1 1269 153 FRAILTY MODIFIES THE INTERVENTION EFFECT OF CHAIR YOGA ON PAIN AMONG OLDER ADULTS WITH LOWER EXTREMITY OSTEOARTHRITIS: SECONDARY ANALYSIS OF A NONPHARMACOLOGICAL INTERVENTION TRIAL. OBJECTIVE: IN AN 8-WEEK NONPHARMACOLOGICAL PAIN INTERVENTION TRIAL AMONG OLDER ADULTS WITH LOWER EXTREMITY OSTEOARTHRITIS (OA), WE AIMED TO EXAMINE: A) THE BASELINE FRAILTY LEVEL OF THE PARTICIPANTS; B) WHETHER SUCH INTERVENTION IS MORE BENEFICIAL FOR BASELINE FRAILER OLDER ADULTS THAN FOR THEIR COUNTERPARTS WITH LESS FRAILTY; AND C) WHETHER THE INTERVENTION COULD ALSO ALTER FRAILTY. METHODS: PARTICIPANTS WERE RANDOMLY ASSIGNED TO EITHER CHAIR YOGA (CY) OR HEALTH EDUCATION PROGRAM (HEP) GROUPS AND ATTENDED TWICE-WEEKLY 45-MINUTE CY OR HEP SESSIONS FOR 8 WEEKS. FOLLOWING A STANDARD PROCEDURE, 82 VARIABLES WERE USED TO CONSTRUCT A FRAILTY INDEX (FI, 0-1). PRIMARY OUTCOMES WERE: WESTERN ONTARIO AND MCMASTER UNIVERSITIES (WOMAC) PAIN AND PAIN INTERFERENCE. LINEAR MIXED-EFFECTS MODELS WERE USED TO EVALUATE THE MODIFYING EFFECT OF BASELINE FRAILTY ON THE INTERVENTION EFFECT OF CY ON PRIMARY OUTCOMES. SIMILAR MODELS WERE USED TO EVALUATE THE EFFECT OF CY ON FRAILTY. RESULTS: A TOTAL OF 112 PARTICIPANTS (N = 63 CY, N = 49 HEP; 75.3 [SD = 7.5] YEARS) WITH 85 FEMALES (75.9%) WERE INCLUDED. THE MEAN VALUES OF BASELINE FI FOR THE CY AND HEP GROUPS WERE SIMILAR (0.428 [0.05] AND 0.433 [0.05], P = 0.355). EACH 0.01 INCREMENT IN BASELINE FI WAS ASSOCIATED WITH HIGHER WOMAC PAIN (BETA = 0.28, P < 0.001) AND PAIN INTERFERENCE (BETA = 0.51, P < 0.001). THERE WAS A SIGNIFICANT INTERACTION EFFECT BETWEEN INTERVENTION, TIME, AND BASELINE FI (P = 0.020 FOR WOMAC PAIN; P = 0.010 FOR PAIN INTERFERENCE), INDICATING THAT PARTICIPANTS WITH HIGHER LEVEL OF BASELINE FI HAD GREATER DECLINES IN WOMAC PAIN AND PAIN INTERFERENCE. THERE WAS NO SIGNIFICANTLY GREATER DECLINE IN FI FOR THE CY GROUP COMPARED TO THE HEP GROUP (BETWEEN-GROUP DIFFERENCE - 0.01; P = 0.509) AND THERE WERE NO SIGNIFICANT TREND CHANGES IN FI (P FOR INTERACTION = 0.605). CONCLUSIONS: FRAILTY MODIFIES THE INTERVENTION EFFECT OF CY ON PAIN AMONG OLDER ADULTS WITH LOWER EXTREMITY OA, UNDERSCORING THE IMPORTANCE OF ASSESSING FRAILTY TO IMPROVE THE MANAGEMENT OF PAIN IN THIS POPULATION. 