BACKGROUND AND PURPOSE:

• Exercise therapy is recommended as a first-line treatment for knee osteoarthritis (OA), but it’s not clear whether different types of exercise have a greater benefit
• Abafita et al. (JAMA Network Open, 2025) compared the effectiveness of yoga vs strengthening exercise for reducing knee pain in patients with knee OA

METHODS:

• Single-center, assessor-blinded, parallel-arm, active-controlled, superiority randomized clinical trial
• Participants
  • Adults ≥40 years
  • Knee OA
  • Knee pain levels of ≥40 on a 100-mm VAS
• Interventions
  • Yoga exercise
  • Strengthening exercise
  • Both groups received
    • Weeks 1 to 12: 2 supervised and 1 home-based session per week
    • Weeks 13 to 24: 3 unsupervised home-based sessions per week
• Study design
  • There was a prespecified noninferiority margin of 10 mm
  • Analysis was by intention to treat
• Primary outcome
  • Difference in VAS score over 12 weeks
• Secondary outcomes
  • Knee pain over 24 weeks using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 
  • Quality of life scores
  • 25 other outcomes

RESULTS:

• Yoga: 58 participants | Strengthening: 59 participants
  • Mean age: 62.5 (SD, 8.3) | Female: 72.6%
  • Mean baseline VAS knee pain: 53.8 (SD, 16.0) – moderate
• The between group mean difference in VAS knee pain change over 12 weeks was not statistically different, and remained within the noninferiority margin
  • –1.1 mm (95% CI, –7.8 to 5.7)
• Of the 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga
  • WOMAC pain: −44.5 mm (95% CI, −70.7 to −18.3)
  • WOMAC function: −139 mm (95% CI, −228.3 to −49.7)
  • WOMAC stiffness: −17.6 mm (95% CI, −30.9 to −4.3)
  • Patient global assessment: −7.6 mm (95% CI, −15.1 to −0.2)
  • 40-m fast-paced walk test: 1.8 (95% CI, 0.4 to 3.2)
  • Depression at 12 weeks: −1.1 (95% CI, −1.9 to −0.2)
  • Quality of life at 24 weeks: 0.04 (95% CI, 0.0 to 0.07)
• Adverse events were similar in both groups and mild

CONCLUSION:

• Both yoga and strength-based training reduced knee pain for patients with knee OA
  • Yoga did significantly improve several other outcomes, compared to strength-based training, including depression, quality of life and knee function
• The authors state

Overall, these findings suggest that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA

Learn More – Primary Sources:

Yoga or Strengthening Exercise for Knee Osteoarthritis: A Randomized Clinical Trial