ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2414

High-Intensity Versus Low-Intensity Physical Activity or Exercises in Patients with Hip or Knee Osteoarthritis: A Meta-Analysis

Jean-Philippe Regnaux1,2,3, Marie-Martine Lefèvre-Colau4, Ludovic Trinquart3, Christelle Nguyen5, Isabelle Boutron1,3,6,7, Lucie Brosseau8 and Philippe Ravaud3,6,7,9, 1METHODS team, INSERM UMR-S 1153, Paris, France, 2EHESP Rennes, Sorbonne Paris Cité, Paris, France, 3French Cochrane Center, Paris, France, 4Univ. Paris Descartes, PRES Sorbonne Paris Cité, Service de rééducation et réadaptation de l’appareil locomoteur et des pathologies du rachis, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France, Paris, France, 5Univ. Paris Descartes, PRES Sorbonne Paris, Cité Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France, Paris, France, 6Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France, 7Centre d’Épidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France, 8Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada, 9METHODS team, INSERM U1153, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , , ,

Session Information

Date: Tuesday, November 10, 2015

Title: Osteoarthritis - Clinical Aspects Poster II: Biomarkers, Biomechanics and Health Services Research

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Exercise or physical activity are complex interventions whose effectiveness depends on more than one component. We aimed to determine the benefits and harms of high- vs low-intensity exercise or physical activity programs in patients with hip or knee OA.

Methods: We searched CENTRAL, MEDLINE and EMBASE to June 2014, CINAHL, PEDro, Scopus and WHO International Clinical Registry to October 2012. We included RCTs of patients with knee or hip OA that compared high- vslow-intensity physical activity or exercise programs. High-intensity programs training referred to an increase in the overall amount of training time or in the amount of work or in effort/energy expenditure. Two authors independently assessed study eligibility and extracted data. The quality of the body of evidence was assessed using the GRADE approach

Results: 6 studies (N=656) were included: 5 studies recruited patients with knee OA (N=620) and 1 with hip or knee OA (N=36). In patients with knee OA, pain symptoms and physical function were more improved with high- than low-intensity exercise programs, immediately at the end of the exercise programs (from 8 to 24 weeks). Low-quality evidence indicated reduced pain on a 20-point WOMAC pain scale (mean difference [MD] -0.84, 95% confidence interval [95% CI] -1.63 to -0.04; 4% absolute reduction; NNTB 11, 95% CI 14 to 22) and improved physical function on the 68-point WOMAC disability subscale. We found no statistical difference on major outcomes at mid- or long-term follow-up. Subgroup analysis of 4 studies showed a statistical significant difference with increased exercise time on pain (MD -1.37, 95% CI -2.47 to -0.28; 7% absolute reduction; NNTB 11, 95% CI 9 to 14, very low level of evidence) and physical function (MD -4.10, 95% CI -8.12 to -0.07; 6% absolute reduction; NNTB 10, 95% CI 8 to 13; very low level of evidence). Only one study systematically monitored adverse effects. We are uncertain whether high intensity increase the number of adverse effects (Peto odds ratio 1.72, 95% CI 0.51 to 5.81; 2% absolute reduction, very low level of evidence). We found the overall quality of evidence as low to very low. Most of the studies had an unclear or high risk of bias for several domains and imprecision. Five of the six studies were at high risk for performance, detection and attrition bias.

Conclusion: We found no clear clinical benefits of high intensity vs low intense exercise programs for pain, function and quality of life in patients with knee or hip OA. We found no important clinical benefits depending on the type of intensity of exercise programs. Very low quality of evidence shows no difference in the rate of adverse effects. The evidence was downgraded from high to low or very low because of the risk of bias, inconsistency and imprecision. The small number of studies comparing high- vs low-intensity exercise programs in OA underscores the need for more studies investigating the dose-response relationship in exercise programs. In particular, further studies are needed to establish the minimal effective intensity of exercise programs needed for clinical effect and the highest intensity patients can tolerate.

Disclosure: J. P. Regnaux, None; M. M. Lefèvre-Colau, None; L. Trinquart, None; C. Nguyen, None; I. Boutron, None; L. Brosseau, None; P. Ravaud, None.

To cite this abstract in AMA style:

Regnaux JP, Lefèvre-Colau MM, Trinquart L, Nguyen C, Boutron I, Brosseau L, Ravaud P. High-Intensity Versus Low-Intensity Physical Activity or Exercises in Patients with Hip or Knee Osteoarthritis: A Meta-Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/high-intensity-versus-low-intensity-physical-activity-or-exercises-in-patients-with-hip-or-knee-osteoarthritis-a-meta-analysis/. Accessed .

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