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CliniCal Features 52 © The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847 ResearchSHARE ® : www.research-share.com • Permissions: [email protected] • Reprints: [email protected] A Comprehensive Review of the Effectiveness of Different Exercise Programs for Patients with Osteoarthritis Yvonne M. Golightly, PT, PhD 1,2,3 Kelli D. Allen, PhD 4,5 Dennis J. Caine, PhD 6 1 Research Assistant Professor, Department of Epidemiology, University of North Carolina, Chapel Hill, NC; 2 Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC; 3 Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC; 4 Associate Research Professor, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC; 5 Research Health Scientist, Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC; 6 Professor and Interim Dean, College of Education and Human Development, University of North Dakota, Grand Forks, ND Correspondence:Yvonne M. Golightly, PT, PhD, University of North Carolina, Thurston Arthritis Research Center, 3300 Thurston Building, Campus Box No. 7280, Chapel Hill, NC 27599-7280. Tel: 919-843-6618 Fax: 919-966-1739 E-mail: [email protected] DOI: 10.3810/psm.2012.11.1988 Abstract: ([HUFLVH LV UHFRPPHQGHG DV D ¿UVWOLQH FRQVHUYDWLYH LQWHUYHQWLRQ DSSURDFK IRU RVWHRDUWKULWLV 2$ $ ZLGH UDQJH RI H[HUFLVH SURJUDPV DUH DYDLODEOH DQG VFLHQWL¿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¿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eywords: RVWHRDUWKULWLV H[HUFLVH SK\VLFDO DFWLYLW\ WUHDWPHQW RXWFRPH HIIHFWLYHQHVV Introduction 2VWHRDUWKULWLV 2$ LV WKH PRVW FRPPRQ IRUP RI DUWKULWLV DQG WKH OHDGLQJ FDXVH RI GLVDELO LW\ DPRQJ ROGHU DGXOWV LQ WKH 8QLWHG 6WDWHV 2VWHRDUWKULWLV LV DVVRFLDWHG ZLWK VLJQL¿FDQW SDLQ DQG LW OLPLWV PRELOLW\ EDVLF GDLO\ DFWLYLWLHV DQG TXDOLW\ RI OLIH ±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

A Comprehensive Review of the Effectiveness of Different Exercise … · 2020. 3. 6. · aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA

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Page 1: A Comprehensive Review of the Effectiveness of Different Exercise … · 2020. 3. 6. · aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA

C l i n i C a l F e at u r e s

52 © The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

A Comprehensive Review of the Effectiveness of Different Exercise Programs for Patients with Osteoarthritis

Yvonne M. Golightly, PT, PhD1,2,3 Kelli D. Allen, PhD4,5 Dennis J. Caine, PhD6

1Research Assistant Professor, Department of Epidemiology, University of North Carolina, Chapel Hill, NC; 2Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC; 3Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC; 4Associate Research Professor, Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC; 5Research Health Scientist, Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC; 6Professor and Interim Dean, College of Education and Human Development, University of North Dakota, Grand Forks, ND

Correspondence: Yvonne M. Golightly, PT, PhD,University of North Carolina,Thurston Arthritis Research Center,3300 Thurston Building,Campus Box No. 7280,Chapel Hill, NC 27599-7280.Tel: 919-843-6618Fax: 919-966-1739E-mail: [email protected]

