Intervention Review
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Exercise for osteoarthritis of the knee
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 8 JUL 2009
Assessed as up-to-date: 12 AUG 2008
DOI: 10.1002/14651858.CD004376.pub2
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
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.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 8 JUL 2009
References
References to studies included in this review
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Baker 2001 {published data only}
- , , , , , . The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. Journal of Rheumatology 2001;28:1655-65.
Bautch 1997 {published data only}
- , , . Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers. Arthritis Care and Research 1997;10:48-55. Direct Link:
Bennell 2005 {published data only}
- , , , , , , , . Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial. Annals of the Rheumatic Diseases 2005;64:906-12.
Deyle 2000 {published data only}
- , , , , , . Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. Annals of Internal Medicine 2000;132(3):173-81.
Ettinger 1997a {published data only}
- , , , , , , , , , , . 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.
Etttinger 1997b {published data only}
- , , , , , , , , , , . 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.
Foley 2003 {published data only}
- , , , , , , . Does hydrotherapy improve strength and physical function in patients with osteoarthritis - a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening program. Annals of the Rheumatic Diseases 2003;62:1162-67.
Fransen 2001 {published data only}
- , , . Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled trial. Journal of Rheumatology 2001;28:156-64.
Fransen 2007 {published data only}
- , , , , . The Physical Activity for Osteoarthritis Management (PAFORM) study. A randomised controlled clinical trial evaluating hydrotherapy and Tai Chi classes. Arthritis Care and Research 2007;57:407-14. Direct Link:
Gur 2002 {published data only}
- , , , , . Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Archives of Physical and Medical Rehabilitation 2003;83:308-16.
Hay 2006 {published data only}
- , , , , , , , . Effectiveness of community physiotherapy and enhanced pharmacy review for knee pain in people aged over 55 presenting to primary care: pragmatic randomised trial. BMJ 2006;333:995.
Hopman-Rock 2000 {published data only}
- , . The effects of a health educational and exercise program for older adults with osteoarthritis of the hip or knee. Journal of Rheumatology 2000;27:1947-54.
Huang 2003 {published data only}
- , , , . A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Seminars in Arthritis and Rheumatism 2003;32:398-406.
Huang 2005a {published data only}
- , , , , . Preliminary results of integrated therapy for patients with knee osteoarthritis. Arthritis Care and Research 2005;53:812-20. Direct Link:
Hughes 2004 {published data only}
- , , , , , . Impact of the Fit and Strong intervention on older adults with osteoarthritis. The Gerontologist 2004;44:217-28.
Keefe 2004 {published data only}
- , , , , , , , , , , . Effects of spouse-assested coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study. Pain 2004;110:539-49.
Kovar 1992 {published data only}
- , , , , , . Supervised fitness walking in patients with osteoarthritis of the knee. Annals of Internal Medicine 1992;116:529-34.
Maurer 1999 {published data only}
- , , , , . Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Archives of Physical Medicine and Rehabilitation 1999;80:1293-99.
Messier 2004 {published data only}
- , , , , , , , , . Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis. Arthritis and Rheumatism 2004;50:1501-10. Direct Link:
Mikesky 2006 {published data only}
- , , , , , . Effects of strength training on the incidence and progression of knee osteoarthritis. Arthritis Care and Research 2006;55:690-99. Direct Link:
Minor 1989 {published data only}
- , , , , . Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis and Rheumatism 1989;32:1396-1405. Direct Link:
O'Reilly 1999 {published data only}
- , , . Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Annals of the Rheumatic Diseases 1999;58:15-19.
Peloquin 1999 {published data only}
- , , , , . Effects of a cross-training exercise program in persons with osteoarthritis of the knee. A randomized controlled trial. Journal of Clinical Rheumatology 1999;5:126-36.
Petrella 2000 {published data only}
- , . Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. Journal of Rheumatology 2000;27:2215-21.
Quilty 2003 {published data only}
- , , , . Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial. Journal of Rheumatology 2003;30:1311-17.
Rogind 1998 {published data only}
- , , , , , . The effects of a physical training program on patients with osteoarthritis of the knees. Archives of Physical Medicine and Rehabilitation 1998;79:1421-27.
Schilke 1996 {published data only}
- , , , . Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nursing Research 1996;45:68-72.
Song 2003 {published data only}
- , , , . Effects of Tai Chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Journal of Rheumatology 2003;30:2039-44.