2020 2 2590 59 YOGA FOR MANAGING KNEE OSTEOARTHRITIS IN OLDER WOMEN: A PILOT RANDOMIZED CONTROLLED TRIAL. BACKGROUND: OSTEOARTHRITIS (OA) IS A COMMON PROBLEM IN OLDER WOMEN THAT IS ASSOCIATED WITH PAIN AND DISABILITIES. ALTHOUGH YOGA IS RECOMMENDED AS AN EXERCISE INTERVENTION TO MANAGE ARTHRITIS, THERE IS LIMITED EVIDENCE DOCUMENTING ITS EFFECTIVENESS, WITH LITTLE KNOWN ABOUT ITS LONG TERM BENEFITS. THIS STUDY'S AIMS WERE TO ASSESS THE FEASIBILITY AND POTENTIAL EFFICACY OF A HATHA YOGA EXERCISE PROGRAM IN MANAGING OA-RELATED SYMPTOMS IN OLDER WOMEN WITH KNEE OA. METHODS: ELIGIBLE PARTICIPANTS (N=36; MEAN AGE 72 YEARS) WERE RANDOMLY ASSIGNED TO 8-WEEK YOGA PROGRAM INVOLVING GROUP AND HOME-BASED SESSIONS OR WAIT-LIST CONTROL. THE YOGA INTERVENTION PROGRAM WAS DEVELOPED BY A GROUP OF YOGA EXPERTS (N=5). THE PRIMARY OUTCOME WAS THE WESTERN ONTARIO AND MCMASTER UNIVERSITIES OSTEOARTHRITIS INDEX (WOMAC) TOTAL SCORE THAT MEASURES KNEE OA PAIN, STIFFNESS, AND FUNCTION AT 8 WEEKS. THE SECONDARY OUTCOMES, PHYSICAL FUNCTION OF THE LOWER EXTREMITIES, BODY MASS INDEX (BMI), QUALITY OF SLEEP (QOS), AND QUALITY OF LIFE (QOL), WERE MEASURED USING WEIGHT, HEIGHT, THE SHORT PHYSICAL PERFORMANCE BATTERY (SPPB), THE PITTSBURGH SLEEP QUALITY INDEX (PSQI), THE CANTRIL SELF-ANCHORING LADDER, AND THE SF12V2 HEALTH SURVEY. DATA WERE COLLECTED AT BASELINE, 4 WEEKS AND 8 WEEKS, AND 20 WEEKS. RESULTS: THE RECRUITMENT TARGET WAS MET, WITH STUDY RETENTION AT 95%. BASED ON ANCOVAS, PARTICIPANTS IN THE TREATMENT GROUP EXHIBITED SIGNIFICANTLY GREATER IMPROVEMENT IN WOMAC PAIN (ADJUSTED MEANS [SE]) (8.3 [.67], 5.8 [.67]; P=.01), STIFFNESS (4.7 [.28], 3.4 [.28]; P=.002) AND SPPB (REPEATED CHAIR STANDS) (2.0 [.23], 2.8 [.23]; P=.03) AT 8 WEEKS. SIGNIFICANT TREATMENT AND TIME EFFECTS WERE SEEN IN WOMAC PAIN (7.0 [.46], 5.4 [.54]; P=.03), FUNCTION (24.5 [1.8], 19.9 [1.6]; P=.01) AND TOTAL SCORES (35.4 [2.3], 28.6 [2.1]; P=.01) FROM 4 TO 20 WEEKS. SLEEP DISTURBANCE WAS IMPROVED BUT THE PSQI TOTAL SCORE DECLINED SIGNIFICANTLY AT 20 WEEKS. CHANGES IN BMI AND QOL WERE NOT SIGNIFICANT. NO YOGA RELATED ADVERSE EVENTS WERE OBSERVED. CONCLUSIONS: A WEEKLY YOGA PROGRAM WITH HOME PRACTICE IS FEASIBLE, ACCEPTABLE, AND SAFE FOR OLDER WOMEN WITH KNEE OA, AND SHOWS THERAPEUTIC BENEFITS. TRIAL REGISTRATION: CLINICALTRIALS.GOV: NCT01832155. 