The Effects of Therapeutic Exercise on Patients With Knee, Hip Osteoarthritis

According to a recent systematic review and individual participant data (IPD) meta-analysis, researchers found that individuals with high levels of osteoarthritis-related pain benefit from therapeutic exercise.

“There was evidence of a small, positive overall effect of therapeutic exercise on pain and physical function compared with non-exercise controls,” the researchers wrote. “However, this effect is of questionable clinical importance, particularly in the medium and long term.”

In total, the researchers used 31 randomized controlled trials (n = 4241) in their meta-analysis. Participants included in the analysis were diagnosed with either knee osteoarthritis, hip osteoarthritis, or both.

A total of 37 different exercise interventions, with varying duration times, were tested within the 31 randomized controlled trials in the meta-analysis. The interventions ranged from strengthening to general aerobics to yoga. To determine whether therapeutic exercise presented an effect on reducing pain in the patient population, the researchers compared heterogeneous exercise interventions with heterogeneous non-exercise controls.

Using a standardized 0 to 100 scale (100 corresponding to worst pain), therapeutic exercise was found to reduce pain with a difference of - 6.36 points in the short term, - 3.77 points in the medium term, and - 3.43 points in the long term. Further, the researchers noted that therapeutic exercise improved physical function with a difference of - 4.46 points in the short term, - 2.71 points in the medium term, and - 3.39 points in the long term.

Participants with higher self-reported pain and physical function scores at baseline demonstrated that therapeutic exercise was more beneficial to those who reported less pain and physical function scores at baseline.

The authors listed several limitations in their study, most notably that due to the time-intensive nature of the trial, the authors obtained IPD from only approximately 40% of all eligible randomized controlled trials, which could have biased the results.

Although the researchers note that the overall effects of exercise are “likely to be small and of questionable clinical importance,” they go on to conclude there is a use for patients with a particular pain level due to knee and hip osteoarthritis.

“Therapeutic exercise had an overall positive effect on pain and physical function compared with non-exercise controls. However, the magnitude of the overall effect was small and of questionable clinical importance, particularly in the medium to long term,” the researchers concluded. “Targeting individuals with higher levels of osteoarthritis-associated pain and disability for exercise therapy might therefore be of merit.”

Reference:

Holden MA, Hattle M, Runhaar J, et al. Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis: a systematic review and individual participant data meta-analysis. Lancet Rheumatol. Published online June 12, 2023. doi:10.1016/S2665-9913(23)00122-4