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Teljigovic S, Dalager T, Nielsen NO, Holm L, Ejvang MB, Sjøgaard G, Søgaard K, Sandal LF. Development and feasibility of a conceptual model for planning individualised physical exercise training ( IPET) for older adults: a cross-sectional study. BMJ Open 2024; 14:e075726. [PMID: 38448065 PMCID: PMC10916106 DOI: 10.1136/bmjopen-2023-075726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Older adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences. DESIGN The concept of IPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementing IPET. SETTING Outpatient setting. PARTICIPANTS We included 115 older adults (70 females) from an outpatient setting with a median age of 74 years. OUTCOME MEASURES Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept of IPET that structures exercise programmes based on the individual citizen's needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator. RESULTS We included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations. DISCUSSION This study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual. TRIAL REGISTRATION NUMBER NCT04862481.
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Affiliation(s)
- Sanel Teljigovic
- Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tina Dalager
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nina Odgaard Nielsen
- Centre for Health and Rehabilitation, University College Absalon, Slagelse, Denmark
| | - Lars Holm
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Mette Bahn Ejvang
- Centre for Health and Older Adults, Activitycentre Midgård, Slagelse Municipality, Slagelse, Denmark
| | - Gisela Sjøgaard
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Louise Fleng Sandal
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Study on the Role of MicroRNA-214 in the Rehabilitation of Cartilage in Mice with Exercise-Induced Traumatic Osteoarthritis. Curr Issues Mol Biol 2022; 44:4100-4117. [PMID: 36135193 PMCID: PMC9497662 DOI: 10.3390/cimb44090281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 01/17/2023] Open
Abstract
This study aimed to explore the possible relationship between the expression of Micro RNA-214 (miR-214) and the pathogenesis and recovery in mice with post-traumatic osteoarthritis (PTOA). In this study, 40 male C57BL/6 mice were randomly divided into five groups: model control (MC) group, model (M) group, rehabilitation control (RC) group, model + rehabilitation (M + R) group, and model + convalescent (M + C) group. Four weeks of high-intensity treadmill exercise (HITE) and 4 weeks of moderate-intensity treadmill exercise (MITE) were implemented for PTOA modeling and rehabilitation, respectively. In vitro, 10% elongation mechanical strain was used for IL-1β stimulated chondrocytes. We found that compared with the MC group, there was a significant increase in the aspect of inflammation and catabolism while a dramatic fall in miR-214 expression was observed in the M group. After the 4 weeks of MITE, the level of inflammation and metabolism, as well as miR-214 expression, was partially reversed in the M + R group compared with the M + C group. The expression of miR-214 decreased dramatically after chondrocyte stimulation by IL-1β and then increased significantly after 10% strain was applied to IL-1β-treated cells. These results suggest that a suitable mechanical load can increase the expression of miR-214, and that miR-214 may play a chondroprotective effect in the development of OA.
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Shema-Shiratzky S, Beer Y, Mor A, Elbaz A. Smartphone-based inertial sensors technology - Validation of a new application to measure spatiotemporal gait metrics. Gait Posture 2022; 93:102-106. [PMID: 35121485 DOI: 10.1016/j.gaitpost.2022.01.024] [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] [Received: 09/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smartphones are increasingly recognized as the future technology for clinical gait assessment. RESEARCH QUESTION To determine the concurrent validity of gait parameters obtained using the smartphone technology and application in a group of patients with musculoskeletal pathologies. METHODS Patients with knee, lower back, hip, or ankle pain were included in the study (n = 72). Spatiotemporal outcomes were derived from the walkway and the smartphone simultaneously. Pearson's correlations and limits of agreement (LoA) determined the association between the two methods. RESULTS Cadence and gait cycle time showed excellent correlation and agreement between the smartphone and the walkway (cadence: r = 0.997, LoA=1.4%, gait cycle time: r = 0.996, LoA = 1.6%). Gait speed, double-limb support and left and right step length demonstrated strong correlations and moderate agreement between methods (gait speed: r = 0.914, LoA=15.4%, left step length: r = 0.842, LoA = 17.0%, right step length: r = 0.800, LoA=16.4%). The left and right measures of single-limb support and stance percent showed a consistent 4% bias across instruments, yielding moderate correlation and very good agreement between the smartphone and the walkway (r = 0.532, LoA = 9% and r = 0.460, LoA=9.8% for left and right single-limb support; r = 0.463, LoA = 5.1% and r = 0.533, LoA = 4.4% for left and right stance). SIGNIFICANCE The examined application appears to be a valid tool for gait analysis, providing clinically significant metrics for the assessment of patients with musculoskeletal pathologies. However, additional studies should examine the technology amongst patients with severe gait abnormalities.
