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Seurk Park1
, So Hi Kwon2
, So Hi Kwon2
Abstract
Purpose
The aim of this study was to evaluate the effect of exercise on chronic musculoskeletal pain in older adults.
Methods
In order to conduct a meta-analysis, a total 7,186 studies were retrieved from seven databases (Pubmed, CINAHL, Cochrane Library, RISS, KISS, NDSL, KoreaMed) without restriction on publication year and the articles published until June 2018 were selected for this study. Sixteen studies were selected for the meta-analysis based on their satisfaction of the inclusion criteria and low risk of bias. Baseline demographic data, exercise features, and outcome data were extracted from all included trials. The data was analyzed using the RevMan 5.2 and CMA 3.0. program.
Results
The results of the meta-analysis (n=16) revealed that the exercise intervention was found to be significantly superior to control group on pain (Standardized Mean Difference [Hedges'g]=−0.43, 95% Confidence Interval [CI]=−0.59~−0.27). Also, meta-ANOVA was performed using study period, length and frequency of session and type of exercise, but no statistically significant moderators were found.
Conclusion
In this study, the exercise demonstrated significant reduction in pain intensity in older adults and there was no difference in pain reduction according to type or duration of exercise. Therefore, exercise that older adults prefers and is feasible in where they are, should be adopted as a nursing intervention for older adults' chronic musculoskeletal pain management.
Figures and Tables
Table 1
Descriptive Summary of Selected 16 Studies
Kima)=Kim Hyang-su; Kimb)=Kim Hyang-sook; RCT=randomized controlled trial; Non-RCT=non equivalent control group design; USA=United States of America; CG=control group; CLBP=chronic low back pain; EG=experimental group; OA=osteoarthritis; NA=not reported; AE=aerobic/endurance exercise; BP=balance/proprioceptive exercise; SD=standard deviation; RS=resistance/strengthening exercise; SR=stretching/rang of motion exercise; KOOS=knee injury and osteoarthritis outcome score; KPS=korean pain scale; NRS=numeric rating scale; VAS=visual analog scale; WOMAC: wester ontario and mcmaster osteoarthritis index score.
Table 2
Characteristics of Included Studies (N=16)
RCT=randomized controlled trial; Non-RCT=non equivalent control group design; EG=experimental group; CG=control group; KOOS=knee injury and osteoarthritis outcome score; KPS=Korean pain scale; NRS=numeric rating scale; VAS=visual analog scale; WOMAC= wester ontario and mcmaster osteoarthritis index score; AE=aerobic/endurance exercise; BP=balance/proprioceptive exercise; RS=resistance/ strengthening exercise; R=stretching/rang of motion exercise.
ACKNOWLEDGEMENT
This article is a revision of the first author' master' thesis from Kyungpook National University.
Appendix
Appendix 1
Studies Included in Meta-Analysis
A1. Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, et al. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis and Cartilage. 2010;18(5):621-8. https://doi.org/10.1016/j.joca.2010.01.010
A2. Doi T, Akai M, Fujino K, Iwaya T, Kurosawa H, Hayashi K, et al. Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial. American Journal of Physical Medicine & Rehabilitation. 2008;87(4):258-69. https://doi.org/10.1097/PHM.0b013e318168c02d
A3. Fitzgerald GK, Piva SR, Gil AB, Wisniewski SR, Oddis CV, Irrgang JJ. Agility and perturbation training techniques in exercise therapy for reducing pain and improving function in people with knee osteoarthritis: a randomized clinical trial. Physical Therapy. 2011;91(4):452-69. https://doi.org/10.2522/ptj.20100188
A4. Foroughi N, Smith RM, Lange AK, Baker MK, Fiatarone Singh MA, Vanwanseele B. Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: a randomized controlled trial. Clinical Biomechanics. 2011;26(2):167-74. https://doi.org/10.1016/j.clinbiomech.2010.08.011
A5. Hyoung HK. Effects of a strengthening program for lower back in older women with chronic low back pain. Journal Korean Academy Nursing. 2008;38(6):902-13. https://doi.org/10.4040/jkan.2008.38.6.902
A6. Jan MH, Lin JJ, Liau JJ, Lin YF, Lin DH. Investigation of clinical effects of high- and low-resistance training for patients with knee osteoarthritis: a randomized controlled trial. Physical Therapy. 2008;88(4):427-36. https://doi.org/10.2522/ptj.20060300.
A7. Jo YK. Effect of a rehabilitation exercise program on pain, physical fitness, depression and life satisfaction of the elderly with osteoarthritis of the knee [master's thesis]. Busan: Kosin University; 2007.
A8. Kim HS. Effect of trunk stabilization exercise program in elderly women with chronic low back pain [dissertation]. Chungnam: Kongju National University; 2013. p. 1-133.
A9. Kim HS. The effect of back pain relieve exercise program on the pain and depression of the elderly with chronic low back pain [master's thesis]. Jinju: Gyeongsang National University; 2000.
A10. Kim H, Suzuki T, Saito K, Kim M, Kojima N, Ishizaki T, et al. Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: a randomized controlled trial. Archives of Gerontology and Geriatrics. 2013;57(3):352-9. https://doi.org/10.1016/j.archger.2013.06.008
A11. Knoop J, van de Leeden M, Roorda LD, Thorstensson CA, van der Esch M, Peter WF, et al. Knee joint stabilization therapy in patients with osteoarthritis of the knee and knee instability: subgroup analyses in a randomized, controlled trial. Journal of Rehabilitation Medicine. 2014;46(7):703-7. https://doi.org/10.2340/16501977-1809
A12. Lin DH, Lin CHJ, Lin YF, Jan MH. Efficacy of 2 nonweightbearing interventions, proprioception training versus strength training, for patients with knee osteoarthritis: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy. 2009;39(6):450-7. https://doi.org/10.2519/jospt.2009.2923.
A13. Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73. https://doi.org/10.1001/jama.2013.277669
A14. Peungsuwan P, Sermcheep P, Harnmontree P, Eungpinichpong W, Puntumetakul R, Chatchawan U, et al. The Effectiveness of Thai exercise with traditional massage on the pain, walking ability and QOL of older people with knee osteoarthritis: a randomized controlled trial in the community. Journal of Physical Therapy Science. 2014;26(1):139-44. https://doi.org/10.1589/jpts.26.139
A15. Ryu SK, Park JM, Mun KS, Cho JY, Hyun KS. Effects of mat training on the balance and VAS of elderly women with chronic low back pain. Journal of Sport and Leisure Studies. 2016; 65(8):601-10.
A16.Wang TJ, Lee SC, Liang SY, Tung HH, Wu SFV, Lin YP. Comparing the efficacy of aquatic exercises and land-based exercises for patients with knee osteoarthritis. Journal of Clinical Nursing. 2011;20(1):2609-22. https://doi.org/10.1111/j.1365-2702.2010.03675.x
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