Physical exercise to manage pain in patients with knee osteoarthritis: a systematic review

Introduction: Osteoarthritis (OA) is a chronic, degenerative joint disease that primarily affects individuals over 55, leading to pain, stiffness, and disability. Traditional treatments involve pharmacological or surgical methods, yet adverse effects have spurred interest in non-pharmacological approaches, particularly physical exercise, which has shown promise in pain management and functional improvement. Material and method: This systematic review followed PRISMA 2020 guidelines, conducting a comprehensive search across databases (Embase, MEDLINE, Scopus, Web of Science). Inclusion criteria targeted randomized controlled trials of participants over 55 with knee OA, focusing on pain outcomes measured by the WOMAC questionnaire. Risk of bias was assessed using the Cochrane RoB-2 tool. Results: Out of 3,939 identified records, 39 studies involving 4,018 participants met inclusion criteria. Resistance-based and mind-body exercises, particularly Tai Chi, showed the most substantial pain relief when conducted for more than 8 weeks. Moderate physical exercise intensity proved effective, while aquatic exercise benefited those with severe pain due to low joint impact. Overall, studies with younger OA patients, lower joint replacement need, and moderate physical exercise intensity reported the best outcomes. Discussion: Findings highlight physical exercise, specifically resistance and mind-body interventions, as effective noninvasive options for OA pain relief. The review’s methodology, utilizing the RoB-2 and PRISMA 2020, enhances transparency and accuracy, yet limitations exist due to missing covariates and bias within included studies. Pain variability and adherence challenges remain, suggesting a need for studies to explore optimal exercise doses and long-term impacts on quality of life. Conclusion: This review supports physical exercise, especially resistance-based and mind-body exercises, as beneficial for OA pain management. Findings guide future exercise intervention design and suggest integrating physical activity into OA management policies for improved patient outcomes.