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. 2001 Dec;60(12):1123–1130. doi: 10.1136/ard.60.12.1123

Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up

M E van Baar 1, J Dekker 1, R Oostendorp 1, D Bijl 1, T Voorn 1, J Bijlsma 1
PMCID: PMC1753453  PMID: 11709454

Abstract

OBJECTIVE—To determine whether the effects of an exercise programme in patients with osteoarthritis of hip or knee are sustained at six and nine months' follow up.
METHODS—A randomised, single blind, clinical trial was conducted in a primary care setting. Patients with osteoarthritis of hip or knee (ACR criteria) were selected. Two intervention groups were compared. Both groups received treatment from their general practitioner, including patient education and drug treatment if necessary. The experimental group also received exercise treatment from a physiotherapist in primary care. The treatment period was 12 weeks, with an ensuing 24 week follow up. The main outcome measures were pain, drug use (non-steroidal anti-inflammatory drugs), and observed disability.
RESULTS—201 patients were randomly allocated to the exercise or control group, and 183 patients completed the trial. At 24 weeks exercise treatment was associated with a small to moderate effect on pain during the past week (difference in change between the two groups −11.5 (95% CI −19.7 to −3.3). At 36 weeks no differences were found between the groups.
CONCLUSIONS—Beneficial effects of exercise decline over time and finally disappear.



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Figure 1  .

Figure 1  

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Participant flow and follow up.

Figure 2  .

