Exercise In Knee Osteoarthritis Research Articles

AB0788 Decrease of Muscle Strength is Associated with Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results from the CHECK Study

BackgroundMuscle weakness has been hypothesized as being an important factor in the development of activity limitations in knee osteoarthritis (OA). Longitudinal evidence to support this hypothesis is scarce in early...

Effect of Quadriceps Strengthening Exercise on Reduction of Pain in Knee Osteoarthritis

Osleoarthritis is the leading cause of musculoskeletal pain and disability. Nonsteroidal anti-inflammatory drugs and physical modalities like Quadriceps muscle strengthening exercise can be used to treat such cases. This Randomized clinical trial study was done in the department of Physical Medicine and Rehabilitation, Sylhet M.A.G Osmani Medical College Hospital Sylhet, lo evaluate the role of quadriceps strengthening exercise in knee osteoarthritis during 1st April 2009 to 3lst October 2009. Sixty patients with knee osteoarthritis were selected according to inclusion and exclusion criteria. They were divided in, group A and group B randomly. Group- A was treated with NSAID (Aceclofenac 100 mg 12hrly) and group-B with NSAID and quadriceps strengthening exercise 10 repetition 3 times daily. Each patient was followed try every week for four weeks. The mean age was 61.067 ± 8.320 years and male female ratio was 1.4:1. Marked improvement was observed in both the groups assessed by pain score (p<0.001), physicians global assessment (p<0.001) and patients global assessment (p<0 001); and was continued throughout the treatment period of 4 weeks; with significantly marked in group A than group B beginning at 1st week of treatment [pain score (p<0.001), physicians global assessment (p<0.040) and patients global assessment (p<0.034)] and was continued at the 4th week of treatment [pain score (p<0.001), physicians global assessment (p<0.001) and patients global assessment (p<0.001)]. The overall difference between the groups from baseline to end point of treatment is significant with group A (exercise plus NSAIDs) experienced a faster pain relief than that of group B (Only NSAID) (p:<0.001). So from the present study, it may be concluded that quadriceps strengthening exercise is useful in reduction of pain in knee osteoarthritis and may be an adjuvant therapy in knee osteoarthritis. DOI: http://dx.doi.org/10.3329/bmj.v41i3.18953 Bangladesh Medical Journal 2012 Vol.41(3): 19-22

Effectiveness of exercise in knee osteoarthritis: should we take a patient’s health status into account?

Effectiveness of exercise in knee osteoarthritis: should we take a patient’s health status into account?

Transcutaneous Electrical Nerve Stimulation as an Adjunct to Education and Exercise for Knee Osteoarthritis: A Randomized Controlled Trial

To determine the additional effects of transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis (OA) when combined with a group education and exercise program (knee group). The study was a randomized, sham-controlled clinical trial. Patients referred for physiotherapy with suspected knee OA (confirmed using the American College of Rheumatology clinical criteria) were invited. Exclusion criteria included comorbidities preventing exercise, previous TENS experience, and TENS contraindications. Prospective sample size calculations required 67 participants in each trial arm. A total of 224 participants (mean age 61 years, 37% men) were randomized to 3 arms: TENS and knee group (n = 73), sham TENS and knee group (n = 74), and knee group (n = 77). All patients entered an evidence-based 6-week group education and exercise program (knee group). Active TENS produced a "strong but comfortable" paraesthesia within the painful area and was used as much as needed during the 6-week period. Sham TENS used dummy devices with no electrical output. Blinded assessment took place at baseline and 3, 6, 12, and 24 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale at 6 weeks. Secondary outcomes included WOMAC pain, stiffness, and total scores; extensor muscle torque; global assessment of change; exercise adherence; and exercise self-efficacy. Data analysis was by intent to treat. All outcomes improved over time (P < 0.05), but there were no differences between trial arms (P > 0.05). All improvements were maintained at 24-week followup. There were no additional benefits of TENS, failing to support its use as a treatment adjunct within this context.

Land-based exercise for knee osteoarthritis: recommendations for informing practice

Invited commentary on: ‘A systematic review to determine the optimal type and dosage of land-based exercises for treating knee osteoarthritis′ Smith, Kirby and Davies.As a leading cause of disabili...

