Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study. The efficacy of a muscle exercise program to improve functional performance of the knee in patients with osteoarthritis. Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial Effects of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee. Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Investigation of Clinical Effects of High- and Low-Resistance Training for Patients With Knee Osteoarthritis: A Randomized Controlled Trial Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical functioning in older women with osteoarthritis: a randomized clinical trial. Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial Improved Function and Reduced Pain after Swimming and Cycling Training in Patients with Osteoarthritis Land-based versus aquatic resistance therapeutic exercises for older women with sarcopenic obesity: study protocol for a randomised controlled trial High-Intensity Interval Training on an Aquatic Treadmill in Adults With Osteoarthritis: Effect on Pain, Balance, Function, and Mobility
Background and Purpose Aquatic physical therapy is frequently used in the management of patients with hip and knee osteoarthritis ( OA ) , yet there is little research establishing its efficacy for this population . The purpose of this study was to evaluate the effects of aquatic physical therapy on hip or knee OA . Subjects A total of 71 volunteers with symptomatic hip OA or knee OA participated in this study . Methods The study was design ed as a r and omized controlled trial in which participants r and omly received 6 weeks of aquatic physical therapy or no aquatic physical therapy . Outcome measures included pain , physical function , physical activity levels , quality of life , and muscle strength . Results The intervention result ed in less pain and joint stiffness and greater physical function , quality of life , and hip muscle strength . Totals of 72 % and 75 % of participants reported improvements in pain and function , respectively , compared with only 17 % ( each ) of control participants . Benefits were maintained 6 weeks after the completion of physical therapy , with 84 % of participants continuing independently . Discussion and Conclusion Compared with no intervention , a 6-week program of aquatic physical therapy result ed in significantly less pain and improved physical function , strength , and quality of life . It is unclear whether the benefits were attributable to intervention effects or a placebo response BACKGROUND Knee osteoarthritis ( OA ) is a painful condition causing disability and muscle weakness . Shortwave diathermy ( SWD ) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice . However , the efficacy of SWD in knee OA is still inconclusive . AIM The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain , function , muscle strength , quality of life and depression in patients with OA . DESIGN This was a r and omised , controlled clinical trial . SETTING Inpatient Physiotherapy Department . POPULATION Forty women aged between 42 and 74 years , with a diagnosis of bilateral primary knee OA . METHODS Patients were sequentially r and omized into two groups . Group 1 ( N.=20 ) received SWD and isokinetic muscular strengthening exercises . Group 2 ( N.=20 ) served as control group and they received isokinetic exercises only . Both of the programs were performed three days a week , for a duration of four weeks , and a total of 12 sessions . Patients were assessed before treatment ( BT ) , after treatment ( AT ) , and at a three-month follow-up ( F ) . Outcome measures included visual analogue scale , Western Ontario and McMaster University Osteoarthritis Index , six minute walking distance , isokinetic muscle testing , Short Form 36 and Beck depression index . RESULTS The patients with OA in each group had significant improvements in pain , disability , depression , walking distance , muscle strength , and quality of life AT and F when compared with their initial status ( P<0.05 ) . There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test ( P>0.05 ) except some isokinetic peak torque measurements ( F-BT scores of extension right 60 ° , 120 ° and flexion right 60 ° ) . CONCLUSION Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain , disability , walking distance , muscle strength , quality of life and depression in patients with knee OA . CLINICAL REHABILITATION IMPACT Considering the time and cost of combination therapy is now , the isokinetic exercise program , as it is efficient , may be preferable for the treatment of knee OA , alone Osteoarthritis ( OA ) is a common chronic and progressive degenerative joint condition . A major consequence of knee OA is physical disability ; especially difficulty with activities requiring ambulation and transfer , which are necessary to maintain independence and a good quality of life . The purpose s of this study were to determine the efficacy of a muscle exercise program along with education about knee care , and investigate the clinical factors which influence its therapeutic efficacy . A prospect i ve study was carried out among elderly Thai people aged 60 years and over , living in an urban community of the Bangkok metropolitan area around Siriraj Hospital , between October 1997 and September 1999 . The number of elderly people with osteoarthritis of the knee was 392 ( male : female=86:306 ) with a mean age of 67.7+/-6 years . They were interviewed for demographic data and information about their