Purpose of Review
This study aims to systematically review and summarise the efficacy and safety of yoga for osteoarthritis. Medline (through PubMed), Scopus, and the Cochrane Library were searched through April 2018 for randomised controlled trials of yoga for osteoarthritis. Primary outcomes were pain intensity, function, and quality of life; secondary outcomes were mental health and safety. Risk of bias was assessed using the Cochrane tool and quality of evidence through GRADE.
Nine trials including 640 individuals with mainly lower extremity osteoarthritis aged 50–80 years were identified, with 80.3% female participants (median). Meta-analyses revealed very low–quality evidence for the effects of yoga on pain (vs. exercise: standardised mean difference (SMD) = − 1.07; 95%CI − 1.92, − 0.21; p = 0.01; vs. non-exercise: SMD = − 0.75; 95%CI − 1.18, − 0.31; p < 0.001), physical function (vs. exercise: SMD = 0.80; 95%CI 0.36; 1.24; p < 0.001; vs. non-exercise: SMD = 0.60; 95%CI 0.30, 0.98; p < 0.001), and stiffness (vs. exercise: SMD = − 0.92; 95%CI − 1.69, − 0.14; p = 0.008; vs. non-exercise: SMD = − 0.76; 95%CI − 1.26, − 0.26; p = 0.003) in individuals with knee osteoarthritis. Effects were not robust against potential methodological bias. No effects were found for quality of life, and depression, or for hand osteoarthritis. Safety was rarely reported.
The findings of this meta-analysis indicate that yoga may be effective for improving pain, function, and stiffness in individuals with osteoarthritis of the knee, compared to exercise and non-exercise control groups. Due to the low methodological quality and potential risk of bias, only a weak recommendation can be made at this time for the use of yoga in adults with osteoarthritis of the knee.
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Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039–49.
Reginster JY. The prevalence and burden of arthritis. Rheumatology (Oxford). 2002;41(Supp 1):3–6.
Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartil. 2011;19(11):1270–85. https://doi.org/10.1016/j.joca.2011.08.009.
Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR evidence based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2005;64(5):669–81. https://doi.org/10.1136/ard.2004.028886.
Lapane KL, Sands MR, Yang S, McAlindon TE, Eaton CB. Use of complementary and alternative medicine among patients with radiographic-confirmed knee osteoarthritis. Osteoarthr Cartil. 2012;20(1):22–8. https://doi.org/10.1016/j.joca.2011.10.005.
Cramer H, Ward L, Steel A, Lauche R, Dobos G, Zhang Y. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. Am J Prev Med. 2016;50(2):230–5. https://doi.org/10.1016/j.amepre.2015.07.037.
Feuerstein G. The yoga tradition. Prescott: Hohm Press; 1998.
Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008(12):1–23.
Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report 2015(79):1–16.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. https://doi.org/10.1136/bmj.b2535.
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. John Wiley & Sons Ltd: West Sussex; 2008.
Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med. 2014;14:328. https://doi.org/10.1186/1472-6882-14-328.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates; 1998.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6. https://doi.org/10.1136/bmj.39489.470347.AD.
Brenneman EC, Kuntz AB, Wiebenga EG, Maly MR. A yoga strengthening program designed to minimize the knee adduction moment for women with knee osteoarthritis: a proof-of-principle cohort study. PLoS One. 2015;10(9):e0136854. https://doi.org/10.1371/journal.pone.0136854.
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(3):287–305. https://doi.org/10.2190/IQ.26.3.f.
Park J, McCaffrey R. Chair yoga: benefits for community-dwelling older adults with osteoarthritis. J Gerontol Nurs. 2012;38(5):12–22; quiz 4-5. https://doi.org/10.3928/00989134-20120410-01.
Taibi DM, Vitiello MV. A pilot study of gentle yoga for sleep disturbance in women with osteoarthritis. Sleep Med. 2011;12(5):512–7. https://doi.org/10.1016/j.sleep.2010.09.016.
Bedekar N, Prabhu A, Shyam A, Sancheti K, Sancheti P. Comparative study of conventional therapy and additional yogasanas for knee rehabilitation after total knee arthroplasty. Int J Yoga. 2012;5(2):118–22. https://doi.org/10.4103/0973-6131.98226.
