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Ann Rheum Dis. Apr 2005; 64(4): 544–548.
PMCID: PMC1755453

Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review


Objective: To compare the efficacy of aerobic walking and home based quadriceps strengthening exercises in patients with knee osteoarthritis.

Methods: The Medline, Pubmed, EMBASE, CINAHL, and PEDro databases and the Cochrane controlled trials register were searched for randomised controlled trials (RCTs) of subjects with knee osteoarthritis comparing aerobic walking or home based quadriceps strengthening exercise with a non-exercise control group. Methodological quality of retrieved RCTs was assessed. Outcome data were abstracted for pain and self reported disability and the effect size calculated for each outcome. RCTs were grouped according to exercise mode and the data pooled using both fixed and random effects models.

Results: 35 RCTs were identified, 13 of which met inclusion criteria and provided data suitable for further analysis. Pooled effect sizes for pain were 0.52 for aerobic walking and 0.39 for quadriceps strengthening. For self reported disability, pooled effect sizes were 0.46 for aerobic walking and 0.32 for quadriceps strengthening.

Conclusions: Both aerobic walking and home based quadriceps strengthening exercise reduce pain and disability from knee osteoarthritis but no difference between them was found on indirect comparison.

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Selected References

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  • Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JWJ, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003 Dec;62(12):1145–1155. [PMC free article] [PubMed]
  • Fransen Marlene, McConnell Sara, Bell Mary. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J Rheumatol. 2002 Aug;29(8):1737–1745. [PubMed]
  • van Baar ME, Assendelft WJ, Dekker J, Oostendorp RA, Bijlsma JW. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 1999 Jul;42(7):1361–1369. [PubMed]
  • Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996 Feb;17(1):1–12. [PubMed]
  • Zhang WY, Li Wan Po A. Analgesic efficacy of paracetamol and its combination with codeine and caffeine in surgical pain--a meta-analysis. J Clin Pharm Ther. 1996 Aug;21(4):261–282. [PubMed]
  • Whitehead A, Whitehead J. A general parametric approach to the meta-analysis of randomized clinical trials. Stat Med. 1991 Nov;10(11):1665–1677. [PubMed]
  • Chamberlain MA, Care G, Harfield B. Physiotherapy in osteoarthrosis of the knees. A controlled trial of hospital versus home exercises. Int Rehabil Med. 1982;4(2):101–106. [PubMed]
  • Wyatt FB, Milam S, Manske RC, Deere R. The effects of aquatic and traditional exercise programs on persons with knee osteoarthritis. J Strength Cond Res. 2001 Aug;15(3):337–340. [PubMed]
  • Cheing Gladys L Y, Hui-Chan Christina W Y, Chan KM. Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain? Clin Rehabil. 2002 Nov;16(7):749–760. [PubMed]
  • Gür Hakan, Cakin Nilgün, Akova Bedrettin, Okay Ertan, Kükoğlu Selçuk. Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee. Arch Phys Med Rehabil. 2002 Mar;83(3):308–316. [PubMed]
  • Kuptniratsaikul Vilai, Tosayanonda Orchatara, Nilganuwong Surasak, Thamalikitkul Visanu. The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. J Med Assoc Thai. 2002 Jan;85(1):33–40. [PubMed]
  • Maurer BT, Stern AG, Kinossian B, Cook KD, Schumacher HR., Jr Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Arch Phys Med Rehabil. 1999 Oct;80(10):1293–1299. [PubMed]
  • Schilke JM, Johnson GO, Housh TJ, O'Dell JR. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res. 1996 Mar-Apr;45(2):68–72. [PubMed]
  • Messier SP, Royer TD, Craven TE, O'Toole ML, Burns R, Ettinger WH., Jr Long-term exercise and its effect on balance in older, osteoarthritic adults: results from the Fitness, Arthritis, and Seniors Trial (FAST). J Am Geriatr Soc. 2000 Feb;48(2):131–138. [PubMed]
  • Penninx BW, Messier SP, Rejeski WJ, Williamson JD, DiBari M, Cavazzini C, Applegate WB, Pahor M. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med. 2001 Oct 22;161(19):2309–2316. [PubMed]
  • Penninx Brenda W J H, Rejeski W Jack, Pandya Jasma, Miller Michael E, Di Bari Mauro, Applegate William B, Pahor Marco. Exercise and depressive symptoms: a comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology. J Gerontol B Psychol Sci Soc Sci. 2002 Mar;57(2):P124–P132. [PubMed]