symptoms . The range of the knee movement , quadriceps strength and the six-minute walking distance and a knee X-ray were evaluated . Group exercise was arranged twice a week for 8 weeks for the intervention group only . The results of the study revealed that the quadriceps strength in the intervention group had a tendency to increase and the walking distance was significantly improved especially in the first two months but there was a tendency to decline by the sixth and twelfth month after enrollment . On the other h and , there was no statistically significant difference of both important outcomes for the control group when assessed in the second month . The findings at the sixth and twelfth month after enrollment were that the quadriceps strength was slightly increased but the walking distance was decreased when compared with the initial assessment . An exercise frequency of 12 sessions in two months was sufficient to improve muscle strength and walking distance . Group exercise produces a significant improvement in strength and walking ability , especially in the first two months . Deterioration over time could be due to multiple factors , such as lack of regular exercise , lack of motivation , lack of family support or poor economic status , so we should encourage the elderly to exercise regularly Background The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis ( OA ) is limited . Objective The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion ( ROM ) , muscle strength , physical fitness , walking capacity , and pain during walking in people with hip OA . Design This was a secondary outcome analysis of a r and omized clinical trial . Setting The setting was a university hospital . Participants One hundred nine people with clinical ly and radiographically evident hip OA were r and omly allocated to receive both exercise therapy and patient education ( exercise group ) or patient education only ( control group ) . Intervention All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists . Two other physical therapists were responsible for providing the exercise therapy program , consisting of 2 or 3 weekly sessions of strengthening , functional , and stretching exercises over 12 weeks . Both interventions were conducted at a sports medicine clinic . Measurements Outcome measures included ROM , isokinetic muscle strength , predicted maximal oxygen consumption determined with the Astr and bicycle ergometer test , and distance and pain during the Six-Minute Walk Test ( 6MWT ) . Follow-up assessment s were conducted 4 , 10 , and 29 months after enrollment by 5 physical therapists who were unaware of group allocations . Results No significant group differences were found for ROM , muscle strength , predicted maximal oxygen consumption , or distance during the 6MWT over the follow-up period , but the exercise group had less pain during the 6MWT than the control group at 10 months ( mean difference=−8.5 mm ; 95 % confidence interval=−16.1 , −0.9 ) and 29 months ( mean difference=−9.3 mm ; 95 % confidence interval=−18.1 , −0.6 ) . Limitations Limitations of the study were reduced statistical power and 53 % rate of adherence to the exercise therapy program . Conclusions The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM , muscle strength , physical fitness , and walking capacity , but exercise in addition to patient education result ed in less pain during walking in the long term AIM This paper reports a study of the effects of aquatic exercise on physical fitness ( flexibility , strength and aerobic fitness ) , self-reported physical functioning and pain in adults with osteoarthritis of the hip or knee . BACKGROUND Osteoarthritis is a common cause of disability and a primary reason for hip and knee joint replacement . Exercise is important for preventing and /or managing the functional limitations associated with joint disease . Aquatic exercise is thought to be beneficial and is often recommended for people with osteoarthritis ; however , few studies have examined the effects on people with osteoarthritis , and these have yielded inconsistent results . METHODS A two-group r and omized controlled trial with a convenience sample was used . Participants were recruited from community sources and r and omly assigned to a 12-week aquatic programme or a non-exercise control condition . Data for 38 participants were collected at baseline , week 6 , and week 12 during 2003 and 2004 . Instruments were a st and ard plastic goniometer , a h and held dynamometer , the 6-minute walk test , the multidimensional Health Assessment Question naire , and a visual analogue scale for pain . RESULTS Repeated measures analysis of variance showed that aquatic exercise statistically significantly improved knee and hip flexibility , strength and aerobic fitness , but had no effect on self-reported physical functioning and pain . The exercise adherence rate was 81.7 % , and no exercise-related adverse effect was observed or reported . CONCLUSIONS Beneficial short-term effects of aquatic exercise were found in adults with osteoarthritis of the hip or knee . Although the programme may not offer pain relief or self-reported improvements in physical functioning , results suggest that aquatic exercise does not worsen the joint condition or result in injury . Nurses engaging in disease management and health promotion for these patients should consider recommending or implementing aquatic classes for patients OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis ( OA ) . DESIGN Single-blind r and omized controlled trial . SETTING Exercise gymnasium and community dwellings . PARTICIPANTS Individuals with medial compartment knee OA ( N=40 ) . INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention ( nonintervention group ) . MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale ( CB&M ) , and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale . Secondary outcomes included knee pain , fear of movement , knee joint proprioception , and muscle strength . RESULTS Forty individuals underwent baseline testing , with 36 participants completing follow-up testing .  