Manual physical therapy and perturbation exercises in knee osteoarthritis

Objectives:Knee osteoarthritis (OA) causes disability among the elderly and is often associated with impaired balance and proprioception. Perturbation exercises may help improve these impairments. Although manual physical therapy is generally a well-tolerated treatment for knee OA, perturbation exercises have not been evaluated when used with a manual physical therapy approach. The purpose of this study was to observe tolerance to perturbation exercises and the effect of a manual physical therapy approach with perturbation exercises on patients with knee OA.Methods:This was a prospective observational cohort study of 15 patients with knee OA. The Western Ontario and McMaster Universities Arthritis Index (WOMAC), global rating of change (GROC), and 72-hour post-treatment tolerance were primary outcome measures. Patients received perturbation balance exercises along with a manual physical therapy approach, twice weekly for 4 weeks. Follow-up evaluation was done at 1, 3, and 6 months after beginning the program.Results:Mean total WOMAC score significantly improved (P = 0·001) after the 4-week program (total WOMAC: initial, 105; 4 weeks, 56; 3 months, 54; 6 months, 57). Mean improvements were similar to previously published trials of manual physical therapy without perturbation exercises. The GROC score showed a minimal clinically important difference (MCID)≥+3 in 13 patients (87%) at 4 weeks, 12 patients (80%) at 3 months, and 9 patients (60%) at 6 months. No patients reported exacerbation of symptoms within 72 hours following each treatment session.Discussion:A manual physical therapy approach that also included perturbation exercises was well tolerated and resulted in improved outcome scores in patients with knee OA.

Neural Mechanisms and Perspectives about the Therapeutic Exercises for Knee Osteoarthritis

Copyright: © 2013 Dionisio VC. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Osteoarthritis (OA) is the most common arthropathy in the worldwide [1], which is characterized by the degradation of articular cartilage and affects all joint structures such as the subchondral bone, fibrocartilage, ligament, capsule, and synovium [2]. The knee OA is highly prevalent in individuals of both sexes over 50 years old [3], and the high levels of pain lead the loss of functional capacity and quality of life [4].

Associations for change in physical and psychological factors and treatment response following exercise in knee osteoarthritis: An exploratory study

Understanding how changes in physical and psychological factors following therapeutic exercise are associated with treatment outcome could have important implications for refining rehabilitation programs for knee osteoarthritis (OA). The objective of this study was to examine the association of changes in these factors with changes in pain and function after an exercise program for people with knee OA. In total, 152 people with knee OA completed an exercise program consisting of lower extremity strengthening, stretching, range of motion, balance and agility, and aerobic exercises. The change from baseline to the 2-month followup was calculated for physical and psychological factors, including self-reported knee instability, quadriceps strength, knee and ankle range of motion, lower extremity muscle flexibility, fear of physical activity, anxiety, and depressive symptoms. Treatment response was defined as a minimum of a 20% improvement from baseline in both a numerical knee pain rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index physical function scale. The association of each factor with treatment response was examined with logistic regression mutually adjusted for age, sex, body mass index, radiographic severity, and exercise group. Change in self-reported knee instability (odds ratio [OR] 1.67 [95% confidence interval (95% CI) 1.13-2.47]) and fear of physical activity (OR 0.93 [95% CI 0.88-1.00]) were the only 2 factors that were significantly associated with treatment response after adjustment for covariates. Improvement in knee instability and fear of physical activity were associated with increased odds of a positive treatment response following therapeutic exercise in subjects with knee OA.

The Effects of Group Cycling on Gait and Pain-Related Disability in Individuals With Mild-to-Moderate Knee Osteoarthritis: A Randomized Controlled Trial

Randomized controlled trial. To determine the effectiveness of a community-based program of stationary group cycling on gait, pain, and physical function in individuals with mild-to-moderate knee osteoarthritis (OA). Knee pain and disability are common symptoms in individuals with knee OA. Though exercise for knee OA has acknowledged benefits, it has the potential to aggravate symptoms in some instances. Thirty-seven subjects (27 women, 10 men) with a mean ± SD age of 57.7 ± 9.8 years were randomly assigned to a cycling (n = 19) or control (n = 18) group for a 12-week intervention study. Outcome variables, measured at baseline and 12 weeks, included preferred and maximal gait velocity, a visual analog pain scale at rest and following a 6-minute walk test, muscle strength, and functional-outcome questionnaires. Data were analyzed using mixed-model analyses of variance for group and time differences. After 12 weeks, the individuals receiving the cycling intervention showed significantly greater improvements (P<.05) for preferred gait velocity (mean difference between groups, 8.7 cm/s; 95% confidence interval [CI]: 2.2, 15.1), visual analog pain scale on the 6-minute walk test (mean difference, 16.5 mm; 95% CI: 2.1, 31.0), the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (mean difference, 14.9 points; 95% CI: 2.6, 27.0) and stiffness subscale (mean difference, 10.8 points; 95% CI: 0.7, 21.3), the Knee injury and Osteoarthritis Outcome Score pain subscale (mean difference, 13.3 points; 95% CI: 3.4, 23.3), and the Knee Outcome Survey activities of daily living subscale (mean difference, 13.9 points; 95% CI: 2.0, 25.9) compared to controls. Stationary group cycling may be an effective exercise option for individuals with mild-to-moderate knee OA and may reduce pain with walking. US trial registration NCT00917618. Therapy, level 1b-.

Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study

Objectives: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee. Design: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups. Setting: Special Rehabilitation Services. Subjects: Forty participants with knee osteoarthritis, 2–4 osteoarthritis degree, aged between 50 and 75 years and both genders. Intervention: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises). Main measures: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks). Results: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group. Conclusion: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

309 A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED, MULTICENTER STUDY OF rhFGF18 ADMINISTERED INTRAARTICULARLY USING SINGLE OR MULTIPLE ASCENDING DOSES IN PATIENTS WITH PRIMARY KNEE OSTEOARTHRITIS (OA), SCHEDULED FOR TOTAL KNEE REPLACEMENT

in-person instruction on at-home knee exercise. The primary outcome measure was a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points), which assessed knee pain, function and stiffness on a per subject basis. The secondary outcome was the Knee Pain Scale (KPS) which assessed knee pain severity and frequency on a per knee basis; both were done at baseline, 5, 9 12, 26 and 52 weeks. Procedure-related opioid medication use, subject satisfaction and adverse events were also assessed. Results: Analysis was by intention to treat. No significant baseline differences existed between the groups in age, gender, pain duration, body mass index or WOMAC scores. 89 subjects (57±8.3 years old, 59 female) with moderate to severe KOA received an average of 4.3±0.7 prolotherapy injection sessions over a 17-week treatment period. All groups reported improved composite WOMAC scores compared to baseline status (p < 0.01) at 52 weeks. However, WOMAC scores for prolotherapy subjects, adjusted for gender, age and body mass index showed significantly greater improvement onWOMAC score at 52 weeks; 15.32±3.52 points for prolotherapy compared to 7.68±3.41 points for saline injection (p < 0.05) and 8.25±3.33 points for exercise (p< 0.05). The improvement by prolotherapy subjects exceeded minimal clinical important difference. KPS scores of prolotherapy subjects showed similar improvement per injected knee compared to baseline status (p < 0.001) and controls (p < 0.05). Prescribed post-procedure opioid medication resulted in rapid diminution of prolotherapy injection pain. Satisfaction with prolotherapy was high and there were no adverse events. Conclusions: Prolotherapy resulted in safe, significant, sustained improvement of pain, function and stiffness scores compared to blinded saline injections and at-home exercises in knee osteoarthritis.

Beneficial Effect of Creatine Supplementation in Knee Osteoarthritis

The aim of this study was to investigate the efficacy of creatine (CR) supplementation combined with strengthening exercises in knee osteoarthritis (OA). A randomized, double-blind, placebo-controlled trial was performed. Postmenopausal women with knee OA were allocated to receive either CR (20 g·d(-1) for 1 wk and 5 g·d(-1) thereafter) or placebo (PL) and were enrolled in a lower limb resistance training program. They were assessed at baseline (PRE) and after 12 wk (POST). The primary outcome was the physical function as measured by the timed-stands test. Secondary outcomes included lean mass, quality of life, pain, stiffness, and muscle strength. Physical function was significantly improved only in the CR group (P = 0.006). In addition, a significant between-group difference was observed (CR: PRE = 15.7 ± 1.4, POST = 18.1 ± 1.8; PL: PRE = 15.0 ± 1.8, POST = 15.2 ± 1.2; P = 0.004). The CR group also presented improvements in physical function and stiffness subscales as evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (P = 0.005 and P = 0.024, respectively), whereas the PL group did not show any significant changes in these parameters (P > 0.05). In addition, only the CR group presented a significant improvement in lower limb lean mass (P = 0.04) as well as in quality of life (P = 0.01). Both CR and PL groups demonstrated significant reductions in pain (P < 0.05). Similarly, a main effect for time revealed an increase in leg-press one-repetition maximum (P = 0.005) with no significant differences between groups (P = 0.81). CR supplementation improves physical function, lower limb lean mass, and quality of life in postmenopausal women with knee OA undergoing strengthening exercises.

