title: Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis.
abstract: OBJECTIVE
  Which types of exercise intervention are most effective in relieving pain and improving function in people with lower limb osteoarthritis?
  
  
  CONCLUSIONS
  As of 2002 sufficient evidence had accumulated to show significant benefit of exercise over no exercise. An approach combining exercises to increase strength, flexibility, and aerobic capacity is most likely to be effective for relieving pain and improving function.
  
  
  BACKGROUND
  Current international guidelines recommend therapeutic exercise (land or water based) as "core" and effective management of osteoarthritis. Evidence from this first network meta-analysis, largely based on studies in knee osteoarthritis, indicates that an intervention combining strengthening exercises with flexibility and aerobic exercise is most likely to improve outcomes of pain and function. Further trials of exercise versus no exercise are unlikely to overturn this positive result.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL UK.
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: van der Windt
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Jordan
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
authors.forename: Krysia S
authors.initials: KS
authors.lastname: Dziedzic
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Healey
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
authors.forename: George M
authors.initials: GM
authors.lastname: Peat
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster