Tina Kline has had rheumatoid arthritis for 20 years, and with it, the sharp pain she feels almost constantly in her joints, the frustration of having to limit her activities and the anguish of knowing she'll almost certainly never be free of the disorder.
For the past three years, though, the Towson woman has been feeling "a whole lot better" emotionally and physically, thanks to a form of mindful exercise developed by a research team at the Johns Hopkins University Bloomberg School of Public Health.
Kline, 60, has become a disciple of yoga after taking part in a seven-year study that showed that the mind-body exercise practice — if tailored to a patient's condition — can produce dramatic results for those suffering from rheumatoid arthritis or osteoarthritis, the two most common forms of the disease.
Trial participants saw their symptoms reduced and their emotional outlook improved within eight weeks — effects that for some lasted more than nine months.
The results of the study, the largest of its kind to date, were described recently in the Journal of Rheumatology.
Kline said practicing the yoga she learned during the study has improved the strength around her joints, her flexibility and her balance in ways she hadn't thought possible — and showed her, too, that she has a measure of control over a malady that once seemed to control her.
"When I was diagnosed in 1995, I honestly never thought I could do something like yoga," she said. "But [the trial] showed me I could, and I've found it makes a significant difference in my life living with arthritis."
Arthritis is a chronic illness that affects about 52.5 million adults and 294,000 children in the United States, according to the Centers for Disease Control and Prevention.
The most common of the condition's 100 forms are osteoarthritis, generally caused by long-term physical wear and tear, and rheumatoid arthritis, an autoimmune disorder in which the body's natural defenses mistakenly attack the cells within the joint tissue.
Osteoarthritis is the most common, causing 27 million Americans pain or stiffness in the joints, most commonly the knees, hips, lower back, neck, fingers and toes, according to the nonprofit Arthritis Foundation in Atlanta. It appears most frequently in those over 65.
Rheumatoid arthritis, which affects about 1.7 million Americans, most often attacks the hands, feet, wrists, elbows, knees or ankles, usually affecting a similar site on both sides of the body.
It's four times more prevalent among women than in men, and tends to begin in young to middle adulthood.
Because arthritis has no cure, treatments focus on managing its symptoms and effects — an approach that, until about 20 years ago, many believed should not include exercise.
Research, though, showed that moderate, controlled, regular exercise improved symptoms and generated positive effects on mood.
"We now know folks with arthritis should be active and exercising," said Susan Bartlett, the Hopkins study's lead investigator. "It's important for maintaining health, for strength, for the integrity of muscles, and for coping with stress."
Walking, limited dance and water aerobics have proved some of the most popular forms of exercise.
A few scattered researchers had tried limited use of yoga. When Bartlett — a trained psychologist and faculty member at the Johns Hopkins School of Medicine and McGill University — began practicing the ancient art a decade ago, it occurred to her it might make a great fit for arthritis treatment.
She was struck by its emphasis on meditation, relaxation and "listening to the body," all of which dovetailed with her longtime belief that patients should be mindful that "how they feel can vary dramatically from day to day, depending on whether they're doing well or in the midst of a disease [flare-up]" — and exercise accordingly.
Soon after taking up the practice, Bartlett met Baltimore native Steffany Moonaz, a yoga instructor and researcher with an extensive background in dance and a lifelong fascination with the pathways by which "mindful" exercise — the kind one performs not in a distracted state, but with a focused mind — produces positive effects on mind and body.
They founded a research team that also included a Johns Hopkins rheumatology professor who practices yoga, Dr. Clifton O. Bingham, and a professor at the public health school, Dr. Lawrence Wissow, to explore the subject from several vantage points.
Armed with grants from the Arthritis Foundation and the National Institutes of Health, they designed a randomized controlled study involving 75 patients who had either osteoarthritis or rheumatoid arthritis.
For eight weeks, members of one group regularly practiced a form of Hatha yoga tailored to accommodate their individual limitations. A control group did not take part in the exercises.
The goals: To determine whether yoga was safe for arthritis and, if it was safe, whether it had helpful effects.
The yoga caused no harm, the team concluded, and those who practiced it three times a week — twice in a class, once at home — showed an average of 20 percent improvement in pain levels, energy, physical health and general sense of well-being.
"A major question was whether yoga could be done with joint damage that often occurs with arthritis," said Bingham, director of the Johns Hopkins Arthritis Center. "Based on the program we developed for the study, I can say the results are very encouraging in terms of recommending yoga with appropriate modifications for people with arthritis."
Moonaz, who had long taught yoga to chronic pain sufferers, developed techniques for tailoring basic yoga positions to each patient's set of conditions.
By carefully introducing props such as chairs, wedges or blocks, she helped participants limit the physical stresses of such basic postures as mountain and downward dog while preserving their essence.
"Sometimes the modification looks nothing like the original pose," Moonaz said. "I might take the pose and flip it over on its back, or I might take a downward dog" — a position that normally requires hands and feet on the floor — "and [move] it against the wall. You're still getting that lengthening of the hamstring and elongated spine, but you won't be putting pressure on painful joints."
Bartlett said arthritis patients should only attempt gentle forms of yoga — and only after consulting with a physician, and communicating their limitations clearly to a trained yoga instructor.
Moonaz has since founded Yoga For Arthritis, an organization that offers classes for arthritis sufferers and for yoga instructors who want to teach the methods developed in the study. Classes meet in Baltimore, New York and Boston, among other cities.
The Arthritis Foundation was so impressed with the study that it financed "Arthritis-Friendly Yoga," a 60-minute DVD featuring Moonaz that is now available in stores and online.
"We've seen countless people and their lives transformed by yoga," Moonaz said, "and not just because they have less pain or more flexibility, but because the way they see things has changed. The main idea is yes, you have this disease, but no, it does not dictate what the rest of your life will be like."
Kline, an administrator in pediatric neurology at Hopkins, said yoga helped her develop just such a perspective, helping her transition from being unable to hold a toothbrush or unscrew a bottle cap to being able to drive herself to many of her activities.
She suffers periodic flare-ups of pain — a symptom that still has no cure — but it now happens only a couple of times a month, not regularly.
Once she started practicing yoga, she said, improvement followed naturally, helping her manage her pain in more ways than one.
"Yoga strengthened the joints, and that helped me use the joints. That reduced my pain level, which kept me more active. And my quality of life gradually started to improve.
"That's the most important thing — improving the quality of life. Without yoga, mine would not be what it is today."
INFORMATION ON CLASSES
A Yoga for Arthritis class meets at Baltimore Yoga Village, 6080 Falls Rd. in Mt. Washington, every Sunday from 12:45 - 2:00 p.m.. For more information, contact Yoga for Arthritis at email@example.com.