Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis
Impact of Exercise Type and Dose on Pain and Disability in Knee Osteoarthritis
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DOI：
10.1002/art.38290
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发表时间：
2014-03-01
影响因子：
13.3
通讯作者：
Lund, H.
中科院分区：
文献类型：
--
作者：
Juhl, C.;Christensen, R.;Lund, H.
目标。确定最佳运动计划，以运动类型和强度、计划长度、个人监督课程持续时间和每周课程次数为特征，以减轻膝关节骨关节炎（OA）的疼痛和患者报告的残疾。对随机对照试验进行系统评价和荟萃分析。标准化平均差异（SMDs）采用随机效应模型进行组合。研究水平的协变量应用于meta回归分析，以减少研究间的异质性。纳入48项试验。在减轻疼痛方面，有氧运动、阻力运动和性能运动也有类似的效果（SMD分别为0.67、0.62和0.48;P = 0.733）。这些单一类型的锻炼计划比包含不同运动类型的计划更有效（SMD为0.61比0.16;P < 0.001）。有氧运动对疼痛缓解的效果随着监督次数的增加而增加（斜率为0.022[95%可信区间0.002,0.043]）。与下肢运动相比，股四头肌专项运动减轻疼痛的效果更好（SMD为0.85比0.39;P = 0.005），当每周至少进行3次监督运动时（SMD为0.68比0.41;P = 0.017）。没有发现强度、个别疗程持续时间或患者特征的影响。类似的结果也发现了对病人报告的残疾的影响。针对膝关节炎的最佳运动方案应该有一个目标，即专注于提高有氧能力、股四头肌力量或下肢表现。为了获得最佳效果，该计划应在监督下进行，每周进行3次。不管病人的特征如何，包括放射学的严重程度和基线疼痛，这些项目都有相似的效果。
Objective. To identify the optimal exercise program, characterized by type and intensity of exercise, length of program, duration of individual supervised sessions, and number of sessions per week, for reducing pain and patient-reported disability in knee osteoarthritis (OA).Methods. A systematic review and meta-analysis of randomized controlled trials were performed. Standardized mean differences (SMDs) were combined using a random-effects model. Study-level covariates were applied in meta-regression analyses in order to reduce between-study heterogeneity.Results. Forty-eight trials were included. Similar effects in reducing pain were found for aerobic, resistance, and performance exercise (SMD 0.67, 0.62, and 0.48, respectively; P = 0.733). These single-type exercise programs were more efficacious than programs that included different exercise types (SMD 0.61 versus 0.16; P < 0.001). The effect of aerobic exercise on pain relief increased with an increased number of supervised sessions (slope 0.022 [95% confidence interval 0.002, 0.043]). More pain reduction occurred with quadriceps-specific exercise than with lower limb exercise (SMD 0.85 versus 0.39; P = 0.005) and when supervised exercise was performed at least 3 times a week (SMD 0.68 versus 0.41; P = 0.017). No impact of intensity, duration of individual sessions, or patient characteristics was found. Similar results were found for the effect on patient-reported disability.Conclusion. Optimal exercise programs for knee OA should have one aim and focus on improving aerobic capacity, quadriceps muscle strength, or lower extremity performance. For best results, the program should be supervised and carried out 3 times a week. Such programs have a similar effect regardless of patient characteristics, including radiographic severity and baseline pain.