January 2017

Asana advantages: Yoga bests typical exercise in seniors

In the moment: Knee OA

By Stephanie Kramer

Yoga may be more effective than conventional exercise for improving symptoms, anxiety, and fear of falling in older patients with knee osteoarthritis (OA), according to recent research from the University of Minnesota in Minneapolis.

In 83 older adults with knee OA, eight weeks of hatha yoga were associated with significantly greater improvements in symptoms and function than conventional exercise (aerobics and strengthening) and an education-only control group. The results were epublished in December 2016 in Rheumatology International.

The study’s authors believe the holistic and meditative aspects of yoga may offer specific benefits for older adults with knee OA.

“Exercise typically targets large muscles,” said lead author Corjena Cheung, PhD, an assistant professor in the School of Nursing at the University of Minnesota. “But yoga targets the whole body.”

It also includes a component that emphasizes balance, focus, and relaxation techniques, Cheung said.

The randomized controlled trial included 83 community-dwelling adults (84% women) aged 60 years or older with symptomatic knee OA. The hatha yoga and aerobic/strengthening exercise interventions involved a 45-minute supervised class and two to four home practice sessions per week. A control group received educational materials.

The hatha yoga intervention consisted of poses, or asanas, performed while standing, sitting, prone, and supine (squats, lunges, twists, and stretches). Participants who were limited by knee pain or other issues could modify poses using props, a chair, or a wall. The aerobic/strengthening program included 15 minutes of mild aerobics and 30 minutes of strength­ening exercises; those participants were also allowed to use props as needed.

Investigators compared results for both groups at four and eight weeks.

“In as little as four weeks, participants in the yoga group had less perceived pain [compared with baseline],” Cheung said.

The pain-related improvements in the yoga group were sustained at eight weeks. Although both the yoga and conventional exercise groups demon­strated improvement from baseline at eight weeks for most of the outcomes assessed, the yoga group had better scores than the other two groups for pain, anxiety, and fear of falling.

Unlike conventional exercise, yoga incorporates medi­tative practices that can help address the psychological vari­ables associated with knee OA symptoms, Cheung said.

“Mind-body intervention is essential for chronic illness,” she said.

Cheung said yoga may have another benefit: Sequences of poses requiring participants to regularly lower themselves to the floor and rise again to a standing position, which could prepare patients mentally for a fall and reduce their fear of falling.

Commenting on the classes she observed, Cheung said, “What amazes me is that the first day they seemed very reluctant, but by halfway through they were much more comfortable getting up and down off the floor.”

Although home practice adherence did not differ between the two groups, she said,  it is conceivable that twice-weekly supervised sessions would ensure better adherence than once-weekly sessions.

The findings make sense, said Ruth McCaffrey, DNP, professor of nursing at Mercer University in Atlanta.

“Aerobic exercise can put stress on the joints like the knee, so you could increase pain,” said McCaffrey. “Standing, but especially seated yoga, is a gentle nonweightbearing exercise, so it is less stressful for the joints.”

McCaffrey and colleagues found eight weeks of chair yoga was associated with significantly improved pain and function in older adults with lower extremity OA who were unable to perform standing exercise. Those findings were epublished in December 2016 by the Journal of the American Geriatrics Society.

McCaffrey added that yoga also limits pain interference, a measure of how pain affects day-to-day life.

While clinicians may be less familiar with yoga than traditional exercise, yoga opens up more options for patients and may be less intimidating, McCaffrey noted.

“Yoga has become mainstream and commonplace for younger and older people,” she said.


Cheung C, Wyman JF, Bronas U, et al. Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int 2016 Dec 2. [Epub ahead of print]

Park J, McCaffrey R, Newman D, et al. A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc 2016 Dec 23. [Epub ahead of print]

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