The addition of structured lifestyle modifications to a traditional exercise program for the management of patients with knee osteoarthritis: A systematic review and meta-analysis of randomised trials.

Larissa Sattler, Adrian Kan, Wayne Hing, Christopher Vertullo

Journal: Musculoskeletal science & practice 2023;68():102858

PMID: 37793243

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Plain Language Summary

Knee osteoarthritis, a degenerative joint disease characterised by joint pain and stiffness, can lead to impaired physical function, poor quality of life and disability. Exercise programmes are considered an effective method for increasing muscle strength, reducing pain and disability, improving quality of life and delaying surgical treatment. Evidence from previous research has shown that lifestyle modifications along with traditional exercise programmes may benefit patients with knee osteoarthritis. This systematic review and meta-analysis included sixteen studies investigating the combined effect of traditional exercise programmes with lifestyle modifications on improving pain, physical function, and quality of life in patients with knee osteoarthritis. The findings suggest that combined lifestyle modification and exercise programmes could be an effective intervention strategy for reducing pain intensity and stiffness and improving physical function in patients with knee osteoarthritis. Healthcare professionals can use this research to understand the benefits of interventions that include lifestyle modifications in addition to traditional exercise programs. Further, more rigorous studies are needed to compare the effectiveness of different lifestyle modifications and their combined effects with various conventional exercise programs.

Abstract

BACKGROUND

Guidelines recommend exercise for the management of knee osteoarthritis (OA), however, recently it has been suggested that including additional lifestyle modifications with a traditional exercise program may elicit greater benefits than exercise alone.

OBJECTIVES

To investigate the influence of the addition of lifestyle modifications to a traditional exercise program, with respect to functional outcomes and quality of life among individuals with knee OA.

DESIGN

Systematic review and meta-analysis.

METHODS

Four databases were searched to identify randomised controlled trials comparing an exercise program, which included the addition of lifestyle modifications, to an exercise program alone in individuals with knee OA. Methodological quality of included studies was assessed via the PEDro scale. Results synthesis through meta-analysis using a random effects model was conducted to determine the pooled effect on eligible outcomes and a GRADE approach was utilised to rate the certainty of evidence.

RESULTS

Meta-analysis of seven studies showed the inclusion of lifestyle modifications to an exercise program can further decrease pain intensity (SMD -0.68 [95% CI -1.26 to -0.10]), improve joint stiffness (MD -0.69 [95% CI -1.21, -0.17]) and increase physical function (MD -1.26 s ([95% CI -1.34, -1.17]) at six-months. Individual results showed improvements in quality of life with the addition of lifestyle modifications, however, this was not demonstrated through meta-analysis.

CONCLUSION

This systematic review supports the inclusion of additional lifestyle modifications to a traditional exercise program, for pain intensity, joint stiffness and physical function for individuals with knee OA.

TRIAL REGISTRATION

PROSPERO registration number: CRD42021279594.

Address: Institution: Bond University, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia. Electronic address: [email protected].; Institution: Bond University, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia. Electronic address: [email protected].; Institution: Bond University, Bond Institute of Health and Sport, 2 Promethean Way, Robina, QLD, 4226, Australia. Electronic address: [email protected].; Institution: Knee Research Australia, 8-10 Carrara Street, Benowa, QLD, 4217, Australia. Electronic address: [email protected].

DOI: 10.1016/j.msksp.2023.102858