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Researchers found yoga was noninferior to strengthening exercises for pain reduction in knee osteoarthritis, and provided gains in mood, function, and QOL.

In adults with knee osteoarthritis (OA), yoga was noninferior to strengthening exercises for pain reduction and conferred additional modest gains in mood, function, and QOL, according to a study published online in JAMA Network Open^.

According to the authors, OA affects more than 595 million people worldwide, including approximately 51.8 million US adults.

“Exercise therapy is recommended by all international guidelines as a first-line treatment for knee OA to improve pain and function … but there is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises,” wrote Bedru Jemal Abafita, MSc, University of Tasmania, and study coauthors. “These findings suggest that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee osteoarthritis.”

Yoga Intervention vs Strengthening Exercise

The single-center randomized clinical trial included 117 adults aged 40 years and older with physician-confirmed knee OA and baseline pain ≥40 mm on a 100-mm visual analog scale (VAS).

Participants were randomized 1:1 to a yoga intervention (n = 58) or a strengthening exercise control (n = 59). Both groups completed two supervised sessions and one home-based session per week for 12 weeks, then transitioned to three unsupervised home sessions weekly during weeks 13–24.

Baseline demographic and clinical characteristics—including a mean VAS pain score of 53.8 mm—were comparable. The primary endpoint was the between-group difference in VAS pain change at 12 weeks; 27 secondary outcomes spanning mood, function, stiffness, global assessment, gait speed, and health-related QOL were evaluated at 12 and 24 weeks.

Yoga Advantages Observed

At 12 weeks, the yoga cohort exhibited a 1.1-mm greater reduction in VAS score compared to strengthening exercises, a non-significant finding that remained within the prespecified noninferiority margin of 10 mm, according to findings.

Among secondary endpoints, seven demonstrated statistically significant advantages favoring yoga. At 12 weeks, yoga participants experienced a modestly greater improvement in depressive symptoms (−1.1 between-group difference in Patient Health Questionnaire–9 score). By 24 weeks, yoga was superior on multiple Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) domains—pain (−44.5 mm), WOMAC function (−139 mm), stiffness (−17.6 mm)—as well as patient global assessment (−7.6 mm), 40-m fast-paced walk time (1.8 s), and the Assessment of Quality of Life–8 Dimensions score (0.04).

Adverse events were predominantly mild and similarly distributed between groups, underscoring the favorable safety profile of both interventions.

Limitations & Conclusions

Notwithstanding its strengths, the authors noted that the study’s single-center design and modest sample size may restrict external validity, while adherence rates and participant expectations could have influenced subjective outcomes.

“However … integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA [osteoarthritis],” the research team concluded.