2014 3 2826 40 YOGA VERSUS MASSAGE IN THE TREATMENT OF AROMATASE INHIBITOR-ASSOCIATED KNEE JOINT PAIN IN BREAST CANCER SURVIVORS: A RANDOMIZED CONTROLLED TRIAL. AROMATASE INHIBITORS (AIS) ARE STANDARD ADJUVANT THERAPY FOR POSTMENOPAUSAL WOMEN WITH OESTROGEN RECEPTOR-POSITIVE, EARLY-STAGE, AND METASTATIC BREAST CANCER. ALTHOUGH EFFECTIVE, THE RISK OF FALLS DUE TO AI-ASSOCIATED KNEE JOINT PAIN SIGNIFICANTLY INCREASED. THE AIM OF THIS STUDY WAS TO EVALUATE THE THERAPEUTIC EFFECTS OF YOGA AND MASSAGE ON AI-ASSOCIATED KNEE JOINT PAIN. BREAST CANCER SURVIVORS WERE RANDOMLY ASSIGNED TO A 6-WEEK YOGA INTERVENTION-2-WEEK REST-6-WEEK MASSAGE EXPOSURE (YOGA FIRST, N = 30) OR A 6-WEEK MASSAGE INTERVENTION-2-WEEK REST-6-WEEK YOGA EXPOSURE (MASSAGE FIRST, N = 30). EVALUATIONS OF THE TREATMENT EFFICACY WERE MADE AT BASELINE, POST-INTERVENTION, AND POST-EXPOSURE USING THE WESTERN ONTARIO AND MCMASTER UNIVERSITIES OSTEOARTHRITIS INDEX (WOMAC) SCALE, PLASMA CYTOKINE LEVELS, AND CHANGES IN MERIDIAN ENERGY. THE RESULTS SHOWED THAT YOGA, SUPERIOR TO MASSAGE INTERVENTION, SIGNIFICANTLY REDUCED AI-ASSOCIATED KNEE JOINT PAIN, AS DEMONSTRATED BY THE WOMAC PAIN SCORE. THE YOGA INTERVENTION IMPROVEMENTS WERE ALSO ASSOCIATED WITH CHANGES IN PLASMA CYTOKINE LEVELS AND MERIDIAN ENERGY CHANGES. IN CONCLUSION, THIS STUDY PROVIDES SCIENTIFIC EVIDENCE THAT YOGA WAS MORE EFFECTIVE THAN MASSAGE FOR REDUCING AI-ASSOCIATED KNEE JOINT PAIN. MERIDIAN ENERGY CHANGES MAY PROVIDE ANOTHER SCIENTIFIC, OBJECTIVE, NON-INVASIVE WAY TO MONITOR THE THERAPEUTIC EFFECTS OF YOGA AND INVESTIGATE ANOTHER ALTERNATIVE, COMPLEMENTARY MEDICINE. 2021 4 1528 45 IYENGAR YOGA FOR TREATING SYMPTOMS OF OSTEOARTHRITIS OF THE KNEES: A PILOT STUDY. OBJECTIVES: THE AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) GUIDELINES FOR THE MEDICAL MANAGEMENT OF OSTEOARTHRITIS (OA) EMPHASIZE THE USE OF NONPHARMACOLOGIC INTERVENTIONS INCLUDING EXERCISE. IMPLEMENTATION OF AN EXERCISE PROGRAM CAN BE DIFFICULT FOR PATIENTS, AND LITTLE IS KNOWN ABOUT THE BENEFITS OF ALTERNATIVE THERAPIES SUCH AS YOGA. THE AIM OF THIS PILOT STUDY WAS TO ASSESS THE FEASIBILITY OF USING YOGA IN THE TRADITION OF B.K.S. IYENGAR TO TREAT THE SYMPTOMS OF OSTEOARTHRITIS OF THE KNEE. DESIGN: PARTICIPANTS