Ghasemi GA, Golkar A, Marandi SM. Effects of hata yoga on knee osteoarthritis. Int J Prev Med. 2013;4(Suppl 1):S133–8.
Krejci M. Yoga training application in overweight control of seniors with arthritis/osteoarthritis. Fizjoterapia. 2011;19(2):3–8. https://doi.org/10.2478/v10109-011-0014-6.
Nambi GS, Shah AA. Additional effect of iyengar yoga and EMG biofeedback on pain and functional disability in chronic unilateral knee osteoarthritis. Int J Yoga. 2013;6(2):123–7. https://doi.org/10.4103/0973-6131.113413.
Buchanan DT, Vitiello MV, Bennett K. Feasibility and efficacy of a shared yoga intervention for sleep disturbance in older adults with osteoarthritis. J Gerontol Nurs. 2017;43:1–10. https://doi.org/10.3928/00989134-20170405-01.
Cheung C, Wyman JF, Savik K. Adherence to a yoga program in older women with knee osteoarthritis. J Aging Phys Act. 2016;24(2):181–8. https://doi.org/10.1123/japa.2015-0048.
McCaffrey R, Park J, Newman D. Chair yoga: feasibility and sustainability study with older community-dwelling adults with osteoarthritis. Holist Nurs Pract. 2017;31(3):148–57. https://doi.org/10.1097/hnp.0000000000000184.
Moonaz SH, Bingham CO 3rd, Wissow L, Bartlett SJ. Yoga in sedentary adults with arthritis: effects of a randomized controlled pragmatic trial. J Rheumatol. 2015;42(7):1194–202. https://doi.org/10.3899/jrheum.141129.
Park J, McCaffrey R, Newman D, Liehr P, Ouslander JG. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc. 2017;65(3):592–7. https://doi.org/10.1111/jgs.14717.
Ebnezar J, Yogitha B. Effectiveness of yoga therapy with the therapeutic exercises on walking pain, tenderness, early morning stiffness and disability in osteoarthritis of the knee joint - a comparative study. J Yoga Phys Ther. 2012;2:114.
Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: a randomized control study. Int J Yoga. 2012;5(1):28–36. https://doi.org/10.4103/0973-6131.91708.
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):463–72. https://doi.org/10.1089/acm.2010.0320.
Ebnezar J, Nagarathna R, Bali Y, Nagendra HR. Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: a randomized control study. Int J Yoga. 2011;4(2):55–63. https://doi.org/10.4103/0973-6131.85486.
Cheung C, Wyman JF, Bronas U, McCarthy T, Rudser K, Mathiason MA. Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int. 2017;37(3):389–98. https://doi.org/10.1007/s00296-016-3620-2.
Cheung C, Wyman JF, Resnick B, Savik K. Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial. BMC Complement Altern Med. 2014;14:160. https://doi.org/10.1186/1472-6882-14-160.
Park J, McCaffrey R, Newman D, Cheung C, Hagen D. The effect of Sit “N” Fit Chair Yoga among community-dwelling older adults with osteoarthritis. Holist Nurs Pract. 2014;28(4):247–57. https://doi.org/10.1097/hnp.0000000000000034.
Park J, McCaffrey R, Dunn D, Goodman R. Managing osteoarthritis: comparisons of chair yoga, Reiki, and education (pilot study). Holist Nurs Pract. 2011;25(6):316–26. https://doi.org/10.1097/HNP.0b013e318232c5f9.
Park J, Newman D, McCaffrey R, Garrido JJ, Riccio ML, Liehr P. The effect of chair yoga on biopsychosocial changes in English- and Spanish-speaking community-dwelling older adults with lower-extremity osteoarthritis. J Gerontol Soc Work. 2016;59(7–8):604–26. https://doi.org/10.1080/01634372.2016.1239234.
Kuntz AB, Chopp-Hurley JN, Brenneman EC, Karampatos S, Wiebenga EG, Adachi JD, et al. Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: a randomized controlled trial. PLoS One. 2018;13(4):e0195653. https://doi.org/10.1371/journal.pone.0195653.
