This systematic review aimed to synthesise the content, structure, and delivery characteristics of effective yoga interventions for managing osteoarthritis symptoms, including joint pain and joint function. JBI guidelines were followed. 17 databases were searched for randomised controlled trials (RCTs) assessing yoga’s effectiveness on osteoarthritis symptoms. Meta-analyses and a narrative synthesis were conducted to address the objective. The systematic review and meta-analysis included 18 and 16 articles (representing 16 and 14 RCTs), respectively. Overall, the included studies had low methodological quality scores. 10 of 14 yoga interventions effectively reduced pain (standardised mean difference (SMD) − 0.70; 95% confidence interval (CI) − 1.08, − 0.32) and/or improved function (− 0.40; − 0.75, − 0.04). Notably, 8 effective interventions had centre-based (supervised, group) sessions, and 6 included additional home-based (unsupervised, individual) sessions. Effective interventions included 34 yogic poses (12 sitting, 10 standing, 8 supine, 4 prone), 8 breathing practices, and 3 meditation and relaxation practices. 8 interventions included yogic poses, and 7 also incorporated breathing practices and/or meditation and relaxation practices. 4 interventions included yogic pose modifications for osteoarthritis. The median duration of centre-based sessions was 8 weeks and each session was around 53 min, mostly delivered once a week. The median duration of home-based sessions was 10 weeks and each session was 30 min, usually instructed to practice 4 times a week. Given previous studies’ limitations, a high-quality long-term RCT should be conducted using synthesised findings of previous effective yoga interventions.
OBJECTIVE: The objective of this review is to conduct a comprehensive and systematic assessment of the efficacy of Yoga as an intervention for knee osteoarthritis (KOA).
METHODS: We searched PubMed, Cochrane Library, Embase, Web of Science, and PEDro as of January 3, 2024. Retrieved a total of 200 articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated.
RESULTS: The study included a total of 8 trials and involved 756 KOA patients. The results indicated that compared to the control group, Yoga exercise showed significant improvements in alleviating pain (SMD = -0.92; 95% CI = -1.64 ~ - 0.20; P = 0.01, I2 = 94%), stiffness (SMD = -0.51; 95% CI = -0.91 ~ -0.12; P = 0.01; I2 = 66%) and physical function (SMD = -0.53; 95% CI = -0.89 ~ -0.17; P = 0.004; I2 = 59%) among KOA patients. However, there was no significant improvement observed in terms of activities of activity of daily living (ADL) (SMD = 1.03; 95% CI = -0.01 ~ 2.07; P = 0.05; I2 = 84%), and quality of life (QOL) (SMD = 0.21; 95% CI = -0.33 ~ 0.74; P = 0.44; I2 = 83%) with the practice of Yoga.
CONCLUSIONS: In general, Yoga has been found to be effective in reducing pain and stiffness in KOA patients, it can also improve the physical function of patients. However, there is limited evidence to suggest significant improvements in terms of ADL and QOL.
The aim of our meta-analysis was to compile the available evidence to evaluate the effect of physical exercise-based therapy (PEBT) on pain, impact of the disease, quality of life (QoL) and anxiety in patients with fibromyalgia syndrome (FMS), to determine the effect of different modes of physical exercise-based therapy, and the most effective dose of physical exercise-based therapy for improving each outcome. A systematic review and meta-analysis was carried out. The PubMed (MEDLINE), SCOPUS, Web of Science, CINAHL Complete and Physiotherapy Evidence Database (PEDro) databases were searched up to November 2022. Randomized controlled trials (RCTs) comparing the effects of physical exercise-based therapy and other treatments on pain, the impact of the disease, QoL and/or anxiety in patients with FMS were included. The standardized mean difference (SMD) and a 95% CI were estimated for all the outcome measures using random effect models. Three reviewers independently extracted data and assessed the risk of bias using the PEDro scale. Sixty-eight RCTs involving 5,474 participants were included. Selection, detection and performance biases were the most identified. In comparison to other therapies, at immediate assessment, physical exercise-based therapy was effective at improving pain [SMD-0.62 (95%CI, -0.78 to -0.46)], the impact of the disease [SMD-0.52 (95%CI, -0.67 to -0.36)], the physical [SMD 0.51 (95%CI, 0.33 to 0.69)] and mental dimensions of QoL [SMD 0.48 (95%CI, 0.29 to 0.67)], and the anxiety [SMD-0.36 (95%CI, -0.49 to -0.25)]. The most effective dose of physical exercise-based therapy for reducing pain was 21-40 sessions [SMD-0.83 (95%CI, 1.1--0.56)], 3 sessions/week [SMD-0.82 (95%CI, -1.2--0.48)] and 61-90 min per session [SMD-1.08 (95%CI, -1.55--0.62)]. The effect of PEBT on pain reduction was maintained up to 12 weeks [SMD-0.74 (95%CI, -1.03--0.45)]. Among patients with FMS, PEBT (including circuit-based exercises or exercise movement techniques) is effective at reducing pain, the impact of the disease and anxiety as well as increasing QoL. Systematic Review Registration: PROSPERO https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021232013.
