Effect of Progressive Resistance Strength Training on Body Mass Index, Quality of Life and Functional Capacity in Knee Osteoarthritis: A Randomized Controlled Trial

The effect of resistance training on patients with knee osteoarthritis: a systematic review and meta-analysis

The objective of this study is to investigate the beneficial effects of resistance training (RT) on individuals suffering from knee osteoarthritis (KOA). In order to gather relevant studies from the beginning of various databases until January 2023, a comprehensive search was conducted on PubMed, Embase, Scopus, Web of Science, and The Cochrane Library. Additionally, manual searches were performed on the reference lists. The association between RT and KOA was analysed using a random-effects model. The results indicated that patients with KOA who underwent RT experienced a significant reduction in the WOMAC (Western Ontario and McMaster Universities Osteoarthritis) Pain index (WMD = -2.441; 95% CI = -3.610 to -1.273; p < 0.01), the WOMAC Stiffness index (WMD = -1.018; 95% CI = -1.744 to -0.293; p < 0.01), the WOMAC Function index (WMD = -7.208; 95% CI = -10.412 to -4.004; p < 0.01), and the VAS (Visual Analogue Scale) index (WMD = -5.721; 95% CI = -9.320 to -2.121; p < 0.01). These improvements were observed when compared to the control group. However, no significant difference was found in the 6-MWT (6-Minute Walk Test) index between the two groups (WMD = 2.659; 95% CI= -16.741 to 22.058; p = 0.788). Consequently, RT has the potential to positively enhance pain, stiffness, and function in patients with KOA, while the 6-MWT index may not exhibit significant improvement.

Effectiveness of lower limb rehabilitation protocol using mobile health on quality of life, functional strength, and functional capacity among knee osteoarthritis patients who are overweight and obese: A randomized-controlled trial

Objectives

This study aims to investigate the effectiveness of the lower limb rehabilitation protocol (LLRP) using mobile health (mHealth) on quality of life (QoL), functional strength, and functional capacity among knee OA patients who were overweight and obese.

Patients and methods

Between August 2019 and November 2020, a total of 96 patients (42 males, 54 females; mean age; 52.9±4.8 years; range, 40 to 60 years) were randomized into either the rehabilitation group with mobile health (RGw-mHealth) receiving reminders by using mHealth to carry on the strengthening exercises of LLRP and instructions of daily care (IDC), the rehabilitation group without mobile health (RGwo-mHealth) following the strengthening exercises of LLRP and instructions of daily care (IDC) and control group (CG) only following the IDC for duration of 12 weeks. The reminders for using mHealth were provided two times a day for three days a week. Primary outcome measures were QoL assessed by the Western Ontario and McMaster Universities Osteoarthritis Index summary score, and functional strength by five-repetition sit-to-stand test. Secondary outcome measure was functional capacity assessed by the Gait Speed Test. The assessments of QoL, functional strength, and functional capacity were taken at baseline and post-test after 12 weeks of intervention.

Results

After 12 weeks of intervention, the patients in all three groups had a statistically significant improvement in QoL within groups (p<0.05). Patients in the RGw-mHealth and RGwo-mHealth had a statistically significant improvement in functional strength and walking gait speed within groups (p<0.05). The pairwise between-group comparisons (Bonferroni post-hoc test) of the mean changes in QoL, functional strength, and functional capacity at post-test assessments revealed that patients in the RGw-mHealth had a statistically significant greater mean change in QoL, functional strength and functional capacity relative to both the RGwo-mHealth and CG (p<0.001).

Conclusion

The improvement in QoL, functional strength, and functional capacity was greater among patients in the RGw-mHealth compared to the RGwo-mHealth or CG.

Exercise Therapy for Knee Osteoarthritis: A Systematic Review and Network Meta-analysis

Background

Exercise is an effective nonpharmaceutical therapy for knee osteoarthritis (KOA).

Purpose

To identify the most effective type of exercise therapy for KOA with regard to pain, stiffness, joint function, and quality of life.

Study Design

Systematic review; Level of evidence, 3.

