In people who have knee osteoarthritis, therapeutic exercise programs reduce pain and improve physical functioning for up to 6 months after the end of the program

Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376.

Review question

In people who have knee osteoarthritis, do therapeutic exercise programs done on land reduce pain or improve physical functioning or quality of life?

Background

Osteoarthritis is the most common form of arthritis. It is a disease of the joints and often occurs in knees. It develops when your joints lose the cartilage that protects the ends of your bones. There is no cure, and it often gets worse over time. People with osteoarthritis can have pain, tenderness, joint stiffness, and worsening physical functioning.

There are various treatments for the symptoms of knee osteoarthritis. This review is about therapeutic exercise programs, which use physical activities to achieve specific aims (e.g., strengthen muscles, improve how well a joint moves).

How the review was done

The researchers did a systematic review, searching for studies that were published in English up to May 2013.

They found 54 randomized or nonrandomized controlled trials with 6,345 people (mean age 53 to 75 years, 42% to 100% women).

The key features of the trials were:

• people were adults with knee osteoarthritis;
• treatments were therapeutic exercise programs done on land (rather than in the water) and included one or more types of exercise (e.g., exercises to strengthen lower limbs or quadriceps muscles, aerobics, walking, or other forms of exercise);
• exercise programs could be done one-on-one or in classes or groups and at home or in another location;
• exercise programs were compared with no treatment or other non-exercise treatments; and
• exercise programs done around the time of surgery were excluded.

What the researchers found

Compared with no exercise program, land-based therapeutic exercise programs:

• reduced pain and improved physical functioning and quality of life immediately after the end of the program;
• reduced pain and improved physical functioning 2 to 6 months after the end of the program; and
• reduced pain and improved physical functioning at more than 6 months after the end of the program.

Conclusion

In people who have knee osteoarthritis, therapeutic exercise programs done on land reduce pain and improve physical functioning up to 6 months after the end of the program.

Therapeutic exercise program vs no exercise program in people with knee osteoarthritis

*Calculated using information provided in the review. When 2 trials with very different results were excluded from the analyses, exercise programs improved physical functioning, but not pain, at more than 6 months after the end of the program.