Impact of a daily exercise dose on knee joint cartilage – a systematic review and meta- analysis of randomized controlled trials in healthy animals A.

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Impact of a daily exercise dose on knee joint cartilage – a systematic review and meta- analysis of randomized controlled trials in healthy animals A. Bricca, C.B. Juhl, A.J. Grodzinsky, E.M. Roos Osteoarthritis and Cartilage Volume 25, Issue 8, Pages 1223-1237 (August 2017) DOI: 10.1016/j.joca.2017.03.009 Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Flow chart of the included studies. RCT = randomized controlled trial. Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10.1016/j.joca.2017.03.009) Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Main results. Synthesis of 29 studies and 64 study comparisons for the outcomes aggrecan content (A), collagen content (B) and cartilage thickness (C). When there was a statistically significant (P<0.05) increase or decrease in cartilage aggrecan, cartilage collagen or cartilage thickness in the intervention group compared to the control group we classified the effect of exercise as (‘+’) or (‘−’) respectively; and as no effect (‘=’) when no statistically significant difference was reported between the intervention and control groups. Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10.1016/j.joca.2017.03.009) Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Forest plot of meta-analysis for study comparisons investigating the effect of exercise dosage on cartilage thickness. Studies are grouped according to daily exercise dose (high, moderate, low). Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10.1016/j.joca.2017.03.009) Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Bubble plot showing the meta-regression analysis of the studies included in the meta-analysis for the impact of exercise dose on cartilage thickness. SMDs of cartilage thickness (y-axis) and dosage of exercise (x-axis) are shown. Weights of included trials were based on the inverse of the total variance and are shown by the size of the circles (a smaller circle contributes less to the overall result). The zero line indicates the threshold separating cartilage thickness increase (positive values of SMDs) and decrease (negative values of SMDs). Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10.1016/j.joca.2017.03.009) Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 'Risk of bias’ summary of six individual ‘Risk of bias’ items for each included study. Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10.1016/j.joca.2017.03.009) Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Funnel plot, for cartilage thickness, of the subset of studies' comparisons included in the meta-analysis, investigating small study bias stratified by exercise dose. Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10.1016/j.joca.2017.03.009) Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10. 1016/j. joca Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10. 1016/j. joca Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10. 1016/j. joca Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions

Osteoarthritis and Cartilage 2017 25, 1223-1237DOI: (10. 1016/j. joca Copyright © 2017 Osteoarthritis Research Society International Terms and Conditions