Patients with worse osteoarthritis pain, physical function benefit most from exercise
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Key takeaways:
- Exercise improved osteoarthritis pain and physical function vs. non-exercise controls.
- Patients with greater pain and poorer physical function benefited more from exercise than those with lower pain and better physical function.
Patients with hip or knee osteoarthritis who exercise fare better than patients who do not, with those demonstrating worse severity and function at baseline benefitting most acutely, according to data published in The Lancet Rheumatology.
However, the researchers cautioned that the overall improvements in OA pain and physical function associated with therapeutic exercise were “small and of questionable clinical importance,” especially across longer time periods.
“Exploratory secondary analyses of randomized controlled trials provide tentative evidence that not all people with osteoarthritis respond similarly to exercise,” Melanie A. Holden, PhD, of Keele University, in the United Kingdom, and colleagues wrote. “However, these post-hoc analyses have low statistical power to detect significant subgroup effects.
“A more robust method to investigate individual response to exercise is to conduct a meta-analysis of individual participant data (IPD),” they added. “This approach enables the inclusion of more participants and has greater power to identify treatment-effect moderators, and avoids the risk of aggregation bias and study-level confounding.”
To assess “individual patient-level moderators” on the impacts of exercise on pain and physical function in patients with knee OA, hip OA or both, Holden and colleagues conducted a systematic review and meta-analysis. They conducted a search of randomized controlled trials where exercise was compared with non-exercise or non-exercise-based control methods of intervention.
The search was conducted from March 1, 2012, to Feb. 25, 2019. Included databases were Medline, EMBASE, Allied and Complementary Medicine Database, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effectiveness, the Cochrane Controlled Trials Register, and the NHS Economic Evaluation Database.
The analysis included data from 31 randomized controlled trials, representing 4,241 patients. Extracted data from the relevant studies included sample size, OA site, type of interventions employed, comparators and outcome assessments. Holden and colleagues analyzed the data to determine if 12 factors were associated with short-, medium- or long-term effects on pain and function.
Overall, compared with non-exercise control participants, those who performed therapeutic exercise demonstrated improved pain in the short, medium and long term, according to the researchers. On a standardized scale of 0 to 100 — with 100 denoting worst pain — therapeutic exercise impacted pain by –6.36 points in the short term (95% CI, –8.45 to –4.27), –3.77 points in the medium term (95% CI, –5.18 to –1.69) and –3.43 points in the long term (95% CI, –5.85 to –1.69).
For physical function scores, the corresponding differences were –4.46 points in the short term (95% CI, –5.95 to –2.98), –2.71 points in the medium term (95% CI, –4.63 to –0.78), and –3.39 points in the long term (95% CI, –4.97 to –1.81).
In addition, the researchers noted that baseline pain and physical function moderated the impact of exercise. According to the researchers, patients with higher self-reported pain and physical function at baseline demonstrated more benefit from exercise vs. those with lower pain and physical function.
“This large international IPD meta-analysis showed a differential response to therapeutic exercise among people with knee, hip, or mixed knee and hip osteoarthritis; individuals with higher pain severity and poorer physical function at baseline benefited more from exercise than did those with lower pain severity and better physical function at baseline,” Holden said. “Therapeutic exercise had an overall positive effect on pain and physical function compared with non-exercise controls.
“However, the magnitude of the overall effect was small and of questionable clinical importance, particularly in the medium to long term,” they added. “Targeting individuals with higher levels of osteoarthritis-associated pain and disability for exercise therapy might therefore be of merit.”
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