  • Peterson MG, Kovar-Toledano PA, Otis JC, Allegrante JP, Mackenzie CR, Gutin B, Kroll MA. Effect of a walking program on gait characteristics in patients with osteoarthritis. Arthritis Care Res. 1993 Mar;6(1):11–16. [PubMed]
  • Rejeski WJ, Ettinger WH, Jr, Martin K, Morgan T. Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. Arthritis Care Res. 1998 Apr;11(2):94–101. [PubMed]
  • Rejeski WJ, Brawley LR, Ettinger W, Morgan T, Thompson C. Compliance to exercise therapy in older participants with knee osteoarthritis: implications for treating disability. Med Sci Sports Exerc. 1997 Aug;29(8):977–985. [PubMed]
  • Deyle GD, Henderson NE, Matekel RL, Ryder MG, Garber MB, Allison SC. Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 2000 Feb 1;132(3):173–181. [PubMed]
  • Minor MA, Hewett JE, Webel RR, Anderson SK, Kay DR. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov;32(11):1396–1405. [PubMed]
  • Halbert J, Crotty M, Weller D, Ahern M, Silagy C. Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms. Arthritis Rheum. 2001 Jun;45(3):228–234. [PubMed]
  • Røgind H, Bibow-Nielsen B, Jensen B, Møller HC, Frimodt-Møller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil. 1998 Nov;79(11):1421–1427. [PubMed]
  • Sullivan T, Allegrante JP, Peterson MG, Kovar PA, MacKenzie CR. One-year followup of patients with osteoarthritis of the knee who participated in a program of supervised fitness walking and supportive patient education. Arthritis Care Res. 1998 Aug;11(4):228–233. [PubMed]
  • van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Bijlsma JW. Effectiveness of exercise in patients with osteoarthritis of hip or knee: nine months' follow up. Ann Rheum Dis. 2001 Dec;60(12):1123–1130. [PMC free article] [PubMed]
  • Bautch JC, Malone DG, Vailas AC. Effects of exercise on knee joints with osteoarthritis: a pilot study of biologic markers. Arthritis Care Res. 1997 Feb;10(1):48–55. [PubMed]
  • Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med. 1992 Apr 1;116(7):529–534. [PubMed]
  • Talbot Laura A, Gaines Jean M, Huynh Tu N, Metter E Jeffrey. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc. 2003 Mar;51(3):387–392. [PubMed]
  • Ettinger WH, Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). JAMA. 1997 Jan 1;277(1):25–31. [PubMed]
  • Baker KR, Nelson ME, Felson DT, Layne JE, Sarno R, Roubenoff R. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. J Rheumatol. 2001 Jul;28(7):1655–1665. [PubMed]
  • Fransen M, Crosbie J, Edmonds J. Physical therapy is effective for patients with osteoarthritis of the knee: a randomized controlled clinical trial. J Rheumatol. 2001 Jan;28(1):156–164. [PubMed]
  • Hopman-Rock M, Westhoff MH. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. J Rheumatol. 2000 Aug;27(8):1947–1954. [PubMed]
  • O'Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomised controlled trial. Ann Rheum Dis. 1999 Jan;58(1):15–19. [PMC free article] [PubMed]
  • Petrella RJ, Bartha C. Home based exercise therapy for older patients with knee osteoarthritis: a randomized clinical trial. J Rheumatol. 2000 Sep;27(9):2215–2221. [PubMed]
  • Quilty Brian, Tucker Marian, Campbell Rona, Dieppe Paul. Physiotherapy, including quadriceps exercises and patellar taping, for knee osteoarthritis with predominant patello-femoral joint involvement: randomized controlled trial. J Rheumatol. 2003 Jun;30(6):1311–1317. [PubMed]
  • Thomas KS, Muir KR, Doherty M, Jones AC, O'Reilly SC, Bassey EJ. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial. BMJ. 2002 Oct 5;325(7367):752–752. [PMC free article] [PubMed]
  • Topp Robert, Woolley Sandra, Hornyak Joseph, 3rd, Khuder Sadik, Kahaleh Bashar. The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee. Arch Phys Med Rehabil. 2002 Sep;83(9):1187–1195. [PubMed]
  • van Baar ME, Dekker J, Oostendorp RA, Bijl D, Voorn TB, Lemmens JA, Bijlsma JW. The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial. J Rheumatol. 1998 Dec;25(12):2432–2439. [PubMed]

Figures and Tables

Figure 1
 Flow of randomised controlled trials included in the systematic review.
Figure 2
 Effect of exercise on pain.
Figure 3
 Effect of exercise on self reported disability.

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


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