Article Tools
Email This
Download This
MEDLINE Abstracts
Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review.
Ann Rheum Dis. 2005; 64(4):544-8 (ISSN: 0003-4967)
Roddy E; Zhang W; Doherty M
Academic Rheumatology, Nottingham City Hospital, Nottingham NG5 1PB, UK. edward.roddy@nottingham.ac.uk
OBJECTIVE: To compare the efficacy of aerobic walking and home based quadriceps strengthening exercises in patients with knee osteoarthritis. METHODS: The Medline, Pubmed, EMBASE, CINAHL, and PEDro databases and the Cochrane controlled trials register were searched for randomised controlled trials (RCTs) of subjects with knee osteoarthritis comparing aerobic walking or home based quadriceps strengthening exercise with a non-exercise control group. Methodological quality of retrieved RCTs was assessed. Outcome data were abstracted for pain and self reported disability and the effect size calculated for each outcome. RCTs were grouped according to exercise mode and the data pooled using both fixed and random effects models. RESULTS: 35 RCTs were identified, 13 of which met inclusion criteria and provided data suitable for further analysis. Pooled effect sizes for pain were 0.52 for aerobic walking and 0.39 for quadriceps strengthening. For self reported disability, pooled effect sizes were 0.46 for aerobic walking and 0.32 for quadriceps strengthening. CONCLUSIONS: Both aerobic walking and home based quadriceps strengthening exercise reduce pain and disability from knee osteoarthritis but no difference between them was found on indirect comparison.
- PreMedline Identifier: 15769914
Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review.
Arthritis Rheum. 2007; 57(7):1245-53 (ISSN: 0004-3591)
Pisters MF; Veenhof C; van Meeteren NL; Ostelo RW; de Bakker DH; Schellevis FG; Dekker J
Netherlands Institute for Health Services Research, Utrecht, The Netherlands. m.pisters@nivel.nl
OBJECTIVE: To determine the long-term effectiveness (>/=6 months after treatment) of exercise therapy on pain, physical function, and patient global assessment of effectiveness in patients with osteoarthritis (OA) of the hip and/or knee. METHODS: We conducted an extensive literature search in PubMed, EMBase, CINAHL, SciSearch, PEDro, and the Cochrane Central Register of Controlled Trials. Both randomized clinical trials and controlled clinical trials on the long-term effectiveness of exercise therapy were included. The followup assessments were at least 6 months after treatment ended. Methodologic quality was independently assessed by 2 reviewers. Effect estimates were calculated and a best evidence synthesis was performed based on design, methodologic quality, and statistical significance of findings. RESULTS: Five high-quality and 6 low-quality randomized clinical trials were included. Strong evidence was found for no long-term effectiveness on pain and self-reported physical function, moderate evidence for long-term effectiveness on patient global assessment of effectiveness, and conflicting evidence for observed physical function. For exercise programs with additional booster sessions, moderate evidence was found for long-term effectiveness on pain, self-reported physical function, and observed physical function. CONCLUSION: The positive posttreatment effects of exercise therapy on pain and physical function in patients with OA of the hip and/or knee are not sustained in the long term. Long-term effectiveness was only found for patient global assessment of effectiveness. However, additional booster sessions after the treatment period positively influenced maintenance of beneficial posttreatment effects on pain and physical function in the long term.
- PreMedline Identifier: 17907210
Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review.
J Rheumatol. 2006; 33(4):744-56 (ISSN: 0315-162X)
Devos-Comby L; Cronan T; Roesch SC
Department of Psychology, San Diego State University, San Diego, California 92182-4611, USA. ldevosco@sciences.sdsu.edu
OBJECTIVE: Osteoarthritis (OA) is the most prevalent health condition among seniors and it causes significant pain and disability. We assessed the influence of patient education and exercise regimens on the well-being of patients with knee OA. METHODS: A metaanalysis was conducted on 16 studies reporting exercise and/or self-management interventions for patients with knee OA. The effects on physical and psychological well-being were assessed immediately after the interventions. RESULTS: Compared to control conditions, exercise regimens led to improvement in physical health (by self-report and direct measures) and in overall impact of OA. Perceived psychological health remained unchanged by the exercise programs. Although the effect sizes for the self-management programs were significant for psychological outcomes and for the overall effect of OA, there was a significant difference between self-management and control groups only in psychological outcomes. CONCLUSION: Overall, both patient education and exercise regimens had a modest, yet clinically important, influence on patients' well-being.
