Page 91 - Petelin, Ana, ur. 2024. Zdravje delovno aktivnih in starejših odraslih / Health of Working-Age and Older Adults. Zbornik povzetkov z recenzijo ▪︎ Book of Abstracts. Koper: Založba Univerze na Primorskem/University of Primorska Press

Effect of added glucosamine to exercise in knee osteoarthritis:
a systematic review and meta-analysis

1,2
Tina Čeh , Nejc Šarabon 1
1 University of Primorska Faculty of Health Sciences, Izola, Slovenia
2 Community Healthcare Center dr. Adolf Drolc Maribor, Slovenia
Introduction: Osteoarthritis is degenerative joint disease and it mainly affects large
weight-bearing joints such as hips and knees. Exercise is known to significantly improve
physical function and alleviate pain in patients with knee osteoarthritis (KOA). Com-
monly used symptomatic slow-acting drugs for osteoarthritis such as glucosamine (G)
and chondroitin (C) have gained wide popularity for KOA, although there are con-
flicting findings regarding the clinical benefits of their use. Evidences on the effective-
ness of combining exercise and dietary supplements for managing KOA are weak and
has not yet been established. The aim was to review the literature on the additional
effects of G or G and C in combination with exercise on pain and physical function in
patients with KOA.
Methods: Study eligibility criteria were structured and organized according to the PI-
COS tool: a) population: adults aged > 50 years with KOA; b) intervention: any type
of home- or institution-based exercise in duration of at least 4 weeks in combination
with G or G combined with C; c) comparison: control or placebo group (exercise in-
tervention only); d) outcome: any tests assessing physical function and pain (instru-
mented and non-instrumented measures and questionnaires); study design: interven-
tional clinical trials with at least two groups (exercise + G and/or C and exercise
group). Studies were searched in several online databases: PubMed, Cochrane Cen-
tral Register of Controlled Trials, PEDro, and Web of Science. Quality assessment of
the literature was conducted using the Pedro scale, and meta-analysis was performed
using Review Manager 5.4 software. For the meta-analysis, the inverse variance meth- preventiva in rehabilitacija ... | prevention and rehabilitation ...
od for continuous outcomes with a random-effects model was used. The effect siz-
es were expressed as standardized mean difference (SMD). For SMD, the respective
95% confidence intervals were also calculated and reported. Statistical heterogeneity
among studies was assessed by calculating I statistics. Statistical significance threshold
2
was set at p ≤ 0.05 for all analyses.
Results: Six studies, comprising 297 participants, were included in the final analysis.
According to the PEDro scale, the average quality of the studies was rated as good
(mean=8.2, range=5–10). The results indicated that the combined effect of G, or
G and C, with exercise was not significant, as evidenced by the assessed knee pain
(WOMAC pain: SMD –0.18, 95% CI –0.47 to 0.11, p = 0.23; and VAS pain: SMD –0.34,
95% CI –0.85 to 0.17, p = 0.20) and physical function (SMD –0.13, 95% CI –0.95 to
0.69, p = 0.76).
Discussion and conclusions: We observed a high variability among study designs, which
made it difficult to assess with certainty the effect of G and C in combination with ex-
ercise on KOA symptoms compared to exercise alone. More high-quality studies are
needed to explore the role of G and/or C combining with exercise in the treatment
of disease. However, the inclusion of G with or without C in a KOA exercise program
did not seem to make exercise therapy more effective.
Keywords: treatment, dietary supplement, physical activity, older adults

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