Objective This study aims to evaluate the time point and magnitude of peak effectiveness of exercise and the effects of various exercise modalities for osteoarthritis (OA) symptoms and to identify factors that significantly affect the effectiveness of exercise. Design Pharmacodynamic model-based meta-analysis (MBMA). Data sources Embase, PubMed, Cochrane Library, Web of Science and Scopus were searched for randomised controlled trials (RCTs) examining the effect of exercise for OA from inception to 20 November 2023. Eligibility criteria RCTs of exercise interventions in patients with knee, hip or hand OA, using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales or Visual Analogue Scale (VAS) pain scores as outcome measures, were included. The minimum clinically important difference (MCID) for WOMAC total, pain, stiffness, function and VAS pain was 9.0, 1.6, 0.8, 5.4 and 0.9, respectively. Results A total of 186 studies comprising 12 735 participants with symptomatic or radiographic knee, hip or hand OA were included. The effectiveness of exercise treatments peaked at 1.6–7.2 weeks after initiation of exercise interventions. Exercise was more effective than the control, but the differences in the effects of exercise compared with control on all outcomes were only marginally different with the MCID (7.5, 1.7, 1.0, 5.4 and 1.2 units for WOMAC total, pain, stiffness, function and VAS pain, respectively). During a 12-month treatment period, local exercise (strengthening muscles and improving mobilisations of certain joints) had the best effectiveness (WOMAC pain decreasing by 42.5% at 12 weeks compared with baseline), followed by whole-body plus local exercise. Adding local water-based exercise (eg, muscle strengthening in warm water) to muscle strengthening exercise and flexibility training resulted in 7.9, 0.5, 0.7 and 8.2 greater improvements in the WOMAC total score, pain, stiffness and function, respectively. The MBMA models revealed that treatment responses were better in participants with more severe baseline symptom scores for all scales, younger participants for the WOMAC total and pain scales, and participants with obesity for the WOMAC function. Subgroup analyses revealed participants with certain characteristics, such as female sex, younger age, knee OA or more severe baseline symptoms on the WOMAC pain scale, benefited more from exercise treatment. Conclusion Exercise reaches peak effectiveness within 8 weeks and local exercise has the best effectiveness, especially if local water-based exercise is involved. Patients of female sex, younger age, obesity, knee OA or more severe baseline symptoms appear to benefit more from exercise treatment than their counterparts. Data are available on reasonable request. All data generated and analysed during this study are included in this published article. The data presented in the article may be requested by consulting the corresponding authors.

中文翻译：

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运动对骨关节炎症状的有效性和相关因素的定量分析：基于药效学模型的荟萃分析


目的 本研究旨在评估运动高峰效果的时间点和幅度以及各种运动方式对骨关节炎 （OA） 症状的影响，并确定显着影响运动效果的因素。设计 基于药效学模型的荟萃分析 （MBMA）。数据来源 Embase、PubMed、Cochrane Library、Web of Science 和 Scopus 检索了随机对照试验 （RCT），这些试验研究了从开始到 2023 年 11 月 20 日运动对 OA 的影响。纳入膝关节、髋关节或手部 OA 患者运动干预的 RCT，使用西安大略大学和麦克马斯特大学骨关节炎指数 （WOMAC） 分量表或视觉模拟量表 （VAS） 疼痛评分作为结局指标。WOMAC 总量、疼痛、僵硬、功能和 VAS 疼痛的最小临床重要差异 （MCID） 分别为 9.0 、 1.6 、 0.8 、 5.4 和 0.9。结果 共纳入 186 项研究，涉及 12 735 名有症状或影像学上患有膝、髋或手 OA 的参与者。运动治疗的有效性在运动干预开始后 1.6-7.2 周达到峰值。运动比对照组更有效，但运动与对照组相比对所有结局的影响差异与 MCID 仅略有不同 （WOMAC 总量、疼痛、僵硬、功能和 VAS 疼痛分别为 7.5、1.7、1.0、5.4 和 1.2 个单位）。在 12 个月的治疗期间，局部锻炼（加强肌肉和改善某些关节的活动）效果最好（与基线相比，12 周时 WOMAC 疼痛减轻了 42.5%），其次是全身加局部锻炼。 在肌肉强化运动和柔韧性训练中加入局部水上运动（例如，温水中肌肉强化）导致 WOMAC 总分、疼痛、僵硬和功能分别改善 7.9、0.5、0.7 和 8.2。MBMA 模型显示，所有量表基线症状评分更严重的参与者、WOMAC 总量表和疼痛量表的年轻参与者以及 WOMAC 功能肥胖参与者的治疗反应更好。亚组分析显示，具有某些特征的参与者，例如女性、年轻、膝关节 OA 或 WOMAC 疼痛量表上更严重的基线症状，从运动治疗中受益更多。结论 运动在 8 周内达到最佳效果，局部锻炼效果最好，尤其是涉及局部水上运动时。女性、年轻、肥胖、膝关节 OA 或更严重基线症状的患者似乎比同行从运动治疗中获益更多。数据可应合理要求提供。本研究期间生成和分析的所有数据都包含在这篇已发表的文章中。文章中提供的数据可以通过咨询通讯作者来索取。