The addition of structured lifestyle modifications to a traditional exercise program for the management of patients with knee osteoarthritis: A systematic review and meta-analysis of randomised trials.

Background: Guidelines recommend exercise for the management of knee osteoarthritis (OA), however, recently it has been suggested that including additional lifestyle modifications with a traditional exercise program may elicit greater benefits than exercise alone.

Objectives: To investigate the influence of the addition of lifestyle modifications to a traditional exercise program, with respect to functional outcomes and quality of life among individuals with knee OA.

Design: Systematic review and meta-analysis.

Methods: Four databases were searched to identify randomised controlled trials comparing an exercise program, which included the addition of lifestyle modifications, to an exercise program alone in individuals with knee OA. Methodological quality of included studies was assessed via the PEDro scale. Results synthesis through meta-analysis using a random effects model was conducted to determine the pooled effect on eligible outcomes and a GRADE approach was utilised to rate the certainty of evidence.

Results: Meta-analysis of seven studies showed the inclusion of lifestyle modifications to an exercise program can further decrease pain intensity (SMD -0.68 [95% CI -1.26 to -0.10]), improve joint stiffness (MD -0.69 [95% CI -1.21, -0.17]) and increase physical function (MD -1.26 s ([95% CI -1.34, -1.17]) at six-months. Individual results showed improvements in quality of life with the addition of lifestyle modifications, however, this was not demonstrated through meta-analysis.

Conclusion: This systematic review supports the inclusion of additional lifestyle modifications to a traditional exercise program, for pain intensity, joint stiffness and physical function for individuals with knee OA.

Trial Registration: PROSPERO registration number: CRD42021279594.