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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Does exercise benefit people with osteoarthritis of the knee?

Vanessa Jordan https://orcid.org/0000-0002-9079-6457 1 *
+ Author Affiliations
- Author Affiliations

1 Department Obstetrics and Gynaecology, Grafton Campus, University of Auckland, Auckland, New Zealand.

* Correspondence to: v.jordan@auckland.ac.nz

Journal of Primary Health Care 16(4) 412-413 https://doi.org/10.1071/HC24182
Submitted: 9 December 2024  Accepted: 10 December 2024  Published: 18 December 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Lawford BJ, Hall M, Hinman RS, Van der Esch M, Harmer AR, Spiers L, Kimp A, Dell’Isola A, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2024, Issue 12. Art. No. CD004376. DOI: 10.1002/14651858.CD004376.pub4.1

Background

The knee is the most common area affected by osteoarthritis (OA).2 Incidence of knee OA increases with age, peaking around 75 years of age, with just under 20% of this population affected.2 Over 650 million individuals worldwide are impacted by knee OA.3 Exercise is hypothesised to improve OA symptoms by strengthening muscles, reducing inflammatory cytokines and reducing weight, which may exacerbate the condition.46

Clinical bottom line

This Cochrane review suggests that compared to attention control/placebo, exercise showed slight improvements in pain and likely improvements in physical function, but little to no improvement in quality of life immediately post-intervention. It is unknown if these benefits are maintained long term as only two trials evaluated this.1

Compared to no treatment/usual care/limited education, exercise improved pain, physical function, and slightly improved quality of life immediately post-intervention. Benefits were sustained long-term but were smaller (Table 1).1

Table 1.Comparing the effect of exercise in people with osteoarthritis.1

ComparisonOutcome measuredSuccessEvidenceCaveat
Attention control/placeboPainExercising resulted in a significant improvement in pain reported by those with OA.This evidence is of low quality and is based on 2874 participants from 28 studies.People were just as likely to withdraw from usual treatment as they were from the exercise group. But those participating in the exercise group were more likely to report adverse events comparative to those in the usual care groups. The benefits seen often fell below the threshold of clinically beneficial effect.
Physical functionExercising resulted in a significant improvement in physical function reported by those with OA.This evidence is of moderate quality and is based on 2536 participants from 24 studies.
Quality of lifeExercising did not result in a significant difference in quality of life reported by those with OA.This evidence is of moderate quality and is based on 454 participants from 6 studies.
No treatment/usual care/limited educationPainExercising resulted in a significant improvement in pain reported by those with OA.This evidence is of low quality and is based on 4184 participants from 56 studies.
Physical functionExercising resulted in a significant improvement in physical function reported by those with OA.This evidence is of moderate quality and is based on 4352 participants from 54 studies.
Quality of lifeExercising resulted in a significant improvement in quality of life reported by those with OA.This evidence is of moderate quality and is based on 2328 participants from 28 studies.

Conflicts of interest

The author declares no conflicts of interest.

Declaration of funding

This summary article did not receive any specific funding.

References:

Lawford BJ, Hall M, Hinman RS, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev [12] 2024; CD004376.
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Cui A, Li H, Wang D, et al. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine 2020; 29–30: 100587.
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Bandak E, Boesen M, Bliddal H, et al. Exercise-induced pain changes associate with changes in muscle perfusion in knee osteoarthritis: exploratory outcome analyses of a randomised controlled trial. BMC Musculoskelet Disord 2019; 20(1): 491.
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Bricca A, Struglics A, Larsson S, et al. Impact of exercise therapy on molecular biomarkers related to cartilage and inflammation in individuals at risk of, or with established, knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Arthritis Care Res 2019; 71(11): 1504-1515.
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Shahid A, Thirumaran AJ, Christensen R, et al. Comparison of weight loss interventions in overweight and obese adults with knee osteoarthritis: a systematic review and network meta-analysis of randomized trials. Osteoarthritis Cartilage 2024;
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