Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial

Corjena Cheung, Jean F Wyman, Barbara Resnick, Kay Savik, Corjena Cheung, Jean F Wyman, Barbara Resnick, Kay Savik

Abstract

Background: Osteoarthritis (OA) is a common problem in older women that is associated with pain and disabilities. Although yoga is recommended as an exercise intervention to manage arthritis, there is limited evidence documenting its effectiveness, with little known about its long term benefits. This study's aims were to assess the feasibility and potential efficacy of a Hatha yoga exercise program in managing OA-related symptoms in older women with knee OA.

Methods: Eligible participants (N=36; mean age 72 years) were randomly assigned to 8-week yoga program involving group and home-based sessions or wait-list control. The yoga intervention program was developed by a group of yoga experts (N=5). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score that measures knee OA pain, stiffness, and function at 8 weeks. The secondary outcomes, physical function of the lower extremities, body mass index (BMI), quality of sleep (QOS), and quality of life (QOL), were measured using weight, height, the short physical performance battery (SPPB), the Pittsburgh Sleep Quality Index (PSQI), the Cantril Self-Anchoring Ladder, and the SF12v2 Health Survey. Data were collected at baseline, 4 weeks and 8 weeks, and 20 weeks.

Results: The recruitment target was met, with study retention at 95%. Based on ANCOVAs, participants in the treatment group exhibited significantly greater improvement in WOMAC pain (adjusted means [SE]) (8.3 [.67], 5.8 [.67]; p=.01), stiffness (4.7 [.28], 3.4 [.28]; p=.002) and SPPB (repeated chair stands) (2.0 [.23], 2.8 [.23]; p=.03) at 8 weeks. Significant treatment and time effects were seen in WOMAC pain (7.0 [.46], 5.4 [.54]; p=.03), function (24.5 [1.8], 19.9 [1.6]; p=.01) and total scores (35.4 [2.3], 28.6 [2.1]; p=.01) from 4 to 20 weeks. Sleep disturbance was improved but the PSQI total score declined significantly at 20 weeks. Changes in BMI and QOL were not significant. No yoga related adverse events were observed.

Conclusions: A weekly yoga program with home practice is feasible, acceptable, and safe for older women with knee OA, and shows therapeutic benefits.

Trial registration: ClinicalTrials.gov: NCT01832155.

Figures

Figure 1
Figure 1
CONSORT Flow diagram of study participants.

