SUMMARY
The benefits of exercise for the management of OA, particularly knee OA, are evident. Regardless of mode, delivery, or duration, exercise demonstrates small to moderate positive effects for pain relief, function, and disability. Most studies of exercise in OA involve the knee; substantially fewer exist for OA of the hip, spine, or hand. Limited evidence supports the use of other rehabilitation interventions (such as physical modalities and manual therapy), although work in this area is growing. Given the paucity of studies, it has not been possible to determine which populations (based on sex, race, or ethnicity, for example) benefit the most from rehabilitation. Nor have rigorous cost-effectiveness studies been undertaken. Uhlig and colleagues commented on the scarcity of economic analyses on rehabilitative interventions for the full spectrum of arthritic conditions.33 Aspects of the design of studies of non-pharmacologic methods, such as the inability to use a control group and limitations in outcome measures, affect the quality of data and our ability to synthesize them systematically.34 Recent systematic reviews attempted to document the benefits of exercise and identify the dosage that yields the greatest benefits,15, 16 but more rigorous study is needed. In the meantime, it’s clear that exercise is as effective as non-steroidal anti-inflammatory drugs in managing many OA symptoms while having fewer risks. Given the heterogeneity of the exercise programs studied, I recommend viewing exercise as we do medications: each mode has its benefits and risks. As the evidence supporting the use of exercise expands, we may become better able to fully address the question of which mode of exercise, and at what frequency, intensity, and duration, is best for helping our patients with OA. ▼