Summary: In a trial in obese older women with knee osteoarthritis, performing the same 12-week therapeutic exercise programme seated rather than standing produced greater pain relief, better knee function, and better physical quality of life, though standing exercise was better for mental quality of life.
PICO Summary
| Element | Detail |
|---|---|
| Population | 54 obese women aged 50–80 with knee osteoarthritis; randomised controlled trial, Indonesia. |
| Intervention | A 12-week seated therapeutic exercise programme (aerobics, hip stretching and strengthening, balance), 45-minute sessions three times weekly. |
| Comparison | An identical programme performed standing. |
| Outcome | The seated group had significantly less pain (Numerical Rating Scale), better knee function (KOOS), and better physical quality of life (SF-12) than the standing group (p<0.05). The standing group had better mental quality of life. |
Expert Commentary
This is a focused, practical trial whose result fits biomechanical logic, since performing exercise seated reduces compressive loading on osteoarthritic knees, which plausibly explains the greater pain relief and functional gain and the better physical quality of life that follows from being able to participate more comfortably. The intriguing counterpoint is the mental-health edge for standing exercise, which resonates with how much older adults value maintaining upright, independent activity, and it argues against treating either position as simply superior. Although this is an osteoarthritis study rather than a diabetes one, it is relevant to the many patients in whom obesity, metabolic disease, and painful weight-bearing joints coexist and limit activity. The limitations the post notes are fair: women only, 12 weeks, no blinding to exercise position with possible expectation effects, unmeasured adherence differences, and no weight-loss outcome. Can I use this with my patients? Yes, as a sensible starting strategy. For an obese patient with painful knees who struggles with weight-bearing exercise, I would begin with seated work to reduce pain and build confidence and then introduce standing activity as tolerated, balancing the physical advantages of sitting against the psychological value of staying upright, guided by the patient’s own priorities.
References
Tamin TZ, Clements C. Efficacy of exercise in the sitting position compared with exercise in the standing position in obese patients with knee osteoarthritis. Acta Med Indones. 2025;57(4):466–473. PubMed: 41502206