Shun Han, Ting Li, Ying Cao, Zewei Li, Yiying Mai, Tianxiang Fan, Muhui Zeng, Xin Wen, Weiyu Han, Lijun Lin, Lixin Zhu, Siu Ngor Fu, Kim L Bennell, David J Hunter, Changhai Ding, Lujin Li, Zhaohua Zhu
{"title":"Quantitative analysis of effectiveness and associated factors of exercise on symptoms in osteoarthritis: a pharmacodynamic model-based meta-analysis.","authors":"Shun Han, Ting Li, Ying Cao, Zewei Li, Yiying Mai, Tianxiang Fan, Muhui Zeng, Xin Wen, Weiyu Han, Lijun Lin, Lixin Zhu, Siu Ngor Fu, Kim L Bennell, David J Hunter, Changhai Ding, Lujin Li, Zhaohua Zhu","doi":"10.1136/bjsports-2023-107625","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors that significantly affect the effectiveness of exercise.</p><p><strong>Design: </strong>Pharmacodynamic model-based meta-analysis (MBMA).</p><p><strong>Data sources: </strong>Embase, PubMed, Cochrane Library, Web of Science and Scopus were searched for randomised controlled trials (RCTs) examining the effect of exercise for OA from inception to 20 November 2023.</p><p><strong>Eligibility criteria: </strong>RCTs of exercise interventions in patients with knee, hip or hand OA, using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales or Visual Analogue Scale (VAS) pain scores as outcome measures, were included. The minimum clinically important difference (MCID) for WOMAC total, pain, stiffness, function and VAS pain was 9.0, 1.6, 0.8, 5.4 and 0.9, respectively.</p><p><strong>Results: </strong>A total of 186 studies comprising 12 735 participants with symptomatic or radiographic knee, hip or hand OA were included. The effectiveness of exercise treatments peaked at 1.6-7.2 weeks after initiation of exercise interventions. Exercise was more effective than the control, but the differences in the effects of exercise compared with control on all outcomes were only marginally different with the MCID (7.5, 1.7, 1.0, 5.4 and 1.2 units for WOMAC total, pain, stiffness, function and VAS pain, respectively). During a 12-month treatment period, local exercise (strengthening muscles and improving mobilisations of certain joints) had the best effectiveness (WOMAC pain decreasing by 42.5% at 12 weeks compared with baseline), followed by whole-body plus local exercise. Adding local water-based exercise (eg, muscle strengthening in warm water) to muscle strengthening exercise and flexibility training resulted in 7.9, 0.5, 0.7 and 8.2 greater improvements in the WOMAC total score, pain, stiffness and function, respectively. The MBMA models revealed that treatment responses were better in participants with more severe baseline symptom scores for all scales, younger participants for the WOMAC total and pain scales, and participants with obesity for the WOMAC function. Subgroup analyses revealed participants with certain characteristics, such as female sex, younger age, knee OA or more severe baseline symptoms on the WOMAC pain scale, benefited more from exercise treatment.</p><p><strong>Conclusion: </strong>Exercise reaches peak effectiveness within 8 weeks and local exercise has the best effectiveness, especially if local water-based exercise is involved. Patients of female sex, younger age, obesity, knee OA or more severe baseline symptoms appear to benefit more from exercise treatment than their counterparts.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":11.6000,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Sports Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bjsports-2023-107625","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SPORT SCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: This study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors that significantly affect the effectiveness of exercise.
Data sources: Embase, PubMed, Cochrane Library, Web of Science and Scopus were searched for randomised controlled trials (RCTs) examining the effect of exercise for OA from inception to 20 November 2023.
Eligibility criteria: RCTs of exercise interventions in patients with knee, hip or hand OA, using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales or Visual Analogue Scale (VAS) pain scores as outcome measures, were included. The minimum clinically important difference (MCID) for WOMAC total, pain, stiffness, function and VAS pain was 9.0, 1.6, 0.8, 5.4 and 0.9, respectively.