WERE INSTRUCTED IN MODIFIED IYENGAR YOGA POSTURES DURING 90-MINUTE CLASSES ONCE WEEKLY FOR 8 WEEKS. SUBJECTS: PARTICIPANTS MET ACR CRITERIA FOR OSTEOARTHRITIS OF THE KNEE AND COMPLETED A MEDICAL HISTORY AND PHYSICAL EXAMINATION, WESTERN ONTARIO AND MCMASTER UNIVERSITIES OSTEOARTHRITIS INDEX (WOMAC), ARTHRITIS IMPACT MEASUREMENT SCALE 2 (AIMS2), PATIENT GLOBAL ASSESSMENT (GA) BY VISUAL ANALOG SCALE (VAS), PHYSICIAN GA BY VAS, AND 50-FOOT WALK TIME BEFORE AND FOLLOWING AN 8-WEEK COURSE OF YOGA INSTRUCTION. ELEVEN (11) SUBJECTS ENROLLED, NINE COMPLETED AT LEAST ONE SESSION AND SEVEN (SIX OF WHOM WERE OBESE) HAD DATA FROM PRE- AND POST-COURSE TIME POINTS AVAILABLE FOR ANALYSIS. RESULTS: STATISTICALLY SIGNIFICANT REDUCTIONS IN WOMAC PAIN, WOMAC PHYSICAL FUNCTION, AND AIMS2 AFFECT WERE OBSERVED WHEN PARTICIPANTS' STATUS WERE COMPARED TO THEIR PRE-COURSE STATUS. WOMAC STIFFNESS, AIMS2 SYMPTOMS, SOCIAL AND ROLE, PHYSICIAN GA, AND PATIENT GA MEASURED TRENDS IN IMPROVEMENT OF SYMPTOMS. NO ADVERSE EVENTS FROM TREATMENT WERE REPORTED. CONCLUSIONS: THIS PILOT STUDY SUGGESTS THAT YOGA MAY PROVIDE A FEASIBLE TREATMENT OPTION FOR PREVIOUSLY YOGA-NAIVE, OBESE PATIENTS >50 YEARS OF AGE AND OFFERS POTENTIAL REDUCTIONS IN PAIN AND DISABILITY CAUSED BY KNEE OA. FUTURE STUDIES SHOULD COMPARE YOGA TO OTHER NONPHARMACOLOGIC INTERVENTIONS FOR KNEE OA, SUCH AS PATIENT EDUCATION OR QUADRICEPS-STRENGTHENING EXERCISES. 2005 5 275 32 ADDITIONAL EFFECT OF IYENGAR YOGA AND EMG BIOFEEDBACK ON PAIN AND FUNCTIONAL DISABILITY IN CHRONIC UNILATERAL KNEE OSTEOARTHRITIS. BACKGROUND: THERE ARE LIMITED DATA ABOUT IYENGAR YOGA AND EMG BIOFEEDBACK IN KNEE OA, ALTHOUGH THE EFFICACY OF EMG BIOFEEDBACK IN THE REHABILITATION OF PATIENTS WITH QUADRICEPS MUSCLE WEAKNESS SECONDARY TO IMMOBILIZATION, CONTRACTURE, AND JOINT SURGERY HAS BEEN WELL ESTABLISHED. MATERIALS AND METHODS: THIRTY SUBJECTS WHO HAVE FULFILLED INCLUSION AND EXCLUSION CRITERIA WERE SELECTED AND DIVIDED INTO TWO GROUPS (GROUP A AND B). BOTH THE GROUPS WERE TREATED WITH EMG BIOFEEDBACK, KNEE MUSCLE STRENGTHENING EXERCISES, AND TENS. GROUP A RECEIVED ADDITIONALLY IYENGAR YOGA FOR 8 WEEKS. BOTH GROUPS WERE EVALUATED BY VISUAL ANALOG SCALE AND MODIFIED WOMAC-WESTERN ONTARIO MCMASTER UNIVERSITIES SCALE. RESULTS: PATIENTS