Exercise therapy for knee-osteartrhritis pain:

Exercise therapy for knee-osteartrhritis pain: 'How does it work'?

Osteoarthritis is the main cause of pain, disability and decreased daily functioning in the elderly affecting over 80% of the population beyond the age 55. International guidelines recommend exercise therapy as the first-choice non-pharmacological treatment for patients with knee-osteoarthritis. Despite the beneficial effects of exercise therapy in patients with knee-osteoarthritis, most guidelines do not provide recommendations on the content of the exercise therapy, highlighting the lack of knowledge regarding the mechanisms of action of exercise therapy. However, peripheral (including inflammation) and brain-orchestrated mechanisms (including endogenous analgesia) are suggested to explain the beneficial effects of exercise in patients with osteoarthritis. 

This study aims to examine anti-inflammation and endogenous analgesia as mediators for the effect of muscle strengthening training and/or behavioral graded activity on pain in patients with knee-osteoarthritis. Therefore, a three-arm randomised controlled trial is established: 12 weeks of muscle strengthening training, behavioral graded activity or control. 

By unravelling the underlying mechanisms of action of exercise therapy in knee-osteoarthritis, exercise therapy programs can be tailored towards specific mechanistic factors and thereby optimizing treatment effects, which will be at a horizon for patients suffering from knee-osteoarthritis.