Table 1. Characteristics of the studies’ participants and interventions.
| Study author, year (ref.) | Condition and patient characteristics 1) subject; 2) number of participants; 3) duration of OA; 4) severity of OA; 5) age | Intervention | 1) Intervention period 2) frequency |
Outcome of 1) physical activity, 2) pain, and 3) time points |
|---|---|---|---|---|
| Allen KD et al. 2018 [43] | 1) Knee OA 2) 350 patients (group 1 = 140 (female = 98), group 2 = 142 (female = 100), group 3 = 62 (female = 53)) 3) 13.1 years 5) group 1, 65.3 ± 11.1 years; group 2, 65.7 ± 10.3 years; group 3, 64.3 ± 12.2 years |
Group 1 (Ex): Internet-based exercise training program (Encouraged to complete strengthening and stretching exercises at least 3 times per week and to engage in aerobic exercises daily, or as often as possible) Group 2 (Ex): Home exercise program and up to eight 1 h supervised physical therapy sessions (home exercise program including strengthening, stretching/range of motion, and aerobic exercises, activity pacing) Group 3 (Con): Waiting list. |
1) 4 months 2) group 1 at least 3 times / week, group 2 not listed |
1) PASE 2) WOMAC 3) BL, 4 months, 12 months (f) |
| Bartholody C et al. [44] | 1) Knee OA 2) 38 patients (group 1 = 19 (female = 15), group 2 = 19 (female = 14)) 3) no listed 5) group 1, 68.0 ± 7.3 years; group 2, 62.0 ± 9.7 years |
Group 1 (Edu): Motivational text message (Information and general advice about the importance of performing daily physical activity) Group 2 (Con): No intervention |
1) 6 weeks 2) 3 times / week |
1) Activity time 2) KOOS 3) BL, 6 weeks |
| Bennell KL et al. [45] | 1) Hip OA 2) 102 patients (group 1 = 49 (female = 26), group 2 = 53 (female = 36) 4) grade 2/3/4: group 1 24/11/14; group 2 27/14/12 5) group 1, 68.0 ± 7.3 years; group 2, 62.0 ± 9.7 years |
Group 1 (Ex): Home exercise (strengthening, stretching, range of motion, functional balance, and gait drills), education, and advice Group 2 (Con): Inactive ultrasound and inert gel |
1) 12 weeks 2) group 1 4 times / week, group 2 3 times / week |
1) PASE, Steps/day 2) VAS, KOOS 3) BL, 13 weeks, 36 weeks (f) |
| Gilbert AL et al. 2018 [46] | 1) Knee OA 2) 155 patients (group 1 = 76 (female = 57.89%), group 2 = 79 (female = 62.03)) 4) grade 2/3/4 (%): group 1 50.0/27.6/22.4; group 2 58.2/26.6/15.2 5) group 1, 61.4 ± 13.3 years; group 2, 64. 8 ± 12.4 years |
Group 1 (Edu): Motivational interviewing (45–60 minutes; individual counseling based on motivational interviewing, individualized goal setting, and tailored strategies for increasing physical activity and monitoring progress) Group 2 (Con): Physician-conducted physical activity counseling session only |
1) 24 months 2) (in first year) 3, 6, and 12 months, (in second year) every 6 months |
1) Activity time 2) WOMAC 3) BL, 3 months, 6 months, 12 months, 24 months |
| Hinman RS et al. [47] | 1) Hip/Knee OA 2) 71 patients (group 1 = 36 (female = 24), group 2 = 35 (female = 24)) 3) group 1 8.0 years, group 2 8.0 years 5) group 1, 63.3 ± 9.5 years; group 2, 61.5 ± 7.8 years |
Group 1 (Ex): Aquatic physical therapy program (Encouraged to continue independent aquatic physical therapy 2 times weekly and recorded in a logbook the sessions of independent aquatic physical therapy) Group 2 (Con): Usual activities and medication regimen |
1) 6 weeks 2) 2 times / week |
1) PASE 2) VAS, WOMAC 3) BL, 6 weeks, 12 weeks (f) |
| Hinman RS et al. 2020 [48] | 1) Knee OA 2) 71 patients (group 1 = 87 (female = 55), group 2 = 88 (female = 55)) 3) group 1 10.0 years, group 2 9.0 years 5) group 1, 62.4 ± 9.1 years; group 2, 62.5 ± 8.1 years |
