Review: Strength training, with or without flexibility and aerobic training, reduces pain in lower limb osteoarthritis

摘要

Commentary One in 4 persons may develop symptomatic hip OA, and knee OA occurs in almost 1 in 2 persons. Pain and disability are frequent and substantial, and impact on quality of life, lost working days, and health care costs is immense. Surgery is invasive, complicated, and a last resort, and drugs often have low efficacy, toxicity, or both. Therefore, proven nonpharmacologic interventions are of utmost value.Exercises for lower limh OA have been found to be useful and recommended before (1) but not with the robustness and scope of the review by Uthman and colleagues, who used state-of-the-art methodology in meta-analysis. For the first time in this setting, network meta-analysis was used, which allowed indirect comparisons of multiple interventions that have not been studied head-to-head. Although such analyses are susceptible to the effects of heterogeneity and inconsistency (2), meta-regression did not reveal substantial differences. 3 pairs of reviewers evaluated each trial, risk for bias was assessed, and trial sequential analysis confirmed the reliability and conclusive ness of findings. Most exercise programs reduced pain,with no additional advantage of aquatic performance. As safe, noninvasive, and inexpensive interventions, these should be implemented. Concurrent positive effects on function may accrue, especially with combined land-based programs, although function was less affected by exercise than pain.