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 Based on pooled data from eight clinical trials with a total of 340
patients, the study team concludes in the British Journal of Sports
Medicine that hip strengthening exercises involving weights or
elastic bands would help the most.
"Despite knowing that exercise is beneficial, what type of exercise
should be included in a thorough exercise program remains largely
unknown," said lead author Andrew Hislop of the University of
Queensland in Brisbane, Australia.
Most international guidelines recommend exercise in the conservative
management of knee osteoarthritis, a bone and cartilage disease that
affects one in four people over age 55. However, many doctors don't
follow up on this advice with patients or refer them to the proper
physiotherapist for an additional appointment, Hislop noted.
"With a growing population and increasing number of lower limb
injuries, there is going to be an ever increasing burden on the
health system to manage knee osteoarthritis," he told Reuters Health
by email.
Hislop and colleagues conducted a systematic review and
meta-analysis of randomized controlled trials that investigated the
effect of adding hip-strengthening exercises to a regimen often
prescribed to strengthen the quadriceps muscles at the front of the
thigh for people with knee arthritis.
The researchers looked at whether aspects of knee and walking
function improved, as well as whether pain and quality of life were
affected by the added hip-strengthening routine.
They also evaluated three types of hip exercises to see which had
the greatest effect: resistance weight-lifting, functional
neuromuscular exercises such as single-leg squats or stepping, and
so-called multimodal exercise that combined these two.
Overall, adding hip-strengthening significantly improved walking
function, though it did not have a statistically meaningful effect
on pain, stair function or the ability to stand from a sitting
position.
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When researchers looked at individual types of hip exercise,
however, they found that resistance exercises in particular were
more effective than functional neuromuscular exercises for improving
pain and functioning. Multimodal exercise had no added effect.
"Strengthening the hip muscles, particularly the hip abductors,
might improve pelvic drop and trunk control, lightening the load on
the knee," Hislop said.
"Many health professionals are concerned only with the site affected
by the disease, forgetting the regional consequences of the disease"
at the hip or beyond, said Dr. Jamil Natour, chief of rheumatology
at the Federal University of Sao Paulo in Brazil, who wasn't
involved in the study.
"We should verify that the 'normal' hip of a patient with knee
osteoarthritis is evaluated and possibly rehabilitated," he told
Reuters Health by email.
Researchers also want to understand exactly how exercise influences
knee osteoarthritis pain. The effect be physical, but could also
stem from other factors such as a general improvement in wellbeing,
attention from a healthcare professional or a placebo effect.
"Over the last decade or so, many researchers have looked for the
optimal exercise program, but unfortunately, without luck," said
Marius Henriksen, head of the Physiotherapy and Biomechanics
Research unit at Copenhagen University Hospital in Frederiksberg,
Denmark, who wasn't involved with the study.
"To me, that suggests that the exercise that is effective is the
exercise that is being done," he told Reuters Health by email. "Go
out there and exercise and be physically active, and do something
that you find fun and meaningful."
SOURCE: https://bit.ly/2CjwUpx British Journal of Sports Medicine,
online February 6, 2019.
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