The relationship between experience of knee pain and physical activity participation: A scoping review of quantitative studies.
Lu Yang, Peipei Wang, Bronwyn McGill
PMID 37128486WHAT IT FOUND
Evidence linking knee pain to physical activity is inconsistent.
Pain may reduce moderate activity but not light activity. Psychological factors like catastrophizing and specific painful movements interfere with participation more than pain intensity alone.
Key findings
01Knee pain was associated with less time in moderate physical activity, but light-intensity activity levels did not differ significantly between pain groups.
02Higher morning pain catastrophizing predicted less moderate-to-vigorous physical activity on the same day, creating a negative cycle with increased pain the next morning.
03For those with severe knee osteoarthritis, pain while walking on flat surfaces, bending, or standing up was associated with lower physical activity levels.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The review included only nine quantitative studies, limiting the robustness of the conclusions. Most included studies were cross-sectional, preventing causal inferences about the relationship between pain and activity. High reliance on self-reported pain measures introduced potential response and recall bias. The evidence is derived exclusively from high-income countries with predominantly Caucasian populations, limiting generalizability. Physical activity was measured using heterogeneous tools (accelerometers, pedometers, questionnaires), making direct comparison difficult.
Declared interests
The authors declared no conflicts of interest. No external funding was received for this work.
The easy way to misread this
Do not assume that knee pain universally prevents physical activity. The evidence is mixed, and light-intensity activity often continues despite pain. Furthermore, this review identifies associations, not causes; do not interpret these findings as proof that reducing pain will automatically increase activity, as psychological factors like catastrophizing play a significant mediating role.