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Affiliation(s)
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel.
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel.
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Godziuk K, Prado CM, Forhan M. Patient engagement in the design of an intervention to prevent muscle loss in individuals with knee osteoarthritis and a body mass index (BMI) ≥ 35. Musculoskeletal Care 2021; 20:557-569. [PMID: 34928546 DOI: 10.1002/msc.1613] [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: 10/27/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Interventions for knee osteoarthritis (OA) in adults with a large body size (defined as a body mass index [BMI] ≥ 35 kg/m2 ) often prioritise weight-loss, which may overshadow specific benefits for physical function, metabolic health, and body composition. As part of the development of a future clinical study, we gathered perspectives from individuals living with knee OA and a large body size to inform the proposed intervention design and delivery. METHODS Purposive and voluntary sampling was used to engage individuals ≥40 years of age with self-reported knee OA and a BMI ≥ 35 kg/m2 . An anonymous electronic survey was distributed on social media between April 2020 and June 2020. Open-ended questions addressed a proposed 12-week multimodal intervention (involving targeted nutrition, resistance exercises, and self-management support). An optional semi-structured interview was offered upon completion, with interviews recorded and transcribed verbatim. Reflexive thematic analysis and interpretation guided by an acceptability framework was used to identify recommendations for the intervention design and delivery. RESULTS Twenty individuals living across Canada completed the survey (100% female; 18 aged <65 years and 2 ≥ 65 years). Ten individuals completed the interview. From aggregate survey and interview data, three recommendations were generated: (1) the effectiveness of the intervention for health improvement (specifically mobility and pain) must be emphasised to avoid perceived weight-loss expectations; (2) extend support beyond 12-weeks and consider terminology free from weight-bias to enhance acceptance; (3) include optional customisation of intervention delivery to reduce acceptability-related burden. CONCLUSION These female patient-derived recommendations may improve perceived intervention acceptability, and thereby may enhance participant enrolment and retention in clinical trials.
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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, Edmonton, Alberta, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Krishnamurthy A, Lang AE, Pangarkar S, Edison J, Cody J, Sall J. Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis. Mayo Clin Proc 2021; 96:2435-2447. [PMID: 34481599 DOI: 10.1016/j.mayocp.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched (ie, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE PreMEDLINE, PubMed, and the Agency for Healthcare Research and Quality website) and evaluated the literature, created a simple 1-page algorithm, and advanced 19 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. This synopsis summarizes key recommendations in all 6 topics covered in the guideline. These topics are diagnosis, self-management, physical therapy, pharmacotherapy, orthobiologics, and complementary and integrative health.
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Affiliation(s)
- Anil Krishnamurthy
- Department of Orthopedics and Plastic Surgery, Dayton Veterans Affairs Medical Center, Dayton, OH; Department of Orthopaedic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA.