Creatine In Osteoarthritis, A Randomized, Double-blinded, Placebo-controlled Trial

PURPOSE: The aim of this study was to investigate the efficacy of creatine (CR) supplementation combined with strengthening exercises in knee osteoarthritis (OA) women. METHODS: A randomized, double-blind, placebo-controlled trial was performed. Patients were allocated to receive either CR or placebo (PL) and were enrolled in a lower limb resistance training program. They were assessed at baseline (PRE) and after 12 weeks (POST). The primary outcome was the physical function as measured by the timed-stands test. Secondary outcomes included lean mass, quality of life, pain, stiffness, and muscle strength. RESULTS: Physical function was significantly improved only in the CR group (p=0.006). Additionally, a significant between-group difference was observed (CR-PRE: 15.7 ± 1.4, POST: 18.1 ± 1.8; PL-PRE: 15.0 ± 1.8, POST: 15.2 ± 1.2; p=0.004). The CR group also presented improvements in physical function and stiffness subscales as evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (p=0.005 and p=0.024, respectively), whereas the PL group did not show any significant changes in these parameters (p>0.05). Additionally, only the CR group presented a significant improvement in lower limb lean mass (p=0.04) as well as in quality of life (p=0.01). Both CR and PL groups demonstrated significant reductions in pain (p<0.05). Similarly, a main effect for time revealed an increase in leg-press 1-RM (p=0.005) with no significant differences between groups (p=0.81). CONCLUSIONS: CR supplementation improves physical function, lower limb lean mass and quality of life in postmenopausal women with knee OA undergoing lower limb strengthening exercises. Clinicaltrials.gov number: NCT00992043.

Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis

Lower-extremity muscle strength and afferent sensory dysfunction, such as reduced proprioceptive acuity, are potentially modifiable putative risk factors for knee osteoarthritis (OA). Findings from current studies suggest that muscle weakness is a predictor of knee OA onset, while there is conflicting evidence regarding the role of muscle weakness in OA progression. In contrast, the literature suggests a role for afferent sensory dysfunction in OA progression but not necessarily in OA onset. The few pilot exercise studies performed in patients who are at risk of incident OA indicate a possibility for achieving preventive structure or load modifications. In contrast, large randomized controlled trials of patients with established OA have failed to demonstrate beneficial effects of strengthening exercises. Subgroups of individuals who are at increased risk of knee OA (such as those with previous knee injuries) are easily identified, and may benefit from exercise interventions to prevent or delay OA onset.

Measuring patient satisfaction with exercise therapy for knee osteoarthritis: evaluating the utility of the physiotherapy outpatient survey

To assess patient satisfaction with exercise for knee osteoarthritis (OA). A convenience sample of 27 patients recruited to a randomized controlled trial (RCT) comparing open kinetic chain and closed kinetic chain exercises for knee OA were reassessed at nine months post-randomization. Clinical outcomes included self-report and physical performance measures of function and pain severity. Patients also completed the Physiotherapy Outpatient Survey (POPS), which is a multi-dimensional measure of patient satisfaction with physiotherapy. There was no significant difference in satisfaction between the two intervention groups. Overall mean satisfaction for the entire cohort was 4.07 of a maximum score of 5 (standard deviation (SD) = 0.52). Lower levels of satisfaction with outcome (mean = 3.56, SD = 0.8) were reported compared with other domains of expectations, communication, organization and the therapist (mean = 3.79-4.49; SDs = 0.42-0.92). Both intervention groups improved from baseline on clinical outcomes of pain, self-report function and walking distance, with no significant differences between the two groups. High levels of satisfaction were reported in this subsample of knee OA patients participating in an RCT evaluating the effects of different exercise approaches for knee OA. Satisfaction varied depending on the satisfaction domain, with lower satisfaction with outcome compared with other aspects of care. The POPS questionnaire can be used to measure the multi-dimensional aspects of satisfaction with physiotherapy.

