The effect of walking interventions on biomechanical knee osteoarthritis outcomes: A systematic review and meta-analysis

Abstract

Purpose: To summarize walking parameters specified in biomechanical analyses for knee osteoarthritis populations, determine the biomechanical effects of walking interventions, and explore associations between walking parameters and biomechanical knee osteoarthritis outcomes.

Methods: Databases (CINAHL, Embase, PubMED, SportDiscus, Scopus) were searched through October 2024. Experimental studies investigating biomechanical effects of walking interventions on knee osteoarthritis were included. Study quality was assessed using the QualSyst tool. Quantitative meta-analyses calculated Hedge's g standardized mean differences (SMD) for first peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment (KFM), and gait speed. Meta-regressions investigated the effect of walking parameters (intervention length; duration, frequency, intensity) on outcomes.

Results: Eighteen studies were included. Interventions investigated walking for 19.4 (SD=25.9) weeks, at 24.6 (SD=9.7) minutes per session, and 3.2 (SD=1.7) sessions per week. Most interventions specified self-selected intensity. Meta-analyses of 13 studies indicated walking interventions provide a very small increase in first peak KAM (SMD=0.18), no effect on KAM impulse (SMD=-0.01), small increase in peak KFM (adjusted SMD=0.23), and small increase in gait speed (SMD=0.35). Meta-regressions revealed longer interventions were associated with increased KFM (β=0.02), and higher walking frequency with increased gait speed (β=0.37). No other parameters were associated with biomechanical outcomes.

Conclusions: Walking interventions elicit minimal-to-no change in discrete biomechanical metrics of joint loading for individuals with mild-to-moderate knee osteoarthritis. Longer walking interventions or more frequent walking may provide additional functional benefit. These results may inform walking guidelines for knee osteoarthritis and predominantly support increased walking without detrimental effects to knee joint health.

Keywords: Biomechanics; Exercise; Knee adduction moment; Knee osteoarthritis; Walking.