| | - Sanjog Pangarkar
- Department of Physical Medicine and Rehabilitation, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA
| | - Jess Edison
- Department of Rheumatology ,Walter Reed National Military Medical Center, Bethesda, MD
| | - John Cody
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - James Sall
- Office of Evidence-Based Practice, Veterans Affairs Central Office, Washington, DC
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Li S, Ng WH, Abujaber S, Shaharudin S. Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis. Sci Rep 2021; 11:16104. [PMID: 34373507 PMCID: PMC8352951 DOI: 10.1038/s41598-021-95426-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/23/2021] [Indexed: 01/08/2023] Open
Abstract
The systematic review aimed to analyze the effects of resistance training in knee osteoarthritis (OA) rehabilitation from a biomechanical perspective. A meta-analysis was performed to determine the potential benefits of resistance training on patients with knee OA. Relevant studies based on the inclusion and exclusion criteria were selected from CENTRAL, PubMed, Scopus, and Web of Science databases inception to August 2020. Outcome measures included gait velocity and knee adduction moment (KAM). The mean differences of the data with a 95% confidence interval were analyzed using STATA 15.1 software The search identified eight studies that satisfied all the inclusion criteria, in which 164 patients were involved in gait velocity studies and another 122 patients were part of KAM studies. Analysis of the pooled data showed that resistance training significantly improved the gait velocity in patients with knee OA (p < 0.01, z = 2.73), ES (95% CI) = 0.03 (0.01, 0.06) m/s. However, resistance training had no significant effect on improving KAM in patients with knee OA (p = 0.98, z = 0.03), ES (95% CI) = 0.00 (− 0.16, 0.16) percentage of body weight × height (%BW × Ht). Therefore, resistance training may enhance gait velocity but not KAM in knee OA patients. The protocol was registered at PROSPERO (registration number: CRD42020204897).
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Affiliation(s)
- Shuoqi Li
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Wei Hui Ng
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Klinik Kesihatan Putrajaya Presint 9, Kementerian Kesihatan Malaysia, 62300, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Sumayeh Abujaber
- School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Shazlin Shaharudin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
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Santamaria S. ADAMTS-5: A difficult teenager turning 20. Int J Exp Pathol 2020; 101:4-20. [PMID: 32219922 DOI: 10.1111/iep.12344] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 12/13/2022] Open
Abstract
A Disintegrin And Metalloproteinase with ThromboSpondin motif (ADAMTS)-5 was identified in 1999 as one of the enzymes responsible for cleaving aggrecan, the major proteoglycan in articular cartilage. Studies in vitro, ex vivo and in vivo have validated ADAMTS-5 as a target in osteoarthritis (OA), a disease characterized by extensive degradation of aggrecan. For this reason, it attracted the interest of many research groups aiming to develop a therapeutic treatment for OA patients. However, ADAMTS-5 proteoglycanase activity is not only involved in the dysregulated aggrecan proteolysis, which occurs in OA, but also in the physiological turnover of other related proteoglycans. In particular, versican, a major ADAMTS-5 substrate, plays an important structural role in heart and blood vessels and its proteolytic processing by ADAMTS-5 must be tightly regulated. On the occasion of the 20th anniversary of the discovery of ADAMTS-5, this review looks at the evidence for its detrimental role in OA, as well as its physiological turnover of cardiovascular proteoglycans. Moreover, the other potential functions of this enzyme are highlighted. Finally, challenges and emerging trends in ADAMTS-5 research are discussed.
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Abstract
PURPOSE OF REVIEW This review focuses on studies published during July 2001 to August 2017 of exercise as an intervention in knee and hip osteoarthritis, including its influence on an array of patient outcomes. RECENT FINDINGS Studies continue to illustrate the efficacy of exercise in treating and managing osteoarthritis, with current literature more focused on the knee compared with the hip joint. Both traditional (e.g. strength, aerobic, flexibility) and more nontraditional (e.g. yoga, Tai Chi, aquatic) training modes improve patient outcomes related to joint symptoms, mobility, quality of life, psychological health, musculoskeletal properties, body composition, sleep, and fatigue. Exercise that is adequately dosed (e.g. frequency, intensity) and progressive in nature demonstrated the greatest improvements in patient outcomes. Supervised, partially supervised, and nonsupervised interventions can be successful in the treatment of osteoarthritis, but patient preference regarding level of supervision and mode of exercise may be key predictors in exercise adherence and degree of outcome improvement. A topic of increasing interest in osteoarthritis is the supplementary role of behavior training in exercise interventions. SUMMARY Osteoarthritis is a complex, multifactorial disease that can be successfully managed and treated through exercise, with minimal risk for negative consequences. However, to have greatest impact, appropriate exercise prescription is needed. Efforts to achieve correct exercise doses and mitigate patient nonadherence are needed to lessen the lifelong burden of osteoarthritis.
