Hasan & Hamza
MA Physical Activity and Health
Institute of Sport Sciences
the Keyword of “Arthritis ”
244,309 Articles on PubMed.
“Osteoarthritis AND Physical Activity”
2242 on PubMed
“Meta-Analysis of 5 Year older”
9 were related to effectiveness of some
4 were found relevant.
of the Article:
“Exercise for lower limb osteoarthritis:
systematic review incorporating trial
sequential analysis and network metaanalysis”
Olalekan , Danielle and all.
Published: 20 September 2013.
Osteoarthritis is the most common form of arthritis and one of
the leading cause of pain and disability worldwide.
*Prevalence of Hip OA is 25.3% & Knee OA is 45.7%
Economic Burden: Direct & Indirect
Uk† (1990 to 2000) 36M working days were Lost OA
Which cost €3.8bn ($5.1bn)
Productivity loss to UK economy is being estimated about 1% of total
GNP(gross national product)/ Year.
USA total(direct and indirect) economical losses in 2003 is
€95.8bn ($128 Bn)
* Murphy et al. One in four people may develop symptomatic hip
osteoarthritis in his or her lifetime.2010
† National Collaborating Centre for Chronic Conditions 2008
Network Meta-analysis of RCTs
Information sources and search strategy
One Inf.Specialist develop strategies. And Six
Reviewer in pairs study the articles form data
Exercise interventions were defined as any type of
therapeutic exercise (land or water
based), regardless of content, duration,
frequency, or intensity.
Medline, Embase, CINAHL, AMED, HMIC, CENTRAL
, DARE and NHS EED.
From Inception to March 2012
No language restriction and bibliography is also
population: Adult of
clinical/Radiographical diagnosis of OA of hip
Interventions: Therapeutic Exercise
Comparator:other form of Ex or Control Group.
Outcome measure: the core set of outcome
measures for clinical trials in osteoarthritis.
include assessment of at least one of self
reported pain and function
Study Design: RCT, Trials were excluded if they
concerned pre-operative exercise therapy
(immediately before or after surgery
used the Cochrane Collaboration’s tool
for assessing risk of bias for quality
assessment of the included trials. The trials
were graded (unclear, high, or low risk of
bias) based on sequence
generation, allocation concealment, blinding
of outcome assessor, incomplete outcome
data, and selective outcome reporting.
Number of Studies: 3796 full text articles 177
(Critical Reading)115(did not match inclusion
criteria) 60 RCT selected (8218 patients).
Time Frame: The trials were published between 1989
and 2012. The maximum length of follow-up ranged
from 4 weeks to 79 weeks (median 15 weeks).
Risk of bias of included trials:
The potential risk of bias likely to be introduced by
incomplete data was high in 10 trials (18%). The risk
of selective reporting bias was low in most trials
Fig 1 Study selection of trials examining exercise in treatment of
lower limb osteoarthritis
> It also shows that some therapeutic
intervention are more beneficial to others.
>Exercise programs that combine
strengthening exercise with exercise aimed
at increasing flexibility and aerobic capacity
seem to be the “best” exercise option that
clinicians can offer to patients as a
Implications for research:
Further research is required in
How? adhere people to exercise and PA
Which? patients with lower limb osteoarthritis
benefit most from exercise.
What? mode of delivery is beneficial for
this study adds
As of the year 2002, there was enough
evidence to show significant benefit of
exercise interventions versus no exercise in
lower limb osteoarthritis, indicating that
further trials of exercise versus no exercise
are unlikely to overturn this positive result.
Evidence from the network metaanalysis, largely based on studies in knee
osteoarthritis, indicates that a programmed
combining flexibility, strengthening, and
aerobic exercise is most likely to improve
outcomes of pain and function
Fig 2 Forest plots for network meta-analysis for pain and physical
function outcomes with no exercise as reference group. SUCRA=1 when
exercise intervention is certain to be best (that is, always ranks first)
and 0 when exercise intervention is certain to be worst
Fig 3 Scatter plot presenting ranking of exercise interventions for pain
reduction and physical function based on cumulative probability of being
most effective intervention
studies shows The greatest improvements
were found in pain, quality of life, and