Guidance for implementing best practice therapeutic exercise for people with knee and hip osteoarthritis: what does the current evidence base tell us?

Melanie A Holden, Kate Button, Natalie J Collins, Yves Henrotin, Rana S Hinman, Jesper B Larsen, Ben Metcalf, Hiral Master, Søren T Skou, Louise M Thoma, Elizabeth Wellsandt, Daniel K White, Kim Bennell

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Abstract

Therapeutic exercise is a recommended first-line treatment for patients with knee and hip osteoarthritis (OA); however, there is little specific advice or practical resources to guide clinicians in its implementation. As the first in a series of projects by the Osteoarthritis Research Society International Rehabilitation Discussion Group to address this gap, we aim in this narrative review to synthesize current literature informing the implementation of therapeutic exercise for patients with knee and hip OA, focusing on evidence from systematic reviews and randomized controlled trials. Therapeutic exercise is safe for patients with knee and hip OA. Numerous types of therapeutic exercise (including aerobic, strengthening, neuromuscular, mind-body exercise) may be utilized at varying doses and in different settings to improve pain and function. Benefits from therapeutic exercise appear greater when dosage recommendations from general exercise guidelines for healthy adults are met. However, interim therapeutic exercise goals may also be useful, given that many barriers to achieving these dosages exist among this patient group. Theoretically-informed strategies to improve adherence to therapeutic exercise, such as patient education, goal-setting, monitoring, and feedback, may help maintain participation and optimize clinical benefits over the longer term. Sedentary behavior is also a risk factor for disability and lower quality of life in patients with knee and hip OA, although limited evidence exists regarding how best to reduce this behavior. Current evidence can be used to inform how to implement best practice therapeutic exercise at a sufficient and appropriate dose for patients with knee and hip OA.

Original languageEnglish
JournalArthritis Care & Research
Volume73
Issue number12
Pages (from-to)1746-1753
ISSN2151-464X
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Dr. Hinman’s work was supported by the National Health and Medical Research Council (Senior Research Fellowship grant 1154217). Dr. Skou’s work was supported by Region Zealand (Exercise First grant) and the European Research Council under the European Union’s Horizon 2020 Research and Innovation Program (grant 801790). Dr. Wellsandt’s work was supported by the Rheumatology Research Foundation (Investigator award) and the NIH (grant R21-AR-075254). Dr. Bennell’s work was supported by the National Health and Medical Research Council (Investigator grant 1174431).
Dr. Henrotin has received honoraria from Expanscience Tilman (less than $10,000) and owns stock or stock options in Expanscience Tilman. Dr. Skou has received consulting fees, speaking fees, and/or honoraria from Munksgaard (less than $10,000) and research grants from the Lundbeck Foundation. Dr. Bennell has received consulting fees from UpToDate (less than $10,000). No other disclosures relevant to this article were reported.

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