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"Online interventions have the potential to reach a wide audience, allowing exercise to be undertaken from the comfort and convenience of home and thereby overcoming some of the barriers to exercise reported in the osteoarthritis population.”
An unsupervised, 12-week online yoga program improved physical function in patients with knee osteoarthritis when compared with online education. However, knee pain was not reduced and results were not sustained at week 24, according to a study published in Annals of Internal Medicine.1
“People typically access yoga in person by attending a facility for supervised group classes,” investigators explained. “However, such programs can be inaccessible or inconvenient for people to attend and often involve a cost to participate. Increasingly, people are accessing health and exercise services and resources online, driven particularly by the global COVID-19 pandemic. Online interventions have the potential to reach a wide audience at little or no cost regardless of a person's location, allowing exercise to be undertaken from the comfort and convenience of home and thereby overcoming some of the barriers to exercise reported in the osteoarthritis population.”
In the randomized controlled trial, investigators created a 2-group superiority parallel design utilizing unblinded participants. Both cohorts received online information about osteoarthritis. However, the yoga group gained access to an unsupervised online yoga program, in which patients received 1 new video per week to be performed 3 times per week and could continue the practice after week 12 if they desired. The program was designed by a team of investigators, 5 yoga therapists, 2 patients with knee osteoarthritis, and a physiotherapist. Primary endpoints were changes in knee pain during walking and physical function at the end of week 12 and week 24. Outcomes were collected via a self-reported online questionnaire and results were analyzed using mixed-effects linear regression models. Secondary endpoints were self-reported knee pain overall, depression, anxiety, stress, fear of movement, stiffness, balance confidence, quality of life, and global change. Any adverse events were also reported.
Of the 212 adults with symptomatic knee osteoarthritis, 92% (n = 195) and 89% (n = 189) reported 12- and 24-week primary outcomes, respectively. Yoga improved function at week 12 in the yoga group when compared with controls (mean difference in change between groups, 4.0 [95% CI, 6.8 to 1.3]). However, knee pain during walking was similar in both groups (mean difference in change, 0.6 [CI, 1.2 to 0.1]). More patients in the yoga program achieved minimal clinically important differences (MCID) for both outcomes and reported greater improvements in knee stiffness, arthritis self-efficacy, and quality of life when compared with controls. Variables, such as age, gender, fear of movement, body mass index, pain self-efficacy, and treatment effect expectations did not impact the effects of the yoga program at 12 weeks. However, benefits were not maintained at week 24.
The most significant limitation was that patients were unblinded to the interventions, which may have impacted the effects of the treatment. As the program was unsupervised, investigators cannot determine if the yoga was performed correctly or completely. They also do not know if those in the control group practiced yoga during the study or whether those in the yoga cohort participated in non-yoga exercise in addition to the program. Lastly, generalizability was limited as all participants were English-speaking and able to confidently use a computer.
“Our results are promising, but further research is needed to fully establish the effects of unsupervised online yoga and to potentially improve on our program in order to enhance treatment benefits,” investigators concluded. “This freely accessible, home-based online yoga program could be a scalable option to improve patient access to exercise, a core recommended osteoarthritis treatment.”
Bennell KL, Schwartz S, Teo PL, et al. Effectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis : A Randomized Clinical Trial [published online ahead of print, 2022 Sep 20]. Ann Intern Med. 2022;10.7326/M22-1761. doi:10.7326/M22-1761