Yoga Helps Both Rheumatoid Arthritis and Osteoarthritis: New Scientific Evidence

by Nina

A Poppy Bud by Melina Meza

“Preliminary evidence suggests yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health and HRQOL.”

Well, I really like everything about that sentence except that last acronym, which turns out to stand for “health-related quality of life.” (I not only wouldn’t have guessed that’s what HRQOL stood for in a million years, but as just looking at the acronym is causing my stress levels to spike a bit, it is causing the opposite effect of its own meaning.)

But, anyway, that sentence is the conclusion from the abstract of a scientific study Yoga in Sedentary Adults with Arthritis: Effects of a Randomized Controlled Pragmatic Trial by Moonaz, et al  that I wanted to tell you about. We have written a number of posts about arthritis in the past (see Arthritis of the Hip Joint, Arthritis of the Spine, Arthritis of the Shoulder, and Arthritis of the Knee, among others) so it’s obvious we’re convinced of the benefits that yoga provides for people (including me!) with this condition. But still it is always good to have a scientific study to back us up. And this new study is both the largest randomized controlled trial of osteoarthritis and rheumatoid arthritis and the first to “assess physical health and fitness using self-reported and performance measures along with psychological function and HRQOL.” 

The goal of this study was to contribute evidence about outcomes associated with yoga practice in sedentary people with arthritis. The researchers hypothesized that yoga would improve physical health, fitness, psychological function, health-related quality of life (HRQOL), and arthritis self-efficacy with no worsening of rheumatoid arthritis (RA) disease activity. They thought that yoga would be well suited for arthritis because it combines physical activity with potent stress management techniques, including breathing, relaxation, and mindfulness. So they asked a registered yoga therapist, with input from the Johns Hopkins Arthritis Center faculty, to develop an 8-week yoga program emphasizing individualized adaptations and monitoring, which they could introduce to beginners who had either rheumatoid arthritis or osteoarthritis of the knees.

Although the full study isn’t available to the general public, I was able to obtain a copy (thank you, Brad). So here’s a basic summary: 

1. The study was done on 75 sedentary adults 18 years or older, with rheumatoid arthritis or knee arthritis. Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean age of 52 years.

2. The subjects either participated in 8 weeks of Integral-based hatha yoga (two sixty minute classes and 1 home practice) or were waitlisted. (Eight weeks was selected for the intervention because this provides sufficient time to introduce independent practice and is a common duration of introductory classes.)

3. Two yoga therapists with 10+ years of experience led the yoga classes, and they provided close supervision and individual attention. 

4. The yoga classes included breath work and chanting (5 min), warm-up and moving sequence (surya namaskara, 15 min), and isometric poses (asanas, 20 min) to increase strength, flexibility, and balance. Classes ended with deep relaxation (sivasana, 10 min), a closing chant, and meditation (5 min).

Poses included gentle forward bends, backbends, twists, balances, standing, sitting, and lying poses, and were modified for individuals at the discretion of the teacher and/or participant. Props included blocks, straps, blankets, and chairs. Participants were encouraged to try new skills, but to remain safe and avoid discomfort. Written instructions with pictures for home practice and selected readings describing potential benefits of yoga components (breathing, meditation, mindfulness) were provided weekly. Home practice evolved gradually to develop the skills and confidence for long-term adherence. 

5. Participants were asked to keep arthritis medications constant and were queried regularly by coordinators about any changes. 

6. The waitlisted group received usual care for eight weeks. (They were asked to maintain current levels of physical activity and inform coordinators of changes in health or arthritis medications. After Week 8 assessments, they were invited to participate in upcoming classes.)

7. After eight weeks and again after 9 months, both groups were measured fitness, psychological function, and HRQO using standardized protocols

The researchers concluded that eight weeks of yoga classes and home practice was associated with “clinically significant improvements in physical and mental health, fitness, psychological function, and HRQOL, with no adverse outcomes.” And they said that the strongest evidence of benefit was for reducing pain and improving mood, both of which were carefully tracked in the two groups. 

Less pain and a better mood sounds pretty good to me! And an additional benefit that yoga provides, which wasn’t measured in this study, is that by moving your joints through their entire range of motion, yoga keeps your arthritic joints nourished (see Yoga for Osteoarthritis). I know from personal experience that practicing yoga with an arthritic joint (a hip in my case) can be pretty challenging, but I'm more convinced than ever about how it important it is not to give up.

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