The role of yoga in arthritis treatment in the UK: a critical examination of the evidence
Publication Date
July 27, 2026
Creator
Abstract
Arthritis comprises a set of musculoskeletal conditions with a rising global prevalence, including in the United Kingdom (UK). It poses significant health, social, and economic burdens and negatively impacts the quality of life. Yoga, an ancient mind-body discipline from the Indian subcontinent, is gaining recognition worldwide and also in the UK. Many people practice it in various health conditions to enhance their well-being. Notably, arthritis is one of the most frequently reported health conditions by attendees in yoga sessions in the UK. However, the term "yoga" encompasses a wide range of practices and yoga interventions tend to be complex, differing in their key features, including content, structure, and delivery characteristics. Previous systematic reviews on the effectiveness of yoga for arthritis have included randomised controlled trials (RCTs) from around the world and have highlighted variations in both the definition and key features of yoga interventions. These inconsistencies make it challenging to select yoga interventions that may be the most effective in arthritis treatment. To address this gap in the UK context, this thesis aimed to conduct two separate systematic reviews to synthesise the key features of effective yoga interventions used as complementary approaches for the treatment of osteoarthritis and rheumatoid arthritis, the two most prevalent types of arthritis in the UK. Given the limited number of UK-specific qualitative studies on barriers and facilitators to yoga practice in people with arthritis, this thesis undertook a qualitative systematic review of global evidence, including studies from the UK, with findings that can support the implementation of yoga interventions in the UK context. Additionally, due to a lack of primary qualitative studies exploring insights from yoga providers regarding arthritis treatment in the UK, a qualitative study was conducted to help guide recommendations for integrating yoga into arthritis treatment. Overall, this thesis aimed to critically examine the role of yoga as a complementary intervention for arthritis, focusing on its potential within the UK. It comprises four chapters, three global systematic reviews and a UK-based qualitative study. All systematic reviews in the thesis adhered to the JBI and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
Chapter Two includes a systematic review of RCTs aimed at synthesising the key features of effective yoga interventions used as a complementary approach to osteoarthritis treatment. A search of 17 databases was conducted up to September 22, 2023, with no date and language restrictions. 18 and 16 articles (representing 16 and 14 RCTs) were included in the systematic review and meta-analysis, respectively. The included studies had low methodological quality scores, with common weaknesses such as around reporting of randomisation, allocation concealment, blinding, outcome measurement, and statistical reporting. 10 of 14 yoga interventions used in addition to pharmacological and/or non-pharmacological treatments including 1402 participants, showed significant reductions in pain (standardised mean difference (SMD) -0.70; 95% confidence interval (CI) -1.08 to -0.32) and improvements in function (-0.40; -0.75 to -0.04), compared with pharmacological (drug-based) and/or non-pharmacological treatments (conventional physiotherapy, conventional exercise, health education, wait-list or attention control, non-yogic physiotherapy, chair exercise), or no intervention. Notably, of the effective interventions, eight interventions incorporated centre-based (supervised, group) sessions, and six included additional home-based (unsupervised, individual) practice. These interventions included 34 yogic poses, eight breathing practices, and three meditation and relaxation practices, with osteoarthritis-specific pose modifications in four interventions. Eight of these effective interventions included yogic poses, and seven of them also incorporated either breathing practices, meditation and relaxation practices, or both. Centre-based sessions typically lasted eight weeks, with 53-minute weekly sessions, while home-based sessions spanned 10 weeks, with 30-minute practice recommended four times per week. Since at least 10 studies could be included in the meta-analysis for pain and function each, a random-effects meta-regression analysis was conducted to examine whether study-level characteristics, such as session duration and intervention duration, were associated with the outcomes. Meta-regression suggested no clear statistical associations between study characteristics and outcomes, although power was limited due to the number and size of included studies.
Chapter Three includes a systematic review of RCTs that aims to synthesise the key features of effective yoga interventions in addition to standard medical treatment for rheumatoid arthritis. 17 databases were searched until November 16, 2023, without date and language restrictions. While Chapter Two did not include a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment, the decision to assess confidence in findings using the GRADE approach in this chapter was based on the development of my methodological knowledge and expertise over the course of this PhD. Nine articles representing five RCTs and involving 718 participants were included and had low methodological quality scores, with similar weaknesses observed as in Chapter Two. Yoga interventions, in addition to standard medical treatment, improved disease activity scores (SMD -0.46; 95% CI -0.73 to -0.18; moderate quality evidence) and function (-0.42; -0.78 to -0.07; moderate quality evidence) but showed no significant reduction in pain (-1.06; -2.62 to 0.50; very low-quality evidence) compared to standard medical treatment alone. All five RCTs found yoga’s beneficial effects on one or more outcomes. All yoga interventions included centre-based (supervised, group) sessions, and two included additional home-based (unsupervised, individual) practice. These interventions incorporated 20 yogic poses, seven breathing practices, and four meditation and relaxation practices, with two interventions offering rheumatoid arthritis-specific pose modifications. Centre-based sessions were typically delivered once a week for eight weeks, with sessions lasting around 68 minutes. Home-based yoga was recommended thrice weekly for a 10-week median duration and 40 minutes per session. Due to the limited number of studies (fewer than 10) that could be included in the meta-analysis for each outcome, meta-regression could not be conducted to examine whether study-level characteristics were associated with outcomes.
Chapter Four includes a systematic review of qualitative evidence on barriers and facilitators to yoga practice in people with arthritis. Seven databases were searched with no date and language restrictions until November 07, 2024, and nine articles, representing eight studies, were included. The studies had moderate to high methodological quality scores, with limitations primarily related to reporting the alignment with research philosophy, researcher positioning, and reflexivity. Narrative synthesis and meta-aggregation were conducted. From 112 extracted findings, 20 categories were formed, leading to five key synthesised findings: (i) Yoga, arthritis, and the body: the anticipated and experienced impacts of yoga on physical well-being influenced yoga practice; (ii) Yoga, arthritis, and the mind: levels of motivation and perceived impact on mental well- being influenced yoga practice; (iii) Yoga, arthritis, and the mind-body impact: yoga’s mind-body benefits supported coping with arthritis and encouraged continued practice; (iv) Yoga, arthritis, and session accessibility and structure: factors related to session accessibility and structure influenced engagement with yoga; and (v) Yoga, arthritis, and the session environment: a supportive social environment in yoga sessions impacted yoga practice.
Chapter Five reports a qualitative study that explored UK-based yoga providers’ clinical knowledge of arthritis, experiences of delivering yoga to people with arthritis, their perceived role in arthritis treatment, and perceived yoga training needs. Semi-structured interviews with 20 yoga providers were conducted, transcribed verbatim, and thematically analysed, revealing eight key themes. Yoga providers were generally aware of their attendees’ health conditions and had clinical knowledge of arthritis through their yoga training. They were reasonably confident in delivering yoga to attendees with arthritis and felt that they had an important role in supporting these attendees. Gentle yoga practices were considered appropriate by the yoga providers, with a perception that a potential interplay between yogic poses, breathing practices, and meditation and relaxation practices could help impart mind-body (holistic) benefits in arthritis. Creating a safe and supportive environment in yoga sessions, being empathetic towards attendees’ needs, and offering tailored modifications were perceived to be important for delivering yoga in arthritis treatment. Major challenges to yoga delivery in arthritis treatment included inadequate promotion of yoga, the unregulated nature of yoga delivery, and the absence of evidence-based arthritis- specific yoga training.
In conclusion, this thesis provides evidence showing yoga’s potential as a complementary approach to arthritis treatment within the UK context. By synthesising evidence from global RCTs and qualitative studies, it identifies some consistent key features, including content, structure, and delivery characteristics, that emerged across effective yoga interventions for major types of arthritis in the UK, and highlights the key factors influencing participation in yoga for arthritis treatment. These findings can inform the adaptation and validation of yoga programmes for the UK healthcare setting and guide the development of and access to arthritis-specific yoga training for yoga providers, using the best available scientific evidence. Strengthening the evidence base through rigorous, long-term RCTs and improving the accessibility, regulation, and promotion of yoga could support its effective integration into arthritis treatment in the UK.
Item Type
ethesis
Thesis Type
PhD
Supervisors
Subjects (LC)
Associated Schools / Departments
School of Medicine
eprints ID
82949
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