Online yoga programs may improve knee function

1. Online yoga programs may improve knee function in the short term


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A randomized trial of adults with symptomatic knee osteoarthritis found that a 12-week online yoga program improved participants’ knee function. However, the program did not significantly improve knee pain while walking. The results have been published in Annals of Internal Medicine.

Knee osteoarthritis is a major contributor to pain and disability. Exercise can improve pain, function, muscle strength, and quality of life in people with knee osteoarthritis, and is universally recommended. Yoga is an increasingly popular low-impact exercise that combines static and dynamic postures with mindfulness strategies, making it a beneficial exercise for people with osteoarthritis of the knee. However, limited, low-quality research into knee osteoarthritis shows some benefits to pain, function, and knee stiffness from yoga programs delivered through moderated group classes.

University of Melbourne researchers recruited 212 adults with symptomatic knee osteoarthritis to complete an unsupervised 12-week online yoga program with an educational or online-only education component. They then compared improvements in knee pain while walking and physical function at 12 and 24 weeks after starting the program. The researchers found that participants assigned to yoga successfully completed two-thirds of the program and reported improvement in knee function and less job difficulty compared to those who participated in education only. However, both groups reported similar levels of knee pain while walking. The authors note that knee function benefits were not maintained among yoga program participants during the elective 12-week period following the initial mandatory program.

According to the authors, their findings suggest that an unsupervised online yoga program is feasible and improves physical function at 12 weeks while participants are participating in the program. However, the improvement was modest and unsustainable. They advise that additional research should be done to improve and maintain the effectiveness of online yoga programs.

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2. Most of the manuscript controls on CVD are not up to the quality standards needed to guide research and clinical practice.


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A systematic review of patient-reported outcome measures (PROMs) used in cardiovascular disease (CVD) found that most of them do not meet the quality standards required to guide research and clinical practice. Few measurements have been reported to validate all FDA-recommended psychometric properties, psychometric properties have been rated as adequate by the consensus-based criteria for the selection of health measuring instruments (COSMIN), or have been determined Minimal significant differences. The review was posted on Annals of Internal Medicine.

Patient-reported outcomes are important measures of treatment effect and can be used to inform approval of medications and cardiovascular devices by the Food and Drug Administration. Health status PROMs assess symptom burden, functional status, and health-related quality of life, and are more reproducible than clinician-elicited measures, which can be limited by reporting variance. Although the proclaimed importance of PROMs is recognized in clinical and research settings, they are still underutilized in CVD trials.

Cardiovascular researchers from McMaster University and the University of Calgary have created a comprehensive evidence map of 50 PROMs for health status from 83 studies. They identified 45 disease-specific lacerations and 5 generic manuscripts. Disease-specific PROMs were tested for specific CVD conditions such as heart failure, ischemic heart disease, and arrhythmia. The investigators reported that 22% of the 50 PROMs validated in CVD had minimal significant differences (MIDs), and 16% reported validating all psychometric properties recommended by the Food and Drug Administration. According to the COSMIN criteria, only 2 PROMs had all of their psychometric characteristics rated as adequate in quality, and 64% of the PROMs had less than 50% of the psychometric characteristics rated as adequate. The authors found that there is no generic PROM and only 1 in 6 disease-specific exercises meet all US Food and Drug Administration requirements for product approval. They also reported that no generic PROMs and only 2 disease-specific PROMs were classified as adequate.

According to the authors, their work highlights the need for strict adherence to standard methodological standards for PROM development and validation and for clear reporting of psychometric properties of existing tools. They add that given the use of PROMs to guide Food and Drug Administration approvals of drugs and devices in CVD, there is a need for better adherence to quality standards in PROM validation studies.

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3. Summary of VA/DoD Guidelines for the Management of Major Depressive Disorder Focuses on Key Recommendations Including Use of Telehealth


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Earlier this year, the Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved joint clinical practice guidelines for the management of major depressive disorders (MDD). These updated guidelines are diverse, and the summary focuses on key recommendations with new evidence for pharmacological management, pharmacogenomics, psychotherapy, complementary and alternative therapies, and the use of telehealth, which have become an important component of treatment during the COVID-19 pandemic. A summary of the main recommendations has been published in Annals of Internal Medicine.

In a change from the 2016 guidelines, the 2022 guideline contains two sections referring to “treatment of uncomplicated MDD” and “treatment of MDD that is severe or has partial or limited response to initial treatment” in order to better align with the body of evidence and clinical practice. Several interventions that did not meet the inclusion criteria or had a limited recommendation in the 2016 guideline are now listed or have higher-level recommendations. The VA/DoD guidelines recommend a range of psychological therapies for treating depression and are the only major guidelines for addressing ketamine, esketamine, and drug use. The guidelines suggest the use of ketamine and esketamine in patients who have not responded to other treatments and only narcotic treatments in a research setting. Interventional therapies, such as electroconvulsive therapy, are recommended for patients who have had several failed attempts at treatment or who need immediate symptom relief. Telemedicine, or virtual therapy, has become widely available during the COVID-19 pandemic, even for mental health issues. While limited evidence points to some benefits of computer-guided therapy, the authors of the guidelines found generally insufficient evidence to recommend or against telehealth for the treatment of major depressive disorder.

Depressive disorders are common and are ranked third after headache and pain in terms of years of living with a disability. Although a wide range of effective treatments are available to treat depressive disorders, most people with depression do not receive adequate care. As such, it is important that patients and providers have knowledge of and access to evidence-based interventions. The Guidelines Working Group has concluded a broad and expanded range of treatment options for major depression and clinical practice guidelines resulting from VA/DoD are best practices for healthcare.

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