Stationary cycling exercise for knee osteoarthritis: A systematic review and meta-analysis

Objective: To evaluate effects of stationary cycling exercise on pain, function and stiffness in individuals with knee osteoarthritis.

Data sources: Systematic search conducted in seven databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, and CNKI) from inception to September 2020.

Review methods: Included studies were randomized-controlled trials involving stationary cycling exercise conducted on individuals with knee osteoarthritis. End-trial weighted mean difference (WMD) and 95% confidence interval (CI) were analyzed, and random-effects models were used. Methodological quality and risk bias were assessed by using the Physiotherapy Evidence Database scale and Cochrane Collaboration tool, respectively.

Results: Eleven studies with 724 participants were found, of which the final meta-analysis was performed with eight. Compared to a control (no exercise), stationary cycling exercise resulted in reduced pain (WMD 12.86, 95% CI 6.90-18.81) and improved sport performance (WMD 8.06, 95% CI 0.92-15.20); although most of the meta-analysis results were statistically significant, improvements in stiffness (WMD 11.47, 95% CI 4.69-18.25), function (WMD 8.28, 95% CI 2.44-14.11), symptoms (WMD 4.15, 95% CI -1.87 to 10.18), daily living (WMD 6.43, 95% CI 3.19 to 9.66) and quality of life (WMD 0.99, 95% CI -4.27 to 6.25) for individuals with knee osteoarthritis were not greater than the minimal clinically important difference values for each of these outcome measures.

Conclusions: Stationary cycling exercise relieves pain and improves sport function in individuals with knee osteoarthritis, but may not be as clinically effective for improving stiffness, daily activity, and quality of life.

Keywords: Physiotherapy; exercise; knee osteoarthritis; meta-analysis; stationary cycling.