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Fenton SAM, Neogi T, Dunlop D, Nevitt M, Doherty M, Duda JL, Klocke R, Abhishek A, Rushton A, Zhang W, Lewis CE, Torner J, Kitas G, White DK. Does the intensity of daily walking matter for protecting against the development of a slow gait speed in people with or at high risk of knee osteoarthritis? An observational study. Osteoarthritis Cartilage 2018; 26:1181-1189. [PMID: 29729332 PMCID: PMC6098720 DOI: 10.1016/j.joca.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/12/2018] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a risk factor for a decline in gait speed. Daily walking reduces the risk of developing slow gait speed and future persistent functional limitation. However, the protective role of walking intensity is unclear. We investigated the association of substituting time spent not walking, with walking at light and moderate-to-vigorous intensities for incident slow gait over 2-years, among people with or at high risk of knee OA. METHOD We used baseline and 2-year follow-up data from the Multicenter Osteoarthritis (MOST) study (n = 1731) and the Osteoarthritis Initiative (OAI, n = 1925). Daily walking intensity was objectively assessed using accelerometer-enabled devices, and classified as; not walking (<1 steps/min), very-light (1-49 steps/min), light (50-100 steps/min), and moderate-to-vigorous (>100 steps/min). We defined slow gait during a 20-m walk, as <1 m/s and <1.2 m/s. Isotemporal substitution evaluated time-substitution effects on incident slow gait outcomes at 2-years. RESULTS Replacing 20 min/day of not walking with walking at a moderate-to-vigorous intensity, demonstrated small to moderate reductions in the risk of developing a gait speed <1.0 m/s (Relative Risk [95% confidence interval (CI)]; MOST = 0.51 [0.27, 0.98], OAI = 0.21 [0.04, 0.98]), and <1.2 m/s (MOST = 0.73 [0.53, 1.00], OAI = 0.65 [0.36, 1.18]). However, only risk reductions for <1.0 m/s met statistical significance. Replacing not walking with very-light or light intensity walking was not associated with the risk of developing slow gait outcomes. CONCLUSION When possible, walking at a moderate-to-vigorous intensity (>100 steps/min) may be best recommended in order to reduce the risk of developing critical slow gait speed among people with, or at high risk of knee OA.
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Affiliation(s)
- Sally A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK,Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, England, UK
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University Medical Center, Boston, MA, USA
| | - Dorothy Dunlop
- Center for Healthcare Studies and Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael Nevitt
- University of California San Francisco, San Francisco, CA, USA
| | - Michael Doherty
- Faculty of Medicine and Health Sciences, University of Nottingham, England, UK
| | - Joan L Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK
| | - Rainer Klocke
- Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, England, UK
| | - Abhishek Abhishek
- Faculty of Medicine and Health Sciences, University of Nottingham, England, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK
| | - Weiya Zhang
- Faculty of Medicine and Health Sciences, University of Nottingham, England, UK
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - George Kitas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England, UK,Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, England, UK
| | - Daniel K. White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Akhavan NS, Ormsbee L, Johnson SA, George KS, Foley EM, Elam ML, Ezzat-Zadeh Z, Panton LB, Arjmandi BH. Functionality in Middle-Aged and Older Overweight and Obese Individuals with Knee Osteoarthritis. Healthcare (Basel) 2018; 6:healthcare6030074. [PMID: 29973574 PMCID: PMC6165234 DOI: 10.3390/healthcare6030074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 12/15/2022] Open
Abstract
Patients with knee osteoarthritis (OA) suffer from immobility and pain. The objective of this cross-sectional study was to investigate the relationship between pain and functionality in middle-aged and older overweight and obese individuals with mild-to-moderate knee OA. Overall pattern, physical activity, and total energy expenditure (TEE) were assessed in 83 participants. The Western Ontario McMaster Universities Arthritis Index (WOMAC) was used to assess lower extremity pain and function. The six-minute walk test (6-MWT) and range of motion (ROM) were also assessed. Results indicated that age was inversely associated with body mass index (BMI) (r = 0.349) and total WOMAC scores (r = 0.247). BMI was positively associated with TEE (r = 0.430) and WOMAC scores (r = 0.268), while ROM was positively associated with the 6-MWT (r = 0.561) and negatively associated with WOMAC (r = 0.338) and pain scores (r = 0.222). Furthermore, women had significantly greater WOMAC scores (p = 0.046) than men. Older participants (≥65 years old) had significantly lower BMI (p = 0.002), and distance traveled during the 6-MWT (p = 0.013). Our findings indicate that older individuals in this population with knee OA had lower BMI, greater ROM, and less pain and stiffness and walked slower than middle-aged individuals. Women reported greater pain, stiffness, and reduced functionality, indicating that the manifestation of OA may vary due to gender.