Results: A total of 186 studies comprising 12 735 participants with symptomatic or radiographic knee, hip or hand OA were included. The effectiveness of exercise treatments peaked at 1.6-7.2 weeks after initiation of exercise interventions. Exercise was more effective than the control, but the differences in the effects of exercise compared with control on all outcomes were only marginally different with the MCID (7.5, 1.7, 1.0, 5.4 and 1.2 units for WOMAC total, pain, stiffness, function and VAS pain, respectively). During a 12-month treatment period, local exercise (strengthening muscles and improving mobilisations of certain joints) had the best effectiveness (WOMAC pain decreasing by 42.5% at 12 weeks compared with baseline), followed by whole-body plus local exercise. Adding local water-based exercise (eg, muscle strengthening in warm water) to muscle strengthening exercise and flexibility training resulted in 7.9, 0.5, 0.7 and 8.2 greater improvements in the WOMAC total score, pain, stiffness and function, respectively. The MBMA models revealed that treatment responses were better in participants with more severe baseline symptom scores for all scales, younger participants for the WOMAC total and pain scales, and participants with obesity for the WOMAC function. Subgroup analyses revealed participants with certain characteristics, such as female sex, younger age, knee OA or more severe baseline symptoms on the WOMAC pain scale, benefited more from exercise treatment.
Conclusion: Exercise reaches peak effectiveness within 8 weeks and local exercise has the best effectiveness, especially if local water-based exercise is involved. Patients of female sex, younger age, obesity, knee OA or more severe baseline symptoms appear to benefit more from exercise treatment than their counterparts.
目的:本研究旨在评估锻炼的时间点和峰值效果以及各种锻炼方式对骨关节炎(OA)症状的影响:本研究旨在评估运动疗效峰值的时间点和幅度,以及各种运动方式对骨关节炎(OA)症状的影响,并确定对运动疗效有显著影响的因素:设计:基于药效学模型的荟萃分析(MBMA):数据来源:Embase、PubMed、Cochrane Library、Web of Science和Scopus检索了从开始到2023年11月20日期间研究运动治疗OA效果的随机对照试验(RCT):采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)分量表或视觉模拟量表(VAS)疼痛评分作为结果测量指标,纳入对膝关节、髋关节或手部 OA 患者进行运动干预的 RCT。WOMAC总分、疼痛、僵硬、功能和VAS疼痛的最小临床重要差异(MCID)分别为9.0、1.6、0.8、5.4和0.9:结果:共纳入了186项研究,包括12 735名膝关节、髋关节或手部有症状或有影像学表现的OA患者。运动治疗的有效性在运动干预开始后1.6-7.2周达到峰值。运动比对照组更有效,但与对照组相比,运动对所有结果的影响在 MCID(WOMAC 总分、疼痛、僵硬、功能和 VAS 疼痛分别为 7.5、1.7、1.0、5.4 和 1.2 个单位)上仅有微小差异。在为期12个月的治疗期间,局部锻炼(增强肌肉力量和改善某些关节的活动度)的效果最好(与基线相比,12周时WOMAC疼痛指数下降了42.5%),其次是全身加局部锻炼。在肌肉强化训练和柔韧性训练的基础上增加局部水上运动(如在温水中进行肌肉强化训练),WOMAC总分、疼痛、僵硬和功能的改善幅度分别为7.9、0.5、0.7和8.2。MBMA模型显示,在所有量表中,基线症状评分更严重的参与者的治疗反应更好;在WOMAC总分和疼痛量表中,更年轻的参与者的治疗反应更好;在WOMAC功能量表中,肥胖的参与者的治疗反应更好。亚组分析显示,具有某些特征的参与者,如女性、年轻、膝关节OA或WOMAC疼痛量表基线症状更严重者,从运动治疗中获益更多:结论:运动治疗在8周内达到最佳效果,局部运动效果最好,尤其是局部水上运动。女性、年轻、肥胖、膝关节 OA 或基线症状更严重的患者似乎从运动治疗中获益更多。
期刊介绍:
The British Journal of Sports Medicine (BJSM) is a dynamic platform that presents groundbreaking research, thought-provoking reviews, and meaningful discussions on sport and exercise medicine. Our focus encompasses various clinically-relevant aspects such as physiotherapy, physical therapy, and rehabilitation. With an aim to foster innovation, education, and knowledge translation, we strive to bridge the gap between research and practical implementation in the field. Our multi-media approach, including web, print, video, and audio resources, along with our active presence on social media, connects a global community of healthcare professionals dedicated to treating active individuals.