Annals of Physical and Rehabilitation Medicine 59 (2016) 190–195

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Review

Rehabilitation (exercise and strength training) and osteoarthritis:

A critical narrative review
Christelle Nguyen a,b,*, Marie-Martine Lefèvre-Colau a,c, Serge Poiraudeau a,c,
François Rannou a,b
a
Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris,
Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
b
Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Université Paris Descartes,
PRES Sorbonne Paris Cité, Paris, France
c
INSERM UMR-S 1153 et Institut Fédératif de Recherche sur le Handicap, University Paris Descartes, PRES Sorbonne Paris Cité, Paris, France

A R T I C L E I N F O A B S T R A C T

Article history: Rehabilitation is widely recommended in national and international guidelines for managing
Received 28 December 2015 osteoarthritis (OA) in primary care settings. According to the 2014 OA Research Society International
Accepted 28 February 2016 (OARSI) recommendations, rehabilitation is even considered the core treatment of OA and is
recommended for all patients. Rehabilitation for OA widely includes land- and water-based exercise,
Keywords: strength training, weight management, self-management and education, biomechanical interventions,
Osteoarthritis and physically active lifestyle. We performed a critical narrative review of the efficacy and safety of
Rehabilitation
rehabilitation for managing OA and discuss evidence-based international recommendations. The process
Exercise
Strength training
of article selection was unsystematic. Articles were selected based on authors’ expertise, self-knowledge,
Evidence-based medicine and reflective practice. For the purpose of the review, we focused on land- and water-based exercise and
strength training for knee, hip and hand OA. Other aspects of rehabilitation in OA are treated elsewhere
in this special issue. Exercise therapy is widely recommended for managing knee, hip and hand OA.
However, the level of evidence varies according to OA location. Overall, consistent evidence suggests that
exercise therapy and specific strengthening exercise or strength training for the lower limb reduce pain
and improve physical function in knee OA. Evidence for other OA sites are less consistent. Therefore,
because of the lack of specific studies, recommendations for hip and hand OA are mainly derived from
studies of knee OA. In addition, no recommendations have been established regarding the exercise
regimen. The efficacy and safety of exercise therapy and strength training need to be further evaluated in
randomized controlled trials of patients with hip and hand OA. The optimal delivery of exercise
programs also has to be more clearly defined.
ß 2016 Elsevier Masson SAS. All rights reserved.

1. Introduction and is recommended for all patients [3]. Rehabilitation for OA

Treatment of osteoarthritis (OA) combines non-pharmacologi-
cal and pharmacological modalities. Rehabilitation is widely
recommended in national and international guidelines for
managing OA in primary care settings [1–3]. According to the
2014 OA Research Society International (OARSI) recommenda-
tions, rehabilitation is even considered the core treatment of OA
* Corresponding author. Service de Rééducation et de Réadaptation de L’Appareil
Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre -
Groupe Hospitalier Cochin, 27, Rue du Faubourg Saint-Jacques, 75014 Paris, France.
Tel.: +33 1 58 41 29 45; fax: +33 1 58 41 25 38.
E-mail address: christelle.nguyen2@aphp.fr (C. Nguyen).
widely includes land- and water-based exercise therapy, strength
training, weight management, self-management and education,
biomechanical interventions [3] and participation in regular
physical activities [2–5]. The World Health Organization defines
physical activity as all forms of activity involving skeletal muscles
that require energy expenditure. Exercise therapy refers to a form
of physical activity that is planned and structured [6] and is most
often delivered by physical and occupational therapists [7].
Pharmacological treatments are usually identical whatever the
anatomical site, and rehabilitation is adjusted to the individual
patient, according to OA location [7]. For lower-limb and hand OA,
prescribed physical activity or exercise therapy aim to improve
joint range of motion, muscle strength, tendon lengthening,

http://dx.doi.org/10.1016/j.rehab.2016.02.010
1877-0657/ß 2016 Elsevier Masson SAS. All rights reserved.
 C. Nguyen et al. / Annals of Physical and Rehabilitation Medicine 59 (2016) 190–195 191

Table 1
Modalities of exercises for knee, hip and hand osteoarthritis (OA) and recommendations from international guidelines [11].

