Abstract
ObjectiveCertain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis.DesignSingle-blind, three-arm randomized controlled trial.SettingCommunity in Southwestern Ontario, Canada.ParticipantsA convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth.InterventionsParticipants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week.MeasurementsPrimary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention.ResultsThe YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE.ConclusionsThe biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required.Trial registrationClinicalTrials.gov (NCT02370667)
Highlights
Knee osteoarthritis (OA) is associated with pain, mobility limitations, and a variety of comorbidities such as cardiovascular, gastrointestinal, and metabolic diseases, as well as depression [1]
The yoga exercise (YE) group demonstrated greater improvements in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, intermittent pain and self-reported physical function compared to no-exercise attention-equivalent control (NE)
traditional exercise (TE) demonstrated a greater improvement in knee flexor strength compared to YE
Summary
Knee osteoarthritis (OA) is associated with pain, mobility limitations, and a variety of comorbidities such as cardiovascular, gastrointestinal, and metabolic diseases, as well as depression [1]. Exercise provides equivalent pain relief to medication while improving physical function, comorbidities, and quality of life [2,3,4]. Some features of common exercises can exacerbate symptoms and contribute to disease progression. Exposure to elevated magnitudes of the knee adduction moment (KAM), a mechanical variable reflecting the ratio of medial to total knee loading, predicts disease progression [5,6,7,8], with repetitive exposure linked to pain severity in OA [9]. It is critical to ensure that exercise prescriptions for knee OA minimize exposure to KAM
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