IN BOTH GROUPS EXPERIENCED SIGNIFICANT REDUCTION IN PAIN AND IMPROVEMENT IN FUNCTIONAL ABILITY. IN VAS SCALE GROUP A SHOWED REDUCTION OF 56.83% (P = 0.001) WHEN COMPARED WITH GROUP B 38.15% (P /=3/10 ON THE NUMERIC PAIN RATING SCALE FOR >3 MONTHS (CONTROLS N=17, PILATES N=20, YOGA N=19). INTERVENTIONS: EXERCISE PARTICIPANTS COMPLETED 12 SMALL-GROUP SESSIONS WITH MODIFICATIONS AND PROGRESSIONS SUPERVISED BY A PHYSIOTHERAPIST. MAIN OUTCOME MEASURES: THE PRIMARY OUTCOME MEASURE WAS THE NECK DISABILITY INDEX (NDI). SECONDARY OUTCOMES WERE PAIN RATINGS, RANGE OF MOVEMENT AND POSTURAL MEASUREMENTS COLLECTED AT BASELINE, 6 WEEKS AND 12 WEEKS. FOLLOW-UP WAS PERFORMED 6 WEEKS AFTER COMPLETION OF THE EXERCISE CLASSES (WEEK 18). RESULTS: NDI DECREASED SIGNIFICANTLY IN THE PILATES {BASELINE: 11.1 [STANDARD DEVIATION (SD) 4.3] VS WEEK 12: 6.8 (SD 4.3); MEAN DIFFERENCE -4.3 (95% CONFIDENCE INTERVAL -1.64 TO -6.7); P<0.001} AND YOGA GROUPS [BASELINE: 12.8 (SD 7.4) VS WEEK 12: 8.1 (SD 5.6); MEAN DIFFERENCE -4.7 (95% CONFIDENCE INTERVAL -2.1 TO -7.4); P<0.00], WITH NO CHANGE IN THE CONTROL GROUP. PAIN RATINGS ALSO IMPROVED SIGNIFICANTLY. MODERATE-TO-LARGE EFFECT SIZES (0.7 TO 1.8) AND LOW NUMBERS NEEDED TO TREAT WERE FOUND. THERE WERE NO DIFFERENCES IN OUTCOMES BETWEEN THE EXERCISE GROUPS OR ASSOCIATED ADVERSE EFFECTS. NO IMPROVEMENTS IN RANGE OF MOVEMENT OR POSTURE WERE FOUND. CONCLUSIONS: PILATES AND YOGA GROUP EXERCISE INTERVENTIONS WITH APPROPRIATE MODIFICATIONS AND SUPERVISION WERE SAFE AND EQUALLY EFFECTIVE FOR DECREASING DISABILITY AND PAIN COMPARED WITH THE CONTROL GROUP FOR INDIVIDUALS WITH MILD-TO-MODERATE CNP. PHYSIOTHERAPISTS MAY CONSIDER INCLUDING THESE APPROACHES IN A PLAN OF CARE. CLINICAL TRIAL REGISTRATION NUMBER: CLINICALTRIALS.GOV NCT01999283. 2016 19 1573 45 MANAGING KNEE OSTEOARTHRITIS WITH YOGA OR AEROBIC/STRENGTHENING EXERCISE PROGRAMS IN OLDER ADULTS: A PILOT RANDOMIZED CONTROLLED TRIAL. ALTHOUGH EXERCISE IS OFTEN RECOMMENDED FOR MANAGING OSTEOARTHRITIS (OA), LIMITED EVIDENCE-BASED EXERCISE OPTIONS ARE AVAILABLE FOR OLDER ADULTS WITH OA. THIS STUDY COMPARED THE EFFECTS OF HATHA YOGA (HY) AND AEROBIC/STRENGTHENING EXERCISES (ASE) ON KNEE OA. RANDOMIZED CONTROLLED TRIAL WITH THREE ARMS DESIGN WAS USED: HY, ASE, AND EDUCATION