A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis - The Fitness Arthritis and Seniors Trial (FAST)

Objective.-To determine the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis. Setting and Design.-A randomized, single-blind clinical trial lasting 18 months conducted at 2 academic medical centers, Participants.-A total of 439 community-dwelling adults, aged 60 years or order, with radiographically evident knee osteoarthritis, pain, and self-reported physical disability. Interventions.-An aerobic exercise program, a resistance exercise program, and a health education program. Main Outcome Measures.-The primary outcome was self-reported disability score (range, 1-5). The secondary outcomes were knee pain score (range, 1-6), performance measures of physical function, x-ray score, aerobic capacity, and knee muscle strength. Results.-A total of 365 (83%) participants completed the trial, Overall compliance with the exercise prescription was 68% in the aerobic training group and 70% in the resistance training group. Postrandomization, participants in the aerobic exercise group had a 10% lower adjusted mean (+/-SE) score on the physical disability questionnaire (1.71+/-0.03 vs 1.90+/-0.04 units; P<.001), a 12% lower score on the knee pain questionnaire (2.1+/-0.05 vs 2.4+/-0.05 units; P=.001), and performed better (mean [+/-SE]) on the 6-minute walk test (1507+/-16 vs 1349+/-16 ft; P<,001), mean (+/-SE) time to climb and descend stairs (12.7+/-0.4 vs 13.9+/-0.4 seconds; P=.05), time to lift and carry 10 pounds (9.1+/-0.2 vs 10.0+/-0.1 seconds; P<,001), and mean (+/-SE) time to get in and out of a car (8.7+/-0.3 vs 10.6+/-0.3 seconds; P<.001) than the health education group, The resistance exercise group had an 8% lower score on the physical disability questionnaire (1.74+/-0.04 vs 1.90+/-0.03 units; P=.003), 8% lower pain score (2.2+/-0.06 vs 2,4+/-0.05 units; P=.02), greater distance on the 6-minute walk (1406+/-17 vs 1349+/-16 ft; P=.02), faster times on the lifting and carrying task (9.3+/-0.1 vs 10.0+/-0.16 seconds; P=.001), and the car task (9.0+/-0.3 vs 10.6+/-0.3 seconds; P=.003) than the health education group. There were no differences in x-ray scores between either exercise group and the health education group, Conclusions.-Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability, physical performance, and pain from participating in either an aerobic or a resistance exercise program. These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis.