At the Live Well centre in San Diego and a group of seniors are skipping, clapping and hooting in the recreation room.
That's precisely what Dr Caroline Meeks, aka "Dr Funshine," ordered. As part of her holistic practice, Meeks, a physician and author, visits senior centres and hospitals aiming to treat chronic seriousness.
Her prescription: frequent doses of "laughter yoga" an hour-long, mind-body exercise class that combines yogic breathing with simulated physical laughter and silly banter.
The exercises, combined with playfulness, singing, dancing and eye contact, usually induce authentic cackling, which Meeks and others believe is good medicine for everybody from cancer patients to people with dementia and depression.
"It's hard to laugh and worry at the same time, or be angry or be profoundly sad, or in pain at that moment. Laughter makes you shift towards ... feeling more connected, grateful, positive," said Meeks.
There is very little research into the connection between laughter and disease remission but some clinical studies have shown that it raises oxygen levels in the lungs, lowers blood pressure and reduces the stress hormone, cortisol.
Taking laughter seriously
Since the introduction of laughter yoga by Dr Madan Kataria and his yoga teacher wife Madhuri in Mumbai, India, in 1995 it has proliferated. Today there are more than 6,000 laughter groups in 60 countries.
Meeks came to laughter yoga stressed out after working in paediatrics for two decades, followed by caring for elder relatives and writing the book "Prescriptions for Parenting."
"I was so enchanted with how quickly it could create an emotional shift in my own body. It was like having a shot of tequila or falling in love or having a great day at the amusement park or watching a funny movie."
"I was hooked and decided, as a physician, to bring more credibility to the laughter movement as something therapeutic for all people," Meeks said.
Recently, Meeks addressed a few dozen seniors. Dementia patient Thelma Howell, 89, stared blankly and a retired minister named Richard had hearing loss.
"I would scrub floors if I had to, to come here," said Wanda Boyce, 87, a professional clown. "Sometimes I think I can't make it, but when I leave here to go home, I'm high."
Meeks began by introducing the minister, who she said has the loudest belly laugh of all.
Welcome to laugh yoga
"This is Richard, everybody! Ha ha ha," Meeks said. "Welcome to Laugh Yoga, where we laugh for no reason at all!"
Laughter yoga does not require comedic material, according to Michael Coleman, a lawyer who received laughter training from Kataria.
"This is a form of exercise when we initiate laughter intentionally from the body," Coleman said.
Near the end of the class, Meeks pretended to pull out "laughter cream" and rubbed it on her arms, encouraging the seniors to do the same, calling it "rejuvenating cream."
Meeks turned to Howell, who continued to stare blankly.
"Pretty silly, Thelma, don't you think? Pretty silly?"
"I think it's fun!" Howell said, suddenly beaming. She rubbed on some imaginary cream and giggled.
Meeks said: "It gives me chills. Thelma is carrying on a conversation ... She came in and she was like, huh? And now she's responding to somebody's voice and following her story. I am amazed."
(Reuters Health, Sarah Tippit, November 2010)