1. Diana M. Taibi, PhD, RN Biobehavioral Nursing & Health Systems University of Washington WUN, 2010 Building a Program of Research on Yoga for Osteoarthritis

2. Yoga for Osteoarthritis: Background on OA Osteoarthritis Affects ~ 27 million adults in US Cost $128 billion in annual direct & indirect costs DisparityMore common in white persons, greater disease burden in African American & Hispanic persons Age Prevalence >50% in persons ≥ 65 y/o Symptoms Pain, sleep disturbance, depressed mood Disability Leading cause of disability in the U.S.

3. Yoga for Osteoarthritis: Background on Yoga Multimodal mind-body intervention Poses, breathing, relaxation & meditation Published studies showed improvements in: Arthritisgrip strength, range of motion, function, joint tenderness, pain Low Back Painpain, functional ability Sleeptime awake, sleep quality ratings, total sleep time

4. Development Collaborative relationships Design “Yoga for OA” program Develop materials for instructor training & program dissemination Yoga for OA Program Research Feasibility & acceptability Efficacy Effectiveness

5. Preliminary Study: Yoga for OA-Related Insomnia in Women Design: one-group, pre/post N=14, age = 65.2 ± 6.9 y. Intervention: 8 weekly classes (75 min) nightly home practice (20 min)

6. Preliminary Study: Yoga for OA-Related Insomnia in Women Good Adherence Attended 7.2 ± 1.0 of the 8 classes Practiced: 5.83 ± 1.66 nights/week 22.59 ± 6.20 min/session Efficacy Significant improvement in sleep outcomes

7. K01: A Yoga Program for OA Symptoms and Disability in Older Adults Training Aims Gain specialized knowledge of gerontology OHSU coursework Hartford Summer Institute at NYU Become active in Gerontological Society of America Expand clinical trials training Work with Dr. Michael Vitiello’s study team Institute of Translational Health Sciences

8. Research Aims 1. To develop a “Yoga for OA” intervention for disability and symptom (pain, sleep disturbance, and depression) reduction that is specifically tailored to the physical needs and limitations of older persons with OA. 2. To test the feasibility and acceptability of the program. 3. To conduct preliminary efficacy testing of the program via a small-scale RCT comparing the Yoga for OA. K01: A Yoga Program for OA Symptoms and Disability in Older Adults

9. A Conceptual Model of the OA Symptom and Disability Cycle (modified from Vitiello, et al., (2009). J Clinical Sleep Med, 5(4), 355-362.)

10. Intervention: Viniyoga Consultant: Robin Rothenberg Emphasis on healthy structural alignment Repetition, rather than holding poses Shown to reduce low back pain 12 weeks, 75 minute classes weekly, 20 minutes home practice daily

11. Yoga for Osteoarthritis: Study Design Pre- Assessment Intervention Post-study period Post- Assessment Follow-up Assessment 1 week 12 weeks3 months 1 week Yoga (n=41*) Attention Control (n=25) Design: Randomized Crossover Trial Participants: N=50, men & women ≥65 y/o with OA. *First 16 will complete Phase 1 only for feasibility. Outcomes: Pain, disability, sleep, & depressed mood questionnaires; objective disability (timed walk, ROM measure by physical therapist) & sleep (actigraphy) Randomization

12. Long-term Goals TimingGoal 2010-2015K01- funded development and efficacy testing 2015-2020R01/K02-funded large efficacy study 2020-2025R01-funded dissemination and effectiveness testing

13. Yoga for OA: Implications Will provide data for obtaining grant funding for a large efficacy trial Health implications Reduced disability & symptoms Improved quality of life Standardized, evidence-based yoga program Safe & effective to recommend to patients Starting place for adults unfamiliar with yoga