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Am Fam Physician. 2004;70(5):865-866

Effect of Exercise Intensity on Osteoarthritis

Clinical Question

Does the intensity of therapeutic exercise for osteoarthritis matter?

Evidence-Based Answer

Although land-based exercise improves physical function, there is no evidence that high-intensity cycling offers benefits over low-intensity cycling for patients with osteoarthritis of the knee.

Practice Pointers

An earlier Cochrane review1 (last updated in 2001) of 17 studies with 2,562 participants found that group and individual exercise were effective in reducing pain (standardized mean difference [SMD], 0.39; 95 percent confidence interval [CI], 0.30 to 0.47) and improving function (SMD 0.31; 95 percent CI, 0.23 to 0.39).

Brosseau and colleagues reviewed the literature to determine whether the intensity of exercise had an effect on pain reduction. The authors identified only three studies in which adults with osteoarthritis who were assigned to different intensities of exercise were followed. One study did not report statistical data, and one had a dropout rate of more than 20 percent, leaving only a single, randomized, moderate-quality study2 for review.

Adults with osteoarthritis of the knee were assigned to low-intensity (40 percent of heart rate reserve) or high-intensity (70 percent of heart rate reserve) stationary cycling. They had three one-hour sessions per week for 10 weeks. At the end of the study period, improvement in pain and functional capacity was similar between the groups.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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