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Affiliation(s)
- Neda S Akhavan
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
- Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), College of Human Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
| | - Lauren Ormsbee
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
- Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), College of Human Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
| | - Sarah A Johnson
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523-1571, USA.
| | - Kelli S George
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
- Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), College of Human Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
| | - Elizabeth M Foley
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
- Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), College of Human Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
| | - Marcus L Elam
- Department of Human Nutrition and Food Science, California State Polytechnic University, Pomona, CA 91768-2557, USA.
| | - Zahra Ezzat-Zadeh
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
| | - Lynn B Panton
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
- Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), College of Human Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
| | - Bahram H Arjmandi
- Department of Nutrition, Food and Exercise Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
- Center for Advancing Exercise and Nutrition Research on Aging (CAENRA), College of Human Sciences, Florida State University, Tallahassee, FL 32306-4310, USA.
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Effects of a dance-based aquatic exercise program in obese postmenopausal women with knee osteoarthritis: a randomized controlled trial. Menopause 2018; 24:768-773. [PMID: 28141662 DOI: 10.1097/gme.0000000000000841] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effects of a dance-based aquatic exercise program on functionality, cardiorespiratory capacity, postexercise heart rate, and fatigue in obese postmenopausal women with knee osteoarthritis. METHODS A randomized controlled trial was performed. In all, 34 obese women diagnosed with knee osteoarthritis participated. Women were randomly allocated to an experimental group (n = 17) or a control group (n = 17). Participants in the experimental group were included in an 8-week dance-based aquatic exercise program conducted in community swimming pools. Those in the control group underwent a global aquatic exercise program. The primary outcome measure was functionality assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were cardiorespiratory capacity evaluated with the 6-minute walk test, and postexercise heart rate and fatigue assessed using a visual analog scale. Variables were measured at baseline, after the intervention, and at 3-month follow-up. RESULTS A between-group analysis showed significant postintervention differences in functionality (aggregate postintervention WOMAC score of 37.30 ± 16.61 vs 41.83 ± 13.69; P = 0.048) in favor of the experimental group. In addition, significant between-group differences were found after the 8 weeks in cardiorespiratory capacity, postexercise heart rate, and fatigue. Follow-up continued to show significant differences between groups in function (aggregate WOMAC score of 38.60 ± 13.61 vs 42.60 ± 9.05; P = 0.038), postexercise heart rate, and fatigue. CONCLUSIONS An 8-week dance-based exercise program significantly improved function and cardiorespiratory capacity, and decreased postexercise heart rate and fatigue. Most of these improvements were maintained at 3-month follow-up in obese postmenopausal women.
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Tian K, Cheng H, Zhang J, Chen K. Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e0240. [PMID: 29642145 PMCID: PMC5908555 DOI: 10.1097/md.0000000000010240] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/09/2018] [Accepted: 03/02/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of intra-articular methylprednisolone for reducing pain in patients with knee osteoarthritis. METHODS We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11), and the Cochrane Library (1900-2017.11) for randomized clinical trials comparing the use of methylprednisolone to treat knee osteoarthritis. The primary outcomes are Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and WOMAC function scores. Each outcome was combined and calculated using the statistical software STATA 12.0. Fixed/random effect model was adopted based on the heterogeneity tested by I statistic. RESULTS A total of 739 patients were analyzed across 4 randomized controlled trials (RCTs). The present meta-analysis revealed that there were significant differences between groups regarding the WOMAC pain scores at 4 weeks (WMD = -1.384, 95% CI: -1.975 to -0.793, P = .000), 12 weeks (WMD = -1.587, 95% CI: -2.489 to -0.685, P = .001), and 24 weeks (WMD = -1.563, 95% CI: -2.245 to -0.881, P = .000). Significant differences were identified in terms of physical function at 4 weeks (WMD = -7.925, 95% CI: -13.359 to -2.491, P = .004), 12 weeks (WMD = -7.314, 95% CI: -13.308 to -1.320, P = .117), and 24 weeks (WMD = -6.484, 95% CI: -11.256 to -1.711, P = .008). CONCLUSION Intra-articular methylprednisolone injection was associated with an improved pain relief and physical function in patients with knee osteoarthritis. Additionally, no severe adverse effects were observed. Due to the limited quality of the evidence currently available, higher quality RCTs were required.