ACR, 2012 [2] EULAR, 2007 [34] and 2013 [1] OARSI, 2008 [16] and 2014 [3]

Knee OA
Regular individualized exercise regimen
Overall exercise
Low-impact aerobic exercise
Aerobic activity and exercise
Land-based exercise including strength
training, active ROM exercise, and aerobic
activity
Water-based exercise
Strength training including resistance-based
lower-limb and quadriceps strengthening
exercises, and both weight-bearing and
non-weightbearing interventions
Strengthening (sustained isometric) exercise
for both legs, including the quadriceps and
proximal hip girdle muscles
Adjunctive ROM/stretching exercises
Mixed programs
Balance
Supervised exercise with manual therapy
Manual therapy alone
Hip OA
Regular individualized exercise regimen
Overall exercise
Low-impact aerobic exercise
Land-based exercise
Water-based exercise
Endurance/strengthening
Mixed programs
Supervised exercise with manual therapy
Hand OA
Education and exercise
– LOE Ib: at least one RCT, LOA: 8.7/10 –
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
Strong recommendation – –
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
– – Appropriate, appropriateness score: 8/9
LOE: SR and MA of RCTs
Appropriate, appropriateness score: 7/9
LOE: SR and MA of RCTs and
quasi-randomized trial
– – Appropriate, appropriateness score: 8/9
LOE: SR and MA of RCTs
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
No recommendation – –
Conditional – –
recommendation
No recommendation – –
– LOE Ib: at least one RCT, LOA: 8.7/10 –
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
Strong recommendation – –
– – LOE IV: expert opinion/clinical experience
– – LOE Ib: RCTs
– – LOE IV: expert opinion/clinical experience
– LOE Ia: MA of RCTs, LOA: 8.5/10 –
Conditional recommendation – –
– LOE IV, SOR 59/100 –

ACR: American College of Rheumatology; EULAR: European League Against Rheumatism; LOA: level of agreement: LOE: level of evidence; MA: meta-analysis; OARSI:
Osteoarthritis Research Society International; RCT: randomized controlled trial; ROM: range of motion; SOR: strength of recommendation; SR: systematic review.

aerobic performance, and proprioception [7]. Available evidence
suggests a small to moderate effect of exercise as compared with
not exercising for hip or knee OA [8,9]. Clinical studies have shown
that aerobic physical activity and muscle-strengthening exercise
may help reduce OA symptoms and improve joint function
[10]. The modalities of exercise are numerous (Table 1) [11] and
should be adjusted to the affected joint and to the comorbidities.
Exercise prescription includes intensity, frequency, duration, and
mode. Intensity in exercise programs may be high, vigorous,
moderate, or low depending on the treatment goal (e.g., muscle
weakness) or the subject population [6]. The delivery of exercise
programs varies by amount and magnitude of work (level of
resistance, frequency, duration, and progression), supervision
(type, mode of delivery) and setting (home, community/gym,
healthcare setting) [6].
Even though rehabilitation is a key treatment modality in OA
and widely recommended, the optimal content of exercise therapy
programs remains inconsistent [7]. Here, we reviewed the
literature relating to efficacy and safety of exercise therapy and
strength training as well as evidence-based international recom-
mendations about their use in managing knee, hip and hand OA.
2. Methods
A critical narrative review was conducted. The process of article
selection was unsystematic. Selection of articles was based on
authors’ expertise, self-knowledge, and reflective practice. We
focused on land- and water-based exercise programs and strength
training for knee, hip and hand OA. Individual trials, systematic
reviews and meta-analyses included in the latest American College
of Rheumatology (ACR), European League Against Rheumatism
(EULAR) and Osteoarthritis Research Society International (OARSI)
international guidelines were searched. MEDLINE was searched via
PubMed from inception to December 2015 for additional
guidelines, trials, systematic reviews and meta-analyses with
the MeSH terms ‘‘exercises,’’ ‘‘knee osteoarthritis.’’ Other aspects of
rehabilitation in OA are treated elsewhere in this special issue.
