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Yoga in sedentary adults with arthritis: effects of a randomized controlled pragmatic trial

Research paper by Steffany Moonaz, Clifton O. Bingham, III, L Wissow, and Susan J. Bartlett. Journal of Rheumatology. 2015;42(7):1194-202. doi: 10.3899/jrheum.141129.

This parallel-arm pragmatic 8-week randomized controlled trial examined the effect of Hatha yoga on physical health and arthritis symptoms in sedentary adults with knee osteoarthritis (OA) or rheumatoid arthritis (RA). “For people with arthritis, physical activity is essential for optimal disease management and improving mobility,” the authors wrote in the introduction to their study paper.

They continued, “Exercise helps maintain range of motion, joint stability, and muscle mass, while reducing pain and fatigue. . . . Yoga may be well-suited for arthritis by combining physical activity with potent stress management techniques including breathing, relaxation, and mindfulness.”

Studies with pragmatic designs test interventions in everyday clinical settings to determine if they will work in real-life situations. Pragmatic studies have flexible inclusion criteria for participants, hence the inclusion of both RA and OA patients in this trial.

“Yoga may be well-suited for arthritis by combining physical activity with potent stress management techniques including breathing, relaxation, and mindfulness.”

Seventy-five sedentary adults (average age, 52 years), mostly female (96%), were randomized to either the yoga intervention (40 participants) or put on a waitlist (35 participants). The 8-week yoga intervention included twice-weekly 60-minute classes taught by yoga therapists at one of two hospital-affiliated fitness centers, as well as one weekly home practice. 

Yoga classes were structured to include time for Q&A (5 min); pranayama and chanting (5 min); warm-ups, then gentle asana, to increase strength, flexibility, and balance (35 min); deep relaxation (10 min); and closing meditation (5 min). Backbends, forward bends, balance poses, and twists were included, and all poses were modified according to participant needs. 

“Participants were encouraged to try new skills but remain safe and avoid discomfort,” the investigators noted.

To help participants develop an at-home practice, investigators provided take-home instructions weekly. These instructions included pictures and selected readings. At the end of 8 weeks, 53 participants (25 in the yoga group, 28 in the waitlist group) had completed the study. Data on physical health and fitness, psychological function, and health-related quality of life (HRQL) were collected through patient self-reporting (primarily using the Medical Outcomes Study Short Form [SF-36] physical component summary [PCS]) and through clinician-assessed performance measures of flexibility, balance, grip strength, and walk capacity.

Data analysis revealed several key findings:

  • Yoga was associated with significantly higher physical health and fitness (as measured by PCS scores) vs the control group.
  • Yoga participants demonstrated a significantly higher walking capacity vs control. (Walk capacity was assessed with the 6-minute walk test [6MWT], which measures the distance a person is able to walk on a hard and flat surface.)
  • Flexibility score was higher in the yoga group, but this difference was not significant.
  • Balance and grip strength were similar between groups.
  • Yoga participants reported less impairment in HRQL measures vs control, with significant improvements shown in the PCS scales for bodily pain; role limitations due to physical health problems; mental health (ie, psychological distress and well-being); vitality (ie, energy level); and perceptions of general health.
  • Psychological function was further measured with the Center for Epidemiologic Studies Depression Scale (CES-D), with yoga participants reporting significantly fewer symptoms of depression vs waitlist participants.

For the 25 study participants with RA, measures were used to assess RA disease activity: a tender and swollen joint count conducted by clinicians, and a patient questionnaire. No signifiant differences were found between the yoga and control groups in these measures.

At the 8-week point, participants who had been randomized to the waitlist were offered the yoga intervention as well. Of the 28 participants in the waitlist group, 22 took part in the program. Data collected on these participants mirrored the results of the yoga group in the initial study, and when investigators pooled data from all yoga participants, significant improvements were shown in PCS scores, flexibility, 6MW, all psychological scores, and most HRQL scores. No yoga-related adverse events were reported.

Furthermore, the study team explored the longterm effects of the yoga intervention in all available yoga participants 9 months after the study. The investigators observed that “significant improvements were still evident in physical function, role physical, pain, general health, and energy” in the 37 yoga participants available at 9 months. 

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