Effects of yoga on pain, physical function, and biomechanical/impairment outcomes in knee osteoarthritis: A systematic review and three-level meta-analysis

BackgroundThe effects of yoga on pain, functional limitations, and biomechanical/impairment deficits in knee osteoarthritis (KOA) remain inconclusive.ObjectiveTo conduct a three-level meta-analysis that retains all eligible effect sizes to evaluate the effects of yoga on KOA and examine potential moderators.MethodsFive Chinese- and English-language databases were searched from inception to 28 August 2025. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADEpro. Pooled effects were estimated using R (metafor). Influence diagnostics, sensitivity analyses, moderator analyses, and publication-bias tests (Egger's test, funnel plots) were performed.ResultsFourteen studies (n = 1183) were included. Low-certainty evidence showed that yoga improved pain (g = -0.79, 95% CI -1.24 to -0.35) and physical function (g = -0.39, 95% CI -0.57 to -0.21). Very-low-certainty evidence indicated benefits for biomechanical/impairment outcomes (g = -0.56, 95% CI -0.85 to -0.26). Weekly session frequency moderated pain outcomes, with 4-7 sessions/week producing the largest effects (g = -1.53). Programs lasting ≥8 weeks were required for consistent analgesic benefit.ConclusionsYoga may provide beneficial effects on pain, physical function, and biomechanical/impairment outcomes in individuals with KOA. Evidence suggests that programs delivered on most days of the week (≥4 sessions/week) and lasting at least 8 weeks are associated with greater pain reduction. Yoga may serve as a feasible and acceptable adjunct to pharmacologic care and established exercise therapies; however, these conclusions should be interpreted cautiously in light of study quality and heterogeneity.