DOI: 10.3810/psm.2012.11.1988

Abstract:�([HUFLVH� LV� UHFRPPHQGHG� DV� D�¿UVW�OLQH� FRQVHUYDWLYH� LQWHUYHQWLRQ� DSSURDFK� IRU�RVWHRDUWKULWLV��2$���$�ZLGH�UDQJH�RI�H[HUFLVH�SURJUDPV�DUH�DYDLODEOH�DQG�VFLHQWL¿F�HYLGHQFH�LV�QHFHVVDU\�IRU�FKRRVLQJ�WKH�RSWLPDO�VWUDWHJ\�RI�WUHDWPHQW�IRU�HDFK�SDWLHQW��7KH�SXUSRVH�RI�WKLV�UHYLHZ�LV�WR�GLVFXVV�WKH�HIIHFWLYHQHVV�RI�GLIIHUHQW�W\SHV�RI�H[HUFLVH�SURJUDPV�IRU�2$�EDVHG�RQ�WULDOV��V\VWHPDWLF�UHYLHZV��DQG�PHWD�DQDO\VHV�LQ�WKH�OLWHUDWXUH��3XEOLFDWLRQV�IURP�-DQXDU\������WR�-XO\������ZHUH�VHDUFKHG�LQ���HOHFWURQLF�GDWDEDVHV�XVLQJ�WKH�WHUPV�RVWHRDUWKULWLV��H[HUFLVH��H[HUFLVH�SURJUDP��HIIHFWLYHQHVV��DQG�WUHDWPHQW�RXWFRPH��6WURQJ�HYLGHQFH�VXSSRUWV�WKDW�DHURELF�DQG�VWUHQJWKHQLQJ�H[HUFLVH�SURJUDPV��ERWK�ODQG��DQG�ZDWHU�EDVHG��DUH�EHQH¿FLDO�IRU�LPSURYLQJ�SDLQ�DQG�SK\VLFDO�IXQFWLRQ�LQ�DGXOWV�ZLWK�PLOG�WR�PRGHUDWH�NQHH�DQG�KLS�2$��$UHDV�WKDW�UHTXLUH�IXUWKHU� UHVHDUFK� LQFOXGH�H[DPLQDWLRQ�RI� WKH� ORQJ�WHUP�HIIHFWV�RI�H[HUFLVH�SURJUDPV�IRU�2$��EDODQFH�WUDLQLQJ�IRU�2$��H[HUFLVH�SURJUDPV�IRU�VHYHUH�2$��WKH�HIIHFW�RI�H[HUFLVH�SURJUDPV�RQ�SURJUHVVLRQ�RI�2$��WKH�HIIHFWLYHQHVV�RI�H[HUFLVH�IRU�MRLQW�VLWHV�RWKHU�WKDQ�WKH�NQHH�RU�KLS��DQG�WKH�HIIHFWLYHQHVV�RI�H[HUFLVH�IRU�2$�E\�VXFK�IDFWRUV�DV�DJH��VH[��DQG�REHVLW\��(IIRUWV�WR�LPSURYH�DGKHUHQFH�WR�HYLGHQFH�EDVHG�H[HUFLVH�SURJUDPV�IRU�2$�DQG�WR�SURPRWH�WKH�GLVVHPLQDWLRQ�DQG�LPSOHPHQWDWLRQ�RI�WKHVH�SURJUDPV�DUH�FUXFLDO�

