Exercise for the Management of Knee Osteoarthritis: A Review of Clinical Effectiveness

Key Message

Evidence from 18 identified systematic reviews suggested the clinical efficacy of exercise compared to no intervention, placebo, or minimal intervention for knee osteoarthritis patients with limited exceptions. Outcomes of pain, physical function, physical performance, and stiffness were frequently associated with statistically significant improvements with exercise, though there were some inconsistencies in the evidence. One identified meta-analysis conducted an indirect comparison of exercise with opioid pain management for knee osteoarthritis patients and the results suggested comparable clinical efficacy. Overall the systematic reviews were conducted with few methodological concerns and the underlying evidence base included high quality randomized controlled trials. The evidence base was associated with potential for measurement and selection bias that limited the confidence in the conclusions of this report. Furthermore the variety of interventions, lengths of follow-up, and frequency or duration of exercise make it difficult to draw conclusions regarding the optimal exercise approach. The systematic reviews also identified under-reporting of adverse event outcomes as a limitation. One identified systematic review identified evidence that the most commonly reported adverse event was falling and that exercise was not associated with increased knee osteoarthritis progression.