Adherence to exercise in the training group was high , with 82.2 % of all home-based exercise sessions completed . No significant changes were observed in any outcome in the nonintervention group at follow-up . Significant improvements in self-reported pain , physical function , and fear of movement were observed in the training group when compared with the nonintervention group . No other within- or between-group differences were observed . CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain , physical function , and fear of movement ; however , there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance Background and Purpose : Muscle strength training is important for people with knee osteoarthritis ( OA ) .  High-resistance exercise has been demonstrated to be more beneficial than low-resistance exercise for young subjects . The purpose of this study was to compare the effects of high- and low-resistance strength training in elderly subjects with knee OA . Subjects and Methods : One hundred two subjects were r and omly assigned to groups that received 8 weeks of high-resistance exercise ( HR group ) , 8 weeks of low-resistance exercise ( LR group ) , or no exercise ( control group ) . Pain , function , walking time , and muscle torque were examined before and after intervention . Results : Significant improvement for all measures was observed in both exercise groups . There was no significant difference in any measures between HR and LR groups . However , based on effect size between exercise and control groups , the HR group improved more than the LR group . Discussion and Conclusion : Both high- and low-resistance strength training significantly improved clinical effects in this study . The effects of high-resistance strength training appear to be larger than those of low-resistance strength training for people with mild to moderate knee OA , although the differences between the HR and LR groups were not statistically significant OBJECTIVE Twelve forms of Sun-style tai chi exercise have been developed specifically to reduce the symptoms and improve the physical functioning of arthritic patients , and this r and omized study examined the changes in symptoms and physical characteristics in older women with osteoarthritis ( OA ) at the completion of a 12-week tai chi exercise program . METHODS Seventy-two patients with OA were r and omly assigned into 2 groups . Due to a 41 % overall dropout rate , 22 experimental subjects and 21 controls completed pre- and post-test measures over a 12 week interval . Outcome variables were physical symptoms and fitness , body mass index , cardiovascular functioning , and perceived difficulties in physical functioning . The independent t test was used to examine group differences . RESULTS The homogeneity test confirmed that there were no significant group differences in demographic data and pretest measures . Mean comparisons of the change scores revealed that the experimental group perceived significantly less pain ( t = -2.19 , p = 0.034 ) and stiffness ( t = -2.13 , p = 0.039 ) in their joints , and reported fewer perceived difficulties in physical functioning ( t = -2.81 , p = 0.008 ) , while the control group showed no change or even deterioration in physical functioning after 12 weeks . In the physical fitness test , there were significant improvements in balance ( t = 3.34 , p = 0.002 ) and abdominal muscle strength ( t = 2.74 , p = 0.009 ) for the tai chi exercise group . No significant group differences were found in flexibility and upper-body or knee muscle strength in the post-test scores . CONCLUSION Older women with OA were able to safely perform the 12 forms of Sun-style tai chi exercise for 12 weeks , and this was effective in improving their arthritic symptoms , balance , and physical functioning . A longitudinal study with a larger sample size is now needed to confirm the potential use of tai chi exercise in arthritis management INTRODUCTION Osteoarthritis ( OA ) is a common degenerative joint disease particularly in older subjects . It is usually associated with pain , restricted range of motion , muscle weakness , difficulties in daily living activities and impaired quality of life . To determine the effects of adding two different intensities of low-level laser therapy ( LLLT ) to exercise training program on pain severity , joint stiffness , physical function , isometric muscle strength , range of motion of the knee , and quality of life in older subjects with knee OA . METHODS Patients were r and omly assigned into three groups . They received 16 sessions , 2 sessions/week for 8 weeks . Group-I : 18 patients were treated with a laser dose of 6 J/cm(2 ) with a total dose of 48 J. Group-II : 18 patients were treated with a laser dose of 3 J/cm(2 ) with a total dose of 27 J. Group-III : 15 patients were treated with laser without emission as