Keywords:�RVWHRDUWKULWLV��H[HUFLVH��SK\VLFDO�DFWLYLW\��WUHDWPHQW�RXWFRPH��HIIHFWLYHQHVV

Introduction

2VWHRDUWKULWLV��2$��LV�WKH�PRVW�FRPPRQ�IRUP�RI�DUWKULWLV�DQG�WKH�OHDGLQJ�FDXVH�RI�GLVDELO�LW\�DPRQJ�ROGHU�DGXOWV�LQ�WKH�8QLWHG�6WDWHV���2VWHRDUWKULWLV�LV�DVVRFLDWHG�ZLWK�VLJQL¿FDQW�SDLQ��DQG�LW�OLPLWV�PRELOLW\��EDVLF�GDLO\�DFWLYLWLHV��DQG�TXDOLW\�RI�OLIH��±��$FFRUGLQJ�WR�GDWD�IURP������WR�������DW�OHDVW����PLOOLRQ�RI�SHRSOH�LQ�WKH�8QLWHG�6WDWHV�KDYH�2$���2YHU�WKH�QH[W�IHZ�GHFDGHV��VXEVWDQWLDO�LQFUHDVHV�DUH�H[SHFWHG�LQ�WKH�LQFLGHQFH��KHDOWK�LPSDFW��DQG�HFRQRPLF�FRQVHTXHQFHV�RI�2$��ODUJHO\�GXH�WR�WKH�DJLQJ�RI�WKH�86�SRSXODWLRQ�DQG�WKH�REHVLW\�HSLGHPLF�����EHFDXVH�ROGHU�DJH�DQG�H[FHVV�ERG\�ZHLJKW�DUH�ERWK�ZHOO�UHFRJQL]HG�ULVN�IDFWRUV�IRU�WKH�GHYHORSPHQW�RI�2$��HVSHFLDOO\�2$�RI�WKH�NQHH��7KH�EXUGHQ�RI�2$�RI�WKH�NQHH�DORQH�LV�SDUWLFXODUO\�KLJK�DQG�LV�RQ�WKH�ULVH�����$SSUR[LPDWHO\���������SULPDU\�WRWDO�NQHH�DUWKURSODVW\��7.$��SURFHGXUHV��D�FRPPRQ�SURFHGXUH�LQ�SDWLHQWV�ZLWK�VHYHUH�2$�RI�WKH�NQHH��DUH�SHUIRUPHG�DQQXDOO\�LQ�WKH�8QLWHG�6WDWHV��DQG�DQQXDO�7.$�YROXPH�LQFUHDVHG��������LQ�WKH�86�0HGLFDUH�SRSXODWLRQ�EHWZHHQ������DQG������8�)XUWKHUPRUH��LQ���������������KRVSLWDO�GLVFKDUJHV�DQG�����ELOOLRQ�LQ�KRVSLWDO�FKDUJHV�ZHUH�GXH�WR�2$�RI�WKH�NQHH��

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Page 2: A Comprehensive Review of the Effectiveness of Different Exercise … · 2020. 3. 6. · aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA

Exercise Programs for OA

© The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847 53

ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

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Materials and Methods

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Land-Based Exercise Programs for OAMixed Land-Based Exercise Programs/DQG�EDVHG�H[HUFLVH�SURJUDPV�KDYH�LQFOXGHG�DHURELF�RU�HQGXU�DQFH�DFWLYLWLHV� �HJ��ZDONLQJ�DQG�F\FOLQJ��� VWUHQJWK� WUDLQLQJ�ZLWK�DQG�ZLWKRXW�ZHLJKWV��DQG�EDODQFH�WUDLQLQJ��7KUHH�V\V�WHPDWLF�UHYLHZV�RI�5&7V�KDYH�EURDGO\�H[DPLQHG�WKH�HIIHFWV�RI�ODQG�EDVHG�H[HUFLVH�SURJUDPV�RQ�SDLQ�DQG�SK\VLFDO�IXQFWLRQ�UHODWHG�WR�NQHH�DQG�KLS�2$��7DEOH�����7KH�UHVXOWV�RI�D�V\VWHP�DWLF�UHYLHZ�RI���5&7V�FRPSDULQJ�ODQG�EDVHG�H[HUFLVH�ZLWK�QRQH[HUFLVH�DPRQJ�SHRSOH�ZLWK�KLS�2$�VKRZHG�RQO\�VPDOO�LPSURYHPHQW�LQ�SDLQ��VWDQGDUGL]HG�PHDQ�GLIIHUHQFH�>60'@������������&,������±������������EXW�QR�EHQH¿FLDO�FKDQJH�LQ�VHOI�UHSRUWHG�IXQFWLRQ��60'��−����������&,��−�����WR��������7KH�DXWKRUV�FRPPHQWHG�WKDW�WKH�OLPLWHG�QXPEHU�DQG�VPDOO�VDPSOH�VL]H�RI�WKH�LQFOXGHG�5&7V��DORQJ�ZLWK�WKH�KHWHURJHQHLW\�RI�WKH�VWXGLHV��PLQLPL]H�WKH�LQWHUSUHWDELOLW\�RI�WKHVH�UHVXOWV�

