近日，浙江大学医学院附属第一医院王斌团队研究了膝骨性关节炎运动方式的疗效和安全性比较。相关论文于2025年10月15日发表在《英国医学杂志》上。

为了评估各种运动方式作为治疗膝关节骨关节炎的干预措施的有效性和安全性，研究组进行一项网络元分析的系统评价，选择比较膝关节骨关节炎患者不同的运动方式，包括有氧运动、柔韧性运动、心身运动、神经运动、强化运动、混合运动和对照组的随机对照试验。主要结局包括疼痛、功能、步态表现和生活质量，分别在短期（4周）、中期（12周）和长期（24周）随访中进行评估。当无法获得准确的时间点时，使用相邻时间窗口的数据。

研究组共纳入217项随机对照试验（涉及15684名受试者）。中等确定性证据表明：与对照组相比，有氧运动可能显著改善短期（标准化均数差-1.10，95%置信区间-1.68至-0.52）与中期（-1.19，-1.59至-0.79）疼痛、中期功能（1.78，1.05至2.51）、中期步态表现（0.85，0.55至1.14）及短期生活质量（1.53，0.47至2.59）。身心运动可能显著改善短期功能（0.88，0.03至1.73；中等确定性），而神经运动训练可能显著提升短期步态表现（1.04，0.51至1.57；中等确定性）。

力量训练（0.86，0.53至1.18）与混合运动（1.07，0.68至1.46）均可显著改善中期功能，所有证据均为中等确定性。长期随访显示：柔韧训练可能大幅减轻疼痛（-0.99，-1.63至-0.36；低确定性）；有氧运动可能显著改善功能（0.87，0.02至1.72，低确定性）；混合运动则可改善功能（0.56，0.26至0.86；低确定性）并可能提升步态表现（0.57，0.21至0.92，中等确定性）。累积排名曲线下面积值（均值0.72）显示，有氧运动在所有结局指标中始终具有最佳治疗效果的最高概率。仅少数研究（40项，18%）报告了安全性结局，运动干预与对照组间未观察到明显差异。

研究结果表明，对于膝骨关节炎患者，有氧运动可能是最有益的运动方式，可以改善疼痛、功能、步态表现和生活质量。

附：英文原文

Title: Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis

Author: Lei Yan, Dijun Li, Dan Xing, Zijuan Fan, Guangyuan Du, Jingwei Jiu, Xiaoke Li, Janne Estill, Qi Wang, Ahmed Atef Belal, Chen Tian, Jiao Jiao Li, Songyan Li, Haifeng Liu, Xuanbo Liu, Yijia Ren, Yiqi Yang, Jinxiu Chen, Yihe Hu, Long Ge, Bin Wang

Issue&Volume: 2025/10/15

Abstract:

Objective To assess the efficacy and safety of various exercise modalities as therapeutic interventions for managing knee osteoarthritis.

Design Systematic review with network meta-analysis.

Data sources PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, AMED, PEDro, Scopus, ClinicalTrials.gov, ICTRP, and ClinicalTrialsRegister.eu from database inception to August 2024.

Eligibility criteria for selecting studies Randomised controlled trials comparing different exercise modalities, including aerobic exercise, flexibility exercise, mind-body exercise, neuromotor exercise, strengthening exercise, mixed exercise, and control group for patients with knee osteoarthritis.

Main outcome measures Primary outcomes included pain, function, gait performance, and quality of life, assessed at short term (four weeks), mid-term (12 weeks), and long term (24 weeks) follow-up. When exact time points were unavailable, data from adjacent time windows were used.

Results 217 randomised controlled trials involving 15684 participants were included. Moderate certainty evidence showed that, compared with the control group, aerobic exercise probably results in large improvements in pain at short term (standardised mean difference 1.10, 95% confidence interval 1.68 to 0.52) and mid-term follow-up (1.19, 1.59 to 0.79), function at mid-term (1.78, 1.05 to 2.51), gait performance at mid-term (0.85, 0.55 to 1.14), and quality of life at short term (1.53, 0.47 to 2.59). Mind-body exercise probably results in a large increase in function at short term follow-up (0.88, 0.03 to 1.73; moderate certainty), while neuromotor exercise probably results in a large increase in gait performance at short term follow-up (1.04, 0.51 to 1.57; moderate certainty). Strengthening (0.86, 0.53 to 1.18) and mixed exercise (1.07, 0.68 to 1.46) probably result in a large increase in function at mid-term follow-up, all with moderate certainty evidence. Regarding long term follow-up, flexibility exercise may result in a large reduction in pain (0.99, 1.63 to 0.36; low certainty); aerobic exercise may result in a large increase in function (0.87, 0.02 to 1.72, low certainty); and mixed exercise may increase function (0.56, 0.26 to 0.86; low certainty) and probably increases gait performance (0.57, 0.21 to 0.92, moderate certainty). Overall, aerobic exercise consistently showed the highest probability of being the best treatment, as reflected by surface under the cumulative ranking curve values (mean 0.72) across outcomes. The safety outcome was reported in a small proportion of studies (40 studies, 18%), and no clear differences were observed between exercise interventions and control.

Conclusions In patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life, with moderate certainty.

DOI: 10.1136/bmj-2025-085242

Source: https://www.bmj.com/content/391/bmj-2025-085242