3. Results
3.1. Exercise and strength training for knee OA
Exercise therapy for knee OA should improve joint range of
motion, muscle and tendon lengthening, strength, and endurance
and decrease pain and loading on the symptomatic compartment
[7]. Functional improvements are expected in walking ability and
daily activities, even sport. The possible modalities of exercise
treatments are numerous and depend on the rhythm, duration and
type or technique, conducted individually or in groups and
supervised or not by a physiotherapist [7].
Exercise therapy can be divided into 2 modalities. The first is
aerobic. Aerobic exercise is, by definition, nonspecific and aims to
improve general physical performance [7]. The second type is
analytic, focuses on the symptomatic joint, and aims to improve
joint range of motion, to increase muscle strength and to decrease
loading of the symptomatic joint compartment. Analytic exercise
is based on a specific evaluation of the joint and muscle
impairment [7].
192 C. Nguyen et al. / Annals of Physical and Rehabilitation Medicine 59 (2016) 190–195
Exercise therapy is recommended in clinical guidelines for
managing knee OA. The third recommendation of the 2003 EULAR
recommendation pointed to the importance of exercise, although
not specified. Effect sizes (ESs) ranged from 0.57 to 1.00 [12]. In
the 2003 Cochrane systematic review of 32 studies, the authors
concluded that exercise therapy for knee OA had at least short-
term benefit in reducing knee pain and improving physical
function [13]. Even though the magnitude of the treatment effect
was considered small, it was comparable to that reported with
non-steroidal anti-inflammatory drugs [13]. In 2005, the MOVE
consensus, involving a literature search and Delphi expert
process, provided more details on the content of exercise therapy.
The consensus mainly recommended aerobic and strengthening
exercise to decrease pain and improve health status [14]. Group
and home exercise was considered equally effective [14,15], and
patients may benefit from referral to a physical therapist
[16]. Finally, proprioceptive exercise could have the same efficacy
as strength training [14,17]. The 2008 OARSI guidelines were
more specific and included ‘‘regular aerobic, muscle strengthen-
ing, and range of motion exercise’’ [16]. The pooled ES for pain
reduction was 0.52 for aerobic exercise and 0.32 for muscle
strengthening.
In the updated 2014 OARSI guidelines, rehabilitation was
considered the core treatment for OA and was recommended for all
OA patients [3]. Land-based exercise was considered appropriate
whatever the OA location and comorbidities, from 4 meta-analyses
that revealed small but clinically relevant short-term benefits for
pain and physical function in knee OA with exercise therapy
combining strength training, active range of motion exercise, and
aerobic activity. The estimated ES for pain ranged from 0.34 to
0.63 and was 0.25 for function [3]. Water-based exercise was
considered appropriate for all knee OA patients, from the results of
a 2007 systematic review that found small to moderate short-term
benefits for function and quality of life but only minor benefits for
pain. The ES for pain or function was not available [3]. Strength
training was considered appropriate for all knee OA patients, from
a 2011 meta-analysis and systematic review demonstrating
moderate effect sizes of strength training for reducing pain and
improving physical function as compared with controls. Strength
training programs primarily incorporated resistance-based lower-
limb and quadriceps strengthening exercise. Both weight-bearing
and non-weight-bearing interventions were included, as were
group and individual programs. The ES was 0.38 for pain and
0.41 for function [3].
Consistently, the 2013 EULAR guidelines concluded that
exercise reduced pain and improved physical function, that
specific quadriceps strengthening exercise or strength training
for the lower limb reduced pain efficiently and improved physical
function [1]. The EULAR group reached consensus on recommend-
ing mixed programs. Initial instruction is required. In the longer
term, the patient should integrate exercise into daily life [1]. In the
2012 American College of Rheumatology (ACR), the technical
expert panel (TEP) strongly recommended that all patients with
symptomatic knee OA be enrolled in an exercise program
commensurate with their ability to perform these activities. The
TEP expressed no preference for aquatic exercise as opposed to
land-based exercise based on benefits or safety; the decision
should be individualized and based on patient preferences and the
ability to perform exercise [2].