Group 1 (Edu): In addition to Group 2, 5–10 consultations with a physiotherapist using telephone planning for “hard” to “very hard” levels of physical activity. Group 2 (Con): Provided information about OA; treatments and self-management strategies; community resources; assistance navigating services; emotional support and care escalation, that was delivered once by nurses. |
1) 6 months 2) 5–10 times / 6 months |
1) PASE 2) NRS, WOMAC 3) BL, 6 months, 12 months (f) |
| Hughes SL et al. 2004 [49] | 1) Hip/Knee OA 2) 150 patients (group 1 = 80 (female = 81.0%), group 2 = 70 (female = 87.1%)) 4) ACR class (grade 1/2/3) (%): group 1, 23.0/66.2/10.8, group 2, 21.0/66.1/12.9 5) group 1, 73.5 ± 6.8 years; group 2, 73.7 ± 6.3 years |
Group 1 (Ex + Edu): Fit and Strong intervention (Resistance training for the lower extremities and trunk, 30 min fitness walking (intensity is to 40% to 60% of maximum heart rate or 13 to 15 on the Borg Scale) + Education (30 min group-discussion-educational component: self-efficacy for exercise, exercise adherence, for manage pain and other arthritis-related symptoms, goal settings and feedback to participants on progress made toward the achievement of these goals) Group 2 (Con): The Arthritis Helpbook, a list of exercise programs |
1) 8 weeks 2) 90 min / 3 times / week |
1) Time spent walking 2) WOMAC 3) BL, 2 months, 6 months (f) |
| Hughes SL et al. 2006 [24] | 1) Hip/Knee OA 2) 215 patients (group 1 = 115 (female = 80.6%), group 2 = 100 (female = 85.9%)) 4) ACR class (grade 1/2/3) (%): group 1 22.6/64.5/12.9, group 2 22.2/64.2/13.6 5) group 1, 73.3 years; group 2, 73.4 years |
Group 1 (Ex + Edu): Fit and Strong intervention (Resistance training for the lower extremities and trunk, 30 minutes’ fitness walking (intensity is to 40% to 60% of maximum heart rate or 13 to 15 on the Borg Scale) + Education (30 min group-discussion-educational component: self-efficacy for exercise, exercise adherence, for manage pain and other arthritis-related symptoms, goal settings and feedback to participants on the progress made toward the achievement of these goals) Group 2 (Con): The Arthritis Helpbook, a list of exercise programs |
1) 8 weeks 2) 90 min / 3 times / week |
1) Time spent walking 2) WOMAC 3) BL, 2 months, 6 months (f), 12 months (f) |
| Li LC et al. 2017 [50] | 1) Knee OA 2) 34 patients (group 1 = 17 (female = 14), group 2 = 17 (female = 14)) 4) Diagnosis OA: yes: 20 (59%), No, but met the "likely OA" criteria: 14 (41%) 5) 55.5 ± 8.6 years; (group 1, 52.3 ± 9.7 years; group 2, 58.7 ± 6.0 years) |
Group 1 (Edu): 1.5-h session; standardized group education session about physical activity (the benefits of physical activity, the detrimental effects of sedentary behavior, ways to be active without aggravating OA symptoms), individual weekly activity counseling with a PT via telephone (identify activity goals, develop an action plan, identify barriers and solutions, rate their confidence in executing the plan), and tracking the participant’s physical activity behavior by using Fitbit Flex Group 2 (Con): Waiting list |
1) 2 months 2) 4 weekly 20 min telephone call |
1) MVPA 2) KOOS 3) BL, 1 months, 2 months |
| Li LC et al. 2018 [51] | 1) Knee OA 2) 61 patients (group 1 = 30 (female = 22), group 2 = 31 (female = 28)) 4) Diagnosis OA: yes: 52 (85%), No, but met the "likely OA" criteria: 9 (15%) 5) 61.7 ± 8.9 years; (group 1, 61.3 ± 9.4 years; group 2, 62.1 ± 8.5 years) |
