Is long-term physical activity safe for older adults with knee pain?: a systematic review

Osteoarthritis Cartilage. 2015 Sep;23(9):1445-56. doi: 10.1016/j.joca.2015.05.002. Epub 2015 May 21.


Objective: To determine whether long-term physical activity is safe for older adults with knee pain.

Design: A comprehensive systematic review and narrative synthesis of existing literature was conducted using multiple electronic databases from inception until May 2013. Two reviewers independently screened, checked data extraction and carried out quality assessment. Inclusion criteria for study designs were randomised controlled trials (RCTs), prospective cohort studies or case control studies, which included adults of mean age over 45 years old with knee pain or osteoarthritis (OA), undertaking physical activity over at least 3 months and which measured a safety related outcome (adverse events, pain, physical functioning, structural OA imaging progression or progression to total knee replacement (TKR)).

Results: Of the 8614 unique references identified, 49 studies were included in the review, comprising 48 RCTs and one case control study. RCTs varied in quality and included an array of low impact therapeutic exercise interventions of varying cardiovascular intensity. There was no evidence of serious adverse events, increases in pain, decreases in physical function, progression of structural OA on imaging or increased TKR at group level. The case control study concluded that increasing levels of regular physical activity was associated with lower risk of progression to TKR.

Conclusions: Long-term therapeutic exercise lasting 3 to 30 months is safe for most older adults with knee pain. This evidence supports current clinical guideline recommendations. However, most studies investigated selected, consenting older adults carrying out low impact therapeutic exercise which may affect result generalizability.

Systematic review registration: PROSPERO 2014:CRD42014006913.

Keywords: Exercise; Knee pain; Osteoarthritis; Physical activity; Safety; Systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Arthroplasty, Replacement, Knee
  • Exercise Therapy / adverse effects
  • Humans
  • Knee Joint
  • Middle Aged
  • Motor Activity / physiology*
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / physiopathology*
  • Osteoarthritis, Knee / therapy
  • Pain / physiopathology
  • Radiography