The role of muscle strengthening in exercise therapy for knee osteoarthritis: A systematic review and meta-regression analysis of randomized trials

Bartholdy C, et al. · Seminars in Arthritis and Rheumatism

ACSM-compliant strength training produced greater knee-extensor strength gains (SMD 0.448, 95% CI 0.091-0.805); analysis suggests a 30-40% strength increase may be needed for clinically meaningful pain/disability improvement. Strengthening per se was not required for symptom relief.

Population

45 trials, 4,699 participants with knee OA (56 comparisons)

Intervention

Exercise following ACSM progressive resistance-training principles vs other exercise

Comparator

Non-ACSM exercise or control

Limitations

Indirect comparisons across trials; strength threshold is a model-based estimate, not a tested target.