Comparative Efficacy of Various Exercise Modalities and Doses in Reducing Pain and Improving Function in Older Adults With Knee or Hip Osteoarthritis: A Bayesian Network and Dose-Response Meta-analysis.

Abstract

To compare the efficacy of different exercise training modalities and doses on pain and function in older adults with osteoarthritis (OA) of the hip and/or knee. We searched Medline, Embase, Web of Science, the Cochrane Library, Scopus, and SPORTDiscus from inception until December 2024. We included randomized controlled trials of exercise interventions for patients with OA of the hip and knee in people aged ≥60 years. Data extraction was conducted by 2 authors (S.T. and Z.L.) Bayesian network analyses and dose-response meta-analyses were performed using random-effects models to analyze the effect of exercise on hip and knee OA pain. The study included 84 randomized clinical trials with a total of 6373 participants, with 16 pain and 13 function trials at high risk of bias. Aerobic exercise was most beneficial for pain (standardized mean difference [SMD], -1.19; 95% confidence interval [CI], -1.66 to -0.74). Flexibility training was the best for function (SMD, -1.07; 95% CI, -1.68 to -0.47). A "U-shaped" dose-response relationship was observed between the amount of energy expenditure and both pain and function. The optimal doses for improving pain and function in OA are 580 metabolic equivalent of tasks-min/wk and 450 metabolic equivalent of tasks-min/wk. The certainty of the evidence was very low to moderate for all outcomes. The efficacy of exercise varies according to the type of exercise, exercise dosage, and outcome measures. By identifying the most effective exercise types and optimal doses, health care providers can offer personalized treatment plans to improve patient outcomes.