a placebo . All patients received same exercise training program including stretching and strengthening exercises . Patients were evaluated before and after intervention by visual analogue scale ( VAS ) , the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index for quality of life , h and held dynamometer and universal goniometer . RESULTS T test revealed that there was a significant reduction in VAS and pain intensity , an increase in isometric muscle strength and range of motion of the knee as well as increase in physical functional ability in three treatment groups . Also analysis of variance ( ANOVA ) proved significant differences among them and the post hoc tests ( LSD ) test showed the best improvements for patients of the first group . CONCLUSION It can be concluded that addition of LLLT to exercise training program is more effective than exercise training alone in the treatment of older patients with chronic knee OA and the rate of improvement may be dose dependent , as with 6 J/cm(2 ) or 3 J/cm(2 ) OBJECTIVE To test the effects of a high intensity home-based progressive strength training program on the clinical signs and symptoms of osteoarthritis ( OA ) of the knee . METHODS Forty-six community dwelling patients , aged 55 years or older with knee pain and radiographic evidence of knee OA , were r and omized to a 4 month home based progressive strength training program or a nutrition education program ( attention control ) .  Thirty-eight patients completed the trial with an adherence of 84 % to the intervention and 65 % to the attention control . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index pain and physical function subscales . Secondary outcomes included clinical knee examination , muscle strength , physical performance measures , and question naires to measure quality of life variables . RESULTS Patients in the strength training group who completed the trial had a 71 % improvement in knee extension strength in the leg reported as most painful versus a 3 % improvement in the control group ( p < 0.01 ) . In a modified intent to treat analysis , self-reported pain improved by 36 % and physical function by 38 % in the strength training group versus 11 and 21 % , respectively , in the control group ( p = 0.01 for between group comparison ) . In addition , those patients in the strength training group who completed the trial had a 43 % mean reduction in pain ( p = 0.01 vs controls ) , a 44 % mean improvement in self-reported physical function ( p < 0.01 vs controls ) , and improvements in physical performance , quality of life , and self-efficacy when compared to the control group . CONCLUSION High intensity , home based strength training can produce substantial improvements in strength , pain , physical function and quality of life in patients with knee OA Objective : To determine the effect of a progressive resistance exercise ( PRE ) program on women with osteoarthritis ( OA ) of the knee . Methods : Eligible subjects included women aged 40 to 70 years with pain between 3 and 8 on a 10-cm pain scale . Among the 144 subjects screened , 60 met the eligibility criteria and were r and omized to the experimental group ( EG ) or control group ( CG ) . Subjects in the EG participated in a 12-week PRE program twice a week and CG remained on a waiting list for physical therapy . The PRE program consisted of strengthening exercises for knee extensors , knee flexors , hip abductors and hip adductors , all performed with 50 % and 70 % of the one-repetition maximum ( 1RM ) using machines with free weights . Resistance was reevaluated every two weeks . Assessment s of pain , muscle strength , walking distance , function and quality of life were performed at baseline , six weeks and 12 weeks by a blinded assessor . Results : Twenty-nine female subjects were r and omly assigned to the EG and 31 were r and omly assigned to the CG . Repeated- measures ANOVA revealed significantly better results in the EG pain ( from 7.0±1.3 to 4.3±3.1 in the EG and from 7.0±1.2 to 6.6±1.5 in the CG - p<0.001 ) , function ( p<0.001 ) , some domains of quality of life ( physical function : p=0.002 ; physical role limitation : p=0.002 ; and pain : p=0.044 ) and muscle strength ( extensors : p<0.001 ; flexors : p=0.002 ; and abductors : p<0.001 ) . Conclusion : The PRE program was effective in reducing pain and improving function , some quality of life domains and strength in women with OA of the knee Objective . Arthritis and its associated joint pain act as significant barriers for adults attempting to perform l and -based physical activity . Swimming can be an ideal form of exercise for patients with arthritis . Yet there is no information on the efficacy of regular swimming exercise involving patients with arthritis . The effect of a swimming exercise intervention on joint pain , stiffness , and physical function was evaluated in patients with osteoarthritis ( OA ) . Methods . Using a r and omized study design , 48 sedentary middle-aged and older adults with OA underwent 3 months of either swimming or cycling exercise training . Supervised exercise training was performed for 45 min/day , 3 days/week at 60–70 % heart rate reserve for 12 weeks . The Western Ontario and McMaster Universities Arthritis Index was used to measure joint pain , stiffness , and physical limitation . Results . After the exercise interventions , there were significant reductions in joint pain , stiffness , and physical limitation accompanied by increases in quality