Supervised Exercise (Still) Beneficial for Knee OA

Most clinical practice guidelines recommend exercise as a first-line treatment for stiffness and pain in knee osteoarthritis (OA), and an updated Cochrane systematic review published in the British Journal of Sports Medicine indicates there's even more reason to do so.

The authors examined 54 randomized clinical trials (RCTs) involving over 5,000 participants to determine the effectiveness of land-based exercise in improving pain, physical function, and quality of life in individuals with knee OA. Participants who completed exercise programs experienced moderate improvement in pain and physical function immediately after treatment, about the same as that of analgesics and nonsteroidal anti-inflammatory drugs.

While pain relief from exercise was still significant at 2 to 6 months after treatment, the effect was smaller, and benefits were minimal after 6 months. Physical function improvement was "better sustained," according to authors, producing small yet significant results even at 6 months.

New to this review was an analysis of data related to quality of life, where pooled results of 13 studies showed a statistically significant benefit of exercise immediately post treatment—"equivalent to an improvement of four points … on a 0–100-point scale," authors write.

The review included studies that compared “any land-based non-perioperative therapeutic exercise regimen” with a non-exercise control group. This wide variation in exercise type, duration, frequency, and intensity didn't allow the authors to evaluate the benefits of one program over another. Also, these findings only pertain to strengthening or weight-bearing exercises—the authors found no studies that examined high-impact exercise as an intervention for knee OA.

Researchers did find that supervised individual exercise programs were more effective than group exercise or home-based programs, with the authors writing that “the magnitude of immediate treatment effects of exercise on pain and physical function increases with the number of face-to-face contact occasions with the healthcare professional.”

The new review updated an earlier Cochrane study on the topic completed in 2008. That study pointed to the positive effects of exercise for pain and physical function in individuals with knee OA.

Eight years and 22 studies later, the evidence still supports that idea.

"Health care professionals and people with OA can be reassured that any type of exercise program that is performed regularly and is closely monitored by healthcare professionals can improve pain, physical function and quality of life related to knee OA in the short term," they write.