Skip to main content
NCBI home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2000 Oct;34(5):326–331. doi: 10.1136/bjsm.34.5.326

Is exercise effective treatment for osteoarthritis of the knee?

R Petrella 1
PMCID: PMC1756252  PMID: 11049140

Abstract

Objective—To review and determine the effectiveness of exercise treatment in osteoarthritis of the knee.

Methods—A computerised literature search of Medline was carried out searching between June 1966 and January 2000.

Results—Twenty three randomised controlled trials were identified from the literature. Only three trials were sufficiently powered. Small to moderate beneficial effects of exercise treatment were found for pain, small beneficial effects on disability outcome measures, and moderate to great beneficial effects were observed according to patient global assessment of effect. It was not possible to obtain evidence on the content of exercise interventions, as studies were hampered by lack of attention to proper concealment, reporting of adverse effects, and long term effects of exercise treatment. The lack of standard outcomes measures is also noted.

Conclusions—The available evidence indicates beneficial short term effects of exercise treatment in patients with osteoarthritis of the knee. However, the number of available studies is limited, and more research is needed to expand this recommendation. Specifically, additional trials should provide information on adherence, home based interventions, interaction with pharmacological treatments, functional outcomes measures relevant to exercise treatment in these patients, and long term effects. At present, doctors should recommend exercise to all patients with mild/moderate disease. Further study should be encouraged and exercise should be continued to be recommended as a mainstay of non-pharmacological treatment of osteoarthritis of the knee.

Key Words: osteoarthritis; knee; exercise

Full Text

The Full Text of this article is available as a PDF (126.4 KB).

Selected References

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

  1. Armstrong S. J., Read R. A., Ghosh P., Wilson D. M. Moderate exercise exacerbates the osteoarthritic lesions produced in cartilage by meniscectomy: a morphological study. Osteoarthritis Cartilage. 1993 Apr;1(2):89–96. doi: 10.1016/s1063-4584(05)80023-8. [DOI] [PubMed] [Google Scholar]
  2. Begg C., Cho M., Eastwood S., Horton R., Moher D., Olkin I., Pitkin R., Rennie D., Schulz K. F., Simel D. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996 Aug 28;276(8):637–639. doi: 10.1001/jama.276.8.637. [DOI] [PubMed] [Google Scholar]
  3. Bellamy N., Kirwan J., Boers M., Brooks P., Strand V., Tugwell P., Altman R., Brandt K., Dougados M., Lequesne M. Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol. 1997 Apr;24(4):799–802. [PubMed] [Google Scholar]
  4. Bellamy N. Osteoarthritis clinical trials: candidate variables and clinimetric properties. J Rheumatol. 1997 Apr;24(4):768–778. [PubMed] [Google Scholar]
  5. Börjesson M., Robertson E., Weidenhielm L., Mattsson E., Olsson E. Physiotherapy in knee osteoarthrosis: effect on pain and walking. Physiother Res Int. 1996;1(2):89–97. doi: 10.1002/pri.6120010205. [DOI] [PubMed] [Google Scholar]
  6. Chamberlain M. A., Care G., Harfield B. Physiotherapy in osteoarthrosis of the knees. A controlled trial of hospital versus home exercises. Int Rehabil Med. 1982;4(2):101–106. doi: 10.3109/09638288209166889. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. 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]
  9. Felson D. T., Naimark A., Anderson J., Kazis L., Castelli W., Meenan R. F. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914–918. doi: 10.1002/art.1780300811. [DOI] [PubMed] [Google Scholar]
  10. Greenhalgh T. Papers that summarise other papers (systematic reviews and meta-analyses). BMJ. 1997 Sep 13;315(7109):672–675. doi: 10.1136/bmj.315.7109.672. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. 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]
  12. Jan M. H., Lai J. S. The effects of physiotherapy on osteoarthritic knees of females. J Formos Med Assoc. 1991 Oct;90(10):1008–1013. [PubMed] [Google Scholar]
  13. Kovar P. A., Allegrante J. P., MacKenzie C. R., Peterson M. G., Gutin B., Charlson M. E. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992 Apr 1;116(7):529–534. doi: 10.7326/0003-4819-116-7-529. [DOI] [PubMed] [Google Scholar]
  14. Kujala U. M., Kettunen J., Paananen H., Aalto T., Battié M. C., Impivaara O., Videman T., Sarna S. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum. 1995 Apr;38(4):539–546. doi: 10.1002/art.1780380413. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. 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]
  17. 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]
  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. 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]
  20. Schilke J. M., Johnson G. O., Housh T. J., O'Dell J. R. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res. 1996 Mar-Apr;45(2):68–72. doi: 10.1097/00006199-199603000-00002. [DOI] [PubMed] [Google Scholar]
  21. Spector T. D., Harris P. A., Hart D. J., Cicuttini F. M., Nandra D., Etherington J., Wolman R. L., Doyle D. V. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum. 1996 Jun;39(6):988–995. doi: 10.1002/art.1780390616. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. de Vet H. C., Koudstaal J., Kwee W. S., Willebrand D., Arends J. W. Efforts to improve interobserver agreement in histopathological grading. J Clin Epidemiol. 1995 Jul;48(7):869–873. doi: 10.1016/0895-4356(94)00225-f. [DOI] [PubMed] [Google Scholar]
  24. 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]
  25. 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]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES