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Henriksen M, Runhaar J, Turkiewicz A, Englund M. Exercise for knee osteoarthritis pain: Association or causation? Osteoarthritis Cartilage 2024; 32:643-648. [PMID: 38490293 DOI: 10.1016/j.joca.2024.03.001] [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: 12/11/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
Exercise is universally recommended as a primary strategy for the management of knee osteoarthritis (OA) pain. The recommendations are based on results from more than 100 randomized controlled trials (RCTs) that compare exercise to no-attention control groups. However, due to the inherent difficulties with adequate placebo control, participant blinding and the use of patient-reported outcomes, the existing RCT evidence is imperfect. To better understand the evidence used to support a causal relationship between exercise and knee OA pain relief, we examined the existing evidence through the Bradford Hill considerations for causation. The Bradford Hill considerations, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework for assessment of possible causal relationships. There are 9 considerations by which the evidence is reviewed: Strength of association, Consistency, Specificity, Temporality, Biological Gradient (Dose-Response), Plausibility, Coherence, Experiment, and Analogy. Viewing the evidence from these 9 viewpoints did neither bring forward indisputable evidence for nor against the causal relationship between exercise and improved knee OA pain. Rather, we conclude that the current evidence is not sufficient to support claims about (lack of) causality. With our review, we hope to advance the continued global conversation about how to improve the evidence-based management of patients with knee OA.
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Affiliation(s)
- Marius Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
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2
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Komarzynski S, Adams L, Davies EH. Case example of a female solo sailor competing in the Vendée Globe reveals extraordinary biological demands. J Sports Sci 2024; 42:793-802. [PMID: 38861588 DOI: 10.1080/02640414.2024.2365011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
The Vendée Globe is a non-stop, unassisted, single-handed round the world sailing race. It is regarded as the toughest sailing race, requiring high cognitive functioning and constant alertness. Little is known about the amount of sleep restriction and nutritional deficit experienced at sea and effects that fatigue have on sailors' performance. This report aimed to investigate these aspects by monitoring one of the female participants of the latest Vendée Globe. Sleep, food intake and stress were self-reported daily using specific app. Cognitive assessments were digitally completed. Heart rate and activity intensity were measured using a wrist-worn wearable device. Mean self-report sleep duration per 24 h was 3 hours 40 minutes. By the end of the 95 race days, the sailor reached a caloric deficit of 27,900 kcal. On average, the sailor spent 50 minutes per day in moderate-to-vigorous activity. Cognitive assessments did not show any effect of fatigue or stress on completion time or performance. Recent technological and communication advancement for offshore sailors, enabled continuous data to be monitored in near real time, even from the Southern Ocean. Moving forward this will enable greater understanding of when sailors will be at risk of poor decision making, illness or injury.
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Affiliation(s)
| | - L Adams
- Operations, Pip Hare Ocean Racing, Poole, UK
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3
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Kornuijt A, Bongers BC, G J Marcellis R, Lenssen AF. Submaximal cardiopulmonary exercise testing to assess preoperative aerobic capacity in patients with knee osteoarthritis scheduled for total knee arthroplasty: a feasibility study. Physiother Theory Pract 2024; 40:603-616. [PMID: 36205558 DOI: 10.1080/09593985.2022.2126740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 10/10/2022]
Abstract
OBJECTIVE To investigate the feasibility of submaximal cardiopulmonary exercise testing (CPET) in patients with knee osteoarthritis (OA) scheduled for primary total knee arthroplasty (TKA) surgery. Secondly, to assess their preoperative aerobic capacity. METHODS In this observational, single-center study, participants performed a submaximal CPET 3-6 weeks before surgery. To examine their experiences, participants completed a questionnaire and one week later they were contacted by telephone. CPET was deemed feasible when five feasibility criteria were met. Aerobic capacity was evaluated by determining the oxygen uptake (VO2) at the ventilatory anaerobic threshold (VAT) and oxygen uptake efficiency slope (OUES). OUES values were compared with two sets of normative values. RESULTS All feasibility criteria were met as 14 representative participants were recruited (recruitment rate: 60.9%), and all participants were able to perform the test and reached the VAT. No adverse events occurred, and all participants were positive toward submaximal CPET. The median VO2 at the VAT was 12.8 mL/kg/min (IQR 11.3-13.6). The median OUES/kg was 23.1 (IQR 20.2-28.9), 106.4% and 109.4% of predicted. CONCLUSION Submaximal CPET using cycle ergometry seems feasible in patients with knee OA scheduled for TKA surgery to evaluate preoperative aerobic capacity.