- PreMedline Identifier: 16583478
The value of individual or collective group exercise programs for knee or hip osteoarthritis. Clinical practice recommendations.
Ann Readapt Med Phys. 2007; 50(9):741-6, 734-40 (ISSN: 0168-6054)
Tiffreau V; Mulleman D; Coudeyre E; Lefevre-Colau MM; Revel M; Rannou F
Service de m??decine physique et de r??adaptation, h??pital Swynghedauw, CHRU de Lille, 59035 Lille cedex, France. v-tiffreau@chru-lille.fr
OBJECTIVE: To develop clinical practice guidelines concerning individual and group exercise therapy for knee and/or hip osteoarthritis (OA). METHOD: We used the SOFMER (French Physical Medicine and Rehabilitation Society) methodology, combining systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, to develop the guidelines. RESULTS: Physical exercises are proposed for knee and hip OA. The benefit of individual exercises is low to moderate for pain, strength and ability to walk. The effectiveness is not maintained over time if the individual exercise program is not continued. The benefit of group exercise is also low to moderate for pain, strength, balance and ability to walk. There is no evidence of the superiority of one modality over the other (individual or group). CONCLUSION: More randomised controlled trials with good methodology are needed to compare the effectiveness of individual versus group exercise therapy for knee and hip OA.
- PreMedline Identifier: 17963971
Effect of muscle strengthening exercises on the muscle strength in patients with osteoarthritis of the knee.
Knee. 2007; 14(3):224-30 (ISSN: 0968-0160)
Iwamoto J; Takeda T; Sato Y
Department of Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, and Department of Neurology, Mitate Hospital, Fukuoka, Japan. jiwamoto@sonata.plala.or.jp
The purpose of the present study was to investigate the short-term effects of muscle strengthening exercises on the muscle strength in patients with osteoarthritis (OA) of the knee, and to determine whether the beneficial effects of the exercises on the muscles strength, if any, would be maintained over the long-term. Twenty-six patients (mean: 62.8 years) with mild-to-moderate OA of the knee were instructed to perform the exercises, which consisted of once-weekly facility-based strengthening exercises of the knee extensor and flexor muscles with a Medx knee machine at the intensity of 50% of the maximum peak torque (MPT) measured at the baseline (20 timesx3 sets per week), together with daily home-based isometric strengthening exercises (setting and straight leg raising) of the extensor and flexor muscles of the knee (30 times per day). The beneficial effects of the exercises on the MPT values of both the extensor and flexor muscles of the knee that began to be observed from 3 to 6 months after the start of the exercise regimen, regardless of the gender, age, body mass index, or baseline MPT values of the muscles, were maintained for up to 1-3 years, but tended to be no longer observed at 5 years. The present study showed the short-term efficacy of combined facility- and home-based muscle strengthening exercises for the muscle strength in patients with mild-to-moderate OA of the knee, as well as the loss of the beneficial effect of the exercise regimen on the muscle strength over the long-term.
- PreMedline Identifier: 17395467
Effects of kinesthesia and balance exercises in knee osteoarthritis.
J Clin Rheumatol. 2005; 11(6):303-10 (ISSN: 1076-1608)
Diracoglu D; Aydin R; Baskent A; Celik A
Istanbul University, Istanbul Medical Faculty, Department of Physical Medicine and Rehabilitation, Turkey. demirhan1@yahoo.com
BACKGROUND: In patients with knee osteoarthritis (OA), there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender. OBJECTIVES: The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA. METHODS: This 8-week study was conducted on 66 female patients with knee OA who were randomized into 2 groups. The first group received kinesthesia and balance exercises (such as retrowalking, walking on their toes, leaning to the sides, balance board exercises, minitrampoline exercises, plyometric exercises, and so on) in addition to strengthening exercises. The second group received only strengthening exercises. RESULTS:: Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC, SF-36 Form, times for performing activities of daily living, isokinetic quadriceps muscle strength, and proprioceptive sensation levels. In the first group with kinesthesia training, compared with the second group, significantly greater improvements were obtained in all the subparameters that measure functional status (WOMAC-physical function value, SF-36 Form [physical function, role limitations-physical and vitality-energy or fatigue variables], 10 stairs climbing, and 10-m walking times) and in isokinetic muscle strength at high angular velocities (P < 0.05). The absolute angular error percentage (to assess proprioceptive accuracy) was significantly improved postexercise in both groups. There were no differences between the groups. CONCLUSIONS: Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated. Used in clinical applications, they should be able to increase the functional capacities of patients. Long-term studies about efficacy and cost-effectivity of these exercises are needed.
