Use of an Aquatics Program for Older Adults With Osteoarthritis: From Clinic to the Community

Individuals with mild-to-moderate hip osteoarthritis have lower limb muscle strength and volume deficits

Background

Individuals with advanced hip osteoarthritis (OA) exhibit generalized muscle weakness of the affected limb and so clinical practice guidelines recommend strength training for the management of hip OA. However, the extent and pattern of muscle weakness, including any between-limb asymmetries, in early stages of the disease are unclear. This study compared hip and knee muscle strength and volumes between individuals with mild-to-moderate symptomatic and radiographic hip OA and a healthy control group.

Methods

Nineteen individuals with mild-to-moderate symptomatic and radiographic hip OA (n = 12 unilateral; n = 7 bilateral) and 23 age-matched, healthy controls without radiographic hip OA or hip pain participated. Isometric strength of the hip and knee flexors and extensors, and hip abductors and adductors were measured. Hip and thigh muscle volumes were measured from lower limb magnetic resonance images. A full-factorial, two-way General Linear Model was used to assess differences between groups and between limbs.

Results

Participants in the hip OA group demonstrated significantly lower knee flexor, knee extensor, hip flexor, hip extensor and hip abductor strength compared to controls and had significantly lower volume of the adductor, hamstring and quadriceps groups, and gluteus maximus and gluteus minimus muscles, but not tensor fasciae latae or gluteus medius muscles. There were no between-limb strength differences or volume differences within either group.

Conclusions

Atrophic, bilateral hip and knee muscle weakness is a feature of individuals with mild-to-moderate hip OA. Early interventions to target muscle weakness and prevent the development of strength asymmetries that are characteristic of advanced hip OA appear warranted.

Effect of aqua-cycling on pain and physical functioning compared with usual care in patients with knee osteoarthritis: study protocol of a randomised controlled trial

Background

Over the last decade aquatic exercise has become more and more popular. One of the latest trends is aqua-cycling, where participants sit on a water-resistant stationary bike and, while immersed chest deep in the water, combine continuous cycling with upper body exercises that utilise water resistance. Since stationary cycling and aquatic exercises are frequently recommended to patients with knee osteoarthritis, combining both would seem an obvious step, and an aqua-cycling exercise programme for patients with knee osteoarthritis has indeed been developed. This study protocol gives a detailed description of the exercise programme and the methodology of a study to compare this programme with treatment involving usual care only.

Methods

The study is a single-blind, parallel-group, randomised controlled trial of Maastricht University Medical Centre+, the Netherlands. Inclusion criteria: knee pain of four to seven on a 10-point pain rating scale; a Kellgren/Lawrence score between one to three; ability to cycle; good mental health; sufficient language skills; indication for physical therapy in conjunction with impairments due to OA. Exclusion criteria: any contra-indication for aquatic exercise; planned total knee replacement; corticosteroid injection <3 months and/or hyaluronic acid injection <6 months; severe joint complaints (other than knee joint); symptomatic and radiological apparent hip OA; inflammatory joint diseases; inability to safely enter and exit the pool; fear of water. Participants will receive two 45-min moderate intense aqua-cycling sessions weekly over a period of 12 weeks in addition to usual care or usual care only. Usual care consists of an individual intervention plan comprising lifestyle recommendations, medication routine and referral to a physical therapist. Participants will be assessed at baseline, and at 12 and 24 weeks after baseline. The primary outcome is self-reported knee pain and physical functioning. Secondary outcomes are lower limb muscle strength, functional capacity, self-reported disease severity, physical activity level, quality of life, self-efficacy and fear of movement. Daily diaries will collect information on knee pain, physical functioning, level of physical activity, pain medication routine and physical therapy (control group only) or exercise participation over two 30-day periods (during the intervention period).

Discussion

To our knowledge the present study is the first randomised controlled trial evaluating the effects of aqua-cycling in the pre-surgical stage of knee osteoarthritis. This trial will demonstrate if the newly designed aqua-cycling intervention, in supplement to usual care, can help to improve impairments due to knee osteoarthritis.

Trial registration

Netherlands Trial Register NTR3766 (21-12-2012).

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-0939-5) contains supplementary material, which is available to authorized users.