Effect of Chair Yoga on Elders With Osteoarthritis

Inclusion Criteria

• age 65 years or older
• living independently in the community and noninstitutionalized at the time of the study
• self-reported joint pain verified by Dr. McCaffrey and a Project Director (nurse practitioner) to be caused by OA and present in one or more lower extremity joints (hip, knee, foot, or ankle)
• ability to ambulate independently with or without assistive devices
• chronic pain at least 15 days of the month for 3 months or longer at a level of at least 4 (moderate pain) on a 0-10 pain bothersomeness scale (0 = no pain to 10 = excruciating pain)
• self-reported inability to participate in regular yoga or standing exercise due to physical disability, fatigue, fear of falling, or balance problems
• not currently participating in yoga or any other exercise program
• ability to understand English or Spanish
• ability to come to designated site at the scheduled times
• willingness to be audiotaped during the intervention sessions

Exclusion Criteria

• Knee surgery (or knee-arthroscopy) or hip(s) within 12 weeks prior to enrollment, causing pain or functional problems
• Systemic or intra-articular corticosteroid use within 60 days of the screening visit
• Serious comorbidity that makes it impossible to participate in the yoga intervention (e.g., heart failure-New York Heart Association (NYHA IV)
• Require assistance by another person (e.g., holding the arm or walking behind) in order to ambulate 30 feet
• Participation in yoga or exercise program currently or in the previous 3 months, or planning to participate in yoga or other exercise program during the chair yoga intervention (including 3-month follow-up)
• Intra-articular steroid injections within 4 weeks of screening
• Inability to understand or speak English or Spanish
• Inability to correctly answer questions, complete the demographic data form, and continue with yoga practice for 1 month post intervention. This is measured by asking participants the following questions (Alzheimer's Association's "questions to determine early cognitive impairment) (http://www.alz.org/alzheimers\_disease\_10\_signs\_of\_alzheimers.asp) as accessed August 27, 2013, as approved by our geriatric content expert, Dr. Joseph Ouslander).

Those who answer three or more of these questions incorrectly are excluded from the study.

• What is today's date? 2. What day of the week is today? 3. On what street do you live? 4. In what town do you live? 5. In what state is your town? 6. Who is the President? 7. What season of the year is this? 8. What month are we in now? 9. How did you get here today?

Screening Evaluation

All participants must have OA. As diagnostic criteria for OA, the participant must exhibit at least three of the following upon history or physical examination to be considered to have a diagnosis of OA and thus to be eligible to participate in the study:

• Pain in the affected joint
• Morning stiffness that is relieved as the day progresses
• Crepitus on active motion
• Bony tenderness
• Bony enlargement
• Decreased range of motion of joint
• Joint instability upon standing or bending
• Increased pain and fatigue with walking or standing
• The participant must ambulate at least 30 feet without assistance from another person (may use cane, walker, or wheelchair). Those who require personal assistance to ambu-late 30 feet (such as needing to hold an arm or to have someone walk behind for safety) are excluded because they would not be able to complete the 6-Minute Walk or Gait Speed Test.

During the screening of potential participants each person is asked whether he or she is able to participate in standing exercise programs or regular yoga programs. The following questions are asked and people are eligible if they identify any two of the following:

Please check any of the following that you feel unable to do because of balance, pain, fear of falling, fatigue or strength

• Standing for 30-45 minutes
• Bending over toward your toes

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