- PreMedline Identifier: 16371799
A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis.
Semin Arthritis Rheum. 2003; 32(6):398-406 (ISSN: 0049-0172)
Huang MH; Lin YS; Yang RC; Lee CL
Department of Physical Medicine, Kaohsiung Medical University Hospital, Taiwan. maohuang@ms24.hinet.net
OBJECTIVE: To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA). METHODS: One hundred thirty-two patients with bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer, and patients' functional status was evaluated by visual analogue scale, ambulation speed, and Lequesne index before and after treatment, and at the follow-up 1 year later. RESULTS: The results showed that the patients with OA in each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up. The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups. A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment. CONCLUSION AND RELEVANCE : Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain, and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time.
- PreMedline Identifier: 12833248
The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis.
J Med Assoc Thai. 2002; 85(1):33-40 (ISSN: 0125-2208)
Kuptniratsaikul V; Tosayanonda O; Nilganuwong S; Thamalikitkul V
Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Osteoarthritis (OA) is a common chronic and progressive degenerative joint condition. A major consequence of knee OA is physical disability; especially difficulty with activities requiring ambulation and transfer, which are necessary to maintain independence and a good quality of life. The purposes of this study were to determine the efficacy of a muscle exercise program along with education about knee care, and investigate the clinical factors which influence its therapeutic efficacy. A prospective study was carried out among elderly Thai people aged 60 years and over, living in an urban community of the Bangkok metropolitan area around Siriraj Hospital, between October 1997 and September 1999. The number of elderly people with osteoarthritis of the knee was 392 (male:female=86:306) with a mean age of 67.7+/-6 years. They were interviewed for demographic data and information about their symptoms. The range of the knee movement, quadriceps strength and the six-minute walking distance and a knee X-ray were evaluated. Group exercise was arranged twice a week for 8 weeks for the intervention group only. The results of the study revealed that the quadriceps strength in the intervention group had a tendency to increase and the walking distance was significantly improved especially in the first two months but there was a tendency to decline by the sixth and twelfth month after enrollment. On the other hand, there was no statistically significant difference of both important outcomes for the control group when assessed in the second month. The findings at the sixth and twelfth month after enrollment were that the quadriceps strength was slightly increased but the walking distance was decreased when compared with the initial assessment. An exercise frequency of 12 sessions in two months was sufficient to improve muscle strength and walking distance. Group exercise produces a significant improvement in strength and walking ability, especially in the first two months. Deterioration over time could be due to multiple factors, such as lack of regular exercise, lack of motivation, lack of family support or poor economic status, so we should encourage the elderly to exercise regularly.
- PreMedline Identifier: 12075718
Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial.
BMJ. 2002; 325(7367):752 (ISSN: 1468-5833)
Thomas KS; Muir KR; Doherty M; Jones AC; O'Reilly SC; Bassey EJ
Academic Rheumatology, City Hospital, Nottingham NG5 1PB.
