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Rosada M, Speciali D, Dias de Oliveira FB, Campedelli RR, Rodrigues H, Antonioli E, Ferretti M. Eight weeks of a lower limb resistance training protocol and gait performance in patients with symptomatic mild to moderate knee osteoarthritis. J Orthop Sci 2024; 29:1037-1045. [PMID: 37532651 DOI: 10.1016/j.jos.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The role of strengthening the lower limbs to optimize the biomechanics of the hip, knee and ankle during walking in patients with knee osteoarthritis, is still unclear. This study aimed to analyse the walking biomechanics of individuals with symptomatic mild to moderate knee osteoarthritis before and after a simplified lower limb resistance training protocol, focused on knee joint exercises with individualized load. METHODS Forty-one patients with symptomatic and radiographic mild to moderate knee osteoarthritis underwent 3D gait analysis pre-post 8 weeks lower limb resistance training protocol performed 3 times a week. Parameters investigated were spatiotemporal, sagittal range of motion, flexion and extension minimum and maximum values, power and moment of hip, knee and ankle, as well as self-reported pain and physical function by the Western Ontario MacMaster University Osteoarthritis Index. Paired t test, Wilcoxon, Spearman's correlation and a logistic model were used for statistical analysis, with p < 0.05. Pain improvement more than 2 points was considered clinically relevant. The effect size (ES) was calculated using Cohen's d. RESULTS Post protocol walking speed increased 6.7% (ES: 0.711), cadence 3.7% (ES: 0.655), stride length 2.6% (ES: 0.542), and double support time reduced 6.9% (ES:0.459). It was also observed a significant increase in one maximum repetition test for legpress 46%, knee extension 23% and knee flexion chair 27% (p < 0.001). Patients reported a 62.5% reduction in pain (ES:1.518) and 64.9% improvement in physical function (ES:1.376). 82% of the patients presented more than 2 points improvement in pain. No evidence of strong correlations between pain, strength gains and gait parameters were found. CONCLUSIONS There was a significant and clinical improvement of spatiotemporal gait parameters, pain, physical function, and strength after 8-week lower limb resistance training protocol. Patients who had a clinically relevant pain improvement presented better gait performance.
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Affiliation(s)
- Mariana Rosada
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | | | | | - Mario Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Rosada M, Speciali D, Dias de Oliveira FB, Ravagnani Campedelli R, Rodrigues H, Antonioli E, Ferretti M. Reply to letter to the editor by Yuhan Gong et al. J Orthop Sci 2024; 29:464-465. [PMID: 37996297 DOI: 10.1016/j.jos.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
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Godziuk K, Prado CM, Forhan M. Protocol for the POMELO (Prevention Of MusclE Loss in Osteoarthritis) randomized pilot feasibility trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100312. [PMID: 36474794 PMCID: PMC9718278 DOI: 10.1016/j.ocarto.2022.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Individuals with advanced knee osteoarthritis (OA) and a large body size [a body mass index (BMI) ≥35 kg/m2] have a higher risk of complications with total knee arthroplasty (TKA), and hence may be ineligible for surgery unless they reduce their BMI. However, pre-TKA weight-loss has not been shown to reduce surgical infection risk and may inadvertently increase risk for muscle loss and development of sarcopenic obesity (low muscle and low strength with higher fat mass). This suggests that a knee OA management approach that doesn't focus on weight change (weight-neutral) may be beneficial. This study examines if a weight-neutral behavioural intervention is feasible and acceptable to participants, and improves muscle mass and physical function in comparison to usual care. Design This pilot randomized clinical trial compares a 12-week multimodal intervention [including targeted nutrition, progressive resistance exercise, and arthritis self-management support] to usual care. Co-primary outcomes are feasibility and acceptability, with secondary outcomes of change in lean soft tissue and physical function within and between groups at 3-months and 9-months from baseline. Change in waist circumference, fat mass, blood biomarkers, energy metabolism, OA-related pain and function, health-related quality of life, self-efficacy for arthritis management, and interest in pursuing a TKA within and between groups will be explored. Conclusion This study will inform future development of more personalized knee OA treatment approaches for adults with larger bodies. Further, this will contribute to effective alternative treatment pathways that reduce inequities in access to OA care for this understudied patient population.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Dalton B, McDougle J, Alesi M, Pereira D, Feito Y. Blood Flow Restriction Training for Individuals With Osteoarthritis. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stassen G, Baulig L, Müller O, Schaller A. Attention to Progression Principles and Variables of Exercise Prescription in Workplace-Related Resistance Training Interventions: A Systematic Review of Controlled Trials. Front Public Health 2022; 10:832523. [PMID: 35400069 PMCID: PMC8990091 DOI: 10.3389/fpubh.2022.832523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions.MethodsA systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000–2020). Controlled trials with apparently healthy “employees” and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated.ResultsOverall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%].ConclusionSeveral key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.
