“HU adults have more difficulty than the cohort of AT teachers when attempting to stand up
smoothly from a seated position” (Cacciatore et al., 2014, p. 723). In fact, the “HU were aware
of their jerky, discontinuous movement and inability to stand up smoothly for slow rises, while
AT teachers showed a gradual, prolonged weight shift to the feet with small increases in
velocity.” (Cacciatore et al., 2014, p. 723 -724)
The study endorses the former findings about the enhancement dynamic modulation of
postural tone through long-term training in AT. The research states that “poor postural regulation
has the capacity to affect movement profoundly” (Cacciatore et al., 2014, p. 727).
Furthermore, the scientists purposed a hypothesis that might be a forerunner of
tomorrow’s additional intervention for older adults. Based on the HU’s results, the authors
suggest that this limitation on performing the STS is in the central nervous system’s control of
the action” (Cacciatore et al., 2014, p. 724). It suggests that the elderly's tonic postural activity
suffer from an exacerbated interference (Cacciatore, Mian, Peters & Day, 2013, p. 727). The

author hypothesizes that the difficulty that older adults have on the sit-to-stand action could not
be derived from a fear of falling or low strength. It could derive from a poor ability to regulate
the postural tone. “If this is the case, perhaps training program should not address strength or
teach greater momentum, but instead address postural control to reduce its interference with
movement, leading to more efficient coordination” (Cacciatore et al., 2014, p. 727). If the AT
lessons could regulate and improve the tonic postural activity, as suggested before by these
researchers, the Alexander Technique could be an effective training for the aging population by
reducing these interferences with movement.
PART IV
DISCUSSION, RECOMMENDATION AND CONCLUSION
This paper began by pointing out the new trend of the aging population for the years to
come. It also noted that a portion of the population is seeking alternatives to deal with their
health and well-being.
After reviewing the literature, it is reasonable to say that the samples from almost all
studies presented were small and that further controlled studies about the benefits of the
Alexander Technique on the aging population are necessary. As Rachel Zahn (2005) comments
“though there are thousands of Alexander Teachers in the world and a hundred years’ worth of
validating testimonials from highly respected scientists and philosophers, F.M. Alexander’s ideas
are still far ahead of the formal validation criterion of social institutions” (Zahn, 2005, p. 29).
However, all the studies reviewed in this paper suggest a statistically significant
improvement in balance, coordination, sit-to-stand strategies and lower back pain after AT
lessons. Another study, not presently described, suggests greater respiratory capacity as an effect
from AT lessons (Austin & Ausubel, 1992). Other benefits claimed by AT teachers include

better posture, decreased stress and stiffness, control over unwanted reaction, increased general
well-being and healthier lifestyle changes.
In order to stimulate further discussion on the potential benefits from this technique for
the aging population, the correlations between gerontology terminologies and the AT, made in
the introduction of this paper, will be clarified.
The Alexander Technique is a method that teaches how the mind and body work together
when performing any action (Reveillau, 2014). This is in accordance with what Longino and
Powell (2004) suggests as an essential characteristic of caring for older adults. This model
emphasizes the mind-body connection (Longino & Powell, 2004, p. 208). The AT sees the
individuals as psychophysical units. This could be supported by Baltes and Smith’s (1997) model
of achieving a comprehensive understanding of the individual process of aging.
One could say that Langer’s studies support the influence of mind-body practices on the
process of aging. The 1989 study by Langer, Alexander, Chandler, Newman and Davies notes
that “changes in state of consciousness or cognitive mode through specific mental technique can
indeed mediate substantive improvements in the health and cognitive functioning of the elderly”
(p. 961).
In addition to that, it is possible to say that the Alexander Technique is a strategic tool in
dealing with whatever the circumstances are. This idea reflects the concept of resilience
proposed by Wild, Wiles and Allien (2013).
The Alexander Technique teaches us to make better plans and to choose what is more
appropriate for one’s circumstances. That gives the older adult the chance to adapt and make the
best of their situation (Moody, 2005). Thus the AT is congruent with the Positive Aging concept
( Wykle, Whitehouse & Morris, 2005, p. 61).

The concept of plasticity (Rabello de Castro, 2011, Baltes, 1990) is embedded in the
Alexander Technique in that one learns to use oneself in new ways, by changing habitual uses.
Moreover, the idea of latent reserve, which means the possibility to learn new things in
advanced age (Baltes, 1990, p. 9-10), is ingrained within the Alexander Technique as a learning
process. Like learning to play a guitar, one learns to manage oneself.
In addition, the Alexander Technique is compatible with the lifespan developmental
psychology approach which postulates that people have the potential to develop as long as they
live. As Frederick Mathias Alexander once wrote: “we never reach the point when we may be
said to finish learning” (p. 201).
It is also important to clarify that the Alexander Technique “is not incompatible with the
practice of conventional medicine. Rather, it emphasizes a view that has gained wide acceptance
among members of the medical community, a view that each person has the capacity and the
responsibility for optimizing his or her sense of well-being” (Edlin, Golanty & Brown, 1998).
Having said that, I would suggest that the AT could be offered to independent older
adults, with low impaired cognition and with few comorbidities, in wellness programs offered by
senior centers and assisted living communities. The AT lessons could also be suitable in outreach
programs which have been increasingly offered around Portland, OR, as a way of supporting the
aging-in-place movement. Examples of outreach programs are the Neighborhood Housing and
Care Program (NHCP) at Our House of Portland and the Villages NW services. The necessary
equipment for the one-on-one AT lessons are solely a massage table and a chair.
This paper has demonstrated that older adults could profit by some benefits of Alexander
Technique which has been validated by scientific criteria. This research paper also has

demonstrated that older adults not only have the ability to learn this technique but also have an
incredible opportunity on their hands to contradict all the fixed ideas about how one should age.
It is hoped that this paper will provide enough information to inspire interest in new
research about the Alexander Technique’s benefits and to allow the inclusion of certified
Alexander Technique teachers in programs offered to the aging population.
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