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Affiliation(s)
- Anke Kornuijt
- Sports and Orthopedics Research Center, Anna Hospital, Geldrop, the Netherlands
- Department of Physical Therapy, Anna Hospital, Geldrop, the Netherlands
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Rik G J Marcellis
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center+, Maastricht, the Netherlands
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4
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Dawson ZE, Beaumont AJ, Carter SE. A Systematic Review of Physical Activity and Sedentary Behavior Patterns in an Osteoarthritic Population. J Phys Act Health 2024; 21:115-133. [PMID: 38086351 DOI: 10.1123/jpah.2023-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To explore physical activity (PA) and sedentary behaviors (SB) in individuals with lower limb (LL) Osteoarthritis (OA) and the influence of age, sex, and body mass index (BMI) on these behaviors. DESIGN Systematic review search: PubMed, Cochrane Library, ScienceDirect, and CINAHL databases were searched from inception until July 2023. Study criteria: Studies that reported quantifiable device-based or self-reported data for PA and SB variables in adults clinically diagnosed with LL OA were included. DATA SYNTHESIS A synthesis of PA and SB levels for those diagnosed with LL OA and the influence age, sex, and BMI have on these behaviors. RESULTS From the 1930 studies identified through the electronic search process, 48 met the inclusion criteria. PA guidelines were met by 33% of the sample population that measured moderate and moderate to vigorous PA. No studies reported 75 minutes per week or more of vigorous PA. Additionally, 58% of the population reporting SB were sedentary for 8 hours per day or more. Also, increasing age, BMI, and the female sex were identified as negative influences on PA levels. There were numerous methodological inconsistencies in how data were collected and reported, such as various activity monitor cut points for PA and SB bout duration. CONCLUSION Adults with LL OA may be at an increased risk of noncommunicable diseases due to low PA and high SB levels. It is important to consider age, sex, and BMI when investigating behavior patterns in those with LL OA.
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Affiliation(s)
- Zoe E Dawson
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Alexander J Beaumont
- School of Science, Technology and Health, York St John University, York, United Kingdom
| | - Sophie E Carter
- School of Science, Technology and Health, York St John University, York, United Kingdom
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Marriott KA, Birmingham TB. Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions. Osteoarthritis Cartilage 2023; 31:1312-1326. [PMID: 37423596 DOI: 10.1016/j.joca.2023.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose-response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
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Affiliation(s)
- Kendal A Marriott
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.
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Verdini E, Maestroni L, Clark M, Turner A, Huber J. Do people with musculoskeletal pain differ from healthy cohorts in terms of global measures of strength? A systematic review and meta-analysis. Clin Rehabil 2023; 37:244-260. [PMID: 36154313 PMCID: PMC9772898 DOI: 10.1177/02692155221128724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is currently unknown if people with musculoskeletal pain display different multi-joint strength capacities than healthy cohorts. The aim was to investigate whether people with musculoskeletal pain show differences in global measures of strength in comparison to healthy cohorts. DATA SOURCES A systematic review was conducted using three databases (Medline, CINAHL and SPORTDiscus) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS Studies involving participants with painful musculoskeletal conditions and multi-joint strength assessment measured at baseline were included. A meta-analysis was also performed to compute standardized mean differences (± 95% confidence intervals), using Hedge's g, and examined the differences in multi-joint strength at baseline between participants with painful musculoskeletal conditions and healthy participants. RESULTS In total, 5043 articles were identified, of which 20 articles met the inclusion criteria and were included in the qualitative analysis. The available evidence revealed that multi-joint strength values were limited to knee osteoarthritis, fibromyalgia, chronic low back pain, and rheumatoid arthritis. Only four studies were included in the quantitative synthesis and revealed that only small differences in both chest press (g = -0.34, 95% CI [-0.64, -0.03]) and leg press (g = -0.25, 95% CI [-0.49, -0.02]) existed between adult women with fibromyalgia and active community women. CONCLUSION There is a paucity of multi-joint strength values in participants with musculoskeletal pain. Quantitative comparison with healthy cohorts was limited, except for those with fibromyalgia. Adult women with fibromyalgia displayed reduced multi-joint strength values in comparison to active community women.
