Efficacy of Tailored Exercise Therapy on Physical Functioning in Patients With Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial

Abstract

Objective. To evaluate the efficacy on physical functioning and safety of tailored exercise therapy in patients with knee osteoarthritis (OA) and comorbidities. Methods. In a randomized controlled trial, 126 participants were included with a clinical diagnosis of knee OA and at least 1 of the following target comorbidities: coronary disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, or obesity (body mass index ‡30 kg/m 2 ), with severity score ‡2 on the Cumulative Illness Rating Scale. The intervention group received a 20-week, individualized, comorbidity-adapted exercise program consisting of aerobic and strength training and training of daily activities. The control group received their current medical care for knee OA and were placed on a waiting list for exercise therapy. Primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index, subscale physical functioning (WOMAC-pf), and the 6-minute walk test (6MWT). Measurements were performed at baseline, after 20 weeks (directly posttreatment), and at 3 months posttreatment. Results. Statistically significant physical functioning differences over time were found between the intervention and control group (WOMAC: B 5 27.43 [95% confidence interval (95% CI) 29.99, 24.87], P < 0.001; and 6MWT: B 5 34.16 [95% CI 17.68, 50.64], P < 0.001) in favor of the intervention group. At 3 months followup, the mean improvements in the intervention group were 33% on the WOMAC scale and 15% on the 6MWT. These improvements are of clinical relevance. No serious adverse events occurred during the intervention. Conclusion. This is the first study showing that tailored exercise therapy is efficacious in improving physical functioning and safe in patients with knee OA and severe comorbidities.

Evaluation of an educational course for primary care physiotherapists on comorbidity‐adapted exercise therapy in knee osteoarthritis: an observational study

“…For example, in patients with knee OA and chronic heart failure (HF), breathlessness and fatigue disproportional to the level of exertion should be avoided because of the risk of cardiac decompensation (Coats, ). Therefore, we have recently developed and evaluated a strategy to adapt knee OA exercises to the comorbid disease in patients with knee OA and severe comorbidity (de Rooij et al, ; de Rooij et al, ). Targeted comorbidities were coronary disease, heart failure, type 2 diabetes, chronic obstructive pulmonary disease, and obesity.…”

“…Targeted comorbidities were coronary disease, heart failure, type 2 diabetes, chronic obstructive pulmonary disease, and obesity. The results of a randomized controlled trial evaluating the exercise strategy, conducted in a specialized rehabilitation centre, showed that tailored exercise therapy greatly improved physical functioning (effect size = 0.9), reduced pain (effect size = 0.8) and was safe for patients with knee OA and (severe) comorbidity (de Rooij et al, ).…”

Do comorbidities predict pain and function in knee osteoarthritis following an exercise intervention, and do they moderate the effect of exercise? Analyses of data from three randomized controlled trials

“…If outcomes from exercise are suboptimal in those with comorbidities and knee OA, a targeted treatment approach, specifically tailoring exercise to meet the needs of this patient group, may be warranted. This targeted approach has recently been shown to be effective compared with current medical care (whilst on a waiting list for exercise) in individuals with knee OA and comorbidities in the Netherlands (de Rooij et al, ). If the effectiveness of such targeted exercise programmes is confirmed in other countries and healthcare settings, this could potentially lead to improved treatment effects and patient outcomes, as well as more efficient use of healthcare services.…”

Impact of a three-month resistance training program for elderly persons with knee osteoarthritis residing in the community of Santa Cruz, Rio Grande do Norte, Brazil

“…These exercises have proven benefits in restoring range of motion, strengthening the muscles, improving pain and promoting improvement in day-to-day activities such as walking, climbing and descending stairs and even participating in sports 29,30 .…”