Group 1 (Edu): 1.5-h session; standardized group education session about physical activity (the benefits of physical activity, the detrimental effects of sedentary behavior, ways to be active without aggravating OA symptoms), individual weekly activity counseling with a PT via telephone (identify activity goals, develop an action plan, identify barriers and solutions, rate their confidence in executing the plan), and tracking the participant’s physical activity behavior by using Fitbit Flex Group 2 (Con): Waiting list |
1) 2 months 2) 4 weekly 20 min telephone call |
1) MVPA 2) KOOS 3) BL, 1 months, 2 months, 4 months (f), 6 months (f) |
| Li LC et al. 2020 [52] | 1) Knee OA 2) 51 patients (group 1 = 26 (female = 23), group 2 = 25 (female = 19)) 4) Diagnosis OA: yes: 37 (73%), No, but met the "likely OA" criteria: 14 (27%) 5) 64.9 ± 8.5 years; (group 1, 65.0 ± 8.0 years; group 2, 64.8 ± 9.0 years) |
Group 1 (Edu): 3 components; an in-person session with 20 min of group education and 30 min of individual counseling with a PT, use of pedometer (Fitbit Flex-2 wristband), PT counseling by phone to review physical activity goals (20–30 min). During weeks 1 to 8, PT remotely reviewed the participants’ progress and counseled them to modify their physical activity goals via 4 biweekly phone calls. During weeks 9 to 12, the participants continued using their Fitbit without counseling. Group 2 (Con): Waiting list |
1) 12 weeks 2) 4 biweekly telephone call |
1) Daily steps, MVPA 2) KOOS 3) BL, 13 weeks, 26 weeks (f), 39 weeks (f) |
| Moseng T et al. 2020 [22] | 1) Knee OA 2) 393 patients (group 1 = 284 (female = 211), group 2 = 109 (female = 68)) 3) no listed 5) group 1 63.0 ± 10.0 years; group 2 65.0 ± 10.0 years |
Group 1 (Ex + Edu): 3-hour group-based education program, focused on knowledge of OA, recommend treatments, emphasizing the importance of exercise. 1 hour group exercise with 5–10 patients. 2–4 sets with 8–12 repetitions of 60–70% of 1 RM were set up. 30–60 minutes of walking and pedaling exercises at home were also recommended. Group 2 (Con): Usual care excluding individual exercise and education program. |
1) 8–12 weeks 2) 2 times / weeks |
1) sitting time 2) NRS, KOOS, HOOS 3) BL, 3 months, 6 months (f) |
| Murphy SL et al. 2018 [53] | 1) Knee OA 2) 57 patients (group 1 = 38 (female = 24), group 2 = 19 (female = 11)) 3) no listed 5) 63.5 ± 8.3 years (group 1 64.8 ± 8.0 years; group 2 60.7 ± 8.5 years) |
Group 1 (Edu): 1-hour session with occupational therapist (explanation of the program’s focus on lifestyle changes to help manage osteoarthritis symptoms through self-monitoring and goal setting,) and online program about CBT program (exercise, sleep, hygiene, pleasant activity scheduling, relaxation, activity pacing, problem solving, wrap-up session that focused on further goal attainment) Group 2 (Con): Usual osteoarthritis care |
1) 6 months 2) 8 times / week |
1) average activity counts 2) BPI 3) BL, 6 months |
| Rewald S et al. 2020 [54] | 1) Knee OA 2) 102 patients (group 1 = 55 (female = 70.9%), group 2 = 47 (female = 51.1%)) 4) K/L grade: group 1 2.0 ± 0.6, group 2 2.0 ± 0.5 5) group 1, 59.0 ± 9.5 years; group 2, 61.0 ± 7.4 years |
Group 1 (Ex). The participants rowed the aqua bike in an upright position in the pool and adjusted their legs to be soaked during the entire row. The participants were immersed in warm water (32°C) between the xiphoid process and the first rib. The participants also incorporated an unsaddled posture, leg exercises, and upper body exercises. Group 2 (Con): Usual care, follow-up of treatment received outside the study is not prohibited. |
