Australian research suggests moderate intensity aerobic exercise doesn’t help pain or function.
Moderate-intensity cardiovascular exercise doesn’t seem to help pain or functioning in hip osteoarthritis patients when added to resistance exercise, according to new Australian research.
Researchers randomly assigned almost 200 Melbourne patients with symptomatic hip OA to undertake three months of resistance exercise combined with moderate-intensity aerobic exercise, or resistance exercise alone, which included a home exercise program and nine sessions with a physiotherapist.
They found that both groups had clinically significant improvements to hip pain severity and function at three months and at the nine-month follow-up, but that cardio exercise conferred no extra benefit.
“Clinical management guidelines for hip osteoarthritis consistently recommend exercise as a core treatment. However, there is no clear evidence to recommend one type of exercise programme over another,” the authors wrote in The Lancet Rheumatology.
“Despite spending around 48% more time in at least moderate intensity activity per week, adding aerobic physical activity to resistance exercise did not improve the primary outcomes of pain and function when compared with resistance exercise alone,” Associate Professor Michelle Hall, osteoarthritis expert at the University of Sydney, and colleagues wrote.
The study, which the authors said was the largest randomised comparative effectiveness trial to test this, encouraged participants to engage with whatever planned or incidental aerobic activity they desired to reach the 150-minute goal.
This group spent an average of 50 minutes more than the controls doing at least moderate-intensity exercise, and the most popular aerobic activities were walking, cycling and gardening.
Both groups had around 20-30 adverse events, but none were serious.
There was some variation in the effects of adding cardio to the resistance exercise program.
At three months, both groups improved similarly on hip pain scores (2.4 points out of 10 for the cardio group and 2.2 for the resistance exercise alone group) and function (7.0 out of 68 on the WOMAC index for the cardio group and 8.9 for the resistance exercise alone group). Timed stair climbs and the 40m fast walk performance, which were secondary outcomes, were the same across groups.
“However, there are preliminary signals that adding aerobic physical activity to resistance exercise might be superior and clinically relevant for patient-specific functional tasks and 30s sit-to-stand. However, more participants in the resistance exercise group reached the minimal clinically important difference in WOMAC function at nine months compared with the aerobic physical activity and resistance exercise group. Thus, the findings should be interpreted with caution,” the authors said.
“Our findings suggest that adding aerobic physical activity to resistance exercise does not have greater benefits for pain and function in people with hip osteoarthritis than resistance exercise alone.
“Collectively, at present there is insufficient evidence to recommend one type of exercise programme over the other for hip osteoarthritis.”
Professor Hall and colleagues noted that there were no detected differences between groups in submaximal cardio-respiratory fitness, which could have explained the lack of between-group differences found in the study.
“We acknowledge that providing the wearable to the resistance exercise group might have inadvertently increased activity time even though participants in the resistance exercise group received no instruction to use the wearable or increase aerobic physical activity.”
Both groups were given wearable activity trackers, and the physiotherapy sessions were mostly telehealth due to the covid pandemic.
