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Cochrane Reviews regarding therapeutic exercise programs

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Summary of relevant Cochrane Reviews regarding therapeutic exercise programs

Cochrane Reviews are systematic reviews of primary research in human health care and health policy.... They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.”  The Cochrane Collaboration

Note: These summaries form part of the evidence base that informed the development of the current policy guidelines for gymnasium-pool memberships for therapeutic exercise programs.

Cochrane Review

Authors' Conclusion

Summary of Evidence

Treatment of Hip and Knee Osteoartritis - Aquatic Exercises

Aquatic exercise appears to have some beneficial short-term effects for patients with hip and/or knee osteoarthritis (OA) while no long-term effects have been documented. Based on this, one may consider using aquatic exercise as the first part of a longer exercise programme for osteoarthritis patients. The controlled and randomised studies in this area are still too few to give further recommendations on how to apply the therapy, and studies of clearly defined patient groups with long-term outcomes are needed to decide on the further use of this therapy in the treatment of osteoarthritis

Exercise for Depression

Exercise seems to improve depressive symptoms in people with a diagnosis of depression, but when only methodologically robust trials are included, the effect sizes are only moderate and not statistically significant.   Further, more methodologically robust trials should be performed to obtain more accurate estimates of effect sizes, and to determine risks and costs.  Further systematic reviews could be performed to investigate the effect of exercise in people with dysthymia who do not fulfil diagnostic criteria for depression.

Exercise for Osteoarthritis of the Hip

The limited number and small sample size of the included randomised control trials (RCTs) restricts the confidence that can be attributed to these results. Adequately powered RCTs evaluating exercise programs specifically designed for people with symptomatic hip OA need to be conducted.

Exercise for Osteoarthritis of the Knee

There is “platinum level” evidence that land-based therapeutic exercise has at least short term benefit in terms of reduced knee pain and improved physical function for people with knee OA. The magnitude of the treatment effect would be considered small, but comparable to estimates reported for non-steroidal anti-inflammatory drugs.

Exercise Therapy for Patellofemoral Pain Syndrome (PFPS)

The evidence that exercise therapy is more effective in treating PFPS than no exercise was limited with respect to pain reduction, and conflicting with respect to functional improvement. There is strong evidence that open and closed kinetic chain exercise are equally effective. Further research to substantiate the efficacy of exercise treatment compared to a non-exercising control group is needed, and thorough consideration should be given to methodological aspects of study design and reporting.

Exercise Therapy for Treatment of Non specific Low Back Pain

Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in healthcare populations. In subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. In acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.

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

Interventions such as supervised or individualised exercise therapy and self-management techniques may enhance exercise adherence. However, high-quality, randomised trials with long-term follow up that explicitly address adherence to exercises and physical activity are needed. A standard validated measure of exercise adherence should be used consistently in future studies.

Supervised exercise versus unsupervised exercise for people with leg pain while walking (intermittent claudication)

This review found that people in a supervised program improved their walking ability more than those following an unsupervised walking program. After three months, the people who followed the supervised, treadmill program could walk 150 meters more than the people who did unsupervised exercise. Before that, they were walking around 300 meters, 200 meters pain free, so this improvement is likely to help with independence. These conclusions are drawn from eight trials in which the participants with intermittent claudication had been assigned to either supervised or unsupervised exercise. Altogether there were 319 participants, ranging in age from 40 to 86 years with a mean age of 67 years. The overall quality of the included trials was good, although each had only a small number of participants. The trials lasted from three to twelve months. Keeping to an exercise program is important because of the decrease in leg pain and the likelihood of improving general physical condition, but it is not yet clear that it also improves compliance or quality of life.