Methods

The PubMed, Web of Science, Embase, and Cochrane Library databases were searched, from inception to April 4, 2022. Included were randomized controlled trials that assessed the efficacy on KOA among 5 different exercise therapy groups (aquatic exercise [AE], stationary cycling [CY], resistance training [RT], traditional exercise [TC], and yoga [YG]) and compared with the control group. Outcomes among the groups were assessed with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 6-minute walk test (6-MWT), visual analog scale (VAS) for pain, and Knee injury and Osteoarthritis Outcome Score (KOOS); weighted mean differences (WMDs) and 95% confidence intervals were calculated. Network meta-analyses comparing outcomes between all groups and with controls were performed, and group rankings were calculated using the surface under the cumulative ranking curve (SUCRA).

Results

A total of 39 studies (N = 2646 participants) were included. Most of the studies failed to blind participants and researchers, resulting in a high risk of performance bias. Significantly worse WOMAC-Pain scores were seen in controls compared with all exercise interventions except AE (WMD [95% CI]: CY, -4.45 [-5.69 to -3.20]; RT, -4.28 [-5.48 to -3.07]; TC, -4.20 [-5.37 to -3.04]; and YG, -0.57 [-1.04 to -1.04]), and worse scores were seen in controls compared with YG regarding WOMAC-Stiffness (WMD, -1.40 [95% CI, -2.45 to -0.34]) and WOMAC-Function (WMD, -0.49 [95% CI, -0.95 to -0.02]). According to the SUCRA, CY was the most effective for improving WOMAC-Pain (80.8%) and 6-MWT (76.1%); YG was most effective for improving WOMAC-Stiffness (90.6%), WOMAC-Function (77.4%), KOOS-Activities of Daily Living (72.0%), and KOOS-Quality of Life (79.1%); AE was the most effective regarding VAS pain (77.2%) and KOOS-Pain (64.0%); and RT was the most effective regarding KOOS-Symptoms (84.5%).

Conclusion

All 5 types of exercise were able to ameliorate KOA. AE (for pain relief) and YG (for joint stiffness, limited knee function, and quality of life) were the most effective approaches, followed by RT, CY, and TC.

Laser therapy versus pulsed electromagnetic field therapy as treatment modalities for early knee osteoarthritis: a randomized controlled trial

BACKGROUND

This randomized controlled trial aimed to compare the effects of pulsed electromagnetic field therapy (PEMFT) and low-level laser therapy (LLLT) on pain and physical function of participants with knee osteoarthritis (KOA).

METHODS

According to the Kellgren-Lawrence classification, participants with grade 2-3 KOA were randomized to receive PEMFT or LLLT for six sessions lasting 15 min/session over a 3-week period. Pain at rest and when walking, standing from a sitting position, and climbing the stairs was assessed using the visual analog scale. Functional level was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up-and-go test (TUG), and 10-m walk (10 MW) test. Measurements were obtained before and after the interventions. Significance was determined at p ≤ 0.05.

RESULTS

Forty participants were included in the study. Pain and physical function improved significantly (p < 0.0001) in both groups. PEMFT was significantly more effective in reducing pain at rest, when standing from a sitting position, and when climbing the stairs, and in improving both WOMAC scores and TUG results (p ≤ 0.0003). The improvements in pain during the activities and the WOMAC scores reached the minimal clinically important difference. No adverse events occurred.

CONCLUSION

Six sessions of PEMFT and LLLT had immediate positive effects on pain and physical function in individuals with low-grade KOA, with PEMFT resulting in significantly better results.

TRIAL REGISTRATION

ISRCTN registry trial ID: ISRCTN17001174.