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Burton I, McCormack A. Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2561142. [PMID: 38655173 PMCID: PMC11023730 DOI: 10.1155/2022/2561142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 04/26/2024]
Abstract
The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy, (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, UK
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Abal del Blanco J, Taboada-Iglesias Y. Effects of resistance exercise in patients with spasticity: Systematic review. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Burton I, McCormack A. The implementation of resistance training principles in exercise interventions for lower limb tendinopathy: A systematic review. Phys Ther Sport 2021; 50:97-113. [PMID: 33965702 DOI: 10.1016/j.ptsp.2021.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The primary purpose of this systematic review is to examine the literature on resistance training interventions for lower limb tendinopathy to evaluate the proportion of interventions that implemented key resistance training principles (specificity, progression, overload, individualisation) and reported relevant prescription components (frequency, intensity, sets, repetitions) and reported intervention adherence. METHODS Two reviewers performed a systematic review after screening titles and abstracts based on eligibility criteria. Identified papers were obtained in full text, with data extracted regarding the implementation of resistance training principles. Included articles were evaluated by the Cochrane risk of bias tool, with a scoring tool out of 10 used for implementation and reporting of the 5 key principles. Scientific databases were searched in November 2020 and included Medline, CINAHL, AMED, and Sportsdiscus. RESULTS 52 randomised controlled trials investigating resistance training in five different lower limb tendinopathies were included. Although most studies considered the principles of progression (92%) and individualisation (88%), only 19 studies (37%) appropriately described how this progression in resistance was achieved, and only 18 studies (35%) reported specific instruction on how individualisation was applied. Adherence was considered in 27 studies (52%), with only 17 studies (33%) reporting the levels of adherence. In the scoring criteria, only 5 studies (10%) achieved a total maximum score of 10, with 17 studies (33%) achieving a maximum score of 8 for implementing and reporting the principles of specificity, overload, progression and individualisation. CONCLUSION There is meaningful variability and methodological concerns regarding the application and reporting of resistance training principles, particularly progression and individualisation, along with intervention adherence throughout studies. Collectively, these findings have important implications for the prescription of current resistance training interventions, including the design and implementation of future interventions for populations with lower limb tendinopathies.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, United Kingdom.
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Neumann IL, de Oliveira DA, de Barros EL, da S Santos G, de Oliveira LS, Duarte AL, Marques CD, Dantas AT, Dantas D, de Siqueira GR, da Silva Tenório A. Resistance exercises improve physical function in chronic Chikungunya fever patients: a randomized controlled trial. Eur J Phys Rehabil Med 2021; 57:620-629. [PMID: 33448754 DOI: 10.23736/s1973-9087.21.06520-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chikungunya fever is an arboviral disease, caused by an alphavirus, the Chikungunya virus, characterized by fever and joint pain that is generally disabling in the acute phase and may last from months to years, with the potential to evolve into chronic musculoskeletal symptoms, as polyarthralgia and arthritis, which can lead to significant impairment of physical function. The non-pharmacological treatment is very important for these patients, and resistance exercises may be one rehabilitation option. AIM This study aimed to evaluate the efficacy of a resistance exercise protocol on the physical function, pain, and quality of life of patients with chronic Chikungunya fever. DESIGN A randomized, controlled, blind trial for the evaluators. SETTING Clinic-school of Physical therapy. POPULATION Thirty-one patients with Chikungunya fever and musculoskeletal symptoms lasting more than three months, recruited from the Rheumatology outpatient clinic at Clinical Hospital, Federal University of Pernambuco (HC-UFPE). METHODS Patients (aged 56±10 years) were randomly assigned into one of two groups: Resistance Exercise Group (REG, N.=15) or Control Group (CG, N.=16). REG performed progressive resistance exercises with elastic bands (24 sessions over 12 weeks). CG only had their symptoms monitored through phone calls, maintaining the usual care treatment. Assessments were taken at baseline and after 6 and 12 weeks of the following: physical function (30-second Chair Stand Test (30-s CST), 4-step Stair Climb Power Test (4SCPT), 40-m Fast-paced Walk Test (40m FPWT), and Disabilities of the Arm, Shoulder, Hand (DASH) questionnaire); pain (VAS and painful joints count); quality of life (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]); and Patient Global Impression of Change (PGIC) scale. RESULTS There was a reduction of pain (P=0.01; d=-0.83) and an improvement of 30-s CST (P=0.04; d=0.85) in REG participants after 12 weeks. There was no significant change in the domains of SF-36. Nearly 70% of trained patients reported improvement on PGIC. CONCLUSIONS Resistance exercises improved physical function in sitting and standing and reduced pain in patients with chronic Chikungunya fever. CLINICAL REHABILITATION IMPACT Resistance exercises can be considered as a treatment approach for patients with musculoskeletal disorders in the chronic stage of Chikungunya fever.
