Efficacy of Progressive Exercise Snacking for Middle-Aged and Older Adults With Knee Osteoarthritis: A Systematic Review and Meta-analysis.
Lidian Meng, Jiayi Chen, Xinxin Huo et al.
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In 30 seconds
This systematic review and meta-analysis assessed progressive exercise snacking (PES) for middle-aged and older adults with knee osteoarthritis. It included 18 randomized controlled trials involving 1,200 participants. PES was associated with short-term improvements in pain (SMD=-1.09; 95% CI=-1.51 to -0.68), joint function (SMD=1.31; 95% CI=0.98-1.64), and quality of life, and with midterm improvement in gait performance. Certainty ranged from low to moderate. Benefits for pain, function, and gait appeared to diminish with longer follow-up, leaving long-term efficacy uncertain.
Key findings
- Short-term pain improved with PES (SMD=-1.09; 95% CI=-1.51 to -0.68; moderate certainty).
- PES improved joint function (SMD=1.31; 95% CI=0.98-1.64; moderate certainty) and quality of life (SMD=0.97; 95% CI=0.14-1.79; low certainty).
- At midterm follow-up, gait performance improved (SMD=0.62; 95% CI=0.25-0.98; low certainty); meta-regression suggested benefits diminished with longer follow-up.
- PES did not appear to increase adverse events (risk ratio=1.80; 95% CI=0.41-2.54; P>.05).
Why it matters
The findings suggest that brief, progressive exercise bouts may offer benefits across symptoms and function for people with knee osteoarthritis, while also highlighting uncertainty about durability. The reported variation in certainty and attenuation over time are important when interpreting expected benefit and discussing the evidence. Further trials could clarify which protocols and exercise doses sustain improvements.
What to keep in mind
Long-term efficacy remains uncertain, and the authors call for larger, high-quality trials with longer follow-up and standardized protocols. Certainty was low for quality-of-life and gait outcomes.