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MSK Pain – Improves physical function

Improves physical function

Evidence summary

A large volume of evidence from systematic reviews of high-quality RCTs shows consistent improvements in physical function following physical activity interventions in those with hip and knee osteoarthritis [1–9]. Interventions included aerobic exercises, strengthening exercises and a combination of both. These benefits are sustained versus controls beyond 6 months [1,6,10,11]. The NNT to improve physical function using the ESCAPE-pain (Enabling Self-management and Coping with Arthritis Pain using Exercise) programme in those with knee osteoarthritis has been shown to be 3.7 immediately after the programme, and 6.7 at 30 months [11]. A combination of strengthening, aerobic and flexibility exercises has been shown to have the greatest effect on physical function [8]. A systematic review looking at the safety of physical activity interventions in those with knee osteoarthritis found that no studies reported lower physical function in the physical activity group versus controls [12].

Quality of evidence

High quality

Strength of recommendation



Regular physical activity can help improve physical function in those with osteoarthritis of the hip or knee.


1         Fransen M, McConnell S, Harmer AR, et al.Exercise for osteoarthritis of the knee: A Cochrane systematic review. Br J Sports Med2015;49:1554–7. doi:10.1136/bjsports-2015-095424

2         Fransen M, McConnell S, Hernandez-Molina G, et al.Exercise for osteoarthritis of the hip. Cochrane Database Syst RevPublished Online First: 22 April 2014. doi:10.1002/14651858.CD007912.pub2

3         Anwer S, Alghadir A, Brismée J-M. Effect of Home Exercise Program in Patients With Knee Osteoarthritis. J Geriatr Phys Ther2016;39:38–48. doi:10.1519/JPT.0000000000000045

4         Li Y, Su Y, Chen S, et al.The effects of resistance exercise in patients with knee osteoarthritis: A systematic review and meta-analysis. Clin Rehabil2016;30:947–59. doi:10.1177/0269215515610039

5         Tanaka R, Ozawa J, Kito N, et al.Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil2013;27:1059–71. doi:10.1177/0269215513488898

6         Fernandopulle S, Perry M, Manlapaz D, et al.Effect of Land-Based Generic Physical Activity Interventions on Pain, Physical Function, and Physical Performance in Hip and Knee Osteoarthritis. Am J Phys Med Rehabil2017;0:1. doi:10.1097/PHM.0000000000000736

7         Sampath KK, Mani R, Miyamori T, et al.The effects of manual therapy or exercise therapy or both in people with hip osteoarthritis: A systematic review and meta-analysis. Clin Rehabil2015;30:1141–55. doi:10.1177/0269215515622670

8         Uthman OA, van der Windt DA, Jordan JL, et al.Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. Bmj2013;347:f5555–f5555. doi:10.1136/bmj.f5555

9         Babatunde OO, Jordan JL, Van Der Windt DA, et al.Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One2017;12:1–30. doi:10.1371/journal.pone.0178621

10       Hurley M V., Walsh NE, Mitchell HL, et al.Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial. Arthritis Care Res2007;57:1211–9. doi:10.1002/art.22995

11       Hurley M V., Walsh NE, Mitchell H, et al.Long-Term outcomes and costs of an integrated rehabilitation program for chronic knee pain: A pragmatic, cluster randomized, controlled trial. Arthritis Care Res2012;64:238–47. doi:10.1002/acr.20642

12       Quicke JG, Foster NE, Thomas MJ, et al.Is long-term physical activity safe for older adults with knee pain?: A systematic review. Osteoarthr Cartil2015;23:1445–56. doi:10.1016/j.joca.2015.05.002