Archive for the ‘Yoga Science Arthritis’ Category

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. 

Summary by Yogabright.com

Research paper by Sharon L. Kolasinski, Marian Garfinkel, Adam Gilden Tsai, Whitney Matz, Alison Van Dyke, H. Ralph Schumacher, Jr. The Journal of Alternative and Complementary Medicine. 2005:11(4):689-693.

This 8-week pilot study was designed to assess the feasibility and safety of using Iyengar yoga to treat symptoms of osteoarthritis (OA) of the knees. In the introduction to their research paper, the investigators noted that practice guidelines for the medical management of OA recognize that “exercise, including both aerobic and strengthening, as well as range of motion, are essential elements of any treatment program for OA of the knees.” For their study, they hypothesized that yoga—which, they noted, “improves both flexibility and strength”—may be an effective addition to a comprehensive treatment for knee OA. 

The Iyengar style of yoga was chosen for the study because of its emphasis on “strength, flexibility, and relaxation, with particular attention to alignment of body structures,” the researchers explained.

The participants in this study were ≥50 years of age and had symptomatic OA in at least one knee 6 months prior to study entry. They had no prior experience with yoga, and they did not participate in any physical therapy or exercise program during the trial. No change in arthritis medication was permitted during the study.

For their study, [the authors] hypothesized that yoga—which, they noted, “improves both flexibility and strength”—may be an effective addition to a comprehensive treatment for knee OA.

Eleven participants were enrolled. Each week, they received one Iyengar-based yoga intervention ranging from 60 to 90 minutes long. (Participants were required to attend a minimum of five sessions to be included in the final study analysis.) 

Sessions were taught by a certified senior Iyengar instructor and included 15 postures selected from B.K.S. Iyengar’s Light on Yoga, including variations of Tadasana (mountain pose), Utthita Trikonasana (triangle pose), Virabhadrasana (warrior pose), Dandasana (staff pose), Supta Padangusthasana (reclining big toe pose), Ardha Uttanasana (flat back pose), Prasarita Padottanasana (wide-legged forward bend), Baddha Konasana (bound angle pose), Virasana (hero’s pose), and Savasana (deep relaxation).  

“Iyengar yoga allows for individual variation in the ability of participants and specifically includes the use of assistive devices such as blocks, belts, and blankets to support parts of the body while performing the asanas,” the researchers wrote. They added that “participants were encouraged to stretch as fully as possible while not exceeding the limits of their comfort . . .” 

Of the original 11 participants, 7 were eligible for analysis at the end of the study. They were female and ranged in age from 50 to 68 years. (Six were obese.) No adverse events were reported. Comparison of pre- and post-study data revealed the following encouraging findings:

• Statistically significant improvement in pain and physical function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Physical Function subscales
• Improvement (although not statistically significant) in stiffness score, also measured with WOMAC
• Statistically significant improvement in “affect”— ie, depression and anxiety—as measured by the Arthritis Impact Measurement Scale 2 (AIMS2), a health-related quality-of-life measurement tool filled out by patients
• A large, but not significant, improvement in symptoms, as measured by AIMS2
• Improvement trends in physician-reported and patient-reported global assessments (Global assessments are commonly use scales that allow physicians and patients to measure study variables, such as change in disease symptoms.) 

“This pilot study suggested that yoga may provide a feasible treatment option for previously yoga-naive, obese patients >50 years of age and offers potential reductions in pain and disability caused by knee OA,” the investigators concluded.

Summary by YogaBright.com

Research paper by Marian S. Garfinkel, H. Ralph Schumacher, Jr, A Husain, M. Levy, Rosemary Reshetar. Journal of Rheumatology. 1994;21(12):2341-2343. 

This randomized, controlled 8-week trial was conducted to observe the effect of yoga on musculoskeletal symptoms in patients with osteoarthritis (OA) of the hands. Thirty participants were randomized to either the treatment group (19 patients), which received 1 weekly 60-minute session of therapeutic Iyengar-based yoga, or the control group (11 patients), which received no treatment.

Participants who received the yoga intervention were taught yoga postures that emphasized stretching and strengthening, with a focus on alignment. Sessions included group discussion.

Study variables—which included hand pain, range of motion, tenderness, and hand function—were assessed with the Stanford Hand Assessment questionnaire. Comparison of pre- and post-treatment data revealed:

• Statistically significant improvement in the yoga group vs the control group in three domains: hand pain during activity, tenderness of the finger joints, and finger range of motion
• Trends toward improvement in hand pain at rest and hand function in the yoga group vs control   

No adverse effects were reported during the study. The investigators concluded that while the program was effective in providing relief in hand OA, further studies are needed to compare yoga interventions with other treatments, and to observe long-term effects of a yoga intervention for hand OA.

Summary by YogaBright.com