The effects of exercise and physical activity on gait biomechanics and pain in knee osteoarthritis: A systematic review and meta-analysis
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Objectives
To evaluate the effects of exercise and physical activity on gait biomechanics and pain in adults with knee osteoarthritis.
Methods
Systematic searches were performed of PubMed, Web of Science, Scopus and SPORTDiscus databases for controlled intervention studies published up to 31 December 2024. Eligible studies included adults with knee osteoarthritis undertaking exercise or physical activity compared with control group(s). Risk of bias was assessed using the Downs and Black Checklist. Bayesian three-level hierarchical random-effects meta-analyses synthesised standardised mean differences (SMD; effect size) with 95% credible intervals (CrIs).
Results
Of 2,602 records identified, 18 studies involving 1,102 participants (345 males and 757 females) were included. Exercise and physical activity reduced pain (SMD 0.61, 95% CrI 0.29 to 0.92) and improved spatiotemporal gait parameters (SMD 0.67, 95% CrI 0.27 to 1.05). Improvements were reported across several intervention types, including strengthening, aerobic, multicomponent, and mind–body exercise. Effects on knee kinematics (SMD 0.12, 95% CrI −0.18 to 0.41) and kinetics (SMD −0.03, 95% CrI −0.25 to 0.18) were small or uncertain.
Conclusions
Exercise and physical activity may improve pain and spatiotemporal gait characteristics in knee osteoarthritis, but consistent improvements in knee kinematics and kinetics were not demonstrated. Further adequately powered trials with standardised biomechanical assessments and longer assessments are needed.
Registration: PROSPERO CRD42024565957.
Key messages
What is already known on this topic
Exercise and physical activity are recommended non-pharmacological interventions for managing knee osteoarthritis, but their effects on gait biomechanics across different exercise modalities remain unclear.
What this study adds
This systematic review and meta-analysis found that exercise and physical activity were associated with reduced pain and improved spatiotemporal gait parameters in people with knee osteoarthritis, while effects on knee kinematics and kinetics were small or uncertain.
How this study might affect research, practice or policy
Exercise/physical activity remain central to knee osteoarthritis management. Future trials should investigate whether targeted interventions can modify knee joint mechanics, using standardised biomechanical assessments and longer follow-up.
