Exercise for osteoarthritis of the knee: a Cochrane systematic review
Open accessAbstract
Objective: To determine whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis (OA) in terms of reduced joint pain or improved physical function and quality of life. Methods: Five electronic databases were searched, up until May 2013. Randomised clinical trials comparing some form of land-based therapeutic exercise with a non-exercise control were selected. Three teams of two review authors independently extracted data and assessed risk of bias for each study. Standardised mean differences immediately after treatment and 2–6 months after cessation of formal treatment were separately pooled using a random effects model. Results: In total, 54 studies were identified. Overall, 19 (35%) studies reported adequate random sequence generation, allocation concealment and adequately accounted for incomplete outcome data. However, research results may be vulnerable to selection, attrition and detection bias. Pooled results from 44 trials indicated that exercise significantly reduced pain (12 points/100; 95% CI 10 to 15) and improved physical function (10 points/100; 95% CI 8 to 13) to a moderate degree immediately after treatment, while evidence from 13 studies revealed that exercise significantly improved quality of life immediately after treatment with small effect (4 points/100; 95% CI 2 to 5). In addition, 12 studies provided 2-month to 6-month post-treatment sustainability data which showed significantly reduced knee pain (6 points/100; 95% CI 3 to 9) and 10 studies which showed improved physical function (3 points/100; 95% CI 1 to 5). Conclusions: Among people with knee osteoarthritis, land-based therapeutic exercise provides short-term benefit that is sustained for at least 2–6 months after cessation of formal treatment.
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Land-based exercise is superior to stretching and aquatic exercise for reducing pain or disability due to osteoarthritis.
“Notably, land-based exercise is superior to stretching and aquatic exercise despite the common perception that these less robust exercises are more productive or feasible in this patient population.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
There is no clear indication of the superiority of any exercise modality over another in reducing pain or disability due to osteoarthritis.
“There is no clear indication of the superiority of any modality over another in reducing pain or disability due to osteoarthritis.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
There is no simple link between improvements in function, pain, and fitness adaptations in patients with osteoarthritis.
“There is no simple link between improvements in function, pain, and fitness adaptations [508].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
The reduction in disability observed in patients with osteoarthritis is likely due to the impact of exercise on various factors, including muscle strength, gait and balance, body weight, pain, comorbid disease expression, self-efficacy, and depressive symptoms.
“The reduction in disability observed in patients with osteoarthritis is likely due to the impact of exercise on various factors, including muscle strength, gait and balance, body weight, pain, comorbid disease expression, self-efficacy, and depressive symptoms.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
Osteoarthritis of the knee is one of the most common conditions leading to disability in advanced age.
“The largest body of data exists for older adults with osteoarthritis of the knee, which is one of the most common conditions leading to disability in advanced age [508].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
There is no clear indication of superiority of any exercise modality over another in reducing pain or disability due to knee osteoarthritis.
“There is no clear indication of the superiority of any modality over another in reducing pain or disability due to osteoarthritis.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
There is no simple link between improvements in function, pain, and fitness adaptations in osteoarthritis.
“There is no simple link between improvements in function, pain, and fitness adaptations [508].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
Land-based exercise is superior to stretching and aquatic exercise for knee osteoarthritis.
“Notably, land-based exercise is superior to stretching and aquatic exercise despite the common perception that these less robust exercises are more productive or feasible in this patient population.”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [508]
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- Authors
- Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L.
- Affiliations
- The University of Sydney (AU)
- St Joseph's Health Centre (CA)
- The University of Melbourne (AU)
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2015-09-24
- Volume
- 49
- Issue
- 24
- Pages
- 1554-1557
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2181578681
- Cited by
- 888
- References
- 88
- Citations by year
- 2026: 60 · 2025: 97 · 2024: 82 · 2023: 100 · 2022: 110 · 2021: 127 · 2020: 87 · 2019: 64 · 2018: 79 · 2017: 35 · 2016: 35 · 2015: 11 · 2014: 1
- FWCI
- 6.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- knee osteoarthritis, exercise therapy, land-based exercise, joint pain, physical function, quality of life, exercise sustainability, post-treatment outcomes
- MeSH terms
- Activities of Daily Living, Exercise Therapy, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Arthralgia, Osteoarthritis, Knee
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