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A review of the clinical evidence for exercise in osteoarthritis of the hip and knee

Published:September 20, 2010DOI:https://doi.org/10.1016/j.jsams.2010.08.002

      Abstract

      Osteoarthritis (OA) is a chronic joint disease with the hip and knee being commonly affected lower limb sites. Osteoarthritis causes pain, stiffness, swelling, joint instability and muscle weakness, all of which can lead to impaired physical function and reduced quality of life. This review of evidence provides recommendations for exercise prescription in those with hip or knee OA. A narrative review was performed. Conservative non-pharmacological strategies, particularly exercise, are recommended by all clinical guidelines for the management of OA and meta-analyses support these exercise recommendations. Aerobic, strengthening, aquatic and Tai chi exercise are beneficial for improving pain and function in people with OA with benefits seen across the range of disease severities. The optimal exercise dosage is yet to be determined and an individualized approach to exercise prescription is required based on an assessment of impairments, patient preference, co-morbidities and accessibility. Maximising adherence is a key element dictating success of exercise therapy. This can be enhanced by the use of supervised exercise sessions (possibly in class format) in the initial exercise period followed by home exercises. Bringing patients back for intermittent consultations with the exercise practitioner, or attendance at “refresher” group exercise classes may also assist long-term adherence and improved patient outcomes. Few studies have evaluated the effects of exercise on structural disease progression and there is currently no evidence to show that exercise can be disease modifying. Exercise plays an important role in managing symptoms in those with hip and knee OA.

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      References

        • Australia A.
        Painful realities: the economic impact of arthritis in Australia in 2007.
        Arthritis Australia. 2007; : 1-88
        • Reeuwijk K.G.
        • de Rooij M.
        • van Dijk G.M.
        • et al.
        Osteoarthritis of the hip or knee: which coexisting disorders are disabling?.
        Clin Rheumatol. 2010; 29: 739-747
        • Farr J.N.
        • Going S.B.
        • Lohman T.G.
        • et al.
        Physical activity levels in patients with early knee osteoarthritis measured by accelerometry.
        Arthritis Rheum. 2008; 59: 1229-1236
        • Messier S.
        • Loeser R.
        • Miller G.
        • et al.
        Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis.
        Arthritis Rheum. 2004; 50: 1501-1510
      1. Vogels E, Hendriks H, van Baar M, et al. Clinical practice guidelines for physical therapy in patients with osteoarthritis of the hip or knee. Royal Dutch Society for Physical Therapy; 2003. www.fysionet.nl/index.html?dossier_id=81&dossiers=1.

