The level of evidence is downgraded by the risk of bias, inconsistency, and imprecision.
A Cochrane review [Abstract] 1 included 6 studies with a total of 656 subjects that compared high- and low-intensity exercise programs. Five studies exclusively recruited people with symptomatic knee osteoarthritis (620 participants), and one study exclusively recruited people with hip or knee osteoarthritis (36 participants). The majority of the participants were females (70%). No studies evaluated physical activity programs.
Reduced pain was indicated on a 20-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale (MD -0.84, 95% CI -1.63 to -0.04; 4% absolute reduction, 95% CI -8% to 0%; number needed to treat for an additional beneficial outcome (NNTB) 11, 95% CI 14 to 22) and improved physical function on the 68-point WOMAC disability subscale (MD -2.65, 95% CI -5.29 to -0.01; 4% absolute reduction; NNTB 10, 95% CI 8 to 13) immediately at the end of the exercise programs (from 8 to 24 weeks). However, these results are unlikely to be of clinical importance. These small improvements did not continue at longer-term follow-up (up to 40 weeks after the end of the intervention). Only one study reported quality of life (0 to 200 scale; MD 4.3, 95% CI -6.5 to 15.2; 2% absolute reduction).
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