Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
Osteoarthritis Cartilage. 2015 Jul;23(7):1071-82. doi: 10.1016/j.joca.2014.12.027. Epub 2015 Apr 9.
Although physical exercise is the commonly recommended for osteoarthritis (OA) patients, the working mechanism behind the positive effects of physical exercise on pain and function is a black box phenomenon. In the present study we aimed to identify possible mediators in the relation between physical exercise and improvements of pain and function in OA patients.
A systematic search for all studies evaluating the effects of physical exercise in OA patients and select those that additionally reported the change in any physiological factor from pre-to post-exercise.
In total, 94 studies evaluating 112 intervention groups were included. Most included studies evaluated subjects with solely knee OA (96 out of 112 groups). Based on the measured physiological factors within the included studies, 12 categories of possible mediators were formed. Muscle strength and ROM/flexibility were the most measured categories of possible mediators with 61 and 21 intervention groups measuring one or more physiological factors within these categories, respectively. 60% (31 out of 52) of the studies showed a significant increase in knee extensor muscle strength and 71% (22 out of 31) in knee flexor muscle strength over the intervention period. All 5 studies evaluating extension impairments and 10 out of 12 studies (83%) measuring proprioception found a significant change from pre-to post-intervention.
An increase of upper leg strength, a decrease of extension impairments and improvement in proprioception were identified as possible mediators in the positive association between physical exercise and OA symptoms.
尽管体育锻炼是骨关节炎（OA）患者的常用推荐治疗方法，但体育锻炼对疼痛和功能的积极影响背后的工作机制仍是一个黑箱现象。本研究旨在确定体育锻炼与 OA 患者疼痛和功能改善之间关系中可能的中介因素。
系统搜索评估 OA 患者体育锻炼效果的所有研究，并选择那些另外报告锻炼前后任何生理因素变化的研究。
共纳入 94 项研究，评估了 112 个干预组。大多数纳入的研究仅评估了膝关节 OA 患者（112 个组中的 96 个）。根据纳入研究中测量的生理因素，形成了 12 类可能的中介因素。肌肉力量和 ROM/灵活性是测量最多的可能中介因素类别，分别有 61 个和 21 个干预组测量了这两个类别的一个或多个生理因素。52 项研究中的 60%（31 项）显示膝关节伸肌力量在干预期间显著增加，31 项研究中的 71%（22 项）显示膝关节屈肌力量显著增加。所有 5 项评估伸展障碍的研究和 12 项测量本体感觉的研究中的 10 项（83%）均发现干预前后有显著变化。
发现大腿力量增加、伸展障碍减少和本体感觉改善可能是体育锻炼与 OA 症状之间正相关的中介因素。
