Restricted accessResearch articleFirst published online 2026
Effects of yoga on pain,physical function,and biomechanical/impairment outcomes in knee osteoarthritis: A systematic review and three-level meta-analysis
The effects of yoga on pain, functional limitations, and biomechanical/impairment deficits in knee osteoarthritis (KOA) remain inconclusive.
Objective
To conduct a three-level meta-analysis that retains all eligible effect sizes to evaluate the effects of yoga on KOA and examine potential moderators.
Methods
Five Chinese- and English-language databases were searched from inception to 28 August 2025. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADEpro. Pooled effects were estimated using R (metafor). Influence diagnostics, sensitivity analyses, moderator analyses, and publication-bias tests (Egger's test, funnel plots) were performed.
Results
Fourteen studies (n = 1183) were included. Low-certainty evidence showed that yoga improved pain (g = -0.79, 95% CI −1.24 to −0.35) and physical function (g = -0.39, 95% CI −0.57 to −0.21). Very-low-certainty evidence indicated benefits for biomechanical/impairment outcomes (g = -0.56, 95% CI −0.85 to −0.26). Weekly session frequency moderated pain outcomes, with 4–7 sessions/week producing the largest effects (g = -1.53). Programs lasting ≥8 weeks were required for consistent analgesic benefit.
Conclusions
Yoga may provide beneficial effects on pain, physical function, and biomechanical/impairment outcomes in individuals with KOA. Evidence suggests that programs delivered on most days of the week (≥4 sessions/week) and lasting at least 8 weeks are associated with greater pain reduction. Yoga may serve as a feasible and acceptable adjunct to pharmacologic care and established exercise therapies; however, these conclusions should be interpreted cautiously in light of study quality and heterogeneity.
SharmaL. Osteoarthritis of the knee. N Engl J Med2021; 384: 51–59.
3.
AbramoffBCalderaFE. Osteoarthritis: pathology, diagnosis, and treatment options. Med Clin North Am2020; 104: 293–311.
4.
YangGWangJLiuY, et al.Burden of knee osteoarthritis in 204 countries and territories, 1990-2019: results from the global burden of disease study 2019. Arthritis Care Res (Hoboken)2023; 75: 2489–2500.
5.
SunXZhenXHuX, et al.Osteoarthritis in the middle-aged and elderly in China: prevalence and influencing factors. Int J Environ Res Public Health2019; 16: 4701.
6.
ChenHWuJWangZ, et al.Trends and patterns of knee osteoarthritis in China: a longitudinal study of 17.7 million adults from 2008 to 2017. Int J Environ Res Public Health2021; 18: 8864.
7.
ZhaoGZhuSZhangF, et al.Global burden of osteoarthritis associated with high body mass index in 204 countries and territories, 1990-2019: findings from the global burden of disease study 2019. Endocrine2023; 79: 60–71.
8.
SteinmetzJDCulbrethGTHaileLM, et al.Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the global burden of disease study 2021. Lancet Rheumatol2023; 5: e508-22.
9.
SmithTOHawkerGAHunterDJ, et al.The OMERACT-OARSI core domain set for measurement in clinical trials of hip and/or knee osteoarthritis. J Rheumatol2019; 46: 981–989.
10.
JakielaJTVoinierDHorneyJA, et al.The association of stair climbing behaviors with hazard of all-cause mortality in adults with or at risk of knee osteoarthritis. J Rheumatol2024; 51: 408–414.
11.
GuoMAxeMJManalK. The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis. Gait Posture2007; 26: 436–441.
12.
SlemendaCBrandtKDHeilmanDK, et al.Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med1997; 127: 97–104.
13.
MiyazakiTWadaMKawaharaH, et al.Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis2002; 61: 617–622.
14.
BueltANarducciDM. Osteoarthritis management: updated guidelines from the American college of rheumatology and arthritis foundation. Am Fam Physician2021; 103: 120-1.
15.
BannuruRROsaniMCVaysbrotEE, et al.OARSI Guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage2019; 27: 1578–1589.
16.