BACKGROUND: Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking.
OBJECTIVES: To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis.
SEARCH METHODS: We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE.
MAIN RESULTS: We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27).
AUTHORS' CONCLUSIONS: Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
Objectives. This systematic review aims to summarize the existing literature on Tai Chi randomized controlled trials (RCTs) and recommend Tai Chi exercise prescriptions for different diseases and populations. Methods. A systematic search for Tai Chi RCTs was conducted in five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) from their inception to December 2019. SPSS 20.0 software and Microsoft Excel 2019 were used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of RCTs. Results. A total of 139 articles were identified, including diseased populations (95, 68.3%) and healthy populations (44, 31.7%). The diseased populations included the following 10 disease types: musculoskeletal system or connective tissue diseases (34.7%), circulatory system diseases (23.2%), mental and behavioral disorders (12.6%), nervous system diseases (11.6%), respiratory system diseases (6.3%), endocrine, nutritional or metabolic diseases (5.3%), neoplasms (3.2%), injury, poisoning and certain other consequences of external causes (1.1%), genitourinary system diseases (1.1%), and diseases of the eye and adnexa (1.1%). Tai Chi exercise prescription was generally classified as moderate intensity. The most commonly applied Tai Chi style was Yang style (92, 66.2%), and the most frequently specified Tai Chi form was simplified 24-form Tai Chi (43, 30.9%). 12 weeks and 24 weeks, 2-3 times a week, and 60 min each time was the most commonly used cycle, frequency, and time of exercise in Tai Chi exercise prescriptions. Conclusions. We recommend the more commonly used Tai Chi exercise prescriptions for different diseases and populations based on clinical evidence of Tai Chi. Further clinical research on Tai Chi should be combined with principles of exercise prescription to conduct large-sample epidemiological studies and long-term prospective follow-up studies to provide more substantive clinical evidence for Tai Chi exercise prescriptions.
BACKGROUND: Public health guidelines suggest that physical activity can be accumulated in multiple short bouts dispersed through the day. A synthesis of the evidence for this approach is lacking.
OBJECTIVE: Our objective was to undertake a systematic review and meta-analysis to examine if exercise interventions consisting of a single bout of exercise compared with interventions comprising the same total duration, mode, and intensity of exercise accumulated over the course of the day have different effects on health outcomes in adults.
METHODS: Six electronic databases were searched (Jan 1970-29 August 2018). Two authors identified studies that evaluated the effects of a single bout of exercise compared with the same intensity, total duration, and mode of exercise accumulated in multiple bouts over the course of a day, in community-dwelling adults. Risk of bias was assessed using the Cochrane Collaboration tool. Pooled effects were reported as standardised mean differences (MDs) and 95% confidence intervals (CIs) using a random effects model.
RESULTS: A total of 19 studies involving 1080 participants met the inclusion criteria. There were no differences between accumulated and continuous groups for any cardiorespiratory fitness or blood pressure outcomes. A difference was found in body mass changes from baseline to post-intervention in favour of accumulated exercise compared with continuous (MD - 0.92 kg, 95% CI - 1.59 to - 0.25, I2 = 0%; five studies, 211 participants). In subgroup analyses, accumulating > 150 min of weekly exercise in multiple bouts per day resulted in small effects on body fat percentage (combined post-intervention and change from baseline values: MD - 0.87%, 95% CI - 1.71 to - 0.04, I2 = 0%; three studies, 166 participants) compared with 150 min of exercise amassed via single continuous bouts per day. There was a decrease in low-density lipoprotein (LDL) cholesterol with accumulated versus continuous exercise (MD - 0.39 mmol/l, 95% CI - 0.73 to - 0.06, I2 = 23%; two studies, 41 participants). No differences were observed for any other blood biomarker (total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting blood glucose, and fasting insulin).