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Affiliation(s)
- Enrico Verdini
- School of Health Sciences, University of Brighton, Brighton, UK,Studio Medico Jacini, Rome, Italy,Enrico Verdini, School of Health Sciences, University of Brighton, Brighton, United Kingdom and Studio Medico Jacini, Piazza Stefano Jacini 26a, 00191, Rome, Italy
| | - Luca Maestroni
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | | | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, London, UK
| | - Jörg Huber
- School of Health Sciences, University of Brighton, Brighton, UK
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7
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Ross RE, VanDerwerker CJ, Saladin ME, Gregory CM. The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes. Mol Psychiatry 2023; 28:298-328. [PMID: 36253441 PMCID: PMC9969795 DOI: 10.1038/s41380-022-01819-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023]
Abstract
Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.
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Affiliation(s)
- Ryan E. Ross
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | | | - Michael E. Saladin
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Chris M. Gregory
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC,Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
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8
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Joseph KL, Dagfinrud H, Hagen KB, Nordén KR, Fongen C, Wold OM, Hinman RS, Nelligan RK, Bennell KL, Tveter AT. The AktiWeb study: feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis. Pilot Feasibility Stud 2022; 8:150. [PMID: 35859065 PMCID: PMC9296765 DOI: 10.1186/s40814-022-01110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient organisations may be an under-utilised resource in follow-up of patients requiring long-term exercise as part of their disease management. The purpose of this study was to explore the feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis (OA). Methods In this pre–post feasibility study, patients aged 40–80 years with hip and/or knee OA were recruited from Diakonhjemmet Hospital. The 12-week intervention was delivered through a patient organisation’s digital platform. Feasibility was evaluated by proportion of eligible patients enrolled, proportion of enrolled patients who provided valid accelerometer data at baseline, and proportion completing the cardiorespiratory exercise test according to protocol at baseline and completed follow-up assessments. Patient acceptability was evaluated for website usability, satisfaction with the initial exercise level and comprehensibility of the exercise program. Change in clinical outcomes were assessed for physical activity, cardiorespiratory fitness and patient-reported variables. Results In total, 49 eligible patients were identified and 35 were enrolled. Thirty (86%) of these attended baseline assessments and provided valid accelerometer data and 18 (51%) completed the maximal cardiorespiratory exercise test according to protocol. Twenty-two (63%) patients completed the follow-up questionnaire, and they rated the website usability as ‘acceptable’ [median 77.5 out of 100 (IQR 56.9, 85.6)], 19 (86%) reported that the initial exercise level was ‘just right’ and 18 (82%) that the exercise program was ‘very easy’ or ’quite easy’ to comprehend. Improvement in both moderate to vigorous physical activity (mean change 16.4 min/day; 95% CI 6.9 to 25.9) and cardiorespiratory fitness, VO2peak (mean change 1.83 ml/kg/min; 95% CI 0.29 to 3.36) were found in a subgroup of 8 patients completing these tests. Across all patient-reported outcomes 24–52% of the patients had a meaningful improvement (n = 22). Conclusion A web-based exercise program delivered by a patient organisation was found to be feasible and acceptable in patients with hip and/or knee OA. Trial registration ClinicalTrials.gov, NCT04084834 (registered 10 September 2019). The Regional Committee for Medical and Health Research Ethics south-east, 2018/2198. URL: Prosjekt #632074 - Aktiv med web-basert støtte. - Cristin (registered 7 June 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01110-3.