1) 12 weeks 2) 45 min / 2 times / week |
1) SQUASH 2) KOOS, NRS 3) BL, 12 weeks, 24 weeks (f) |
| Schlenk EA et al. 2020 [23] | 1) Knee OA 2) 182 patients (group 1 = 91 (female = 67), group 2 = 91 (female = 66)) 3) group 1 11.7 ± 9.9 years, group 2 11.3 ± 9.2 years 5) 64.7 ± 8.1 years; (group 1, 64.5 ± 8.5 years; group 2, 65.0 ± 7.8 years) |
Group 1 (Ex + Edu): 6 weekly 60–65 min individual face-to-face sessions including graduated LEE, and progressive fitness walking. Nine biweekly 15–20 min telephone sessions with the licensed registered nurse for ongoing goal setting and support, which were conducted in the project office; and daily e-diary for self-monitoring physical activity during the 6-month intervention. Group 2 (Con): Usual care and 15 sessions of 15–20 min telephone sessions. 15 sessions covered health topics from the National Institute on Aging website that avoided any mention of knee OA and their management, including physical activity. |
1) 6 months 2) 6 weekly face-to-face sessions and Nine biweekly 15–20 min telephone call |
1) activity time 2) WOMAC 3) BL, 6 months, 12 months (f) |
| Shahine NF et al. 2020 [55] | 1) Knee OA 2) 66 patients (group 1 = 33 (female = 21), group 2 = 33 (female = 16)) 3) (less than 5 years/ 5–10 years/ +10 years): group 1 16/10/7, group 2 14/13/6 5) group 1, 65.6 ± 5.0 years; group 2, 66.9 ± 5.8 years |
Group 1 (Edu): Pedometer self-monitoring, aerobic weekly step count goals and weekly telephone follow ups. Educational booklet used for improving the patient’s knowledge level in four sessions. The patients received their individualized daily step count goals every week to increase gradually by 10% of baseline steps/d for weeks 2–12. Patients received a weekly telephone call of duration10-15 min for feedback and providing new step count goals. Group 2 (Con): Usual care |
1) 12 weeks 2) 10–15 minutes telephone / week, 4 session for education with booklet |
1) Daily steps 2) WOMAC 3) BL, 12 weeks |
| Vincent KR et al. 2020 [56] | 1) Knee OA 2) 88 patients (group 1 = 17 (female = 11), group 2 = 19 (female = 13), group 3 = 17 (female = 11)) 3) group 1 7.8 ± 8.1 years; group 2 12.8 ± 11.9 years; group 3 7.9 ± 8.1 years 5) 68.3 ± 6.4 years (group 1, 69.5 ± 6.5 years; group 2, 66.8 ± 5.4 years; group 3, 68.6 ± 7.1 years) |
Group 1 (Ex): Concentrically focused resistance training of 12 repetitions with 60% 1 RM. One set of each of the following exercises was completed during each session: leg press, knee flexion, knee extension, calf press, chest press, seated row, shoulder press, and biceps curl. The resistance load was raised for the set to keep the rating of perceived exertion value at approximately 17–18 of 20 points for each exercise over the study duration. Group 2 (Ex): Eccentrically focused resistance training enhanced eccentric training continually performs the eccentric muscle action with the equivalent of the 1RM and to sequentially reduce the load to 60% of 1RM for the concentric muscle action. Group 3 (Con): Usual activity |
1) 4 months 2) 2 times / week |
1) Daily steps, activity time 2) NRS 3) BL, 4 months |
| Waller B et al. 2017 [57] | 1) Knee OA 2) 87 patients; all women (group 1 = 43, group 2 = 44) 4) grade 1/2: group 1 23/20; group 2 24/20 5) group 1, 63.8 ± 2.4 years; group 2, 63.9 ± 2.4 years |
