Remotely Delivered Yoga for Chronic Musculoskeletal and Widespread Pain: A Systematic Review of Randomized Controlled Trials
Keywords:
Ankylosing spondylitis, Chronic musculoskeletal pain, Low back pain, Osteoarthritis, Remote yoga, Systematic review, Telerehabilitation, Virtual yoga, YogaAbstract
Background: Chronic musculoskeletal pain is a leading cause of global disability, and guidelines recommend exercise-based approaches including yoga. In-person delivery embeds barriers of travel, cost, and scheduling, and remote delivery is advocated to overcome them, but no systematic review has examined it in this population.
Methods: Five databases were searched to June 2026 for randomized controlled trials of yoga delivered predominantly online to adults with chronic musculoskeletal or widespread pain. Co-primary outcomes were pain intensity and physical function. Risk of bias (RoB) was assessed using RoB 2 and certainty using Grading of Recommendations, Assessment, Development and Evaluation. Findings were synthesized narratively by International Classification of Diseases-11 pain category; meta-analysis was not appropriate.
Results: Six trials (589 participants, five conditions) were included: Five delivered supervised synchronous classes, and one an unsupervised pre-recorded program. Function improved relative to control in four trials. Effects on pain were inconsistent and clinically important in only one, in which live-streamed classes reduced pain and disability in chronic low back pain at 12 weeks, sustained to 24 weeks. Unsupervised asynchronous yoga did not reduce knee pain. Three trials were at some concerns and three at high RoB. No serious adverse events occurred, although minor musculoskeletal events were more frequent with yoga where systematically collected. Certainty was moderate to very low. All trials invoked access barriers, yet none recruited an access-limited population or measured travel burden.
Conclusion: Remotely delivered yoga appears safe and may improve physical function, but the evidence is sparse and of low certainty, delivery mode remains confounded, and the equity rationale on which it is advocated is untested.
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