Comparing Exercise Therapies For Knee Osteoarthritis

Among patients with knee osteoarthritis, for most outcomes, the benefits of high-dose exercise therapy were more or less similar to those of a low-dose therapy, according to a team of Swedish investigators. The results are published in the Annals of Internal Medicine.

“The results do not support the superiority of high-dose exercise over low-dose exercise for most outcomes,” the team of 6 investigators said. “However, small benefits with high-dose exercise were found for knee function in sports and recreation and for quality of life.”

In total, 189 patients with diagnosed knee osteoarthritis and a history of pain and decreased knee function were part of the Swedish and Norwegian multicenter randomized controlled superiority trial. The results were documented through multiple follow-ups up to 12 months after the intervention.

While 98 patients were assigned to high-dose therapy consisting of 11 exercises ranging from 70 to 90 minutes; 91 patients were assigned to low-dose therapy consisting of 5 exercises ranging from 20 to 30 minutes. The types of exercises were global (aerobic), semiglobal (multisegmental), and local (joint-specific) designed to be performed 3 times a week for 12 weeks under supervision of a physiotherapist. All exercise programs were tailored to each patient.

The Knee Injury and Osteoarthritis Outcome Score (KOOS), a self-reported questionnaire analyzing pain, function in daily living (ADL), function in sports and recreation, and knee-related QoL, was evaluated biweekly during the 3-month intervention period as well as 6 and 12-months post-intervention. The primary outcome was the mean difference (MD) between intervention groups in KOOS.

The researchers found that at the 6-month follow-up, the KOOS score for function in sports and recreation was superior in the high-dose therapy group (MD, 8 [95% CI, 2 to 14]; Cohen d = 0.31) At the end of 12 weeks, more than half of the patients (47% to 60%) in both groups reported clinically meaningful improvements in all KOOS categories.

Treatment adherence was 98% in both cohorts.

—Priyam Vora

Reference:
Torstensen TA, Østerås H, LoMartire R, Rugelbak GM, Grooten WJA, and Äng B. High- versus low-dose exercise therapy for knee osteoarthritis: A randomized controlled multicenter trial. Annals of Internal Medicine. Published online: January 24, 2023. qhttps://doi.org/10.7326/m22