Talbot 2003 {published data only}
- , , , . A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Journal of the American Geriatric Society 2003;51:387-92. Direct Link:
Thomas 2002 {published data only}
- , , , , , . Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ 2002;325:752-7.
Thorstensson 2005 {published data only}
- , , , . Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial. BMC Musculoskeletal Disorders 2005;6:27.
Topp 2002 {published data only}
- , , , , . The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Archives of Physical and Medical Rehabilitation 2002;83:1187-95.
van Baar 1998 {published data only}
- , , , , , , . The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. Journal of Rheumatology 1998;25:2432-9.
References to studies excluded from this review
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Atamaz 2006 {published data only}
- , , , , , . A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis. Rheumatology International 2006;26:873-8.
Borjesson 1996 {published data only}
Callaghan 1995 {published data only}
- , , . An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single-blind randomized controlled trial. Clinical Rehabilitation 1995;9:213-8.
Chamberlain 1982 {published data only}
Cheing 2002 {published data only}
- , , . Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?. Clinical Rehabilitation 2002;16:749-60.
Cheing 2004 {published data only}
- , . Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone?. Clinical Rehabilitation 2004;18:487.
Deyle 2005 {published data only}
- , , , , , , et al. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Physical Therapy 2005;12:1301-17.
Dias 2003 {published data only}
- , , . Impact of an exercise and walking protocol on the quality of life of the elderly with osteoarthritis of the knee. Physiotherapy Research International 2003;8:121-30. Direct Link:
Diracoglu 2005 {published data only}
- , , , , , , et al. Effects of kinesthesia and balance exercises in knee osteoarthritis. Journal of Clinical Rheumatology 2005;11:303-10.
Durmus 2007 {published data only}
- , , . Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clinical Rheumatology 2007;26:674-8.
Eungpinichpong 1997 {published data only}
- . The efficacy of physical exercise programmes for patients with osteoarthritis of the knee as determined by clinical and gait parameters. New Zealand Journal of Physiotherapy 1998;26:5.
Evcik 2002 {published data only}
- , . Effectiveness of a home-based exercise therapy and walking program on osteoarthritis of the knee. Rheumatology International 2002;22:103-6.
Eyigor 2004 {published data only}
- , , et al. A comparison of muscle training methods in patients with knee osteoarthritis. Clinical Rheumatology 2004;23:109-15.
Forster 2007 {published data only}
- , , , , , , . Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial. BMJ 2007;335:436.
Green 1993 {published data only}
- , , , . Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. British Journal of Rheumatology 1993;32:812-5.
Haslam 2001 {published data only}
Hinman 2007 {published data only}
- , , . Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial. Physical Therapy 2007;87:32-43.
Hoeksma 2004 {published data only}
- , , , , , , et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis and Rheumatism 2004;51:722-9. Direct Link:
Huang 2005b {published data only}
- , , , . Use of ultrasound to increase effectiveness of idokinetic exercise for knee osteoarthritis. Archives of Physical and Medical Rehabilitation 2005;86:1545-51.
Hurley 1998 {published data only}
- , . Improvements in quadriceps sensorimotor function and disability of patients with knee osteoarthritis following a clinically practicable exercise regime. British Journal of Rheumatology 1998;37:1181-7.
Jan 1991 {published data only}
Kreindler 1989 {published data only}
- , , , . Effects of three exercise protocols on strength of persons with osteoarthritis of the knee. Topics in Geriatriatric Rehabilitation 1989;4:32-9.
Kuptniratsaikul 2002 {published data only}
- , , , . The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. Journal fo the Medical Association of Thailand 2002;85:33-9.
Lankhorst 1982 {published data only}
- , , , , , . Relationship of isometric knee extension torque and functional variables in osteoarthrosis of the knee. Scandinavian Journal of Rehabilitation Medicine 1982;14:7-10.
Lim 2002 {published data only}
- . A comparative study of open and closed kinetic chain exercise regimes in patients with knee osteoarthritis. Physiotherapy Singapore 2002;5:34-40.
Lin 2004 {published data only}
- , , . Community rehabilitation for older adults with osteoarthritis of the lower limb: a controlled clinical trial. Clinical Rehabilitation 2004;18:92-101.
Lin 2007 {published data only}
- , , , , . Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis. Clinical Rheumatology 2007;26:520-8.
