Rheumatology Advance Access originally published online on September 7, 2004
Rheumatology 2005 44(1):67-73; doi:10.1093/rheumatology/keh399
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Rheumatology Vol. 44 No. 1 © British Society for Rheumatology 2004; all rights reserved
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Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus
Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, 1 MRC Epidemiology Resource Centre, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, 2 Interdisciplinary Research Centre in Health, School of Health and Social Sciences, Coventry University, Priory St, Coventry CV1 5FB, 3 Musculoskeletal Research Group, 4th Floor Cookson Building, Framlington Place, University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4HH, 4 Haroldwood Hospital, Gubbins Lane, Romford, Essex RM3 OBE, 5 Langbaurgh PCT, Langbaurgh House, Bow Street, Guisborough, Cleveland TS14 7AA, 6 Primary Care Sciences Research Centre, Keele University, Staffordshire ST5 5BG, 7 Primary Care Rheumatology Society, Northallerton, North Yorkshire DL7 8YG, 8 King's College London, Rehabilitation Research Unit, Dulwich Hospital, East Dulwich Grove, London SE22 8PT, 9 The Centre for Rehabilitation Science, University of Manchester, Oxford Road, Manchester M13 9WL, 10 Department of Medicine, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, 11 Division of Physiotherapy Education, School of Community Health Sciences, University of Nottingham, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, 12 Derbyshire Royal Infirmary, London Rd, Derby DE1 2QY, 13 Craigavon Area Hospital, 68 Lurgan Rd, Portadown, Co Armagh BT63 5QQ, 14 Poole Hospital, Longfleet Road, Poole BH15 2JB, UK.
Correspondence to: E. Roddy, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK. E-mail: edward.roddy{at}nottingham.ac.uk
Objectives. Exercise is an effective and commonly prescribed intervention for lower limb osteoarthritis (OA). Many unanswered questions remain, however, concerning the practical delivery of exercise therapy. We have produced evidence-based recommendations to guide health-care practitioners.
Methods. A multidisciplinary guideline development group was formed from representatives of professional bodies to which OA is of relevance and other interested parties. Each participant contributed up to 10 propositions describing key clinical points regarding exercise therapy for OA of the hip or knee. Ten final recommendations were agreed by the Delphi technique. The research evidence for each was determined. A literature search was undertaken in the Medline, PubMed, EMBASE, PEDro, CINAHL and Cochrane databases. The methodological quality of each retrieved publication was assessed. Outcome data were abstracted and effect sizes calculated. The evidence for each recommendation was assessed and expert consensus highlighted by the allocation of two categories: (1) strength of evidence and (2) strength of recommendation.
Results. The first round of the Delphi process produced 123 propositions. This was reduced to 10 after four rounds. These related to aerobic and strengthening exercise, group versus home exercise, adherence, contraindications and predictors of response. The literature search identified 910 articles; 57 intervention trials relating to knee OA, 9 to hip OA and 73 to adherence. The evidence to support each proposition is presented.
Conclusion. These are the first recommendations for exercise in hip and knee OA to clearly differentiate research evidence and expert opinion. Gaps in the literature are identified and issues requiring further study highlighted.
KEY WORDS: Knee osteoarthritis, Hip osteoarthritis, Exercise, Aerobic exercise, Strengthening exercise, Evidence-based recommendations
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