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Rheumatol Int. 2019 Mar 26. doi: 10.1007/s00296-019-04289-6. [Epub ahead of print]

Evidence synthesis of types and intensity of therapeutic land-based exercises to reduce pain in individuals with knee osteoarthritis.

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Health Evidence Based Program, Federal University of Sao Paulo, School of Health Sciences (ESCS), Rua Napoleão de Barros, 865 - Vila Clementino, São Paulo, SP, 04024-002, Brazil.
Cochrane Musculoskeletal Group, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada.
Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
School of Medicine, University of Ottawa, Ottawa, Canada.
School of Human Kinetics, University of Ottawa, Ottawa, Canada.
Federal University of Sao Paulo, São Paulo, Brazil.
Physiotherapy Program, School of Rehabilitation, UNIFESP, São Paulo, Brazil.


The objective of this study is to construct an evidence synthesis to identify the types of land-based exercises most investigated in the current literature, the intervention duration, frequency of the programs and the exercises which are most frequently implemented. A search was performed on the reference list of included and excluded studies of one systematic review, on land-based exercises for knee osteoarthritis and, an updated search of The Cochrane Library, Embase, CINAHL and PEDro was completed. Two authors independently selected the studies and a third author was consulted for an additional opinion. The inclusion criteria were male or female with tibiofemoral knee osteoarthritis, land-based exercises, non-exercise control group and randomized clinical trials. The exclusion criteria were mixed diagnosis or comparison to other types of exercise. The data were extracted by two authors. Fifty-five full-text articles were included. Strengthening, proprioception and aerobic exercises resulted in significant pain reduction. The intervention durations which were significant for pain reduction were either the period of 8-11 weeks or 12-15 weeks. The frequency of three times per week was found significant in comparison to a non-exercise control group. The results, which formed an evidence synthesis, demonstrate that there is substantial evidence regarding the benefits of strengthening exercises to reduce pain in knee osteoarthritis patients. Based on the included studies analysis, exercises should be performed three times weekly for a duration of 8-11 or 12-15 weeks. Health professionals working with knee osteoarthritis patients can use this evidence synthesis as a fast and pragmatic instrument to obtain information about several effective types of exercises for pain reduction.


Evidence-based clinical practice guideline; Knee osteoarthritis; Management; Recommendations; Rehabilitation; Rheumatology; Systematic review; Therapeutic exercise


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