Does tailored exercise work better than generic, one-size-fits-all programming? This pragmatic trial attempted to answer that question for people with knee osteoarthritis.
There is a large caveat that needs to be acknowledged. Exercise has many goals. Previous research has shown that tailored approaches considering the participant's training history yield superior improvements in fitness markers (strength, hypertrophy, aerobic fitness) than standard approaches. To address kinesiophobia, graded exposure involving the specific movements the participant is fearful of is required.
This study specifically looked at pain and function as outcome measures. Pain and function (measured by patient- reported outcome measures, such as FOTO or ODI) can be influenced by many things, including time/natural history. This study used a stratified approach, allocating patients into well-accepted OA phenotypes: a ‘low muscle strength subgroup’ (LMS) (‘age-induced phenotype), a ‘high muscle strength subgroup’ (HMS) (‘post-traumatic phenotype), and an ‘obesity subgroup’ (OS) (‘metabolic phenotype).
Specific exercises were designed for each group. Bear in mind, this does not mean the exercise was tailored to the individual, but rather, a smaller group than knee OA.
The control group received 'standard' PT.' At 3 and 12-month follow-ups, there were no significant differences in pain or function. The average number of sessions was 8.4 for the experimental groups and 9.6 for the control groups. At that volume, we shouldn't expect much difference in physical performance outside of the influence of pain.
If the goal is pain reduction and general function improvements, any type of physical activity will work well. If the goals are patient-specific (fear or specific activities), fitness-based (strength and aerobic capacity), or body-composition-based, then a tailored approach at a higher dose of care is likely warranted.
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