Effects of yoga exercise in reducing the risk of knee osteoarthritis and fibulin-3 levels among overweight population: a randomized controlled trial


  • Nila Wahyuni
  • I Putu Gede Adiatmika
  • Govinda Vittala
  • Agung Nova Mahendra




Yoga, fibulin-3, knee osteoarthritis, neuromuscular coordination


Background and purpose: One of the main risk factors for knee osteoarthritis is overweight. The purpose of this study is to determine the effectiveness of yoga exercise in reducing the risk of knee osteoarthritis and fibulin-3 levels in overweight populations.

Methods: This study was a randomized controlled trial involving 24 participants who met the inclusion and exclusion criteria. Participants were randomly divided into two groups: group one was given yoga exercise intervention and group two was given neuromuscular coordination exercise as the control group. Risk of knee osteoarthritis measurements were carried out using The Western Ontario and McMasters University Osteoarthritis Index (WOMAC). Fibulin-3 measurement used ELISA technique using human fibulin-3 kit, FBLN3 BT-LABkit 96T E4667Hu.

Results: Participants of both groups were comparable, except for age where the control group is slightly older. Pre and post-test comparison showed improvement in pain, stiffness, physical function, total WOMAC score, and fibulin-3 levels in both groups. While, the post-test comparison between the two groups showed that yoga group has better scores on all indicators compared to the control groups which was statistically significant (p≤0.001).

Conclusion: Both interventions are effective in reducing the risk of knee osteoarthritis and fibulin-3 levels, but yoga showed better result. We recommend yoga training to reduce the risk of knee osteoarthritis compared to conventional training. Future research is needed to measure other knee osteoarthritis biomarkers that describe the pathological process of knee osteoarthritis.


Zheng H, Chen C. Body mass index and risk of knee osteoarthritis: Systematic review and meta-analysis of prospective studies. BMJ Open. 2015; 5(12): 1–8.

Ahmad IW, Rahmawati LD, Wardhana TH. Demographic profile, clinical and analysis of osteoarthritis patients in Surabaya. Biomolecular and Health Science Journal. 2018; 1(1): 34–39.

Reyes C, Leyland KM, Peat G, Cooper C, Arden NK, Prieto-Alhambra D. Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: A population-based cohort study. Arthritis and Rheumatology. 2016 Aug 1; 68(8): 1869–1875.

de Zwart AH, Dekker J, Lems WF, Roorda LD, Van Der Esch M, Van Der Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. Journal of Rehabilitation Medicine. 2018; 50(2): 140–150.

Tomlinson DJ, Erskine RM, Morse CI, Winwood K, Onambélé-Pearson G. The impact of obesity on skeletal muscle strength and structure through adolescence to old age. Biogerontology. 2016; 17(3): 467–483.

Vincent KR, Vincent HK. Resistance exercise for knee osteoarthritis. American Academy of Physical Medicine and Rehabilitation. 2012; 4(50): S45–S52.

Segal NA, Glass NA. Is quadriceps muscle weakness a risk factor for incident or progressive knee osteoarthritis?. Physician and Sports Medicine. 2011; 39(4): 44–50.

Roos EM, Arden NK. Strategies for the prevention of knee osteoarthritis. Nature Reviews Rheumatology. 2016; 12(2): 92–101.

Prabhakar AJ, Joshua AM, Prabhu S, Kamat YD. Effectiveness of proprioceptive training versus conventional exercises on postural sway in patients with early knee osteoarthritis – A randomized controlled trial protocol. International Journal of Surgery Protocols. 2020; 24: 6–11.

Brenneman EC, Kuntz AB, Wiebenga EG, Maly MR. A yoga strengthening program designed to minimize the knee adduction moment for women with knee osteoarthritis: A proof-of-principle cohort study. PLoS One. 2015 Sep 14; 10(9): 1–19.

Sanchez C, Mazzucchelli G, Lambert C, Comblain F, DePauw E, Henrotin Y. Comparison of secretome from osteoblasts derived from sclerotic versus non-sclerotic subchondral bone in OA: A pilot study. PLoS One. 2018; 13(3): 1–20.

Losina E, Weinstein AM, Reichmann WM, Burbine S, Solomon DH, Daigle ME, et al. Lifetime risk and age of diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care & Research. 2013; 65(5): 703–711.

Raud B, Gay C, Guiguet-Auclair C, Bonnin A, Gerbaud L, Pereira B, et al. Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Scientific Reports. 2020; 10(1): 1–7.

Yağlı NV, Şener G, Arıkan H, Sağlam M, Ince DI, Savcı S, et al. Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors? Integrative Cancer Therapies. 2015; 14(2): 125–132.

Bukowski EL, Conway A, Glentz LA, Kurland K, Galantino ML. The effect of iyengar yoga and strengthening exercises for people living with osteoarthritis of the knee: A case series. International Quarterly of Community Health Education. 2006; 26(3): 287–305.

Bennell KL, Egerton T, Wrigley TV, Hodges PW, Hunt M, Roos EM, et al. Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: A randomised controlled trial protocol. BMC Musculoskeletal Disorders. 2011; 12(276): 1–12.

Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: A systematic review. Medicine & Science in Sports & Exercise. 2010; 42(3): 413–421.




How to Cite

Wahyuni, N., Adiatmika, I. P. G., Vittala, G., & Nova Mahendra, A. (2023). Effects of yoga exercise in reducing the risk of knee osteoarthritis and fibulin-3 levels among overweight population: a randomized controlled trial. Public Health and Preventive Medicine Archive, 11(2), 157–165. https://doi.org/10.53638/phpma.2023.v11.i2.p04