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Affiliation(s)
- Isabel L Neumann
- Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil
| | | | - Erika L de Barros
- Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil
| | - Gabriela da S Santos
- Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil
| | | | - Angela L Duarte
- Department of Clinical Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Claudia D Marques
- Department of Clinical Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Andrea T Dantas
- Department of Clinical Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Diego Dantas
- Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil
| | - Gisela R de Siqueira
- Department of Physical Therapy, Federal University of Pernambuco, Recife, Brazil
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Raghava Neelapala YV, Bhagat M, Shah P. Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature. J Geriatr Phys Ther 2021; 43:89-98. [PMID: 30407271 DOI: 10.1519/jpt.0000000000000214] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA. METHODS An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale. RESULTS AND DISCUSSION The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment. CONCLUSION The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.
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Affiliation(s)
- Y V Raghava Neelapala
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Madhura Bhagat
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Purvi Shah
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
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Dechaumet B, Cleret D, Linossier MT, Vanden-Bossche A, Chanon S, Lefai E, Laroche N, Lafage-Proust MH, Vico L. Hypergravity as a gravitational therapy mitigates the effects of knee osteoarthritis on the musculoskeletal system in a murine model. PLoS One 2020; 15:e0243098. [PMID: 33296408 PMCID: PMC7725345 DOI: 10.1371/journal.pone.0243098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
Insights into the effects of osteoarthritis (OA) and physical interventions on the musculoskeletal system are limited. Our goal was to analyze musculoskeletal changes in OA mice and test the efficacy of 8-week exposure to hypergravity, as a replacement of physical activity. 16-week-old male (C57BL/6J) mice allocated to sham control and OA groups not centrifuged (Ctrl 1g and OA 1g, respectively) or centrifuged at 2g acceleration (Ctrl 2g and OA 2g). OA 1g displayed decreased trabecular bone in the proximal tibia metaphysis and increased osteoclastic activity and local TNFα gene expression, all entirely prevented by 2g gravitational therapy. However, while cortical bone of tibia midshaft was preserved in OA 1g (vs. ctrl), it is thinner in OA 2g (vs. OA 1g). In the hind limb, OA at 1g increased fibers with lipid droplets by 48% in the tibialis anterior, a fact fully prevented by 2g. In Ctrl, 2g increased soleus, tibialis anterior and gastrocnemius masses. In the soleus of both Ctrl and OA, 2g induced larger fibers and a switch from type-II to type-I fiber. Catabolic (myostatin and its receptor activin RIIb and visfatine) and anabolic (FNDC5) genes dramatically increased in Ctrl 2g and OA 2g (p<0.01 vs 1g). Nevertheless, the overexpression of FNDC5 (and follistatine) was smaller in OA 2g than in Ctrl 2g. Thus, hypergravity in OA mice produced positive effects for trabecular bone and muscle typology, similar to resistance exercises, but negative effects for cortical bone.