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Affiliation(s)
- Kenth Louis Joseph
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway. .,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Hanne Dagfinrud
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- Division of Health Service, Norwegian Institute of Public health, Oslo, Norway
| | - Kristine Røren Nordén
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Camilla Fongen
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Rachel K Nelligan
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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9
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Goel S, Kamath SU, Annappa R, Krishnamurthy SL, Jain M, Thakkar S, Damsas L, Banerjee S, Divakar PM. Cross-sectional assessment of cardiovascular risk factors in patients with knee osteoarthritis. F1000Res 2022; 10:508. [PMID: 35265321 DOI: 10.12688/f1000research.27744.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Osteoarthritis (OA) and cardiovascular disease (CVD) are prevalent in India. However, there is dearth of literature among Indians studying the relationship between the two. This study was carried out to assess various cardiovascular (CV) risk factors in patients with knee OA with an objective to investigate their association, screening and management. Methods: In total, 225 patients were included in this cross-sectional study. Participants were diagnosed with knee OA on the basis of the Kellgren and Lawrence (K-L) classification of their radiograph. Participants were also assessed for CV risk factors (age, body mass index, systolic blood pressure, diabetes mellitus, total cholesterol, high-density lipoprotein, smoking) with the help of the Joint British Society QRisk3 calculator (JBS3) a comprehensive risk score calculator as well as a screening tool, which produces three more variables, namely 10-years risk of developing CVD, physiological heart age and life expectancy. Chi Square, Fishers exact test and one-way ANOVA tests were used to compare the categorical and quantitative variables, respectively. Pearson's correlation coefficient was used to assess the relationship between CV risk factors and knee OA. Multiple regression analysis was done to adjust the multiple con-founders and determine their significance. Results: Patients with severe knee OA had a statistically significantly higher prevalence of CV risk factors (p<0.05). Grade 4 knee OA patients were found to have a mean JBS3 risk of 38%, heart age of 82 years and life expectancy of 77 years as compared to grade 2 patients who had a mean JBS3 risk of 11%, heart age of 63 years and life expectancy of 82 years. Conclusions: Our study concluded that there is a strong positive correlation between knee OA and CVD, with CV risk score being directly proportional to the severity of OA.
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Affiliation(s)
- Sagar Goel
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Surendra Umesh Kamath
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Rajendra Annappa
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sunil Lakshmipura Krishnamurthy
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Manesh Jain
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Samarth Thakkar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Lulu Damsas
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sayak Banerjee
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Prajwal Madapura Divakar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
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10
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Ardern CL, Büttner F, Andrade R, Weir A, Ashe MC, Holden S, Impellizzeri FM, Delahunt E, Dijkstra HP, Mathieson S, Rathleff MS, Reurink G, Sherrington C, Stamatakis E, Vicenzino B, Whittaker JL, Wright AA, Clarke M, Moher D, Page MJ, Khan KM, Winters M. Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. Br J Sports Med 2022; 56:175-195. [PMID: 34625401 PMCID: PMC8862073 DOI: 10.1136/bjsports-2021-103987] [Citation(s) in RCA: 142] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 02/01/2023]
Abstract
Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinicians and policy-makers implement results in practice. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and its accompanying Explanation and Elaboration document provide general reporting examples for systematic reviews of healthcare interventions. However, implementation guidance for sport and exercise medicine, musculoskeletal rehabilitation, and sports science does not exist. The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address this problem. Nineteen content experts collaborated with three methods experts to identify examples of exemplary reporting in systematic reviews in sport and exercise medicine (including physical activity), musculoskeletal rehabilitation (including physiotherapy), and sports science, for each of the PRISMA 2020 Statement items. PERSiST aims to help: (1) systematic reviewers improve the transparency and reporting of systematic reviews and (2) journal editors and peer reviewers make informed decisions about systematic review reporting quality.
