Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis: A Systematic Review and Meta‐Regression Analysis of Randomized Controlled Trials

Abstract

Objective. To identify the optimal exercise program, characterized by type and intensity of exercise, length of program, duration of individual supervised sessions, and number of sessions per week, for reducing pain and patient-reported disability in knee osteoarthritis (OA).Methods. A systematic review and meta-analysis of randomized controlled trials were performed. Standardized mean differences (SMDs) were combined using a random-effects model. Study-level covariates were applied in meta-regression analyses in order to reduce between-study heterogeneity.Results. Forty-eight trials were included. Similar effects in reducing pain were found for aerobic, resistance, and performance exercise (SMD 0.67, 0.62, and 0.48, respectively; P ‫؍‬ 0.733). These single-type exercise programs were more efficacious than programs that Conclusion. Optimal exercise programs for knee OA should have one aim and focus on improving aerobic capacity, quadriceps muscle strength, or lower extremity performance. For best results, the program should be supervised and carried out 3 times a week. Such programs have a similar effect regardless of patient characteristics, including radiographic severity and baseline pain.

Optimal primary care management of clinical osteoarthritis and joint pain in older people: a mixed-methods programme of systematic reviews, observational and qualitative studies, and randomised controlled trials

“…207 The BEEP trial 188 is a logical consequence of recent primary care trials, systematic reviews and guidelines for knee pain in older adults, which consistently support exercise-based interventions but highlight the short-term, small-to moderate-sized, benefits. 34,192 The overall aim of the BEEP trial was to test, in older adults with knee pain attributable to OA, whether or not pain and function outcomes can be improved through changing the characteristics of the exercise programme in comparison with UC. The research hypotheses were (1) a physiotherapy-led individualised, supervised and progressed lower limb exercise programme would be superior to UC and (2) a physiotherapy-led intervention targeting exercise adherence in the longer term and supporting the transition from lower limb exercise to general lifestyle physical activity would be superior to UC.…”

“…Recent systematic reviews clearly show that exercise is effective for knee OA compared with no exercise controls, 122 that exercise should be supervised 192 and that the number of sessions is important in terms of achieving greater changes in pain and function. 33,192 There is conflicting evidence from two recent systematic reviews and meta-analyses about whether combining exercise types (such as strengthening, flexibility and aerobic exercise) 122 or focusing on single exercise types are more effective for knee OA.…”

“…191 Clinical trials and systematic reviews consistently show the benefit of exercise, in a variety of forms, for this patient group. 33,122,[192][193][194] Exercise improves muscle dysfunction and reduces pain and disability without exacerbating joint damage. 195 It can reduce the risk of other chronic conditions 196 and improve the physical status of people with OA.…”

“…34,203 Similarly, other recent trials 30,98 and reviews 204 showed small to moderate, short-term reductions in knee pain and disability that are not sustained in the long term. 192 Exercise is clearly worth doing but we need to find out if, and how, the beneficial effects can be maintained over time. This is crucial to the management of a chronic long-term condition like knee OA.…”

“…205 Adherence, independent of exercise type, may be an important factor in the success of exercise interventions. There is evidence that better adherence to exercise improves pain relief 192 and disability 205 and that the addition of booster sessions may be helpful in maintaining positive effects on pain and function. 204 A UK consensus 32 identified adherence and tailoring of exercise to individuals as important research topics.…”