How Intense Is Effective? Exploring Aerobic Exercise Intensity for Knee Osteoarthritis Through a Bayesian...

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Sports Science

Background:

• Knee osteoarthritis (KOA) presents with pain, stiffness, and functional limitations.
• Aerobic exercise (AE) is a recognized treatment modality for KOA, offering significant benefits.

Purpose of the Study:

• To identify the most effective aerobic exercise (AE) intensity for managing knee osteoarthritis (KOA).

Main Methods:

• A systematic literature search was conducted across seven databases, including randomized controlled trials focusing on AE interventions for KOA.
• Bayesian random-effects network meta-analyses were employed to compare different AE intensities, assessing outcomes like pain, walking, and sit-to-stand performance.
• Methodological quality and bias were rigorously evaluated, with evidence certainty rated using GRADE criteria.

Main Results:

• Fifteen studies were included, with most exhibiting "some concerns" or "high risk" of bias.
• Meta-analyses for pain and walking performance revealed non-significant and imprecise results across AE intensities.
• The certainty of evidence for AE intensity comparisons was rated as very low.

Conclusions:

• Insufficient evidence currently exists to pinpoint the optimal AE intensity for knee osteoarthritis (KOA).
• High risk of bias and wide credible intervals limit current findings.
• Clinicians should adopt a patient-centered approach, gradually progressing AE and considering combined interventions, while advocating for high-quality trials with direct AE intensity comparisons.