Rheumatoid arthritis affects more than joints; it can affect body organs, mental health, energy levels, and a person's overall quality of life. It is important for a person living with RA to treat the disease and to stay as strong, flexible, and active as possible. That's not always easy to do and oftentimes we're on our own.
Staying physically active takes on many different forms depending upon a person's abilities and interests. What may be simple activities of daily living (such as bathing or dressing oneself) for one person might become significant range of motion exercises for another. In our community video discussing exercise and staying active, I chose to feature yoga as my choice of physical activity.
What is yoga?
Yoga is an ancient Hindu practice which helps to bring the mind and body into harmony. While there are different types of yoga, each form of yoga involves specific physical postures (asanas), breathing techniques (pranayamas), concentration (dharana), and meditation (dhyana). The most prevalent form of yoga practiced in the United States, Hatha Yoga, may be identified by its various subtypes, such as Iyengar, Bikram, or Sivananda Yoga.
With Iyengar yoga, props are commonly used, such as blocks, bolsters, chairs, blankets, belts, or sand bags, to help persons adjust or support themselves in the different postures in a way that focuses on technique and body alignment, is safe and effective, and respects one's range of motion and physical ability. In Iyengar yoga, the sequence and timing of asanas are emphasized to gain the most benefit from the practice.
Is yoga good for RA?
The short answer is yes, research has demonstrated positive benefits of yoga for persons living with RA. In preparation for writing this article, I conducted a quick search (using terms rheumatoid arthritis and yoga) of research studies indexed in PubMed and came up with 25 entries. It was interesting that among those 25 entries, I discovered:
- a small number of the published articles were papers that detailed the protocols for future research studies (e.g., Evans, 2011; Middleton, 2013);
- a small number of the studies were pilot studies conducted to investigate the feasibility of conducting larger studies (e.g., Evans, 2010);
- not many studies have been conducted which specifically investigate yoga and RA, with less than a handful being randomized, controlled studies; and
- a significant number of the articles were actually reviews or meta-analyses of the small number of completed studies published within a certain time period (e.g., Telles, 2012).
How does yoga benefit persons with RA?
Here are some of the reported benefits of yoga in patients with RA seen during select clinical trials of various methods, outcomes, measurements, and duration.
Yoga helps to decrease:
- Rheumatoid factor levels (reduced in both men and women, but remained above normal in women; Telles, 2011)
- C-reactive protein levels (primarily in women; the average levels in male participants more than doubled; Telles, 2011)
Yoga helps to improve:
- Range of motion and balance
- Chronic pain acceptance
- Sleep quality
- Self-efficacy and confidence
- Vitality and general health
- Daily functioning
- Quality of life
- Hand grip strength (males only in one study; Telles, 2011)
Yoga did not seem to affect:
- Stress hormone levels as measured in one study (Bosch, 2009).
In an earlier study conducted by Evans et al. (2010), the improvements seen during the time participants were attending regular yoga classes began to regress back to baseline following the time that no specific instruction was given as most participants did not continue to practice yoga on their own. However, in a later study conducted by Evans et al. (2013), improvements in quality of life, pain disability, and mood persisted at the 2-month follow-up.
Although no adverse effects or injuries were observed in these few studies of yoga in RA patients, it is important to emphasize that not all yoga classes (or yoga videos) are the same. It is important to think about personal safety, especially as you will certainly have special needs due to RA, and the expertise and training of the yoga instructor. Choose an instructor who can demonstrate specialized training and has experience working with medical populations. Be aware that the results seen above may not generalize to other forms of yoga which were not studied.
Yoga Styles (n.d.). DoYogaWithMe.com. Accessed at http://www.doyogawithme.com/types-of-yoga
Bosch PR, TraustadÃ³ttir T, Howard P, Matt KS. Functional and physiological effects of yoga in women with rheumatoid arthritis: a pilot study. Altern Ther Health Med. 2009 Jul-Aug;15(4):24-31.
Evans S, Cousins L, Tsao JC, et al. A randomized controlled trial examining Iyengar yoga for young adults with rheumatoid arthritis: a study protocol. Trials. 2011 Jan 21;12:19. doi: 10.1186/1745-6215-12-19.
Evans S, Moieni M, Lung K, et al. Impact of iyengar yoga on quality of life in young women with rheumatoid arthritis. Clin J Pain. 2013 Nov;29(11):988-97. doi: 10.1097/AJP.0b013e31827da381.
Evans S, Moieni M, Subramanian S, et al. "Now I see a brighter day": expectations and perceived benefits of an Iyengar yoga intervention for young patients with rheumatoid arthritis. J Yoga Phys Ther. 2011 Jun 11;1(101). pii: 101.
Evans S, Moieni M, Taub R, et al. Iyengar yoga for young adults with rheumatoid arthritis: results from a mixed-methods pilot study. J Pain Symptom Manage. 2010 May;39(5):904-13. doi: 10.1016/j.jpainsymman.2009.09.018.
Middleton K, Acevedo A, et al. Yoga and Physical Rehabilitation Medicine: A Research Partnership in Integrative Care. J Yoga Phys Ther. 2013 Dec 7;3(4). pii: 149.
Middleton KR, Ward MM, et al. A pilot study of yoga as self-care for arthritis in minority communities. Health Qual Life Outcomes. 2013 Apr 2;11:55. doi: 10.1186/1477-7525-11-55.
Telles S, Naveen KV, Gaur V, Balkrishna A. Effect of one week of yoga on function and severity in rheumatoid arthritis. BMC Res Notes. 2011 Apr 12;4:118. doi: 10.1186/1756-0500-4-118.
Telles S, Singh N. Is yoga a suitable treatment for rheumatoid arthritis: current opinion. Open Access J Sports Med. 2012 Aug 8;3:81-7. doi: 10.2147/OAJSM.S25707. Review.