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05_Golightly.indd 53 12/28/12 11:18 AM

Page 3: A Comprehensive Review of the Effectiveness of Different Exercise … · 2020. 3. 6. · aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA

Golightly et al

54 © The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

Table 1. Systematic Reviews of Exercise as a Treatment for OA

Study Study Purpose Design and

Procedures

Number of

Studies Reviewed

Number of

Participants

Types of

Intervention and

Duration

Study Results and

Conclusions

Mixed Land-Based Exercise Programs

Fransen et al21 To determine whether land-based exercise reduced joint pain or improved function in people with hip OA when compared with no exercise.

Meta-analysis; systematic review of 5 electronic databases from 1966–2008. All RCTs recruited people with hip OA and land-based therapeutic exercise groups were compared with nonexercise groups.

5 RCTs, but only 1 exclusively recruited people with hip OA. The other 4 RCTs also recruited participants with knee OA.

204 with hip OA for pain outcomes; 187 with hip OA for physical function outcomes.

Interventions were 6–12 wks. Class-based exercise interventions included strengthening, Tai Chi, and resistance. Classes were conducted 1–3 times per week.

Small improvement in pain (SMD, 0.38; 95% CI, 0.09–0.67). No change in self-reported function (SMD, 0.02; 95% CI, −0.31 to 0.28). Important limitations were the small number of studies with the small sample for this area of research.

Fransen and McConnell23

To determine whether land-based exercise reduced joint pain or improved function in people with knee OA when compared with no exercise.

Meta-analysis; systematic review of 5 electronic databases up until December 2007.

32 RCTs 3616 subjects with knee pain data and 3719 subjects with self-reported physical function data.

Programs were either delivered individually or in a class-based format, and most were home programs. Programs ranged from straight leg raises and mostly aerobic walking to very complex, comprehensive programs (manual therapy, strengthening, balance training, and Tai Chi). Study duration ranged from 6–72 wks with sessions occurring 2–4 times per week.

Land-based exercise programs were EHQHÀFLDO��60'��������95% CI, 0.30–0.50; SMD, 0.37; 95% CI, 0.25–0.49) for physical function. Providing a greater number of directly supervised sessions (! 12 visits) improved knee pain and physical function outcomes.

Roddy et al24 To compare aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA.

Meta-analysis of 5 electronic databases and the Cochrane Central Register of Controlled Trials (searched 1966–2003) for RCTs of subjects with knee OA.

13 RCTs total. 3 studies included an aerobic intervention, 9 studies included home-based strengthening exercises, and 1 study combined aerobic walking with a home-based strengthening program.

156 subjects from aerobic studies and 1709 subjects from strength training trials.

Interventions were 8–24 weeks for aerobic walking and 8 wks–2 yrs for strengthening.

Pooled ES for pain: 0.52 for aerobic walking (95% CI, 0.34–0.70) and 0.32 for strengthening (95% CI, 0.23–0.41). Pooled ES for disability: 0.46 for aerobic walking (95% CI, 0.25–0.67) and 0.32 for strengthening (95% CI, 0.23–0.41). Both aerobic walking and home-based quadriceps strengthening exercises were effective in reducing pain and disability in knee OA.

Strength Training Programs

Liu and Latham29

To assess the effectiveness of PRT in older people.

Systematic review searching 8 electronic databases (1966–2008) plus reference lists of articles. Conference abstracts were reviewed and authors were contacted.

RCTs reporting physical outcomes of PRT for older people. 121 trials ZHUH�LGHQWLÀHG��DQG�6 had participants with knee or hip OA.

503 participants with knee or hip OA.

PRT was performed 2–3 times per week and at a high intensity.

Participants with OA reported a reduction in pain following PRT (SMD, −0.30; 95% CI, −0.487 to −0.13).