CONTROL. BOTH HY AND ASE GROUPS INVOLVED 8 WEEKLY 45-MIN GROUP CLASSES WITH 2-4 DAYS/WEEK HOME PRACTICE SESSIONS. CONTROL GROUP RECEIVED OA EDUCATION BROCHURES AND WEEKLY PHONE CALLS FROM STUDY STAFF. STANDARDIZED INSTRUMENTS WERE USED TO MEASURE OA SYMPTOMS, PHYSICAL FUNCTION, MOOD, SPIRITUAL HEALTH, FEAR OF FALLING, AND QUALITY OF LIFE AT BASELINE, 4 AND 8 WEEKS. HY/ASE ADHERENCES WERE ASSESSED WEEKLY USING CLASS ATTENDANCE RECORDS AND HOME PRACTICE VIDEO RECORDINGS. PRIMARY ANALYSIS OF THE DIFFERENCE IN THE CHANGE FROM BASELINE WAS BASED ON INTENT-TO-TREAT AND ADJUSTED FOR BASELINE VALUES. EIGHT-THREE ADULTS WITH SYMPTOMATIC KNEE OA COMPLETED THE STUDY (84% FEMALE; MEAN AGE 71.6 +/- 8.0 YEARS; MEAN BMI 29.0 +/- 7.0 KG/M(2)). RETENTION RATE WAS 82%. COMPARED TO THE ASE GROUP AT 8 WEEKS, PARTICIPANTS IN THE HY GROUP HAD A SIGNIFICANT IMPROVEMENT FROM BASELINE IN PERCEPTION OF OA SYMPTOMS (-9.6 [95% CI -15.3, -4]; P = .001), ANXIETY (-1.4 [95% CI -2.7, -0]; P = .04), AND FEAR OF FALLING (-4.6 [-7.5, -1.7]; P = .002). THERE WERE NO DIFFERENCES IN CLASS/HOME PRACTICE ADHERENCE BETWEEN HY AND ASE. THREE NON-SERIOUS ADVERSE EVENTS WERE REPORTED FROM THE ASE GROUP. BOTH HY AND ASE IMPROVED SYMPTOMS AND FUNCTION BUT HY MAY HAVE SUPERIOR BENEFITS FOR OLDER ADULTS WITH KNEE OA. TRIAL REGISTRATION THE FULL TRIAL PROTOCOL IS AVAILABLE AT CLINICALTRIALS.GOV (NCT02525341). 2017 20 444 26 CHAIR YOGA: BENEFITS FOR COMMUNITY-DWELLING OLDER ADULTS WITH OSTEOARTHRITIS. THE AIM OF THIS PILOT STUDY WAS TO EXAMINE WHETHER CHAIR YOGA WAS EFFECTIVE IN REDUCING PAIN LEVEL AND IMPROVING PHYSICAL FUNCTION AND EMOTIONAL WELL-BEING IN A SAMPLE OF COMMUNITY-DWELLING OLDER ADULTS WITH OSTEOARTHRITIS. ONE-WAY REPEATED MEASURES ANALYSIS OF VARIANCE WAS PERFORMED TO EXAMINE THE EFFECTIVENESS OF CHAIR YOGA AT BASELINE, MIDPOINT (4 WEEKS), AND END OF THE INTERVENTION (8 WEEKS). ALTHOUGH CHAIR YOGA WAS EFFECTIVE IN IMPROVING PHYSICAL FUNCTION AND REDUCING STIFFNESS IN OLDER ADULTS WITH OSTEOARTHRITIS, IT WAS NOT EFFECTIVE IN REDUCING PAIN LEVEL OR IMPROVING DEPRESSIVE SYMPTOMS. FUTURE RESEARCH PLANNED BY THIS TEAM WILL USE RIGOROUS STUDY METHODS, INCLUDING LARGER SAMPLES, RANDOMIZED CONTROLLED TRIALS, AND FOLLOW UP FOR MONITORING HOME PRACTICE AFTER THE INTERVENTIONS. 2012