• Tom Arild Torstensen, Håvard Østerås, Riccardo LoMartire, Georg Mørtvedt Rugelbak, GrootenWilhelmus Johannes AndreasWJA0000-0002-1697-9781Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Women's Health and Allied Health Professionals Theme, Medical Unit Occupa, and Björn Olov Äng.
• Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden, and Holten Institute, Stockholm, Sweden (T.A.T.).
• Ann. Intern. Med. 2023 Feb 1; 176 (2): 154165154-165.

BackgroundThe benefits of exercise in patients with knee osteoarthritis are well documented, but the optimal exercise dose remains unknown.ObjectiveTo compare high-dose versus low-dose exercise therapy with regard to knee function, pain, and quality of life (QoL) in patients with long-term symptomatic knee osteoarthritis.DesignA Swedish and Norwegian multicenter randomized controlled superiority trial with multiple follow-ups up to 12 months after the intervention. (ClinicalTrials.gov: NCT02024126).SettingPrimary health care facilities.Patients189 patients with diagnosed knee osteoarthritis and a history of pain and decreased knee function were assigned to high-dose therapy (n = 98; 11 exercises; 70 to 90 minutes) or low-dose therapy (n = 91; 5 exercises; 20 to 30 minutes).InterventionPatient-tailored exercise programs according to the principles of medical exercise therapy. Global (aerobic), semiglobal (multisegmental), and local (joint-specific) exercises were performed 3 times a week for 12 weeks under supervision of a physiotherapist.MeasurementsThe Knee Injury and Osteoarthritis Outcome Score (KOOS) was measured biweekly during the 3-month intervention period and at 6 and 12 months after the intervention. The primary end point was the mean difference in KOOS scores between groups at the end of the intervention (3 months). Secondary outcomes included pain intensity and QoL. The proportion of patients with minimal clinically important changes in primary and secondary outcomes was compared between groups.ResultsBoth groups improved over time, but there were no benefits of high-dose therapy in most comparisons. One exception was the KOOS score for function in sports and recreation, where high-dose therapy was superior at the end of treatment and at 6-month follow-up. A small benefit in QoL at 6 and 12 months was also observed.LimitationThere was no control group that did not exercise.ConclusionThe results do not support the superiority of high-dose exercise over low-dose exercise for most outcomes. However, small benefits with high-dose exercise were found for knee function in sports and recreation and for QoL.Primary Funding SourceSwedish Rheumatic Fund.

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