. 2021 Jun 14;9(6):23259671211016900. doi: 10.1177/23259671211016900

Table 2.

Summary of exercise programs strongly recommended by the Ottawa Panel

Exercise Type	Exercise Program	Details of Program	Results*	Recommended for
*Mind-Body*	Sun Style Tai Chi³²	20 weeks, 3 sessions/week (20-40 min). Program consists of Sun style tai chi led by certified instructor in a group.	n=24, 100% participation. WOMAC pain (0-20) avg -2.60, WOMAC physical function (0-68) avg -6.82 No adverse events	Pain relief, improved physical function
*Strength Training*	Supervised isokinetic, isotonic, and isometric muscle strengthening program¹²	8 weeks, 3 sessions/week. Program consists of hot packs and stretching, warm-up on stationary bike, then 5 sets 5 reps of one of following strengthening exercises for hamstrings and quadriceps: - Isokinetic exercise = use machines that vary tension to keep constant joint speed. - Isotonic exercise = exert a constant tension on muscles regardless of joint speed e.g. leg extensions. - Isometric exercises = exert a constant tension with no joint movement e.g. wall sit. After 8 weeks, at-home program was provided	n=132, 86.4% participation. VAS pain (0-10) avg -2.1, LI physical function (0-24) avg -2.9 Adverse events: 8 people withdrawn due to knee pain	Pain relief, improved physical function
	Progressive exercise program¹³	6 weeks, 2 sessions/week (45 min). In group or individually. Integrate exercise, education, self-management, and coping strategies. Program consists of warm-up and individualized progressive strengthening, balance and motor control exercises devised and supervised by physiotherapist.	n=418, 82% participation. WOMAC physical function (0-68) avg -5.6 Adverse events: 5 people withdrawn due to knee pain	Improved physical function
	High (HR) and low (LR) resistance strengthening program¹⁵	8 weeks, 3 session/week 10% (low resistance: LR) and 60% (high resistance HR) of 1-repetition maximum (RM) leg training for quadriceps. Program consists of warm-up on stationary bike, low intensity (15 reps, 10 sets) or high intensity (8 reps, 3 sets) leg press exercise, and cold packs after. Supervised by therapist	n=102, 93% participation. WOMAC pain (0-20) avg LR -3, avg HR -3.7, WOMAC physical function (0-68) avg LR -11.3, avg HR -11.7 Adverse events: 3 people withdrawn due to knee pain	Pain relief, improved physical function
	Non-weight (NWB) or weight bearing (WB) exercise program¹⁴	8 weeks, 3 sessions/week WB or progressive NWB strength training. Program consists of warm-up on stationary bike, 6 reps, 4 sets WB (one foot leg press) or NWB (one foot leg extension 50% RM + 5% every 2 weeks) for each knee, and cold pack after. Supervised by therapist	n=106, 92% participation. WOMAC physical function (0-68) avg WB -10.3, avg NWB – 17.2 Adverse events: 5 people withdrawn due to knee pain	Improved physical function
	Quadriceps strengthening program¹⁶	24 months, 2 times/day At-home program mostly self-supervised. Program consists of progressive exercises beginning with non-resistant flexibility exercises up to month 2, then continuing with graded therapeutic elastic band strengthening exercises targeting the quadriceps and functional strengthening exercises (e.g. rising from sitting position) twice daily.	n=389, 74% participation. WOMAC pain (0-20) avg Exercise groups -1.78 with 44% of participants achieving >30% pain reduction. (Dietary intervention groups also evaluated but no effects on pain), 45% self-reported high compliance to exercise program No adverse events	Pain relief
	Home-based physiotherapist supervised quadriceps strengthening program²⁰	12 weeks, 5 sessions/week Home-based partially supervised (physiotherapist interventions usually 1x/week). Program consists of 5 quadriceps exercises that use ankle weights and therapeutic elastic bands (ankle weight knee extension while sitting, ankle weight knee extension supine, ankle weight full leg extension, ankle weight isometric knee extension sitting, TheraBand knee extension sitting). Exercise dosage determined and adjusted by physiotherapist as comfortable for patients.	n=107, 91% participation. WOMAC pain (0-100) avg neutrally aligned -13, avg maligned -4.6 (Study evaluated patients with maligned vs neutrally aligned knee joints), 87% compliance based on exercise journal completion Adverse events: 2 people withdrawn due to knee pain 1 person withdrawn due to neck pain	Pain relief