CONCLUSIONS: There is no difference between continuous and accumulated patterns of exercise in terms of effects on fitness, blood pressure, lipids, insulin and glucose. There is some evidence from a small number of studies that changes in body mass and LDL cholesterol are more favourable following the accumulated condition. Collectively our findings suggest that adults are likely to accrue similar health benefits from exercising in a single bout or accumulating activity from shorter bouts throughout the day. This review will inform public health guidelines for physical activity at the global and national levels (PROSPERO 2016 CRD42016044122).
OBJECTIVE: The purpose of this systematic review was to describe studies examining rehabilitation for people with osteoarthritis (OA) and to summarize findings from selected key systematic reviews (SRs) and randomized controlled trials (RCTs).
DESIGN: A systematic search was performed using Pubmed, Embase and Cochrane databases from April 1
RESULTS: From 1211 articles, 80 articles met the eligibility criteria including 21 SRs and 61 RCTs. The median of the methodological quality of the SRs and RCTs was 7 (2-9) and 6 (3-10), respectively. The studies were grouped into several themes, covering the most important rehabilitation fields.
CONCLUSIONS: Striking is the small number of studies investigating another joint (18%) than the knee (82%). Exercise is the most common treatment evaluated and should be accompanied with education to effectuate a behavioural change in physical activity of people with OA. No new insights in the field of braces (or orthoses) and in the field of acupuncture were found.
The main clinical manifestations of knee osteoarthritis are pain, swelling, stiffness, and limited activity, which have a serious impact on the life of patients. Exercise therapy can effectively improve the related symptoms of patients with knee osteoarthritis. This paper uses the method of network meta-analysis to compare the efficacy of different exercise types in the treatment of knee osteoarthritis.
METHODS:
CNKI, WanFang, PubMed, Embase, Cochrane Library, Web of Science, Scopus, Ebsco, SinoMed, and UpToDate were searched with Chinese search terms “knee osteoarthritis, exercise therapy” and English search terms “knee osteoarthritis, exercise”. Randomized controlled trials on the application of different exercise types in patients with knee osteoarthritis from October 2013 to October 2023 were collected. The outcome measures included visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index score, Timed Up and Go test, and 36-item short form health survey. Literature quality analysis was performed using the Cochrane Manual recommended tool for risk assessment of bias in randomized controlled trials. Two researchers independently completed the data collection, collation, extraction and analysis. RevMan 5.4 and Stata 18.0 software were used to analyze and plot the obtained data.
RESULTS:
A total of 29 articles with acceptable quality were included, involving 1 633 patients with knee osteoarthritis. The studies involved four types of exercise: aerobic training, strength training, flexibility/skill training, and mindfulness relaxation training. (1) The results of network meta-analysis showed that compared with routine care/health education, aerobic training could significantly improve pain symptoms (SMD=-3.26, 95%CI:-6.33 to-0.19, P < 0.05); strength training (SMD=-0.79, 95%CI:-1.34 to-0.23, P < 0.05) and mindfulness relaxation training (SMD=-0.79, 95%CI:-1.23 to-0.34, P < 0.05) could significantly improve the function of patients. Aerobic training (SMD=-1.37, 95%CI:-2.24 to-0.51, P < 0.05) and mindfulness relaxation training (SMD=-0.41, 95%CI:-0.80 to-0.02, P < 0.05) could significantly improve the functional mobility of patients. Mindfulness relaxation training (SMD=0.70, 95%CI: 0.21-1.18, P < 0.05) and strength training (SMD=0.42, 95%CI: 0.03-0.81, P < 0.05) could significantly improve the quality of life of patients. (2) The cumulative probability ranking results were as follows: pain: aerobic training (86.6%) > flexibility/skill training (60.1%) > strength training (56.8%) > mindfulness relaxation training (34.7%) > routine care/health education (11.7%); Knee function: strength training (73.7%) > mindfulness relaxation training (73.1%) > flexibility/skill training (56.1%) > aerobic training (39.9%) > usual care/health education (7.6%); Functional mobility: aerobic training (94.7%) > mindfulness relaxation training (65.5%) > strength training (45.1%) > flexibility/skill training (41.6%) > routine care/health education (3.2%); Quality of life: mindfulness relaxation training (91.3%) > strength training (68.0%) > flexibility/skill training (44.3%) > aerobic training (34.0%) > usual care/health education (12.3%).