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Affiliation(s)
- Benoit Dechaumet
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
| | - Damien Cleret
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
| | | | | | - Stéphanie Chanon
- CarMeN Laboratory, INSERM, INRA, University of Lyon, Pierre-Bénite, France
| | - Etienne Lefai
- CarMeN Laboratory, INSERM, INRA, University of Lyon, Pierre-Bénite, France
| | - Norbert Laroche
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
| | | | - Laurence Vico
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
- * E-mail:
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Osteoarthritis year in review 2019: rehabilitation and outcomes. Osteoarthritis Cartilage 2020; 28:249-266. [PMID: 31877379 DOI: 10.1016/j.joca.2019.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Inactivity and obesity are risk factors for osteoarthritis (OA) progression. The purpose of this review was to highlight intervention parameters of exercise and lifestyle diet interventions on clinical outcomes in OA that were published over 15 months, starting January 1, 2018. DESIGN Systematic literature searches were performed in Medline (Pubmed, OVID), Scopus, CINAHL, CENTRAL and Embase from January 1, 2018 to April 1, 2019. Key words included osteoarthritis, exercise, physical activity, diet and nutrition. Randomized controlled designs and data synthesis papers (systematic reviews, meta-analyses, clinical guidelines) written in English, that included humans with OA of any joint were included. Trials were evaluated using the Physiotherapy Evidence Database (PEDro) critical appraisal tool and the Template for Intervention Description and Replication (TIDieR). Systematic reviews and meta-analyses were evaluated using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). Intervention details (RCTs) and key finding from papers were summarized. RESULTS Of 540 titles and abstracts retrieved, 147 full articles were reviewed and 53 met the inclusion criteria, comprised of 39 RCTs and 14 synthesis papers. By addressing inactivity, exercise effectively improves clinical outcomes and, based on low-moderate quality evidence, without further damage to cartilage or synovial tissue. By comparison, much less work focused on minimizing obesity. Diet must be combined with exercise to improve pain, but alone, can improve physical function. CONCLUSIONS Future work is necessary to identify the ideal exercise frequency and intensity and lifestyle diet intervention parameters. Improved adherence to reporting guidelines in future work will greatly enhance the OA rehabilitation field.
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Collins NJ, Hart HF, Mills KAG. Osteoarthritis year in review 2018: rehabilitation and outcomes. Osteoarthritis Cartilage 2019; 27:378-391. [PMID: 30529739 DOI: 10.1016/j.joca.2018.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Conduct a systematic review of systematic reviews and randomised controlled trials (RCTs) from the past year evaluating rehabilitation for people with osteoarthritis, and provide narrative synthesis of findings focused on core recommended treatments for osteoarthritis (exercise, education, biomechanical interventions, weight loss). DESIGN A comprehensive search strategy was used to search PubMed, EMBASE and Cochrane databases (16th May 2017 to 22nd March 2018). Search terms included 'osteoarthritis', 'rehabilitation', 'systematic review', and 'randomised controlled trial'. Inclusion criteria were: (1) RCT, or systematic review of randomised clinical trials (RCTs); (2) human participants with osteoarthritis (any joint); (3) evaluation of rehabilitation intervention; and (4) at least one patient-reported measure. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) tool (systematic reviews) and PEDro rating scale (RCTs). Narrative synthesis mapped findings to core recommendations from existing osteoarthritis clinical guidelines. RESULTS From 1994 records, 13 systematic reviews and 36 RCTs were included. 73% of these evaluated knee osteoarthritis (36 studies). The remaining studies evaluated hand osteoarthritis (6 studies), hip, hip/knee and general osteoarthritis (each 2 studies), and neck osteoarthritis (1 study). Exercise was the most common intervention evaluated (31%). Updated recommendations for exercise prescription and preliminary guidance for psychological interventions are provided. CONCLUSION Level 1 and 2 osteoarthritis rehabilitation literature continues to be dominated by knee osteoarthritis studies. Consistent with current clinical guidelines, exercise should be a core treatment for osteoarthritis, but future studies should ensure that exercise programs follow published dose guidelines. There is a clear need for research on rehabilitation for hip, hand, foot/ankle, shoulder and spine osteoarthritis.
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Affiliation(s)
- N J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - H F Hart
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia; School of Physical Therapy and Bone and Joint Institute, The University of Western Ontario, London, Ontario, Canada
| | - K A G Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Hislop AC, Collins NJ, Tucker K, Deasy M, Semciw AI. Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis. Br J Sports Med 2019; 54:263-271. [DOI: 10.1136/bjsports-2018-099683] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2018] [Indexed: 12/15/2022]
Abstract
ObjectivesTo determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.DesignSystematic review with meta-analysis.Data sourcesMedline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018.Eligibility criteria for selecting studiesRandomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.ResultsEight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference −1.06, 95% CI −2.01 to −0.12), but not for outcomes of pain (−0.09, 95% CI –0.96 to 0.79), patient-reported function (−0.74, 95% CI –1.56 to 0.08) or stair function (−0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (−0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).ConclusionWalking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.
