Self-managed exercise may work for knee osteoarthritis

Self-managed physical therapy exercises such as aerobics, aquatics, strengthening and proprioception were effective for knee osteoarthritis, a literature review concluded.

Researchers conducted a literature review of physical therapy interventions for community-dwelling adults with knee osteoarthritis, finding 193 randomized, controlled trials (RCTs) published from 1970 to February 2012. Researchers extracted means of outcomes, interventions and risk of bias to pool standardized mean differences. Results appeared in the Nov. 6 Annals of Internal Medicine.

Four RCTs including 247 patients undergoing proprioception exercise found it improved pain but not composite function or gait function. Eleven RCTs of 1,553 patients trying aerobic exercise found it led to statistically significant improvements in pain lasting longer than 26 weeks and disability, but not in psychological disability or health perception. Within three months, aerobic exercise also improved composite function and gait function (walking speed difference, −0.11 m/s [95% CI, −0.15 to −0.08 m/s]). At 12 months, the benefits of aerobic exercise continued for gait function (walking speed difference, −0.11 m/s [95% CI, −0.17 to −0.05 m/s]) but not for composite function.

Three RCTs among 348 participants found that aquatic exercise reduced disability but had no statistically significant effects on pain relief or quality of life. Nine RCTs among 1,982 participants found that strengthening exercise had no statistically significant effect on disability or quality of life but did improve pain relief, composite function and gait function. The improvements in pain and composite function were clinically important. Two RCTs among 511 participants showed that education programs had no statistically significant effect on pain relief.

Future studies should compare combined interventions, which is how physical therapy is generally administered for pain associated with knee osteoarthritis, researchers noted.

“Our analyses further indicate a possible association between high adherence to exercise and improvement in knee pain and function,” researchers wrote. “Thus, therapeutic exercise programs should focus on achieving higher adherence rather than increasing the amount or intensity of exercise.”