Abstract
The aim of the study was to compare the effects of low-intensity exercise programs for lower extremities, either supervised or at home, on pain, muscle strength, balance and the hemodynamic parameters of knee osteoarthritis (OA) patients. This randomized study included 78 patients with knee OA in 2 groups of supervised and home-based exercise program. Exercises were applied to the first group in the clinic as a group exercise program and were demonstrated to the second group to be performed at home. Before and after the 6-week exercise program, assessment was made of pain, quadriceps and hamstring muscle strengths, 6-min walk test (6MWT), and non-invasive hemodynamic parameters. Results of the 78 patients, 56 completed the study. Pain, muscle strength, and 6MWT scores showed significant improvements in both groups. There were also significant differences in the amount of change in pain and muscle strength (pain: p = 0.041, Rqdc: 0.009, Lqdc: 0.013, Rhms: 0.04) which indicated greater improvements in the supervised group. The balance scores of supervised group showed a significant improvement (p = 0.009). No significant change was determined in hemodynamic parameters of either group. Conclusion according to the results of this study showed that low-intensity lower extremity exercises conducted in a clinic under the supervision of a physiotherapist were more effective than home-based exercises in reducing post-activity pain levels and improving quadriceps and right hamstring muscle strength. Both the supervised and home exercise programs were seen to be effective in reducing rest pain and increasing 6 MW distance in knee osteoarthritis patients.
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References
Neogi T (2013) The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil 21(9):1145–1153
Kacar C, Gilgil E, Urhan S, Arıkan V, Dündar Ü, Öksüz MC et al (2005) The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol Int 25(3):201–204
Covinsky K (2006) Aging, arthritis, and disability. Arthritis Rheum 55(2):175–176
Dunlop D, Manheim L, Song J, Chang R (2001) Arthritis prevalence and activity limitations in older adults. Arthritis Rheum 44(1):212–221
Beals, CA, Lampman RM, Banwell BE, Braunstein EM, Albers JW, Castor CW (1985) Measurement of exercise tolerance in patients with rheumatoid arthritis and osteoarthritis. Rheumatol 12:458–461
Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ (1992) Weight loss reduces the risk for symptomatic knee osteoarthritis in women: the Framingham study. Ann Intern Med 116(7):535–539
Philbin EF, Groff GD, Ries MD, Miller TE (1995) Cardiovascular fitness and health in patients with end-stage osteoarthritis. Arthritis Rheum 38:799–805
Bindawas SM, Vennu V (2015) Longitudinal effects of physical inactivity and obesity on gait speed in older adults with frequent knee pain: data from the osteoarthritis initiative. Int J Environ Res Public Health 12(2):1849–1863
Ries MD, Philbin EF, Groff GD. Relationship between severity of gonarthrosis and cardiovascular fitness. Clin Orthop Relat Res 1995;(313):169–176
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, Lancet Physical Activity Series Working Group (2012) Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380(9838):219–229
Philbin EF, Ries MD, Groff GD, Sheesley KA, French TS, Pearson TA (1996) Osteoarthritis as a determinant of an adverse coronary heart disease risk profile. J Cardiovasc Risk 3(6):529–533
McAlindon TE, Cooper C, Kirwan JR, Dieppe PA (1993) Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis 52(4):258–262
Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP et al (1997) Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 127:97–104
Juhl C, Christensen R, Roos EM, Zhang W, Lund H (2014) Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and meta-regression analysis of randomized controlled trials. Arthritis Rheumatol 66(3):622–636
Regnaux JP, Lefevre-Colau MM, Trinquart L, Nguyen C, Boutron I, Brosseau L, Ravaud P (2015) High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis. Cochrane Database Syst Rev 10:CD010203
Research Randomizer. http://www.randomizer.org/. Accessed 01 May 2014
Bijur PE, Silver W, Gallagher EJ (2001) Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8:1153–1157
Livingston T, Bernardi D, Carroll M (2015) The Commander™ Muscle Tester User’s Manual. JTECH Medical, USA, pp 1–19
Swisher A, Goldfarb A (1998) Use of the six-minute walk/run test to predict peak oxygen consumption in older adults. Cardiopulm Phys Ther J 9(3):3–5
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 166(1):111–117
Techno Consept. EQUIBOARD Freeman© Equilibre & Proprioseption Plateau de Freeman Electronique avec Biofeedback. Data Sheet (2013) http://pdf.medicalexpo.com/pdf/techno-concept/equiboard/77870-106767.html. Accessed 19 May 2014
Charloux A, Lonsdorfer-Wolf E, Richard R, Lampert E, Oswald-Mammosser M, Mettauer B et al (2000) A new impedance cardiograph device for the non-invasive evaluation of cardiac output at rest and during exercise: comparison with the “direct” Fick method. Eur J Appl Physiol 82(4):313–320
Tan KH, Lai FO, Hwang NC (2006) Measurement of cardiac output using Physio Flow with different positions of electrode placement. Singapore Med J 47(11):967–970
Li XD, Sun GF, Zhu WB, Wang YH (2015) Effects of high intensity exhaustive exercise on SOD, MDA, and NO levels in rats with knee osteoarthritis. Genet Mol Res 14(4):12367–12376
Kim HS, Yun DH, Yoo SD, Kim DH, Jeong YS, Yun JS et al (2011) Balance control and knee osteoarthritis severity. Ann Rehabil Med 35(5):701–709
Hurley MV, Scott DL, Rees J, Newham DJ (1997) Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56(11):641–648
Fransen M, McConnell S (2008) Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 8(4):CD004376
Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL (2015) Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med 49(24):1554–1557
Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA (2011) Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. J Physiother 57(1):11–20
Rathod VJ, Alagesan J, Ramasamy P (2011) Effect of supervised exercise program and home based exercise program in osteoarthritis of knee joint. IJCRR 3(1):18–27
Palmoski MJ, Colyer RA, Brandt KD (1980) Joint motion in the absence of normal loading does not maintain normal articular cartilage. Arthritis Rheum 23(3):325–334
Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L (2008) Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc 40(3):422–427
National Institute for Health and Care Excellence (2014) Osteoarthritis Care and Management in Adults. https://www.nice.org.uk/guidance/CG177. Accessed 06 June 2016
Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG et al (2013) EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheumatic Dis 72(7):1125–1135
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM et al (2014) OARSI guidelines for the non-surgical management of knee. Osteoarthritis Cartilage 22(3):363–388
Barrett DS, Cobb AG, Bentley G (1991) Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br 73(1):53–56
Marks R, Quinney HA, Wessel J (1993) Proprioceptive sensibility in women with normal and osteoarthritic knee joints. Clin Rheumatol 12(2):170–175
Pandya NK, Draganich LF, Mauer A, Piotrowski GA, Pottenger L (2005) Osteoarthritis of the knees increases the propensity to trip on an obstacle. Clin Orthop Relat Res 431:150–156
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This study was supported by the Scientific Research Project Committee of Marmara University. (SAG-A-100713-0300) These funds were used primarily used for the purchasing of equipment. This fund provider had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Kuru Çolak, T., Kavlak, B., Aydoğdu, O. et al. The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises. Rheumatol Int 37, 399–407 (2017). https://doi.org/10.1007/s00296-016-3646-5
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DOI: https://doi.org/10.1007/s00296-016-3646-5