Exercise for musculoskeletal conditions

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Musculoskeletal conditions frequently have an adverse influence on health and quality of life, and cause more functional limitations than any other group of disorders within the adult population in most developed countries. Estimates from global data indicate that one in four people will experience chronic musculoskeletal pain at some time, and that musculoskeletal conditions are the most commonly reported cause of chronic impairments in the United States. Thus, musculoskeletal conditions are considered to be an international public health issue. Exercise therapy is considered an important component of the treatment of musculoskeletal conditions with the aims of: reducing pain; improving joint stability, functional ability, quality of life and aerobic capacity; and preventing bone loss and fractures.

This special collection brings together a selection of Cochrane Reviews assessing exercise for musculoskeletal conditions including: osteoarthritis, osteoporosis and rheumatoid arthritis, ankylosing spondylitis, fibromyalgia, juvenile idiopathic arthritis; regional musculoskeletal conditions in the knee, low back, neck and shoulder; and chronic musculoskeletal pain

The Cochrane Reviews highlighted in this special collection have been prepared by authors and editors from the Cochrane Musculoskeletal Group, Cochrane Bone, Joint and Muscle Trauma Group, and the Cochrane Back Group.

Osteoarthritis

Exercise for osteoarthritis of the knee

Biomechanical factors, such as reduced muscle strength and joint malalignment, have an important role in the initiation and progression of knee osteoarthritis. Currently, there is no known cure for osteoarthritis; however, disease-related factors, such as impaired muscle function and reduced fitness, are potentially amenable to therapeutic exercise. This review assesses whether land-based therapeutic exercise is beneficial for people with knee osteoarthritis in terms of reduced joint pain or improved physical function. 

Exercise for osteoarthritis of the hip

Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis are based on expert opinion only. This review assesses whether land-based therapeutic exercise is beneficial for people with hip osteoarthritis in terms of reduced joint pain and/or improved physical function.

Aquatic exercise for the treatment of knee and hip osteoarthritis

Clinical experience indicates that aquatic exercise may have advantages for people with osteoarthritis. This review compares the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis.

Osteoporosis

Exercise for preventing and treating osteoporosis in postmenopausal women

Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Treatment of osteoporosis typically involves the use of pharmacological agents. In general it is thought that disuse (prolonged periods of inactivity) and unloading of the skeleton promotes reduced bone mass, whereas mechanical loading through exercise increases bone mass. This review examines the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women.

Rheumatoid arthritis

Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis

An overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking. This review assesses the effectiveness and safety of short-term (< three months) and long-term (> three months) dynamic exercise therapy programs (aerobic capacity and/or muscle strength training), either land or water based, for people with rheumatoid arthritis.

Tai chi for treating rheumatoid arthritis

Rheumatoid arthritis is a chronic, systemic inflammatory autoimmune disease that results in the destruction of the musculoskeletal system. The major goals of treatment are to relieve pain, reduce inflammation, slow down or stop joint damage, prevent disability, and preserve or improve the person's sense of well-being and ability to function. Tai Chi, interchangeably known as Tai Chi Chuan, is an ancient Chinese health-promoting martial art form that has been recognized in China as an effective arthritis therapy for centuries. This review assesses the effectiveness and safety of Tai Chi as a treatment for people with rheumatoid arthritis.

Balance training (proprioceptive training) for patients with rheumatoid arthritis

Patients with rheumatoid arthritis may have an increased risk of falls due to impairments in lower-extremity joints, which may result in either mobility, or postural stability problems. Evidence indicates that balance, agility and co-ordination training techniques can induce changes in lower-extremity muscle activity patterns that result in improvement in dynamic joint stability. The mechanoreceptors present in and around the joints are responsible for maintaining postural control and joint position sense. These receptors are integrated to compose the somatosensorial system. In combination with visual and auditory inputs, which improve our spatial perception even further, the systems are able to maintain a stable body posture. However, there is a lack of information on the efficacy of balance training alone in patients with rheumatoid arthritis. This review assesses the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis.