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Goff AJ, Page WS, Clark NC. Reporting of acute programme variables and exercise descriptors in rehabilitation strength training for tibiofemoral joint soft tissue injury: A systematic review. Phys Ther Sport 2018; 34:227-237. [PMID: 30388671 DOI: 10.1016/j.ptsp.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Strength training acute programme variables (APVs) can impact tibiofemoral joint injury outcomes. Exercise descriptors (EDs; e.g. patient-position) specify configurations within which APVs are applied. Evidence-based practice depends on adequate reporting of APVs and EDs to replicate strength training interventions in clinical practice. This systematic review assessed APV and ED reporting for adults with tibiofemoral joint injury (anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL)/medial collateral ligament (MCL)/lateral collateral ligament (LCL)/meniscus/hyaline cartilage (HC)). METHODS PRISMA guidelines were followed. Specific key-term combinations were employed and database searches performed. Descriptive/observational/experimental studies were included (2006-2018). Studies needed to report pre-defined APVs or EDs for ≥51% of all exercises to be included. Frequency counts were made of studies adequately reporting APVs and EDs. RESULTS Sixteen articles were included (ACL = 13; meniscus = 3). No PCL/MCL/LCL/HC articles were identified. Of nine APVs, five and four were consistently reported by the majority of ACL (≥7) and meniscal (≥2) studies, respectively. Of eight EDs, four were consistently reported by the majority of both ACL (≥8) and meniscal (≥2) studies. CONCLUSION Many APVs and EDs were not adequately reported. Future studies should better document APVs and EDs for higher standards of intervention reporting and enhanced translation of research to clinical practice.
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Affiliation(s)
- Anthony J Goff
- Health and Social Sciences, Singapore Institute of Technology, 10 Dover Drive, 138683, Singapore.
| | - William S Page
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldegrave Road, Twickenham, TW1 4SX, UK.
| | - Nicholas C Clark
- Faculty of Sport, Health and Applied Sciences, St Mary's University, Waldegrave Road, Twickenham, TW1 4SX, UK.
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16
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Hoglund LT, Pontiggia L, Kelly JD. A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study. Pilot Feasibility Stud 2018; 4:70. [PMID: 29636983 PMCID: PMC5889597 DOI: 10.1186/s40814-018-0262-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/22/2018] [Indexed: 01/18/2023] Open
Abstract
Background Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA. Methods Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate. Results At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention. Conclusions PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise. Trial registration ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).
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Affiliation(s)
- Lisa T Hoglund
- 1Department of Physical Therapy, Thomas Jefferson University, 901 Walnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Laura Pontiggia
- 2Department of Mathematics, Physics and Statistics, University of the Sciences, Philadelphia, PA USA
| | - John D Kelly
- 3Department of Sports Medicine and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
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17
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Hall M, Hinman RS, Wrigley TV, Kasza J, Lim BW, Bennell KL. Knee extensor strength gains mediate symptom improvement in knee osteoarthritis: secondary analysis of a randomised controlled trial. Osteoarthritis Cartilage 2018; 26:495-500. [PMID: 29427725 DOI: 10.1016/j.joca.2018.01.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/09/2018] [Accepted: 01/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if an increase in knee extensor strength mediates the effect of a 12-week knee extensor strength training program on pain and physical function improvement in people with knee osteoarthritis (OA). DESIGN Secondary analysis from a randomised controlled trial comparing the effects of a 12-week knee extensor strengthening exercise program to a control group with no intervention. METHODS Data from participants with complete data (n = 97) enrolled in a previous clinical trial were analysed. Baseline and 12-week follow-up assessments included peak isometric knee extensor strength, pain and physical function. Peak knee extensor strength (Nm/kg) was assessed on an isokinetic dynamometer and subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index were used to assess pain and physical function. Twelve-week change in pain and physical function were regressed separately, on 12-week change in knee extensor strength and group allocation. Covariates included baseline pain or physical function as appropriate, and baseline knee extensor strength, age, sex and knee alignment (stratification variable). RESULTS Improved knee extensor strength mediated the effect of the strengthening program on both pain relief (mediated effect size = 0.69, 95% confidence intervals (CI) 0.05-1.33, P = 0.03), and improved physical function (mediated effect size = 1.86, 95% CI 0.08-3.64, P = 0.04), at 12 weeks. CONCLUSIONS Increased knee extensor strength partially mediates the effect of a knee extensor strength training program on pain and physical function improvement in people with knee OA.