KolasinskiSLNeogiTHochbergMC, et al.2019 American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Rheumatol2020; 72: 220–233.
CramerHLaucheRLanghorstJ, et al.Yoga for depression: a systematic review and meta-analysis. Depress Anxiety2013; 30: 1068–1083.
19.
CheungCWymanJFBronasU, et al.Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatol Int2017; 37: 389–398.
20.
CheungCWymanJFSavikK. Adherence to a yoga program in older women with knee osteoarthritis. J Aging Phys Act2016; 24: 181–188.
21.
EbnezarJNagarathnaRYogithaB, et al.Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. J Altern Complement Med2012; 18: 463–472.
22.
LuJKangJHuangH, et al.The impact of yoga on patients with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. PloS one2024; 19: e0303641.
23.
LaucheRHunterDJAdamsJ, et al.Yoga for osteoarthritis: a systematic review and meta-analysis. Curr Rheumatol Rep2019; 21: 47.
24.
BiswasINalbantGLewisS, et al.Key characteristics of effective yoga interventions for managing osteoarthritis: a systematic review and meta-analysis. Rheumatol Int2024; 44: 1647–1677.
25.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J2021; 372: 71.
26.
BennellKLDobsonFHinmanRS. Exercise in osteoarthritis: moving from prescription to adherence. Best Pract Res Clin Rheumatol2014; 28: 93–117.
27.
SterneJACSavovićJPageMJ, et al.Rob 2: a revised tool for assessing risk of bias in randomised trials. Br Med J2019; 366: l4898.
28.
AssinkMWibbelinkCJ. Fitting three-level meta-analytic models in R: a step-by-step tutorial. Quant Methods Psychol2016; 12: 154–174.
29.
CheungMW. Modeling dependent effect sizes with three-level meta-analyses: a structural equation modeling approach. Psychol Methods2014; 19: 211–229.
30.
CuiXZhangSYuS, et al.Does working memory training improve emotion regulation and reduce internalizing symptoms? A pair of three-level meta-analyses. Behav Res Ther2024; 179: 104549.
31.
ViechtbauerWCheungMW. Outlier and influence diagnostics for meta-analysis. Res Synth Methods2010; 1: 112–125.
32.
IrwigLMacaskillPBerryG, et al.Bias in meta-analysis detected by a simple, graphical test. Graphical test is itself biased. Br Med J1998; 316: 470.
33.
WarnekeKPlöschbergerGLohmannLH, et al.Foam rolling and stretching do not provide superior acute flexibility and stiffness improvements compared to any other warm-up intervention: a systematic review with meta-analysis. J Sport Health Sci2024; 13: 509–520.
34.
LiuCChenRYunSM, et al.Intervention effect of exercise on working memory in patients with depression: a systematic review. PeerJ2024; 12: e17986.
35.
BennellKLSchwartzSTeoPL, et al.Effectiveness of an unsupervised online yoga program on pain and function in people with knee osteoarthritis : a randomized clinical trial. Ann Intern Med2022; 175: 1345–1355.
36.
BokaeianHREsfandiarpourFZahednejadS, et al.Effects of an exercise therapy targeting knee kinetics on pain, function, and gait kinetics in patients with knee osteoarthritis: a randomized clinical trial. Adapt Phys Activ Q2021; 38: 377–395.
37.
CheungCWymanJFResnickB, et al.Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial. BMC Complement Altern Med2014; 14: 60.
38.
DeepeshwarSTanwarMKavuriV, et al.Effect of yoga based lifestyle intervention on patients with knee osteoarthritis: a randomized controlled trial. Front Psychiatry2018; 9: 2018.
39.
EbnezarJNagarathnaRBaliY, et al.Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: a randomized control study. Int J Yoga2011; 4: 55–63.
40.
EbnezarJNagarathnaRYogithaB, et al.Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: a randomized control study. Int J Yoga2012; 5: 28–36.
41.
YaoCTLeeBOHongH, et al.Effect of chair yoga therapy on functional fitness and daily life activities among older female adults with knee osteoarthritis in Taiwan: a quasi-experimental study. Healthcare2023; 11: 1024.