(Continued)

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Table 1. (Continued)

Study Study Purpose Design and

Procedures

Number of

Studies Reviewed

Number of

Participants

Types of

Intervention and

Duration

Study Results and

Conclusions

Latham and Liu30

To determine the effectiveness of PRT in older adults with OA.

Meta-analysis with systematic review of 9 databases.

8 RCTs. 7 trials of patients (mean age, 65) with knee OA and 1 trial included patients with hip and knee OA.

907 participants with 20–295 people in each study.

Moderate- to high-intensity programs that included 1–9 exercises. In 7 studies, participants exercised 3 times per week; 1study had partici-pants exercise 5 times per week. Duration of the programs ranged from 6–72 wks.

Reduced pain (SMD, −0.35; 95% CI, −0.52 to −0.18), improved function (SMD 0.33, 95% CI, 0.18, 0.49), and improved leg extensor strength (SMD, 0.33; 95% CI, 0.12–0.54) for PRT compared with nonstrength training control groups.

Pelland et al38 To determine the effectiveness of PRT programs in adults with OA.

Meta-analysis; a systematic review of 3 databases up to and including 2004; included RCTs of strengthening exercises and participants with OA.

21 RCTs 2325 patients with a primary diagnosis of OA.

Exercise types: isometric, isotonic, isokinetic, concentric, concentric/eccentric, dynamic; alone or with other exercises (stretching, ROM); facility-based, home-based, or both.

Strengthening exercises improved pain, range of motion, strength, and functional status in patients with OA. The combination RI�MRLQW�VSHFLÀF�strengthening with general strength and pro-gression of the program were key components.

Balance and Neuromuscular Training

Silva et a146 To examine the effectiveness of exercise on balance in women with OA.

Systematic review; 6 electronic databases and the Cochrane Collaboration RCTs published 2000–2010.

9 RCTs 833 participants Exercise programs included aerobic exercise and strength training, Tai Chi, hydro-therapy, vibrating plat-form exercise, balance exercises, and educa-tional programs.

Interventions ran 4 wks to 18 mo and a wide range of pain and bal-ance assessments were used. Overall, balance in women with knee OA improved following exercise.

Smith et al59 To determine the effectiveness of propriocep-tive exercises for knee OA.

Meta-analysis; systematic review of 7 published and 4 unpublished trials/registries databases.

7 RCTs comparing a proprioceptive exer-cise program with a nonproprioceptive exercise program or nontreatment control for adults with OA.

560 patients with mean age of 63; 203 males and 357 females.

All proprioceptive exercises were weight-bearing, based on functional activities (ie, stepping, standing, walking, or balancing). Nonproprioceptive exercise programs were lower extremity exercises. Duration of the programs was 4–8 wks in duration.

Proprioceptive exercises VLJQLÀFDQWO\�LPSURYHG�functional outcomes compared with non-treatment (P " 0.02). Outcomes were similar between proprioceptive and nonproprioceptive programs except results were better for the proprioceptive programs for joint position sense-related measurements (ie, timed walk over uneven ground [P = 0.03] and joint position angula-tion error [P " 0.01]).

Water-Based Programs

Bartels et al64 To compare the effectiveness and safety of aquatic-exercise interventions in knee and hip OA.

Meta-analysis; 5 electronic databases were searched (1945–2006).

6 RCTs were LGHQWLÀHG����LQFOXGHG�patients with hip or knee OA (N = 672), 1 RCT had subjects with hip OA only (N = 28), and 1 RCT had subjects with knee OA only (N = 43).

800 participants All types of exercises in therapeutic or heated indoor pool (range of motion, dynamics, aerobics, etc.) were included.

Small-to-moderate effect on function (SMD, 0.26; 95% CI, 0.11–0.42) and a small-to-moderate effect on quality of life (SMD, 0.32; 95% CI, 0.03–0.61).

