Physical Exercise and Weight Loss for Hip and Knee Osteoarthritis in Very Old Patients: A Systematic Review of the Literature

Jean-Laurent Le Quintrec 1, Bernard Verlhac 2, Christian Cadet 3, Philippe Bréville 4, Jean M Vetel 5, Jean B Gauvain 6, Claude Jeandel 7, Emmanuel Maheu*, 8
1 Service de Médecine Gériatrique 3 [Department of Geriatric Medicine 3], Hôpital Sainte-Périne (A.P-H.P), Paris, France
2 Pôle Vieillissement, réadaptation et Accompagnement [Centre for the Aged, Rehabilitation and Support], Hôpital Paul Brousse (A.P-H.P) Villejuif, France
3 Medical Office, Paris, France
4 Service de Rhumatologie [Department of Rheumatology], Groupe Hospitalier Paris Saint Joseph, Paris, France
5 Centre Hospitalier, Le Mans, France
6 Centre de Médecine Interne Gériatrique [Centre for Geriatric Internal Medicine], Centre Hospitalier régional, Orléans, France
7 Service de Médecine interne et Gériatrie [Department of Internal and Geriatric Medicine], Montpellier, France
8 Service de Rhumatologie, Rheumatology Department, Medical Office / Hôpital Saint Antoine -A.P-H.P, Paris, France

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© Le Quintrec et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Service de rhumatologie AP-HP Hôpital Saint Antoine F-75012, Paris, France; Tel: +33 6 22 24 89 80; E-mail:


Background :

Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.

Methods :

Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles.

Results :

We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients.

Physical exercise (8 trials):

was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation.

Aquatic exercise (5 trials):

was as effective as land-based exercise.

Weight loss (2 trials):

only patients under diet + exercise had significant improvement on symptoms.

Conclusion :

Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.

Keywords: Hip osteoarthritis, knee, physical exercise, systematic review, very old, weight loss..