Relative efficacy of different exercises for pain, function, performance and quality of life in knee and hip osteoarthritis: systematic review and network meta-analysis

Goh, Siew-Li; Persson, Monica S.M.; Stocks, Joanne; Hou, Yunfei; Welton, Nicky J.; Lin, Jianhao; Hall, Michelle C.; Doherty, Michael; Zhang, Weiya

Abstract

Background: Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations.

Objectives: To investigate the relative efficacy of different exercises (aerobic, mind-body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (Qol) for knee and hip OA at, or nearest to, 8 weeks.

Methods: We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta–analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865)

Findings: We identified and analysed 103 trials (9,134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95%CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind–body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind–body exercises. Trend for exercise hierarchy was significant for pain (p=0.01), but not for function (p=0.07), performance (p=0.06) or QoL (p=0.65)

Conclusion:The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind–body exercise may be the best for pain and function improvements.

Citation

Goh, S.-L., Persson, M. S., Stocks, J., Hou, Y., Welton, N. J., Lin, J., …Zhang, W. (2019). Relative efficacy of different exercises for pain, function, performance and quality of life in knee and hip osteoarthritis: systematic review and network meta-analysis. Sports Medicine, 49(5), 743–761. https://doi.org/10.1007/s40279-019-01082-0

• Journal Article Type: Article
• Acceptance Date: Feb 17, 2019
• Online Publication Date: Mar 4, 2019
• Publication Date: 2019-05
• Deposit Date: Feb 22, 2019
• Publicly Available Date: Mar 5, 2019
• Journal: Sports Medicine
• Print ISSN: 0112-1642
• Electronic ISSN: 1179-2035
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 49
• Issue: 5
• Pages: 743–761
• DOI: https://doi.org/10.1007/s40279-019-01082-0
• Public URL: https://nottingham-repository.worktribe.com/output/1578323
• Publisher URL: https://link.springer.com/article/10.1007%2Fs40279-019-01082-0
• Contract Date: Feb 22, 2019