EFFECTS OF STRENGTH TRAINING ON PHYSICAL STABILITY IN DANCERS

ABSTRACT Introduction: Ballroom dance has evolved from a simple self-taught part of folklore to a technical, performative, and artistic competitive dance called the International Standard Dance. Objective: Study the effects of special lower limb strength training on the physical stability of dancers. Methods: 20 volunteers, students of a university specialized in dance, were divided into experimental and control groups, undergoing training of 30 minutes daily, 3 times a week, for 3 months. The control group followed the daily training, while the experimental group received special lower limb strength training. The relevant physical data measured before and after the intervention were statistically analyzed. Results: Compared to the control group, there was a significant difference in the athletes of the experimental group (P<0.05). The experimental group's lower limb strength and special skills were significantly improved. Conclusion: The lower extremity strength training protocol significantly improved the dancers’ muscle strength, proportionally increasing the stability of the sports skills. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

EFFECTS OF STRENGTH TRAINING ON PHYSICAL CONDITIONING IN SOCCER PLAYERS

ABSTRACT Introduction: With the development of contemporary soccer, it can be seen that the physical conditioning of athletes has become the gold standard for player evaluation. Objective: Analyze the effects of strength training on soccer players' physical conditioning. Methods: By combining functional strength training with traditional soccer training, the literature was compared, using the method of mathematical statistics and comparative analysis to study the influence of physical conditioning in youth soccer (n=62). Results: After the test, the difference between the control group and the experimental group was significantly enhanced (p = 0.66> 0.05), but there was no difference in effectiveness between the experimental group and the control group after 10 minutes (p = 0.03. <0.05). There was a significant difference in post-test performance between the experimental group and the control group (p = 0.04 <0.05), with emphasis on the hand-throw performance after training. Conclusion: The strength training protocol presented here had a positive impact on the physical conditioning of soccer players, especially on the agility performance of young athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.

EFFECTS OF VARIABLE EXERCISE ON STRENGTH TRAINING IN THROWING ATHLETES

ABSTRACT Introduction: Throwing is a physical phenomenon with its base resistance and speed, demanding the high explosive force of its practitioners. Objective: Observe the implications of exercise with speed and variable load on the explosive strength training of throwing practitioners. Methods: The author uses scientific literature to execute an experiment on throwing techniques, dividing 24 athletes randomly into control and experimental groups. Variations of discus weight and throwing distances were applied in the groups. The results were compared in SPSS and Excel to perform the corresponding statistical processing. Results: The athletes showed throwing performance with an increasing trend, but not evident enough among the control group. The increase in the experimental group was evident compared to the performance before the experiment. Conclusion: Training with variable speed and variable load exercises positively affects strength training in throwing events. It is recommended to perform variable speed and variable load exercises for athletes in throwing practitioners. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Does land-based exercise-therapy improve physical activity in people with knee osteoarthritis? A systematic review with meta-analyses

PRIMARY OBJECTIVE

Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA).

DESIGN

Systematic review and meta-analysis of randomised or quasi-randomised trials investigating land-based exercise-therapy on physical activity, fitness, and general health in people with KOA. We updated a 2013 Cochrane review search on exercise-therapy for KOA in April 2021 and applied the Cochrane Risk-of-Bias Tool 1.0 to included articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. GRADE was used to assess certainty of the evidence.

RESULTS

Twenty-eight randomised controlled trials (2,789 participants) evaluating the effects of resistance-training (n = 10), walking (n = 6) and mixed-exercise programs (n = 7) were identified. Low to moderate certainty evidence indicated small increases in physical activity for exercise-therapy compared to non-exercise interventions in the short-term (SMD, 95% CI = 0.29, 0.09 to 0.50), but not the medium- (0.03, -0.11 to 0.18) or long-term (-0.06, -0.34 to 0.22). Low certainty evidence indicated large increases in physical activity for walking programs (0.53, 0.11 to 0.95) and mixed-exercise programs (0.67, 0.37 to 0.97) compared to non-exercise interventions in the short-term. Low certainty evidence indicated moderate and small increases in physical activity for resistance-training combined with education focused on pain coping skills and self-efficacy compared to education alone at medium-term follow-up (0.45, 0.19 to 0.71).

CONCLUSION

Walking and mixed-exercise, but not resistance-training, may improve physical activity in people with KOA in the short-term. Combining resistance-training with education may increase physical activity in the medium-, but not the long-term, highlighting the potential importance of developing more effective longer-term interventions for people with KOA. Future studies evaluating land-based exercise-therapy are encouraged to include physical activity outcomes and longer-term follow-up to increase the certainty of evidence.

