Whitfield Max, Tomlinson Owen W
University of Exeter Medical School, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
Front Aging. 2025 Feb 4;6:1458983. doi: 10.3389/fragi.2025.1458983. eCollection 2025.
Osteoarthritis (OA) is a progressive osteoarticular disease affecting the whole joint. In the United Kingdom, OA is the most prevalent joint disease, with knee osteoarthritis (KOA) being the most common type of OA. Key symptoms of KOA include knee pain, stiffness, and loss of physical function. Different types of exercise can be performed in people with KOA, which exert different magnitudes of impact forces on the knee joint, whereby the National Institute for Health and Care Excellence (NICE) OA guidelines in fact recommend exercise as the core form of therapeutic OA management. However, the optimal type or dose - the cumulative intensity, duration, and frequency - of therapeutic exercise that most effectively provides KOA management is not currently known. This review aims to summarise and compare the literature, discussing optimal exercise modalities and doses for the management of KOA. All exercise modalities proved similarly beneficial at managing KOA with comparable improvements to knee pain, stiffness, and physical function, therefore with no optimal exercise modality identified. Benefits to KOA management was observed in everyone, including the elderly, obese, and those with severe KOA. Although, in those with severe KOA, walking was observed to only prevent further deterioration, rather than induce any symptomatic improvement. Furthermore, there was minimal difference between exercise modalities in relation to the improvements not only in KOA symptoms, but also modifiable KOA risk factors, adherence, adverse events, and QoL. Assessment of the dose-response relationship of each exercise modality showed that any dose of regular exercise was effective. Although, moderate intensity exercise performed three times weekly for 20-to-60-min appears optimal for KOA symptom control following most exercise modalities. Therefore, those with KOA should be encouraged to continue whatever exercise they currently do as should effectively manage symptoms, regardless of the modality or dose. However, those who do no exercise should use the present review in collaboration with clinicians via shared decision making to create a holistic exercise prescription. In summary, this review contributes to the literature through comprehensive discussion of different exercise modalities and doses in managing not only KOA symptoms, but modifiable KOA risk factors, exercise adherence, adverse events, and QoL. Additionally, summarised findings are discussed to give practical exercise recommendations to promote effective KOA management and recommendations for ongoing research.
骨关节炎（OA）是一种影响整个关节的进行性骨关节疾病。在英国，OA是最常见的关节疾病，其中膝骨关节炎（KOA）是OA最常见的类型。KOA的主要症状包括膝关节疼痛、僵硬和身体功能丧失。KOA患者可以进行不同类型的运动，这些运动对膝关节施加的冲击力大小不同，因此英国国家卫生与临床优化研究所（NICE）的OA指南实际上推荐运动作为OA治疗管理的核心形式。然而，目前尚不清楚哪种最佳类型或剂量——累积强度、持续时间和频率——的治疗性运动能最有效地管理KOA。本综述旨在总结和比较相关文献，讨论管理KOA的最佳运动方式和剂量。所有运动方式在管理KOA方面都显示出类似的益处，对膝关节疼痛、僵硬和身体功能有类似的改善，因此未确定最佳运动方式。在包括老年人、肥胖者和重度KOA患者在内的所有人中都观察到了对KOA管理的益处。不过，在重度KOA患者中，观察到步行仅能防止病情进一步恶化，而不能改善任何症状。此外，运动方式之间不仅在KOA症状改善方面，而且在可改变的KOA危险因素、依从性、不良事件和生活质量方面的差异都很小。对每种运动方式的剂量反应关系评估表明，任何剂量的规律运动都是有效的。尽管如此，对于大多数运动方式而言，每周进行三次、每次20至60分钟的中等强度运动似乎对KOA症状控制最为理想。因此，应鼓励KOA患者继续他们目前所做的任何运动，因为无论运动方式或剂量如何，都应能有效控制症状。然而，那些不运动的人应通过共同决策，与临床医生合作利用本综述制定全面的运动处方。总之，本综述通过全面讨论不同的运动方式和剂量，不仅有助于管理KOA症状，还有助于管理可改变的KOA危险因素、运动依从性、不良事件和生活质量，从而为相关文献做出了贡献。此外，还讨论了总结的研究结果，以给出实际的运动建议，促进有效的KOA管理，并为正在进行的研究提供建议。