OBJECTIVES: To determine whether a home based exercise programme can improve outcomes in patients with knee pain. DESIGN: Pragmatic, factorial randomised controlled trial of two years' duration. SETTING: Two general practices in Nottingham. PARTICIPANTS: 786 men and women aged >/=45 years with self reported knee pain. Interventions: Participants were randomised to four groups to receive exercise therapy, monthly telephone contact, exercise therapy plus telephone contact, or no intervention. Patients in the no intervention and combined exercise and telephone groups were randomised to receive or not receive a placebo health food tablet. MAIN OUTCOME MEASURES: Primary outcome was self reported score for knee pain on the Western Ontario and McMaster universities (WOMAC) osteoarthritis index at two years. Secondary outcomes included knee specific physical function and stiffness (scored on WOMAC index), general physical function (scored on SF-36 questionnaire), psychological outlook (scored on hospital anxiety and depression scale), and isometric muscle strength. RESULTS: 600 (76.3%) participants completed the study. At 24 months, highly significant reductions in knee pain were apparent for the pooled exercise groups compared with the non-exercise groups (mean difference -0.82, 95% confidence interval -1.3 to -0.3). Similar improvements were observed at 6, 12, and 18 months. Regular telephone contact alone did not reduce pain. The reduction in pain was greater the closer patients adhered to the exercise plan. CONCLUSIONS: A simple home based exercise programme can significantly reduce knee pain. The lack of improvement in patients who received only telephone contact suggests that improvements are not just due to psychosocial effects because of contact with the therapist.
- PreMedline Identifier: 12364304
Biochemical change in joint fluid after isometric quadriceps exercise for patients with osteoarthritis of the knee.
Osteoarthritis Cartilage. 2003; 11(4):252-9 (ISSN: 1063-4584)
Miyaguchi M; Kobayashi A; Kadoya Y; Ohashi H; Yamano Y; Takaoka K
Department of Orthopaedic Surgery, Osaka City University Medical School, Osaka, Japan.
OBJECTIVE: The purpose of this study was to analyze the biochemical changes in the joint fluid, and pain relief resulting from isometric quadriceps exercise in patients with osteoarthritis of the knee. DESIGN: Nineteen osteoarthritic knees in 17 patients with joint effusion were included. The patients performed isometric quadriceps exercise for 3 months. Isometric muscle torque at 30 and 60 degrees flexion, pain as measured using the visual analog scale and biochemical markers in joint fluid were evaluated before and after the exercise. RESULTS: Pain score decreased from 3.9 to 2.3 after 12 weeks of exercise (P<0.001). Extension torque at 30 and 60 degrees knee flexion significantly increased from 4.7 to 6.9 kgm (47% increase, P<0.001) and from 10.8 to 12.6 kgm (17% increase, P<0.005) after 12 weeks of exercise. The molecular weight of hyaluronan increased from 2.11 to 2.40x10(6)(P<0.05) and the viscosity of joint fluid increased from 45.8 to 59.8 mPas after 12 weeks of exercise (P<0.05). Chondroitin 4-, 6-sulfate concentration in joint fluid decreased from 81.9 to 75.5 nmol/ml (P<0.05).CONCLUSIONS: Isometric quadriceps exercise resulted in significant changes in joint fluid biochemical parameters, and these changes, at least in part, may explain the ameliorative effect of muscle exercise for osteoarthritis of the knee.
- PreMedline Identifier: 12681951
Is exercise effective treatment for osteoarthritis of the knee?
Br J Sports Med. 2000; 34(5):326-31 (ISSN: 0306-3674)
Petrella RJ
Department of Family Medicine, Faculty of Medicine, School of Kinesiology, University of Western Ontario, London, Canada.
OBJECTIVE: To review and determine the effectiveness of exercise treatment in osteoarthritis of the knee. METHODS: A computerised literature search of Medline was carried out searching between June 1966 and January 2000. RESULTS: Twenty three randomised controlled trials were identified from the literature. Only three trials were sufficiently powered. Small to moderate beneficial effects of exercise treatment were found for pain, small beneficial effects on disability outcome measures, and moderate to great beneficial effects were observed according to patient global assessment of effect. It was not possible to obtain evidence on the content of exercise interventions, as studies were hampered by lack of attention to proper concealment, reporting of adverse effects, and long term effects of exercise treatment. The lack of standard outcomes measures is also noted. CONCLUSIONS: The available evidence indicates beneficial short term effects of exercise treatment in patients with osteoarthritis of the knee. However, the number of available studies is limited, and more research is needed to expand this recommendation. Specifically, additional trials should provide information on adherence, home based interventions, interaction with pharmacological treatments, functional outcomes measures relevant to exercise treatment in these patients, and long term effects. At present, doctors should recommend exercise to all patients with mild/moderate disease. Further study should be encouraged and exercise should be continued to be recommended as a mainstay of non-pharmacological treatment of osteoarthritis of the knee.
- PreMedline Identifier: 11049140