Mangione 1999 {published data only}
- , , , , , . The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. Journal of Gerontology 1999;54A:M184-90.
McCarthy 2004 {published data only}
- , , , , , . 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;43:880-6.
Messier 1997 {published data only}
- , , . Effects of long-term aerobic or weight training regimes on gait in an older, osteoarthritic population. Journal of Applied Biomechanics 1997;13:205-25.
Messier 2000 (1) {published data only}
- , , , , , , . Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study. Journal of the American Geriatric Society 2000;48:1062-72.
Messier 2000 (2) {published data only}
- , , , , , . Long-term exercise and its effect on balance in older, osteoarthritis adults: results from the Fitness, Arthritis and Seniors Trial (FAST). Journal of the American Geriatric Society 2000;48:131-8.
Moss 2007 {published data only}
- , , . The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Manual Therapy 2007;12:109-18.
Nicklas 2004 {published data only}
- , , , , , , et al. Diet-induced weight loss, exercise, and chronic inflammation in older, obese adults: a randomized controlled clinical trial. American Journal of Clinical Nutrition 2004;79:544-51.
Ozdincler 2005 {published data only}
- , , . The effects of closed kinetic chain exercise on pain and functional performance of patients with knee osteoarthritis. The Pain Clinic 2005;1:107-15.
Penninx 2001 {published data only}
- , , , , , , et al. Physical exercise and prevention of disability in activities of daily living in older persons with osteoarthritis. Archives of Internal Medicine 2001;19:2309-16.
Penninx 2002 {published data only}
- , , , , , , et al. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. Journal of Gerontology. 2002;57B:P127-32.
Peterson 1993 {published data only}
- , , , , , , . Effect of a walking program on gait characteristics in patients with osteoarthritis. Arthritis Care and Research 1993;6:11-6. Direct Link:
Quirk 1985 {published data only}
- , , . An evaluation of interferential therapy, shortwave diathermy and exercise in the treatment of osteoarthrosis of the knee. Physiotherapy 1985;71:55-7.
Ravaud 2004 {published data only}
- , , , , , et al. Management of osteoarthritis with an unsupervised home based exercise programme and/or patient administered assessment tools. A cluster randomised controlled trial with a 2x2 factorial design. Annals of the Rheumatic Diseases 2004;63:703-8.
Rejeski 1998 {published data only}
- , , , . Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. Arthritis Care and Research 1998;11:94-101. Direct Link:
Sen 2004 {published data only}
- , , , , . The frequency of visits by the physiotherapist of patients receiving home-based exercise therapy for knee ostoearthritis. Knee. 2004;11:151-3.
Stitik 2007 {published data only}
- , , , , , , et al. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain. Archives of Physical and Medical Rehabiltation 2007;88:135-41.
Sullivan 1998 {published data only}
- , , , , . One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Arthritis Care and Research 1998;11:228-33. Direct Link:
Sylvester 1989 {published data only}
- . Investigation of the effect of hydrotherapy in the treatment of osteoarthritic hips. Clinical Rehabilitation 1989;4:223-8.
Toda 2001 {published data only}
Tuzun 2004 {published data only}
- , , , . Effectiveness of two different physical therapy programmes in the treatment of knee osteoarthritis. Pain Clinic 2004;16:379-87.
van Baar 2001 {published data only}
- , , , , , . Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up. Annals of the Rheumatic Diseases 2001;60:1123-30.
Van Gool 2005 {published data only}
- , , , , , , et al. Effects of exercise adherence on physical function among overweight older adults with knee osteoarthritis. Arthritis Care and Research 2005;53:24-32. Direct Link:
Wang 2006 {published data only}
- , , , , . Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Journal of Advanced Nursing 2006;57:141-52. Direct Link:
Williamson 2007 {published data only}
- , , , . Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology 2007;46:1445-9.
Wyatt 2001 {published data only}
- , , , . The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. Journal of Strengthening Research 2001;15:337-40.
Yip 2007 {published data only}
- , , , , , , . Impact of an arthritis self-management programme with an added exercise component for osteoarthritic knee sufferers on improving pain, functional outcomes, and use of health care services: an experimental study. Patient Education Counseling 2007;65:113-21.
