Effects of three types of resistance training on knee osteoarthritis: A systematic review and network meta-analysis

Resistance training (RT) is recognized in clinical guidelines as a beneficial treatment for knee osteoarthritis (KOA), but the efficacy of different RT types is not well-established. This network meta-analysis (NMA) aimed to compare the effects of different types of RT, namely, isometric muscle strengthening (IMMS), isokinetic muscle strengthening (IKMS) and isotonic muscle strengthening (ITMS), on pain, function and quadriceps muscle strength of patients with KOA. A systematic search was conducted up to September 2023 on databases, including PubMed, Cochrane Library, EMbase, Web of Science and China National Knowledge Infrastructure. The included studies comprised randomised controlled trials (RCTs) comparing RT with conventional rehabilitation and physiotherapy or other types of RT. Compared with the control group (CG) that received conventional physiotherapy, IKMS was optimal in terms of pain relief (MD = -1.33, 95% CI: -1.83 to -0.83), function (MD = -12.24, 95% CI: -17.29 to -7.19) and knee extension torque (SMD = -0.44, 95% CI: -0.74 to -0.14). Compared with conventional rehabilitation therapy, all three types of RT can improve pain and knee-joint function in KOA patients. IKMS demonstrated the best results among the different RT modalities. PROSPERO registration number: CRD42023448579.