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Affiliation(s)
- Clare L Ardern
- Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Renato Andrade
- Clinical Research, Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, Porto, Portugal
| | - Adam Weir
- Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sinead Holden
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - H Paul Dijkstra
- Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Skovdal Rathleff
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Guus Reurink
- Academic Center for Evidence Based Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre, School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Bill Vicenzino
- University of Queensland School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, Queensland, Australia
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Alexis A Wright
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University, Belfast, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Institutes of Health Research-Institute of Musculoskeletal Health, Vancouver, British Columbia, Canada
| | - Marinus Winters
- Center for General Practice, Aalborg University, Aalborg, Denmark
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11
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Goel S, Kamath SU, Annappa R, Krishnamurthy SL, Jain M, Thakkar S, Damsas L, Banerjee S, Divakar PM. Cross-sectional assessment of cardiovascular risk factors in patients with knee osteoarthritis. F1000Res 2021; 10:508. [PMID: 35265321 PMCID: PMC8866909 DOI: 10.12688/f1000research.27744.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/01/2023] Open
Abstract
Background: Osteoarthritis (OA) and cardiovascular disease (CVD) are prevalent in India. However, there is dearth of literature among Indians studying the relationship between the two. This study was carried out to assess various cardiovascular (CV) risk factors in patients with knee OA with an objective to investigate their association, screening and management. Methods: In total, 225 patients were included in this cross-sectional study. Participants were diagnosed with knee OA on the basis of the Kellgren and Lawrence (K-L) classification of their radiograph. Participants were also assessed for CV risk factors (age, body mass index, systolic blood pressure, diabetes mellitus, total cholesterol, high-density lipoprotein, smoking) with the help of the Joint British Society QRisk3 calculator (JBS3) a comprehensive risk score calculator as well as a screening tool, which produces three more variables, namely 10-years risk of developing CVD, physiological heart age and life expectancy. Chi Square, Fishers exact test and one-way ANOVA tests were used to compare the categorical and quantitative variables, respectively. Pearson's correlation coefficient was used to assess the relationship between CV risk factors and knee OA. Multiple regression analysis was done to adjust the multiple con-founders and determine their significance. Results: Patients with severe knee OA had a statistically significantly higher prevalence of CV risk factors (p<0.05). Grade 4 knee OA patients were found to have a mean JBS3 risk of 38%, heart age of 82 years and life expectancy of 77 years as compared to grade 2 patients who had a mean JBS3 risk of 11%, heart age of 63 years and life expectancy of 82 years. Conclusions: Our study concluded that there is a strong positive correlation between knee OA and CVD, with CV risk score being directly proportional to the severity of OA.
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Affiliation(s)
- Sagar Goel
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Surendra Umesh Kamath
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Rajendra Annappa
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sunil Lakshmipura Krishnamurthy
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Manesh Jain
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Samarth Thakkar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Lulu Damsas
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sayak Banerjee
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Prajwal Madapura Divakar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
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12
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McLarnon M, Heron N. Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:550. [PMID: 34134679 PMCID: PMC8208610 DOI: 10.1186/s12891-021-04308-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/29/2021] [Indexed: 01/06/2023] Open
Abstract
Background Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee osteoarthritis (OA), particularly in the UK. IA platelet-rich plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. Methods All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC/VAS score (or subscores), comparing IA PRP to CS injections across studies. Results Included were eight studies and 648 patients, 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. Overall, the studies were considered at low risk of bias. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3, 6 and 9 months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (− 0.78 (− 1.34 to − 0.23) standard mean deviations (SMD) and − 1.63 (− 2.14 to − 1.12) SMD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. At 6 months PRP allowed greater return to sporting activities than CS, measured by the KOOS subscale for sporting activity, of magnitude 9.7 (− 0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months follow-up (P < 0.01). Conclusions IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than 1 IA-PRP injection. Prospero trial registration number CRD42020181928. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04308-3.
