Clinician Article

Comparing Different Stretching Exercises on Pain, Stiffness, and Physical Function Disability in Older Adults With Knee Osteoarthritis.

  • Zhu GC
  • Chen KM
  • Belcastro F
Arch Phys Med Rehabil. 2024 May;105(5):953-962. doi: 10.1016/j.apmr.2023.07.001. Epub 2023 Jul 17. (Review)
PMID: 37467937
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  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 5/7


OBJECTIVE: To assess and compare the effects of different stretching exercise programs on pain, stiffness, and physical function disability in older adults with knee osteoarthritis (KOA).

DATA SOURCES: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for network meta-analysis (NMA). Relevant randomized controlled trials were identified by searching 7 databases up to December 2022.

STUDY SELECTION: Inclusion criteria included (1) older adults with KOA; (2) intervention included stretching exercises; (3) control groups received no stretching exercise; and (4) outcome measurements included pain, stiffness, or physical function disability. Methodological quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2.

DATA EXTRACTION: NMA was performed using R and MetaInsight, with results presented as a standardized mean difference (SMD) with 95% confidence interval (CI).

DATA SYNTHESIS: We examined 17 studies, and NMA results indicated that proprioceptive neuromuscular facilitation (PNF) stretching, mind-body exercises, and multi-component exercise programs were effective in mitigating pain in older adults with KOA (SMD=2.54 [95% CI: 1.23; 3.84], SMD=1.09 [95% CI: 0.27; 1.92], SMD=0.57 [95% CI: 0.06; 1.09]). Moreover, mind-body exercises and multi-component exercises were the most effective programs in reducing stiffness (SMD=1.31 [95% CI: 0.12; 2.51]) and physical function disability (SMD=1.67 [95% CI: 0.01; 3.33]) in older adults with KOA, respectively.

CONCLUSION: Findings suggest that PNF stretching, mind-body exercises, and multi-component exercises can be incorporated into exercise programs to better mitigate pain, stiffness, and physical function disability in older adults with KOA.

Clinical Comments

Physical Medicine and Rehabilitation

According to this network MA, in adults aged 65 years and older with knee osteoarthritis (KOA), a treatment program including PNF stretching or a mind-body program (e.g., Yoga, Baduanjin, Tai Chi Qigong) incorporating stretching are both effective in reducing pain. Also, compared with controls of receiving only health counseling or an exercise program without stretching, mind-body practices are most effective in improving joint stiffness, and multicomponent exercise programs combining various training regimens for lower limb muscles (e.g., strengthening and stretching) are more effective in improving physical disability. On the other hand, there is limited evidence that conventional static stretching can reduce pain, stiffness, and disability in older adults with KOA. Concerning limits of generalizability of the final results: the number of women participants was significantly higher than the number of men, and fewer studies specifically recruited adults over 65.

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