A recommended exercise program appropriate for patients with knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (KOA) is a common degenerative disease. Recommended first-line management includes exercise. However, there is still no standard recommendation for the appropriate exercise program for patients with KOA.

Purpose: This study aims to compare the effects of a land-based exercise program with high vs. uncertain compliance with recommendations among people with KOA in pain, function, and stiffness.

Methods: From January 2000 to January 2022, PubMed, EBSCO, Sport-discuss, Medline, and Web of Science were searched. A comprehensive review of meta-analyses of land-based exercise programs with exercise prescriptions was done in symptomatic individuals with KOA. The Cochrane Collaboration’s standards were followed for study selection, eligibility criteria, data extraction, and statistics, and the Cochrane Collaboration’s tool was used to assess the risk of bias. Review Manager 5 software was used to extract the baseline mean and follow-up values, as well as the accompanying standard deviation, to calculate the standardized mean difference (SMD). In meta-analyses, SMD was calculated for pain outcomes, self-reported physical function, and stiffness. The effects of the outcomes on the subgroups of studies were compared. A fixed- or random-effects model was used in group research studies with comparable outcomes.

Results: There were 15 studies with a total of 1,436 participants. Compliance with the ACSM recommendations was categorized as “high” in five cases and “uncertain” in nine others. The SMD for pain was −0.31 (95% CI −0.47, −0.14) in the subgroup with a high ACSM compliance ratio and −0.55 (95% CI −0.69, −0.41) in the subgroup with uncertain ACSM compliance. For physical function, in the high-compliance group, the SMD was −0.21 (95% CI −0.38, −0.05), while in the uncertain-compliance group, it was −0.61 (95 % CI −0.82, −0.40). The SMD was −0.40 (95 % CI −0.61, −0.19) for stiffness and high compliance with ACSM. The SMD was −0.29 (95% CI −0.66, 0.07) for study interventions with uncertain compliance.

Conclusion: The results showed that the land-based training program significantly improved pain, physical function, and stiffness in KOA patients compared to controls. Exercise interventions with high adherence to ACSM recommendations differed significantly only in stiffness measures compared with the uncertain-compliance group.

Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, identifier PROSPERO (ID CRD42022311660)

Efficacy and safety of focused low-intensity pulsed ultrasound versus pulsed shortwave diathermy on knee osteoarthritis: a randomized comparative trial

The aim of this study was to compare the efficacy and safety of focused low-intensity pulsed ultrasound (FLIPUS) with pulsed shortwave diathermy (PSWD) in subjects with painful knee osteoarthritis (OA). In a prospective randomized trial, 114 knee OA patients were randomly allocated to receive FLIPUS or PSWD therapy. The primary outcome was the change from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores. Secondary outcomes included the numerical rating scale (NRS) for pain assessment, time up and go (TUG) test, active joint range of motion (ROM) test, and Global Rating of Change (GRC) scale. Data were collected at baseline, 12 days, 12 weeks and 24 weeks. Patients receiving FLIPUS therapy experienced significantly greater improvements in the WOMAC total scores than patients receiving PSWD therapy at 12 days (mean difference, - 10.50; 95% CI - 13.54 to - 7.45; P = 0.000). The results of the NRS, TUG test, ROM test and GRC scale showed that participants treated with FLIPUS reported less pain and better physical function and health status than those treated with PSWD at 12 days (P = 0.011, P = 0.005, P = 0.025, P = 0.011, respectively). Furthermore, patients in the FLIPUS group showed significant improvements in the WOMAC total scores and NRS scores at 12 weeks (mean difference, - 7.57; 95% CI - 10.87 to - 4.26; P = 0.000 and - 1.79; 95% CI - 2.11 to - 1.47, respectively) and 24 weeks (mean difference, - 6.96; 95% CI - 10.22 to - 3.71; P = 0.000 and - 1.37; 95% CI - 1.64 to - 0.96; P = 0.000, respectively) of follow-up. There were no adverse events during or after the interventions in either group. This study concluded that both FLIPUS and pulsed SWD are safe modalities, and FLIPUS was more effective than PSWD in alleviating pain and in improving dysfunction and health status among subjects with knee OA in the short term.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032735. Registered 08/05/2020, http://www.chictr.org.cn/showproj.aspx?proj=53413 .