Which muscle to strengthen? Answering this question in
terms of the international recommendations is difficult. The
response can only come from expert opinion. Strengthening the
quadriceps may improve joint stability [18], as may hamstring
muscle strengthening. To decrease loading in the medial
compartment, strengthening the lateral muscle knee chain would
open the medial compartment [7]. In contrast, for lateral knee OA,
medial muscle chain strengthening could decrease the load on the
lateral compartment. These last recommendations are based on
only the clinical experience of the authors and need the
involvement of a physical therapist [7]. Specific strengthening
exercises for patello-femoral OA have been scarcely assessed [19]
and are usually based on elective strengthening of the quadriceps
and medial muscle chain to decrease the load on the lateral
patello-femoral compartment, which is the most often involved.
Finally, knee flessum is probably important to detect and treat
with postural exercise in extension. This last aspect of the
treatment is never defined in international recommendations but
may improve the natural course of knee OA and have better
results after total knee replacement [7].
From a practical point of view, in managing knee OA:
 aerobic, strengthening, range-of-motion and proprioceptive
exercise is recommended to decrease pain and improve function
and quality of life in knee OA;
 inexpensive aerobic exercise can include sport, walking,
swimming, cycling and any physical activity the patient
particularly enjoys [7];
 quadriceps and hamstring muscle strengthening may improve
joint stability [7];
 for medial knee OA, strengthening the lateral muscle knee chain
may decrease the load on the medial compartment [7];
 for lateral knee OA, strengthening the medial muscle knee chain
may decrease the load on the medial compartment [7];
 specific postural exercise in extension may guard against
flessum [7];
 analytic exercise needs to be evaluated in randomized clinical
trials (RCTs) [7];
 proprioceptive exercise needs to be evaluated in RCTs [7].
3.2. Exercise therapy and strength training for hip OA
Exercise therapy is largely recommended in clinical guidelines
for managing hip OA. However, although exercise has been shown
to reduce pain in patients with hip OA (ES for pain, 0.38 [95%
confidence interval 0.08–0.68) [20], we lack evidence to support
the effects of exercise therapy on pain, function and quality of life
in hip OA [14,20–26]. Research evidence specific to hip OA is
considered sparse, and recommendations for managing hip OA are
largely derived from trials including patients with both hip and
knee OA or knee OA alone [1]. Recent evidence suggested that
exercise therapy associated with patient education versus patient
education alone significantly increased the 6-year cumulative
survival of the native hip in 109 patients with symptomatic and
radiographic hip OA and reduced the need for total hip
replacement by 44% [27]. In addition, in a 52-week prospective
study of 203 patients with hip OA, the annual direct medical costs
per patient were significantly lower for patients with exercise
therapy than controls, without the risk of significant negative
health effects [28].
The third recommendation of the 2005 EULAR recommenda-
tions pointed to the importance of exercise, without specification
[26]. No trial included was specifically devoted to hip OA, and ES
values were calculated from pooled results of hip and knee OA
studies [26]. The 2008 OARSI guidelines were more specific and
included ‘‘regular aerobic, muscle strengthening, and range of
motion exercise’’ [16]. These were the same recommendations as
for knee OA, but for hip OA ‘‘exercise in water can be effective’’
[16]. The content of the exercise program and the modality of the
delivery recommended are the same as those described for knee
OA [14,16]. In the 2012 ACR guidelines, the TEP strongly
recommended that all patients with symptomatic hip OA be
 C. Nguyen et al. / Annals of Physical and Rehabilitation Medicine 59 (2016) 190–195
enrolled in an exercise program commensurate with their ability to
perform these activities. The TEP expressed no preference for
aquatic exercise as opposed to land-based exercise based on
benefits or safety; the decision should be individualized and based
on patient preferences and the ability to perform exercise [2]. In
the 2013 EULAR guidelines, the level of evidence for the
recommendations of different types of exercise in people with
hip OA could not be graded [1]. More recently, from a review of
4 high-quality studies demonstrating the general effectiveness of
variations of strength training, stretching, and flexibility exercise
for improving management of hip OA [29–32], the Ottawa Panel
recommended land-based therapeutic exercise, notably strength
training, for reducing pain, stiffness and self-reported disability
and improving physical function and range of motion [33]. Recom-
mendations were formulated as follows:
 strength training exercise has the greatest improvement for
pain, disability, physical function, stiffness and range of motion
within a short time (8–24 weeks);
 stretching greatly improves physical function;
 flexibility exercise improves pain, range of motion, physical
function and stiffness [33].