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Affiliation(s)
- Michael McLarnon
- , Ballymena, UK. .,School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom.
| | - Neil Heron
- School of Medicine, Dentistry and Biomedical Science, Queens University Belfast, Belfast, United Kingdom.,Centre for Public Health Research, Queen's University, Belfast, UK.,UKCRC Centre of Excellence for Public Health Research (Northern Ireland), Belfast, United Kingdom.,Department of General Practice, Keele University, Newcastle, England
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13
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Muscle strength gains after strengthening exercise explained by reductions in serum inflammation in women with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 86:105381. [PMID: 34000629 DOI: 10.1016/j.clinbiomech.2021.105381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/13/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023]
Abstract
Background Individuals with knee osteoarthritis have elevated circulating inflammatory markers and altered cartilage properties but it is unclear if these features adapt to exercise. We aimed to determine (1) whether inflammatory markers, cartilage transverse relaxation time and thickness mediate the effect of body mass index (BMI) on quadriceps strength at baseline; and (2) whether these changes explain variance in quadriceps strength improvements after 12 weeks of exercise in women with knee osteoarthritis. Methods This secondary analysis (17 women with clinical knee osteoarthritis) of a randomized control trial compared supervised group interventions, 3 times/week for 12 weeks (36 sessions): (a) weight-bearing progressive resistive quadriceps exercise or (b) attention control. (1) From baseline, separate linear regressions were conducted with strength (Nm/kg) as the dependent, BMI as the predictor, and c-reactive protein, tumor necrosis factor, interleukin-6, cartilage transverse relaxation time or thickness as potential mediators. (2) Multiple linear regression analyses were completed with 12-week strength change (post-pre) as the dependent, change in serum inflammatory markers and cartilage measurements as predictors, and age, BMI and adherence as covariates. Findings (1) At baseline, there was no mediation. (2) A decrease in each of interleukin-6 (β = -0.104 (95% confidence intervals: -0.172, -0.036), R2 = 0.51, P < 0.007) and tumor necrosis factor (β = -0.024 (-0.038, -0.009), R2 = 0.54, P < 0.005) was associated with strength gains. Interpretation At baseline, inflammatory markers and cartilage measurements do not act as mediators of BMI on quadriceps strength. After 12 weeks of exercise, reduced interleukin-6 and tumor necrosis factor were associated with increased quadriceps strength in women with knee osteoarthritis.
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14
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Maestroni L, Read P, Bishop C, Papadopoulos K, Suchomel TJ, Comfort P, Turner A. The Benefits of Strength Training on Musculoskeletal System Health: Practical Applications for Interdisciplinary Care. Sports Med 2021; 50:1431-1450. [PMID: 32564299 DOI: 10.1007/s40279-020-01309-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Global health organizations have provided recommendations regarding exercise for the general population. Strength training has been included in several position statements due to its multi-systemic benefits. In this narrative review, we examine the available literature, first explaining how specific mechanical loading is converted into positive cellular responses. Secondly, benefits related to specific musculoskeletal tissues are discussed, with practical applications and training programmes clearly outlined for both common musculoskeletal disorders and primary prevention strategies.
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Affiliation(s)
- Luca Maestroni
- Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy. .,StudioErre, Via della Badia, 18, 25127, Brescia, BS, Italy. .,London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK.
| | - Paul Read
- Athlete Health and Performance Research Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Chris Bishop
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Konstantinos Papadopoulos