Garfinkel MS, Schumacher HR Jr, Husain A, Levy M, Reshetar RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol. 1994;21(12):2341–3.
Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:Cd004376. https://doi.org/10.1002/14651858.CD004376.pub3.
Osteras N, Kjeken I, Smedslund G, Moe RH, Slatkowsky-Christensen B, Uhlig T, et al. Exercise for hand osteoarthritis. Cochrane Database Syst Rev. 2017;1:Cd010388. https://doi.org/10.1002/14651858.CD010388.pub2.
Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for rheumatic diseases: a systematic review. Rheumatology (Oxford). 2013;52(11):2025–30. https://doi.org/10.1093/rheumatology/ket264.
Kim S, Bemben MG, Bemben DA. Effects of an 8-month yoga intervention on arterial compliance and muscle strength in premenopausal women. J Sports Sci Med. 2012;11(2):322–30.
Peeler J, Ripat J. The effect of low-load exercise on joint pain, function, and activities of daily living in patients with knee osteoarthritis. Knee. 2018;25(1):135–45. https://doi.org/10.1016/j.knee.2017.12.003.
Findlay DM. Vascular pathology and osteoarthritis. Rheumatology (Oxford). 2007;46(12):1763–8. https://doi.org/10.1093/rheumatology/kem191.
Middleton KR, Magaña López M, Haaz Moonaz S, Tataw-Ayuketah G, Ward MM, Wallen GR. A qualitative approach exploring the acceptability of yoga for minorities living with arthritis: ‘where are the people who look like me?’. Complement Ther Med. 2017;31:82–9. https://doi.org/10.1016/j.ctim.2017.02.006.
Bhimani NT, Kulkarni NB, Kowale A, Salvi S. Effect of Pranayama on stress and cardiovascular autonomic function. Indian J Physiol Pharmacol. 2011;55(4):370–7.
Sinha B, Sinha TD, Pathak A, Tomer OS. Comparison of cardiorespiratory responses between Surya Namaskar and bicycle exercise at similar energy expenditure level. Indian J Physiol Pharmacol. 2013;57(2):169–76.
Vallath N. Perspectives on yoga inputs in the management of chronic pain. Indian J Palliat Care. 2010;16(1):1–7. https://doi.org/10.4103/0973-1075.63127.
Cramer H, Anheyer D, Lauche R, Dobos G. A systematic review of yoga for major depressive disorder. J Affect Disord. 2017;213:70–7. https://doi.org/10.1016/j.jad.2017.02.006.
Desveaux L, Lee A, Goldstein R, Brooks D. Yoga in the management of chronic disease: a systematic review and meta-analysis. Med Care. 2015;53(7):653–61. https://doi.org/10.1097/mlr.0000000000000372.
Cramer H, Ostermann T, Dobos G. Injuries and other adverse events associated with yoga practice: a systematic review of epidemiological studies. J Sci Med Sport. 2018;21(2):147–54. https://doi.org/10.1016/j.jsams.2017.08.026.
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. 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(7):1334–59. https://doi.org/10.1249/MSS.0b013e318213fefb.
Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309.
Slade SC, Dionne CE, Underwood M, Buchbinder R, Beck B, Bennell K, et al. Consensus on exercise reporting template (CERT): modified Delphi study. Phys Ther. 2016;96(10):1514–24. https://doi.org/10.2522/ptj.20150668.
Ioannidis JP, Evans SJ, Gotzsche PC, O'Neill RT, Altman DG, Schulz K, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141(10):781–8.
Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28–55. https://doi.org/10.1016/j.ijsu.2011.10.001.
DJH is supported by an NHMRC Practitioner Fellowship. JA is supported by an ARC Professorial Future Fellowship (FT140100195).
Conflict of Interest
Romy Lauche, Jon Adams, and Holger Cramer each declare no potential conflicts of interest.
David J. Hunter has received person fees from Merck Serono, Pfizer, Lilly, and TLCBio,
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Lauche, R., Hunter, D.J., Adams, J. et al. Yoga for Osteoarthritis: a Systematic Review and Meta-analysis. Curr Rheumatol Rep 21, 47 (2019). https://doi.org/10.1007/s11926-019-0846-5