References

    1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F. National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35. doi: 10.1002/art.23176.
    1. Centers for Disease Control and Prevention (CDC) Arthritis at a glance. 2012. .
    1. Allen KD, Renner JB, Devellis B. Hip and knee osteoarthritis significantly associated with sleep problems. J Rheumatol. 2008;35:1102–1107.
    1. Jakobsson U, Hallberg IR. Quality of life among older adults with osteoarthritis: an exploratory study. J Gerontol Nurs. 2006;32:51–60.
    1. Cheung CK, Wyman JF, Halcon LL. Use of complementary and alternative therapies in community-dwelling older adults. J Altern Complement Med. 2007;13:997–1006. doi: 10.1089/acm.2007.0527. doi: 10.1089/acm.2007.0527.
    1. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee, 2000 update. Arthritis Rheum. 2000;43:1905–1915.
    1. Garfinkel M, Schumacher HR. Yoga. Rheum Dis Clin N Am. 2000;26:125–132. doi: 10.1016/S0889-857X(05)70126-5.
    1. National Center for Complementary and Alternative Medicine. Yoga. . Accessed June 2, 2013.
    1. Taylor MJ. Yoga therapeutics: an ancient, dynamic systems theory. Tech Orthop. 2003;18:115–125. doi: 10.1097/00013611-200303000-00017.
    1. Grober JS, Thethi AK. Osteoarthritis: when are alternative therapies a good alternative? Consultant. 2003;43:197–202.
    1. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga. 2011;4(2):49–54. doi: 10.4103/0973-6131.85485. doi: 10.4103/0973-6131.85485.
    1. Smith JA, Greer T, Sheets T, Watson S. Is there more to yoga than exercise. Altern Ther. 2011;17:22–29.
    1. Arthritis Foundation. Yoga benefits for arthritis. .
    1. Bussing A, Ostermann T, Ludtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012;13(1):1–9.
    1. Cramer H, Lauche R, Haller H, Dobos GA. Systematic review and meta-analysis of Yoga for low back pain. Clin J Pain. 2012. .
    1. Sawyer AM, Martinez SK, Warren GL. Impact of yoga on low back pain and function: a systematic review and meta-analysis. Yoga Phys Ther. 2012. .
    1. Haaz S, Bartlett SJ. Yoga for arthritis: a scoping review. Rheum Dis Clin North Am. 2011;37(1):33–46. doi: 10.1016/j.rdc.2010.11.001. doi: 10.1016/j.rdc.2010.11.001.
    1. Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. J Altern Complement Med. 2012;18(5):463–472. doi: 10.1089/acm.2010.0320. doi:10.1089/acm.2010.0320.
    1. Kolasinski SL, Garfinkel M, Tsai AG. Iyengar Yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Alternative Compl Med. 2005;11:689–693. doi: 10.1089/acm.2005.11.689.
    1. Bukowski EL, Conway A, Glentz LA, Kurland K, Galantino ML. The effect of Iyengar Yoga and strengthening exercises for people living with osteoarthritis of the knee: a case series. Int Q Community Health Educ. 2006;26:287–305. doi: 10.2190/IQ.26.3.f.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley S, Mankin H, McShane DJ, Medsger T, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rothschild B, Segal M, Sokoloff L, Wolfe F. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee. Arthritis Rheum. 1986;29:1039–1049. doi: 10.1002/art.1780290816.
    1. Wu C, Morrell M, Heinze E, Concoff AL, Wollaston SJ, Arnold EL, Singh R, Charles C, Skovrun ML, FitzGerald JD, Moreland LW, Kalunian KC. Validation of American College of Rheumatology classification criteria for knee osteoarthritis using arthroscopically defined cartilage damage scores. Semin Arthritis Rheum. 2005;35(3):197–201. doi: 10.1016/j.semarthrit.2005.06.002.
    1. Pfeiffe E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975;23:433–441.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Guralnik J, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–M94. doi: 10.1093/geronj/49.2.M85.
    1. Buysse D, Reynold C, Monk T, Berman S, Kupfer D. Pittsburg sleep quality index. Psychiatry Res. 1989;28:193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Ware JE, Kosinski M, Keller SD. A 12-item Short Form health survey. Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233. doi: 10.1097/00005650-199603000-00003.
    1. Cantril H. The Pattern of Human Concerns. New Brunswick, NJ: Rutgers University Press; 1965.
    1. Chakraborty H, Gu HA. Mixed Model Approach for Intent-to-Treat Analysis in Longitudinal Clinical Trials with Missing Values. Research Triangle Park, NC: RTI International; 2009. .
    1. Garber CE, Blissmer B, Deschenes M, Franklin BA, Lamonte M, Lee IM, Nieman DC, Swain DP. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43:1334–1359. doi: 10.1249/MSS.0b013e318213fefb. .
    1. Grimm R, Spring K, Dietz N. The Health Benefits of Volunteering: A Review of Recent Research. Washington, DC: Corporation for National and Community Service, Office of Research and Policy Development; 2007. .
    1. Findorff M, Wyman J, Gross C. Predictors of long-term exercise adherence in a community-based sample of older women. J Women’s Health. 2009;18:1769–1776. doi: 10.1089/jwh.2008.1265.
    1. Monitor on Psychology. Yoga as a practice tool. APA. 2009;40(10) .
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16:137–162. doi: 10.1016/j.joca.2007.12.013.

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