PAIN+ CPN

OBJECTIVE: To compare the efficacy of different exercise training modalities and doses on pain and function in older adults with osteoarthritis (OA) of the hip and/or knee.

DATA SOURCES: We searched Medline, Embase, Web of Science, the Cochrane Library, Scopus, and SPORTDiscus from inception until December 2024.

STUDY SELECTION: We included randomized controlled trials of exercise interventions for patients with OA of the hip and knee in people aged =60 years.

DATA EXTRACTION: Data extraction was conducted by 2 authors (S.T. and Z.L.) Bayesian network analyses and dose-response meta-analyses were performed using random-effects models to analyze the effect of exercise on hip and knee OA pain.

DATA SYNTHESIS: The study included 84 randomized clinical trials with a total of 6373 participants, with 16 pain and 13 function trials at high risk of bias. Aerobic exercise was most beneficial for pain (standardized mean difference [SMD], -1.19; 95% confidence interval [CI], -1.66 to -0.74). Flexibility training was the best for function (SMD, -1.07; 95% CI, -1.68 to -0.47). A "U-shaped" dose-response relationship was observed between the amount of energy expenditure and both pain and function. The optimal doses for improving pain and function in OA are 580 metabolic equivalent of tasks-min/wk and 450 metabolic equivalent of tasks-min/wk. The certainty of the evidence was very low to moderate for all outcomes.

CONCLUSIONS: The efficacy of exercise varies according to the type of exercise, exercise dosage, and outcome measures. By identifying the most effective exercise types and optimal doses, health care providers can offer personalized treatment plans to improve patient outcomes.

Rehab Clinician (OT/PT) rater

The authors tout that their findings assist clinicians to identify the most efficacious types of exercise training and the optimal dosages, for prescribing the right treatment for the right patient with OA of the knee/hip. Based on effect sizes published between different exercise modalities, aerobic exercise was a key winner to alleviate short term pain. The other exercise modalities were beneficial in reducing pain and improving function, albeit with varying effect sizes. Before translating the authors’ finding to real-world clinical practice, the limitations reported by the authors need to be fully appreciated by the reader. In addition, the intervention variability within each exercise modality varies greatly, confounding clinical interpretation and translation of the study results. For example, FT was superior in improving functional ability, yet ROM was combined with balance/coordination exercises. So, was the authors’ findings driven by balance or ROM intervention?

Rehab Clinician (OT/PT) rater

"The optimal doses for improving pain and function in OA are 580 metabolic equivalent of tasks-min/wk and 450 metabolic equivalent of tasks-min/wk." Probably useful metrics or guides linking activity / energy output (effort), although one considers that the level of 580MET sits on the cusp between moderate to vigorous effort. One wonders then whether this level is in fact readily achievable in (a) older individuals; (b) OA severity dependent; and (c) other limiting co-morbidities.

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