Physical Activity Levels in the Early Knee Osteoarthritis Population

PURPOSE: The KNEE study is a randomized clinical trial of the effects of resistance exercise in knee osteoarthritis (KOA) patients. For this report, we describe objectively measured physical activity (PA) assessed by accelerometry in KOA subjects and compare their PA to health-related recommendations for the general public. METHODS: Men (n = 61) and women (n = 201) with a radiographic status of grade II OA in at least one knee, as denned by the Kellgren and Lawrence classification, wore the Actigraph accelerometer (model 7164, Manufacturing Technologies Inc. Health Systems, Shalimar, FL) daily (except for sleeping) for 7 days. Activity counts corresponding to light, moderate (MPA) and vigorous (VPA) levels of activity were 50–2,190, 2,191–6,153, > 6,154 counts/min, respectively, based on the literature. Average age, height, weight, and body mass index were as follows: 54.6 ±7.1 years, 168.0 ± 10.1 cm, 78.9 ± 15.6 kg, and 27.9 ± 4.8 kg/m2. RESULTS: Average accelerometer wearing time was 13.5 hours/day. Average daily MPA was significantly (p < 0.05) higher in males (31.1 ± 19.9 minutes/day) than females (21.6 ± 15.3 minutes/day). Males and females accumulated little VPA (0.84 ±3.4 minutes/day). Thus, average daily moderate plus vigorous activity was higher in males (32.7 ± 2.75 minutes/day) than females (22.2 ± 1.2 minutes/day). Weekday MVPA exceeded weekend MVPA by about 3 minutes. CONCLUSIONS: KOA patients were compliant wearers of Actigraph, making it a good tool for objective assessment of PA in this population. Males with KOA are more active than females, meeting recommendations for daily MVPA. Both males and females with KOA achieve significantly less VPA than the recommendations prescribed for the general public. Supported by NIH/NIAMS Grant #5R01 AR047595.

Consensus Agreement on the Design and Conduct of Clinical Studies with Low-Level Laser Therapy and Light Therapy for Musculoskeletal Pain and Disorders

Consensus Agreement on the Design and Conduct of Clinical Studies with Low-Level Laser Therapy and Light Therapy for Musculoskeletal Pain and Disorders

Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis

The aim of this study was to evaluate the effects of electrical stimulation program on pain, disability, and quadriceps strength in the patients with knee osteoarthritis. Fifty women diagnosed as knee osteoarthritis were randomized into two groups as electrical stimulation and biofeedback-assisted isometric exercises. Both of the programs were performed 5 days a week, for a duration of 4 weeks. Outcome measures for pain were visual analogue scale pain score and Western Ontario McMaster osteoarthritis index (WOMAC) pain score. Disability and stiffness were assessed with WOMAC physical function and stiffness score. One repetition maximum (RM) and 10 RM were used for measuring quadriceps strength. In addition, 50 m walking time and 10 steps stairs climbing up-down time were evaluated. Both groups showed significant improvements in pain, physical function, and stiffness scores after the therapy. There were statistically significant improvements in 50 m walking time and 10 steps stairs climbing up-down time and 1 RM and 10 RM values indicating the improvement in muscle strength. In addition, there were no significant differences between the groups after the therapy. We conclude that electrical stimulation treatment was as effective as exercise in knee osteoarthritis and electrical stimulation treatment can be suggested especially for the patients who have difficulty in or contraindications to perform an exercise program.

Effects of Kinesthesia and Balance Exercises in Knee Osteoarthritis

In patients with knee osteoarthritis (OA), there is a prominent loss in proprioception and kinesthesia sensation compared with control subjects of the same age and gender. The aim of this study is the investigation of short-term clinical effects of kinesthesia and balance exercises in patients with knee OA. This 8-week study was conducted on 66 female patients with knee OA who were randomized into 2 groups. The first group received kinesthesia and balance exercises (such as retrowalking, walking on their toes, leaning to the sides, balance board exercises, minitrampoline exercises, plyometric exercises, and so on) in addition to strengthening exercises. The second group received only strengthening exercises. : Statistically significant improvements were observed postexercise for both groups with respect to baseline for WOMAC, SF-36 Form, times for performing activities of daily living, isokinetic quadriceps muscle strength, and proprioceptive sensation levels. In the first group with kinesthesia training, compared with the second group, significantly greater improvements were obtained in all the subparameters that measure functional status (WOMAC-physical function value, SF-36 Form [physical function, role limitations-physical and vitality-energy or fatigue variables], 10 stairs climbing, and 10-m walking times) and in isokinetic muscle strength at high angular velocities (P < 0.05). The absolute angular error percentage (to assess proprioceptive accuracy) was significantly improved postexercise in both groups. There were no differences between the groups. Additive positive effects of kinesthesia and balance exercises in knee OA have been demonstrated. Used in clinical applications, they should be able to increase the functional capacities of patients. Long-term studies about efficacy and cost-effectivity of these exercises are needed.

Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858

BackgroundStudies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life.MethodsPatients aged 36–65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at ≥ 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months.ResultsSixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02).ConclusionA six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group.