What is knee osteoarthritis?
Knee osteoarthritis involves progressive, irreversible knee joint dysfunction caused by the breakdown of cartilage in the knee joint. The prevalence of knee osteoarthritis is increases with age. The aging of the American population portends increasing prevalence of knee osteoarthritis in the coming decades. Persons with knee osteoarthritis have reduced physical function, decreased mobility, decreased leg strength, and decreased balance. Fear of falling due to balance problems accelerates other aspects of impaired physical function. Guidelines from medical authorities recommend physical activity as the best way to manage symptoms of knee osteoarthritis.
Home-based exercise
Supervised exercise therapy helps manage pain, improve physical function, and improve quality of life for patients with knee osteoporosis. However, supervised therapy might not be readily available for many people given the difficulty of making appointments, traveling to doctors’ offices, and lack of insurance coverage. Researchers in China conducted a systematic review and meta-analysis of 12 randomized controlled trials of home-based exercise interventions to determine their efficacy. All but one of the studies had good methodological quality. In fact, home-based exercise interventions significantly reduced pain and improved physical function with small effect sizes compared to health education or no treatment. Home-based exercise interventions improved quality of life with moderate effect sizes significantly more than did health education. More importantly, home-based exercise interventions led to similar improvements compared to clinic-based and drug treatments at lower cost.
Aerobic exercise for knee osteoarthritis
Little doubt exists that various types of physical activity can help reduce the pain and limited mobility that arises from knee osteoarthritis. Yet, previous meta-analyses of randomized clinical trials suffered from a key deficiency: lack of evaluation of the effectiveness of physical activity interventions over time. A new meta-analysis of 217 studies from an international team of researchers rectified this problem. Outcomes (pain, function, gait performance, quality of life) were analyzed at 4, 12, and 24 weeks after the start of the respective interventions. Overall, aerobic exercise produced the best long-term results with the highest certainty of evidence. Depending on the specific outcome, mixed exercise and flexibility exercise also appeared to be helpful. The meta-analysis authors emphasized the need for consistent, long-term, structured physical activity with help of a qualified health professional to reduce the adverse effects of knee osteoarthritis.
Multi-component balance training
Researchers in China conducted a systematic review and meta-analysis of 22 studies to determine how balance training might be optimized to improve two measures of balance, the Berg balance scale and time-up-and-go. Multi-component training produced clinically relevant improvement in both measures. Specifically, training lasting at least 8 weeks, at least 3 times per week, with sessions lasting at least 60 minutes each produced the greatest improvement in balance for persons with knee osteoporosis. In addition, patients younger than 60 years of age had better results than patients older than 60. The study authors urged clinicians to recommend multi-component training as first-line therapy for their patients with knee osteoarthritis.
Mind-body exercise
Mind-body exercise (MBE) therapy appears effective for treating knee osteoarthritis. However, the relative efficacy of different types of MBE remained unclear. Researchers in China conducted a systematic review and network meta-analysis of 38 randomized controlled trials that used different types of MBEs to reduce pain intensity and improve physical function and quality of life. All participants in the included studies had diagnosed knee osteoarthritis. With respect to reduced pain intensity and physical function, pilates, tai chi, and qigong all significantly outperformed usual care or no treatment with large effect sizes and with moderate certainty of evidence. In addition, both pilates and tai chi significantly outperformed conventional therapeutic exercise with moderate certainty of evidence with respect to pain reduction. Only tai chi showed significant improvement in quality of life compared to usual care or no treatment with moderate effect size and moderate certainty of evidence. Pilates and tai chi were the most effective MBEs for pain reduction and improved physical function, while tai chi provided the greatest improvement in quality of life for patients with knee osteoarthritis
Tai chi online
Studies show that tai chi classes reduce knee pain and stiffness and improves function, mobility, and mental health comparably with other forms of physical activity. Researchers in Australia developed a novel approach that greatly expands the availability of tai chi to seniors – with or without health insurance. The My Joint Tai Chi multimodal on-line intervention (what a mouthful!) includes a 12-week on-line program with one pre-recorded 45-minute tai chi video each week led by an experienced teacher. Participants watch the introductory video three times during the first week following the movements of the teacher. Subsequent weekly videos feature progressively more skillful movements.
The same group of researchers designed the RETREAT randomized clinical trial (the gold standard for scientific studies) to test whether the combination of the on-line intervention plus on-line educational materials produced better knee osteoarthritis results, such as less pain and more mobility, compared to only on-line educational materials. Participants in the study included 178 Australians (average age 62 years) who were recruited on-line and through advertisements. All participants had diagnosed knee osteoarthritis. Half of the participants were randomized to the intervention and educational materials group and half were randomized to the control group that had access to the educational materials but did not to the videos. Intervention group participants were instructed to watch each video and perform the exercises three times each week for 12 weeks without receiving any guidance from the researchers.
Did the intervention deliver the goods? Yes, it did. Compared to the control group, the intervention group participants had significantly less knee pain and greater functionality after 12 weeks. Compared to the control group, more participants in the intervention group achieved the minimal clinically importance difference in knee pain (73 vs. 47 percent) and functionality (72 vs. 52 percent). Finally, the intervention group had better results in 11 of 12 secondary outcomes, such as sport and recreation function, quality of life, and balance confidence. Here’s the best news: The program is available free of charge at https://myjoint-taichi.org. You can also download a free mobile app that helps you stick with the program. While I have not used this program, it comes from a reputable source. If you’ve been diagnosed with knee osteoarthritis, I suggest that you check out this program.
What to do
While osteoarthritis is irreversible, different treatments are available short of knee joint replacement surgery, which has its own risks. If you have knee osteoarthritis, how about trying one of the exercise therapies discussed above?
