Primary objective

Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA).

Design

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.

Results

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).

Conclusion

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.

中文翻译：

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陆上运动疗法能改善膝骨关节炎患者的身体活动吗？荟萃分析的系统评价

主要目标

调查陆上运动疗法对膝骨关节炎 (KOA) 患者身体活动的影响。

设计

对调查陆地运动疗法对 KOA 患者身体活动、健康和一般健康状况的随机或半随机试验的系统评价和荟萃分析。我们在 2021 年 4 月更新了 2013 年关于 KOA 运动疗法的 Cochrane 评论搜索，并将 Cochrane 偏倚风险工具 1.0 应用于纳入的文章。计算了标准化平均差 (SMD) 和 95% 置信区间 (CI)。GRADE 用于评估证据的确定性。

结果

确定了 28 项评估阻力训练（ n  = 10）、步行（n  = 6）和混合运动计划（n  = 7）效果的随机对照试验（2,789 名参与者） 。

低到中等质量的证据表明，与短期的非运动干预相比，运动疗法的身体活动略有增加（SMD，95% CI = 0.29，0.09 至 0.50），但不是中等（0.03，-0.11至 0.18）或长期（-0.06，-0.34 至 0.22）。低确定性证据表明，与短期非运动干预相比，步行计划（0.53、0.11 至 0.95）和混合运动计划（0.67、0.37 至 0.97）的身体活动大幅增加。低确定性证据表明，在中期随访中，与仅接受教育相比，阻力训练结合以疼痛应对技能和自我效能为重点的教育会适度和小幅增加身体活动（0.45，0.19 至 0.71）。

结论

步行和混合运动，但不是阻力训练，可能会在短期内改善 KOA 患者的身体活动。将阻力训练与教育相结合可能会增加中期的身体活动，但不会增加长期的身体活动，这凸显了为 KOA 患者制定更有效的长期干预措施的潜在重要性。鼓励未来评估陆上运动疗法的研究包括身体活动结果和长期随访，以增加证据的确定性。