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Affiliation(s)
- Kewei Tian
- Department of Hip Injury and Disease, Orthopedic Hospital of Henan Province, Luoyang City
| | - Huiguang Cheng
- Joint Surgery Hospital Hip Joint Ward, Xi’ an Hong Hui Hospital , Xi’ an
| | - Jiangtao Zhang
- Department of Knee Injury and Disease, Orthopedic Hospital of Henan Province, Luoyang City, China
| | - Ke Chen
- Department of Hip Injury and Disease, Orthopedic Hospital of Henan Province, Luoyang City
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Huang L, Guo B, Xu F, Zhao J. Effects of quadriceps functional exercise with isometric contraction in the treatment of knee osteoarthritis. Int J Rheum Dis 2017; 21:952-959. [PMID: 28544687 DOI: 10.1111/1756-185x.13082] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aims to investigate the effects of a quadriceps isometric contraction exercise method in the treatment of knee osteoarthritis (OA). METHODS A total of 250 patients with a confirmed diagnosis of knee OA were enrolled. The patients were randomly divided into an exercise treatment test group (128 patients) and a traditional treatment control group (122 patients). Quadriceps isometric contraction exercise was used in the test group, and local physiotherapy and oral nonsteroidal anti-inflammatory drugs were used in the control group. Knee joint function was evaluated with a visual analog scale (VAS) score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire before treatment, and 1 and 3 months after treatment. RESULTS VAS scoring and the WOMAC questionnaire showed significant relief in pain 1 month after treatment in the test group (P < 0.05), but minimal relief in the control group; at 1 month, there was also minimal joint function improvement in the test group (P > 0.05), but significant improvement in the control group (P < 0.05). However, 3 months after treatment, pain relief and knee joint function were more improved in the test group than in the control group, with a significant difference (P < 0.05). CONCLUSION Through our short-term observation, joint pain was effectively relieved and knee joint function was improved with systematic quadriceps isometric contraction exercise.
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Affiliation(s)
- Lanfeng Huang
- Department of Orthopaedics, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bin Guo
- Department of Orthopaedics, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Feixiang Xu
- Department of Orthopaedics, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jinsong Zhao
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, Jilin, China
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14
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Neuromuscular function of the quadriceps muscle during isometric maximal, submaximal and submaximal fatiguing voluntary contractions in knee osteoarthrosis patients. PLoS One 2017; 12:e0176976. [PMID: 28505208 PMCID: PMC5432168 DOI: 10.1371/journal.pone.0176976] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Knee osteoarthrosis (KOA) is commonly associated with a dysfunction of the quadriceps muscle which contributes to alterations in motor performance. The underlying neuromuscular mechanisms of muscle dysfunction are not fully understood. The main objective of this study was to analyze how KOA affects neuromuscular function of the quadriceps muscle during different contraction intensities. MATERIALS AND METHODS The following parameters were assessed in 20 patients and 20 healthy controls: (i) joint position sense, i.e. position control (mean absolute error, MAE) at 30° and 50° of knee flexion, (ii) simple reaction time task performance, (iii) isometric maximal voluntary torque (IMVT) and root mean square of the EMG signal (RMS-EMG), (iv) torque control, i.e. accuracy (MAE), absolute fluctuation (standard deviation, SD), relative fluctuation (coefficient of variation, CV) and periodicity (mean frequency, MNF) of the torque signal at 20%, 40% and 60% IMVT, (v) EMG-torque relationship at 20%, 40% and 60% IMVT and (vi) performance fatigability, i.e. time to task failure (TTF) at 40% IMVT. RESULTS Compared to the control group, the KOA group displayed: (i) significantly higher MAE of the angle signal at 30° (99.3%; P = 0.027) and 50° (147.9%; P < 0.001), (ii) no significant differences in reaction time, (iii) significantly lower