Intervention Review

Exercise for osteoarthritis of the knee

  1. Marlene Fransen1,*,
  2. Sara McConnell2

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 12 AUG 2008

DOI: 10.1002/14651858.CD004376.pub2

How to Cite

Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004376. DOI: 10.1002/14651858.CD004376.pub2.

Author Information

  1. 1

    University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia

  2. 2

    St Joseph's Health Care Centre, Department of Medicine, Toronto, Ontario, Canada

*Marlene Fransen, Faculty of Health Sciences, University of Sydney, Room 0212, Cumberland Campus C42, Sydney, New South Wales, 1825, Australia. m.fransen@usyd.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Biomechanical factors, such as reduced muscle strength and joint malalignment, have an important role in the initiation and progression of knee osteoarthritis (OA). Currently, there is no known cure for OA; however, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to therapeutic exercise.

Objectives

To determine whether land-based therapeutic exercise is beneficial for people with knee OA in terms of reduced joint pain or improved physical function.

Search methods

Five electronic databases were searched, up until December 2007.

Selection criteria

All randomized controlled trials randomising individuals and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in the water) with a non-exercise group.

Data collection and analysis

Two review authors independently extracted data and assessed methodological quality. All analyses were conducted on continuous outcomes.

Main results

The 32 included studies provided data on 3616 participants for knee pain and 3719 participants for self-reported physical function. Meta-analysis revealed a beneficial treatment effect with a standardized mean difference (SMD) of 0.40 (95% confidence interval (CI) 0.30 to 0.50) for pain; and SMD 0.37 (95% CI 0.25 to 0.49) for physical function. There was marked variability across the included studies in participants recruited, symptom duration, exercise interventions assessed and important aspects of study methodology. The results were sensitive to the number of direct supervision occasions provided and various aspects of study methodology. While the pooled beneficial effects of exercise programs providing less than 12 direct supervision occasions or studies utilising more rigorous methodologies remained significant and clinically relevant, between study heterogeneity remained marked and the magnitude of the treatment effect of these studies would be considered small.

Authors' conclusions

There is platinum level evidence that land-based therapeutic exercise has at least short term benefit in terms of reduced knee pain and improved physical function for people with knee OA. The magnitude of the treatment effect would be considered small, but comparable to estimates reported for non-steroidal anti-inflammatory drugs.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Exercise for osteoarthritis of the knee

This summary of a Cochrane review presents what we know from research about the effect of exercise on osteoarthritis (OA).

The review shows that, on average, in people with OA, exercise results in a modest reduction in pain and a modest improvement in physical function.

What is OA of the knee and what is exercise?

Osteoarthritis (OA) is a disease of the joints, such as your knee. When your knee loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable.

Doctors used to think that osteoarthritis was caused by wear and tear on the cartilage. However, it's now thought that osteoarthritis is a disease of the whole joint.

OA is one of the most common forms of arthritis and affects men and women equally. OA is one of the main causes of disability as people grow older.

Exercise can be any activity that enhances or maintains muscle strength, physical fitness and overall health. People exercise for many different reasons including weight loss, strengthening muscles and to relieve the symptoms of OA. 

Best estimate of what happens to people with OA who exercise:

In the short term, a supervised exercise program:

Reduces knee pain by 1 point on a scale of 0 to 20; and

Improves knee function by 3 points on a scale of 0 to 68.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

膝退化性關節炎之運動

某些生物力學因素,如肌力下降及關節位置相對排列不良,對於膝退化性關節炎(OA,knee osteoarthritis) 之開始及進展有重要影響。而目前膝退化性關節炎並無治癒之辦法。但是某些疾病相關因素,如肌力下降及體適能下降,確有潛在作為治療運動之可能。

目標

測試是否陸上運動是否可減輕膝退化性關節炎疼痛及促進身體功能。

搜尋策略

搜尋至2007十二月之5個電子檔。

選擇標準

均屬於隨機對照試驗,比較陸上運動 (以相對於水中運動)和無運動組之療效。

資料收集與分析

兩組回顧作者獨立擷取資料和評估方法論品質。所有分析均為連續性結果。

主要結論

32組研究族群提供3616膝痛個案及3719自我報告身體功能個案,此分析發現對疼痛有效治療之標準差為0.4 (信賴區間0.3至0.5),對身體功能有效治療之標準差為0.37 (信賴區間0.25至0.49)。但是各研究參與個案之選擇、症狀時間、運動方式,及方法論重點均存在巨大差異。治療結果對於提供直接監督的次數以及研究方法許多方面具有敏感性。運動族群有療效者只提供少於十二次直接監督次數,然更積極運動方法組仍有統計意義。儘管如此,因為研究差異性太大,這些研究對臨床療效之意義不大。

作者結論

有白金等級的證據指出,對於膝關節病人,陸上運動為基礎的運動治療至少具有短期減少膝蓋疼痛與改善身體功能的療效。不過與非類固醇抗發炎藥物比較下,其療效較小。

翻譯人

本摘要由林口長庚醫院葉文凌翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

此考科藍回顧文獻逞現已知運動對膝關節退化性關節炎治療之療效之研究。此回顧發現,一般而言,對膝關節退化性關節炎患者,運動對減少疼痛及促進身體功能有中等效果。又,什麼是膝關節退化性關節炎?又,什麼是運動?退化性關節炎是關節疾病之一,如發生在膝蓋者。當膝關節失去軟骨時,骨骼即生長以嘗試修補損害,但是因為新骨骼生的不正常反而起反效果,舉例而言新骨可因生長位置異常造成關節疼痛及不穩定。醫師以往常以為退化性關節炎是軟骨磨損及破裂,但是現在臨床上認為退化性關節炎是整個關節的疾病。退化性關節炎是最常見之關節疾病,一般男女發生均等。退化性關節炎是人老化殘障之主因。運動指的是,任何可以促進肌力、體適能、及整體健康之活動。人們因許多理由而運動或減肥、或增強肌力,以達減少退化性關節炎症狀之目的。評估退化性關節炎患者運動後發生什麼事之最好方式是什麼?短期而言是受監督之運動行程,以疼痛0至20而言,可以減少1分;以功能0至68分而言,可以增加3分。