Research Article: The Effects of Traditional Chinese Exercise in Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis

Date Published: January 25, 2017

Publisher: Public Library of Science

Author(s): Yingjie Zhang, Lulu Huang, Youxin Su, Zhengxuan Zhan, Yanan Li, Xingquan Lai, Mikko Juhani Lammi.


Traditional Chinese exercise (TCE) includes a variety of exercise, which is being accepted by more and more people in the treatment of knee osteoarthritis (OA) from different countries. With the attendant, many clinical reports focus on it. Our meta-analysis aimed to systematically assess the effects of traditional Chinese exercise on pain, stiffness, physical function, quality of life, mental health and adverse events in people with knee osteoarthritis.

PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), the Web of Science, and Chinese Biomedical Literature Database (CBM) were searched from the time of their inception through April 2016 and risk of bias was independently assessed by two authors. Outcome measures included pain, physical functional, joint stiffness, quality of life, mental health and safety. For pooled outcomes, standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated.

Eight randomized controlled trials with a sample size of 375 cases met the criteria to be included in the study indicating that high quality literature is lacking in this field. Results of the meta-analysis showed that short-term TCE could relieve pain (SMD: -0.77;95% CI: -1.13 to -0.41; P<0.0001), improve physical function (SMD -0.75; 95% CI: -0.98 to -0.52; P<0.00001), and alleviate stiffness (SMD: -0.56; 95%: CI -0.96 to -0.16; P<0.006), but had no significant effect on quality of life (SMD: 0.57; 95% CI: 0.17 to 0.97; P = 0.005), and mental health (SMD 4.12; 95% CI: -0.50 to 8.73; P = 0.08). Moreover, TCE was not associated with serious adverse events. Our systematic review revealed that short-term TCE was potentially beneficial in terms of reducing pain, improving physical function and alleviating stiffness. These results may suggest that TCE could prove useful as an adjuvant treatment for patients with knee OA. Further studies are urgently needed to confirm these results.

Partial Text

Knee osteoarthritis (OA) is becoming increasingly prevalent among older adults [1] and is the major cause of chronic pain and disability worldwide [2]. Knee OA often causes pain and stiffness in the affected joint, often leading to a sharp decrease in knee strength and a slowing of gait speed that is beyond what is normally expected due to advancing age [3]. The occurrence of knee OA is often associated with destruction of the articular cartilage in addition to underlying bony changes at the joint margins. And the main symptoms are significant pain, functional limitations which seriously affects quality of life [4,5] and can even cause mental and physical distress [6].

This study was probably the first systematic review and meta-analysis to determine the effects of TCE for the treatment of knee OA. Although it has certain limitations, the study might have proved that short-term TCE can reduce pain, improve physical function and alleviate stiffness. Further, this review has demonstrated that there might be no doubt in the effectiveness and safety of TCE, suggesting that it was potentially useful as an adjuvant treatment for patients with knee OA. More studies are urgently needed to confirm these results, to determine whether the positive effects of TCE can be supported by appropriately designed studies with long-term follow-ups.