Ankylosing spondylitis

Physiotherapy interventions for ankylosing spondylitis

Ankylosing spondylitis is a chronic, inflammatory rheumatic disease. Physiotherapy is considered an important part of the overall management of ankylosing spondylitis. This review aims to summarise the available scientific evidence on the effectiveness of physiotherapy interventions in the management of ankylosing spondylitis.

Fibromyalgia

Exercise for treating fibromyalgia syndrome

Fibromyalgia is a syndrome expressed by chronic widespread body pain which leads to reduced physical function and frequent use of health care services. Exercise training is commonly recommended as a treatment. This review evaluates the effects of exercise training, including cardiorespiratory (aerobic), muscle strengthening, and/or flexibility exercise on global well-being, selected signs and symptoms, and physical function in individuals with fibromyalgia.

Juvenile idiopathic arthritis

Exercise therapy in juvenile idiopathic arthritis

Exercise therapy is considered an important component of the treatment of arthritis. The efficacy of exercise therapy has been reviewed in adults with rheumatoid arthritis but not in children with juvenile idiopathic arthritis. This review assesses the effects of exercise therapy on functional ability, quality of life and aerobic capacity in children with juvenile idiopathic arthritis. 

Regional musculoskeletal conditions

Knee pain

Exercise therapy for patellofemoral pain syndrome

Patellofemoral pain syndrome is a common problem among adolescents and young adults, characterised by retropatellar pain (behind the kneecap) or peripatellar pain (around the kneecap) when ascending or descending stairs, squatting or sitting with flexed knees. Aetiology, structures causing the pain, and treatment methods are all debated in literature, but consensus has not been reached so far. Exercise therapy to strengthen the quadriceps is often prescribed, though its efficacy is still debated. This review aims to summarise the evidence of effectiveness of exercise therapy in reducing anterior knee pain and improving knee function in patients with patellofemoral pain syndrome.

Low-back pain

Exercise therapy for treatment of non-specific low back pain

Exercise therapy is widely used as an intervention in low-back pain. This review evaluates the effectiveness of exercise therapy in adult non-specific acute, subacute and chronic low-back pain versus no treatment and other conservative treatments.

Exercises for prevention of recurrences of low-back pain

Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a post-treatment programme, can reduce back pain recurrences. This review investigates the effectiveness of exercises for preventing new episodes of low-back pain or low-back-pain-associated disability.

Neck pain

Exercises for mechanical neck disorders

Neck disorders are common, limit function, and are costly to individuals and society. Exercise therapy is a commonly used treatment for neck pain, but the effectiveness of exercise therapy remains unclear. This review assesses the effectiveness of exercise therapy to relieve pain, or improve function, disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders.

Shoulder pain

Physiotherapy interventions for shoulder pain

The prevalence of shoulder disorders has been reported to range from seven to 36% of the population accounting for 1.2% of all General Practitioner encounters in Australia. Substantial disability and significant morbidity can result from shoulder disorders. While many treatments have been employed in the treatment of shoulder disorders, few have been proven in randomised controlled trials. Physiotherapy is often the first line of management for shoulder pain and to date its efficacy has not been established. This review assesses the efficacy of physiotherapy interventions for disorders resulting in pain, stiffness and/or disability of the shoulder.

Chronic musculoskeletal pain

Interventions to improve adherence to exercise for chronic musculoskeletal pain in adults

Chronic musculoskeletal pain is a major health problem, accounting for approximately one-quarter of general practice consultations in the United Kingdom. Exercise and physical activity is beneficial for the most common types of chronic musculoskeletal pain, such as back and knee pain. However, poor adherence to exercise and physical activity may limit long-term effectiveness. This review assesses the effects of interventions to improve adherence to exercise and physical activity for people with chronic musculoskeletal pain.

Acknowledgements: Tracey Howe, Professor of Rehabilitation Sciences, Glasgow Caledonian University, Director of External relations and partnerships at Glasgow City of Science, and Editor of the Cochrane Musculoskeletal Review Group, for drafting the text; and the Cochrane Musculoskeletal Group for comments and edits.

Image credit: Gustoimages/Science Photo Library, P100/0253

Date published: 15 February 2012

Contact: Cochrane Editorial Unit (editorial-unit@cochrane.org)

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