Arthritis Research UK Pain Centre, Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.
Sports Medicine Unit, University of Malaya, Kuala Lumpur, Malaysia.
Sports Med. 2019 May;49(5):743-761. doi: 10.1007/s40279-019-01082-0.
Guidelines recommend exercise as a core treatment for osteoarthritis (OA). However, it is unclear which type of exercise is most effective, leading to inconsistency between different recommendations.
The aim of this systematic review and network meta-analysis was to investigate the relative efficacy of different exercises (aerobic, mind-body, strengthening, flexibility/skill, or mixed) for improving pain, function, performance and quality of life (QoL) for knee and hip OA at, or nearest to, 8 weeks.
We searched nine electronic databases up until December 2017 for randomised controlled trials that compared exercise with usual care or with another exercise type. Bayesian network meta-analysis was used to estimate the relative effect size (ES) and corresponding 95% credibility interval (CrI) (PROSPERO registration: CRD42016033865).
We identified and analysed 103 trials (9134 participants). Aerobic exercise was most beneficial for pain (ES 1.11; 95% CrI 0.69, 1.54) and performance (1.05; 0.63, 1.48). Mind-body exercise, which had pain benefit equivalent to that of aerobic exercise (1.11; 0.63, 1.59), was the best for function (0.81; 0.27, 1.36). Strengthening and flexibility/skill exercises improved multiple outcomes at a moderate level. Mixed exercise was the least effective for all outcomes and had significantly less pain relief than aerobic and mind-body exercises. The trend was significant for pain (p = 0.01), but not for function (p = 0.07), performance (p = 0.06) or QoL (p = 0.65).
The effect of exercise varies according to the type of exercise and target outcome. Aerobic or mind-body exercise may be the best for pain and function improvements. Strengthening and flexibility/skill exercises may be used for multiple outcomes. Mixed exercise is the least effective and the reason for this merits further investigation.
指南建议将运动作为骨关节炎（OA）的核心治疗方法。但是，哪种运动类型最有效尚不清楚，这导致不同建议之间存在不一致。
本系统评价和网络荟萃分析旨在研究不同运动（有氧运动、身心运动、力量训练、柔韧性/技巧训练或混合运动）在改善膝和髋 OA 患者的疼痛、功能、表现和生活质量（QoL）方面的相对疗效，治疗时间为 8 周或接近 8 周。
我们检索了截至 2017 年 12 月的 9 个电子数据库，以查找比较运动与常规护理或与另一种运动类型的随机对照试验。使用贝叶斯网络荟萃分析来估计相对效应量（ES）及其相应的 95%可信区间（CrI）（PROSPERO 注册号：CRD42016033865）。
我们共确定并分析了 103 项试验（9134 名参与者）。有氧运动在疼痛方面最有益（ES 1.11；95%CrI 0.69，1.54），在表现方面也最有益（1.05；0.63，1.48）。身心运动在疼痛方面的获益与有氧运动相当（1.11；0.63，1.59），在功能方面最有益（0.81；0.27，1.36）。力量训练和柔韧性/技巧训练可适度改善多种结局。混合运动对所有结局的效果最差，并且在缓解疼痛方面明显不如有氧运动和身心运动。疼痛方面的这种趋势具有统计学意义（p = 0.01），但在功能（p = 0.07）、表现（p = 0.06）或 QoL（p = 0.65）方面则没有统计学意义。
运动的效果因运动类型和目标结局而异。有氧运动或身心运动可能最有利于改善疼痛和功能。力量训练和柔韧性/技巧训练可用于多种结局。混合运动的效果最差，这一现象的原因值得进一步研究。