(Continued)

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56 © The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

Table 1. (Continued)

Study Study Purpose Design and

Procedures

Number of

Studies Reviewed

Number of

Participants

Types of

Intervention and

Duration

Study Results and

Conclusions

Batterham et al72

To examine the effectiveness of aquatic-compared with land-based exercise on function in people with arthritis.

Systematic review of 4 databases with meta-analysis.

10 RCTs compared land with aquatic exercise for adults with rheumatoid or OA. Land-based exercise included any exercise training for strength, endurance, resistance, or aerobic capacity, whether gym or home based.

354 water-based participants, 305 land-based participants, and 113 controls.

7 of the RCTs described the exercises in their land-based and aquatic programs. Duration was 4–18 wks. Aquatic exercise included running, jumping, cycling of the legs and walking, and strengthening exercises (ie, hip and knee ÁH[LRQ�DQG�H[WHQVLRQ��hip adduction and abduction, calf raises, and squats).

Results did not differ for the 2 rehabilitation strategies. The authors suggested that when SHRSOH�KDYH�GLIÀFXOW\�with land-based exercises, aquatic programs may be a good alternative.

Mixed Water-Based and Land-Based Programs

Escalante et al76

To examine the effectiveness and structure of exercise programs on pain in patients with hip and knee OA.

Systematic review of 5 electronic databases.

33 studies total with 22 land-based intervention studies (ie, strengthening, Tai Chi, aerobic), 5 aquatic studies, and 6 mixed-exercise programs.

1507 subjects from land-based studies; 569 subjects from aquatic studies, and 603 subjects from mixed-exercise programs.

Study intervention duration lasted 6–72 wks (most often 8 wks) with 1–7 sessions/wk (most with 3 sessions/wk). 30–60 min sessions, with most at 30 min.

Pain decreased in 80% of strength interventions (ES, 0.01–1.12), 70% of Tai Chi studies (ES, 0.28–1.67), and 80% of the aquatic studies (ES, 0.19–0.72). Pain decreased in 1 of 2 aerobic studies (ES = 1.06). Only 1 of the 6 mixed programs resulted in reduced pain (ES = 0.40).

Escalante et al77

To examine the effectiveness and structure of exercise programs on functional aerobic capacity in individuals with hip and knee OA.

Systematic review of 7 databases.

20 studies; included 19 RCTs and 1 controlled clinical trial.

Total of 2142 subjects: the 19 RCTs included 2093 subjects; controlled clinical trial included 49 subjects.

Interventions included aerobic programs (n = 4), strength programs (n = 2), Tai Chi programs (n = 3) mixed programs (n = 8), and hydrotherapy programs (n = 3). The outcome measure used was the 6-minute walk test.

Functional aerobic capacity improved in Tai Chi program (ES = 0.66; 95% CI, 0.23–1.09), aerobic programs (ES = 0.90; 95% CI, 0.70–1.10), and mixed programs (ES = 0.47, 95% CI, −0.38 to 0.39). Hydrotherapy programs did not improve functional aerobic capacity (ES 0.00; 95% CI, −0.38 to 0.39).

Abbreviations: ES, effect size; OA, osteoarthritis; PRT, progressive resistive training; RCT, randomized controlled trial; SMD, standardized mean difference.

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Exercise Programs for OA

© The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847 59

ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

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Page 9: A Comprehensive Review of the Effectiveness of Different Exercise … · 2020. 3. 6. · aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA

Golightly et al

60 © The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

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Exercise Programs for OA

© The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847 61

ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

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Golightly et al

62 © The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

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Summary

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05_Golightly.indd 62 12/28/12 11:18 AM

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Exercise Programs for OA

© The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847 63

ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]

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Acknowledgments

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Golightly et al

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Page 14: A Comprehensive Review of the Effectiveness of Different Exercise … · 2020. 3. 6. · aerobic walking and home-based quadriceps strengthening exercises in patients with knee OA

Exercise Programs for OA

© The Physician and Sportsmedicine, Volume 40, Issue 4, November 2012, ISSN – 0091-3847 65

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