Figure 2  

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Effect sizes of primary outcome measures in the course of the trial.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Altman R. D., Fries J. F., Bloch D. A., Carstens J., Cooke T. D., Genant H., Gofton P., Groth H., McShane D. J., Murphy W. A. Radiographic assessment of progression in osteoarthritis. Arthritis Rheum. 1987 Nov;30(11):1214–1225. doi: 10.1002/art.1780301103. [DOI] [PubMed] [Google Scholar]
  2. Altman R., Alarcón G., Appelrouth D., Bloch D., Borenstein D., Brandt K., Brown C., Cooke T. D., Daniel W., Feldman D. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991 May;34(5):505–514. doi: 10.1002/art.1780340502. [DOI] [PubMed] [Google Scholar]
  3. Altman R., Alarcón G., Appelrouth D., Bloch D., Borenstein D., Brandt K., Brown C., Cooke T. D., Daniel W., Gray R. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum. 1990 Nov;33(11):1601–1610. doi: 10.1002/art.1780331101. [DOI] [PubMed] [Google Scholar]
  4. Altman R., Asch E., Bloch D., Bole G., Borenstein D., Brandt K., Christy W., Cooke T. D., Greenwald R., Hochberg M. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–1049. doi: 10.1002/art.1780290816. [DOI] [PubMed] [Google Scholar]
  5. Dekker J., Boot B., van der Woude L. H., Bijlsma J. W. Pain and disability in osteoarthritis: a review of biobehavioral mechanisms. J Behav Med. 1992 Apr;15(2):189–214. doi: 10.1007/BF00848325. [DOI] [PubMed] [Google Scholar]
  6. Deyle G. D., Henderson N. E., Matekel R. L., Ryder M. G., Garber M. B., Allison S. C. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000 Feb 1;132(3):173–181. doi: 10.7326/0003-4819-132-3-200002010-00002. [DOI] [PubMed] [Google Scholar]
  7. Ettinger W. H., Jr, Burns R., Messier S. P., Applegate W., Rejeski W. J., Morgan T., Shumaker S., Berry M. J., O'Toole M., Monu J. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997 Jan 1;277(1):25–31. [PubMed] [Google Scholar]
  8. Fisher N. M., Pendergast D. R., Gresham G. E., Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil. 1991 May;72(6):367–374. [PubMed] [Google Scholar]
  9. Hochberg M. C., Altman R. D., Brandt K. D., Clark B. M., Dieppe P. A., Griffin M. R., Moskowitz R. W., Schnitzer T. J. Guidelines for the medical management of osteoarthritis. Part I. Osteoarthritis of the hip. American College of Rheumatology. Arthritis Rheum. 1995 Nov;38(11):1535–1540. doi: 10.1002/art.1780381103. [DOI] [PubMed] [Google Scholar]
  10. Hochberg M. C., Altman R. D., Brandt K. D., Clark B. M., Dieppe P. A., Griffin M. R., Moskowitz R. W., Schnitzer T. J. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum. 1995 Nov;38(11):1541–1546. doi: 10.1002/art.1780381104. [DOI] [PubMed] [Google Scholar]
  11. Keefe F. J., Caldwell D. S., Queen K., Gil K. M., Martinez S., Crisson J. E., Ogden W., Nunley J. Osteoarthritic knee pain: a behavioral analysis. Pain. 1987 Mar;28(3):309–321. doi: 10.1016/0304-3959(87)90066-2. [DOI] [PubMed] [Google Scholar]
  12. Mangione K. K., McCully K., Gloviak A., Lefebvre I., Hofmann M., Craik R. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci. 1999 Apr;54(4):M184–M190. doi: 10.1093/gerona/54.4.m184. [DOI] [PubMed] [Google Scholar]
  13. Maurer B. T., Stern A. G., Kinossian B., Cook K. D., Schumacher H. R., Jr Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Arch Phys Med Rehabil. 1999 Oct;80(10):1293–1299. doi: 10.1016/s0003-9993(99)90032-1. [DOI] [PubMed] [Google Scholar]
  14. McDaniel L. K., Anderson K. O., Bradley L. A., Young L. D., Turner R. A., Agudelo C. A., Keefe F. J. Development of an observation method for assessing pain behavior in rheumatoid arthritis patients. Pain. 1986 Feb;24(2):165–184. doi: 10.1016/0304-3959(86)90039-4. [DOI] [PubMed] [Google Scholar]
  15. Minor M. A. Exercise in the management of osteoarthritis of the knee and hip. Arthritis Care Res. 1994 Dec;7(4):198–204. doi: 10.1002/art.1790070407. [DOI] [PubMed] [Google Scholar]
  16. Minor M. A., Hewett J. E., Webel R. R., Anderson S. K., Kay D. R. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov;32(11):1396–1405. doi: 10.1002/anr.1780321108. [DOI] [PubMed] [Google Scholar]
  17. Newell D. J. Intention-to-treat analysis: implications for quantitative and qualitative research. Int J Epidemiol. 1992 Oct;21(5):837–841. doi: 10.1093/ije/21.5.837. [DOI] [PubMed] [Google Scholar]
  18. O'Reilly S. C., Muir K. R., Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis. 1999 Jan;58(1):15–19. doi: 10.1136/ard.58.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000 Sep;43(9):1905–1915. doi: 10.1002/1529-0131(200009)43:9<1905::AID-ANR1>3.0.CO;2-P. [DOI] [PubMed] [Google Scholar]
  20. Rejeski W. J., Brawley L. R., Ettinger W., Morgan T., Thompson C. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc. 1997 Aug;29(8):977–985. doi: 10.1097/00005768-199708000-00001. [DOI] [PubMed] [Google Scholar]
  21. Røgind H., Bibow-Nielsen B., Jensen B., Møller H. C., Frimodt-Møller H., Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil. 1998 Nov;79(11):1421–1427. doi: 10.1016/s0003-9993(98)90238-6. [DOI] [PubMed] [Google Scholar]
  22. Sforzo G. A., McManis B. G., Black D., Luniewski D., Scriber K. C. Resilience to exercise detraining in healthy older adults. J Am Geriatr Soc. 1995 Mar;43(3):209–215. doi: 10.1111/j.1532-5415.1995.tb07324.x. [DOI] [PubMed] [Google Scholar]
  23. Steultjens M. P., Dekker J., van Baar M. E., Oostendorp R. A., Bijlsma J. W. Internal consistency and validity of an observational method for assessing disability in mobility in patients with osteoarthritis. Arthritis Care Res. 1999 Feb;12(1):19–25. doi: 10.1002/1529-0131(199902)12:1<19::aid-art4>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  24. Sullivan T., Allegrante J. P., Peterson M. G., Kovar P. A., MacKenzie C. R. One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Arthritis Care Res. 1998 Aug;11(4):228–233. doi: 10.1002/art.1790110403. [DOI] [PubMed] [Google Scholar]
  25. Waddell G., Newton M., Henderson I., Somerville D., Main C. J. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993 Feb;52(2):157–168. doi: 10.1016/0304-3959(93)90127-B. [DOI] [PubMed] [Google Scholar]
  26. van Baar M. E., Assendelft W. J., Dekker J., Oostendorp R. A., Bijlsma J. W. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 1999 Jul;42(7):1361–1369. doi: 10.1002/1529-0131(199907)42:7<1361::AID-ANR9>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
  27. van Baar M. E., Dekker J., Lemmens J. A., Oostendorp R. A., Bijlsma J. W. Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics. J Rheumatol. 1998 Jan;25(1):125–133. [PubMed] [Google Scholar]
  28. van Baar M. E., Dekker J., Oostendorp R. A., Bijl D., Voorn T. B., Lemmens J. A., Bijlsma J. W. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. J Rheumatol. 1998 Dec;25(12):2432–2439. [PubMed] [Google Scholar]

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