Complementary and Alternative Medicine for Rheumatic Diseases

Ralph Yachoui; Sharon L Kolasinski

Disclosures

Aging Health. 2012;8(4):403-412. 

In This Article

Yoga

Yoga is a discipline developed in ancient India, characterized as a science of self-study and awareness through 'asanas' (body postures), 'pranayama' (patterns of breathing) and meditation. The ultimate goal of this practice is the achievement of harmony in body, mind and spirit. Yoga has been embraced in western settings as a form of exercise and relaxation. Currently, yoga programs are relatively low cost, widely available and safe when performed properly.

Yoga has been associated with a number of physical benefits including reductions in oxygen consumption, minute ventilation, diastolic and systolic blood pressure and heart rate.[23] The practice of yoga can offer positive effects on psychological functioning including increased self-efficacy, coping and mood. A recent review concluded that yoga provides psychophysiological benefits that are particularly apparent for people with musculoskeletal conditions.[24]

A recent study by Tilbrook and colleagues looked at the use of yoga in patients with chronic or recurrent back pain.[25] This parallel-group, randomized, controlled trial was conducted from April 2007 to March 2010 at 13 non-National Health Service establishments in the UK. Three hundred and thirteen patients with a mean age of 46 years and chronic or recurrent lower back pain were split into two groups. One group was offered a 12-session, gradually progressive yoga program delivered by 12 teachers over 3 months and the other group received usual care. Compliance was adequate to assess efficacy. Ninety three patients (60%) offered yoga attended at least three of the first six sessions and at least three other sessions. The yoga group had better back function at 3, 6 and 12 months than the usual care group. The adjusted mean Roland–Morris Disability Questionnaire score, a 24-item questionnaire with scores ranging from 0 (best) to 24 (worst), was 2.17 points (95% CI: 1.03–3.31 points) lower in the yoga group at 3 months, 1.48 points (95% CI: 0.33–2.62 points) lower at 6 months, and 1.57 points (95% CI: 0.42–2.71 points) lower at 12 months. The yoga and usual care groups had similar back pain and general health scores at 3, 6 and 12 months, but the yoga group had higher pain self-efficacy scores at 3 and 6 months but not at 12 months. Two of the 157 usual care participants and 12 of the 156 yoga participants reported adverse events, mostly increased pain. A more recent trial supports the feasibility of a standardized evening yoga practice as a potential treatment option for OA-related insomnia in middle-aged to older women. All participants completed an 8-week yoga program that included 75-min weekly classes and 20 min of nightly home practice. The Insomnia Severity Index and diary-reported sleep-onset latency, sleep efficiency, and number of nights with insomnia were significantly improved at 1 week postintervention.[26]

A recent trial randomized 53 women with FM to the 8-week 'Yoga of Awareness' program including gentle poses, meditation, breathing exercises, yoga-based coping instructions or to a wait-listed standard care group. At follow-up after treatment, women assigned to the yoga program showed significantly greater improvements on standardized measures of FM symptoms and functioning, including pain, fatigue and mood, as well as in pain catastrophizing, acceptance and other coping strategies.[27]

A study is currently being conducted by Evans and coworkers looking at the use of yoga in rheumatoid arthritis patients. Seventy patients aged 16–35 years will be randomized into either the 6-week yoga program or the 6-week wait-list control. The wait-list group will crossover to the yoga program following completion of the first arm of the study. Data will be collected quantitatively using questionnaires, markers of disease activity and qualitatively using semi-structured interviews. The ongoing study should contribute to the understanding of yoga as a nonpharmacologic intervention in rheumatoid arthritis patients.[28]

Implementation of yoga for knee OA was suggested by a trial that demonstrated reduction in pain and functional disability using WOMAC scores in a group of obese patients >50 years of age who completed an 8 week yoga program.[29] However, there was only a small group of participants in this trial and no long-term follow-up was pursued. A study of the effects of a 10-week course of yoga for symptoms of OA of the hands showed reductions in finger joint tenderness and hand pain during activity, as well as short-term improvement in range of motion.[30]

Several small studies showed that a yoga-based regimen was more effective than wrist splinting or no treatment in relieving some symptoms and signs of carpal tunnel syndrome. In one study, patients with carpal tunnel syndrome participated in an 8-week yoga program and had significant improvements in grip strength and pain.[27]

No serious side effects have been reported in the trials assessing yoga for musculoskeletal complaints. A few case reports of reversible compression neuropathy from sustained postures have been reported in the context of individual practice. Bilateral sciatic nerve compression occurred in a woman after falling asleep in the head-to-knees yoga position, also called 'Paschimottanasana'.[31] There is also one report of isolated lateral collateral ligament rupture during yoga practice.[32]

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