References to studies awaiting assessment
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Alayli 2007 {published data only}
- , , . The effects of aerobic exercise and home exercise on pain and disability in patients with knee osteoarthritis. Journal of Rheumatology and Medical Rehabilitation 2007;18:46-50.
Brismee 2007 {published data only}
- , , , , , , et al. Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial. Clinical Rehabilitation 2007;21:99-111.
Rawiworrakul 2007 {published data only}
- , , , , , . A community-based exercise program promotes self-efficacy for exercise among Thai women with osteoarthritis of the knee. Thai Journal of Nursing Research 2007;11:132-50.
Salli 2006 {published data only}
- , , . Comparison of the effectiveness of concentric, combined concentric-eccentric and isometric exercises on symptoms and functional capacity in patients with knee osteoarthritis. [Turkish]. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2006;52:61-7.
Additional references
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Altman 1991
- . Criteria for the classification of clinical osteoarthritis. Journal of Rheumatology 1991;18 Suppl 27:10-2.
Bellamy 1997
- , , , , , , et al. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip and hand osteoarthritis. Consensus development at OMERACT III. Journal of Rheumatology 1997;24:799-802.
Buchner 1992
- , , , , . Effects of physical activity on health status in older adults II: Intervention studies. Annual Review of Public Health 1992;13:469-88.
Cohen 1977
- . Statistical Power Analysis for the Behavioural Sciences. New York: Academic, 1977.
Cooper 1995
- . Occupational activity and the risk of osteoarthritis. Journal of Rheumatology 1995;22:10-2.
Davis 1991
- , , , . Knee osteoarthritis and physical functioning: evidence from the NHANES 1 epidemiologic followup study. Journal of Rheumatology 1991;18:591-8.
Felson 1987
- , , , , , . The prevalence of knee osteoarthritis in the elderly: the Framingham Osteoarthritis Study. Arthritis and Rheumatism 1987;30:914-8. Direct Link:
Felson 1995
- . Weight and osteoarthritis. Journal of Rheumatology 1995;22:7-9.
Fiatarone 1993
- , . The etiology and reversibility of muscle dysfunction in the aged. Journal of Gerontology 1993;48:77-83.
Guccione 1994
- , , , , , , et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham study. American Journal of Public Health 1994;84:351-8.
Jadad 1996
- , , , , , , et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1-12.
Kujala 1995
- , , , , , , et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis and Rheumatism 1995;38:539-46. Direct Link:
McAlindon 1999
- , , , , . Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: The Framingham Study. American Journal of Medicine 1999;106:151-7.
Minor 1988
- , , , , . Exercise tolerance and disease related measures in patients with rheumatoid arthritis and osteoarthritis. Journal of Rheumatology 1988;15:905-11.
Philbin 1995
- , , , . Cardiovascular fitness and health in patients with end-stage osteoarthritis. Arthritis and Rheumatism 1995;38:799-805. Direct Link:
Rangger 1995
- , , , , . Osteoarthritis after arthroscopic partial meniscectomy. American Journal of Sports Medicine 1995;23:240-4.
Roddy 2005
- , , , , , , , , et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee - the MOVE consensus. Rheumatology 2005;44:67-73.
Schulz 1995
- , , , . Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408-12.
Scott 1993
- , , , , , . Reliability of grading scales for individual radiographic features of osteoarthritis of the knee. The Baltimore Longitudinal Study of Aging Atlas of Knee Osteoarthritis. Investigative Radiology 1993;28:497-501.
Slemenda 1997
- , , , , , , et al. Quadriceps weakness and osteoarthritis of the knee. Annals of Internal Medicine 1997;127:97-104.
Tugwell 2004
- , , . Evidence-based rheuamtology. Evidence-based Rheumatology. London: BMJ Books, 2004.
Woodard 2001
Zhang 1996
- , , . Musculoskeletal disease research: should we analyze the joint or the person?. Journal of Rheumatology 1996;23:1130-4.
Zhang 2001
- , , , , , , , . Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States. Arthritis and Rheumatism 2001;44:2065-71. Direct Link:
Zhang 2008
- , , , , , , et al. OARSI recommendtions for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage 2008;16:137-62.
References to other published versions of this review
- References to studies included in this review
- References to studies excluded from this review
- References to studies awaiting assessment
- Additional references
- References to other published versions of this review
Fransen 2002
- , et al. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. Journal of Rheumatology 2002;29:1737-45.