Group 1 (Ex): Aquatic resistance training sessions (three resistance levels (barefoot, small resistance fins, large resistance boots)) Training intensity was set at as “hard and fast as possible” Group 2 (Con): Usual care (continue their usual leisure time activities, participate in two sessions consisting of 1 h of light stretching, relaxation, and social interaction) |
1) 16 weeks 2) 1 hour / 3 times / week |
1) LTPA 2) KOOS 3) BL, 4 months, 16 months (f) |
| Wallis JA et al. 2017 [58] | 1) Knee OA 2) 46 patients (group 1 = 23 (female = 9), group 2 = 23 (female = 11)) 4) grade 3/4: group 1 1/21; group 2 2/21 5) group 1, 68.8 ± 8.0 years; group 2, 67.0 ± 7.0 years) |
Group 1 (Ex + Edu): Walking (at least moderate intensity: determined by the Rate of Perceived Exertion Scale (0 to 10) where level 3 = “I am still comfortable but am breathing a little harder”), behavioral change techniques and strategies (①planning session with a physiotherapist (up to 30 min to plan the location, day and time of day for each walk) ②regular physiotherapy supervision and monitoring each week (one-to-one supervised walking sessions or group supervised walking sessions based on patient preference, and regular phone calls or SMS reminders) ③wearing a pedometer and recording the number of steps taken and time spent walking during each session in a logbook ④engaging social supports such as walking with a friend, family member or other research participants) + usual care Group 2 (Con): Non-operative management to manage pain and symptoms including pharmacological and non-pharmacological interventions |
1) 12 weeks 2): at least 10 min / time, 70 min / week |
1) Steps, Walking time 2) NRS, WOMAC 3) BL, 13 weeks |
| Wortley M et al. 2013 [59] | 1) Knee OA 2) 31 patients (group 1 = 13 (female = 9), group 2 = 12 (female = 9), group 3 = 6 (female = 4)) 4) K/L grade (median(range)): group 1 2 (2); group 2 3 (3); group 3 2 (1) 5) group 1, 69.5 ± 6.7 years; group 2, 68.1 ± 5.3 years; group 3, 70.5 ± 5.0 years |
Group 1 (Ex): Open-kinetic chain resistance training program including seated leg extension, standing hamstring curl, straight leg raise, standing hip abduction, standing hip adduction, standing hip flexion, standing calf raise, which started with either a 5 lb. or 10 lb. ankle weight and progressed from two sets of eight repetitions to three sets of 12 repetitions during the first 6 weeks, and were allowed to increase the weight as needed during the final 4 weeks. Group 2 (Ex): 1-hour training of 12 basic movements adapted from the Yang Style Tai Ji. The program began by learning the first two movements during the first session, and then adding a new movement during each session for the first 5 weeks. Group 3 (Con): Usual physical activity |
1) 10 weeks 2) 1 hour/ section; 2 times / week |
1) PASE 2) WOMAC 3) BL, 6 months |
Abbreviations. ref, reference number; OA, osteoarthritis; Ex, exercise; Edu, educational intervention; Ex + Edu, Combination therapy of exercise and educational intervention; Con, control; ACR, American College of Rheumatology; K/L, Kellgren-Lawrence; PT, physical therapy; RM, repetition maximum; CBT, cognitive behavioral therapy; LEE, lower extremity exercise; BL, baseline; PASE, physical activity scale for Elderly; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index; KOOS, knee injury and osteoarthritis outcome score; VAS, visual analog scale; NRS, numerical rating scale; MVPA, moderate to vigorous physical activity; HOOS, hip disability and osteoarthritis outcome score; BPI, brief pain inventory; SQUASH, short questionnaire to assess health-enhancing physical activity; LTPA, average monthly leisure time physical activity