Exercise therapy for hip OA has the same objective as for knee
OA, namely, improving joint range of motion, muscle and tendon
lengthening, strength and endurance and decreasing pain and
loading on the symptomatic compartment [7]. Aerobic exercise is
by definition nonspecific; thus, it is similar to that recommended
for knee OA. Analytic exercise is different because it focuses on a
specific joint site [7].
Which muscles to strengthen? To date, answering this question
in terms of international recommendations is difficult. The
response comes only from expert opinion. Strengthening hip
stabilizer muscles could improve joint stability. To decrease the
loading on the hip joint, pelvi-trochanterian muscle strengthening
could be added. These last recommendations are based on only the
clinical experience of the authors and need the involvement of a
physical therapist [7]. Finally, extension deficit and hip flessum are
probably important to detect and to treat with postural exercise in
extension. This last aspect of treatment is never defined in
international recommendations but may improve the natural
course of hip OA and have better results after total hip replacement
[7].
From a practical viewpoint, for managing hip OA:
 aerobic, strengthening and range-of-motion exercise is recom-
mended to decrease pain and exercise can be done on land or in
water [1,2,16,33];
 inexpensive aerobic exercise can include sport, walking,
swimming, cycling and any physical activity the patient
particularly enjoys [7];
 strengthening hip stabilizer muscles could improve joint
stability [7];
 strengthening pelvi-trochanterian muscles could decrease the
load on the hip joint [7];
 specific postural exercise in extension could guard against
extension deficit and flessum [7];
 analytic exercise needs to be evaluated in RCTs [7].
3.3. Exercise therapy and strength training for hand OA
Exercise therapy for hand OA is recommended by the
2007 OARSI guidelines [34] but is not mentioned in 2012 ACR
guidelines [2]. The value of exercise therapy for hand OA is unclear
because of lack of adequately powered studies. The 2007 OARSI
193
recommendations are mainly based on evidence extrapolated from
studies of OA affecting other joint sites or on expert opinion [34]
and are weakly supported by research evidence [8,35]. In their
recent literature research [35], Kjeken et al. found 3 studies that
examined a combination of exercise and other treatment modali-
ties for hand OA [36–38], which allowed for assessing the effect of
hand exercise alone, and 3 studies that examined the effectiveness
of hand exercise alone [39–41]. The authors concluded limited
evidence for hand exercise efficacy in reducing pain and in
increasing range of motion and strength in hand OA [35]. Bennell
et al. recently reviewed the 2 latest RCTs of exercise therapy in
hand OA and found conflicting evidence [8]. One RCT involved
80 women and found that home-based range of motion and
strengthening exercise, 3 times per week, over 3 months, in
addition to information, improved activity performance as
compared with information only. More women in the exercise
group (13/40) showed improvement as compared with controls (3/
40), and 16/40 versus 2/40 fulfilled the OARSI/OMERACT response
criteria [42]. Conversely, in another RCT of 257 participants, hand
exercise was not more effective than no hand exercise at 6 months
[43].
OARSI recommendations include ‘‘range of motion and
strengthening exercise’’. Experts did not mention aerobic or
proprioceptive exercise [34]. The 2012 ACR guidelines contained
no strong recommendations by the TEP for non-pharmacological
treatment of hand OA [2]. The TEP conditionally recommended
that all patients with hand OA be evaluated by a health
professional for the ability to perform activities of daily living
and receive assistive devices as necessary, instruction in joint
protection techniques and the use of thermal agents for relief of
pain and stiffness [2]. From a practical viewpoint, for managing
hand OA:
 strengthening and range-of-motion exercise is recommended
[34];
 inexpensive aerobic exercise can be recommended, including
sport, walking, swimming, cycling and any physical activity that
the patient particularly enjoys [7];
 strengthening of hand joint stabilizer muscles could improve
joint stability [7];
 specific postural exercise to open the first web could be of
interest [7];
 analytic, aerobic, and proprioceptive exercise needs to be
evaluated in RCTs [7].