IMVT (-41.6%; P = 0.001) and tendentially lower RMS-EMG of the rectus femoris (-33.7%; P = 0.054), (iv) tendentially higher MAE of the torque signal at 20% IMVT (65.9%; P = 0.068), significantly lower SD of the torque signal at all three torque levels and greater MNF at 60% IMVT (44.8%; P = 0.018), (v) significantly increased RMS-EMG of the vastus lateralis at 20% (70.8%; P = 0.003) and 40% IMVT (33.3%; P = 0.034), significantly lower RMS-EMG of the biceps femoris at 20% (-63.6%; P = 0.044) and 40% IMVT (-41.3%; P = 0.028) and tendentially lower at 60% IMVT (-24.3%; P = 0.075) and (vi) significantly shorter TTF (-51.1%; P = 0.049). CONCLUSION KOA is not only associated with a deterioration of IMVT and neuromuscular activation, but also with an impaired position and torque control at submaximal torque levels, an altered EMG-torque relationship and a higher performance fatigability of the quadriceps muscle. It is recommended that the rehabilitation includes strengthening and fatiguing exercises at maximal and submaximal force levels.
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Losina E, Klara K, Michl GL, Collins JE, Katz JN. Development and feasibility of a personalized, interactive risk calculator for knee osteoarthritis. BMC Musculoskelet Disord 2015; 16:312. [PMID: 26494421 PMCID: PMC4618755 DOI: 10.1186/s12891-015-0771-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/02/2015] [Indexed: 11/25/2022] Open
Abstract
Background The incidence of knee osteoarthritis (OA) is rising. While several risk factors have been associated with the development of knee OA, this information is not readily accessible to those at risk for osteoarthritis. Risk calculators have been developed for several prevalent chronic conditions but not for OA. Using published evidence on established risk factors, we developed an interactive, personalized knee OA risk calculator (OA Risk C) and conducted a pilot study to evaluate its acceptability and feasibility. Methods We used the Osteoarthritis Policy (OAPol) Model, a validated, state-transition simulation of the natural history and management of OA, to generate data for OA Risk C. Risk estimates for calculator users were based on a set of demographic and clinical factors (age, sex, race/ethnicity, obesity) and select risk factors (family history of knee OA, occupational exposure, and history of knee injury). OA Risk C presents personalized risk of knee OA in several ways to maximize understanding among a wide range of users. We conducted a study of 45 subjects in a primary care setting to establish the feasibility and acceptability of the OA risk calculator. Pilot study participants were asked several questions regarding ease of use, clarity of presentation, and clarity of the graphical representation of their risk. These questions used a five-level agreement scale ranging from strongly disagree to strongly agree. Results OA Risk C depicts information about users’ risk of symptomatic knee OA in 5 year intervals. Study participants estimated their lifetime risk at 38 %, while their actual lifetime risk, as estimated by OA Risk C, was 25 %. Eighty-four percent of pilot study participants reported that OA Risk C was easy to understand, and 89 % agreed that the graphs depicting their risk were clear and comprehensible. Conclusions We have developed a personalized, computer-based OA risk calculator that is easy to use. OA Risk C may be utilized to estimate individuals’ knee OA risk and to deliver educational and behavioral interventions focused on osteoarthritis risk reduction.
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Affiliation(s)
- Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, BC 4-016, 02115, Boston, MA, USA. .,Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
| | - Kristina Klara
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, BC 4-016, 02115, Boston, MA, USA.
| | - Griffin L Michl
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, BC 4-016, 02115, Boston, MA, USA.
| | - Jamie E Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, BC 4-016, 02115, Boston, MA, USA. .,Harvard Medical School, Boston, MA, 02115, USA.
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St, BC 4-016, 02115, Boston, MA, USA. .,Harvard Medical School, Boston, MA, 02115, USA. .,Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, 02115, USA.
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