Highlights
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Summary
High-Dose Versus Low-Dose Exercise Therapy for Knee Osteoarthritis
Background:
The benefits of exercise in patients with knee osteoarthritis are well documented, but the optimal dose of exercise remains unknown.
Aim:
To compare high-dose versus low-dose exercise treatment with respect to knee function, pain, and quality of life (QoL) in patients with long-term symptomatic knee osteoarthritis.
Design:
A Swedish and Norwegian multicenter randomized controlled superiority trial with multiple follow-ups up to 12 months post-intervention. (ClinicalTrials.gov: NCT02024126)
Setting:
Primary health care facilities.
Patients:
189 patients with diagnosed knee osteoarthritis and a history of knee pain and decreased function were assigned to high-dose therapy (n = 98; 11 exercises; 70 to 90 minutes) or low-dose therapy (n = 91; 5 exercises; 20 to 30 minutes).
Intervention:
Exercise programs tailored to the patient in accordance with the principles of medical exercise therapy. Global (aerobic), semi-global (multisegmental), and local (joint-specific) exercises were performed 3 times a week for 12 weeks under the supervision of a physical therapist.
Measurements:
The Knee Injury and Osteoarthritis Outcome Score (KOOS) was measured every two weeks during the 3-month intervention period and at 6 and 12 months post-intervention.
The primary endpoint was the mean difference in KOOS scores between groups at the end of the intervention (3 months). Secondary outcomes included pain intensity and QoL. The proportion of patients with minimal clinically important changes in primary and secondary outcomes was compared between groups.
Results:
Both groups improved over time, but there was no benefit from high-dose therapy in most comparisons. One exception was the Knee Injury and Osteoarthritis Outcome Score (KOOS) for sports and recreation function, where high-dose therapy was superior at the end of treatment and at 6 months follow-up. A small benefit in QoL was also seen at 6 and 12 months.
Limitation:
There was no control group that did not exercise.
Conclusion:
The results do not support the superiority of high-dose exercise over low-dose exercise for most outcomes. However, small benefits were found with high doses of exercise for knee function in sports and recreation and for QoL.
Final message
This was a multicenter randomized controlled trial evaluating high versus low dose exercise therapy for the treatment of knee osteoarthritis. There were 189 patients assigned to the high-dose (70-90 minutes) or low-dose (20-30 minutes) exercise option. Patients participated in 3 sessions per week for 12 weeks under the supervision of a physical therapist. The results showed that both study groups improved over time.
The authors concluded that the data did not support the superiority of high-dose exercise over low-dose exercise for the treatment of knee arthritis. However, a small benefit of high-dose exercise was seen for knee function in sports and recreation and for quality of life.
This study reaffirmed that exercise at high or low doses is useful for the treatment of pain and dysfunction related to knee arthritis. In selected patients, exercise at high doses may be more beneficial, particularly for sports and recreation. I believe the current findings do not alter accepted standards of practice. We must continue to adhere to traditional exercise guidelines for general health endorsed by national organizations such as the CDC and AMSSM.