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
| | - Timothy J Suchomel
- Department of Human Movement Sciences, Carroll University, Waukesha, WI, USA.,Directorate of Psychology and Sport, University of Salford, Frederick Road, Salford, Greater Manchester, UK
| | - Paul Comfort
- Directorate of Psychology and Sport, University of Salford, Frederick Road, Salford, Greater Manchester, UK.,Institute for Sport, Physical Activity and Leisure, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Centre for Exercise and Sport Science Research, Edith Cowan University, Joondalup, Australia
| | - Anthony Turner
- London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, UK
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15
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Roberts JD, Willmott AGB, Beasley L, Boal M, Davies R, Martin L, Chichger H, Gautam L, Del Coso J. The Impact of Decaffeinated Green Tea Extract on Fat Oxidation, Body Composition and Cardio-Metabolic Health in Overweight, Recreationally Active Individuals. Nutrients 2021; 13:nu13030764. [PMID: 33652910 PMCID: PMC7996723 DOI: 10.3390/nu13030764] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/14/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
This study investigated the effect of decaffeinated green tea extract (dGTE), with or without antioxidant nutrients, on fat oxidation, body composition and cardio-metabolic health measures in overweight individuals engaged in regular exercise. Twenty-seven participants (20 females, 7 males; body mass: 77.5 ± 10.5 kg; body mass index: 27.4 ± 3.0 kg·m2; peak oxygen uptake (V.O2peak): 30.2 ± 5.8 mL·kg−1·min−1) were randomly assigned, in a double-blinded manner, either: dGTE (400 mg·d−1 (−)-epigallocatechin−3-gallate (EGCG), n = 9); a novel dGTE+ (400 mg·d−1 EGCG, quercetin (50 mg·d−1) and α-lipoic acid (LA, 150 mg·d−1), n = 9); or placebo (PL, n = 9) for 8 weeks, whilst maintaining standardised, aerobic exercise. Fat oxidation (‘FATMAX’ and steady state exercise protocols), body composition, cardio-metabolic and blood measures (serum glucose, insulin, leptin, adiponectin, glycerol, free fatty acids, total cholesterol, high [HDL-c] and low-density lipoprotein cholesterol [LDL-c], triglycerides, liver enzymes and bilirubin) were assessed at baseline, week 4 and 8. Following 8 weeks of dGTE+, maximal fat oxidation (MFO) significantly improved from 154.4 ± 20.6 to 224.6 ± 23.2 mg·min−1 (p = 0.009), along with a 22.5% increase in the exercise intensity at which fat oxidation was deemed negligible (FATMIN; 67.6 ± 3.6% V.O2peak, p = 0.003). Steady state exercise substrate utilisation also improved for dGTE+ only, with respiratory exchange ratio reducing from 0.94 ± 0.01 at week 4, to 0.89 ± 0.01 at week 8 (p = 0.004). This corresponded with a significant increase in the contribution of fat to energy expenditure for dGTE+ from 21.0 ± 4.1% at week 4, to 34.6 ± 4.7% at week 8 (p = 0.006). LDL-c was also lower (normalised fold change of −0.09 ± 0.06) for dGTE+ by week 8 (p = 0.038). No other significant effects were found in any group. Eight weeks of dGTE+ improved MFO and substrate utilisation during exercise, and lowered LDL-c. However, body composition and cardio-metabolic markers in healthy, overweight individuals who maintained regular physical activity were largely unaffected by dGTE.
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Affiliation(s)
- Justin D. Roberts
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK; (A.G.B.W.); (M.B.); (R.D.); (L.M.)
- Correspondence: ; Tel.: +44-845-196-5154
| | - Ashley G. B. Willmott
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK; (A.G.B.W.); (M.B.); (R.D.); (L.M.)
| | - Liam Beasley
- Department for Health, University of Bath, Bath BA2 7AY, UK;
| | - Mariette Boal
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK; (A.G.B.W.); (M.B.); (R.D.); (L.M.)
| | - Rory Davies
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK; (A.G.B.W.); (M.B.); (R.D.); (L.M.)
| | - Laurence Martin
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK; (A.G.B.W.); (M.B.); (R.D.); (L.M.)
| | - Havovi Chichger
- School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK; (H.C.); (L.G.)
| | - Lata Gautam
- School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK; (H.C.); (L.G.)