42.
KuntzABChopp-HurleyJNBrennemanEC, et al.Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: a randomized controlled trial. PloS One2018; 13: e0195653.
43.
ParkJMcCaffreyRNewmanD, et al.A pilot randomized controlled trial of the effects of chair yoga on pain and physical function among community-dwelling older adults with lower extremity osteoarthritis. J Am Geriatr Soc2017; 65: 592–597.
44.
VaghelaNMishraDPatelJ, et al.Promoting health and quality of life of patients with osteoarthritis of knee joint through non-pharmacological treatment strategies: a randomized controlled trial. J Educ Health Promot2020; 9: 56.
45.
ZhouJPanH. Effect of iyengar yoga exercises in middle-aged and elderly women with knee. Contemp Sports Technol2014; 4: 2.
46.
AbafitaBJSinghAAitkenD, et al.Yoga or strengthening exercise for knee osteoarthritis: a randomized clinical trial. JAMA Network Open2025; 8: e253698.
47.
WuBLiuWWangS, et al.Effects of different mind-body exercises on pain in patients with knee osteoarthritis: a pairwise, network, and dose-response meta-analysis. Complement Ther Med2025; 92: 103188.
48.
MoLJiangBMeiT, et al.Exercise therapy for knee osteoarthritis: a systematic review and network meta-analysis. Orthop J Sports Med2023; 11: 23259671231172773.
49.
DjalilovaDMSchulzPSBergerAM, et al.Impact of yoga on inflammatory biomarkers: a systematic review. Biol Res Nurs2019; 21: 198–209.
50.
LongpréHSBrennemanECJohnsonAL, et al.Identifying yoga-based knee strengthening exercises using the knee adduction moment. Clin Biomech2015; 30: 820–826.
51.
SeagersKUhlrichSDKolesarJA, et al.Changes in foot progression angle during gait reduce the knee adduction moment and do not increase hip moments in individuals with knee osteoarthritis. J Biomech2022; 141: 111204.
52.
RokhmanovaNKuchenbeckerKJShullPB, et al.Predicting knee adduction moment response to gait retraining with minimal clinical data. PLoS Comput Biol2022; 18: e1009500.
53.
JonesMDHansfordHJBastianonA, et al.Exercise adherence is associated with improvements in pain intensity and functional limitations in adults with chronic non-specific low back pain: a secondary analysis of a cochrane review. J Physiother2025; 71: 91–99.
54.
de WitJHaberTHallM, et al.Association between prescribed dosage of resistance exercise and change in pain and physical function in knee osteoarthritis: a systematic review with meta-regression. Musculoskeletal Care2025; 23: e70110.
55.
Rausch OsthoffAKNiedermannKBraunJ, et al.2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis2018; 77: 1251–1260.
56.
van MiddelkoopMSchiphofDHattleM, et al.People with short symptom duration of knee osteoarthritis benefit more from exercise therapy than people with longer symptom duration: an individual participant data meta-analysis from the OA trial bank. Osteoarthritis Cartilage2024; 32: 1620–1627.
57.
NaugleKMNaugleKERileyJL. Reduced modulation of pain in older adults after isometric and aerobic exercise. J Pain2016; 17: 719–728.
58.
DobsonFHinmanRSRoosEM, et al.OARSI Recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthritis Cartilage2013; 21: 1042–1052.
59.
IversenMDPriceLLvon HeidekenJ, et al.Physical examination findings and their relationship with performance-based function in adults with knee osteoarthritis. BMC Musculoskelet Disord2016; 17: 73.
60.
LeeACHarveyWFPriceLL, et al.Mindfulness is associated with psychological health and moderates pain in knee osteoarthritis. Osteoarthritis Cartilage2017; 25: 824–831.
61.
MoonazSHBinghamCOWissowL, et al.Yoga in sedentary adults with arthritis: effects of a randomized controlled pragmatic trial. J Rheumatol2015; 42: 1194–1202.
62.
American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exercise2009; 41: 687–708.
