medwireNews: Findings from the TARGET trial suggest that weight-bearing (WB) and non-weight-bearing (NWB) exercise result in similar improvements in pain and function among obese people with medial knee osteoarthritis (OA), but the latter is associated with better quality of life and fewer adverse events.
The trial included 123 participants who were randomly assigned to undertake WB functional exercise or NWB quadriceps strengthening exercise for 12 weeks. Patients in both groups took part in individual physiotherapist sessions five times over the 12-week period, and were advised to complete the activities from home four times a week.
Kim Bennell (The University of Melbourne, Victoria, Australia) and co-investigators report that the primary outcomes of knee pain and physical function improved in both the WB and NWB groups, with no significant between-group differences.
Specifically, average knee pain as measured on an 11-point numeric rating scale improved from 5.9 points at baseline to 3.4 points at week 12 in the WB group, and from 5.9 to 4.1 points in the NWB arm, giving a nonsignificant mean difference in improvement of 0.73 points between the groups.
And for physical function, average WOMAC scores in the WB and NWB groups improved from 28.1 to 18.8 points and from 27.5 to 21.2 points, respectively, with a nonsignificant mean difference of 2.80 points.
Bennell and team say that there were no significant differences between the WB and NWB groups for the majority of secondary outcomes, with the exception of quality of life, with AQoL-6D scores improving to a significantly greater degree in the NWB group (mean difference=0.043 points).
Adverse events (AEs) were reported by significantly fewer patients in the WB versus the NWB group (23 vs 39%), and included increased knee pain (15 vs 23%), pain in other areas (8 vs 20%), and swelling/inflammation (2 vs 0%).
“This might be especially relevant for people with co-morbid joint pain elsewhere, given that WB exercise was associated with fewer pain flares at other sites,” write the study authors in Osteoarthritis & Cartilage.
While they acknowledge the lack of a non-exercise control group, Bennell et al say that their findings from the TARGET trial “suggest that either exercise program could be recommended for these patients.”
However, they say that “WB exercise may be preferred over NWB exercise given fewer adverse events and potential additional benefits on some secondary outcomes, which require confirmation in future research.”
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Osteoarthritis Cartilage 2020; doi:10.1016/j.joca.2020.02.838