| | - Juan Del Coso
- Centre for Sport Studies, Rey Juan Carlos University, 28943, Fuenlabrada, Spain;
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16
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Primeau CA, Birmingham TB, Moyer RF, O'Neil KA, Werstine MS, Alcock GK, Giffin JR. Trajectories of perceived exertion and pain over a 12-week neuromuscular exercise program in patients with knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1427-1431. [PMID: 32828912 DOI: 10.1016/j.joca.2020.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Exercise programs rely on the overload principle, yet patients with knee osteoarthritis (OA) may not adequately progress exercises due to fear of exacerbating symptoms. OBJECTIVE To describe trajectories for perceived exertion and exercise-induced knee pain during a neuromuscular exercise program for patients with knee OA. DESIGN Participants with knee OA completed a 12-week neuromuscular exercise program consisting of weekly supervised sessions plus home exercises. During each supervised session, the Borg's rating of perceived exertion (RPE; 6 = no exertion, 20 = maximal exertion) and knee pain (pre, post, max) using Numeric Rating Scales (NRS; 0 = no pain, 10 = worst imaginable pain) were completed. Mean changes in RPE and pain from weeks 1-12 were calculated. Mixed effects regression was used to investigate trajectories over time (weeks) for RPE, and maximum pain (pre-to-max) and pain-change (pre-to-post) during exercise. RESULTS 56 patients (95%) completed the program. From week 1-12, RPE increased by 2.6 (95%CI, 1.7 to 3.5), from 'somewhat hard' to 'very hard', while max pain decreased by 1.0 NRS (95%CI, 0.5 to 1.3) and pain-change decreased by 0.9 NRS (95%CI, 0.4 to 1.3). Linear mixed effects regression showed a quadratic increase for RPE over time until between weeks 9 and 10, then RPE plateaued. Maximum pain decreased linearly over time. Pain-change showed a quadratic decrease over time until approximately week 9, then pain-change plateaued. CONCLUSIONS In patients with knee OA participating in a 12-week neuromuscular exercise program, perceived exertion during exercise progressed from 'somewhat hard' to 'very hard' at 9 weeks, while exercise-induced knee pain decreased. Patients were able to work harder while experiencing decreases rather than increases in pain.
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Affiliation(s)
- C A Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Bone and Joint Institute, Western University, London, ON, Canada; Wolf Orthopaedic Biomechanics Laboratory, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Bone and Joint Institute, Western University, London, ON, Canada; Wolf Orthopaedic Biomechanics Laboratory, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - R F Moyer
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - K A O'Neil
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - M S Werstine
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - G K Alcock
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
| | - J R Giffin
- Bone and Joint Institute, Western University, London, ON, Canada; Wolf Orthopaedic Biomechanics Laboratory, Western University, London, ON, Canada; Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University Ontario, London, ON, Canada.
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17
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Wainwright TW, Burgess LC, Immins T, Cowan N, Middleton RG. A cycling and education intervention for the treatment of hip osteoarthritis: A quality improvement replication programme. SAGE Open Med 2020; 8:2050312120946522. [PMID: 32821389 PMCID: PMC7406946 DOI: 10.1177/2050312120946522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/10/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives: The Cycling against Hip Pain programme is a 6-week exercise and education treatment pathway for people with hip osteoarthritis. Preliminary results of the Cycling against Hip Pain programme found significant improvements in clinical and patient-reported outcome measures for patients referred from primary care. This article evaluates the effectiveness of the changes made to the pathway in a quality improvement replication programme. Methods: The replicated Cycling against Hip Pain programme was delivered between February 2018 and September 2019 in a region of England with a high percentage of adults aged over 65 years. All participants were referred from the orthopaedic outpatient department of the funding hospital (secondary care). The programme was delivered at a local leisure centre and combined 30 min of education on osteoarthritis with 30 min of progressive static cycling, once a week for 6 weeks. Results: The participants on the replicated Cycling against Hip Pain programme did not differ from the original cohort in terms of age or pre-programme weight, however, presented with worse hip symptoms at baseline. Consistent with the findings from the original cohort, participants demonstrated significant improvements to their Oxford Hip Score, 30-s chair stand performance, Timed Up and Go score, Hip Osteoarthritis Outcome Score function and pain, EQ5D health rating, EQ5D-5L score and pain at rest and on weight bearing. In addition, participants reported an increase in knowledge, confidence and motivation to exercise. Conclusion: A 6-week cycling and education intervention for the treatment of hip osteoarthritis provided benefits to function, pain and quality of life for patients referred from secondary care. These results are consistent with findings from patients who were referred from primary care and further support the potential of the pathway in the conservative management of hip osteoarthritis.
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Affiliation(s)
- Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK.,The Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
| | - Louise C Burgess
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Tikki Immins
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
| | - Neil Cowan
- The Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK.,Royal Perth Bentley Group, Perth, WA, Australia
| | - Robert G Middleton
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK.,The Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
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18
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Davis AM, Davis KD, Skou ST, Roos EM. Why Is Exercise Effective in Reducing Pain in People with Osteoarthritis? CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00154-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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