Preoperative Strength Training for Clinical Outcomes Before and After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background

There is an increasing interest in preoperative strength training for promoting post-operative rehabilitation, but the effectiveness of preoperative strength training for clinical outcomes after total knee arthroplasty (TKA) remains controversial.

Objective

This study aims to systematically evaluate the effect of preoperative strength training on clinical outcomes before and after TKA.

Methods

We systematically searched PubMed, Cochrane Library, Web of Science, and EMBASE databases from the inception to November 17, 2021. The meta-analysis was performed to evaluate the effects of preoperative strength training on clinical outcomes before and after TKA.

Results

Seven randomized controlled trials (RCTs) were included (n = 306). Immediately before TKA, the pooled results showed significant improvements in pain, knee function, functional ability, stiffness, and physical function in the strength training group compared with the control group, but not in strength (quadriceps), ROM, and WOMAC (total). Compared with the control group, the results indicated strength training had a statistically significant improvement in post-operative knee function, ROM, and functional ability at less than 1 month and 3 months, and had a statistically significant improvement in post-operative strength (quadriceps), stiffness, and WOMAC (total) at 3 months, and had a statistically significant improvement in post-operative pain at 6 months. However, the results indicated strength training had no statistically significant improvement in post-operative strength (quadriceps) at less than 1 month, 6, and 12 months, had no statistically significant improvement in post-operative pain at less than 1 month, 3, and 12 months, had no statistically significant improvement in post-operative knee function at 6 and 12 months, and had no statistically significant improvement in post-operative physical function at 3 months.

Conclusions

Preoperative strength training may be beneficial to early rehabilitation after TKA, but the long-term efficacy needs to be further determined. At the same time, more caution should be exercised when interpreting the clinical efficacy of preoperative strength training for TKA.

Short-Term Effects of Strengthening Exercises of the Lower Limb Rehabilitation Protocol on Pain, Stiffness, Physical Function, and Body Mass Index among Knee Osteoarthritis Participants Who Were Overweight or Obese: A Clinical Trial

BACKGROUND

Osteoarthritis (OA) of the knee is defined as a progressive disease of the synovial joints and is characterized by wear and tear of the cartilage and underlying bone. This study aimed to determine the short-term effects of the lower limb rehabilitation protocol (LLRP) on pain, stiffness, physical function, and body mass index (BMI) among knee OA participants who were overweight or obese. Methodology. A single-blinded randomized controlled trial of one-month duration was conducted at Rehmatul-Lil-Alameen Postgraduate Institute, Lahore, Pakistan. Fifty overweight or obese participants with knee OA were randomly divided into two groups by a computer-generated number. Participants in the rehabilitation protocol group (RPG) were provided with leaflets explaining the strengthening exercises of the LLRP and instruction of daily care (IDC), while the participants in the control group (CG) were provided with leaflets explaining the IDC only for a duration of four weeks. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function. The secondary outcome measures were BMI, exercise adherence, and patients' satisfaction assessed by using the numeric rating scale ranging from 0 to 10. The paired-sample t-test was used to analyze the differences within groups from baseline to posttest evaluations. The analysis of variance 2 × 2 factor was used to analyze the differences in BMI, knee pain, stiffness, and physical function between the groups.

RESULTS

Participants in the RPG and CG reported a statistically significant reduction in knee pain and stiffness (p ≤ 0.05) within the group. The reduction in the scores of knee pain was higher in participants in the RPG than that in participants in the CG (p=0.001). Additionally, participants in the RPG reported greater satisfaction (p=0.001) and higher self-reported exercise adherence (p=0.010) and coordinator-reported exercise adherence (p=0.046) than the participants in the CG.

CONCLUSION

Short-term effects of the LLRP appear to reduce knee pain and stiffness only, but not physical function and BMI.