The effect of walking interventions on biomechanical knee osteoarthritis outcomes: A systematic review and meta-analysis

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism Pub Date : 2025-05-14 DOI:10.1016/j.semarthrit.2025.152755

Aleksandra R. Budarick , Cheryl L. Hubley-Kozey , Olga Theou , William D. Stanish , Meaghan Hannigan , Rebecca F. Moyer

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Abstract

Purpose

To summarize walking parameters specified in biomechanical analyses for knee osteoarthritis populations, determine the biomechanical effects of walking interventions, and explore associations between walking parameters and biomechanical knee osteoarthritis outcomes.

Methods

Databases (CINAHL, Embase, PubMED, SportDiscus, Scopus) were searched through October 2024. Experimental studies investigating biomechanical effects of walking interventions on knee osteoarthritis were included. Study quality was assessed using the QualSyst tool. Quantitative meta-analyses calculated Hedge’s g standardized mean differences (SMD) for first peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment (KFM), and gait speed. Meta-regressions investigated the effect of walking parameters (intervention length; duration, frequency, intensity) on outcomes.

Results

Eighteen studies were included. Interventions investigated walking for 19.4 (SD=25.9) weeks, at 24.6 (SD=9.7) minutes per session, and 3.2 (SD=1.7) sessions per week. Most interventions specified self-selected intensity. Meta-analyses of 13 studies indicated walking interventions provide a very small increase in first peak KAM (SMD=0.18), no effect on KAM impulse (SMD=-0.01), small increase in peak KFM (adjusted SMD=0.23), and small increase in gait speed (SMD=0.35). Meta-regressions revealed longer interventions were associated with increased KFM (β=0.02), and higher walking frequency with increased gait speed (β=0.37). No other parameters were associated with biomechanical outcomes.

Conclusions

Walking interventions elicit minimal-to-no change in discrete biomechanical metrics of joint loading for individuals with mild-to-moderate knee osteoarthritis. Longer walking interventions or more frequent walking may provide additional functional benefit. These results may inform walking guidelines for knee osteoarthritis and predominantly support increased walking without detrimental effects to knee joint health.

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步行干预对生物力学膝骨关节炎结局的影响：一项系统回顾和荟萃分析

目的总结膝关节骨性关节炎人群生物力学分析中指定的步行参数，确定步行干预的生物力学效应，并探讨步行参数与膝关节骨性关节炎生物力学预后之间的关系。方法检索至2024年10月的数据库（CINAHL、Embase、PubMED、SportDiscus、Scopus）。研究了步行干预对膝关节骨性关节炎的生物力学影响的实验研究。使用QualSyst工具评估研究质量。定量荟萃分析计算了第一次膝关节内收力矩峰值（KAM）、KAM脉冲、膝关节屈曲力矩峰值（KFM）和步态速度的Hedge’s g标准化平均差（SMD）。meta回归研究了行走参数(干预时间；持续时间，频率，强度)对结果的影响。结果共纳入18项研究。干预措施调查了19.4 （SD=25.9）周的步行时间，每次24.6 （SD=9.7）分钟，每周3.2 （SD=1.7）次。大多数干预规定了自我选择的强度。13项研究的荟萃分析表明，步行干预对第一峰值KAM （SMD=0.18）的增加非常小（SMD=0.18），对KAM冲动（SMD=-0.01）没有影响，峰值KFM（调整后的SMD=0.23）增加很小（SMD=0.35），步态速度增加很小（SMD=0.35）。meta回归显示，干预时间越长，KFM越高（β=0.02），步行频率越高，步速越快（β=0.37）。没有其他参数与生物力学结果相关。结论：对于轻度至中度膝骨性关节炎患者，步行干预对关节负荷的离散生物力学指标影响极小，甚至没有变化。更长时间的步行干预或更频繁的步行可能提供额外的功能益处。这些结果可能为膝关节骨关节炎的步行指南提供信息，并主要支持增加步行而不会对膝关节健康产生有害影响。

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来源期刊

Seminars in arthritis and rheumatism 医学-风湿病学

CiteScore

9.20

自引率

4.00%

发文量

176

审稿时长

46 days

期刊介绍： Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.