Can exercise interventions reduce external knee adduction moment during gait? A systematic review and meta-analysis

Daniel F Cottmeyer; Brian H Hoang; Mark A Lyle; Gordon L Warren; Liang-Ching Tsai

doi:10.1016/j.clinbiomech.2023.106064

Can exercise interventions reduce external knee adduction moment during gait? A systematic review and meta-analysis

Clin Biomech (Bristol, Avon). 2023 Oct:109:106064. doi: 10.1016/j.clinbiomech.2023.106064. Epub 2023 Aug 9.

Authors

Daniel F Cottmeyer¹, Brian H Hoang¹, Mark A Lyle², Gordon L Warren¹, Liang-Ching Tsai³

Affiliations

¹ Department of Physical Therapy, Georgia State University, 145 Piedmont Ave SE, Atlanta, GA 30303, USA.
² Division of Physical Therapy, Emory University, 1462 Clifton Rd, Atlanta, GA 30322, USA.
³ Department of Physical Therapy, Georgia State University, 145 Piedmont Ave SE, Atlanta, GA 30303, USA. Electronic address: ltsai@gsu.edu.

PMID: 37672821
DOI: 10.1016/j.clinbiomech.2023.106064

Abstract

Background: An increased external knee adduction moment has been identified as a factor contributing to the progression of medial knee osteoarthritis. Interventions that reduce knee adduction moment may help prevent knee osteoarthritis onset and progression. While exercise interventions have been commonly used to treat knee osteoarthritis, whether exercises can modulate knee adduction moment in knee osteoarthritis patients remains unknown. This systematic review and meta-analysis aimed to determine if exercise interventions are effective in reducing knee adduction moment during gait.

Methods: Study reports published through May 2023 were screened for pre-specified inclusion/exclusion criteria. Nine studies met the eligibility criteria and yielded 24 effect sizes comparing the reduction in knee adduction moment of the exercise intervention groups to the control groups. Moderator/experimental variables concerning characteristics of the exercise interventions and included subjects (e.g., sex, BMI, type of exercise, muscle group targeted, training volume, physical therapist supervision) that may contribute to variation among studies were explored through subgroup analysis and meta-regression.

Findings: The effect of exercise intervention on modulating knee adduction moment during gait was no better than control (ES = -0.004, P = 0.946). Sub-group analysis revealed that the effect sizes of studies containing only females (positive exercise effect) were significantly greater than studies containing both males and females.

Interpretation: Exercise may not be effective in reducing knee adduction moment during gait. Clinicians aiming to decrease knee adduction moment in patients with medial knee osteoarthritis should consider alternative treatment options. Exploring the underlying mechanism(s) regarding a more positive response to exercises in females may help design more effective exercise interventions.

Keywords: Exercise; Gait; Knee; Knee adduction moment; Osteoarthritis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Biomechanical Phenomena
Exercise Therapy
Female
Gait / physiology
Humans
Knee
Knee Joint / physiology
Male
Osteoarthritis, Knee* / therapy