As I mentioned earlier in Rheumatology Network, results of a 12-week randomized controlled trial indicated that physical function was improved in patients with knee osteoarthritis who participated in an unsupervised online yoga program compared to patients who received only online education. Using the two-group superiority parallel design method, patients were assigned to receive either osteoporosis education or education in addition to an online yoga program, in which patients are given one new video clip per week, performed 3 times per week. After week 12, patients were given the option to continue practice up to 24 weeks.
In the following questions and answers, Dr. Kim Bennell, PhD, and co-lead author, discusses the study “Effectiveness of an unsupervised online yoga program on pain and function in people with knee osteoarthritis: a randomized clinical trial.” Bennell is director of the Center for Health, Exercise and Sports Medicine, University of Melbourne’s Department of Physical Therapy.
Rheumatology Network: What first got your team interested in studying the effects of yoga on patients with knee osteoarthritis?
Kim Bennell, Ph.D.: Our research focused on different types of non-pharmacological management strategies to help people deal with osteoporosis with a particular focus on exercise. We’ve done a lot of research on different types of exercise, as well as looking at interventions for telehealth (even before COVID). We’ve been looking at ways to get it delivered remotely to increase access to software because Australia is a big country and you want to be able to access the services. We’ve also been interested in programs and services that don’t need a therapist’s input and be able to make them available for free because a lot of people can’t necessarily pay for care. We were also looking at various forms of online sports interventions, and since there hasn’t been a lot of research looking at yoga, we thought we should determine how effective yoga might be.
At first, we were talking about doing yoga face to face. But then we thought it would be nice to do a yoga program that we could sort of come up with. We can make software that we’ve modified and developed specifically for people with osteoporosis, and then do it online so that it’s freely available to people. This was how we started researching an unmoderated online yoga program. First, like I said, because there wasn’t much evidence about yoga. And second, we were interested in how to have a program that was easy for people to access.
Rn: Do you think the unsupervised aspect of the program was a hindrance in any way?
Kilobytes: I think we know from any kind of online program that commitment can be a problem because you don’t have a therapist or someone to help you with commitment. So, here, the obligation is less. Having said that, our program was probably better than a lot of the programs you see out there and it may be because people joined the study and were excited to participate in the first place.
We’ve also seen that adherence affects outcomes. We performed a secondary exploratory analysis, removed, where we considered default commitment and the impact of being more committed. We found that if you have more commitment, and if you do the program two or more times a week, there will be better improvements in pain and improvements in function than if you don’t. Commitment plays a role and you will get better results if you stick to the program. It will certainly reduce the results in terms of reducing the benefits that you can get, but if it’s something you want to do or want to try, and you don’t have the possibility to go see a therapist, I think it’s a good option for people to try.
Rn: definitely. Not to mention you also give them the educational aspect of it, as well as yoga instructions. The results indicated that physical function improved at week 12 but was not maintained at week 24. Do you think this has anything to do with adherence?
Kilobytes: Yes, and we were not surprised by that. In fact, we were wondering if we should include that point in time at all. In previous studies, we give patients a program and then ask them to continue with it. But in this article we didn’t really stress that we wanted them to continue, we made it optional. Generally, people complete 12 weeks and don’t do it anymore. And then, as you’d expect, they lose out on the benefits. It is no different whether it is a strengthening program or a walking program; If you stop doing the exercise, you will lose the benefits.
Rn: Regardless, improvements in physical function were seen during the 12-week study period. What are the clinical implications of these findings?
Kilobytes: We, as a group, did not find a statistical improvement in pain. However, the percentage of subjects with clinically relevant improvements in pain was better in the older group. So, I think there’s something there from a pain perspective for some people that is likely to show some benefit to pain, and as I said, physical function has improved. Physical function is a major issue for people with osteoporosis, so if you can improve physical function, it is highly recommended.
Clinically, it is another exercise option for patients to try that can help improve physical function. We also found other secondary outcomes such as improvements in knee stiffness, quality of life, and self-efficacy. Exercise is the primary treatment recommended for people with osteoporosis.
Rn: Does your team plan to conduct any additional research on the effect of yoga on these patients?
Kilobytes: We were very fortunate when we were designing the study that one of our research assistants, Sarah Schwartz, MScPT, was a physical therapist and yoga instructor. She has taken a large part in putting together a yoga panel for yoga therapists, bringing patients with osteoporosis to help design the program and making sure it’s safe for people. So, we might look at some other different types of yoga because we looked at a form that was more focused on the physical aspects. But as you know, there are a lot of different types of yoga, including those that focus more on the meditative aspect. In terms of other ways to promote adherence, we can also look at how to get people to adhere to programs.
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