4. Discussion and conclusions
Our narrative review of evidence and international guidelines
for the efficacy of exercises and strength training for OA strongly
suggests that exercise therapy be widely recommended in
managing knee, hip and hand OA. However, the level of evidence
varies by OA location. Overall, consistent evidence suggests that
exercise therapy and specific strengthening exercise or strength
training for the lower limb reduce pain and improve physical
function in knee OA. Groups of muscles to strengthen in knee OA
should depend on the compartment predominantly involved based
on mechanical adverse factors. Surprisingly, only a few studies
assessed the preferential strengthening of certain groups of
muscles according to knee OA and most focused on quadriceps
strengthening exercises only. However, some evidence suggests
that strengthening the hamstrings in addition to strengthening the
quadriceps could be beneficial for improving symptoms related to
knee OA [44].
Evidence for other OA sites are less consistent. Because of the
lack of specific studies, recommendations for hip and hand OA are
194 C. Nguyen et al. / Annals of Physical and Rehabilitation Medicine 59 (2016) 190–195
mainly derived from studies of knee OA. In addition, no
recommendations have been established for the exercise regimen.
In a recent systematic review and meta-analysis of high- versus
low-intensity physical activity or exercise in patients with hip or
knee OA, based on low- to very low-quality evidence, we found no
clinical significant benefits of high- versus low-intensity exercise
programs for pain, function and quality of life in patients with knee
OA and no clinical important benefits in subgroup analyses
depending on the type of intensity of exercise program (time vs
level of resistance) [6]. Trials comparing different strengthening
modes and using innovative devices are ongoing [45].
The efficacy and safety of analytic, aerobic, and propriocep-
tive exercise and strength training need to be further evaluated
in RCTs of patients with hip and hand OA [7]. The optimal
delivery of exercise programs still has to be clearly defined in
terms of amount and magnitude of work, supervision, and
setting [6]. Overall, further RCTs should address ‘‘Which
personalized exercise and strength training program, for which
OA and which patients?’’ in order to design better tailored and
more efficient programs for OA management. To date, over
200 ongoing or completed trials assessing exercises for knee OA
are registered.
Disclosure of interest
The authors declare that they have no competing interest.
References
[1] Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG,
et al. EULAR recommendations for the non-pharmacological core management
of hip and knee osteoarthritis. Ann Rheum Dis 2013;72:1125–35.
[2] Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al.
American College of Rheumatology 2012 recommendations for the use of
nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand,
hip, and knee. Arthritis Care Res (Hoboken) 2012;64:465–74.
[3] McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-
Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee
osteoarthritis. Osteoarthritis Cartilage 2014;22:363–88.
[4] Brosseau L, Rahman P, Poitras S, Toupin-April K, Paterson G, Smith C, et al. A
systematic critical appraisal of non-pharmacological management of rheuma-
toid arthritis with Appraisal of Guidelines for Research and Evaluation II. PLoS
One 2014;9:e95369.
[5] Vignon E, Valat JP, Rossignol M, Avouac B, Rozenberg S, Thoumie P, et al.
Osteoarthritis of the knee and hip and activity: a systematic international
review and synthesis (OASIS). Joint Bone Spine 2006;73:442–55.
[6] Regnaux JP, Lefèvre-Colau MM, Trinquart L, Nguyen C, Boutron I, Brosseau L,
et al. High-intensity versus low-intensity physical activity or exercise in
people with hip or knee osteoarthritis. Cochrane Database Syst Rev
2015;10:CD010203.
[7] Rannou F, Poiraudeau S. Non-pharmacological approaches for the treatment of
osteoarthritis. Best Pract Res Clin Rheumatol 2010;24:93–106.
[8] Bennell KL, Buchbinder R, Hinman RS. Physical therapies in the management of
osteoarthritis: current state of the evidence. Curr Opin Rheumatol
2015;27:304–11.
[9] Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance
for clinical practice. Lancet 2011;377(9783):2115–26.