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Affiliation(s)
- M Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - T V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
| | - B-W Lim
- School of Applied Science, Republic Polytechnic, Singapore.
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Victoria, Australia.
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18
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Veronese N, Punzi L, Sieber C, Bauer J, Reginster JY, Maggi S. Sarcopenic osteoarthritis: a new entity in geriatric medicine? Eur Geriatr Med 2018; 9:141-148. [PMID: 34654260 DOI: 10.1007/s41999-018-0034-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/31/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Osteoarthritis, a disease characterized by cartilage degradation, abnormal subchondral bone remodeling and some grade of inflammation, and sarcopenia, a condition of low muscle mass associated with reduced strength and function, are prevalent disorders in older adults. In this review, we examine what is known about the relationship between osteoarthritis and sarcopenia, with particular focus on the older population. We also discuss how osteoarthritis and sarcopenia may interact and affect each other in clinical progression and the potential benefits from developing treatments that address such muscular-skeletal interaction. METHODS We searched in Pubmed and Scopus through a combination of search and MESH terms, for osteoarthritis and sarcopenia. RESULTS Even if more literature is needed, there is increasing evidence that decline in lower limb muscle strength is associated with knee or hip osteoarthritis in a pathological network of pain, altered joint stability, maladapted postures and defective neuromuscular communication. At the cellular levels, chondrocytes and myoblasts share common pathways, and the close anatomical location of both cell types also suggest the possibility of paracrine communication. CONCLUSIONS Sarcopenia and osteoarthritis are significantly intercorrelated and in the near future should be considered as an only entity, as we have recently proposed for sarcopenia and osteoporosis. The treatment of both sarcopenia and osteoarthritis is based on physical exercise and nutritional interventions with the aim of improving cartilage, bone and muscle health. Future studies are needed, particularly to know the exact prevalence of sarcopenia in people with osteoarthritis, its peculiar consequences and the most appropriate treatments.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Padua, Italy
| | - Cornel Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Jurgen Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128, Padua, Italy
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Krause Neto W, de Assis Silva W, Polican Ciena A, Bocalini D, Aparecido Baptista Nucci R, Alberto Anaruma C, Florencio Gama E. Total training load may explain similar strength gains and muscle hypertrophy seen in aged rats submitted to resistance training and anabolic steroids. Aging Male 2018; 21:65-76. [PMID: 28817355 DOI: 10.1080/13685538.2017.1365832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This study aimed to quantify training parameters and analyze the morphological response of aged muscles submitted to resistance training and anabolic steroids. Aged Wistar rats were divided into groups: C - initial control; CF - final control; CAS - control with anabolic steroid, RT - resistance training, and RTA - resistance training with anabolic steroid. Maximum carried load, absolute and relative loads increased significantly in RT and RTA. RTA demonstrated greater relative load than RT. Average total volume, total climbing volume, relative total volume, relative total climbing volume, and mean climbing volume were similar between groups RT and RTA. For soleus, CAS, RT, and RTA enlarged cross-sectional area of type I fibers and nuclear ratio. As for type II fibers, RTA was higher than C and CF. For plantaris, RT and RTA showed significant increases in myofibers type I compared to C and CF. For type II fibers, RTA showed a significant increase compared to C and CF. Regarding the nuclear ratio, RT and RTA showed a higher ratio than C, CF, and CAS. Our results demonstrated that both RT and RTA were not different among the analyzed morphological parameters. This fact can be explained by the absence of differences found in the training variables analyzed.
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Affiliation(s)
- Walter Krause Neto
- a Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
| | - Wellington de Assis Silva
- a Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
| | - Adriano Polican Ciena
- b Department of Physical Education, Laboratory of Morphology and Physical Activity , São Paulo State University "Júlio de Mesquita Filho" , Rio Claro , Brazil
| | - Danilo Bocalini
- c Translational Physiology Laboratory, Physical Education and Aging Science Program , São Judas Tadeu University , São Paulo , Brazil
| | - Ricardo Aparecido Baptista Nucci
- a Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
| | - Carlos Alberto Anaruma
- b Department of Physical Education, Laboratory of Morphology and Physical Activity , São Paulo State University "Júlio de Mesquita Filho" , Rio Claro , Brazil
| | - Eliane Florencio Gama
- a Department of Physical Education, Laboratory of Morphoquantitative Studies and Immunohistochemistry , São Judas Tadeu University , São Paulo , Brazil
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