This randomized trial evaluated the effectiveness of yoga among adults with symptomatic knee osteoarthritis. The investigators assessed changes in knee pain during walking, physical function, and other outcomes over 12 weeks among adults who received online osteoarthritis information plus access to an unsupervised online yoga program versus information alone.
Abstract
Background:
Yoga is a mind–body exercise typically done in groups in person, but this delivery method can be inconvenient, inaccessible, and costly. Effective online programs may increase access to exercise for knee osteoarthritis.
Objective:
To evaluate the effectiveness of an unsupervised 12-week online yoga program.
Design:
Two-group superiority randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12620000012976)
Setting:
Community.
Participants:
212 adults with symptomatic knee osteoarthritis.
Intervention:
Both groups received online osteoarthritis information (control). The yoga group also received access to an unsupervised online yoga program delivered via prerecorded videos over 12 weeks (1 video per week, with each session to be performed 3 times per week), with optional continuation thereafter.
Measurements:
Primary outcomes were changes in knee pain during walking (0 to 10 on a numerical rating scale) and physical function (0 to 68 on the Western Ontario and McMaster Universities Osteoarthritis Index) at 12 weeks (primary time point) and 24 weeks, analyzed using mixed-effects linear regression models. Secondary outcomes were self-reported overall knee pain, stiffness, depression, anxiety, stress, global change, quality of life, self-efficacy, fear of movement, and balance confidence. Adverse events were also collected.
Results:
A total of 195 (92%) and 189 (89%) participants provided 12- and 24-week primary outcomes, respectively. Compared with control at 12 weeks, yoga improved function (between-group mean difference in change, −4.0 [95% CI, −6.8 to −1.3]) but not knee pain during walking (between-group mean difference in change, −0.6 [CI, −1.2 to 0.1]), with more yoga participants than control participants achieving the minimal clinically important difference (MCID) for both outcomes. At 12 weeks, knee stiffness, quality of life, and arthritis self-efficacy improved more with yoga than the control intervention. Benefits were not maintained at 24 weeks. Adverse events were minor.
Limitation:
Participants were unblinded.
Conclusion:
Compared with online education, an unsupervised online yoga program improved physical function but not knee pain at 12 weeks in people with knee osteoarthritis, although the improvement did not reach the MCID and was not sustained at 24 weeks.
Primary Funding Source:
National Health and Medical Research Council and Centres of Research Excellence.
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Author, Article, and Disclosure Information
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., S.S., P.L.T., S.H., D.M., A.J.K., B.M., R.S.H.)
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia (F.M.)
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, and Methods and Implementation Support for Clinical Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.E.L.)
Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia (D.J.H.).
Acknowledgment: The authors thank Associate Professor Romy Lauche and the expert panel (Maria Kirsten, Lisa Westlake, Therese Lew, Trish David, Margaret Clarke, and Elizabeth Nelson) for their involvement in the development and design of the yoga program; Lisa Westlake (instructor) and Shayne Milsom, Margaret Clarke, and Bob Gardner (group actors) for starring in the yoga videos; and Dr. Jessica Kasza for formulating the sample size and randomization schedule.
Grant Support: By a National Health and Medical Research Council Program Grant (#1091302) and the Centres of Research Excellence (#1079078).
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-1761.
Data Sharing Statement: The following data will be made available beginning 1 January 2023: deidentified participant data and data dictionary. We will share all data that support published results of the trial. Additional data that have not been published will be withheld until at least 6 months after publication. Data will be made available as required for specific, approved analyses and will be provided from a locked, cleaned, and deidentified study database. Requests will be reviewed by the principal investigator before approval. The following supporting documents will be made available beginning on 1 January 2023: statistical/analytic code and informed consent form (contact the principal investigator, Kim Bennell, at k.
Corresponding Author: Kim L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia; e-mail, k.
Author Contributions: Conception and design: K.L. Bennell, R.S. Hinman, D.J. Hunter, S. Schwartz, P.L. Teo.
Analysis and interpretation of the data: K.L. Bennell, R.S. Hinman, D.J. Hunter, K.E. Lamb, F. McManus, B. Metcalf, P.L. Teo.
Drafting of the article: K.L. Bennell, A.J. Kimp, K.E. Lamb, B. Metcalf, P.L. Teo.
Critical revision for important intellectual content: K.L. Bennell, R.S. Hinman, D.J. Hunter, K.E. Lamb, F. McManus, B. Metcalf, P.L. Teo.
Final approval of the article: K.L. Bennell, S. Hawkins, R.S. Hinman, D.J. Hunter, A.J. Kimp, K.E. Lamb, D. Mackenzie, F. McManus, B. Metcalf, S. Schwartz, P.L. Teo.
Statistical expertise: K.E. Lamb, F. McManus.
Obtaining of funding: K.L. Bennell.
Administrative, technical, or logistic support: K.L. Bennell, S. Hawkins, A.J. Kimp, D. Mackenzie, B. Metcalf, S. Schwartz, P.L. Teo.
Collection and assembly of data: A.J. Kimp, B. Metcalf, S. Schwartz, P.L. Teo.
This article was published at Annals.org on 20 September 2022.
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