	Lower extremity strengthening program²⁴	6 months, 1 time/day Home-based partially supervised (Therapist interventions at beginning, after 2 weeks, 6 weeks, and 3 months). Program consists of 5 quadriceps exercises (isometric quadriceps contraction, isotonic quadriceps contraction, isotonic hamstrings contraction, isotonic quadriceps contraction with TheraBand, stair step up and down). Exercises are progressively increased to a max of 20 reps each.	n=191, 94% participation. HADS anxiety (0-21) avg -0.57, HADS depression (0-21) avg -0.57. No adverse events	Improved quality of life
	Mechanical diagnosis and therapy (MDT) program²⁹	2 weeks, 10 reps/2-3 hrs Home-based, partially supervised. Program consists of exercises targeting quadriceps, either modified leg flexion or extension (if patient has directional preference of joint) or regular strengthening exercises like stationary biking (if patient doesn’t have directional preference of joint). Mackenzie MDT certified physiotherapists taught and monitored through 2-3 interventions.	n=180, 69% participation. P4 pain (0-40) avg -2, KOOS pain (0-100) +7, KOOS physical function (0-100) +5, compliance not measured Adverse events: people withdrawn due to knee pain	Pain relief, improved physical function
*Aerobic + Strength Combination*	Individual or group aerobic and strengthening program⁷	8 weeks, 2 sessions/week (1 hr) Individual or group supervised. Program consists of stretching (quadriceps, hamstring, gastrocnemius), stationary bike 20 mins, NWB leg extensions 20-40 reps, WB resistance climber 100 steps, NWB eccentric and concentric quadriceps exercises 20-40 reps, WB eccentric controlled step down. Home exercise program also provided which was stretches and 20 mins walking/biking.	n=126, 85% participation. WOMAC pain reversed (100-0) avg +10.6 No adverse events	Pain relief
	Community physiotherapy exercise program¹⁰	10 weeks, 3-6 sessions (20 mins) Program consists of individualised aerobic and strengthening exercise program and advice leaflet about activity and pacing delivered and supervised by physiotherapist. Exercises are progressively increased in intensity.	n=325, 54% participation. WOMAC pain (0-20) avg -1.56, WOMAC physical function (0-68) avg -4.79 No adverse events	Pain relief, improved physical function
	Aerobic and strengthening exercise and OA educational program²⁷	3 months, 3 sessions/week (1 hr) Program consists of stretching, aerobic exercises (brisk walking, medium intensity), and strengthening exercises (starting with isometric, going to isotonic with increasing reps and intensity, using thera band). Exercises are progressively increased in intensity and supervised by therapist.	n=137, 91% participation. AIMS2 pain (0-10) avg -1.44 AIMS2 physical function (0-10) avg -1.5 Compliance avg 86% Adverse events: 1 person withdrawn due to knee pain	Pain relief, improved physical function

Note: WOMAC = Western Ontario and McMaster universities osteoarthritis index, VAS = Visual and analogue scale of pain, LI = Lequesne index, HADS = Hospital anxiety and depression Scale, P4 = 4 item pain measure (pain in morning, afternoon, evening, and with activity), KOOS = Knee injury and OA outcome score, AIMS2 = Arthritis impact measurement scale 2

* n is total number of participants in all study groups including control, participation calculated as percentage of people who participated until end of study including follow-up, only outcome values relevant to recommendations shown, all outcome values are averages and are at least P<0.05, 95% CI, adverse events are people who left/were stopped from study due to excessive pain or other effects related to study interventions.