Challenging Current Exercise Prescription for Osteoarthritis of the Knee with a Yoga-Inspired Approach

Abstract

Background: Knee osteoarthritis is a chronic disease involving the breakdown of joint tissues resulting in pain and disability. Exercise provides equivalent pain relief to medication, improves physical functioning, and ameliorates co-morbidities. However, certain forms of exercise can potentially overload the joint and exacerbate symptoms; the optimal type is unknown. We developed a yoga-based exercise intervention designed for knee osteoarthritis by incorporating postures that minimize a mechanical loading variable implicated in disease progression. Purpose: The objective was to compare the efficacy of this biomechanically-tailored yoga program as treatment for knee osteoarthritis with the current “gold standard” of physical therapy, and a no-exercise attention control group. Methods: A single-blinded, 12-week, 3-arm, parallel randomized control trial was conducted. Participants (women 50 years or over, with clinical knee osteoarthritis; n=31) were stratified by disease severity and randomized to receive biomechanical yoga exercise (YE; n=10), traditional exercise (TE; n=11), or no-exercise (NE; n=10). The primary outcome measure was pain; secondary outcomes included patient-reported physical function and mobility performance; and tertiary outcomes included muscular strength, quality-of-life, and symptoms of depression. Results: The YE and TE groups demonstrated statistically and clinically significant within-group improvements in pain, physical function, and mobility performance (p<0.017), while the NE group did not. The YE group reported greater improvements in pain compared to the NE group (p=0.003). The YE group also demonstrated greater improvements in physical function compared to NE (p=0.010). There were no significant between-group differences in mobility performance, strength, quality-of-life, or depression (p>0.05). Conclusion: Yoga appears as an efficacious and well-tolerated conservative treatment option for women with knee osteoarthritis. The yoga intervention yielded comparable, and in some cases possibly greater improvements in the major burdening symptoms of the disease compared to traditional physical therapy. Future investigations with larger samples are warranted to establish effectiveness and possibly superiority to traditional exercise.