[10] Latham N, Liu CJ. Strength training in older adults: the benefits for osteoar-
thritis. Clin Geriatr Med 2010;26:445–59.
[11] Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review
of recommendations and guidelines for the management of osteoarthritis: The
chronic osteoarthritis management initiative of the U.S. bone and joint initia-
tive. Semin Arthritis Rheum 2014;43:701–12.
[12] Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al.
EULAR Recommendations 2003: an evidence based approach to the manage-
ment of knee osteoarthritis: Report of a Task Force of the Standing Committee
for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann
Rheum Dis 2003;62(12):1145–55.
[13] Fransen M, McConnell S, Bell M. Exercise for osteoarthritis of the hip or knee.
Cochrane Database Syst Rev 2003;CD860042.
[14] Roddy E, Zhang W, Doherty M, Arden NK, Barlow J, Birrell F, et al. Evidence-
based recommendations for the role of exercise in the management of
osteoarthritis of the hip or knee–the MOVE consensus. Rheumatology (Oxford)
2005;44:67–73.
[15] Tiffreau V, Mulleman D, Coudeyre E, Lefèvre-Colau MM, Revel M, Rannou F.
The value of individual or collective group exercise programs for knee or hip
osteoarthritis. Clinical practice recommendations. Ann Readapt Med Phys
2007;50:741–6 [34–40].
[16] Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al.
OARSI recommendations for the management of hip and knee osteoarthritis.
Part II: OARSI evidence-based expert consensus guidelines Osteoarthritis
Cartilage 2008;16:137–62.
[17] Lin DH, Lin CH, Lin YF, Jan MH. Efficacy of 2 non-weight-bearing interventions,
proprioception training versus strength training, for patients with knee
osteoarthritis: a randomized clinical trial. J Orthop Sports Phys Ther
2009;39:450–7.
[18] Felson DT, Clinical practice. Osteoarthritis of the knee. N Engl J Med
2006;354:841–8.
[19] Quilty B, Tucker M, Campbell R, Dieppe P. Physiotherapy, including quadriceps
exercises and patellar taping, for knee osteoarthritis with predominant
patello-femoral joint involvement: randomized controlled trial. J Rheumatol
2003;30:1311–7.
[20] Hernandez-Molina G, Reichenbach S, Zhang B, Lavalley M, Felson DT. Effect of
therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis.
Arthritis Rheum 2008;59:1221–8.
[21] Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for
osteoarthritis of the hip. Cochrane Database Syst Rev 2009;CD120079.
[22] French HP, Gilsenan C, Cusack T. Gluteal muscle dysfunction and the role of
specific strengthening in hip osteoarthritis: a review. Phys Ther Rev
2008;13:333–44.
[23] McNair PJ, Simmonds MA, Boocock MG, Larmer PJ. Exercise therapy for the
management of osteoarthritis of the hip joint: a systematic review. Arthritis
Res Ther 2009;11:R98.
[24] Moe RH, Haavardsholm EA, Christie A, Jamtvedt G, Dahm KT, Hagen KB.
Effectiveness of nonpharmacological and nonsurgical interventions for hip
osteoarthritis: an umbrella review of high-quality systematic reviews. Phys
Ther 2007;87(12):1716–27.
[25] Ricci NA, Coimbra IB. Exercise therapy as a treatment in osteoarthritis of
the hip: a review of randomized clinical trials. Rev Bras Reumatol 2006;46:
273–80.
[26] Zhang W, Doherty M, Arden N, Bannwarth B, Bijlsma J, Gunther KP, et al. EULAR
evidence based recommendations for the management of hip osteoarthritis:
report of a task force of the EULAR Standing Committee for International
Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis
2005;64:669–81.
[27] Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may post-
pone total hip replacement surgery in patients with hip osteoarthritis: a long-
term follow-up of a randomised trial. Ann Rheum Dis 2015;74:164–9.
[28] Tan SS, Teirlinck CH, Dekker J, Goossens LM, Bohnen AM, Verhaar JA, et al. Cost-
utility of exercise therapy in patients with hip osteoarthritis in primary care.