        • Jan M.H.
        • Tang P.F.
        • Lin J.J.
        • et al.
        Efficacy of a target-matching foot-stepping exercise on proprioception and function in patients with knee osteoarthritis.
        J Orthop Sports Phys Ther. 2008; 38: 19-25
        • Sekir U.
        • Gur H.
        A multi-station proprioceptive exercise program in patients with bilateral knee osteoarthrosis: functional capacity, pain and sensorimotor function. A randomized controlled trial.
        J Sports Sci Med. 2005; 4: 590-603
        • Lange A.K.
        • Vanwanseele B.
        • Singh M.A.F.
        Strength training for treatment of osteoarthritis of the knee: a systematic review.
        Arthritis Rheum-Arthritis Care Res. 2008; 59: 1488-1494
        • Ettinger Jr., W.H.
        • Burns R.
        • Messier S.P.
        • et al.
        A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST).
        JAMA. 1997; 277: 25-31
        • O’Reilly S.C.
        • Jones A.
        • Muir K.R.
        • et al.
        Quadriceps weakness in knee osteoarthritis: the effect on pain and disability.
        Ann Rheum Dis. 1998; 57: 588-594
        • Zhang W.
        • Nuki G.
        • Moskowitz R.W.
        • et al.
        OARSI recommendations for the management of hip and knee osteoarthritis. Part III. Changes in evidence following systematic cumulative update of research published through January 2009.
        Osteoarthritis Cartilage. 2010; 18: 476-499
        • Fransen M.
        • McConnell S.
        Exercise for osteoarthritis of the knee.
        Cochrane Database Syst Rev. 2008;
        • Pelland L.
        • Brosseau L.
        • Wells G.
        • et al.
        Efficacy of strengthening exercises for osteoarthritis (Part I): a meta-analysis.
        Phys Ther Rev. 2004; 9: 77-108
        • Lange A.K.
        • Vanwanseele B.
        • Fiatarone Singh M.A.
        Strength training for treatment of osteoarthritis of the knee: a systematic review.
        Arthritis Rheum. 2008; 59: 1488-1494
        • Fransen M.
        • McConnell S.
        • Hernandez-Molina G.
        • et al.
        Exercise for osteoarthritis of the hip.
        Cochrane Database Syst Rev. 2009; : CD007912
        • McNair P.
        • Simmonds M.
        • Boocock M.
        • et al.
        Exercise therapy for the management of osteoarthritis of the hip joint: a systematic review.
        Arthritis Res Ther. 2009; 11: R98
        • Hernandez-Molina G.
        • Reichenbach S.
        • Zhang B.
        • et al.
        Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis.
        Arthritis Rheum. 2008; 59: 1221-1228
        • Bartels E.
        • Lund H.
        • Hagen K.
        • et al.
        Aquatic exercise for the treatment of knee and hip osteoarthritis.
        Cochrane Database Syst Rev. 2007;
        • Hall A.
        • Maher C.
        • Latimer J.
        • et al.
        The effectiveness of Tai Chi for chronic musculoskeletal pain conditions: a systematic review and meta-analysis.
        Arthritis Rheum. 2009; 61: 717-724
        • Wang C.
        • Collet J.P.
        • Lau J.
        The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review.
        Arch Intern Med. 2004; 164: 493-501
        • Ettinger W.H.
        • Burns R.
        • Messier S.P.
        • et al.
        A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis.
        JAMA. 1997; 277: 25-31
        • Mikesky A.
        • Mazzuca S.
        • Brandt K.
        • et al.
        Effects of strength training on the incidence and progression of knee osteoarthritis.
        Arthritis Rheum. 2006; 55: 690-699
        • Miyazaki T.
        • Wada M.
        • Kawahara H.
        • et al.
        Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis.
        Ann Rheum Dis. 2002; 61: 617-622
        • Lim B.W.
        • Hinman R.S.
        • Wrigley T.V.
        • et al.
        Does knee malalignment mediate the effects of quadriceps strengthening on knee adduction moment, pain, and function in medial knee osteoarthritis? A randomized controlled trial.
        Arthritis Rheum. 2008; 59: 943-951
        • Bennell K.L.
        • Hunt M.A.
        • Wrigley T.V.
        • et al.
        Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial.
        Osteoarthritis Cartilage. 2010; 18: 621-628
        • Roddy E.
        • Zhang W.
        • Doherty M.
        • et al.
        Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus.
        Rheumatology (Oxford). 2005; 44: 67-73
        • Zhang W.
        • Moskowitz R.W.
        • Nuki G.
        • et al.
        OARSI recommendations for the management of hip and knee osteoarthritis. Part II. OARSI evidence-based, expert consensus guidelines.
        Osteoarthritis Cartilage. 2008; 16: 137-162
        • Fransen M.
        • Nairn L.
        • Winstanley J.
        • et al.
        Physical activity for osteoarthritis management: a randomized controlled clinical trial evaluating hydrotherapy or Tai Chi classes.
        Arthritis Rheum. 2007; 57: 407-414
        • Toda Y.
        The effect of energy restriction, walking, and exercise on lower extremity lean body mass in obese women with osteoarthritis of the knee.
        J Orthop Sci. 2001; 6: 148-154
        • Radin E.L.
        • Martin R.B.
        • Burr D.B.
        • et al.
        Effects of mechanical loading on the tissues of the rabbit knee.
        J Orthop Res. 1984; 2: 221-234
        • Radin E.L.
        • Ehrlich M.G.
        • Chernack R.
        • et al.
        Effect of repetitive impulsive loading on the knee joints of rabbits.
        Clin Orthop Relat Res. 1978; : 288-293
        • McCarthy C.
        • Mills P.
        • Pullen R.
        • et al.
        Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis.
        Rheumatology. 2004; 43: 880-886
        • Ravaud P.
        • Giraudeau B.
        • Logeart I.
        • et al.
        Management of osteoarthritis (OA) with an unsupervised home based exercise programme and/or patient administered tools. A cluster randomised controlled trial with a 2 × 2 factorial design.
        Ann Rheum Dis. 2004; 63: 703-708
        • Society A.G.
        Exercise prescription for older adults with osteoarthritis pain: consensus practice recommendations. A supplement to the AGS Clinical Practice Guidelines on the management of chronic pain in older adults.
        J Am Geriatr Soc. 2001; 49: 808-823
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1435-1445
        • Christensen R.
        • Bartels E.M.
        • Astrup A.
        • et al.
        Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis.
        Ann Rheum Dis. 2007; 66: 433-439
        • Messier S.P.
        • Gutekunst D.J.
        • Davis C.
        • et al.
        Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis.
        Arthritis Rheum. 2005; 52: 2026-2032
        • Jan M.H.
        • Lin J.J.
        • Liau J.J.
        • et al.
        Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: A randomized controlled trial.
        Phys Ther. 2008; ([January Epub])
        • Mangione K.K.
        • McCully K.
        • Gloviak A.
        • et al.
        The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis.
        J Gerontol A Biol Sci Med Sci. 1999; 54: M184-M190
        • Pisters M.F.
        • Veenhof C.
        • van Meeteren N.L.
        • et al.
        Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review.
        Arthritis Rheum. 2007; 57: 1245-1253
        • Mazieres B.
        • Thevenon A.
        • Coudeyre E.
        • et al.
        Adherence to, and results of, physical therapy programs in patients with hip or knee osteoarthritis. Development of French clinical practice guidelines.
        Joint Bone Spine. 2008; 75: 589-596
        • McCarthy C.
        • Mills P.
        • Pullen R.
        • et al.
        Supplementation of a home-based exercise programme with a class-based programme for people with osteoarthritis of the knees: a randomised controlled trial and health economic analysis.
        Health Technol Assess. 2004; 8: 1-61
        • Campbell R.
        • Evans M.
        • Tucker M.
        • et al.
        Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee.
        J Epidemiol Community Health. 2001; 55: 132-138
        • Marks R.
        • Allegrante J.
        Chronic osteoarthritis and adherence to exercise: a review of the literature.
        J Aging Phys Activity. 2005; 13: 434-460
        • Messier S.P.
        • Loeser R.F.
        • Miller G.D.
        • et al.
        Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial.
        Arthritis Rheum. 2004; 50: 1501-1510