La Trobe Sport & Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia; Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Australia; Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Australia.
Osteoarthritis Cartilage. 2022 Nov;30(11):1420-1433. doi: 10.1016/j.joca.2022.07.008. Epub 2022 Aug 12.
Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA).
Systematic review and meta-analysis of randomised or quasi-randomised trials investigating land-based exercise-therapy on physical activity, fitness, and general health in people with KOA. We updated a 2013 Cochrane review search on exercise-therapy for KOA in April 2021 and applied the Cochrane Risk-of-Bias Tool 1.0 to included articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. GRADE was used to assess certainty of the evidence.
Twenty-eight randomised controlled trials (2,789 participants) evaluating the effects of resistance-training (n = 10), walking (n = 6) and mixed-exercise programs (n = 7) were identified. Low to moderate certainty evidence indicated small increases in physical activity for exercise-therapy compared to non-exercise interventions in the short-term (SMD, 95% CI = 0.29, 0.09 to 0.50), but not the medium- (0.03, -0.11 to 0.18) or long-term (-0.06, -0.34 to 0.22). Low certainty evidence indicated large increases in physical activity for walking programs (0.53, 0.11 to 0.95) and mixed-exercise programs (0.67, 0.37 to 0.97) compared to non-exercise interventions in the short-term. Low certainty evidence indicated moderate and small increases in physical activity for resistance-training combined with education focused on pain coping skills and self-efficacy compared to education alone at medium-term follow-up (0.45, 0.19 to 0.71).
Walking and mixed-exercise, but not resistance-training, may improve physical activity in people with KOA in the short-term. Combining resistance-training with education may increase physical activity in the medium-, but not the long-term, highlighting the potential importance of developing more effective longer-term interventions for people with KOA. Future studies evaluating land-based exercise-therapy are encouraged to include physical activity outcomes and longer-term follow-up to increase the certainty of evidence.
调查基于陆地的运动疗法对膝骨关节炎（KOA）患者身体活动的影响。
对基于陆地的运动疗法对 KOA 患者身体活动、健身和一般健康的随机或准随机试验进行系统评价和荟萃分析。我们于 2021 年 4 月更新了 2013 年关于 KOA 运动疗法的 Cochrane 综述搜索，并对纳入的文章应用了 Cochrane 偏倚风险工具 1.0。计算标准化均数差（SMD）和 95%置信区间（CI）。使用 GRADE 评估证据的确定性。
确定了 28 项随机对照试验（2789 名参与者），评估了抗阻训练（n=10）、步行（n=6）和混合运动方案（n=7）的效果。低到中等确定性证据表明，与非运动干预相比，运动疗法在短期（SMD，95%CI=0.29，0.09 至 0.50）内可适度增加身体活动，但在中期（0.03，-0.11 至 0.18）或长期（-0.06，-0.34 至 0.22）内则不然。低确定性证据表明，与非运动干预相比，步行方案（0.53，0.11 至 0.95）和混合运动方案（0.67，0.37 至 0.97）在短期可显著增加身体活动。低确定性证据表明，与仅接受教育相比，将注意力集中在疼痛应对技能和自我效能上的抗阻训练与教育相结合，在中期随访时身体活动适度增加（0.45，0.19 至 0.71）。
步行和混合运动，但不是抗阻训练，可能会在短期内提高 KOA 患者的身体活动水平。将抗阻训练与教育相结合可能会增加中期（但不是长期）的身体活动水平，这突出了为 KOA 患者开发更有效的长期干预措施的潜在重要性。鼓励未来评估基于陆地的运动疗法的研究纳入身体活动结果和长期随访，以提高证据的确定性。