of life in both groups ( all p < 0.05 ) . Functional capacity as assessed by maximal h and grip strength , isokinetic knee extension and flexion power ( 15–30 % increases ) , and the distance covered in the 6-min walk test increased ( all p < 0.05 ) in both exercise groups . No differences were observed in the magnitude of improvements between swimming and cycling training . Conclusion . Regular swimming exercise reduced joint pain and stiffness associated with OA and improved muscle strength and functional capacity in middle-aged and older adults with OA . Additionally , the benefits of swimming exercise were similar to the more frequently prescribed l and -based cycling training . Trial registration : clinical trials.gov NCT01836380 Background Sarcopenic obesity is a health condition that combines excess adipose tissue and loss of muscle mass and strength . Sarcopenic obesity predisposes to more functional disabilities than obesity or sarcopenia alone . Progressive resistance exercises are recommended for older people as a potential treatment for sarcopenia and also for obesity . However , there is a lack of evidence indicating which programmes are best applied to older people , and no studies have investigated their effects on sarcopenic obese people . The aims of this protocol study are to investigate and compare the efficacy of l and -based and aquatic resistance exercise programmes on improving muscle performance , functional capacity and quality of life of older women with sarcopenic obesity . Methods / Design This is a protocol study for a parallel r and omised controlled clinical trial . Eligible participants are older women ( ≥65 years ) with a body mass index ≥30 kg/m 2 and h and grip strength ≤21 kg force . A total sample of 36 participants will be r and omly allocated to one of the intervention groups in blocks of three : l and -based , aquatic or control . Each intervention group will undergo 2-week sessions of a 10-week therapeutic exercise programme for strength , power and endurance training of the lower-limb muscles . Participants in the control group will not participate in any strengthening activity for lower limbs and will receive telephone calls once a week . Baseline and final evaluation of outcomes will encompass muscle performance of the lower limbs assessed by an isokinetic dynamometer ; functional tests of usual walking speed , maximal walking speed ( shuttle walking test ) , stair speed and the Short Physical Performance Battery ; and health-related quality of life ( Medical Outcomes Study Short Form Question naire – SF-36 ) . Data collectors will be blinded to r and omisation and will not be in touch with participants during the interventions . Discussion This study is the first r and omised controlled trial design ed to evaluate resistance exercises in older patients with sarcopenic obesity . If our hypothesis proves correct , both intervention programmes will be effective , with the l and -based exercises conferring better results in muscle performance . Trial registration Registro Brasileiro de Ensaios Clínicos : Abstract Bressel , E , Wing , JE , Miller , AI , and Dolny , DG . High-intensity interval training on an aquatic treadmill in adults with osteoarthritis :  effect on pain , balance , function , and mobility . J Strength Cond Res 28(8 ) : 2088–2096 , 2014—Although aquatic exercise is considered a potentially effective treatment intervention for people with osteoarthritis ( OA ) , previous research has focused primarily on calisthenics in a shallow pool with the inherent limitations on regulating exercise intensity . The purpose of this study was to quantify the efficacy of a 6-week aquatic treadmill exercise program on measures of pain , balance , function , and mobility .  Eighteen participants ( age = 64.5 ± 10.2 years ) with knee OA completed a non-exercise control period followed by a 6-week exercise period . Outcome measures included visual analog scales for pain , posturography for balance , sit-to-st and test for function , and a 10-m walk test for mobility . The exercise protocol included balance training and high-intensity interval training ( HIT ) in an aquatic treadmill using water jets to destabilize while st and ing and achieve high ratings of perceived exertion ( 14–19 ) while walking . In comparison with pretests , participants displayed reduced joint pain ( pre = 50.3 ± 24.8 mm vs. post = 15.8 ± 10.6 mm ) , improved balance ( equilibrium pre = 66.6 ± 11.0 vs. post = 73.5 ± 7.1 ) , function ( rising index pre = 0.49 ± 0.19 % vs. post = 0.33 ± 0.11 % ) , and mobility ( walk pre = 8.6 ± 1.4 s vs. post = 7.8 ± 1.1 s ) after participating in the exercise protocol ( p = 0.03–0.001 ) . The same benefits were not observed after the non-exercise control period . Adherence to the exercise protocol was exceptional and no participants reported adverse effects , suggesting that aquatic treadmill exercise that incorporates balance and HIT training was well tolerated by patients with OA and may be effective at managing symptoms of OA
Beneficial effects of aquatic exercise were found on physical function .
Water-based exercises are recommended for people with osteoarthritis ( OA ) , due to the beneficial effects on physical function , quality of life and symptom reduction .
However , the effects on muscle strength are still controversial .
The aim of this review was to assess and compare the effects of aquatic exercise programs on muscle strength and physical function in people with OA .