Osteoarthritis Cartilage 2016;24:581–8.
[29] Fernandes L, Storheim K, Nordsletten L, Risberg MA. Development of a
therapeutic exercise program for patients with osteoarthritis of the hip. Phys
Ther 2010;90:592–601.
[30] French HP, Cusack T, Brennan A, Caffrey A, Conroy R, Cuddy V, et al. Exercise
and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis
of the hip: a multicenter randomized controlled trial. Arch Phys Med Rehabil
2013;94:302–14.
[31] Juhakoski R, Tenhonen S, Malmivaara A, Kiviniemi V, Anttonen T, Arokoski JP. A
pragmatic randomized controlled study of the effectiveness and cost conse-
quences of exercise therapy in hip osteoarthritis. Clin Rehabil 2011;25:370–
83.
[32] Tak E, Staats P, Van Hespen A, Hopman-Rock M. The effects of an exercise
program for older adults with osteoarthritis of the hip. J Rheumatol
2005;32:1106–13.
[33] Brosseau L, Wells GA, Pugh AG, Smith CA, Rahman P, Alvarez Gallardo IC, et al.
Ottawa Panel evidence-based clinical practice guidelines for therapeutic
exercise in the management of hip osteoarthritis. Clin Rehabil 2015 [Epub
ahead of print. PMID: 26400851 (pii: 0269215515606198)].
[34] Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, et al. EULAR
evidence based recommendations for the management of hand osteoarthritis:
report of a Task Force of the EULAR Standing Committee for International
Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis
2007;66:377–88.
[35] Kjeken I, Grotle M, Hagen KB, Osteras N. Development of an evidence-based
exercise programme for people with hand osteoarthritis. Scand J Occup Ther
2015;22:103–16.
[36] Boustedt C, Nordenskiold U, Lundgren Nilsson A. Effects of a hand-joint
protection programme with an addition of splinting and exercise: one-year
follow-up. Clin Rheumatol 2009;28:793–9.
[37] Stamm TA, Machold KP, Smolen JS, Fischer S, Redlich K, Graninger W, et al.
Joint protection and home hand exercises improve hand function in patients
with hand osteoarthritis: a randomized controlled trial. Arthritis Rheum
2002;47:44–9.
[38] Wajon A, Ada L. No difference between two splint and exercise regimens for
people with osteoarthritis of the thumb: a randomised controlled trial. Aust J
Physiother 2005;51:245–9.
[39] Garfinkel MS, Schumacher Jr HR, Husain A, Levy M, Reshetar RA. Evaluation of
a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol
1994;21(12):2341–3.
[40] Lefler C, Armstrong J. Exercise in the treatment of osteoarthritis in the hands of
the elderly. Clin Kinesiol 2004;54:13–7.
 C. Nguyen et al. / Annals of Physical and Rehabilitation Medicine 59 (2016) 190–195
[41] Rogers MW, Wilder FV. Exercise and hand osteoarthritis symptomatology: a
controlled crossover trial. J Hand Ther 2009;22:10–7 [discussion 9-20;
quiz 18].
[42] Hennig T, Haehre L, Hornburg VT, Mowinckel P, Norli ES, Kjeken I. Effect of
home-based hand exercises in women with hand osteoarthritis: a randomised
controlled trial. Ann Rheum Dis 2015;74:1501–8.
[43] Dziedzic K, Nicholls E, Hill S, Hammond A, Handy J, Thomas E, et al. Self-
management approaches for osteoarthritis in the hand: a 2  2 factorial
randomised trial. Ann Rheum Dis 2015;74:108–18.
195
[44] Al-Johani AH, Kachanathu SJ, Ramadan Hafez A, Al-Ahaideb A, Algarni AD,
Meshari Alroumi A, et al. Comparative study of hamstring and quadriceps
strengthening treatments in the management of knee osteoarthritis. J Phys
Ther Sci 2014;26:817–20.
[45] Jegu AG, Pereira B, Andant N, Coudeyre E. Effect of eccentric isokinetic
strengthening in the rehabilitation of patients with knee osteoarthritis: Isogo,
a randomized trial. Trials 2014;15:106.