Dual interventions best for osteoarthritis knee pain, non-exercise methods best for hips
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Key takeaways:
- Comparator interventions impact the measured effect of resistance exercise on OA pain and function.
- Lower extremity strength gain had a dose-response relationship to pain and function improvement in knee OA.
Knee osteoarthritis pain responds best to exercise combined with a non-exercise intervention, such as diet, while hip osteoarthritis moderately benefits from non-exercise interventions vs. resistance exercise, according to data.
Overall, the results of the study, published in Seminars in Arthritis and Rheumatism, suggest that the benefits of resistance exercise for hip and knee OA vary depending on the intervention they are being compared with.
“A lot of studies examine exercise in knee OA. However, a consensus on the impact of resistance exercise on clinically important outcomes, especially in hip OA, was lacking,” co-investigators Monica R. Maly, PT, PhD, and Kendal A. Marriott, PT, PhD, both of the department of kinesiology and health sciences at the University of Waterloo, in Canada, told Healio in a joint statement. “Recent studies have raised questions about whether resistance exercise is more effective than placebo. We believed that examining the effect of resistance exercise in comparison to different types of control groups would provide clarity on this question.”
To assess the impacts of resistance exercise on OA pain and function, and whether they varied based on control groups, the researchers conducted a systematic review and meta-analysis of 280 studies on hip or knee OA. Eligible studies compared land-based, resistance exercise interventions to one of four other options:
- No exercise, placebo, sham or usual care;
- other exercise interventions alone, such as aerobic, resistance and flexibility;
- non-exercise interventions alone, such as manual therapy, diet and electrotherapeutic methods; and
- combined exercise alongside non-exercise interventions, such as aerobic exercise and diet.
The primary outcomes were changes in patient-reported knee or hip pain and physical function. Physical function was analyzed in two separate subscales — activities of daily living (ADL) and sport and recreation (SPORT).
Between-group effect sizes were calculated for post-intervention pain and function, while meta-regression evaluated links between improvements in hip or knee strength, as well as pain and function, regardless of intervention.
In knee OA, resistance exercise yielded large benefits for pain (effect size, –0.92; 95% CI, –1.15 to –0.69), physical function ADL (effect size, –0.79; 95% CI, –1.01 to –0.56) and physical function SPORT (effect size, –0.79; 95% CI, –1.02 to –0.56), compared with no intervention, according to the researchers. Meanwhile, compared with resistance exercise, combined interventions (effect size, 0.44; 95% CI, 0.23-0.65) demonstrated moderate benefits in knee pain.
Across 15 studies evaluating hip OA, exercise interventions yielded moderate benefit for pain (effect size, –0.51; 95% CI, –0.68 to –0.33), ADL (effect size, –0.57; 95% CI, –0.78 to –0.36) and SPORT (effect size, –0.52; 95% CI, –0.70 to –0.35) vs. no intervention, according to the researchers. Non-exercise interventions showed moderate benefit for hip pain (effect size, 0.57; 95% CI, 0.17-0.97), compared with resistance exercise.
In knee OA, meta-regression analyses linked greater gains in strength with greater improvements in pain, physical function ADL and physical function SPORT, the researchers added.
Overall, the results indicate that non-exercise interventions “have a role” in improving pain and function in knee and hip OA, particularly for those who are unable to do resistance exercise, according to Maly and Marriott.
“Clinicians can recommend a variety of treatment options, including different types of exercise, diet and psychosocial/behavioral interventions,” they said. “Clinicians can reassure patients that they will benefit from any of these treatment approaches. Nonetheless, among those with knee OA, individuals who experience greater strength improvements experience greater pain and function improvements.”
Maly and Marriott emphasized that the best treatment approaches vary between hip and knee OA.
“The most effective approach for knee OA appears a combination of resistance exercise with an additional intervention,” they said. “While based on fewer studies, the most effective approach for hip OA includes non-exercise interventions, such as diet or psychosocial/behavioral intervention.”
For more information:
Monica R. Maly, PT, PhD, can be reached at mrmaly@uwaterloo.ca. Kendal A. Marriott, PT, PhD, can be reached at kmarriott@uwaterloo.ca.
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